The ACA is dead… Long live the ACA!

I am beginning to feel like I should turn in my psychology credentials because I struggle to understand how Senator Sanders whopped Secretary Clinton in every demographic except seniors in the New Hampshire primary.  At a 5:1 clip, young women rushed to cast their vote for Sanders.  That’s just amazing!  More interesting, though, is how Sanders, a self-proclaimed neo-socialist, is resonating with a broad cross-section of Americans.  How is this possible?  Given my background and training, I should understand this, but I don’t.

Socialist Sanders wants to replace the Affordable Care Act with a single payer, Medicare-for-all health care system.  What does the fact that he has an ever-growing constituency rallying to his call mean?  I’m not sure, but a new Kaiser Health Tracking Poll  may provide us with some insight into the Sanders phenomena.  The poll results tell us that though the ACA ranks eight on the list of priorities for voters, 44 percent hold an unfavorable view of it.  Again, that’s just amazing!  Defying the predictions of most health policy pundits, the needle on consumer acceptance of the ACA has not moved over time.  Here we are, six years after its passage and four years after its implementation, and nearly half of the voting population still do not like it.

Chief among the complaints about the ACA is that it is too complex, and it allows profiteering in the financing and delivery of health care to continue if not flourish.  The claim here is that health care operating on free-market principles, while good for the payers and providers, is not good for consumers.  And the cost of health care is still rising at twice-to-thrice the overall rate of inflation, threatening to consume 20 percent of our nation’s gross domestic product by the end of this decade.

Other industrialized nations that provide universal coverage have, arguably, done better for consumers than the ACA.  What they did, though, provides us with a tough prescription to cure what’s ailing our health care financing and delivery system.  Specifically, any health care system seeking to cover everyone and keep costs down must include these three features, as follows:

  1. Everyone must be required to have insurance coverage. The ACA has a soft mandate for this…We need to beef up the penalties and subsidies for low-income residents, and we need to eliminate the coverage exclusions, including the undocumented.
  2. Health plans must not be allowed to make a profit on basic coverage. They may profit off of supplemental coverage plans, but basic coverage for routine and necessary care must be provided at cost.
  3. A single payer or all-payer system must be installed; i.e., payment rate regulation for both commercial and government-sponsored health care provided by doctors, hospitals and others must replace the pluralistic payment models currently used.


Again, these features are proven to be effective for nations desiring to provide universal coverage for its residents without breaking the bank in the process.  And Senator Sanders dares to embrace this with his Medicare-for-all proposal.  Will he succeed?  Four months ago I would have said “no way.”  However, four months ago, I also would have said that Donald Trump’s campaign would be dead by now.