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The real debate: Single payer vs. ACA/AHCA/BCRA

The Senate’s Secretly Bipartisan Health Bill

By Avik Roy
The New York Times, June 26, 2017

In 2010, when Democrats passed the Affordable Care Act, Republicans complained that they did so with no Republican support. Democrats responded by pointing out that the centerpiece of their plan — tax credits to buy private insurance — came from a Republican governor, Mitt Romney of Massachusetts.

Something similar is happening today. Democrats are denouncing the partisan nature of the Republican effort to repeal and replace Obamacare. They’re right to note that if the new bill passes the Senate, it will do so along party lines.

But the core planks of the Senate Republicans’ health bill — the Better Care Reconciliation Act — borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones.

The bipartisan heritage of the bill does not eliminate areas of philosophical disagreement between conservatives and progressives. It increases the role of private insurers, and decreases the role of state-run Medicaid programs in covering the uninsured. It reduces federal spending on health care, whereas Obamacare increased it. The Senate bill repeals or rolls back all of the A.C.A.’s tax increases.

But think about it this way. Imagine an alternate universe in which, in 2009, Democrats and Republicans passed a bipartisan health bill. That bipartisan bill — let’s call it the Baucus-Collins Act — expanded coverage to tens of millions of Americans through a system of means-tested, age-adjusted tax credits in a voluntary-but-regulated individual insurance market where insurers were required to charge the same premiums to the sick and the healthy and guarantee coverage for those with pre-existing conditions.

In the Baucus-Collins Act, this increased spending on the uninsured was paid for through reforms of the Medicare program. In addition, the alternate-universe bill enacted a near-replica of Mr. Clinton’s proposal for Medicaid reform in order to make the program fiscally sustainable over the long term. The act also capped the previously unlimited tax break for employer-sponsored health insurance, albeit at a high threshold.

Democrats and Republicans would be celebrating historic reforms that expanded coverage in a fiscally responsible way. Both blue states like California and red states like Texas would see substantial coverage gains. And we might be talking about further bipartisan efforts to strengthen the Baucus-Collins Act.

What I’ve just described as a bipartisan achievement is, in effect, the synthesis of Obamacare and the Senate Republican health care bill.

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NYT Reader Comments

By Don McCanne, M.D.

Avik Roy’s framing is that there are two polarized partisan views of reform and that somewhere in the middle is the compromise on which we can all agree. Nonsense.

If we are to use linear polarization to frame the debate, then the two sides are health care policies that benefit the patients - all patients - versus health care policies that cater to special interests, whether they be the medical-industrial complex or the political ideologues.

The similarities noted by Roy are due to the fact that the neoliberal views of the Democrats are not that far from the conservative views of the Republicans, in spite of all the noise generated by this debate. Trying to establish policies that benefit the various special interests results in the profoundly expensive, highly wasteful, inequitable, fragmented, dysfunctional system that we have.

A well designed single payer system takes care of patients first, with much greater efficiency, effectiveness, and equity. The special interests that might otherwise appropriately benefit would do well in such a system though they would have to set aside personal greed and vacuous ideology.

https://www.nytimes.com...

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The other reform model: Single payer

“If the GOP does not disengage the country’s health-care system from the disaster of Obamacare, we are headed for the misery of single-payer.”
Hugh Hewitt, The Washington Post, June 27, 2017
https://www.washingtonpost.com...

“Senator Elizabeth Warren now says Democrats should endorse a government-run, single-payer health insurance system for the upcoming 2018 midterm elections and beyond.”
Boston Globe, June 27, 2017
https://www.bostonglobe.com...

“Sen. John Thune (R-S.D.) said, ‘If we don’t get this done and we end up with Democratic majorities in ‘18, we’ll have single payer. That’s what we’ll be dealing with.’ Sen. Pat Roberts (R-Kan.) added that Congress has to pass an unpopular far-right bill, no matter what, because the alternative is single payer, ‘and that’s socialized medicine.’”
MSNBC, June 27, 2017
http://www.msnbc.com...

“Republicans have opened up the space for Democrats to go much further than they’ve been willing to before. It’s not impossible to foresee Democrats winning the House in 2018, then taking the presidency and the Senate in 2020 — and then taking the first steps toward making single-payer health care in America a reality.”
Paul Waldman, The Washington Post, June 27, 2017
https://www.washingtonpost.com...

“It wasn’t long ago that the mere mention of single-payer inspired gasps of horror among centrists and conservatives. Now, not so much.”
Caroline Baum, MarketWatch, June 28, 2017
http://www.marketwatch.com...

“Tom (Sullivan) warned that, if the GOP fails to pass a sufficient healthcare plan in the near future, a single-payer healthcare system in the United States could be inevitable.”
Tom Sullivan Show, Fox News Radio, June 27, 2017
https://radio.foxnews.com...

“Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.”
Joshua Gear, Press Herald, June 26, 2017
http://www.pressherald.com...

“Anyone who argues in 2017 that single-payer health care is unfeasible is either ignorant, malignant, depraved enough to rationalize profit from human suffering, or absent of the basic moral imagination to aspire to something better.”
Timothy Faust, Jacobin, June 26, 2017
https://www.jacobinmag.com...

“With my limited knowledge, I think (single payer) probably is the best system.”
Warren Buffett, PBS NEWSHOUR, June 26, 2017
http://www.pbs.org...

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Comment:

By Don McCanne, M.D.

The issue is simple. The nation is dissatisfied with the deficiencies of the Affordable Care Act, and now they realize that the repeal and replace movement was never founded on sound health policies and would leave us mired in the same old system. The Democratic and Republican politicians are quibbling over details of a dysfunctional, fragmented, inequitable health care financing system that costs too much and delivers too little. Now, more than ever before, the nation is realizing that the other real option is, instead, a single payer national health program - an improved Medicare for all.

Again, the real debate is not between the twins of ACA vs. AHCA/BCRA, but rather it is between our terribly mediocre health care financing system vs. single payer - improved Medicare for all.

The momentum for single payer is greatly intensifying. Next week members of Congress are returning to their districts as they try to reorganize their concepts and strategy on health care reform. They need to hear loudly and clearly our voice on health care justice for all - single payer!

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