On the politics of health care

To the editor:

I read the editorial in Monday’s Enterprise initially with dismay, but then it grew on me. As I started to read it, it seemed like a recitation of Congresswoman Stefanik’s talking points that the Affordable Care Act is “a mess,” which, in turn, is a recitation of the talking points of the ideologues who oppose universal health care in any form.

Health care cost inflation has slowed in recent years since the implementation of the ACA, but the prospective premium increases for the coming year are a cause for concern. However, the headline numbers tend to quote the outliers on the upside. According to the Congressional Budget Office, ObamaCare exchange premiums are expected to rise an average of 8.5 percent per year over the next three years. That’s partly due to the scheduled phasing out of transitional government programs to protect insurance company bottom lines from taking on higher-cost enrollees.

As you say, Republican politicians have failed to offer any real alternative. The irony is that the ACA was a Republican idea going back to 1989, when it was proposed by the conservative Heritage Foundation in an effort to come up with a market-based solution to the issue. It was famously and successfully taken up by Gov. Mitt Romney in Massachusetts, who later felt compelled to disavow it because Barack Obama thought it was a good idea. Such is party politics!

Now to the good part. As you point out, the insurance-based system is inherently inefficient. Insurance companies are obliged by their fiduciary responsibility to shareholders to minimize their payouts. Hence, they employ armies of people to avoid paying claims and to exclude costs (such as preventative care) that don’t result in immediate benefit. According to the WHO figures you quote, we are paying 60 percent more than Canadians for health care with worse (on almost any measure) outcomes. The reason is the enormous overhead associated with the insurance-based system that is currently in place.

Every other developed country has some variant of a single-payer system, and I applaud your advocacy of such a system for the United States. Let us hope that Senator Sanders’ run for the presidential nomination will bring this back into public debate.


Alan Brown

Saranac Lake