Single-Payer Prescription for What Ails Obamacare

By Amy Goodman for Truth Dig

“We apologize for the inconvenience. The Marketplace is currently undergoing regularly scheduled maintenance and will be back up Monday 10/7/3013.” You read it right, 3013. That was the message on the homepage of the New York state health insurance exchange website this past weekend.

Yes, the Affordable Care Act (ACA), popularly known as Obamacare, is going through difficult birth pains, as the marketplace websites went live only to crash. The government is not giving out numbers, but informed observers speculate that very few people have succeeded in signing up for any of the plans so far.

The ACA rollout occurred as Republicans shut down the government in their attempt to defund Obamacare. But their strategy backfired. Had there been no shutdown, all of the attention would have been on the disastrous rollout. The fundamental issue, at the core of the health-care dispute, is typically ignored and goes unreported: The for-profit health-insurance industry in the United States is profoundly inefficient and costly, and a sane and sustainable alternative exists—single-payer, otherwise known as expanded and improved Medicare for all. Just change the age of eligibility from 65 to zero.

“When Medicare was rolled out in 1966, it was rolled out in six months using index cards,” Dr. Steffie Woolhandler told me Monday. “So if you have a simple system, you do not have to have all this expense and all this complexity and work.” Woolhandler is professor of public health at CUNY-Hunter College and a primary-care physician. She is a visiting professor at Harvard Medical School and the co-founder of Physicians for a National Health Program, or PNHP. PNHP is an organization with 17,000 physicians as members, advocating for a single-payer health-care system in the U.S.

What is single-payer? Critics denounce it as “socialized medicine,” while ignoring that single-payer is already immensely popular in the U.S., as Medicare. A 2011 Harris poll found that Medicare enjoyed 88 percent support from American adults, followed closely by Social Security. Woolhandler explained that with a Medicare-for-all system, “you would get a card the day you’re born, and you’d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it’s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion [per year].” Dr. Woolhandler went on, rather than “thousands of different plans, tons of different co-payments, deductibles and restrictions—one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want … not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.”

Monthly premiums in most cases are expected to decrease with Obamacare’s health-exchange systems, which will enhance the transparency and ease of comparison for people shopping for a health-insurance policy. If and when the technical problems are eliminated from the online health insurance exchanges, and people can easily shop, there will likely be a huge number of people buying policies for the first time. The ACA offers important advances, which even single-payer advocates acknowledge: subsidies for low-income applicants will make insurance affordable for the first time. Medicaid expansion also will bring many poor people into the umbrella of coverage. Young people can stay on their parents’ insurance until the age of 26. People with so-called pre-existing conditions can no longer be denied insurance.

While the ACA was deemed constitutional by the Supreme Court, the opinion gave states the option to opt out of the Medicaid expansion, which 26 states with Republican governors have done. A New York Times analysis of census data showed that up to 8 million poor people, mostly African-Americans and single mothers, and mostly in the Deep South, will be stranded without insurance, too poor to qualify for ACA subsidies, but stuck in a state that rejected Medicaid expansion.

So, while partisan bickering (between members of Congress who have among the best health and benefits packages in the U.S.) has shut down the government, the populace of the United States is still straitjacketed into a system of expensive, for-profit health insurance. We pay twice as much per capita as other industrialized countries, and have poorer health and lower life expectancy. The economic logic of single-payer is inescapable. Whether Obamacare is a pathway to get there is uncertain. As Dr. Woolhandler summed up, “It’s only a road to single-payer if we fight for single-payer.”


  1. Bonnie Boggs on October 11, 2013 at 7:00 pm

    it is about time Single Payer is used in the USA.

  2. Bonnie Boggs on October 13, 2013 at 3:41 pm

    It is like he said. Social Security is available for all.
    Why not Health Care for all? There is a system called Single Payer for all. Wake up!!!!!
    Bonnie Boggs

  3. Bonnie Boggs on October 13, 2013 at 9:46 pm

    Why is this taking so long? It is like you said “other countries have insurance for the people. Why are we dragging on?

    • Jerry Peavy on November 11, 2013 at 4:02 pm

      It is taking this long because we must deal with conservatives who will do anything to stop single payer. Conservatives do not fight single payer health care because they have some ideological problem with it, they fight it because the are paid by the drug, medical and insurance industry. I think President Obama recognizes that in the present situation single payer would never become law, even though I believe that it is exactly what he wants. The president is very good at laying traps for the conservatives and single payer may be closer than we imagine!

      • paul on November 15, 2013 at 9:13 am

        Yet Obama was the first to throw SinglePayer overboard, and then he threw the public option overboard too. I think you are mistaken if you think the Dems are any less beholden to the financial sector than the Pubs. If anything, they are more beholden.

  4. Nicolas on October 30, 2013 at 4:23 pm

    Yes for a single payer system but only with co-pay to make people responsible . Otherwise the system is going to be overused in the same manner if at a wedding the drinks are free you drink more than needed, but if you have to pay you won’t!

