Critical Thinking Paper Final

Karuna Nandkumar
CAP 9
Green Group

5/5/14

2

The United States Congress must pass a law that replaces ObamaCare with a Single
Payer health care system, because ObamaCare is inadequate due to its costliness, inefficiency,
and failure to improve the availability of health care in the U.S. ObamaCare, otherwise known as
the Patient Protection and Affordable Care Act, was passed in March of 2010. This act was
designed to improve health care in the United States by introducing more regulations into the
industry, reducing health care spending, making health insurance more affordable and available
to all income levels, and improving the quality of health care; however, because of the clauses
and complexities of this act, it is proving difficult to implement. A Single Payer health care
system would avoid many of these complications, and lead to an easier and more successful
government-funded health care system that would provide coverage for medically necessary
services for every person in the United States.
Attempts to improve health care in the U.S. have been carried out many times before, but
each time they have failed to make the health care system as subsidized and universal as many
programs in European countries (PNHP, A Brief History). In the late 1800s through early
1900s, these European countries began addressing the issue of health care. In 1883, Germany
instituted a compulsory sickness insurance, and some others, such as Sweden and Denmark, also
initiated the beginnings of subsidized health care around that time. The U.S., however, did not
start to look at health care seriously until the late 1930s; and even then, although its government
was much more liberal than those of most European countries at the time, health care in the U.S.
was nowhere near becoming government-funded. Group health insurance was first introduced in
the 1930s as an employment benefit. Then, during the Roosevelt administration, Franklin
Roosevelt asked Congress for a bill that included the right to adequate health care, but, because
of the more pressing issue of unemployment that accompanied the Great Depression, National
3

Health Insurance was left out of the final Social Security bill. Harry Truman, in his Fair Deal,
proposed a plan for a single national health program that would include all Americans, but the
American Medical Association denounced this system, labeling it as Communist (PBS).
Between 1950 and 1960, all suggested health care legislation failed to pass, because of the
intense American fear of socialism and government control. In the 1960s, the cost of health care
began to rise, making it hard for the poor, old, and sick to afford health care. President Lyndon
B. Johnson managed to succeed in passing the act that created the entitlement programs of
Medicare and Medicaid in 1965. These programs were the most significant health care
legislation yet, and they seemed to work extremely well. Soon, however, costs began to rise once
again. (PBS).
From the 1970s until the 2000s, Medicare and Medicaid expenses rose dramatically, from
4.9 percent to 23.2 percent of total federal outlays (FAS.org). An economic crisis in the 1970s
led to an era of strict health care regulation. During this period, there was a shift towards the
privatization of health care. Health insurance costs seemed to be under control for a while, but in
the early 2000s, they began to rise once again. Some people view Medicare and Medicaid as
unsustainable under the current economic structure, and, to address this, in 2008 President
Barack Obama made healthcare coverage for all Americans a key point in his campaign.
President Obama signed the Patient Protection and Affordable Care Act into law in 2010. This
was viewed as a huge victory for people who supported more government control in the health
care system, but now, as the many new institutions are being put into place, insurance companies
are blaming ObamaCare for the continued rise in health care prices; for example, like many
insurance companies, AOL CEO Tim Armstrong blames [the ACA for] $7.1 million in
additional ObamaCare costs that the company is facing this year (Luhby, CNN Money). It has
4

