Tag Archives: Obamacare

So What Exactly is Wrong With “Single-Payer” Healthcare?



About a month ago, I posted a blog (click here to read) making the case that Obamacare has failed to achieve its primary objective of providing affordable healthcare for all Americans. While 17 million more Americans now have health coverage under Obamacare, it is far from affordable and there are still almost 30 million Americans who lack any form of healthcare. My suggestion was to repeal Obamacare and replace it by expanding Medicare and Medicaid, so that all Americans would be guaranteed access to basic healthcare.

The reaction to the blog was swift and sometime acerbic. Comments split pretty much along party lines, but by far most of those who opposed my proposal did so by criticizing it as a “single-payer” system. I was not surprised by that, but that argument is an old dog that just won’t hunt any longer.

You see, “single-payer” is a dog-whistle phrase the insurance industry – and their lobbyist friends – created and have used for decades to protect their turf in the healthcare business. The “single-payer” concept has become a code-word derisively repeated ad nauseam by the insurance industry and its supporters, arguing that “single-payer” is a dark conspiracy of the part of the government to usurp the freedom and right of Americans to select a personal healthcare provider and manage their own healthcare.   

The strategy employed by the insurance industry in this deceitful, greed-driven approach has been to shift the focus away from the need and right of individuals to access affordable healthcare and instead, make it a debate about individual freedom. That’s a nice trick if you can pull it off, but the insurance companies along their well-funded friends have done it.

For decades, the idea of a single-payer healthcare system has been metaphorically the “third-rail” of politics that was so charged with controversy that politicians were afraid to touch it. We see how terrified politicians are to take on the NRA and responsible gun control; well it has been the same with politicians taking on the insurance industry with a single-payer system of healthcare. The chief reason President Obama was willing to accept the insurance industry centered cumbersome system of “insurance exchanges” that are at the core of Obamacare was because he feared taking on the myths of “single-payer” head on. The result is that the insurance companies get their way and their profits and the rest of us are stuck with a muddled, inefficient and high-cost healthcare system. And millions more Americans still lack access to basic healthcare.

So What Really is a Single-Payer System?

A single-payer healthcare system is simple. Under such a plan the government would collect the taxes and premiums needed to fund universal healthcare. The government would then contract with and reimburse private doctors and hospitals for the healthcare services they provide.

What would such a plan look like and how would it work?   

Well, many may not realize it, but Medicare is an example of this dreaded single-payer system. Medicare has proven to work well and covers millions of Americans – including me — without a loss of freedom or choice. Anyone covered under Medicare has the right to choose any doctor or healthcare provider they desire; so long as that doctor or hospital accepts Medicare. The most recent survey determined that over 90 percent of all doctors and virtually every hospital accepted Medicare payments.

It should be noted that Medicare gives those covered the freedom to not only select their personal provider, but virtually any type of medically necessary service. For example, Medicare covers the reasonable costs of doctor, hospital, preventative care, long-term care, mental health, reproductive health, dental, vision, prescription drug and medical supply costs. Contrary to what critics of the single-payer system claim, Medicare actually expands the freedom of individuals to manage their healthcare, because it lowers the financial barriers to selecting the doctor or hospital they choose.  

Those fearful of a single-payer system might suggest that such an all-encompassing government program would be inefficient and costly. Based on the history of other government programs, that might seem logical, but the reality is that the administrative costs for Medicare are at about 2 percent of total services. At the same time, the overall embedded administrative costs in the private healthcare system amount to over 30 percent of the services provided.

The insurance industry and its supporters argue that expanding the single-payer concept of Medicare and Medicaid to all Americans would bankrupt the system, but the truth is it would secure the financial viability of both programs. The system could be funded with premiums paid (based upon ability) by those covered and employer health taxes (employers would actually save money by not being required to provide coverage), but the most significant funding would come from savings obtained by replacing the current system of patchwork coverage. America now has the most inefficient and highest cost system of any industrialized nation; while failing to provide coverage for all citizens. Redirecting the expenditures from this failed private system would provide more than adequate funding for the single-payer Medicare and Medicaid systems. Furthermore, with everyone covered under the same plan, the government would have the clout to monitor and control the costs of services and medication.

The bottom line is that it is all well and good to discuss and debate whether all Americans should have a right to basic healthcare and if expanding Medicare and Medicaid is the way to provide it. However, to base opposition to these questions solely on the “evils” of a single-payer system is to fall prey to the self-serving, greedy and disingenuous arguments of the health insurance industry.  


