Pros and Cons of ObamacareIs It What the United States Need.docx

Pros and Cons of Obamacare:
Is It What the United States Needs?
WHY DO AMERICANS STILL NEED SINGLE-PAYER
HEALTH CARE AFTER MAJOR HEALTH REFORM?
Claudia Chaufan
Many observers have considered the Affordable Care Act
(ACA) the most
significant health care overhaul since Medicare, in the tradition
of Great
Society programs. And yet, in opinion polls, Americans across
the political
spectrum repeatedly express their strong support for Medicare,
alongside
their disapproval of the ACA. This feature of American public
opinion is
often seen as a contradiction and often explained as
“incoherence,” a mere
feature of Americans’ “muddled mind.” In this article I argue
that what
explains this seeming contradiction is not any peculiarity of
Americans’

psychology but rather the grip of the corporate class on the
political process
and on key social institutions (e.g., mass media, judiciary), no
less
extraordinary today than in the past. I also argue that ordinary
Americans,
like millions of their counterparts in the world, would eagerly
support a
single-payer national health program that speaks to their
interests rather
than to those of the 1 percent. I will describe the ACA, compare
it to
Medicare, explain the concept of single payer, and conclude that
the task is
not to persuade presumably recalcitrant Americans to support
the ACA
but rather to organize a mass movement to struggle for what is
right and
join the rest of the world in the road toward health justice.
The American health care system is the most expensive in the
world, even as
it consistently ranks last in international comparisons with
wealthy economies

on most measures of performance, including access, quality, and
equity (1–3).
Improving it was the motivation behind the Affordable Care Act
(ACA), signed
into law by President Obama on March 24, 2010 (4).
International Journal of Health Services, Volume 45, Number 1,
Pages 149–160, 2015
doi: http://dx.doi.org/10.2190/HS.45.1.l
149
© 2015, The Author(s)
joh.sagepub.com
Many have considered the ACA the most significant health care
overhaul
since Medicare, in the tradition of Great Society programs (5).
And yet, in opinion
polls, Americans across the political spectrum repeatedly
express their strong
support for Medicare (6) alongside their disapproval of the ACA
(7). This
feature of American public opinion is often seen as a
contradiction and explained

(away) as “incoherence” on the part of Americans—a mere
feature of Americans’
“muddled mind” (8). If only Americans chose the right
presidential candidate,
ponder some international observers, health reform would be at
their reach (9).
In this article, I argue that what explains this seeming
contradiction in U.S.
opinion polls about health reform is not, nor has it ever been,
any peculiar feature
of Americans’ psychology, but rather the grip of the corporate
class on the
political process and on key social institutions (e.g., mass
media, judiciary), as
extraordinary today as it was in the past (10). I also argue that
ordinary Americans,
like millions of their counterparts throughout the planet, would
eagerly support
a single-payer national health program—Improved and
Expanded Medicare for
All—that speaks to their interests rather than to the interests of
the 1 percent. I will
describe the ACA, compare it to Medicare, explain the concept
of single payer,

and conclude that the task is not to persuade presumably
recalcitrant Americans
to embrace the ACA but rather to organize a mass movement to
struggle for what
is right and join the rest of the world in the road toward health
justice.
IS THE AFFORDABLE CARE ACT IN THE TRADITION OF
GREAT SOCIETY PROGRAMS LIKE MEDICARE?
Since its inception, the ACA has been plagued by intractable
problems. First, it
has not resolved, and is unlikely to resolve, the problem of
access. Even after
expanding coverage to millions of Americans, as many as 31
million—most of
them citizens and legal residents (11)—will remain uninsured
by 2024 (12).
Second, the ACA is unlikely to significantly reduce financial
barriers to
care. Indeed, the United States is unique in that medical
bankruptcy, a leading
cause of personal bankruptcy in the country, affects largely
individuals who have
insurance. Many Americans insured after the ACA have already
expressed that

