John Geyman's timely book on ACA and single payer

How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans

By John Geyman, M.D.
Copernicus Healthcare, January, 2015

As we all know, the intense debate over Obamacare, or the Affordable Care Act (ACA), is a polarizing issue that sharply divides political parties and the public. Confusion reigns over its benefits, problems and prospects as claims and counterclaims fill press and media coverage.

This book is an attempt to make sense out of all of this - to cut through the rhetoric, disinformation and myths to assess what is good and bad about the ACA, and to ask whether or not it can remedy our system's four main problems - uncontrolled costs, unaffordability, barriers to access, and mediocre, often poor quality of care.

In Part One, we will briefly trace historical roots of various reform attempts over the years, and summarize some of the major trends that have changed the delivery system, professional roles and values, the ethics of health care, and the role of government vs. the private sector. In Part Two, we will compare the ACA's promises with realities of what it has accomplished, examine its initial outcomes on access, cost containment, affordability and quality of care, ask whether its flaws can be fixed with a private insurance industry, and point out the lessons that we can already take away from the first five years of the law. In Part Three, we will discuss the many myths that are perpetuated by opponents of single-payer national health insurance (NHI) and show how that approach stands ready to deal directly with what has become a national disgrace - our increasingly fragmented and cruel health care system that serves corporate interests at the expense of ordinary Americans. We will make the case for NHI in three ways - economic, social/political, and moral. Most other advanced countries around the world came to this conclusion many years ago.

Why this book now? With the 2014 midterm elections behind us, divisions between the parties are even more polarized. The future of health care is even more uncertain. The 2016 election cycle is already underway, and both parties have to confront the failures of yet another incremental attempt to reform our so-called health care system. We have a short year and a half to re-assess where we are and try once again to get health care reform right. As much of the public knows all too well, the stakes get higher every day.

"How Obamacare Is Unsustainable" can be purchased through PNHP for $15.00, here. It is also available through and for $18.95.



By Don McCanne, MD

John Geyman has been a prolific writer of books describing the major deficiencies in health care in the United States, but "How Obamacare Is Unsustainable" is set apart from the others for a couple of important reasons. He explains what has been wrong with our five year experiment in reform and what we can do about it, and, especially pertinent, it is timed to coincide with a moment in history in which there will be an intense national dialogue recognizing the health care failures of the past and present, with a demand for political solutions as we enter the season of the 2016 presidential election.

Just today, Sen. Burr, Sen. Hatch and Rep. Upton released a nine page report being characterized as the Republican response to Obamacare (though Speaker Boehner has requested another, likely similar proposal from a House team that includes Rep. Upton). Unfortunately, the Burr/Hatch/Upton response is highly partisan and thus gets most of the policy wrong. Although the Affordable Care Act was conceived as a non-partisan solution, it too became partisan as the politics shifted from a largely right-wing concept advanced by Democrats (non-partisan) to an exclusively Democrat-endorsed proposal (highly partisan). In the turmoil, the result ended up being the most expensive model of reform, yet it contained terribly flawed policies that fall intolerably short of universality, affordability, accessibility, efficiency and equity. Both the Democrats and the Republicans are wrong.

As we enter the pending national dialogue on reform we need to move the rhetoric from partisan sniping to informed discussions of policy. We know where Congress lies in the highly-polarized partisan divide, but what about the nation?

According to a January 2015 Gallup poll, 42% of voters are Independents, 29% are Republicans, and 28% are Democrats. Thus a plurality is non-partisan.

According to that same Gallup poll, 45% of Independents support getting their insurance "through an expanded, universal form of Medicare." To no surprise, 79% of Democrats also support universal Medicare, but, of great importance, 23% of Republicans do as well. When people understand policy, the partisan polarization diminishes.

At this time in history, it is imperative that all solutions be on the table, including those that give up on comprehensive reform (Burr/Hatch/Upton), those that perpetuate unacceptable mediocrity (the Affordable Care Act), and those that would actually achieve the goals that a large majority of Americans support (single payer, improved Medicare for all).

This is why John Geyman's book is so timely. It is a book on optimal policy. It can be contrasted with today's partisan release on the Republican answer to Obamacare. Their nine page proposal can be accessed at the following link:

Partisan politics has not served us well with the Democrats giving us overpriced and mediocre reform and the Republicans proposing to further expose patients to the perverse dysfunctions of the market. Maybe Independents can help us stamp out partisanship and instead become serious about doing what is right for the nation.

Right now we have a chance to change history. We should make widely available John Geyman's book based on sound, effective policy - just what the nation desperately needs.