Finding a Health Care System That Works


If the Affordable Care Act was flawed when it finally got passed in 2010, Trumpcare was an entirely different kind of monster. For now, we still have the ACA, commonly called Obamacare, while the GOP’s rewrite hasn’t been forthcoming. But that doesn’t mean the issue of health care is going away.

The ACA is far from a perfect plan. Fewer people ended up with insurance than Democrats had hoped for, and health care costs certainly haven’t fallen, but the plan wasn’t a complete failure. The most important thing was that more people did end up with insurance coverage, and the coverage itself was better.

The positives of the ACA don’t erase the existing problems with the system, but it did take care of some of the significant issues our health care system had before the law passed. The two changes that probably made the biggest impact were getting rid of the pre-existing conditions loophole — which prevented many people from getting insurance at all — and removing a lifetime cap on insurance payouts.

Obamacare vs. Trumpcare

Earlier this year, the GOP made several attempts to end Obamacare and replace it with their version, something they’ve been promising since 2010. All their attempts failed, mainly because their party is incredibly divided on what their version of a health plan should look like.

What we do know about Trumpcare is that the versions presented so far have done little, if anything, to address any of the flaws of Obamacare. Instead, every iteration has somehow made things worse. For the moment, Congress has put health care reform on hold — but the GOP has a long time to bring it up again.

A Better Option

There are other options we could have, besides Obamacare or whatever the GOP comes out with. One option is the single-payer health care system.

Single-payer health care, also known as state-provided health care, is a tax-financed health care system that would cover medically necessary services for all U.S. citizens. Right now, some people in the U.S. are already using a single-payer system — Medicaid.

Medicaid covers those who need regular, life-saving medications like rescue inhalers or insulin, even when they can’t afford insurance. Not only does Medicaid save lives, it is more efficient than regular insurance. It costs the government about 22 percent less to cover an adult with Medicaid than it costs an insurance company to cover the same person.

And that’s not the end of Medicaid’s advantages. Another study found society sees about $68,000 quality-adjusted life-year per Medicaid enrollee. The overall result is that individuals benefit while offering a cost-saving option for states. Of course, during a budget crisis, the states may need some incentive to fund their Medicaid programs. But Medicaid and Medicare are our current public health insurance options. Switching over to a single-payer system would be different.

Is a Single-Payer System the Future?

For starters, a single-payer system would dramatically change our health care landscape. There are approximately 466,000 insurance sales agents working in the U.S., many of whom only sell health insurance. With a single-payer system, that entire industry will probably collapse to a fraction of its size. Most of what they sell would probably change to covering cosmetic or elective procedures, and that shrinkage would cut out a ton of their income.

The decline of private health insurance providers doesn’t mean we shouldn’t consider single-payer health care. The U.S. is the only major industrialized nation that fails to provide some form of universal health coverage for all its citizens. But getting there will be difficult. The raw numbers for providing federally funded health care to more than 300 million people are staggering.

The problem is that the U.S. doesn’t fit the pattern of what other countries have had happen. In those cases, establishing federal health care for everyone has resulted in an overall lower cost per capita. That last part is important because we need the individual cost, not the total cost.

Providing universal health care would cost more in the U.S. because our country is so large compared with, for example, a European nation that doesn’t even come close to having the same population density. Currently, the U.S. has the highest per capita health care costs, and that’s with private insurance companies. Switzerland is second, and it costs them about $2,000 less per person than we currently have.

Part of the reason for this discrepancy is the way we process health care charges. Currently, doctors are paid for each service they provide — including appointments, lab tests and surgeries. When doctors make more money per procedure, it leads to problems such as ordering unnecessary tests, or putting women through a shocking number of C-sections to deliver babies.

A single-payer system makes costs easier to regulate. It can also curb unnecessary work, though probably not completely eliminate it. Administrative costs also tend to plummet. If you’ve ever had a mix-up with your health insurance, you know they don’t try very hard to get their work done quickly. However, in a single-payer system, there’s virtually no advertising, and they don’t have to worry about losing clients or training sales agents. The government can also get a much better deal with medical providers than private companies.

The result is that a single-payer system is expensive — but not as expensive as most people think. The costs drop off substantially after a few years, and when the general population is covered instead of just the most medically needy, the per capita rate drops even lower. Single-payer isn’t a perfect solution. But it could be a life-saving, cost-saving one. And that means it could be a good move if we can convince our elected officials it should happen.