the cost of care remains a significant barrier, because they
cannot afford to
actually use the policies they may afford to purchase (13). In
2012, 80 million
people reported that, during the past year, they did not go to the
doctor when
sick or did not fill a prescription because of cost, 75 million
reported problems
paying their medical bills or were paying off medical bills over
time, about
28 million adults reported using all their savings to pay off
bills, and 4 million
had to declare bankruptcy in the previous two years (14).
Third, it is even more unlikely that the ACA will guarantee
continuity of care.
Like pre-ACA health care, the ACA relies on multiple insurers
and plans com-
peting for customers (even if competition is virtually
nonexistent in many markets
dominated by insurance monopolies). As coverage and
eligibility depend on
150 / Chaufan

market considerations (e.g., price, profitability), so does access
to a given source
of care. The ACA also ties coverage to income and jobs. Thus
Medicaid enrollees
often “churn” in and out of the program and are forced to
change coverage, hence
providers, as their income, and subsequently their eligibility,
change over time
(15). For those with employer-sponsored coverage, coverage
and source of care
change with changes in job situation, not unusual in times of
precarious, scarce,
and “flexible” employment. In fact, coverage often does change
even without
changes in job situation, as employers try to cut their health
costs and stressed-out
employees struggle to understand yet another set of (forced)
“choices,” which
typically consist of higher payments for increasingly restricted
services. The
University of California San Francisco, for example, announced
its annual “health
benefits open enrollment” period with the slogan of “Big
Changes, New Choices.”

Finally, the ACA will not address spiraling costs (health care
costs have
increased worldwide, yet nowhere at U.S. rates), not explained
by inflation,
age structure, health status, above-average utilization, or
medical technologies
(although segments of the population may use more health care
and advanced
technologies, for millions of Americans the real problem is too
little, not too much,
care) (16). Even if the “tinkering-around-the-edges” cost-
cutting approaches
encouraged by the ACA—electronic health records, pay-for-
performance, greater
price transparency, or “cost consciousness”—were successful
(and the empirical
evidence supporting the cost-cutting abilities of these
approaches ranges from
dubious to nonexistent) (17, 18), none of them utilizes the
power of economies of
scale. For this reason, they cannot yield lower prices nor reduce
administrative
overhead—savings that would amount to around $600 billion
(all dollar amounts

in U.S. dollars) annually (19, 20). Nor can they yield the
savings that would
ensue from ending overpayments to private (“Advantage”)
Medicare plans—
$282.6 billion, or 24.4 percent, of total Medicare spending on
private plans
between 1985 and 2012 (21). Altogether, these savings would
be more than
enough to provide first-dollar coverage for every U.S. resident.
Nor can any of
these measures deal with inscrutable “benefit packages,” skimpy
coverage, ever-
narrowing provider networks, or changes in coverage with
changes in jobs or
income level, among so many other problems built into the very
design of the ACA.
In stark contrast, less than a year into becoming the law of the
land in 1965 as
a national social insurance program administered by the U.S.
federal government,
Medicare had already enrolled, and was paying the bills on
behalf of, more than
19 million seniors (99% of those eligible for coverage)—with
no websites,

navigators, or the threat of penalties. How? Very simple. Most
seniors were
already known to the Social Security Administration, which
used Social Security
numbers for Part A (hospital services) and index cards for Part
B (doctors’
services) enrollment, while creating jobs for 5,000 low-income
seniors who went
door to door to help contact those among the aged who were
difficult to reach (22).
As a government program that granted seniors full rights to the
same com-
prehensive package of services and free choice of any
participating provider,
Single-Payer Health Care after Reform / 151
Medicare dispensed with the pursuit of profit that is the
lifeblood of commer-
cial insurance, so the costs of marketing or of helping users
navigate “coverage
options”—substantial with the ACA (23–25)—were zero.
Providers gained independence in medical decision making and
the guarantee

