Blowing up the system

One of the most interesting aspects of the 2016 Presidential race thus far is that the discussion over the Affordable Care Act — what little discussion there is — has involved, essentially, blowing up the system and starting over.

Democratic candidate Sen. Bernie Sanders has gained significant traction with his call of “Medicare for all” — another way of talking about a single-payer system like the one in Canada (which is actually called “medicare”). The buzz stirred by Sanders and his supporters for a single-payer plan, with the government being the player, can be directly traced to the complicated and not-so-consumer friendly Affordable Care Act. The 2010 law has gone a long way toward getting millions of Americans coverage, but falls short of being all that affordable for too many and is still out of reach — thanks to backwards-thinking states like Georgia — for millions of low income people who should be, but aren’t covered by Medicaid. Why not simplify it? Enact payroll and income taxes to support it and make health insurance available to everyone — young, old, affluent and poor — the way Medicare is available to everyone over the age of 65.

The discussion on the Republican side has had a less-than-lofty tone, with presumptive nominee Donald Trump promising to repeal Obamacare and replace it with something or another that someone or another will present him when he becomes the greatest president of all time. Trump has also declared that he wouldn’t let people die in the streets, which has been — for more than a century now — the default health care policy of the United States since public hospitals, like Atlanta’s Grady Memorial, serve everyone regardless of ability to pay. (In this way, America doesn’t let our poor die on the streets. They can get sick on the streets, but they die in public hospitals because we don’t have a mechanism to ensure their health to keep them out of the hospital.)

On a more serious note, Republicans in Congress, including Georgia’s Tom Price, have offered boilerplate GOP proposals for repealing Obamacare and making insurance more affordable by instituting high-risk health pools, selling cheap policies across state lines, enacting more limits on malpractice lawsuits and other fixes that have demonstrably failed in the past at controlling costs or getting more Americans coverage. Interestingly, none of the talked-about plans have had a serious airing in the Republican-controlled House or Senate.

Now comes two more Republicans, Rep. Pete Session of California and Sen. Bill Cassidy of Louisiana — states with some of the highest rates of uninsured Americans — to offer another GOP plan. They want to change the tax code so as to provide every American adult with $2,500 to purchase coverage. They would do away with the tax credits provided to American employers for covering their workers on the job and essentially throw open the health insurance market to buy health insurance the way we now buy auto or home insurance.

Not gonna happen.

Just like Bernie’s single-payer plan, to do either of these things would require the current health insurance system to be torched and rebuilt from the ashes. For better or worse, the employer-based system we have now has been in effect for seven or so decades. It’s not going away, not very easily anyway.

It is no surprise that neither plan outlines in any detail how we get from here to there — from the current system of Medicare, Medicaid, private commercial insurance purchased on the Obamacare exchanges or elsewhere, or insurance provided and paid for by employers and their employees. How, under what time frame, do we go from this to a single payer, or a $2,500 stipend for everyone to go buy a plan on their own?

These are important questions that need be answered. Vox has a good piece up today about what would be needed to get to what Bernie is taking about.

My own best guess is that the Sessions-Cassidy plan is mostly just election year talk, whereas the single-payer option will continue to have resonance if a Democrat retains the White House in November. But we are still a long way from either. Meanwhile, we have Obamacare and in all likelihood we’ll tinker with that first. Incrementally, and with no small amount of blood, sweat, tears and another round of misrepresentation and outright lies about the impact — we’ll eventually adopt a universal plan that, in the end, looks a lot like Medicare-for-all.

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Mike King is the author of “A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals,” on sale now through Amazon.com