The Affordable Care Act, better known now as ObamaCare, was promoted to the public by Democrats as the solution for rising healthcare costs. But polls today show Americans are increasingly worried about the cost of healthcare and many have dropped their ObamaCare coverage because they can’t afford it.

Anna Wilde Mathews, healthcare analyst for The Wall Street Journal, tells us millions of Americans dropped their ACA plans after higher subsidies expired and now struggle to pay their medical bills. ACA enrollment fell by about 2.6 million as of February after enhanced federal subsidies expired.

To call the Affordable Care Act unaffordable is nothing new. I called it that in a blog post I wrote over ten years ago in 2015 (The Affordable Care Act is Unaffordable). The truth is ObamaCare has been a train wreck since the day it was passed without a single Republican vote. Why? Because it never lived up to its promises. Democrats, especially President Obama, was so eager to push new healthcare legislation that would move the country closer to socialized medicine that he told lies to sell the new legislation.

In my 2014 book The ObamaCare Train Wreck, I listed the broken promises made by President Obama:

• “I will sign a universal health care bill into law by the end of my first term as president that will cover very American.” (June 23, 2007)
• “I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase. Not you income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” (September 12, 2008)
• “We’ll lower premiums by up to $2500 for a typical family per year. . . We’ll do it by the end of my first term as president of the United States.” (June 5, 2008)
• “I will not sign a plan that adds one dime to our deficits.” (September 9, 2009)
• “If you like your doctor, you will be able to keep your doctor, period. If you like your healthcare plan, you’ll be able to keep your healthcare plan, period. No one will take it away, no matter what.” (June 15, 2009)
• On December 15, 2009, President Obama asserted the bill would “finally reduce the costs of health care.”

 

There isn’t space here to list the many ways these promises have been broken, but suffice it to say that all of these promises were broken. (The details can be found in my book.)

The reasons for the rise of healthcare costs are many, but the underlying fault with ObamaCare is that it is a “one size fits all” system where everyone must purchase the same coverage regardless of their individual needs. This is so extreme that men must pay premiums that include mammograms and woman must pay for prostate exams. No joke!

The solution to our rising healthcare costs is market-based reforms that push the right incentives and reward good health. This is doable except Democrats will resist anything that threatens to eliminate their precious ACA – because what they really want is socialized medicine. While ObamaCare is not yet socialized medicine, it is a large step in that direction. Medicare for All – the Bernie Sanders system being promoted by socialist candidates now – is even further in that direction. If you think our system is bad now, just wait until the Democrats deliver on their Medicare for All promises.

(Note: For more on Medicare for All see recent posts listed on my home page.)

 

Surveys tell us that many Americans are upset with the cost of healthcare. Democrats in particular are using this dissatisfaction in their campaigns to convince people to vote Democratic. They’re also complaining about “affordability” and blaming the problem on the Trump administration. There’s a common theme in both of these issues.

You wouldn’t call an arsonist to put out a fire – but both of the above problems were created by the arsonists – the Democratic Party! Inflation got out of control during the Biden administration and the cost of healthcare is directly related to the passage of ObamaCare during the Obama administration. While Republicans have failed to correct these problems to the satisfaction of the American people, they can’t expect Democrats to have the solutions when they caused the problems in the first place!

Further evidence that Democrats can’t solve these problems is a recent bill introduced in the Congress by Rep. Lloyd Doggett (D- Texas) and co-sponsored by more than 40 House Democrats that would sharply reduce government payments to Medicare Advantage plans. Medicare Advantage plans are privately managed policies for Medicare enrollees. They are extremely popular since they provide greater benefits at lower costs than traditional Medicare.

But Mr. Doggett introduced the bill because he said it would “level the playing field” between traditional Medicare and Medicare Advantage plans. In other words, they want to make these plans less attractive and more costly! Why would they want to do something that would make healthcare more expensive?

John C. Goodman, writing for The Wall Street Journal, gives us the explanation.

