Here are topics and background for discussion following the Feb. 7 Sanders-Cruz debate over Obamacare (the Affordable Care Act, ACA).
Discuss how the ACA fits the criteria for a neo-liberal model of health care. Who wrote the ACA and whom was the ACA designed to benefit?
Background: Neoliberalism is a policy model of social studies and economics that transfers control of economic factors to the private sector from the public sector. The blueprint for the ACA was written by Liz Fowler, a lobbyist for Well Point, one of the largest insurance companies in the United States. According to Wendell Potter, for the first seven years of the ACA, private health insurance profits have made astounding gains. “While the Dow Jones average has increased an impressive 253 percent since March 5, 2009, Humana’s share price is up a truly remarkable 1010 percent. No, that’s not a typo. Cigna’s share price has done even better. It’s up 1113 percent. That’s more than four times better than the Dow. The other big companies aren’t far behind. Anthem is up 469 percent. Aetna is up 628 percent. And UnitedHealth Group is up 814 percent. But it’s WellCare that takes the prize. Its stock price is up an astounding 1,410 percent. Thanks entirely to its federal and state government customers.” Pharmaceutical corporations are another sector that are making high profits.
Discuss how the ACA changed the healthcare system in the United States. Did the ACA move our healthcare system closer to a public single payer system or closer to a privatized system?
Background: The ACA is based on the Mandate Model for healthcare. It is composed of an expansion of Medicaid for people with low incomes, a mandate that everybody who is not covered by a public program purchase health insurance and the use of public dollars to subsidize the cost of health insurance. Public insurances such as Medicaid and Medicare, which covers seniors and people with disabilities, have become increasingly privatized through managed care companies and private ‘Medicare Advantage’ plans. Consolidation of health insurances, pharmaceutical corporations and health provider facilities has escalated since passage of the ACA.
Discuss the changes suggested by Republican members of Congress and the White House. How would they impact costs and access to healthcare?
Background: Republicans are suggesting that the ACA be repealed and replaced with Health Savings Accounts, high risk pools, selling private insurance across state lines, block grants for Medicaid and vouchers for Medicare. Health Savings Accounts are financial tools that permit the wealthy to hide more of their wealth. HSAs can be used to pay for premiums, out-of-pocket expenses and even gym memberships. Two-thirds of people in the US do not have cash on hand to cover a $500 emergency. High risk pools have failed due to the high price of premiums. Selling health insurance across state lines means that insurers will create plans in states with the fewest regulations and offer low-cost skimpy plans to everyone. Medicaid is a state-run public insurance. By moving to block grants, states will have to cut people or benefits from the program when demand rises. And moving Medicare to a voucher system means that seniors will no longer have a guaranteed set of benefits; instead they will have a set amount of money to purchase a private plan and will have to accept only the benefits they can afford.
Discuss the role of health insurance companies in the United States? How do health insurance companies make profits? Is health care a commodity or a public good?
Background: Health insurance companies collect money from enrollees through premiums, charge up front costs such as co-pays at the time patients receive care and require that deductibles are met before coverage begins. Health insurers define what is covered and where patients can seek care. If patients go outside of these restrictions, then they are required to pay some or all of the costs of care. Health insurance companies make profits by charging as much as they can for premiums, attracting healthy patients and avoiding patients with health problems (cherry picking), requiring high out-of-pocket costs and denying payment for care. A commodity is defined as a marketable item produced to satisfy wants or needs. A public good is defined as is a good (product or service) that is both non-excludable and non-rivalrous in that individuals cannot be effectively excluded from use and where use by one individual does not reduce availability to others. (Definitions from Wikipedia)
Discuss the basics of a National Improved Medicare for All system. Who would be covered in NIMA? What impacts would NIMA have on the economy and on people’s daily lives?
Background: A National Improved Medicare for All (NIMA) healthcare system is a national health insurance that is paid for up front through progressive taxes and includes everyone from birth to death. There are no out-of-pocket costs in the form of co-pays or deductibles. Coverage is comprehensive. Patients can choose where they go for care and health decisions are made by patients and health professionals. Simplified administrations mean that the system is easier to use than the current heavily bureaucratic system and saves hundreds of billions of dollars each year on paperwork. The system is transparent and accountable to the public. The bottom line is health for everyone, not profits for a few. NIMA would provide health security for everyone, end personal bankruptcies due to medical costs, stop families from having to choose between paying for health care and paying for other necessities and it would free people to change jobs, start their own businesses or retire early.
Discuss the obstacles to achieving NIMA in the United States. What will it take to overcome these obstacles? How does the fight for universal healthcare compare to other social struggles?
Background: The greatest obstacle to winning NIMA is to force members of Congress to pass legislation and the President to sign it into law. This means changing the political culture in the United States so that NIMA is the only politically-viable solution. This is accomplished through education, organization and mobilization of a broad movement of movements with this demand that pressures lawmakers. Like other major social gains, NIMA will take a lot of effort to win. And people will be told that we are asking for too much. We must understand that in every great social struggle people were told they were asking for too much and remain undeterred. Health impacts everyone and is connected to every aspect of our lives. The struggle for health over profit unites us across issues, class and other lines of social division.