become apparent that despite the expansion of Medicaid, only the lower economic class is
benefiting from this act, and, for the upper middle class, there is nothing that is very affordable
about the Affordable Care Act. In fact, premiums for the middle class have gone up, and they are
not eligible for subsidies. Scott Gottlieb, MD, says For a [middle class] family of four,
premiumscould still cost more than $15,000 annually on the exchanges. Only their incomes
will make them ineligible for the premium assistance credits that are meant to offset some of the
cost of buying the pricey comprehensive coverage that the Obama plan mandates
(RealClearMarkets). So, although ObamaCare is a step in the right direction, it does not provide
equally affordable health care for all people. Also, the many clauses in ObamaCare maintain the
former profit-based system, so private insurance companies still have control over health care in
the U.S. Private control of health insurance is undesirable because it adds costly administrative
charges to the process, and a Single Payer system would eliminate these charges.
The Affordable Care Act, in addition to the aforementioned charges, continues to allow
private companies to change, restrict, or limit peoples health insurance policies; this affects all
people with or without health care. ObamaCare also introduces many new requirements that
complicate the system. Those who are affected by the current system include all of the middle
class, and people who have health insurance through the individual marketplace. Although
ObamaCare now prevents companies from denying health care to people with pre-existing
conditions, health insurance companies can still raise their costs until they are unable to pay.
Cost assistance subsidies for reduced premiums and reduced out-of-pocket costs are available to
individuals and families making less than 400% of the Federal Poverty Level (which ranges from
45,960 94,200 based on family size), but those who are just above the line will not be
subsidized (Himmelstein, Woolhandler). Insurers can continue to change their policies, restrict the
5

doctors and hospitals that the insured can use, and limit care by increasing patients co-pays,
deductibles and other out-of-pocket costs. This will affect all people who are above the poverty
line, but who are not part of the upper class. In addition, many people who are self-employed and
do not receive insurance from their jobs were insured through the individual marketplace that
existed before ObamaCare. When this act was put in place, all of those people lost that health
insurance and had to change to ObamaCare, where they now have to pay more money
(RealClearMarkets). In the individual marketplace, people had no health security; however, some
people had good deals, and were willing to give up that security to pay less. When ObamaCare
was instituted, these people lost their low rates, but gained security. Many of them are now angry
about these new expenses (The Broad Side).
Next, ObamaCare maintains the inefficient system in which money goes through private
companies, causing the government to spend much more than necessary because of the lengthy
process and introduction of state-based exchanges. Over the next ten years, it will increase health
care spending by about $1.1 trillion (PNHP, A Superior System). ObamaCare also continues
to allow private companies to limit ones choice of doctor and hospital. An article in the
Washington Post says The Obama administration made it a priority to keep down the cost of
insurance on the exchanges.One way that insurers have been able to offer lower rates is by
creating networks that are far smaller than what most Americans are accustomed to
(Somashekhar, Cha). This law contains over a thousand pages of health care reform, making the
system extremely complicated. It is so full of obscure details that a single change in a familys
income could make them lose their current insurance plan. Among the many details are some of
the following: small employers can be denied help with premiums if they buy coverage through a
Taft-Hartley Fund; employers who do not offer coverage must pay a fine, unless a person works
6

for less than a certain amount of time; and, everyone is covered by the laws consumer
protections, except over 50 percent of non-governmental workers whose employers provide
health care benefits at their own financial risk. As two professors from the City University
School of Public Health at Hunter College say, Got it? We dont either. And theres much more
arcane detail that can mean life or death for thousands, penury or plenty for millions
(Himmelstein, Woolhandler). Moreover, after all of these complexities, there will still be about
thirty million people without health insurance by 2022 (PNHP, What Is Single Payer).
Forbes.com confirms this statement: According to the governments own and most authoritative
study, Obama Care will leave 30 million Americans uninsured during its first decade (Gregory).
A Single Payer health care system is the solution to the problems that ObamaCare is
unable to remedy. Single Payer is government-funded, so the difficulties that occur due to the
current privatized system will be addressed. First, instead of continuing an unfair system where
families with chronically ill members and lower to middle class families pay for an inordinate
amount of health care, everyone would help to fund the program equally through moderate taxes
based on ones ability to pay. The middle class would also benefit, because, with single payer,
there are no premiums, co-pays, deductibles, or other inconvenient out-of-pocket costs. Next, the
organization Physicians for a National Health Program confirms that a Single Payer system
redirects the $400 billion in administrative waste towards health care; [there will be] no net
increase in health spending (PNHP, A Superior System). Federal health care costs will
eventually go down (PNHP, A Superior System). Also, people will have free choice of doctor
and hospital with Single Payer, and doctors will regain complete control over patient care.
Finally, with a Single Payer system, all residents of the U.S. would automatically be covered for
all required medical services, including doctor, hospital, long-term care, reproductive health care,
7

