Friday, December 30, 2016

I seem to recall...

...reading somewhere (although I can't find it right now) that a prominent Democratic senator (I think it was Daniel Patrick Moynihan) leaned over to one of his colleagues during the debate over Hillarycare back in 1993 and said in response to its mind-numbing complexity, "Why don't we just pass Medicare for all?"

The answer, of course, is simple: private health insurance companies, while they add little to no value, are very profitable and thus very powerful. They, along with the rest of the health care industry, give a ton of money (second only to Wall Street, I think) to Congressmen and senators and they expect (and get) a lot in return. (Remember when Joe Lieberman said he just couldn't support a public option back in 2009? Do you think that was a matter of conscience?)

So when President Obama and the rest of the Democrats decided to take "another bite at the apple" in 2009 they decided that if you can't beat 'em, join 'em, and structured the Affordable Care Act -- okay, Obamacare -- around the private insurers. Rather than pass a single-payer system (which would have been impossible anyway), why not just pass the Republican "alternative" plan from the 1990s (which later became known as Romneycare)?

Well, I won't go into what happened next (we're all sick of the whole thing by now, right?), but fast-forward to 2016. Paul Ryan & Company are planning to repeal the ACA next year and replace it with . . . what? (Psst: nothing.) After nearly seven years Republicans still don't have a replacement plan that's as good as Obamacare, and replacing the ACA would result in a tax increase on the rich. And, let's face it, they never wanted to reform health care in the first place. The GOP's constituents -- doctors, insurance companies, hospitals, drug companies, medical device manufacturers, etc. -- were doing just fine thank you very much in the old "system." (Actually, absence of a health care "system.") So while Republicans are expected to repeal Obamacare quickly before anyone can react, they'll probably delay its replacement until . . . forever, I think.

But this may come back to bite them and their constituents in the rear end. (I'm back to avoiding more explicit language.) My prediction is that if the GOP gets its wish (wet dream is more like it), they'll repeal the law and everything will go back to the profound dysfunction we all experienced before 2010. (Some might argue, not without justification, that things are still profoundly dysfunctional. Point taken.) But, my second prediction, which would follow the first, is that when the Democrats regain control in Washington (and it's only a matter of time, isn't it?), rather than repass Obamacare or Hillarycare or some other unpopular Rube Goldberg-esque system, they'll just cut to the chase this time and pass Medicare for All, like Bernie Sanders wanted. It would be so much simpler to understand and have the added benefit of being the cheapest and most efficient way to deliver health care in America.

(Ask yourself, have you ever met a senior who didn't like Medicare? Even that crazy uncle of yours who watches Fox News all day -- and we all have one -- loves his government-provided single-payer health care Medicare.)

What about the private insurers, etc.? Well, I never thought I'd say this (but then again I never thought Donald Trump would get the Republican nomination -- much less the presidency -- either), but Medicare for All may just replace them in a single-payer system. I know, I know, I never thought it would be possible, but we all have to reassess what's possible after this last year.

I always thought, like almost everyone else, that Hillary would win in November. And I assumed, as a result, that Obamacare would be forever tweaked around the margins until the American health care system would ultimately -- some day -- resemble Germany's: single-payer through the back door, as I would put it. In other words, private insurers would continue to deliver health care, although in a heavily-regulated fashion -- like utilities -- until they just acted as the middle men in a de facto single-payer system. Every doctor, hospital, etc. would take everyone's insurance and they would all cover the same things for the same deductible and premium. Insurance companies would compete, as they do in Germany and some other countries, primarily on service. That way they could survive even as the U. S. moved more toward universal coverage.

But now I'm starting to rethink my assumptions. Obamacare may very well get repealed next year, the Republicans won't replace it, and the Democrats may just extend Medicare to all when they retake the White House and Congress in 2020 or 2024 or . . . whenever. It's inevitable that they will have a majority at some point in the future -- remember when we had the GOP dead and buried? And when it happens they won't screw around this time -- they'll just pass Medicare for all and the insurance companies can pound salt.

So the moral of the story is: be careful what you wish for, Republicans, you just might get it. Obamacare may get repealed and you may end up someday with something you consider much, much worse.

By the way, for those of you not familiar with single-payer, Physicians for a National Health Program is a great website. Click here for some FAQs, including "What is single payer?"

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