Health care debates are back in the news again, with the GOP and moderate Dems arguing about the best ways to fix the ACA (Obamacare!), the right wing of the GOP still wants to destroy it, progressives want to replace it with single payer, and insurance companies are laughing all the way to the bank. Here’s a brief update:

The ACA has problems right now. Some are a part of the growing pains of a relatively new program and need to be fixed. But at the moment, many are caused by a combination of lack of action in Congress, a desire by many in Congress and the White House to destroy the program, and insurance company greed.

The real problems? Not enough people were covered, and the ACA did not do anywhere near enough to contain health care costs. These are issues that need to be addressed. But most in Congress aren’t talking about that. (more on single payer at the end)

And now a GOP controlled Congress, who campaigned on ditching the program, are stuck with it. And it’s not going well. They can’t repeal, we’ve been there and tried that. The White House is doing everything it can to kill the program, including massive cuts to advertising to enroll new participants. Please note that this is a HUGE issue: if more people don’t enroll, costs go up, more people are without health insurance, and more insurance companies have an excuse to leave markets. This is a government action driving people off of insurance and driving insurance companies away. Inaction is leading to insecurity for these companies — insurance is based on predicting what’s going to happen in the future, and the future is VERY uncertain right now. Congress and the White House are also talking about cutting or withholding subsidies both to insurance companies to incent them to join the markets, and to individuals to help them pay for insurance – and without these things, the ACA will slowly fail.

The moderate Dems would like to fix the program, but in many ways are just as happy to lay the blame in the GOPs lap and watch them choke on it. The problem here is that this leaves more American’s uninsured than ever, and costs keep going up.

The insurance companies hate/love this battle. What do they not want? Single payer, as this will massively cut into their profits. If the government is paying for medicare like insurance, they are left with only supplemental plans, and these are nowhere near as profitable. In addition, right now the insurance companies can raise premiums as high as they can get away with on the ACA market, and in some cases just leave it all-together. Please note: this is nothing but a profit grab.

If the government forced their hand, insurance companies could ABSOLUTELY charge less for insurance to individuals on the ACA marketplace, and still make a profit. Many of the individuals are higher risk, but this is ALREADY CALCULATED INTO INSURANCE COSTS. Saying that you have to charge someone more b/c they have a disease is absolute, complete and utter crap. What we should all have is the best rates available — and right now the insurance companies only give those to huge employers (1000s of employees). Note that insurance companies still make money off of these big companies with low rates. But if you are in a small company, you pay more. Do you cost more? Absolutely not — insurance company amortization tables and costs are based on the laws of big numbers and averages, with everyone averaged out, including those who have little-no cost (young males) and the very expensive (cancer patients). But small companies have to pay more for insurance – not because they cost more, but because they don’t have the negotiating power of big companies. They don’t have as many “lives covered.” And individuals pay the most, because they have ZERO negotiating power by comparison. If insurance companies had their way, they would never sign someone up who is sick, and kick off anyone who gets sick. We have REGULATIONS to protect us from this kind of behavior, and those regulations can and should go much further.

If you want to be in the insurance business, you should be ready to provide equal coverage for healthcare to EVERYONE who pays your price. And there is no reason this price should differ from person to person. Average out the costs and charge everyone for that. You never know when you are going to get a disease, and your rates should not go up when you do.

And single payer? I wish Bernie and the progressive Dems the best here. I will write more soon with what I would like to see – it differs a bit from the current plan, but is in the same ballpark. The main issue: single payer is the ONLY way to insure everyone AND control costs. Leaving insurance to private markets is INEFFICIENT — the market absolutely does NOT work when it comes to paying for health care, and we have ample proof of that. Single payer countries provide much better care at much lower costs than the US, and this is shown over and over again. That’s right — if the government runs the program, every example we have in the world shows that COSTS WILL GO DOWN compared to private insurance. Private insurance won’t cease to exist, as things like medicare supplement plans will still be there to cover the things that insurance doesn’t cover. No insurance plan pays for everything, and this is an unreasonable expectation for a US single payer system.

For those who love the free market, please note that I absolutely still want a marketplace in which you can be free to pick your doctor, specialist, etc as you see fit. And single payer does a BETTER job of allowing that than most people’s insurance right now, which limits your choice of doctors.

Where do we go from here? Unfortunately that’s up to our politicians. And they’ve been doing a pretty bad job of things so far, so I’m not hopeful. Maybe it’s time for us to start putting some real pressure on them for CONSTRUCTIVE change, and to move away from just being obstructionist and saying “no” to the other side all the time…