that their bills would get paid. There was, and there remains,
much room for
improvement—in access, coverage, quality, and cost control.
But the relevant
feature of Medicare was, and remains, its financial structure:
the program is
organized as a social insurance system that spreads the financial
risk asso-
ciated with illness across society to protect everyone. Enrollees
pay into the
system according to their ability and are entitled to the same
broad package
of services according to their medical needs. Medicare, unlike
the ACA, is a
single-payer-like system.
WHAT IS SINGLE PAYER?
Single-payer national health insurance is a system in which a
single public or
quasi-public agency (or strictly regulated subsidiaries)
organizes health care
financing, that is, collects the money from users, purchases
services in bulk, and
negotiates rates and payment schemes with, and pays, providers.

The delivery
of care may remain or not in private hands (26). Nations that
have adopted
single-payer systems cut across cultures, political ideologies,
and levels of devel-
opment. They include countries as different as the United
Kingdom, Iceland,
Taiwan, Spain, and Cuba. In fact, all wealthy nations with the
exception of the
United States, and many poor nations, have organized their
health care systems
as variants of single payer (27).
The Expanded and Improved Medicare for All Act, HR 676,
based on a
physicians’ proposal crafted by members of Physicians for a
National Health
Program and published in the Journal of the American Medical
Association,
would establish an American single-payer health insurance
system (28).
Under this system, all residents, documented or not, would be
covered for all
medically necessary services, including doctor, hospital,
preventive, long-term,

mental health, reproductive health, dental, and vision care;
prescription drugs; and
medical supplies. Dramatic overall savings would ensue from
the system’s power
to purchase goods and services in large amounts, thus negotiate
prices with
providers’ associations, pharmaceutical companies, and medical
device suppliers.
Importantly, paperwork that does not contribute to more or
better care would
be eliminated (19).
Wasteful paper pushing comes from essentially three sources:
(a) the need
of multiple insurers to market plans to profitable customers,
authorize or deny
services, pay handsome CEO salaries, and make a profit; (b)
providers’ need
to screen patients’ coverage and file claims to multiple insurers
to get paid
(or fight back when services are not “approved”) (29); and (c)
users’ need to
juggle with an extraordinarily cumbersome system that requires
thousands of

152 / Chaufan
“navigators” to help them figure out which plans meet their
needs (and fit
their pockets), what services they are entitled to, and how to
handle denied
services (Table 1).
A U.S. single-payer plan as proposed by HR 676 would do away
with this
waste: it would dramatically reduce prices, slash overhead, and
utilize col-
lective savings to purchase health care for all (20). Even as
taxes might slightly
increase, most Americans would save money, time, and distress,
as they would
no longer be compelled to comparison-shop for increasingly
pricier and
inscrutable plans, juggle with unpredictable (and unaffordable)
out-of-pocket
costs (premiums and out-of-pocket costs would disappear), or
struggle to figure
out which providers are “in network,” as most providers in the
country would

find it convenient to join the system.
DO WE NEED TO PERSUADE AMERICANS TO
SUPPORT THE AFFORDABLE CARE ACT?
Why have the crafters of the ACA been unable to sell the
legislation to the
American public? Is it a matter of “messaging” (30)? Don’t
Americans understand
the purpose or value of health insurance? Do they indeed have
“muddled minds”?
Or is it the substance of the ACA that makes it a hard sale? If
we are to go by
then-House Majority Leader Nancy Pelosi’s statement before
the passage of the
2,400-plus pages of regulations in the ACA—“we have to pass
the bill so that you
can find out what is in it” (31)—there is reason to believe that
Americans have
turned against it not because they shun socialism, lack
solidarity, are incoherent, or
fail to grasp the value of insurance, but because they know
better.
Indeed, most insured Americans are realizing that even after
major “reform,”

