Culleton: Private insurance is fatal flaw of any healthcare plan

In the wild and wacky film "The Mouse That Roared" (1959) a tiny nation facing financial failure seeks to win by losing; they declare war on the United States, hoping to get American aid after their inevitable and fast defeat.

But the tables are turned when they capture the only prototype of America's secret weapon and win, a contingency they had not planned for.


Sometimes life imitates art.

Republicans did well in the Obama era, winning a majority in the House and later a majority in the Senate nationally, plus a majority of governorships and state legislatures. They railed against Obamacare and passed repeal bill after repeal bill, secure in the knowledge that they would be vetoed by the president. Those citizens who disliked Obamacare voted their way and those well satisfied simply ignored the issue. It was a winning strategy for Republicans.

In 2016, they nominated an absolutely unqualified and unelectable candidate for President, and expected his defeat in the face of the well-qualified Hillary Clinton. Donald Trump, a billionaire with zero public service experience defied all expectations and became President.

Now the Republican winning strategy on health care has become a serious liability. If the Republicans succeed in repeal of Obamacare, they will become obligated to provide a better alternative, and in the present political climate that may be impossible.

It is a central tenet of Republican mythology that private industry solutions to any problem are always better than public sector solutions. They never allow real world facts to shake this faith. In fact, we are the only large nation that depends heavily on private insurance to finance health care.

We also spend more than twice as much per citizen on health care than any other large nation. Our private insurance rates are climbing rapidly, whether via Obamacare, or the Federal Employees Health Benefits (FEHB) program that I use, or just in the open market.

But there are two bright spots. Medicare, a federal program supported by a dedicated payroll tax, works well. Medical providers will tell you that Medicare is easier to deal with than private insurance companies. Medicaid, a tax-supported federal/state partnership, has brought health care to millions who never had it before.

A word about Obamacare: It is based on a plan created by the ultra-conservative Heritage Foundation. In my view, its major flaw is its over-dependence on private insurance.

In my view, a cost-effective replacement would be Medicare for all as proposed by Bernie Sanders. A smooth way to transition out of this flawed Obamacare program would be to add a public option to all the Obamacare Exchanges, supported by monthly premiums just like private sector insurance.

You want to lower insurance rates via competition in the marketplace? That is the best way. But Republicans are afraid of that competition and won't even consider it. Sen. Rand Paul has some additional suggestions that never get adequate consideration.

We can argue political philosophies until the cows come home. But our most successful health system to date, Medicare, was not initially developed through political argument or in congressional staffs. I know because I was a very junior member of the very first health care planning group.

When we finished the Congress was presented with a workable blueprint as a starting point.

My suggestion to all participants in this debate: Let's not argue, let's investigate. Call upon the staff of Health and Human Services or academia and have them study what works and what doesn't around the world. Study Denmark and Germany, South Korea and Australia, even Cuba. My best health insurance ever was provided by my then-employer the State of Maryland. Study that.

Study the payment mechanisms but also cost control in the delivery systems.


We may have to do some Teddy Roosevelt-style trust-busting, when allegedly nonprofit health combines pay their CEOs multiple millions of dollars annually.

In the meantime, Congress can focus on infrastructure repair and development. That is a badly needed program we can all agree on.

John Culleton writes from Eldersburg. His column appears every second Tuesday. Email him at