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Fixing Obamacare

Members of Congress are heatedly debating how to change the Affordable Care Act, as was promised by Donald Trump when he was running for president. But it would appear at first glance that their efforts are likely to be extremely difficult.

In fact, except for suggesting the act be killed, they are no closer to improving the law that was too big for anybody to read than they were when it was first written.

But a fairly simple solution to improving the law nicknamed Obamacare is actually at hand, and it works. And, the cost of its administration is less than half the cost of Obamacare’s administration. Here is how it operates: All those who qualify for coverage are covered, regardless of the condition for which the covered person is being treated, pre-existing or not.

You probably know by now we are talking about Medicare, the healthcare plan for Americans aged 65 or over, along with some others who have been included. It isn’t a particularly simple plan, but it is a much simpler plan than Obamacare, which many members of Congress want to shoot in the head, and with good reasons.

Medicare covers the highest-risk health insurance pool — senior citizens. Younger people are a lower risk pool, and are not covered, but they still pay into Medicare, which is one reason why Medicare costs of treatment and administration are much lower than those incurred in the private market.

The private market also provides coverage for the Medicare population through administration contracts with Medicare and through supplemental policies to cover conditions which Medicare doesn’t cover, and to help make up the difference between what Medicare pays health care providers and what patients are expected to pay for themselves. Medicare recipients don’t have to buy supplemental coverage, but most do, because it is smart. Medicare also provides prescription drug coverage that is bolstered by supplemental private insurance.

Medicare could be expanded to cover the entire U.S. population at a cost somewhat less than the Affordable Care Act. In fact, most analysts believe that the total cost of health coverage in the U.S. would go down if Medicare or a program like it were made universal.

The Canadians have a system similar to “Medicare for All,” and that country not only spends less per capita on medical care than does the United States, but the Canadians also have greater life expectancies and higher rates of survival from birth.

In the U.S., doctors hate the Affordable Care Act, and many — even here in Madera — will take no new patients if those patients are covered by Obamacare. They say the paperwork burden is too great and the reimbursement for services is too low.

“We can’t be expected to lose money on every treatment under Obamacare,” one doctor said to me. (That doctor said he would welcome a “Medicare for all plan in a heartbeat.”)

Under Obamacare, those who are covered are expected to buy health insurance policies, but can receive a subsidy if they are below a certain income level. That doesn’t lead to efficiency in care delivery because some policies are better than others, but a patient may not find out the difference until he or she sees how payments are made and gets the bill for the insurance.

Promises that Obama-care would result in lower costs have not been kept. Costs actually are going higher at a faster rate than the costs of Medicare, even though Medicare covers a more vulnerable pool.

Conservatives generally don’t like the idea of Medicare for all because they see it as potentially an unrestricted giveaway that could get out of hand; to make it work for conservatives, everyone would have to have “skin in the game,” which is entirely reasonable. There could be no free rides; people who didn’t pay a fair share couldn’t get care.

And of course, conservatives don’t like the ACA any better, and many believe it should be turned over to the “free market.” Unfortunately, the free market, if there is such a thing in healthcare, is but a distant memory, when healthcare was simpler and cheaper.

The liberals in Congress would be unlikely to accept any system which would leave the poor without some coverage.

The best way to do that, and satisfy conservatives at the same time, is to institute Medicare for all with requirements that all pay a fair share, and that private insurers play a big part as they do in Medicare now.

Patients, insurers and taxpayers all would be winners.


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