Providence Journal

March 29. 2015 2:01AM

Froma Harrop: Obamacare should be less complex

Next to what we had before, Obamacare has been a spectacular success. The Affordable Care Act has brought medical security to millions of previously uninsured Americans and has helped slow the rise in health-care spending.

But the health reforms would have been more spectacular had they been simpler to understand. Complexity is their big flaw. It was the product of politicians cutting so many private interests into the deal -- and the fear of radically changing a system of health coverage largely based on employment.

Thus, many Americans who received tax credits to buy coverage on the health insurance exchanges now must calculate whether they overestimated or underestimated their 2014 income in determining their subsidy.

If they made more than they expected, they must repay some of the money.

Others are finding that they earned less than they thought they would in the year. They can expect a refund. A nicer surprise, for sure, but still, figuring these things out is a chore.

There's another group. Those folks who did not enroll and do not have health insurance are facing a tax penalty of $95 or 1 percent of their income, whichever number is higher. That penalty will rise with the years. Many can obtain an exemption from this fine but must apply for it.

Some objected to being forced to buy coverage. Others were unaware of the mandate. And many people just couldn't wrap their brains around the concept of exchanges and the choices they offered.

Bringing the entire population into the insurance risk pool is essential to any health reform, and a mandate to buy coverage is one way to get there. But that puts a burden on a lot of ordinary folk.

Medicare brings everyone 65 or older into the program by simply enrolling them. Hospital coverage is automatic. Those wanting coverage for visits to the doctor can pay extra. If they want coverage for drugs, they can buy a drug plan. Or they can sign up with a Medicare Advantage plan.

Medicare does offer subsidies to some low-income people, but they are relatively simple. The program is funded by payroll taxes, premiums and the Treasury. No one needs an accountant to figure what one gets or pays.

There's much waste in Medicare. But the program does curb spending through low administration costs and by setting a price on each service.

Ironically, some of Obamacare's leading critics want to make Medicare more like Obamacare. Rep. Paul Ryan proposes a system whereby the elderly would receive vouchers to buy coverage from a private insurer on ... a health insurance exchange.

Gone would be the guaranteed benefits. Patients of modest means wanting choice of doctor might have to settle for plans with limited provider networks. Those who object would have to fight it out with the insurer. The Ryan plan would give insurers more freedom to determine the benefits offered by their plans. Companies could then tailor their offerings to attract the healthy -- and therefore cheaper -- enrollees and avoid the sickly.

Would some leader in Washington start the wheels turning to bring all Americans into the promised land of Medicare as we now know it? And don't repeal Obamacare. Mend it and bend it to fit into Medicare.

Froma Harrop (fharrop@gmail.com) is a syndicated columnist and a former member of The Journal's editorial board. She can be followed on Twitter: @FromaHarrop.

http://www.providencejournal.com/article/20150329/OPINION/150329271

Bullet Points for Legislators

  • Single Payer saves money.  For the past 20 years, states have commissioned studies on different types of health care systems.   In EVERY case, single payer was shown to be the only way to cover everyone and the only system that saved money and controlled costs.

  • Publicly financed does not mean government run health care.  YOU have publicly finance health coverage, but the government does not make decisions regarding your health care.

  • Cost conscious patients often don't get the care they need.   Most decisions are made by the doctor in concert with the patient, but the patient relies on the doctor's knowledge to make a decision.  Expensive tests and treatments cannot be ordered by the patient, only the doctor.

  • Lifestyle choices are not what is fueling high costs in health care.   The United States ranks low in general health indicators, but high in good health habits.  We smoke less, drink less and consume less animal fat that many other countries with better health indicators and much lower health care costs.

  • Businesses can accurately determine their health care costs and are not subject to unanticipated large premium increases.

  • It will reduce labor costs due to a more efficient way of financing health care, eliminating much wasteful administration.

  • Workers' Compensation costs will be reduced, likely by half, due to the fact that everyone has health coverage and there is no need for the medical portion.

  • It reduces the need for part time employees and provides easier recruiting.  There are no pre-existing conditions or Cobra issues.

  • Eliminates the oversight of health benefits and bargaining health coverage with employees.

  • It creates healthier personnel and more stable employees, reduces absenteeism and eliminates employer health coverage complaints.

  • It reduces employee health related debt and personal bankruptcies.

  • It frees up family income that can be spent on other goods and services, thus stimulating the economy.

Tips for Writing Letters to Editor

Follow guidelines for your local paper (word count, submission instructions, etc.)

Frame your letter in relation to a recent news item Use state specific data whenever possible (let us know if you need help finding some!)

Address counter arguments

Be aware of your audience and emphasize how Medicare for All is good for ALL residents of the state

Criticize other positions, not people Include your credentials (especially if you work in the healthcare field)

Avoid jargon and abbreviations

Don’t overload on statistics and minor details

Cover only one or two points in a single letter

Avoid rambling and vagueness

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