Kudos to Bill Toland for his April 27 piece “How Did America End Up With This Health Care System?” To briefly summarize 100 years of our patchwork, dysfunctional health care system is almost as remarkable as finding a real solution for it. Mr. Toland gets all the particulars right, but the solution will not be found in the Affordable Care Act, no matter how long we wait for it to change.
As Americans gain more experience with the ACA, they will become disappointed when they realize that plans in the marketplace have low actuarial value and high deductibles. Narrow provider networks will prevent Americans from having choices in physicians and hospitals. Those previously satisfied with their employer-sponsored coverage will find they, too, have fewer options at greater cost. This incremental step will put billions in the pockets of insurance companies, entrenching them further in our system.
The solution today as in 1915, when the first national health insurance bill was introduced in Congress, is a health care system that is truly universal, affordable, accountable, accessible, sustainable and just.
Only with a single-payer system or improved and expanded Medicare for all will we ever have a health care system worth $2.8 trillion — something that cannot be said for what we have today or what we are getting under the ACA.
ANA MALINOW, M.D.