Two of the criticisms from the right are that the Affordable Care Act represents a “government takeover of America’s health care” and that it is “socialism.”
How does one sort all this out? There is a rather simple method to break down and compare various health care systems.
No matter which country or which idea, you simply ask three questions. First, who pays? Second, who insures? And third, who provides health care?
In a socialist system, like the former Soviet Union, the answer to all three questions would be “government.” The British are quite proud of their National Health Service. This was clearly on display during the opening ceremonies for the London Olympics. Private care is available, but the British National Health Service relies on government revenue, government insurance and government hospitals. Most of the doctors are government employees.
Health care in the United States is a mix of several systems. We have one system where the answer to the three questions would be “government.” That is the Veterans Administration. The government pays, the government insures and government hospitals and doctors provide most of the care. By most accounts, the system works well and has administrative costs that run half as much as private care.
While the VA is similar to a socialist model, it would not be a good design for the United States as a whole. It would not be a good fit for our political culture, and no such system has been suggested as a model for universal coverage in the United States.
Most health coverage in the United States is employer-sponsored. The majority of Americans are covered by this system to varying degrees. The answer to the three questions would be: privately financed, private insurance, and private health care delivery.
The Medicare system for those older than 65 is slightly more complicated. Roughly 80 percent of Medicare recipients have government insurance. The government writes the check, the government insures, but health care is a matter of private hospitals, doctors and pharmacies.
Medicare recipients have an option. Twenty percent of those covered have signed up for a Medicare Advantage program in which they take a government voucher and purchase private insurance. In that case, government pays, but the insurance and health care are private.
The Medicare Advantage program is one model of what is sometimes called a “single-payer” system. Government writes the check, but the rest is private. Some European countries have such a system. It provides universal coverage within a private market environment.
The Affordable Care Act (Obamacare) retains the basic design of our current system.
This is no surprise. It was originally designed by the Heritage Foundation, a conservative think tank, as an answer to Hillary Clinton’s health care proposal back in the 1990s. It was adopted by Massachusetts and signed into law by Mitt Romney. The Romney plan is popular and covers 98 percent of Massachusetts’ population.
Our current health care system is as follows:
Who pays? Mostly private individuals pay. This number
will increase under the Affordable Care Act.
Who insures? Most people today are privately insured. This number will grow by
millions under the ACA.
Who provides health care? It is overwhelmingly private and will remain so under the ACA.
The Affordable Care Act continues our reliance on private markets. It is a good fit for both our economy and our political culture. There will be successes and failures, and inevitably adjustments will have to be made, as there were under Romneycare.
But relying as it does on private markets, it is clearly not a government takeover of health care, and it can’t be reasonably described as socialism.
n Mickey McGuire, a retired high school social studies teacher, is among a select group of local residents with columns in the Tracy Press.