On Tuesday, when Marilyn Tavenner took responsibility for the failure of HealthCare.gov to launch effectively, I was confused and troubled.
"I want to apologize to you that the website does not work as well as it should," she told the House Ways and Means Committee, adding that HealthCare.gov "can and will be fixed."
Why was I confused? Because Marilyn Tavenner is the head of the federal Centers for Medicare and Medicaid Services (CMS), and it hadn't occurred to me that the ACA would fall under the auspices of CMS. After all, the ACA operates under a completely different model than Medicare and Medicaid which are federal programs that use tax dollars to subsidize payments to health care providers and hospitals. On the contrary, the ACA's Marketplace uses tax dollars to subsidize payments to private health care insurers.
This is a critical distinction, and it begins to explain why the ACA confuses so many people. The ACA uses federally collected dollars to subsidize health care, a long-sought aspiration of liberal health care expansion, but the money ends up in the hands of shareholders and CEOs, a characteristic of neo-liberal federal spending. The ACA, unlike Medicare and Medicaid, is not a public service at all, but a conduit for flowing tax dollars into the pockets of CEOs and shareholders of private insurance corporations.
The ACA does more than maintain the status quo, it reinforces an obsolete insurance model that was never good in the first place. So long as employer-based health insurance remains a "perk" for full-time workers, employers will be encouraged to reduce employee hours, lowering workers' pay, and freeing businesses from the legal obligation to provide their employees with health insurance. The notion that the workers can then simply go to the exchange for comparable insurance is a fallacy because their yearly incomes and benefit packages have just been reduced. Paying for health care insurance that used to be a perk of your job after your pay has been reduced is an unfair burden, even at subsidized rates.
While it is true that the employee's reduced income may mean she/he is entitled to federal health insurance subsidies on the ACA Exchange, it is important to realize that these subsidies are being paid to the private insurance companies for brokering the deal instead of being paid directly to health care providers and hospitals, as it is under the Medicare program. Ultimately, the insurance corporations are the ones being subsidized, not low-income people.
This law is a travesty, and it may effect the way public spending is framed in future discussions. And this is why I am so troubled. Lumping the ACA in with CMS sets a dangerous precedent. If embraced by our non-representatives in Congress, the practice of subsidizing private corporations to run federal programs that have historically been publicly operated is very likely to become the new model for Medicare and Social Security in the future. (We already see this happening with our public education system and the corporate-run charter school explosion).
The ACA positions health care as a corporate commodity and distances us from a place where health care is embraced as a human right. The shareholders are winning and people are losing. This is not the road toward Single Payer, and any foggy notion to see it as such must be resisted.