Monday, October 21, 2013

Fwd: qotd: Antonia Maioni explains why Obamacare makes single payer impossible to attain

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Antonia Maioni explains why Obamacare makes single payer
impossible to attain
Date: Mon, 21 Oct 2013 10:10:01 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

The Globe and Mail
October 2, 2013
Obamacare vs. Canada: Five key differences
By Antonia Maioni

Despite the partisan war in Washington that shut down the federal
government this week, President Barack Obama has succeeded in
implementing the first major health reform in the United States in
nearly 50 years, as the Patient Protection and Affordable Care Act goes
into effect. Even though its most virulent critics raise the spectre of
"Canadian-style" health care, "Obamacare" does little to change the
enduring differences between the two health care system. What, exactly,
does "Obamacare" look like compared to Canada?

Not single-payer:

Canadian critics tend to rail against "two-tiered" medicine, but in
fact, the U.S. has a multi-tiered system. And despite the hype on both
sides of the Congressional aisles, Obamacare keeps the same complex
structure in place, while adding another layer through the introduction
of health care "exchanges" for uninsured Americans. But the majority of
Americans will continue to access care through a variety of health
insurance plans made available or subsidized by their employer; nearly
50 million elderly and disabled through the federal Medicare program;
another 60 million lowest-income through state-federal Medicaid

Not universal coverage:

Health care in Canada is based on a simple proposition: every legal
resident is covered through a publicly-financed provincial or
territorial plan. The individual mandate, derived from a Republican
precedent in Massachusetts, stands in stark contrast to Canada's
universality principle. Even though Obamacare broadens coverage, the
individual mandate relies on a fundamental insurance principle – care
depends on type of coverage – and compels Americans to purchase
insurance to access care. Americans now have more affordable insurance
options and subsidies to cover their costs, and the lowest-income may be
eligible for public coverage through the expansion of Medicaid. Still,
despite the crush of online traffic as enrolment began Tuesday, only
half of the estimated 40-plus million uninsured will be affected by

Not "national" health insurance:

One of the hallmarks of health care in Canada is that, although each
province and territory administers a health plan, everyone can expect to
be covered for a comprehensive range of services, no matter where they
live. And the federal government is expected to chip in to provincial
coffers to make this happen. There's plenty of intergovernmental
friction as a result, but nothing like the fractured federalism of the
United States. The implementation of Obamacare will further exacerbate
regional and state differences, mainly as a result of the Supreme Court
decision to curtail the federal government's obligation for states to
expand their Medicaid coverage. As a result, only about half of the
states have chosen to sign on to the new Medicaid program.

Not equal access:

There's been some controversy in Canada lately over wait times and
access to timely care, but this pales in comparison to the wide gulf
that exists in access to care in the United States. Obamacare tries to
address this in its provisions for insurance reform, such as lifting
pre-existing conditions and limits on co-payment. But for all of the
emphasis on affordable care, the new law reinforces the notion that
access depends on how much you can afford, not how much you need. In the
health insurance exchanges, the price of premiums will depend on your
age, health, income, and on whether you opt for a bronze, silver, gold
or platinum coverage. In Canada, access to necessary health care
services is not a competitive sport.

Not cost containment:

The sharpest critics of Obamacare argue it does little to address the
fundamental challenge of cost control. The new law includes a review of
Medicare reimbursement and the expansion of Accountable Care
Organizations to reward cost-effective care. But it doesn't grapple in a
systematic fashion with the overall inefficiencies in health care
delivery and financing, the administrative burden of multiple payers,
providers and plans, and the cost pressures of defensive medicine.
Governments in Canada know that health care is a searing financial
responsibility, but they have at their disposal cost containment
measures – monopoly fee negotiations with providers, global budgets for
hospitals – that remain unfathomable in the American context.

Obamacare is a huge step in American health reform and, if it seen to
improve the system, will represent a major victory for Democrats. Like
other major reforms of the past, however, it will entrench the private
nature of the system, and likely render national health insurance, or
anything remotely like "Canadian-style" health care, impossible to attain.

(Antonia Maioni is an associate professor at McGill University)

Brief bio of Professor Maioni:

Comment: It is frequently said that Obamacare will lead to a
Canadian-style single payer system - a statement of optimism by some
supporters, and a threat by opponents. McGill University Professor
Antonia Maioni explains why Obamacare will do no such thing.

Many of the Quote of the Day messages describe very serious flaws in the
Obamacare model - flaws that perpetuate high costs, administrative
excesses, impairments in access, and many other unjust inequities
inherent in our system. I frequently receive messages stating that I
should cease criticizing Obamacare, and, instead, I should be supporting
Obamacare measures as incremental steps leading to single payer.
Although we do not want to reject even minimal improvement in our
system, most of the serious structural flaws cannot be corrected with
simple remedial legislation.

Professor Maioni explains some of the fundamental structural defects in
the U.S. financing system that cannot be merely tweaked to get it right.

As Professor Maioni states, "Obamacare… will entrench the private nature
of the system, and likely render national health insurance, or anything
remotely like 'Canadian-style' health care, impossible to attain."

The incremental path to single payer through Obamacare has no bridge
across the chasm. It would be a tragedy to spend a decade or two,
standing on one edge of the chasm, looking across and trying to figure
out how legislative patches can build a bridge to the other side, when
patches cannot repair a bridge that doesn't even exist. Only a new
infrastructure will do. We must begin building a single payer system
with all due haste.

No comments:

Post a Comment