What happens when you lose your health care?

James Call

Republicans are scrambling to “repeal and replace” Obamacare with little consensus so far on how to accomplish it. Citizens are worried about their coverage. The student health care that our $19 per semester pays for is fairly comprehensive, but it won’t last forever. If the Affordable Care Act (ACA) is repealed, then what? What will be available when we leave school? Hopefully, California will step into the breach. Two state senators aim to do just that.


Senators Toni Atkins and Ricardo Lara last month submitted SB-562 to enact a single-payer health care plan in California. This is in direct response to the danger posed to ACA by the Trump administration and by Republicans in Congress. David Rolland, Atkins’ communications director, says the details of the bill are yet to be fleshed out. The bill signals intent to create a health care plan to cover all Californians. For a good comparison between a single-payer plan and the U.S. under ACA, one need look no further than our nextdoor neighbor, Canada.


What is single-payer health care?


Broadly speaking, it is a system in which the state funds all health care costs rather than private hospitals or insurance companies. This may be accomplished in a number of ways. The government might own the hospitals and employ the doctors directly; the government might contract private health care providers; or it may use some combination of these methods.


Aren’t there long waits to see a doctor and other compromises on quality?


Rhonda Hackett is a Canadian clinical psychologist who lives in the U.S. and who has made a comparison study of the health care systems of both countries. She says that in Canada there are no waits for urgent care. The care of certain specialists may take some time to obtain and elective surgeries longer still. Yet, 14.4 percent of Americans claim unmet medical needs against 11.3 percent of Canadians. To use cancer as a benchmark, Canadians are able to claim lower incidence and mortality rates than the U.S. for all cancers, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society.


But wait, wouldn’t that make taxes extremely high?


According to Hackett, Canadian taxes are only slightly higher than in the U.S. However, counting money saved on out-of-pocket healthcare costs, as well as cheaper higher education, family allowance, and other tax credits, Canadians keep 82 percent of their gross income, while Americans retain 81.9 percent. Canadians have nearly free health care and actually have more money to spend after taxes.


According to Physicians for a National Health Program (PNHP), replacing thousands of different private plans and hundreds of insurers with a single non-profit program would save more than $400 billion, which would be available to pay down the actual costs of a tax supported program. PNHP estimates the savings on administrative costs alone could top $150 billion.


What about co-pays and deductibles, which under ACA have risen?


Under ACA insurance companies determine co-pays and deductibles. In a single-payer system the law would determine how much they would be. In Canada, for instance, for most people they are non-existent.


Isn’t state run health care an expensive and inefficient bureaucratic mess?


The Organisation for Economic Co-operation and Development (OECD) reports that 10 percent of Canada’s GDP goes to health care for 100 percent of its population. The U.S. spends 17 percent of its GDP on health care, yet 15 percent of Americans have no coverage at all and millions more have too little.


According to Single-Payer Action, a website advocating single-payer health care, about 64 percent of U.S. health care costs are picked up by the taxpayer. Many poor people, having no plan of their own, must resort to emergency room visits, which are more expensive than primary care. When they cannot pay, the government does. In reality, Americans are paying for universal health care and not getting it. It is U.S. health care that is an expensive, bureaucratic mess.


What about “death panels?”


In the U.S. insurance companies decide who gets what health care. That has been mitigated only somewhat by ACA. In Canada it is doctors who decide what procedures are necessary and only doctors. Not the government, not an insurance company. In reality, it is the U.S. that has so-called “death panels.”


If California is able to implement some form of single-payer health care it would be a big improvement over even ACA. We should cut out the middleman — the insurance companies who take a cut of our health care costs without providing any healthcare at all. And I would think employers would want to get out of the health care business altogether. It is our system that is bloated and inefficient.
Health care is not something that everyone is “entitled” to. It is not an entitlement. But single-payer is affordable and humane and something that we, as decent human beings, should do for each other.