Jonathan Cohn has posted an article at the New Republic entitled "7 Charts That Prove Obamacare Is Working." I’d like to take a moment to examine the benefits of the ACA Cohn points out, and draw some comparisons with the most popular legislative Single Payer alternative.
Cohn’s article is lengthy, but essentially boils down seven benefits of the law:
- More people have health insurance than before the law was passed.
- People who are getting health insurance are almost certainly better off, based on two recent studies showing improvements in physical and financial health.
- "Winners" (probably) outnumber "Losers" in the new exchanges, in terms of increased premiums.
- Premiums in the exchanges are rising slower than expected.
- Premiums for employers are rising slower than expected.
- Overall healthcare costs are rising at historically low rates.
- The net effect on the budget has been to reduce the federal deficit.
This is all good news. But evidence also shows that a single payer style system could not only achieve all these benefits, but do so in a way that is vastly superior to the Affordable Care Act.
- While more people have health insurance under Obamacare than they did previously, there are still millions of people without health insurance. While this number will likely fall as the exchanges continue to get up and running, the fact remains that under a Single Payer-style system, universal coverage is guaranteed. The motto of single payer advocates has always been "everybody in, nobody out." Even with the mixture of private and public health insurance markets we have now, millions of people still fall through the cracks. The ACA has covered more people, but it can’t cover everyone. Millions still get left out under the ACA.
- Another issue affecting the ACA’s ability to extend health insurance coverage is legal challenges. The ACA has already been hamstrung twice by the U.S. Supreme Court, and may suffer another blow as a recent statutory-based challenge to ACA subsidies works its way through the courts. Single payer, meanwhile, is already Constitutionally sound. Medicare—the equivalent of single payer for American seniors—has withstood Constitutional scrutiny for decades. The U.S. Supreme Court also suggested in its Hobby Lobby decision that publicly-financed healthcare provides a solution to the Constitutional challenges posed by the ACA. So the Constitutionality of Single Payer is not in question like it is with the complicated legal mechanisms of the ACA.
- While it’s great that healthcare costs are rising slower under the ACA, this cost reduction is nothing compared to the potential cost savings of a Single Payer system. Single Payer style healthcare has reduced costs relative the United States in every single jurisdiction it has been implemented. The U.S. spends 2.5 times more on healthcare than the OECD average. Switching to Single Payer would provide a savings of up to $400 billion per year, according to recent estimates. And contrary to common criticism, access to healthcare in countries with universal public health insurance coverage is not the problem it’s been made out to be. Even in countries like Canada, where critics often cite longer wait times for elective procedures, Canadians overwhelmingly prefer their system to the U.S.
- While the “winners” may outnumber the “losers” in the ACA exchanges, under a Single Payer system, there would be no “winners” and “losers” in terms of coverage. Everybody would have access to basic healthcare coverage. People unsatisfied with their coverage will also have the option of purchasing supplemental private insurance, which is a very common (and eminently more affordable) practice in countries with universal public health insurance coverage.
- The overall cost savings under the ACA are negligible when compared to the potential cost savings of Single Payer. In New York, Green Party gubernatorial candidate Howie Hawkins is touting single payer health reform which would pay for a property tax cut for New York residents, according to a State-sponsored study. The functional effect would be a reduction in tax expenditures for 95% of New York residents.
So it’s great that the ACA is starting to realize some of the benefits that the law’s drafters were hoping for. On the other hand, a Single Payer-style system definitely provides an alternative that is cheaper, more effective, and won’t be subject to the endless stream of lawsuits that the infamously-lengthy & prolix ACA law has been subject to. And perhaps more importantly, it would be guaranteed to cover everybody.