their health benefits are eroding—their out-of-pocket costs are
increasing,
“preferred” providers’ networks are becoming narrower, and
benefits remain
as uncertain as pre-ACA at the moment of use. The manifest
function of the
ACA was to achieve initially universal (and later “near-
universal”) health care—
by expanding coverage through Medicaid, (selectively)
subsidizing commer-
cial insurance in the individual market, or allowing insured
Americans to
“keep their coverage if they liked it.” Yet the latent function
appears quite
different: the law has done much to yield extraordinary profits
for a few and
even more to rescue the health insurance industry from the
weight of its own
incompetence—incompetence, that is, to secure health care to
Americans.
OPEN SECRETS
As President Obama pointed out early in his political career,
you can have
universal coverage, and you can have lower costs, but you need

single payer
to have both. Regrettably, as Democrats gained both houses of
Congress and
the White House, the party and their leader concluded that
single payer was
154 / Chaufan
Table 1
Comparing gains under ACA and single payer
ACA Single payer
Universal
coverage
Full range of
benefits
Choice of
doctors and
hospitals
Out-of-pocket

Savings
Cost control/
sustainability
Progressive
financing
NO. More than 30 million remain
uninsured (mostly citizens and
documented residents) by 2024
and tens of millions underinsured.
NO. HHS provides “guidance” on
“essential health benefits.” What
counts as benefits decided on the
basis of existing plans, i.e., by
insurers themselves.
NO. Insurance companies continue
to restrict access through
increasingly narrower networks
of “preferred” (by them!) providers.

YES. Varying degrees of co-pays
and deductibles. Trade-offs between
lower premiums (even if ever
increasing) and higher out-of-pocket
expenses, via “consumer-directed”
plans.
NO. Increases health spending by
about $1.1 trillion.
NO. Preserves a fragmented system
incapable of controlling costs.
Gains in coverage erased by rising
out-of-pocket expenses, bureaucratic
waste, and profiteering by private
insurers and Big Pharma.
NO. Costs are disproportionately
paid by middle- and lower-income
Americans and families facing
acute or chronic illness.

YES. Everybody is covered
automatically at birth.
YES. Covered for all
medically necessary care.
YES. Patients can choose among
any participating provider. Most
providers in the country would
find it convenient to participate.
NO. Co-pays and deductibles
eliminated.
YES. Redirects $600 billion
in administrative waste and
inflated drug prices toward
care; no net increase in health
spending.
YES. Large-scale cost controls
through economies of scale to
ensure that benefits are sus-

tainable over the long term.
YES. Premiums and out-of-
pocket costs are replaced with
progressive income and
wealth taxes. 95 percent of
Americans pay less.
“too disruptive” (32)—and at any rate, not “politically feasible”
(33). They opted
for ignoring single payer, dismissing it as “too much socialism,”
or, when they
could no longer ignore it, excluding single-payer advocates
from the debate, if
necessary by force (34). It may have helped that, as talk about
health care gained
traction in the run-up to the presidential elections, insurance
and pharmaceutical
corporations rushed to increase their political donations (33).
The drug and
health products sector alone gave Barack Obama $2,436,836 for
his campaign,
more than twice the amount given to his nearest rival (35).

This surge in political spending may have led Congress and the
president
to conclude that single payer was “unfeasible,” and to opt
instead for a plan
that relied on “market forces” and was modeled after a proposal
of the Heritage
Foundation. The legislation was in large part written by a
former insurance
company executive from WellPoint, Liz Fowler, who went on to
be hired by the
U.S. Department of Health and Human Services to implement
the law (36)
and now works for a pharmaceutical giant (37).
As the icing on the cake, leading academic journals, such as
Health Affairs
or the New England Journal of Medicine, dismissed single payer
as little more
than a fringe view—at the (left) extreme of a continuum in
which vouchers were
at the other (right) extreme and the ACA at the center (38).
They co-opted the
concept of reform so that it would only mean what corporate
interests considered