medical supply costs, dental, preventative, prescription drugs, vision, prescription drug and
mental health (PNHP, What Is Single Payer). This simple solution will easily ensure that every
person in the U.S. has permanent and inexpensive health care. People will no longer have to
declare bankruptcy because they cannot pay the bills for the operation, medicine, or treatment
that saved their life. President Obama himself, at a health care conference in July of 2009, said
the truth is that unless you have what's called a single-payer system, in which everybody's
automatically covered, then you're probably not going to reach every single individual (PNHP,
What Is Single Payer). As can be seen, Single Payer is the solution to the problems that
ObamaCare has attempted, but failed, to solve.
There are numerous arguments that people make against a Single Payer system. Some of
the major issues include the assumption that the uninsured are taken care of well enough by
emergency care centers; the opposition to government-run health care in favor of the free market;
and, the most common argument, that the quality of care will suffer, and medical research and
technological innovation will slow down under Single Payer. To begin with, the uninsured are
definitely not adequately protected by hospitals and other emergency care centers. Only a small
amount of the uninsured are covered by government-sponsored hospitals and free clinics, or
private charity care, but recently, rising health care expenses are preventing private insurers from
offering as much free care (AMSA, Arguments). Also, the uninsured do not have a steady
source of care, so emergency rooms are used frequently. This ultimately results in the increased
cost of health care for those who are insured. Then, there is the issue of government versus free
market. Many conservatives argue against an expanded government role in the US, fearing that it
will lead to socialism or communism in the future. They believe that Single Payer is a step
toward big government, and that it is socialized medicine. The people who argue against big
8

government think that Single Payer will require a large amount of federal spending; however,
PNHP recently released a study predicting at least 3.5 trillion in federal spending would be saved
over ten years with Single Payer (AMSA, Arguments) by curtailing bureaucracy and
fostering health planning (PNHP, A National Health Program). Next, those who argue that
Single Payer is socialized medicine are technically wrong. Socialized medicine is defined as
medicine that is both delivered and financed by the federal government (AMSA,
Arguments). While Single Payer is financed by the government, delivery would remain
private. The final and most popular argument against a government-funded system is that
medical innovation and quality of care would suffer. Contrary to public belief, biomedical
research and technology would not decrease. Already, most biomedical research is being
publicly funded by the NIH. Likewise, the quality of care would not suffer; Single Payer would
make it possible to create a unified database that monitors the quality of patient treatment,
without interfering with the patient-doctor relationship like private companies do under
ObamaCare (Schiff, Dr. Gordon). Given these points, Single Payer presents no problems to our
current economic system, and is the most sensible and easy solution to the complications created
by ObamaCare.
If the Affordable Care Act remains the health care system in the US, the possible
repercussions include rapidly rising health care costs that will lead to a higher federal budget
deficit, and millions of people will remain uninsured. In the last ten years, health care costs have
risen from over 700 billion in 2004 to just under 1200 billion in 2013. If the health care system is
not changed to Single Payer, ObamaCare will add 1700 billion to the federal budget by 2020
(UsGovernmentSpending.com). In addition, as mentioned before, thirty million people will be left
without health insurance by the 2020s. Without Single Payer, there is no way to ensure that all
9

