PG executive editor David Shribman, in his column “Learning From Obamacare” (March 30), criticizes the Obama administration for mistakes made in enacting the Affordable Care Act. There is nothing particularly new or insightful in Mr. Shribman’s analysis. What strikes me is that the very strategy that Mr. Shribman says President Barack Obama got right, i.e., “sell to the middle,” is precisely the reason the ACA will fail in the long run.
There are two fundamental, structural problems with the ACA: (1) the low-income subsidies cannot be maintained, and when they disappear, the insurance exchanges — if they survive — will just be another place to buy overpriced health insurance; and (2) the ACA does practically nothing to deal with the biggest problem with the U.S. health insurance system, the out-of-control costs. As a result the ACA, like the private insurance system it attempts to reform, is unsustainable.
Instead of cutting a deal with the insurance industry and taking the single-payer option off the table from the get-go, Mr. Obama should have used the leverage of his election mandate and gone over the heads of the right-wing congressional Republicans and Democrats, to, according to polls, an already sympathetic American public and pushed for a single-payer health insurance system.
Improving and expanding Medicare — a successful single-payer model — to all Americans is the easiest and cheapest way to insure everyone. It was Mr. Obama’s decision to “sell to the middle” that led to the unnecessarily costly, complicated and unsustainable Affordable Care Act.