Sunday, November 17, 2019

From Here To There

Notwithstanding the continuation of elements of the Affordable Care Act, this health care post is not about Barack Obama.

Nonetheless, President Obama is one of the most skillful politicians of this generation. Accordingly, as Politifact noted six years ago, "at least 37 times since Obama’s inauguration where he or a top administration official made a variation of the pledge that if you like your plan, you can keep it,."

There was a reason that the President continually lied or misled people by assuring them that he was not taking away their health insurance. We Americans may not like our health insurance, most people are afraid that anything which would replace it would leave them out in the cold.

It's a regrettable state of affairs, but an undeniable one.  Pro Publica points out that a Kaiser Family Foundation report in July

showed that how politicians talk about the issue matters, with 63% responding favorably to the terms “Medicare-for-all” and “universal health coverage.” Those positive feelings begin dissipating when it’s called a “single-payer national health insurance system,” dropping to 49%. They essentially evaporate if it means eliminating private insurance, increasing taxes or disrupting the current Medicare system, with about 60% opposing a national health care plan.

That may be the reason Elizabeth Warren, according to Slate's Jordan Weissman, now

promises that within her first 100 days as president, she’ll use the executive branch’s regulatory powers to start bringing down health costs, push for fast-track legislation to build on the Affordable Care Act, make traditional Medicare available to everyone over the age of 50, and create a very generous public insurance option with modest premiums that Americans will be able to purchase on Obamacare’s exchanges, which she is branding as the “Medicare for All option.”

Warren argues that these reforms will eventually pave the way to pass a second bill that fully moves the United States to a single-payer system like Sanders has envisioned, by putting all Americans on a single government plan and banning private insurers from selling competing coverage. “No later than my third year in office, I will fight to pass legislation that would complete the transition to full Medicare for All,” her plan states. “By this point, the American people will have experienced the full benefits of a true Medicare for All option, and they can see for themselves how that experience stacks up against high-priced care that requires them to fight tooth-and-nail against their insurance company.”

Sanders' shorter timeline for eliminating private insurance and implementing single-payer is more ambitious and thus more viscerally appealing.  And there are other pitfalls to Warren's approach, as Weissman points out. Nonetheless, it is

a far-reaching health care plan that at least has some vague grounding in political reality. It would still require a bunch of new federal spending but far less than single payer, since it charges some premiums. It’s probably more comprehensive than anything Joe Manchin will want to pass, but you could still theoretically do it using the budget reconciliation process, which lets Congress enact spending bills with a bare majority vote, and which any health care legislation will need to rely on so long as the filibuster exists.

Part of that particular reality is that Americans currently are unwilling to immolate private health insurance companies. Currently. However, Medicare is popular, both as policy and as branding, which is why the Vermont senator introduced single-payer as "Medicare for All" rather than "single payer for all."

President Obama understood that Americans generally are risk-averse about radically changing their health care policy. If the Massachusetts senator is elected and can lower the eligible age for Medicare to 50, she, and the country, would be off and running, after which a transition to single-payer would be significantly more plausible. It may not be sexy, but it is grounded in political reality and provides the best route yet for getting to the health care destination needed. 

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