Repeal Obamacare!

(AP Photo/Alex Brandon)


There is no doubt that The Patient Protection and Affordable Care Act — AKA Obamacare – has failed to achieve its most fundamental objectives. The primary goal of the legislation was to make health insurance available to all Americans, with the parallel promise that this health care would be affordable. Obamacare has failed on both points and is so flawed it should be repealed.  

While 17 million Americans have been added to the rolls of those insured, there are still over 25 million who remain uninsured. Furthermore, those who have been able to obtain medical insurance are finding that the coverage is anything but affordable. Once the newly insured are signed-on, the insurance companies (unencumbered by regulation) are systematically raising the cost of coverage by as much as 30 to 50 percent annually.

There are (at least) three reasons for the failure of Obamacare: 1) Obama was willing to give up on principles in order to get any law passed. 2) To gain their support, insurance companies were allowed to participate in the design of the plan in a way that would benefit them financially. 3) The Republicans were unwilling to support any plan that would guarantee insurance coverage for all Americans.

The problems with Obamacare remain unresolved because it has become no more than a ball in a political rugby scrum. The plan’s supporters – mostly Democrats — are struggling to find ways to fix the unfixable, while Republicans remain fixated on blanket repeal. Both of these approaches to Obamacare talk at the problems but fail to offer real solutions. Have you noticed that one group is not complaining about Obamacare? That would be the insurance companies, because they are too busy piling up huge profits from Obamacare.  

As a general proposition, the Republican Party believes that medical care is a privilege not a right. They believe all Americans should have all the healthcare they need and want, just so long as they have the resources to pay for it. As a result, every single GOP presidential candidate’s position on healthcare starts with repeal of Obamacare, but none of them offer even a hint of an alternative. Can you just imagine the chaos and confusion that would ensue in the health-care arena if Obamacare was simply repealed and no viable alternative was available?  

The Democrats, on the other hand, act as though the “right” to have healthcare coverage means that it should be free; as if there was no real cost involved. Can you just imagine how costly and confusing healthcare will be if Obamacare is allowed to continue down its current path?      

The good intentions and objectives of Obamacare were admirable, but for reasons outlined above, the design and implementation of the plan were both botched and it is beyond repair. The longer Obamacare is allowed to stumble down its current path, the more costly and inefficient it will become.  The goal of insuring all Americans at affordable cost will never be met. The Republicans are right – Obamacare should be repealed. But the Republicans are callous and dead wrong to suggest that the healthcare – or lack thereof – for millions of Americans should be left to the caprices of the insurance companies, driven by profit alone. Does it seem fair to you that an individual’s access to reasonable healthcare should not be determined by the weight of their wallet?

There is a Better Path to Healthcare for all Americans

Already in place, time-tested and working effectively (as any government program can) are the Medicare and Medicaid programs. Medicare provides effective and efficient medical care to millions of Americans 65 and over. Medicaid – a combination of state programs funded by the Federal government – provides medical care to millions of low income individuals.

The point is that these two programs have processes and procedures in place and are in point of fact administering healthcare (from private hospitals and physicians) for millions of Americans, but not for all. So the question is: Why not repeal Obamacare and replace it with the two national healthcare programs already in existence and functioning effectively? The simplest and most direct way to offer all Americans basic healthcare at affordable costs is to expand and enroll everyone – at any age – into Medicare or Medicaid.

This can’t be done with a flip of the switch, but an organized expansion phase-in over time could make it happen. For example, in the first year those age 60 to 65 would be eligible for Medicare, then the next phase would include those 55 to 60 and so on until everyone was covered.

Of course, adjustments and changes would have to be made to both systems, but these would be more administrative and cost-control measures. For example, premiums and deductibles for coverage could be adjusted based upon income or wealth. There is no reason why someone making $1 million a year should pay the same premium or deductible as another making $50,000.

There is not space in this blog to delineate all the adjustments that would be required in order to make Medicare and Medicaid work for all Americans, but they are more administrative in nature and don’t go to the core of the programs. Ultimately the Medicare and Medicaid programs could be merged. The point is that we have two time-tested and functioning programs providing healthcare for millions of Americans, so why not just do the right thing and expand them to include all Americans?

Can Everyone be Happy?

Of course not everyone will be happy with these changes, but when is everyone ever happy with any action?

