The ACA vs Single Payer - Accessibility, Affordability, Cost Control

Despite the ACA’s modest benefits, the law (1) will not achieve universal coverage, as it leaves at least 30 million uninsured (and 26,000 deaths/year), (2) will not make health care affordable to Americans with insurance, because of high co-pays and gaps that leave patients vulnerable to financial ruin in the event of serious illness, and (3) it will not control costs.

Why is this so? Because the ACA perpetuates a dominant role for the private insurance industry.

  • That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals;
  • It denies care to increase insurers’ bottom line; and
  • It obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control.

  • It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.
  • Research shows the savings in administrative costs alone would amount to $400 billion annually, enough to provide quality coverage to everyone with no overall increase in U.S. health spending.

Contrary to the claims of those who say we are “unrealistic,” a single-payer system is within practical reach.

  • The most rapid way to achieve universal coverage would be to improve upon the existing Medicare program by excluding private insurance participation (through so-called Medicare Advantage plans) and expand it to cover people of all ages.
  • There is legislation before Congress, notably HR 676, the “Expanded and Improved Medicare for All Act,” and HR 1200, the “American Health Security Act,” which would do precisely that.
  • Polls show such an approach is supported by about two-thirds of the public and a solid majority of physicians.
  • What is truly unrealistic is believing that we can provide universal and affordable health care in a system dominated by private insurers and Big PHARMA.

Healthcare under the Accountable Care Act

Yes, there are some good things about the ACA – insurance will be available to half of

those who do not have it now, there will be some limits on insurance company abuses,

preventive medicine will get a boost, there is money for new community clinics, and more.

But overall, the ACA facilitatesthe corporate takeover of medicine.

Corporate takeover of our medical system and the ACA

  • Private insurance isstrengthened by millions of new patients with gov’t subsidies – increasing money for political influence and the power to obstruct serious efforts to control costs.
  • Increasing horizontal consolidation of health care payers – insurance companies buying each other, increasing their influence and bargaining power.
  • Increasing vertical consolidation of healthcare – hospitals now employ 70% of physicians. Insurance corporations buying hospitals, doctors groups and ACO’s equals physicians as “assets’ working for corporations.
  • Pressure on providers to increase the corporation bottom line pitting investor interest vs. their patients’ interest –increased workload, decreased staff help, deteriorating doctor/patient relationship, career satisfaction and quality of life.

ACA -more people will have insurance, but the new standard is underinsurance

  • Increased deductibles, co-pays, and coinsurance remain barriers to using insurance and seeking health care. US has highest rate of unnecessary deaths and decreased life expectancy due to healthcare barriers.
  • ACA will not the affect the rate of personal bankruptcies (Massachusetts experience), foreclosures, and family financial disaster for those who develop a significant illness.

ACA - exchanges are not equitable

  • Four plan options (Platinum, Gold, Silver and Bronze (Lead)) with different coverage, premiums and out of pocket expenses. Families with lower income levels will choose the cheaper plans (actuarial values covering only 60-70% of expenses) with less coverage and more exposure to financial disaster.

ACA - wishful thinking on cost control measures

  • EMR – studies show increased cost from upcoding and more studies ordered in hospital systems. More provider time required.
  • Health IT/Evidence-based medicine – may be good for patients but hasn’t been shown to decrease costs.
  • Chronic care management – may be good for patients but hasn’t been shown to decrease costs.
  • Pay for Performance – no studies show no decreased costs or increased quality. Sets up competition between doctors. Easily gamed by upcoding and avoiding caring for high-risk patients.

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  • ACO’s (Accountable Care Organizations) – no track record that can be generalized to ACA’s future costs. Wishful thinking that it will control costs and improve quality, given past negative experience with the similar HMO’s and with the increased corporatization the ACA supports.

ACA - a setback for safety-net hospitals

  • ACA’s reduced Medicare payments earmarked for hospitals that support unfunded care and for residents education will not be counteracted by expected increased payments from increased numbers of Medicaid patients and the newly insured, especially in the safety-net hospitals like Harborview. Community clinics will be flooded with the remaining uninsured.

ACA - an incremental step toward health care justice?

  • Overall, it may be a step backward as it empowers the corporate takeover of medicine.
  • People will “wait to see what happens” with more suffering in the interim.

Where do we go from here?

Is Single Payer realistic?

  • Most polls over last decade show 2/3rds of public would support a publically financed government program guaranteeing medical care to all.
  • 60% of physicians would support a single payer national health program.
  • Unrealistic to think that a universal, affordable health care can be achieved in a system dominated by the insurance industry and big PHARMA.
  • What once seemed politically impossible has come to pass because of grassroots movements – women’s suffrage, civil rights in the South, Medicare, and recently in our state, marriage equality and legalization of marijuana.

How do we get to improved Medicare for All?

  • We need a grassroots movement based on Health Care is a Human Right and traditional American values of freedom (from disease and financial disaster), equal opportunity (that requires good health) and justice for all (that requires government guarantees).
  • Medical students and residents need to take a leadership role as their future and thatof their families and patients depends upon it.

Current Single Payer Efforts

  • National
  1. HR676 – Improved and Expanded Medicare for All (Conyers)
  2. HR1200 – American Health Security Act (McDermott)
  • States
  1. Vermont on the road to achieve single payer Green Mountain Health Care in 2017
  2. More than 20 other states with single payer bills in their legislatures.
  3. Washington Health Security Trust– HB1850(WHST) introduced in WA House of Reps (Senate bill shortly). Designed to be substituted for the ACA in WA State in 2017, after a waiver granted by the federal Dep’t of Health & Human Services.

Local Organizations working for Improved Medicare for All and the WHST:

  • PNHP-Western Washington Chapter –
  • Health Care for All Washington –
  • United for Single Payer -

PNHPWW Monthly Meetings – third Wednesday every month 7PM, Swedish Medical Center Cherry Hill Campus Conference Center Auditorium

Join the Physicians for a National Health Program – Western Washington Chapter

Visit our website at

Join our email list –send a message to

Join in the WA State Alliance for Health Care is a Human Rightgrassroots-building campaign