Boost the ACA by expanding Medicare and weighing a public option

Health insurer Aetna says it’s going to lose $300 million on insurance plans issued under the Affordable Care Act, and thus will stop selling individual plans under federal health care exchanges in 11 of the 15 states where it had been participating. Other companies have done the same, and unfortunately one of the states affected by Aetna’s decision is North Carolina. That will mean fewer choices for people who need health insurance and need the ACA exchanges to get it.

Blue Cross and Blue Shield of North Carolina, the state’s major insurer, also has complained of losses associated with the ACA.

Aetna is of course a highly profitable company, and Chief Executive Mark T. Bertolini’s 2015 compensation was valued at $17.3 million last year. Interestingly, the company has defended its pullback from the ACA exchanges as not motivated by the fact that the federal government stopped a proposed $37 billion merger with Humana. Is this indeed political hardball? The feds should explore the matter further.

The ACA has been a necessary and noble attempt to make America healthier, and indeed it has covered millions of people, between 11 million and 20 million. But insurers say they can’t make it work for their bottom lines.

Absent a single-payer government system, such as those that work in a multitude of developed countries around the world, the ACA remains a bold and right-minded step. Clearly, it may need to be refined, but it overcame a difficult start – technological problems – and has worked well despite the ongoing resistance of some Republican governors and the repeated attempts to repeal it by tea-party Republicans in Congress.

But here’s the rub: Those Republicans would never agree to participate in an effort to fix what ails the ACA, to fine-tune it, to improve it. It is President Obama’s signature achievement, and it’s a big one. GOP lawmakers aren’t about to help it succeed, even though their half-hearted claims of creating a substitute for “Obamacare” haven’t gone anywhere.

America’s health care system is a mess, with drug costs escalating beyond the means of people in need, and with hospitals and doctors’ groups and insurance companies driven by the need to make money, more and more of it. The United States has needed a single-payer system for more than 50 years (Harry Truman talked about it during his presidency) as costs have outpaced the ability to pay.

Was Obamacare a step in that direction? Of course it was. And a better system surely is coming. In fact Democrat Hillary Clinton is considering a plan to allow people to buy into Medicare at age 55. That would be a viable, important step toward progress.

This story was originally published August 21, 2016 at 3:00 PM with the headline "Boost the ACA by expanding Medicare and weighing a public option."