Healthcare has become one of the most divisive issues on the US political scene, in striking contrast to most countries, where keeping the citizenry alive and healthy is a matter of cohesive common concern, and national health-care systems engender intense pride. Does it have to be this way in America? Or, since healthcare is a field where most everybody can agree on the goals of staying alive and well, couldn’t we work together to find a compromise? Do we have to cling to — or hate — “Obamacare” as a primary criterion of political party allegiance?
An important first step toward breaking the impasse would be for Democrats to admit that Obamacare as originally passed is a flawed piece of legislation that hasn’t fully lived up to its promises, and for the Republicans to admit that, flawed or not, the Affordable Care Act did a lot of good things that helped a lot people.
Beyond that, one tradeoff that the Democrats and President Trump should both consider in light of the recent failure of Republican efforts to replace Obamacare would be to offer Americans of all ages three options: the right to sign up for Medicare, keep private insurance, or buy no insurance at all. Equivalent age- and income-related subsidies could go to under-65-year-old purchasers of Medicare and to those who opt for private coverage — with purchasers perhaps also allowed to decide whether to take these subsidies as the tax credits Republicans prefer or the upfront reductions in premiums most Democrats favor.
This would maximize both choice and marketplace competition, things Republicans heartily espouse, and get rid of the insurance “mandate” that they so hate. At the same time, it would give the left-wing of the Democratic Party a foot in the door for a single payer system — what most of them wanted but were unable to obtain from their own party when Obamacare was passed in the first place, and most of the developed world uses to such advantage.
Giving up mandatory insurance may sound like a big sacrifice for Democrats, but it may be spilt milk not worth crying over, given that Trump has said he isn’t going to enforce that mandate strictly in any case, and may not enforce it at all. Also, it’s worth remembering that former President Barack Obama himself didn’t support making health insurance obligatory until after he was elected in 2008, and then mainly because he was sold on the idea that it was critical to bringing down costs.
Other aspects of this compromise would help compensate on the cost front for the loss of the mandate. First, insurance companies would have to compete for customers with Medicare under a system of equivalent subsidies. No one would operate in the monopoly or semi-monopoly situation that applies in many states under Obamacare marketplaces today. In addition, the Democrats could go along with Trump’s idea of negotiating with the drug companies and other medical service providers to get lower prices. It’s an idea that more than a few Democrats already favor.
The pharmaceutical and insurance industries would strenuously fight such an approach, of course, but both must surely be losing a bit of credibility as their prices and premiums soar along with their profits. And other important parts of the healthcare system, including many doctors and hospitals, might well support such an effort if they were brought in on the crafting of the grand compromise.
That leaves the question of whether and why Republicans would ever buy off on “socialized medicine,” as an extension of Medicare would be labeled by many in their party. The answer could be because Medicare coverage would not be obligatory, but just another offering out there in the marketplace. Those on the Libertarian wing of the party, at least, should welcome giving individuals the right to decide.
Doubtless, some number of Republicans wouldn’t accept that argument. Some centrists in the Democratic Party who are more concerned with preserving the “legacy” of the Obama legislation than with tackling its shortcomings, and not much enamored themselves of a government-run system, might also balk. The huge advantage of a bipartisan — “nonpartisan” would be a preferable label — approach is that you don’t have to get everybody in either party onboard. Just some reasonable portion of each.
Evidence is in fact spreading of the potentially wide appeal of a single-payer US medical system, implemented either immediately or first tested as an “option,” as we suggest. This Democracy Now interview, pegged to Sen. Bernie Sanders’ pending single-payers bill, points toward interest within the Democratic establishment in Washington in an interim step in this direction, as proposed in our article. A New York Post commentary by conservative columnist and sometime Trump speechwriter F.H. Buckley (no relation to William F.) demonstrates potential support within the Trump camp for a single-payer system.
And if the politicians can’t agree, why not let the people decide between public and private insurance, not as a theoretical proposition at the ballot box, but as a practical proposition in a competitive marketplace? Aren’t health and long life important enough to at least give it a try?
Sarah Miller is a thinker, writer and editor with experience as a journalist in Brussels, Washington, London and New York. She now lives in Camden, Maine, and is active with the local philosophical society, annual Camden Conference on foreign policy issues, gardening and piano.