The lead story in the Oct. 13 New York Times details the ongoing problems of the Affordable Care Act’s websites intended to facilitate access by individuals to the law’s hallmark online health insurance marketplaces. Those problems continue.
To summarize, many of the state-run and all of the 36 federally run websites are currently experiencing significant problems providing access to the exchanges, and nobody seems willing or able to predict when they will be fixed. This failure to launch President Barack Obama’s signature domestic achievement is hugely embarrassing for the administration, and will undoubtedly provide a great deal of fodder for late-night comedians. It will also provide an almost unlimited source of talking points for tea partiers and other government-haters, who will cite this unfolding fiasco as more evidence that “government can’t get anything right.”
That would be incorrect.
In 1965 and the years following, I witnessed the implementation of Medicare, which enrolled 19 million beneficiaries almost seamlessly in less than a year, despite the formidable opposition of Southern hospitals wary of its requirements that they desegregate their wards. As I wrote last month, the problem with the ACA is not that the federal government is involved, but that literally thousands of private insurers have their fingers in the cookie jar, resulting in a law that is much too complicated for what it needs to accomplish, and too complex for anybody to administer efficiently and effectively.
Together, Medicare and Social Security — both run by the federal government — have been successfully providing access to private health care and income security for millions of seniors and the disabled for almost 50 years. They have been a major factor in keeping seniors in our country out of poverty.
Both programs are overwhelmingly popular with doctors, patients, the general public and most politicians. Medicare is also much more successful than private, for-profit insurance in holding down the prices paid for medical services and products and overhead costs — 6 percent compared with 20 percent or more. But Medicare is still not doing nearly enough to control costs.
It is estimated that there is at least $750 billion worth of waste in the U.S. health care system.
Politics is the only credible reason for retaining the complex and confusing web of private insurance plans in a health care system that aspires to cover everybody. In order to gain congressional approval, the ACA had to first accommodate the interests of the corporate medical-industrial complex, putting the interests of the American people in a distant second place. Congress’ approval rating now hovers around five percent.
We can do better. It took over 50 years from the time President Theodore Roosevelt first proposed national health insurance until Medicare and Medicaid were enacted. It took almost another 50 years for the ACA to be enacted, expanding insurance coverage and enacting some protections against some of the insurance industry’s predatory practices.
We have had to endure almost 100 years of acrimonious political debate, name-calling, disinformation and outright lies — much of it designed to protect and defend some doctors’ incomes and corporate health care companies’ windfall profits — to even approach what all other wealthy countries take for granted: health care as a human right.
We need expanded and improved Medicare-for-All. And we need to vote any politician who won’t advance us toward that goal out of office. We’re moving in the right direction. But we can’t afford to take another 100 years to get there.