people have health care. ObamaCare will extend health insurance to more people, but it is
impossible to force every person in the US to sign up for health care; and, in the process of
extending Medicaid, billions of dollars will be added to the federal budget, and health care costs
will continue to rise.
In conclusion, although ObamaCare extends Medicaid to more people, it spends billions
of extra dollars in the process. Single Payer would save much of this money and redirect it
towards better quality health care for all. ObamaCare does not succeed in fixing many of the
previous problems with health care; while it does prohibit private companies from discriminating
based on pre-existing conditions, it does not prevent them from increasing out-of-pocket costs
for these people. Single Payer would eliminate the complexities of the current system and
eradicate all out-of-pocket costs. ObamaCare lets private insurance companies put limits on
choice of doctor and hospital, whereas Single Payer offers free choice of doctor and hospital and
gives the doctor autonomy over patient care, guaranteeing higher quality care. Most importantly,
ObamaCare fails to provide affordable health care for all American citizens, a program that most
European countries have already installed. For these reasons, the United States Congress must
immediately pass a law that replaces ObamaCare with a Single Payer health care system, and
finally ensures that every person in the U.S. has easy and affordable access to health care.

10

Works Cited

"A Brief History: Universal Health Care Efforts in the US." Physicians for a National Health
Program. PNHP, n.d. Web. 03 May 2014.
"A Superior System: Single Payer Legislation vs. Affordable Care Act." Physicians for a
National Health Program. PNHP, n.d. Web. 29 Mar. 2014.
"Arguments and Counterarguments About Health Care Reform." AMSA, n.d. Web. 30 Mar.
2014.
"Future Spending: History and Charts for US Governments - UsGovernmentSpending.com."
Future Spending: History and Charts for US Governments - UsGovernmentSpending.com. N.p., n.d.
Web. 30 Mar. 2014.
"Insurance Cancelled Under ObamaCare? Blame Your Insurance Company." The Broad Side.
N.p., n.d. Web. 30 Mar. 2014.
"Mandatory Spending Since 1962." FAS.org. Congressional Research Service, 23 Mar. 2012.
Web. 29 Mar. 2014.
"PBS- Healthcare Crisis: Healthcare Timeline." PBS. PBS, n.d. Web. 30 Mar. 2014.
"RealClearMarkets - The Obama Health Plan Will Squeeze the Middle Class." RealClearMarkets
- The Obama Health Plan Will Squeeze the Middle Class. N.p., n.d. Web. 30 Mar. 2014.
"What Is Single Payer?" Physicians for a National Health Program. N.p., n.d. Web. 29 Mar.
2014.
David Himmelstein and Steffie Woolhandler. "A Simpler, Better Solution." The New York Times.
Physicians for a National Health Program, 26 Sept. 2013. Web. 30 Mar. 2014.
Luhby, Tami. "AOL Is Latest to Blame Obamacare." CNNMoney. Cable News Network, 06 Feb.
2014. Web. 03 May 2014.
Schiff, Dr. Gordon. "How Single-Payer Health System Reform Improves Quality." PNHP.
Physicians for a National Health Program, n.d. Web. 28 Mar. 2014.
11

Somashekhar, Sandhya, and Ariana Eunjung Cha. "Insurers Restricting Choice of Doctors and
Hospitals to Keep Costs down." Washington Post. The Washington Post, 21 Nov. 2013. Web. 04 May
2014.
Gregory, Paul Roderick. "Government Study Finds Obama Care Leaves Thirty Million
Uninsured." Forbes. Forbes Magazine, 22 Feb. 2013. Web. 04 May 2014.
"A National Health Program for the United States: A Physicians' Proposal." A National Health
Program for the Unied States. N.p., n.d. Web. 04 May 2014.

12

Annotated Bibliography

1. "Access to Health Care." Global Issues in Context Online Collection. Detroit: Gale, 2014. Global
Issues In Context. Web. 30 Mar. 2014.
This article on the CAP suggested database Gale-Cengage gives a broad overview of the
health care issue in the U.S. It was useful in the early stages of research for this paper. This
website provided background knowledge of the subject, before the paper required more in-depth
detail.

2. FRIEDMAN, GERALD. "Universal Health Care. (Cover Story)." Dollars & Sense 295 (2011):
13. Points of View Reference Center. Web. 30 Mar. 2014.
This article is also on a CAP suggested database, Points of View, and gives another broad
overview of the health care issue in the U.S. Like the previous source, it was useful in the early
stages of research for this paper, and provided background knowledge of the subject, before the
paper required more in-depth detail.