The Republicans are going to have to disabuse themselves of the belief that health care is a privilege and not a right. They accept basic education as a right, why not basic health care? Aren’t both of those part of the Constitutional right to “life, liberty and the pursuit of happiness”? The reality is that of the 47 largest industrial nations in the world, the United States is the only country that does not consider basic health care as a fundamental right of its citizens. But Republicans can be happy too. They can take credit for repealing Obamacare and swallow the expansion of Medicare and Medicaid. After all, every Republican president since Nixon has accepted and expanded Medicare and Medicaid. 

The insurance industry will certainly not be happy. So what?! The insurance companies have had a free-hand to provide health insurance for Americans for over 50 years. They have done a miserable job. If you had lots of money and were in good health, you could buy all the health insurance you wanted. But woe betide the individual who was poor or had a preexisting condition. Besides, the insurance companies could make a ton of money selling supplemental policies (as they do today) that pay the deductibles for Medicare, or for extra care not covered by Medicare.

The hospitals and doctors will not be happy. Don’t be so sure. I have hear many hospital administrators and doctors complain about Obamacare, but I have never heard any complaints about Medicare. Sure, they will complain about Medicare’s attempt to control costs and for not reimbursing the hospital or doctor for what they want to charge for their services. But have you ever heard of a hospital or doctor going bankrupt because Medicare or Medicaid didn’t pay enough for the services they provided?

And the Moral of the Story …

If we (as we should) want to provide effective, affordable healthcare for all Americans – despite age or resources – we have to recognize that, for all its good intentions, Obamacare is not the answer and it should be repealed. Doing nothing or “letting the market determine” who gets coverage is not the answer, either.

But the answer in right in front of us. Medicare and Medicaid has worked for millions of Americans and with just a little effort we can repeal Obamacare and replace it with these systems that have proven to work. So?

Obamanemia: (noun) 1. A Chronic Ailment Caused by a Lack of Leadership and Management Skills.

No matter how lofty ideas and goals may be, they will fail without strong leadership and effective management.

So you’ve got some great ideas for a new business. Maybe you’ve discovered a way to make your company work better or even change the very industry in Obamanemicwhich you work. You also have this great vision of success and accomplishment. Maybe see yourself as a consummate entrepreneur or transformational leader who will stir the passions and loyalty of followers. Most of all, you are absolutely convinced that what you want to do is the right thing to do, not only for you but for others as well. If so, then say hello to President Obama and multitudes of others who have felt this way, only to fail. Their dreams fell prey to an ailment now coming to be diagnosed as the Obamanemia Syndrome: a failure to exhibit consistently strong leadership and management.

There’s Something Missing . . .

Simply having a great idea, a passion to be successful, a willingness to take a risk and a commitment to work hard is great—but it’s not enough. Nothing will come of this – other than disappointment – unless you can demonstrate strong, consistent leadership traits and effective management skills. It’s like you have promised your friends a wonderful dinner and have all the makings splayed out on the kitchen counter. But if you have no idea or experience putting these ingredients together to make the dinner come out as planned, then what you have is a recipe for disaster and disappointment. Despite great ideas and a passion to succeed, it is the inability to exhibit strong leadership and management skills that causes one to suffer from Obamanemia.

More words than there are grains of sand on the beach have been written in an effort to inoculate people with the leadership skills and management techniques to keep them from becoming Obamanemic. But the best way to become immune is to observe real-time, real-life examples of the challenge to leadership and management that others have faced as they attempted to implement a new idea or change. The best current example available is President Obama and his desire to bring forth health care reform.

A number of leadership and management principles are essential for implementing any new idea or to bring about change. Just a few of these would include:

  • The ability to demonstrate a clear need for the new idea or change that is understood and accepted.
  • A well-defined, simple, effectively communicated vision of what is to be accomplished.
  • Understanding that complicated problems are best resolved with simple solutions.

Much can be learned by reviewing how these principles were followed or violated by President Obama as he sought to reform health care in America.

Point One: Is health care really sick?

Despite the fact that over 40 million Americans had no health care coverage and that millions more were under-insured, President Obama was never able to convince a majority of Americans that reform was needed; let alone that government was the solution. As a result, there was no great ground swell of support for the changes he proposed. This inhibited Obama’s freedom to present a clear vision outlining his ideas for a better health care system and sucked him into a pedantic debate over the cost and effectiveness of the existing system that is both confusing and unwieldy.