permissible reforms (39), framed the debate so that the “public
option” became
the leftmost “progressive” alternative (40), and showcased
corporate actors
such as Karen Ignani, CEO of America’s Health Insurance
Plans, as merely one
disinterested (i.e., declaring “no relevant conflict of interests”)
expert informant
in the “debate” (41). Giving a token nod to the “extraordinary
complexity of
the U.S. health insurance marketplace” and faithfully toeing the
official—and
corporate—line, academics concluded that the failure of
ordinary, usually low-
income, persons to grasp this complexity—“low health literacy”
(42)—was a
critical “problem” with health reform, whose “solution” was to
use health care
professionals as “navigators” to guide people through the
insurance maze (43).
“Clarifying, simplifying, and standardizing” the given
marketplace set the boun-
daries of imaginable change (43).
The judiciary gave the “coup de grâce” by limiting the federal

government’s
ability to enforce the ACA’s planned Medicaid expansion while
upholding the
individual mandate, that is, the individual obligation to carry a
policy (44). The
corporate media happily obliged and dutifully continues to
convey expert (and
corporate) opinion (45), carefully limiting improvements to
more wellness
programs (46), tradeoffs between affordability and coverage
(47), or savvier
experts to help users lobby the billing departments of insurance
companies (48).
And yet, polls show strong support for government-guaranteed
health insurance
when the questions are adequately asked (“Would you support
or oppose a
universal coverage program in which everyone is covered by a
program like
Medicare that is government-run and financed by taxpayers?”)
(49) and most of

those who disapprove of the ACA still do not want to see it
repealed but improved
(7). Only a tiny fraction rejects it because they view it as
“socialized medicine”
(50)—remarkably, given the strong establishment opposition to
socialized modes
of health care financing, manufactured confusion about “lack of
choice” and
“competition” under single payer (27), and outright
falsifications about other
countries’ publicly financed health systems (51). Polls also
show that a majority
of physicians, especially in primary and family care, support
government legis-
lation to establish national health insurance (52).
The belief that only conservatives in government oppose single-
payer national
health insurance is untrue. The fact is, both major parties
respond to their real
“constituents”—the medical-industrial complex that handsomely
finances their
campaigns and privileges (33). Finally, the argument that “we”
the people cannot
afford a single-payer system is simply false—we are already

paying for universal
and comprehensive health care coverage, yet not getting it (53).
THE WAY FORWARD
None of the problems of the ACA should come as a surprise.
After all, the law
has implemented a system organized around profit-seeking
insurers who manage
their risk portfolio by adjusting their pricing to the estimated
health care usage
of their customers—usage that they label “medical loss.” This
market-based
system treats health care as a profit source for Wall Street, like
driver’s insurance,
one analogy that President Obama used to persuade Americans
to embrace the
individual mandate.
Yet, as Dr. Margaret Flowers and Kevin Zeese, policy experts,
corporate
watchdogs, and political activists, persuasively argue, this
“uniquely American
solution” will allow the big drivers of the rising cost of health
care—insurance
conglomerates, Big Pharma, for-profit hospitals—to become

only stronger, at the
same time that it will institutionalize the wealth divide (36).
They point out that
while the privileged few, such as Senator Ted Cruz and his
wife, will receive the
best health care from their employer—in their case, from Ms.
Cruz’s employer,
Goldman Sachs—many will be pushed into the so-called
marketplace and divided
into four classes of people based on their wealth. Many more
will receive poor
health care for poor people (Medicaid), and millions will remain
in the cold. A few
“fortunate” among these will be spared from paying a fine for
not complying
with the mandate, as they are found eligible for “hardship
exemptions” (e.g., due
to being homeless, a victim of domestic violence, or bankrupt)
and granted the
“right” to remain uninsured (54)—provided they can make their
case in court.
As Flowers and Zeese assert—and I agree: “There was an
easier, more polit-
ically popular route. All that President Obama had to do was to