3. "What Is Single Payer?" Physicians for a National Health Program. N.p., n.d. Web. 29 Mar.
2014.
This article by Physicians for a National Health Program helps one to understand the
components of a Single Payer health care system. PNHP is a non-profit physician organization
advocating a universal comprehensive Single Payer national health program. This website is
intended to educate physicians and other health professionals about the benefits of this system.

4. "What Is ObamaCare / What Is Obama Care?" What Is ObamaCare / What Is Health Care
Reform? N.p., n.d. Web. 30 Mar. 2014.
This website provides a strong overview of ObamaCare, but also provides many facts and
details about the law itself. It is a privately owned company; however, it is very well organized
and seems to be reliable. It is a good website to use for gaining a better understanding of the
policies that make up ObamaCare, but no direct quotes or figures were used from this website in
this paper.

5. "A Superior System: Single Payer Legislation vs. Affordable Care Act." Physicians for a
National Health Program. PNHP, n.d. Web. 29 Mar. 2014.
This chart is also by PNHP, the non-profit physician organization that advocates for a
universal comprehensive Single Payer national health program. It is an organized table comparing
the coverage, benefits, sustainability, choice, and financing of Single Payer and ObamaCare.

6. Sirota, David. "Single-payer Healthcare vs. ObamaCare." Saloncom RSS. Salon, n.d. Web. 30
Mar. 2014.
Salon is an online magazine which contains articles on all social, economic, and political
issues. This article was written by a staff writer of Salon. It describes the troubles that
ObamaCare has faced during its implementation, and identifies that many of these issues are due
to the fact that the private insurance companies are still in charge. It then explores why Single
Payer would be a superior program and would avoid the complications brought by ObamaCare.

13

7. David Himmelstein and Steffie Woolhandler. "A Simpler, Better Solution." The New York Times.
Physicians for a National Health Program, 26 Sept. 2013. Web. 30 Mar. 2014.
This article, written by two professors at City University School of Public Health at
Hunter College (Co-founders of Physicians for a National Health Program), describes how Single
Payer would be a simpler and better solution to the problems caused by ObamaCare. It also
provides concrete examples of the complicated details included in the Affordable Care Act. This
article appeared in the opinion pages of the New York Times.

8. "A Brief History: Universal Health Care Efforts in the US." Physicians for a National Health
Program. N.p., n.d. Web. 29 Mar. 2014.
This is an informative article provided by the nonprofit organization Physicians for a
National Health Program. The article gives an overall assessment of how past attempts to reform
health care in the US have failed. It was useful for the historical section of this paper.

9. Hoffman, Catherine. "National Health Insurance a Brief History of Reform Efforts in the U.S."
Collaborationhealthcare.com. The Henry J. Kaiser Family Foundation, Mar. 2009. Web. 30 Mar.
2014.
This is an article documenting the history of health care reform efforts in the US from
1934 to 1994. It is a very informative and factual document with good references. It was useful
for the historical section of this paper.

10. "PBS- Healthcare Crisis: Healthcare Timeline." PBS. PBS, n.d. Web. 30 Mar. 2014.
This article chronicles each step of the health care journey in the US from 1900 to 2000.
It is provided by the Public Broadcasting Service (PBS) and was extremely useful for the
historical section of this paper.

11. "History of Health Care- How We Got To Where We Are." History of Health Care. N.p., n.d.
Web. 30 Mar. 2014.
This is a brief overview of the important points in the history of health care in the US.
This page is written by Collaboration Health Care Inc., and company founded by former
researchers of health insurance companies, and designed to provide individuals with information
about the changing roles in the health care industry.

12. "Mandatory Spending Since 1962." FAS.org. Congressional Research Service, 23 Mar. 2012.
Web. 29 Mar. 2014.
This is a congressional report documenting mandatory federal spending since 1962. It
was prepared for members and committees of Congress by the Congressional Research Institute.
It includes numerous graphs and charts, and was extremely useful in obtaining data to support this
paper.