“It is no secret that many congressional Democrats dislike private health insurance even though private insurers were heavily involved in designing ObamaCare. Politicians on the left often speak about the desirability of a “public option.” But Medicare has already had a competing public option for more than two decades. It’s called traditional Medicare, and it has been losing the competition. More than half of all Medicare enrollees are in private plans. For all its faults, Medicare Advantage is arguably the best healthcare program we have. It’s much better than the ObamaCare exchange plans and most employer plans. Mr. Doggett is attacking this overall well-functioning program while ignoring our nation’s worst program: Medicaid.

Goodman goes on to explain that one of the great ironies in U.S. healthcare is that the private insurance industry is largely responsible for administering both the best and worst health insurance programs we have. What Mr. Doggett calls the “giant private insurance companies that profiteer off Medicare” are mostly the same companies that are administering Medicaid.

If private companies run both programs, why is one so much better? Goodman says the answer lies in how the program is structured. Medicare Advantage gets four things right:

First, it is the only program in our entire healthcare system in which a doctor who discovers a patient’s previously unknown health problem can send that information to the insurer (in this case Medicare). This results in a higher premium payment for the health plan to cover the higher expected cost of care.

Second, because of a sophisticated risk-adjustment program, Medicare Advantage plans are the only plans in our healthcare system that actually want sick people as enrollees. No employer, commercial insurer or ObamaCare marketplace plan wants a sick enrollee.

Mr. Doggett insists that Medicare Advantage plans seek to enroll only the healthy, but the reverse is true. Significantly more low-income beneficiaries were enrolled in Medicare Advantage plans (68% vs. 32%) in 2023. In 2021, such plans were also the preferred choice of black (59%) and Hispanic (67%) enrollees relative to whites (43%). These minorities are known to have above-average medical needs.

Third, Medicare Advantage is the only program in our healthcare system in which health plans can specialize in the treatment of specific conditions such as diabetes, congestive heart failure or HIV. This allows them to create focused factories that are increasingly skilled at providing care. By contrast, in the ObamaCare marketplace, health plans are forced to be all things to all people.

Finally, Medicare Advantage plans make money by keeping people healthy. Long before the price of insulin became a political issue, some plans were discounting the out-of-pocket cost to diabetics. While the political focus today is on $35 insulin, some Medicare Advantage plans make insulin available free in special-needs plans for diabetics. Keeping diabetics out of emergency rooms is cost-effective medicine.

Yet, Democrats want to destroy this popular, cost-effective, healthcare program by making it more like traditional, more-costly and less popular traditional Medicare. Remember, these are the same people who sold us on the concept of ObamaCare with the promise it would lower healthcare costs for every family and guarantee “if you like your doctor, you can keep your doctor” in the immortal words of President Obama.

You can’t expect the same people who created the problem to fix it. There’s an old saying that applies here: “Fool me once, shame on you, fool me twice, shame on me.”

 

(Author’s Note: Recently candidates for Congress nominated by the Democratic Socialists of America (DSA) have won primary victories in the Democratic party. These candidates support Medicare for All, the radical change in our healthcare system first advocated by socialist Vermont Senator Bernie Sanders. Medicare for All is a euphemism for socialized medicine, much like socialism is a euphemism for communism. Today I am re-publishing articles I wrote in the past explaining Medicare for All so that everyone can understand the evils of this proposal.)

8/4/20

Most seniors like their Medicare. While it is far from free, it does cost less than private health insurance because it is federally subsidized. Since nearly every doctor accepts Medicare, there is rarely any difficulty finding access to healthcare.

Therefore, when people hear progressives like Vermont Senator Bernie Sanders speak about his socialized medicine program called Medicare for All, they believe he simply wants to extend the same healthcare benefits to all Americans. Nothing could be further from the truth.

Recently, I had lunch with an old friend and attorney and we discussed this very issue. His comments about Medicare for All revealed many misconceptions about what that would mean to our healthcare. It occurred to me that if this educated man could be misinformed, many others would be, too. To address this misinformation, I have listed some of his questions and their answers:

If Medicare is good for seniors, won’t Medicare for All be good for everyone?

Although Medicare is mostly funded by taxpayers, it is not strictly a government system. It was formed originally by providing a standard benefit package offered by Blue Cross in 1965. It has always been privately administered, mostly by Blue Cross, that continues to provide private insurance to non-seniors. In recent years, one third of all seniors are enrolled in plans offered by private insurers such as Cigna, Humana, and United Healthcare under a cooperative program called Medicare Advantage. The success of the Medicare Advantage program is mostly due to the competition between these private insurers which lowers costs and improves the quality and range of services provided.