push for what
he said he once believed in, Medicare for All. By dropping two
words, ‘over 65,’
the country could have gradually improved Medicare [and
moved the country]
toward the best health care in the world, rather than being mired
at the bottom.
156 / Chaufan
To replace [the ACA] with a single-payer system, we need to
[oppose treating]
health care as a commodity like a cell phone—or, as President
Obama suggested,
like auto insurance—[and] recognize that ending the corporate
domination of
health care is part of breaking the domination of big business
over the U.S.
government. Health care is at the center of the conflict of our
times, the battle
between the people and corporate interests, the battle to put
people and planet
before profits.” In short, the battle for democracy and humanity.
Acknowledgment — The author wishes to acknowledge the

invaluable feedback
of Mark Almberg, Don McCanne, and Julian Field. She also
acknowledges the
continuing inspiration of all members of Physicians for a
National Health Program
in their unflinching determination to achieve health care justice.
REFERENCES
1. Davis, K., et al. Mirror, Mirror on the Wall, 2014 Update:
How the U.S. Health
Care System Compares Internationally. The Commonwealth
Fund, New York
and Washington, DC, 2014.
http://www.commonwealthfund.org/~/media/files/
publications/fund-
report/2014/jun/1755_davis_mirror_mirror_2014.pdf (accessed
June
19, 2014).
2. Davis, K., et al. Mirror, Mirror on the Wall: An International
Update on the Compara-
tive Performance of American Health Care. The Commonwealth
Fund, May 2007.
http://www.commonwealthfund.org/Publications/Fund-
Reports/2007/May/Mirror—

Mirror-on-the-Wall—An-International-Update-on-the-
Comparative-Performance-of-
Americ.aspx#citation (accessed June 12, 2007).
3. Davis, K., Schoen, C., and Stremikis, K. Mirror, Mirror on
the Wall: How the
Performance of the U.S. Health Care System Compares
Internationally, 2010 Update.
The Commonwealth Fund, New York and Albany, 2010.
http://www.
commonwealthfund.org/Publications/Fund-
Reports/2010/Jun/Mirror-Mirror-Update.
aspx?page=all (accessed September 12, 2010).
4. Obama, B. Obama’s health care speech to Congress. The New
York Times, September
12, 2009.
5. Gruber, J. Health Care Reform: What It Is, Why It’s
Necessary, How It Works. Hill and
Wang, New York, 2011.
6. Condon, S. Poll: Most Americans say Medicare is worth the
cost. http://www.
cbsnews.com/news/poll-most-americans-say-medicare-is-worth-
the-cost (accessed
April 21, 2011).

7. Kaiser Family Foundation. Kaiser Health Tracking Poll: July
2014: Share of
Americans With An Unfavorable View of the Affordable Care
Act Rises in July;
Majority Continues to Want Congress to Improve, Not Repeal,
the Law. 2014.
http://kff.org/health-reform/poll-finding/kaiser-health-tracking-
poll-july-2014 (accessed
August 4, 2014).
8. Bernstein, J. Loving and Hating Obamacare with One
Muddled Mind. http://www.
bloombergview.com/articles/2014-08-25/loving-and-hating-
obamacare-with-one-
muddled-mind (accessed August 26, 2014).
9. The Lancet, Americans’ choice for health. Lancet
380(9846):949, 2012.
10. Navarro, V. The Politics of Health Policy: The U.S.
Reforms, 1980–1994. Wiley-
Blackwell, Hoboken, 1995.
11. Nardin, R., et al. The uninsured after implementation of the

Affordable Care Act:
A demographic and geographic analysis. Health Aff. 2013.
http://healthaffairs.org/
blog/2013/06/06/the-uninsured-after-implementation-of-the-
affordable-care-act-a-
demographic-and-geographic-analysis (accessed June 6, 2013).
12. Congressional Budget Office (CBO). Insurance Coverage
Provisions of the Affordable
Care Act—CBO’s April 2014 Baseline. 2014.
http://www.cbo.gov/sites/default/files/
cbofiles/attachments/43900-2014-04-ACAtables2.pdf (accessed
August 3, 2014).
13. Himmelstein, D. U., et al. Medical bankruptcy in the United
States, 2007: Results of
a national study. Am. J. Med. 122(8):741–746, 2009.
14. Rao, B., and Hellander, I. The widening U.S. health care
crisis three years after
the passage of ‘Obamacare.’ Int. J. Health Serv. 44(2):215–232,
2014.
15. Fleming, C. Frequent churning predicted between Medicaid
and exchanges. Health
Aff. 2011. http://healthaffairs.org/blog/2011/02/04/frequent-
churning-predicted-between-