13. "Affordable Care Act History." Affordable Health California. N.p., n.d. Web. 28 Mar. 2014.
This article gives a short history of the ACA and the slow process of how the law was
passed. It also covers the recent implementation of this act. The article is provided by the health
insurance company Affordable Health California, California States ObamaCare insurance
exchange.

14

14. The Tech Firm Will Now Pay Its 401(k) Company Match Only to Employees Who Are Active on
Dec. 31 of That Year. "AOL Is Latest to Blame ObamaCare." CNNMoney. Cable News Network,
06 Feb. 2014. Web. 30 Mar. 2014.
This article on CNN Money describes how one specific insurance company blamed
ObamaCare for rising costs. CNN Money is a well-known online service that the Cable News
Network (CNN) offers.

15. "RealClearMarkets - The Obama Health Plan Will Squeeze the Middle Class." RealClearMarkets
- The Obama Health Plan Will Squeeze the Middle Class. N.p., n.d. Web. 30 Mar. 2014.
Real Clear Markets is an online magazine that displays political and economic articles.
This particular article describes some of the negative effects that ObamaCare has on the finances
of the middle class.

16. "Arguments Against a Single Payer Health Care System." Fairly Conservative. N.p., n.d. Web.
30 Mar. 2014.
This website is a political blog written by Cindy Kilkenny. The page cited describes
common conservative arguments against a Single Payer health care system. It was useful in this
paper to help explore the conservative point of view.

17. "Arguments and Counterarguments About Health Care Reform." AMSA, n.d. Web. 30 Mar.
2014.
This document shows every possible conservative argument against government-funded
health care, and provides a counter-argument for each one. It is provided by AMSA the
nonprofit organization of the American Medical Student Association. The document is given as a
facilitators guide for discussions about health care reform.

18. Schiff, Dr. Gordon. "How Single-Payer Health System Reform Improves Quality." PNHP.
Physicians for a National Health Program, n.d. Web. 28 Mar. 2014.
This document, also by PNHP, is an informative point-by-point summary of how Single
Payer improves the quality of health care. It is adopted from A Better Quality Alternative:
Single-Payer Health System Reform by Dr. Gordon Schiff and writers for PNHP.

19. "Future Spending: History and Charts for US Governments - UsGovernmentSpending.com."
Future Spending: History and Charts for US Governments - UsGovernmentSpending.com. N.p.,
n.d. Web. 30 Mar. 2014.
This website is a compilation of U.S. Government data. It includes past, present, and
future government spending published by government agencies such as the Congressional Budget
Office and the Medicare and Social Security Trustees. This website was very useful in obtaining
monetary figures for this paper.

20. "Insurance Cancelled Under ObamaCare? Blame Your Insurance Company." The Broad Side.
N.p., n.d. Web. 30 Mar. 2014.
The Broad Side is an online magazine written by woman on subjects such as culture,
health, lifestyle, and politics. It was useful in understanding some of the problems that people
have with ObamaCare.

15

21. Somashekhar, Sandhya, and Ariana Eunjung Cha. "Insurers Restricting Choice of Doctors and
Hospitals to Keep Costs down." Washington Post. The Washington Post, 21 Nov. 2013. Web. 04
May 2014.
This source is an article written by multiple authors and featured in the Washington Post.
It was used for supporting a general statement made in this paper.

22. Gregory, Paul Roderick. "Government Study Finds Obama Care Leaves Thirty Million
Uninsured." Forbes. Forbes Magazine, 22 Feb. 2013. Web. 04 May 2014.
This is an article on Forbes.com, a respected financial online magazine, and it was used
to find quotes to support figures.

23. "A National Health Program for the United States: A Physicians' Proposal." A National Health
Program for the Unied States. N.p., n.d. Web. 04 May 2014.
This source was used to support statements made in this paper. The article outlines
physicians opinions on a Single Payer system, and gives details to support arguments made in
this paper.