Will The Democrats Develop A Health Care Plan For 2020?

By

Leonard Zwelling

https://www.nytimes.com/2018/11/17/opinion/sunday/democrats-aca-medicaid-exchanges.html

In The NY Times of Sunday, November 18, Harold Pollack, a professor at the University of Chicago, wrote a piece about the need for planning on the part of the Democrats if they wish to win the White House in 2020. In particular, Professor Pollack thought the Dems need a comprehensive plan to improve ObamaCare and get more people health insurance.

I could not agree more!

Ever since the passage of ObamaCare in 2010 through legislative slight of hand on the part of then, and likely soon to be again, House Speaker Nancy Pelosi, the country has struggled with whether ObamaCare was a benefit or a curse. Of course, it’s really a bit of both because while it does insure 10-12 million more people, it fell well short of the hoped for increase of over 30 million on the insurance rolls. It did advance the concept of insuring those with pre-existing conditions and allowing young people to stay on their parents’ policies longer, but there are still many who are not insured. Medicaid was not expanded as planned in the original legislation thanks to a Supreme Court decision that reduced the pressure on states to expand Medicaid, and costs are still soaring. And while the computer-based exchanges used to buy insurance are now under control, their start was anything but encouraging.

Pollack makes several points in his piece.

First, he assumes that any bill that the Dems can pass if they take both houses of Congress plus the White House in 2020 will be done with no Republican support. This is short sighted in my mind. If the legislation proposed is any good, thinking Republicans could get on board, especially if they find themselves deep in the minority and replace Mitch McConnell who has become a major impediment to any progress at all.

Second, a single payer system is an unlikely winner in 2020. The country is simply not ready to jettison the entire insurance system and go with Medicare for all. Such a system would likely decrease overall costs but would necessitate increasing taxes. That might be offset by the fact that most people (and employers) would no longer have to pay insurance premiums, but good luck getting a tax increase through the Congress.

Medicare could be made an option to all though. You have to buy in if you are under 65, but it’s not impossible to make Medicare the “public option.” It could even be one of the options employers offer. Of course, demolishing the private insurance companies would go a long way toward fixing the problem, but they have one of the strongest lobbies in DC. That is not likely to occur.

Another proposal is called Medicare Extra for those with incomes below 150% of the federal poverty line. This would be for those who live in states that haven’t expanded Medicaid. In essence, the next step is make the government option competitive with the current private options for those above 138% of the federal poverty line (Medicaid ineligible) and those under 65 (Medicare ineligible). This might slowly wean Americans away from private insurance plans and onto public ones.

Pollack’s real point is that the Dems need to develop the plan on which they will run now. ObamaCare duplicated 2006’s RomneyCare and was a Republican idea hatched in 1989 at the Heritage Foundation. RomneyCare in Massachusetts and then ObamaCare were in the planning long before Mr. Obama even had the 2008 Democratic nomination. The same needs to take place now.

The Democrats need to get together and determine what one plan they will present to the American people in 2020 as an alternative to any Republican rehash of ditching ObamaCare and whatever nonsense President Trump might come up with, although he surely hasn’t yet.

It is time for a uniquely American health care system. It has to cover everyone. It has to lead to a decrease in overall costs (estimated to exceed $3 trillion annually) and has to maintain or improve the quality of the delivered care. The sooner we close the private insurance business for routine health coverage the better. Those companies need to make a profit and guess who pays for that. It’s a premium that no one should be paying.

There can be a private market for gold-plated care with costs borne by gold-plated insurance. Concierge care can continue. But somehow America has got to get to a place where everyone has access to care of reasonable quality and cost. It’s a matter of national security that the Democrats could promote as such. They could. But will they?

Leonard Zwelling