medicaid-and-exchanges (accessed March 2, 2011).
16. Anderson, G. F., et al. The prices, stupid: Why the United
States is so different from
other countries. Health Aff. 22(3):89–105, 2003.
17. Himmelstein, D. U., and Woolhandler, S. Hope and hype:
Predicting the impact of
electronic medical records. Health Aff. 24(5):1121–1123, 2005.
18. Himmelstein, D., Ariely, D., and Woolhandler, S. Pay-for-
performance: Toxic to
quality? Insights from behavioral economics. Int. J. Health
Serv. 44(2):203–214, 2014.
19. Woolhandler, S., Campbell, T., and Himmelstein, D. U.
Costs of health care
administration in the United States and Canada. N. Engl. J.
Med. 349(8):768–775,
2003.
20. Friedman, G. Funding a national single-payer system
“Medicare for All” would save
billions, and could be redistributive. Dollars & Sense,
March/April, 2012, pp. 24–25.
http://www.dollarsandsense.org/archives/2012/0312friedman.pd
f.
21. Hellander, I., Himmelstein, D., and Woolhandler, S.

Medicare overpayments to pri-
vate plans, 1985–2012: Shifting seniors to private plans has
already cost Medicare
US$282.6 billion. Int. J. Health Serv. 43(2):305–319, 2013.
22. Social Security Administration. Social Security History.
http://www.ssa.gov/history/
ssa/lbjmedicare3.html (accessed June 12, 2013).
23. California Healthline. HHS offers $150M to boost
enrollment in state health
exchanges. May 10, 2013.
http://www.californiahealthline.org/articles/2013/5/10/hhs-
announces-program-to-enroll-uninsured-in-state-health-exchan
(accessed May 10, 2013).
24. California Healthline. Calif. Health exchange to spend
$290M on public outreach
efforts. April 13, 2013.
http://www.californiahealthline.org/articles/2013/4/26/calif-
health-exchange-to-spend-290m-on-public-outreach-efforts.
25. Kaiser Family Foundation. Consumer Assistance in Health
Reform. April 18, 2013.
http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8434
.pdf (accessed June
1, 2013).

26. Physicians for a National Health Program. What is Single
Payer? http://www.pnhp.org/
facts/what-is-single-payer (accessed July 3, 2008).
27. Chaufan, C. Influences of policy on health care of families.
In Encyclopedia of
Family Health, ed. M. J. Craft-Rosenberg. SAGE Publications,
Newbury Park, 2011,
pp. 650–658.
158 / Chaufan
28. The Physicians’ Working Group for Single-Payer National
Health Insurance, Proposal
of the physicians’s working group for single-payer national
health insurance. JAMA
290(6):798–805, 2003.
29. Casalino, L. P., et al. What does it cost physician practices
to interact with health
insurance plans? Health Aff. 28(4):w533–w543, 2009.
30. Lakoff, G. The policyspeak disaster for health care.
Huffington Post, August 7,
2014.

