By Daniel Schaffer M.D.

By now, almost everyone has developed an opinion about the status of health care in our country, and it usually divides along ideological lines, with the word Obamacare in the middle. This is unfortunate if it ends the discussion, because both advocates and opponents agree that the Affordable Care Act (ACA) is not the final solution to our current health caredilemma.

We are still left with the fact that up to 10 percent of our population will continue to lack health care coverage. Some would rather pay the tax penalty than sign up for insurance; some because they cannot

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By now, almost everyone has developed an opinion about the status of health care in our country, and it usually divides along ideological lines, with the word Obamacare in the middle. This is unfortunate if it ends the discussion, because both advocates and opponents agree that the Affordable Care Act (ACA) is not the final solution to our current health caredilemma.

We are still left with the fact that up to 10 percent of our population will continue to lack health care coverage. Some would rather pay the tax penalty than sign up for insurance; some because they cannot afford the rates even with a subsidy, some because their employers have cut their hours to part time, and others because their states have elected not to expand Medicaid. We also have not addressed the inevitable increased cost of fully enacting the ACA but once again have kicked the can down theroad.

There are many factors that will determine what our health care system will eventually look like, but one of the most important is the mechanism of paying for those services. Unlike the other industrialized nations, our payment system for those under age 65 has evolved using private insurance companies, both for-profit and nonprofit. The result is that health care and insurance have unfortunately become fused into a singleterm.

Insurance is designed to protect people from events that will rarely occur, such as an automobile accident or a house fire. The system works because the majority of people paying their premiums will never collect any benefit, so there is a substantial cash reserve to pay for those whodo.

Health care, however, is something that everyone will utilize at some time and, in fact, should be utilizing even more than they currently do to obtain preventive services. To create a large enough cash reserve, in addition to paying for administrative costs and dividends to shareholders, insurance rates continue to escalate. This is made even worse when only the people with health problems that require expensive treatment are the ones who have insurance. This system is unsustainable in the long term because at some point premiums will exceed what individuals and employers are willing to pay, or co-pays and deductibles will reach the point where having insurance will be beyond the means of mostpeople.

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Special to The Spokesman-Review: Single-payer system the best option for health care - Sat, 18 Jan 2014 PST