By Rose Ann DeMoro
The Guardian (UK)
November 27, 2013
There’s no reason to rollback the progress the ACA has made. But we should
go all the way and dump the for-profit system.
Lost amidst the well-chronicled travails of the Affordable Care Act
rollout are the long term effects of people struggling to get the health
coverage they need without going bankrupt.
If that sounds familiar, it’s because that’s been the main story line of
the US healthcare system for several decades. Sadly, little has changed.
Still, with all the ACA’s highly publicized snafus, and less discussed
systemic flaws, there’s no reason to welcome the cynical efforts to repeal
or defund the law by politicians whose only alternative is more of the
same callous, existing market-based healthcare system.
US nurses oppose the rollback and appreciate that several million
Americans who are now uninsured may finally get coverage, principally
through the expansion of Medicaid, or access to private insurance they’ve
been denied because of their prior health status.
At the same time, nurses will never stop campaigning for a fundamental
transformation to a more humane single-payer, expanded Medicare for all
system not based on ability to pay and obeisance to the policy confines of
insurance claims adjustors.
Website delays – the most unwelcome news for computer acolytes since the
tech boom crashed – are not the biggest problem with the ACA, as will
become increasingly apparent long after the signup headaches are a distant
What prompted the ACA was a rapidly escalating healthcare nightmare, seen
in 50 million uninsured, medical bills plunging millions into un-payable
debt or bankruptcy, long delays in access to care, and record numbers
skipping needed treatment due to cost.
The main culprit was our profit-focused system, with rising profiteering
by a massive health care industry, and an increasing number of employers
dropping coverage or just dumping more costs onto workers.
The ACA tackles some of the most egregious inequities: lack of access for
many of the working poor who will now be eligible for Medicaid or
subsidies to offset some of their costs for buying private insurance
through the exchanges, a crackdown on several especially notorious
insurance abuses, and encouragement of preventive care.
But the law actually further entrenches the insurance-based system through
the requirement that uncovered individuals buy private insurance. It’s
also chock full of loopholes.
Some consumers who have made it through the website labyrinth have found
confusing choices among plans which vary widely in both premium and out of
pocket costs even with the subsidies, a pass through of public funds to
the private insurers.
The minimum benefits are also somewhat illusory. Insurance companies have
decades of experience at gaming the system and warehouses full of experts
to design ways to limit coverage options.
The ACA allows insurers to cherry pick healthier enrollees by the way
benefit packages are designed, and as a Washington Post article noted on
21 November, consumers are discovering insurers are restricting their
choice of doctors and excluding many top ranked hospitals from their
The wide disparity between the healthcare you need, what your policy will
cover, and what the insurer will actually pay for remains.
Far less reported is what registered nurses increasingly see – financial
incentives within the ACA for hospitals to prematurely push patients out
of hospitals to cheaper, less regulated settings or back to their homes.
It also encourages shifting more care delivery from nurses and doctors to
robots and other technology that undermines individual patient care, and
that may work no better than the dysfunctional ACA websites.
Is there an alternative? Most other developed nations have discovered it,
a single-payer or national healthcare system.
Without the imperative of prioritizing profits over care, Medicare for all
streamlines the administrative waste and complex insurance billing
operations endemic to private insurance. That waste is a major reason why
the US has more than double the per capita cost of healthcare of other
developed nations, yet lower life expectancies than many.
Medicare for all eliminates the multi-tiered health plans that plague both
the individual and group insurance markets that are tied to the girth of
your wallet not your need for care. Class, gender, and racial disparities
in access and quality of care vanish under Medicare for all.
It’s beyond time that we stop vilifying government and perpetuating a
corporatized healthcare system that has abandoned so many. We can, with a
system of Medicare for all, we can cut healthcare costs and promote a much
more humane society.
Medicare for All/Single Payer Comparison Chart is beneath the article at
RoseAnn DeMoro is executive director of National Nurses United and member
of the AFL-CIO Executive Council.
News on HR 676
On Nov. 19, 2013, Congresswoman Betty McCollum of Minnesota signed on to
HR 676, Expanded and Improved Medicare for All, bringing the total of
cosponsors in the House to 53. Congressman John Conyers, Jr. of Michigan
introduced HR 676 into Congress in 2003, and reintroduced it in every
Congress since then. McCollum has been in Congress since 2001, but this
is the first time that she has become a cosponsor of HR 676.
Three other Congresspersons have signed on to HR 676 since September.
They are Chaka Fattah (PA 2), Alan Lowenthal (CA 47) and Linda Sanchez (CA
HR 676 would institute a single payer health care system by expanding a
greatly improved Medicare to everyone residing in the U. S.
HR 676 would cover every person for all necessary medical care including
prescription drugs, hospital, surgical, outpatient services, primary and
preventive care, emergency services, dental (including oral surgery,
periodontics, endodontics), mental health, home health, physical therapy,
rehabilitation (including for substance abuse), vision care and
correction, hearing services including hearing aids, chiropractic, durable
medical equipment, palliative care, podiatric care, and long term care.
HR 676 ends deductibles and co-payments. HR 676 would save hundreds of
billions annually by eliminating the high overhead and profits of the
private health insurance industry and HMOs.
In the current Congress, HR 676 has 53 co-sponsors.
HR 676 has been endorsed by 609 union organizations including 146 Central
Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT,
OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX,
IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV,
MA, RI, NH, ID & NM).
For further information, a list of union endorsers, or a sample
endorsement resolution, contact:
All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551