31. Real Clear Politics Video. David Gregory asks Pelosi about
“Pass the bill so you can
find out what’s in it” comment. 2013.
http://www.realclearpolitics.com/video/2013/
11/17/david_gregory_asks_pelosi_about_pass_the_bill_so_you_
can_find_out_whats_
in_it_comment.html (accessed November 23, 2013).
32. Obama on Single Payer Health Care. p.
https://www.youtube.com/watch?v=
-hsqzSKuC44 (accessed on March 13, 2013).
33. Geyman, J. Hijacked: The Road to Single Payer in the
Aftermath of Stolen Health Care
Reform. Common Courage Press, Monroe, 2010.
34. The Real News Network. Single Payer Advocates Protest
Senate Hearing. http://
therealnews.com/t2/index.php?option=com_content&task=view
&id=31&Itemid=74&
jumival=3665 (accessed June 5, 2010).
35. Open Secrets, Presidential Candidates: Selected Industry
Totals, 2008 Cycle. 2008.
http://www.opensecrets.org/pres08/select.php?ind=H04
(accessed March 29, 2010).
36. Zeese, K., and Flowers, M. Obamacare: The Biggest

Insurance Scam in History.
Truthout, 2013. http://www.truth-out.org/opinion/item/19692-
obamacare-the-biggest--
insurance-scam-in-history (accessed November 1, 2013).
37. Stein, S., and Wilkie, C. Liz Fowler, top Obama health care
aide, to lobby for Johnson
& Johnson. Huffington Post, December 5, 2012.
38. Fuchs, V. R. Health care reform — Why so much talk and so
little action? N. Engl.
J. Med. 360(3):208–209, 2009.
39. Oberlander, J. Great expectations — The Obama
administration and health care
reform. N. Engl. J. Med. 360(4):321–323, 2009.
40. Halpin, H. A., and Harbage, P. The origins and demise of
the public option. Health
Aff. 29(6):1117–1124, 2010.
41. Ignagni, K. Health insurers at the table — Industry
proposals for regulation and reform.
N. Engl. J. Med. 361(12):1133–1134, 2009.
42. U.S. Department of Health and Human Services. Quick
Guide to Health Literacy.
http://www.health.gov/communication/literacy/quickguide/Quic

kguide.pdf (accessed
August 6, 2014).
43. Sentell, T. Implications for reform: Survey of California
adults suggests low health
literacy predicts likelihood of being uninsured. Health Aff.
31(5):1039–1048, 2012.
44. Kaiser Family Foundation, A Guide to the Supreme Court’s
Affordable Care Act
Decision. 2012 (July): p.
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/
8332.pdf
45. Mandelbaum, R. Ezekiel Emanuel further explains his
prediction that employers
will drop health insurance. The New York Times, April 7, 2014.
46. Ableson, R. Employers test plans that cap health costs. The
New York Times, June
24, 2013.
47. Pear, R. Lower health insurance premiums to come at cost
of fewer choices. The New
York Times, September 23, 2013.

48. Bernard, T. Getting lost in the labyrinth of medical bills.
The New York Times, June
23, 2012.
49. ABC News/Kaiser Family FoundationUSA Today. Health
Care in America 2006
Survey. 2006 [cited 2006 November 15, 2006]; Available from:
http://kaiserfamily
foundation.files.wordpress.com/2013/01/7572.pdf.
50. Kaiser Family Foundation. Kaiser Health Tracking Poll:
March 2014. 2014. http://
kaiserfamilyfoundation.files.wordpress.com/2014/03/8565-
t2.pdf (accessed April 2,
2014).
51. Carroll, A. E. 5 Myths About Canada’s Health Care System.
2013. http://www.
pnhp.org/news/2012/june/5-myths-about-canada%E2%80%99s-
health-care-system
(accessed April 20, 2012).
52. Carroll, A. E., and Ackerman, R. T. Support for national
health insurance among
U.S. physicians: 5 years later. Ann. Intern. Med. 148(April
1):566–567, 2008.

53. Woolhandler, S., and Himmelstein, D. U. Paying for
national health insurance–and not
getting it. Health Aff. 21(4):88–98, 2002.
54. HealthCareGov. Exemptions from the Fee for not Having
Health Coverage. https://
www.healthcare.gov/exemptions (accessed August 5, 2014).
Claudia Chaufan, MD, PhD
Associate Professor
University of California, San Francisco
3333 California St., Suite 340
San Francisco, CA 94118
[email protected]
160 / Chaufan
Corresponding Author:

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