In recent years new have reached a national consensus that access to health care ought to be considered a right. Even Donald Trump with his obsession about getting rid of Obamacare does not deny that health care is a right, though he has no clue what he would replace it with if the courts grant his wish.
Health care is a major issue among the Democratic presidential candidates for three reasons:
- voters fear that Republicans would make it less available and/or more costly,
- the courts have already cut into some of the Obamacare’s provisions, rendering it less coherent, and
- the law itself reflected attempts to compromise with Republicans who voted against it anyway.
The basic argument among the Democrats is over whether to go for Medicare for All or stay with Obamacare and fix it. The idea of Medicare for All is appealing because the program already works well for senior citizens and the disabled, at a cost lower than private insurance. So why not just expand it to cover everyone?
Bernie Sanders and Elizabeth Warren support Medicare for All, though Warren has said she won’t try to pass it until her third year in office. The other candidates have been skeptical, mostly on the basis of cost projections that Sanders and Warren don’t accept. But the moderates worry that voters will be scared off by the cost, and that those who have employer-provided or other private insurance would be loath to give it up.
No matter how elegantly simple the initial proposal, the final result will be complex, ugly, and maybe worse than what we have now.
Upon reflection I have concluded that the skeptics have a point. Or three. First point: even if Democrats control both houses of Congress and the presidency, the process of enacting any new health care program will inevitably be messy. No matter how elegantly simple the initial proposal, the final result will be complex, ugly, and maybe worse than what we have now.
Second point: a comprehensive reform, when put into practice, will not work as intended. There will be glitches, some major. Some (perhaps many) people will feel that they are worse off than before.
Third point: people who are used to the plans they have now, people who haven’t yet been screwed by their insurance companies, really won’t want to change to something new and untried, and they really will vote against someone who promises to make them change.
If reforming health care becomes a major campaign issue, that puts the Democrats on the defensive, when they should be attacking Trump.
What, then are the Democrats to do? The premise is that access to affordable health care is a right. The question is how to reach that goal. The answer should be pragmatic, rather than picking fights we don’t need. The health care sector has become the largest part of our national economy. While our health care does cost us much more than it ought to, trying to wipe the slate clean and start over will be a political nonstarter.
Two provisions are essential: a public option (like Medicare for all who want it), and allowing Medicare to negotiate drug prices.
We should leave private health insurance alone. Employer-provided plans a will be going away as fast as employers can make employees into independent contractors. Employees who like their plans now will soon be begging for Medicare. And individual plans won’t be able to compete with a public option. So overall, private insurance is a problem that will resolve itself.
Such a cautious approach to health care reform will let Democrats keep the campaign’s focus where it ought to be: on Donald Trump.