Replace Obamacare with single-payer national health insurance

By Claudia Fegan, M.D.
STAT, January 20, 2017

During the bruising 2016 presidential campaign, Donald Trump vowed to repeal Obamacare “on day one of the Trump administration.” Today is that day. If soon-to-be President Trump makes good on that promise, I urge him to replace it with single-payer national health insurance.

If it, or some other equitable form of insurance, isn’t quickly put in place, I worry about the patients who will die when they lose access to timely health care.

The Affordable Care Act expanded coverage to 20 million people and improved their access to care. Every day I see its beneficial impact on the patients I serve as the chief medical officer at Chicago’s largest public hospital. Tens of thousands of our patients were covered for the first time, many under the law’s Medicaid expansion, and we were able to provide them care that was previously out of their reach.

While the ACA represents an important step forward in other respects, such as eliminating penalties for preexisting conditions and covering children until age 26 on their parents’ plan, our health care system is still the worst of any wealthy nation.

Millions remain uninsured, and most Americans’ coverage comes with gaping holes, like a hospital gown that looks pretty good in front but leaves a lot hanging out in back. Patients often find they can’t afford care, given the high deductibles and copays, and their choice of doctors and hospitals is often restricted. Costs continue to soar, and greedy corporations have gained an even tighter stranglehold on health care.

Defending that status quo, as many Democratic politicians have been trying to do, is a losing battle. The ACA continues to allow insurance companies to limit access to health care, and the pharmaceutical industry to limit access to lifesaving treatment with predatory pricing.

Soon-to-be President Trump and the Republicans want the law repealed. Most people in favor of that happening want something better, not a return to the past. Replacement has to move forward to universal and upgraded coverage and move away from shifting costs to the patients least able to bear the financial burden of illness rather than going backward to the bad old pre-ACA days.

Here’s one inspiring vision of health care reform that would lift the vast majority of Americans: single-payer national health insurance. Enactment of a single-payer plan would demonstrate that we are a caring nation. People shouldn’t die in the richest country in the world due to lack of access to care.

According to a Gallup poll last year (and a similar Kaiser survey), more than half of Americans wanted to repeal the ACA, and most Americans still have a dim view of the law. They know it is not working. They know the deductibles are too high and they can’t afford the copayments. (Curiously, on the eve of its repeal, a growing number of Americans say they support the law.)

But the Gallup poll also showed that 58 percent of Americans — including 41 percent of Republicans and 53 percent of those who favored repeal — wanted the ACA replaced with “a federally funded health care program providing insurance for all Americans,” in other words, single-payer reform. They want a plan that covers the care they need and lets them see the providers they choose with no out-of-pocket costs.

Now is the time for a single-payer health system — improved Medicare for all. It would take the hundreds of billions now wasted on insurance bureaucracy and billing paperwork and use that money to expand and upgrade coverage. It would cover all of the uninsured. And it would abolish copayments and deductibles for the 91 percent of Americans who are currently covered by health insurance.

After Trump’s election, my newly insured patients began to ask if they were going to lose their health insurance. Trump has said he has a plan to cover everyone, cut costs, and cut painful deductibles and copayments that limit access to care. But so far there is no firm plan, he is notoriously unpredictable, and his cabinet nominees indicate that his administration will take a different course.

Single-payer health systems have a proven track record on cost control. When Canada passed its single-payer medical insurance plan in the 1960s, its health spending was commensurate with ours and growing at the same rate. Today, Canada spends about half of what the US does. Much of the savings have come from slashing insurance overhead and paperwork. Where insurance giant Aetna keeps about 20 cents of every premium dollar for itself, the comparable figure for overhead in Canada’s system is 2 cents, and for Medicare it’s 3 cents. And Canada has saved vast amounts by simplifying hospitals’ and doctors’ billing paperwork.

Republican plans for the ACA threaten the health of my patients and millions of other Americans, and the status quo is unacceptable. That’s why I, and the 20,000 colleagues who have joined me in Physicians for a National Health Program, are fighting for single payer — a health reform that would cure America’s health care ills, not just provide some pain relief.

Now is the time to take that step.

Claudia Fegan, MD, is an internist who serves as the national coordinator of Physicians for a National Health Program. She is a coauthor of “Universal Health Care: What the United States Can Learn from Canada” and is a contributor to “10 Excellent Reasons for National Health Care.”