    • Jerry Peavy on November 11, 2013 at 4:08 pm

      Co-pay will not cause people to over use medical care! On of the problems with medical care is getting people to go to the Doctor. Unless they are sick most people do not go to the Doctor, which leads to more expensive health care. In the beginning there will be a pent up demand cause by those in need without health care, but in the end fewer will need more advanced care and more will stay healthy.

  5. Ronald on November 1, 2013 at 6:59 pm

    He Lied!

    • paul on November 15, 2013 at 9:36 am

      Obama is a proven liar, yet his defenders will not back off. They double down their passion for him, claiming that he is a byzantine worker of the corridors of power, which indeed he is, and Our Brave Champion. What do they base this on? What really do they base this on? That he has a stint as a ‘community worker’? That he can use words and tone of voice way better than most presidents? It’s crazy that they believe fervently in this Secretly Saintly Obama, but they deride anyone pointing out that his track record and associations suggest a deeply dyed corporatist stooge as a ‘conspiracy theorist’!

  6. Thomas Cox PhD RN on November 11, 2013 at 2:58 pm

    A single payer health insurer’s advantage over private, for profit insurers is that a single payer would be an extraordinarily more efficient insurer.

    Unfortunately, Medicare transfers much of the insurance risk it ought to be managing to health care providers: Physicians, hospitals, nursing homes and home health agencies. As insurers, these entities are less efficient than our current private health insurance system – partly because our current health insurance system is already doing this through capitation, bundled payments and episode based care arrangements.

    So merely making Medicare everyone’s insurer is a good idea, it has to be accompanied by changing the way Medicare works so that it is really is an insurer, not just an agent picking up applications and accepting premiums while transferring the insurance risks to health care providers “Standard Errors: Our Failing Health Care (Finance) Systems And How To Fix Them”.

    • Jay Mucha on November 11, 2013 at 7:46 pm

      ” Medicare transfers much of the insurance risk … provider: …”
      Could you explain that for me? My Medicare seems to operate as single payer with limits placed on providers for their charges. Seems to me that broadening the base to the whole population is actuarially the soundest way to ensure. And then get rid of the “profit margin”.

      The 800 lb gorilla in the room is the lack of open accounting and accountability on providers. For example, “not-for-profit” hospitals seem to be doing extremely well these days. I have seen at least 10 new hospitals built in the Houston area over the last 7 years; and I know that in Western Pennsylvania, UPMC has expanded from a single hospital in Pittsburgh 40 years ago to encompass nearly half the state. How is that? Well, in accounting, if you have debt you can right off, and charge higher rates and still show no profit. The same accounting practices proliferate through out the supply-side – including the insurance companies! Single-payer and closer scrutiny could change all that and bring our health-care costs in line with the rest of the world.

  7. John on November 11, 2013 at 3:03 pm

    Adding millions more to a system dominated by for-profit insurance companies with exorbitant claims processing overhead and outlandish executive salaries is sheer madness.

    Medicare for All, Now. Please.

  8. Elizabeth Downie on November 11, 2013 at 3:37 pm

    Rep. John Conyers, D. from Detroit, has been introducing H.R. 676 every year for probably nine years now – “Health Care for All – no exceptions.” Pay attention, folks!

  9. Myra Lemson on November 11, 2013 at 4:31 pm

    The current situation is untenable. My friend in TexAss has diabetes, $749/mo pension and is expected to pay a tax and cover her own medical bills because TexAss in its “wisdom” decided not to expand Medicaid??
    She Lives with her daughter there. If she leaves, how will this 60 yr old woman with diabetes and arthritis from lifting heavy baggage on and off airplanes Survive? Rent+food+medications+medical bills=???
    And I am in a bad place, one year from qualifying for Medicare, my current policy doesn’t cover medications. One of my essential medications is a long acting Insulin which costs $325/mo.
    We need to stop companies like Sanofi who make insulin from holding us hostage, just because we need insulin. It’s”Your Money or Your Life”.
    What the hell is wrong with extending Medicare to all?
    Or is the problem that these rich congresspersons with their excellent benefits don’t want to upset their rich insurance sponsors??

  10. John Smethrus on November 11, 2013 at 5:04 pm

    I agree completely with the single payer system. It would not differ from any other program that we endorse in the US including FICA, schools, and virtually every other government program. Most schools are paid by property taxes, the kid from the million dollar home may go to the same school with the kid from the $100,000 home. if people stopped paying property taxes because they felt that was unfair, all of the programs that support the quality of our lives would fall apart. The “For Profit” notion of healthcare is totally wrong and contrary to the Creed taken by doctors. Our major hospital operates as a non profit organization yet it turns 13% profits and pays salaries above the million dollar range. It has more power to buy and build real estate that any employer in the city. I am not against a hospital having a solid fiscal policy, but I am not sure that the way it is currently structured is serving the patient who seeks care there. They have the ability to raise their charges indiscriminately without regard to whether the average person can afford the care. For too long, people have gone under the notion that their insurance plans covers the charges “so why should I care”. This was a big mistake and now we are paying the price. As one other person said, we pay twice as much for services than the rest of the G20 countries and get poorer quality of medicine. ONE COMPONENT OF THE ACA IS MISSING, and maybe it will come in time as the system matures, but that is how the cost of care goes down as more people are covered. Hospitals have indigent care built into their budgets. some of that cost comes from Medicare, some from the states and much is built into the cost that they charge patients who do have insurance. If the hospitals will no,longer have to include that in their budgets because everybody has insurance, will the hospitals automatically reduce their fees? Don’t hold your breath. Let’s get real. Maybe the cost of health plans is not going up because of ACA but because the insurance companies are protecting their own bottom line. Everybody is yelling about their policy amount increasing as if it has never happened before!! The inflationary factor of health care has decreased over Obama’s two terms. The Single Payer system for health care is to help simplify how you provide health care to an entire nation but also to lower costs. France and Germany forbid insurance companies to make a profit on health insurance policies, they make their money by selling other insurances at the same time. If a hospital was given a finite amount of money to run their hospital, I have a feeling that their priorities would change in how run and compensate their staff. just a few thoughts. Thanks, john

