Single Payer Advocate Woolhandler: Complexity Baked into Obamacare

October 7, 2013

One week into Obamacare enrollment and it’s still a nightmare to sign up through the website.

But even if the computer glitches are worked out, “complexity is baked into Obamacare.”

That’s the take of  single payer advocate Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program (PNHP).

“The exchanges have to deal with millions of enrollees, they have to deal with income verification, they have to deal with thousands of private insurance plans,” Woolhandler told Democracy Now host Amy Goodman. “It’s a very complex system. And unfortunately, that complexity also contributes to high expense. The private insurance industry that is offering the insurance through the exchanges has overhead costs that are about four times as high as traditional Medicare. And in addition, we are going to have overheard of about four percent added to insurance overhead just for the exchanges. So it’s a complex system, a very expensive system and when we see the way it’s performing, we understand why we need a simple single payer system that could save about $400 billion on administrative simplification.”

Goodman asked Woolhandler: For people who don’t have insurance, should they go to the exchanges to sign up for Obamacare?

“People need to take a look,” Woolhandler said. “But they also need to know that many of the new plans have high co-payments, high deductibles, they can have very restrictive networks. So for some people, this can be a great deal if you income is in the low range. If you are middle income, I think you are going to find that you are paying an awful lot of money for some very skimpy coverage through the exchanges.”

“When Medicare was rolled out in 1966 it was rolled out in six months using index cards,” Woolhandler said. “Under single payer, you would have a simple system. You would not need all of this complexity. They didn’t have computers back in 1966. They went from zero to over 20 million people enrolled in Medicare in a period of six months. And because it was a simple system based on Social Security records, you didn’t have hundreds of people programming in the state of Oregon, thousands of different plans, tons of different co-pays, restrictions and deductibles. You had one single payer plan, which is what we need for all Americans to give Americans the choice they want — which is not a choice between insurance company A and insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.”

Woolhandler said that much of the coverage under Obamacare is “going to be extremely skimpy and not particularly affordable.”

“Thirty one million will be left out of Obamacare,” Woolhandler said. “About five million of those thirty million will be uninsured because of the red state governors who won’t expand Medicaid. But 25 million of those uninsured are uninsured by the very design of Obamcare. They were never included in the original estimations of the bill. That’s because you have to take money out of your pocket to buy insurance. And as you get up into the middle income levels, the insurance is extremely expensive and many people won’t be buying it.”

“About one third of those people will be undocumented immigrants. But two thirds will be U.S. citizens, mostly working poor, who still will not be able to afford health insurance under Obamacare.”

“Obamacare is a very expensive program that offers halfway coverage to half of the people who need it,” Woolhandler said. “We need to be moving forward to single payer to make sure that every single American can go to any doctor they want and be able to afford that.”

Woolhandler said there were disagreements within PNHP on how to deal with Obamacare.

“Our group has about 17,000 members,” Woolhandler said. “As you can imagine, there are some disagreements. Some people are very pro-Obamacare. Some people are more tepid, like myself. But we all agree that it is not a solution, that we still need single payer and we need to move forward and build the movement for single payer.”

“Under Obamacare, someone my age with an income of about $45,000 or year or more would have to pay $8,300 a year in premiums,” Woolhandler said. “And very few people have room for that in their budget. And that’s why many middle income people will remain uninsured under Obamacare. Plus they will be paying a penalty for not participating in that expensive insurance. It’s simply not going to be affordable.”

“Obamacare is not a solution to the health care crisis,” she said. “Once they realize that Obamacare, whatever its strengths, is not a solution, they will be motivated to join the movement for single payer.”

“The Republicans have made a big deal that about half of Americans reject Obamacare. But what they don’t tell you is that a third of those people reject Obamacare because they didn’t think it went far enough. In the New York Times on Saturday, they interviewed a very conservative guy in Georgia who said — I hate Obamacare, I support the Republicans. What we need is a single payer system.”

Goodman asked — what would have happened if single payer and not Obamacare that went into effect October 1?

“We could have enrolled everyone automatically through the Social Security Administration, which already has the names of everyone,” Woolhandler said. “We wouldn’t have had to set up all of these exchanges. By going with a Social Security based system like they have in Canada, like they have in most of Europe, you save all of the paperwork costs, and that allows you to devote more money to care. Other nations have non-profit national health insurance and spend substantially less than we do and cover everyone, largely because they save on that administrative complexity and expense.”