If, as a leader, Obama had focused the debate on the morality of a health care system that was based on privilege rather than right or need – something that people could have understood – he would have been in a much better position to control the debate, gain acceptance of the need for change and engender support for his vision. The tenor of the debate could have been: American citizens have a right of free speech, a right to vote, a right to receive a basic education; along with a right to fire and police protection. Should American citizens be denied the right to receive basic health care? Or is health care a privilege reserved only for those who can pay for it?

After all, of the 50 largest industrial nations in the world, America is the only country that does not offer basic health care as a right of every citizen. This was a simple, specific issue that everyone could understand and decide. Once Americans had decided whether heath care was either a right or privilege, the debate over “if” something should be done would be over.

The failure of President Obama to crystallize the health care debate in such simple terms opened the door for those opposed to change to control the discussion and delay the process. In effect, he was drawn into a debate trying to justify the workings of the new system that had not yet been quantified. This allowed the opponents to shift focus away from the need and attack the solution. The failure of Obama to clearly delineate and gain acceptance of a need for change was the first symptom of Obamanemia.

P0int Two: Making the complicated more complicated

There was no question that the existing health care system was complicated, inefficient and selective in benefits offered. President Obama made the mistake that many bureaucrats and weak leaders make and that is to assume that a complicated problem can only be solved with an even more complicated solution.

By the time Obamacare emerged from the sausage factory called the United States Congress, the bill was 2,000 pages in length and contained 350,000 words of government-speak. In addition, over 11,000 pages of regulations were needed to explain what was in the 2,000 pages. It is estimated that more people understand the meaning of life than understand the meaning of Obamacare. The only result that can come from offering a complicated solution for a complicated problem is to give everyone a severe case of Obamanemia.

President Obama failed to understand that the way to solve a complicated problem is to offer a simple solution. And it’s not like a simple remedy was not available. Instead of needing 350,000 words to parse out the solution, it could have been done using just 10 words:

All American citizens will be required to enroll in Medicare.

Since its inception in 1965, Medicare has been refined and restructured numerous times and has proven to be an effective provider of health care for citizens over age 65. The rules, administration and structure are in place – and its web site works! A simple solution – and one that everyone could understand – would have been to simply open up Medicare to those below age 65. (I know there is more to it than we can go into in this post, but the point is that if an objective can be attained by making an existing system better, it is a lot simpler than trying to invent a new system.)

Point Three: Chowing down on the elephant

The final point that brought on Obamanemia was a management failure. You know the old saying that the best way to eat an elephant is one bite at a time. Obama tried to eat the whole elephant in one bite and that will always give you a good dose of Obamanemia. No matter how you slice it, offering initial coverage to over 40 million participants and fundamentally changing the system in one fell-swoop on day one is a virtual impossibility. Obama did not understand what all successful leaders do and that is that big changes are best implemented one step at a time. Do simple things, but simply do them till the goal is reached.

It’s not that Obama did not have examples to follow. Given the highly-charged caustic political debate and resistance to Obamacare, it may be surprising to fdrmany that when Social Security was introduced in 1935, the opposition and emotional debate was even more scathing. Although he was not accused of being a foreign-born Muslim, Roosevelt was branded as a socialist out to destroy democracy and capitalism. Just as with Obamacare 75 years later, the opponents of Social Security called it unconstitutional and fought to have it repealed. They even took their case to the Supreme Court where just as with Obamacare, Social Security was ruled constitutional by a five to four vote.

There was one big difference between Roosevelt’s approach to Social Security and Obama’s to health care. Roosevelt did not try to eat the elephant in one bite. When Social Security was introduced, less than five percent of the workers were eligible to participate. Roosevelt may have wanted everyone covered, but as an effective manager he understood that the path to universal coverage was one step at a time. He recognized that once the basic concept was accepted, then over time – step by step – the final objective would be achieved. So even though Roosevelt faced as much, if not more, opposition and criticism as Obama, his understanding of managing change made him immune to Obamanemia.

And the Moral of the Story …

The lesson for all of us to learn is that even if we have a great idea and desire for a new business, a new product or a belief that change is needed to be better, that is not enough to bring on success. Can we convince others that there is a need for what we propose? Can we lay out a clear, focused vision that others can understand, support and even take on as their own? Do we have the talent and patience to manage the process? Always keeping our eye on the objective, but recognizing the best way to get there is one step at a time. The truth is that unless we can understand and exhibit the fundamental principles of leadership and management, all of our best ideas and intentions will just lead to a bad case of Obamanemia.