While the constitutional challenges to last year?s health care reform act barely pass the snicker test, the fact remains that the Patient Protection and Affordable Care Act is badly flawed.
We have two existing, popular, successful, and relatively efficient government-based health care plans: Medicare, which provides nationalized medical insurance for all Americans over sixty-five; and the VA system, which provides nationalized medical care for veterans.
The simplest form of national health care reform, thus, would have been simply to extend one of these existing systems to all Americans. Better still, we could have retained both the advantages of those reasonably well-run systems and added competition and choice by offering all Americans the option of choosing one of the two government-run systems or a nongovernmental, for-profit alternative.
Instead, the Obama Administration decided to take a fundamentally Reaganite approach. The PPAC Act imposes privatization without true competition, by subsidizing customers rather than creating a cheaper provider without the excess layers of costs and inefficiency that private insurance imposes. Despite its significant cost-reduction provisions, its fundamental structure was designed to overcome insurance company and GOP opposition by protecting the profits of incumbent insurance companies and, to a lesser extent, care-providers, at the expense of the taxpayers. The basic problems of private insurance?the strong incentives to cherry pick customers and deny needed care in order to protect executive pay and shareholder profits?remain in place, and regulation can only do so much to counteract them.
Now is the time to preempt GOP claims that health care finance reform is a disguised attack on Medicare, Tea Party attempts to repeal all forms of reform, court attacks on the constitutionality of this particular system, and insurance company attempts to enhance profits by capturing the regulators entrusted with resisting their pursuit of profits at the customers? expense.
The Democratic leadership should propose the reform we really needed and that polls suggest Americans really want: a simple statute, mandating that every American have medical insurance, but offering every American the opportunity to enroll in Medicare or the VA system at the current fee schedule. If private companies can compete, let them do so. Don?t repeal, replace?with Medicare for all.