Medicare for All calls for the elimination of all private health insurance. There will be no competition and all healthcare decisions will be made by the government. The lack of competition will lead to lower quality, fewer services, and higher costs. With no competition, providers will be stuck with fixed rates and no means to appeal. As a result, providers will lose incentives to provide more than the minimum care needed. This trend is already prevalent in socialized medicine systems operating today in Canada and Great Britain.

We have the best quality healthcare in the world, though not the cheapest. Won’t we continue to have the best healthcare even with Medicare for All?

My friend and I agree that America leads the world in providing the best possible healthcare. He believes this will continue despite a change to socialized medicine. This is not the pattern we see when studying socialized medicine systems in other countries. Healthcare outcomes are dramatically worse in countries where the government controls all healthcare. We may have the best trained doctors in the world, but those doctors’ hands will be tied by government officials who will determine who gets care and what care they get. This is most dramatically seen in cancer screening and treatment.

Socialized medicine systems such as the United Kingdom and Canada don’t allow for expensive drugs and therefore these countries do not enjoy our cancer survival rates. The U.K.’s National Institute for Health and Care Excellence (a misnomer at best) has rejected immunotherapies because they are too expensive. Better healthcare comes at a price that socialized systems are not willing to pay.

As a result, these systems have lower cancer survival rates. The age-adjusted mortality rate is about 20% higher in the U.K. and 10% higher in Canada and France than in the U.S. Survival rates for hard -to-treat cancers are also higher in the U.S. than in most countries with nationalized health systems.

The British medical journal Lancet  published last year that an individual diagnosed with pancreatic cancer between 2010 and 2014 had nearly twice the likelihood of surviving five years in the U.S. than in the U.K.

Here are some five-year survival comparisons:

• Brain Cancer
  • S. – 36.5%
  • France – 27.2%
  • K. – 26.3%
• Stomach Cancer
  • S. – 33.1%
  • France – 26.7%
  • K. – 20.7%

 

The availability of expensive drug treatments is only one reason for better survival rates in the U.S. Another reason is better methods of detecting cancer at earlier stages. MRI scanners are more widespread and available for earlier diagnosis. Other diagnostic advances include Google’s artificial intelligence (AI) that can now detect breast and lung cancers with better accuracy – meaning fewer false positives and negatives – than radiologists. AI systems are also enabling researchers to identify more genetic links and to personalize treatments.

With Medicare for All, all physicians will work for the government. Since we’ll have the same great doctors, won’t we still receive the same great healthcare?

Medicare for All will mean the government sets all prices for doctor services and approves or disapproves of all treatment. All doctors will have to accept the fee schedules set by the government or cease to practice medicine. Many older, experienced physicians will see this as an incentive to retire, or at least leave the clinical practice of medicine. This will strip many talented physicians from the work force.

They will be replaced by younger physicians without the experience or work ethic of some of our best physicians. These new physicians will be willing to accept the lower fees mandated by the government, but they will demand reduced hours and will produce less service. Combining these changes, the net result will be severe exacerbation of our physician shortage, which is already alarming.

The real problem is the government will have to approve all treatment. It doesn’t matter how good your doctor is, he or she will be limited by government approval. Combining this feature of socialized medicine with an increasing doctor shortage leads to a common situation experienced in all socialized medicine systems.

All socialized medicine systems suffer from common ailments:

• Delays in treatment – longer waiting times to see a physician
• Rationing of healthcare – delays or denial of specialized care
• Poorer healthcare outcomes – lower survival and life expectancy rates

 

Joe Biden tries to distance himself from Medicare for All by saying he just wants to “improve ObamaCare.” However, his platform calls for a “public option” to be added to ObamaCare, which simply means a slower timetable until socialized medicine is a reality. The end result is the same – total government control of healthcare. Don’t be fooled. Medicare for All will mean the elimination of all private health insurance – which means Medicare for None.

(Note: For more on Medicare for All, use the Search feature on my blog to see earlier posts on this same subject.)