  11. tanya on November 11, 2013 at 7:11 pm

    Pardon me but we have no health care system in the US. You are recommending medical coverage for all; ie, drugs for everyone, especially when they are dangerous and not needed. Single Payer will cover everyone but still wont’ provide health care. As long as the current system is totally subservient to the Drug corporations, we will have ongoing disease and shortening life spans.

    Any real health care system MUST include holistic health care. All health protocols need to be covered in this type of system. Then people really will be able to make choices for health and with growing health, costs will decrease.

  12. Carmen on November 11, 2013 at 8:53 pm

    I agree with Tanya and most of the other comment makers. It’s a U.S. cultural myth, originating in the conservative Republican fixation on $$$ as the be-all and end-all of existence that you “value” something only when you Dollarize it. Not true. Who in their right mind wants to spend precious time in hospital and doctor’s waiting rooms needlessly? Whoever is doing so needs to get some therapy. We need improved expanded Medicare for all now, from conception to demise. The current set up of premiums and co-pays for older people is outrageous. $10,000 maximum income and you have to pay a premium? Obscene. Clearly shows the cultural hatred for older people and low income. Let’s fast forward to improved Medicare for all now, puh-leese.

  13. James Ludwig on November 11, 2013 at 9:34 pm

    Just give me the socialized, single payer, health care system, the one the hypocrites in Congress have. I’ll be just fine with that, thank you. What a corrupt, double speak, unjust, political system we have in the US. For profit insurance health care for the luckey US citizen who can afford it and socialized, single payer system for our political representatives. If it wasn’t for so much suffering and misery and death for the majority of US citizens, this political smoke and mirrors system would almost be laughable.

  14. paul on November 15, 2013 at 9:31 am

    I find it very disturbing that this article finds it somehow necessary to defend Obamacare. Obamacare is a right wing policy, sold to the left wing by means of some sugar sprinkled on top. It’s a disaster to depict this as a step forward. ACA firmly establishes, as a principle, that people get the healthcare they pay for, thus that it is not a human right. In conjunction with this, and as if to underline it, it establishes a class-based, tiered system of health coverage. It also moves to privatize medicare, taking a huge step towards turning medicare into a voucher system. Also, all the talk about ‘best practices’ will translate as rationed care and forced treatments, and the information computerization and sharing systems will further break down key privacy walls in our society. On top of all this, we can be sure that many or all of the sugar dustings on ACA will be undermined or stripped away. Nor is it true that premiums will go down generally, I believe. Many are losing the coverage they have, and this trend will grow. In five to ten years, workplace coverage will probably be unheard of. Even if premiums are less with Obamacare coverage, the actual coverage will be less. Amidst all this, we are ignoring one screaming fact: health insurance is essentially extortion.

    And then there is the mandate. It’s sickening that the entire Left, virtually, has decided to ignore the significance of the mandate. The mandate is a key step towards fascism. There is no reading of the constitution that can reasonably claim that our system of government is intended to allow the federal government to force each citizen to buy a product. It is a screaming perversion of our system of government to use it this way, and this is PRECISELY what the Insurance companies have done. The Supreme Court should have thrown out the mandate, but why would they when they are corporatists themselves? For the Left to accept political positioning that positions them, us, as defenders of fascism is demented. We need to wake up. Some defenders of ACA have cited weak and ancient precursors for the mandate. You have a better case when you try to argue that precedents make slavery legal and precedents make segregation (apartheid) constitutional. They’ve even used the Power of Precedent to turn corporations into citizens, as Thom Hartmann points out! But the precedents for the ACA mandate are weak and old in any case.

    Obamacare is a bill that turns the people into a subject population, controlled by the Federal gvt., for the benefit of the financial/medical sector. It is a step into hell. Sometimes the Rightwing screamers are correct, even if it’s invariably for the wrong reasons.

  15. Paul Glover on November 19, 2013 at 10:31 pm

    We can expand Medicare to everyone without raising taxes by creating a national network of genuinely nonprofit clinics and member-owned health plans. This will cut HMOs out of the deal, reduce administrative overhead, and convert the system from greed to generosity. My book “Health Democracy,” based on my successful co-op experiment, explains how: