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The way forward on health care

The most valid place to start when criticizing the Affordable Care Act is from the left. Kevin Zeese and Margaret Flowers do a great job of that, Obamacare: The Biggest Insurance Scam in History.

The fundamental flaw of the ACA is that it entrenches a market-based system that treats health care as a commodity and profit center for Wall Street. The big drivers of the rising cost of health care – insurance, pharmaceuticals and for-profit hospitals – continue. The wealth divide that is a major byproduct of neoliberal economics is institutionalized by law under the ACA. Some, like Senator Ted Cruz, will receive the best health care from their employer, in Cruz’s case his wife’s employer, Goldman Sachs. Others, forced into the individual insurance marketplace, will be divided in four classes based on wealth, and millions will be in Medicaid, the inadequate health plan for the poor. Thus, after a high-stakes partisan battle, we’ve made no progress in confronting the fundamental problems in US health care. Indeed we have made some of them worse.

There was an easier route and a more politically popular route. All that President Obama had to do was to push for what he used to believe in, Medicare for all. By just dropping two words, “over 65,” the United States would not have needed the 2,200-page ACA. Then the country could have worked to gradually improve Medicare so that the United States moved toward the best health care in the world, rather than being mired at the bottom.

To replace Obamacare with the single-payer system, we need to be clear about the shortcomings of the law, especially its fundamental flaw of making a human right, one of many human rights Americans do not realize they have, into a commodity like a cellphone. We need to recognize that ending the corporate domination of health care is part of breaking the domination of big business over the US government and the economy. Health care is at the center of the conflict of our times, the battle between the people and corporate interests, the battle to put people and planet before profits.

The problem is that neither party is working toward a real solution like that, which the people favor. While it’s clear that the right wing wants to stop the ACA, they have no solution other than some free-market scheme like we had before.

One part of the fight between the right wing and President Obama that’s so disturbing, especially in Texas, is our elected GOP leaders cruel decision not to expand Medicaid.  It’s going to cause unneeded suffering. It’s created the coverage gap and will effect over 1 million Texans.

Nationally, nearly five million poor uninsured adults will fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania.

The interesting thing is that the Medicaid expansion part may be the most beneficial to the Democrats in the future. Toward the end of this this recent Evan Smith interview with Jonathan Alter, Alter talks about how Texas suffer, because of this decision in the near future. In essence saying that people may see Texas as a risky place to live, as opposed to a state where they can get health care.

Not to mention the cruelty of the decision, Romneycare/Obamacare Architect Jonathan Gruber Blasts ‘Disgusting’ Refusal To Expand Medicaid.

Sattler: Is the refusal of 25 states to expand Medicaid distorting the market?

Gruber: I think in those states, by my own estimates, it’s going to raise premiums by about 15 percent in the exchange because sicker people will be in the exchange. I think it’s really disgusting that these states aren’t providing their poorest residents free insurance [financed] by the federal government. It’s pretty amazing that they can get away with that.

Sattler: What do you think about the right-wing argument that having no insurance at all is better than Medicaid?

Gruber:  It’s just incorrect. There’s no credible evidence to support that. There have been dozens of studies over the years that show that giving Medicaid to patients improves their health. Most recently a study I was involved with in Oregon just sort of randomly assigned Medicaid to people and found significant improvements in mental health.

Sattler: Do you expect more states to expand their Medicaid programs?

Gruber: Right now we’re at about half the states expanding. That’s going to grow over time. But we’re going to have a hardcore group of states that don’t want to expand, and I hope there’s pressure to do so.

The ACA is what we have to work with right now. If it’s repealed we’re likely in a worse place then when we started. The criticism from the left is valid and damning of the ACA. Unfortunately the political will does not exist, and our political system is too corrupted, at this time to get something like Medicare for all passed. The best was forward is to elect politicians that are committed to fixing what’s wrong with the ACA, by moving us closer to a single-payer/Medicare for all health care system. And in Texas that must start with electing those who are committed to expanding Medicaid.

Further Reading:
MAP: The 5 Million People The GOP Cut Out Of Obamacare.
Quote: The ACA as redistribution.


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