Looking for a really good Obamacare replacement? Here it is
By David Lazarus
Los Angeles Times, Feb. 3, 2017
Supporters of healthcare reform may feel disheartened as President Trump and Republican lawmakers prepare to repeal the Affordable Care Act and replace it with … well, something. They can’t even agree among themselves on what the U.S. healthcare system should look like.
But there’s reason for hope, albeit a long shot.
OK, a very long shot.
In other words, it would build on the successful single-payer insurance program that already covers more than 55 million people and bring the United States in line with almost all other developed nations in providing taxpayer-funded health coverage for everyone.
Needless to say, the legislation — HR 676 — has no chance of passage by the Republican-controlled Congress.
However, the fact that such a bill exists serves as a reminder that there are some in positions of power who understand the pitfalls of the U.S.’s private-sector-dominated health insurance system, and who are willing to place national interest ahead of corporate profits.
Also, some backers of the legislation think there’s at least one prominent Republican who might come around to their way of thinking.
Taking 20 million people out of Obamacare is going to help our cause. We’ve got all the arguments on our side. — Rep. John Conyers Jr. (D-Mich.)
“Donald Trump is a businessman, not a lifetime politician,” said Dr. Carol Paris, head of Physicians for a National Health Program, which represents 20,000 doctors who support creation of a U.S. single-payer insurance system. “HR 676 is a formula for good business. It makes good business sense.”
She’ll get no argument from me. A 2014 study by the Commonwealth Fund compared the U.S. healthcare system to those of 10 other developed countries, including Canada, Germany, France and Britain.
It found that the United States had by far the most expensive system in the world but trailed its peers in delivering bang for its healthcare bucks.
Administrative costs — paperwork, incompatible computer systems, interactions between doctors, hospitals and hundreds of insurers — eat up about 25% of U.S. healthcare spending.
Meanwhile, at an average of more than $10,000 per person, the United States pays more for healthcare annually than any other developed country without any significant improvement in outcome, such as longer life expectancy. The typical American can expect to live to 79, whereas citizens of other developed nations will live past 80, according to the Organization for Economic Cooperation and Development.
“International experience shows that single-payer financing systems, like the one described in Rep. Conyers’ bill, are the fairest and most cost-effective way to assure that everyone gets high-quality care,” Paris said.
Conyers, however, isn’t holding his breath.
He told me he doesn’t think Trump — whom he described as “erratic” — will suddenly embrace the common-sense advantages of Medicare for all. Nor does he think House Republicans will be flexible in their thinking.
“This is not something that they’re going to buy into,” Conyers said, “even though countries with universal healthcare find that it costs less and is healthier for people. We’re just too polarized right now.”
Nevertheless, he said he’s optimistic about the future. Conyers expects the Republicans’ replacement of Obamacare to be so troublesome that the public will grow increasingly receptive to new ideas. This will allow a case to be made for Medicare expansion.
“Taking 20 million people out of Obamacare is going to help our cause,” he said. “We’ve got all the arguments on our side.”
His bill already has 51 co-sponsors, including California’s Judy Chu, Mark DeSaulnier, John Garamendi, Jared Huffman, Barbara Lee, Ted Lieu, Zoe Lofgren, Grace Napolitano, Lucille Roybal-Allard and Mark Takano. No Republicans have signed on.
Under HR 676, “all individuals residing in the United States (including any territory of the United States) are covered under the Medicare For All Program, entitling them to a universal, best quality standard of care.”
The bill would cover primary care, emergency care, prescription drugs, medical equipment, long-term care, mental health services, dental services, chiropractic services, basic vision care and other healthcare needs.
And try this on for size: “No deductibles, copayments, coinsurance or other cost-sharing shall be imposed with respect to covered benefits.” Instead, funding would be made primarily through payroll taxes, as is already the case with Medicare and Social Security.
A 2013 analysis of an earlier version of Conyers’ legislation by Gerald Friedman, a healthcare economist at the University of Massachusetts Amherst, found that progressive federal tax payments “would cost less for 95% of households” than the current system of deductibles, premiums and copayments.
He also concluded that because of huge administrative savings and greater negotiating strength with hospitals, doctors and drug companies, a Medicare-for-all system “would make it possible to provide universal coverage and comprehensive benefits to future generations.”
This isn’t “socialism” and it isn’t “government-run healthcare.” Doctors would still be free to practice medicine as they see fit.
It’s simply a more effective and efficient way of managing healthcare risk for the entire population.
Private health insurers would battle ferociously to prevent such a change, but they wouldn’t be put out of business. Rather than providing total coverage, they’d simply shift to offering supplemental plans, as they already do. A more competitive market for added coverage would only benefit Americans.
It’s widely believed that Republican replacements for the Affordable Care Act will include health savings accounts coupled with high-deductible plans from private insurers, as well as high-risk pools for people with pre-existing conditions that all but guarantee limited coverage and sky-high premiums.
Think about that. Now think about the broad coverage featured in Conyers’ bill being available for less than what you pay now.
Think about having the same coverage regardless of your job (or lack thereof). Think about the number of people without insurance dropping to zero.
Think about Americans finally enjoying the same healthcare benefits as the rest of the developed world.
What’s not to like?