Health Care Reform: We’re Not Done Yet

By Walter Tsou –

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer – single-payer national health insurance, also known as an improved Medicare for all – would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed “politically impossible.”

“Politically impossible” means that the mere utterance of “single payer” would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world’s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers’ tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably – remarkably low for a “uniquely American” solution.

Our politics have robbed us from even discussing a practical, commonsense solution – improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program ( and resides in Philadelphia.


  1. D Hickey on July 11, 2012 at 11:49 am

    Keep hearing the roar of the Republicans we are getting rid of Obamacare and then what? What are you offering that we hard working Americans can afford? Premiums have been going up for years even before Obamacare and the amount we all pay in deductions? Why has the sytem been allowed to become this expensive who and what is making the bucks? My one son had a snow mobile accident recently and broke his clavicle in hospital 3 days and told me he got his bill? $80,000 and he is to pay per his deductible $6000 of this? What cost this much for a small clavicle ? Send these people home get home health care cheaper give the IV at home? How many can just afford $6000 today? Cost of living? What if was a heart and cost almost half million and what is your cost for this? Even for us on Medicare the cost? Anti group has been strong since Obama started this health care listen to Rush, Boortz, Hannity totally anti care for the middle class they are millionaires who can afford health care. OUr Congress has taken good care of themselves but not the rest of us ask why people ask why ?

  2. Don Rich on July 15, 2012 at 8:56 am

    Yes, i am for single payer but do you realize what we are up against???? If we had a left leaning congress such as the congress that passed social security and medicare ….i think it would have a chance. We also have to fight one of the biggest and most powerfull lobby groups….the insurance industry.
    We will never go back to a congress like we had in the thirty’s and forty’s because that was when unions (the backbone of the Democratic party)were so dominant. We may have a chance for a public option but i really doubt that.