Repeal the Insurance Mandate

The organizations It’s Our Economy and Single Payer Action, along with 50 doctors, filed an amicus brief in HHS v. Florida, to challenge the Affordable Care Act (ACA) recently considered by the Supreme Court. They support health care reform, but oppose the insurance mandate. By removing the words “over 65” from the Medicare law, every American could have health care based on a proven public health-care model that has been in existence since 1965. This would control costs and immediately provide health care to everyone in the United States.

Forcing Americans to buy insurance is both unconstitutional and bad policy. Even the most favorable estimates of ACA predict that tens of millions of Americans will not have health insurance when it is fully implemented in 2019. The number of employers offering health benefits will decline under the ACA, pushing employees into the individual insurance market where coverage is skimpier and more expensive. The cost of premiums will continue to rise and insurance coverage will continue to shrink, putting patients at risk of personal bankruptcy if they suffer a serious accident or illness.

The United States already spends enough to provide health care to all. As the amicus brief states: “Studies conducted by the nonpartisan General Accounting Office and the nonpartisan Congressional Budget Office have consistently concluded that if a national single payer system were implemented in the United States, administrative cost-savings alone would be enough to guarantee universal coverage without increasing overall health-care spending.”

In addition, improved Medicare for all will slow the cost of health care, which, under Medicare, is growing more slowly than private insurance-based health care, despite the fact that it deals with America’s elderly and disabled populations, groups that generally need more health care services. Unlike private insurance, under Medicare the increase is not due to administrative costs and bureaucracy as its costs have been consistently about 2 percent while private insurance’s administrative costs are16 percent.

Instead, the ACA builds and expands the system of private insurance, a system that is among the least efficient of any health-care system currently operating in the developed nations. The HHS v. Florida brief states, “In 2009, 28 healthcare expenditures accounted for 17.4 percent of GDP in the United States, compared with only 9.6 percent in the average OECD [Organization for Economic Co-operation and Development] nation” and “measured per capita, health-care expenditures in the United States ‘are by far the highest among OECD countries’.”

As the brief also points out: “In addition to achieving universal coverage for Americans aged 65 and older and maintaining consistently low administrative costs, Medicare is highly rated by senior citizens who are its primary beneficiaries—51 percent of whom give their health insurance an ‘excellent’ rating.”

If Congress had considered an evidence-based approach to health reform, instead of writing a bill that would funnel more wealth to insurance companies that deny and restrict care, it would have been a no brainer to adopt improved Medicare for all. All the data point to a single payer system as the best way to accomplish universal health care and control costs. Also, mandating that all Americans must buy a corporate product takes corporate welfare to extreme new levels.

Finally, an improved Medicare for all system will give everyone in the United States the greatest control of their own health care; the insurance industry will be removed from between doctors and patients; doctors will not have to convince a profit-minded insurance bureaucrat to pay for a treatment; and people will no longer be threatened with increased premiums, decreased coverage, and financial ruin caused by an insurance industry that puts profits before people.

Forcing people to purchase a flawed product—private health insurance—is not necessary and will not achieve the goals of universal, guaranteed, and affordable health care. There is already a health-care model in the U.S. that will achieve these goals and is constitutional and simple to attain—improved Medicare for all.


Kevin Zeese is co-director of It’s Our Economy and an organizer of the National Occupation of Washington, DC.