Tuesday's edition contained an article stating that "Obamacare is still a fiscal train wreck." It addresses in considerable detail how the Patient Protection and Affordable Care Act will have continuing and ruinous effects. The author is largely correct but he fails to explain why. Nor does he offer promising solutions.

Obamacare has many admirable provisions, including extending coverage of youth, eliminating pre-existing conditions, and an emphasis on health promotion and disease prevention, especially for children and women. Its weaknesses may be even greater. It ties health care to for-profit corporations, mandates their purchase and draws heavily on taxpayer dollars to pay companies to cover people who can't afford policies. It does little to control costs other than to require that companies keep no more than 20 percent of policy charges to cover profits, executive compensation, overhead and paying employees to deny claims. Compare those costs to the reported 3 percent overhead of Medicare. These excessive charges could easily cover vastly improved coverage and services if we had a strengthened Medicare-for-all system.

Furthermore, Obamacare was not designed to deal with high costs of medication and medical equipment although there will be some $260 billion in savings (according to estimates) from getting rid of the Medicare Advantage system which corporations insisted would save money but did not. Nor is Obamacare designed to address a fee-for-service system that gives priority to testing and treatment rather than to promoting health through immunization, pre-natal care, preventing obesity, smoking and alcohol abuse.


Strengthening Obamacare at this point will not be easy. Fortunately, the Act does allow for innovations at the state level. Vermont is moving in the direction of a single-payer system, which reduces the profit motive. An exciting and promising development right here in Colorado is a forthcoming bill to establish a statewide health community health cooperative which could provide comprehensive disease prevention and treatment services to every Colorado resident. Physical, mental, dental and other services would be fully covered. The system would be operated by cooperative members rather than government officials. Co-pays, deductibles and caps on payments would be eliminated, and most of the disadvantages of our current system would be greatly reduced. (see: healthcareforallforless.org)

Designing a humane, efficient and effective health care system is not rocket science. Such systems can be found throughout Europe, in Japan, Taiwan and even in developing nations such as Thailand. American led the way to perceiving education as a human right, one which benefits our entire society. It's time for us to view health care as a human right as well, to truly enable us to be part of a national "pursuit of happiness".

Barry Karlin, Doctor of Public Health


-- Dr. Karlin has been a public health specialist since 1956 and has spent years in developing countries with The World Health Organization and other non-profit agencies. He is an Adjunct Professor at CU.