On the road to single payer?


After the humiliating debacle in which Paul Ryan and Donald Trump had to pull their health care bill from the floor or see it go down in flames, the talk was that the reform effort was dead, at least for some time, and that Trump and Ryan would reluctantly defer health care actions that hurt the poor and middle class and instead move on to other things dear to their hearts that hurt the poor and middle class, like cutting taxes on the wealthy.

But suddenly, talk of a new health care bill emerged. It wasn’t clear if this was a serious effort or just a smokescreen put up by the Republican party to try to convince their supporters that they were still going to repeal Obamacare and thus erase the image of failure. Trump even threatened to work with Democrats to craft a new bill if the Republicans would not cooperate with him. This threat was empty in that Democrats were unlikely to sign on to anything that took away key features of Obamacare the way that Republicans want and those Republicans who opposed the first effort knew that..

The attempt to forge a compromise seemed to become more real when vice-president Mike Pence was sent to Congress on Wednesday night to meet with those Republicans who torpedoed the first effort to see if an agreement could be reached with them. But even before the talks could begin, reports emerged of it unraveling and the talks ended up with no deal being reached, and the various parties as usual blaming others for the failure.

Chris Collins, a moderate Trump ally from New York, said resignedly that the ball was in the court of the Freedom Caucus, a coalition of arch-conservative legislators who didn’t support the initial Republican healthcare proposal. “We built them a bridge,” said Collins. “All they have to do is walk across.” He added, simply: “The problem is with the Freedom Caucus.”

To Collins, this faction within the House GOP had been not been straightforward in negotiating over healthcare in recent days. “Indications … were on Monday that they wanted to get to yes,” said Collins. “Actions speak louder than words and over the past few days, actions would indicate that those words would not have been sincere.”

In his opinion, the Freedom Caucus kept on “moving the goal posts”.

Conservatives returned fire. Mo Brooks of Alabama, a member of the Freedom Caucus, noted that House Republicans had voted to totally replace the ACA in 2015 and reluctance to do anything less than that represented a flip-flop. In Brooks’s opinion, those who wanted to preserve parts of the ACA had “not only moved the goalposts, they’ve taken out the stadium, chopped ’em up and burned them”.

On Wednesday, conservative groups lashed out at moderate Republicans, blaming them for derailing the latest attempt to repeal and replace the Affordable Care Act.

Dan Holler, the vice-president of Heritage Action, said conservatives had already “ceded a lot of ground” on fully repealing the healthcare law.

What bugs me about this reporting is this talk of ‘moderate’ Republicans. There is no such species. What the Republican party consists of are extremists and ultra-extremists and calling the former moderates is utterly misleading.

One thing that I found interesting is this column titled The road to single payer health care by Charles Krauthammer, someone who is a reliable hardline conservative and neoconservative. First he predictably makes the silly right–wing argument that we should be able to pick and choose what health needs we want to cover.

Even more significant would be stripping out the heavy-handed Obamacare coverage mandate that dictates what specific medical benefits must be included in every insurance policy in the country, regardless of the purchaser’s desires or needs.

Best to mandate nothing. Let the customer decide. A 60-year-old couple doesn’t need maternity coverage. Why should they be forced to pay for it? And I don’t know about you, but I don’t need lactation services.

Ha, ha! Good one, Charlie! But why stop there? Why not go further? Why should those who do not have cancer pay for the expensive chemotherapy, radiation, and surgical treatments of those who do?

Of course, being able to pick and choose only what we need goes against the entire concept of what makes insurance affordable, by spreading the costs and risks over a large population of sick and healthy alike. Eliminate that, and what you have is each person being stuck with the costs of their own treatment, which is fine if you are rich. And that is, of course, the point, the dream of Republicans.

But he then argues goes on to reveal what really scares him, that what we might be seeing is the first stage on the road to creating a government-run single-payer system, the thing that most developed countries have and that Republicans hate the most because it would provide free health care to those who are not wealthy. It is worth quoting him at length.

But there is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage.

Acceptance of its major premise — that no one be denied health care — is more widespread than ever. Even House Speaker Paul Ryan avers that “our goal is to give every American access to quality, affordable health care,” making universality an essential premise of his own reform. And look at how sensitive and defensive Republicans have been about the possibility of people losing coverage in any Obamacare repeal.

A broad national consensus is developing that health care is indeed a right [My emphasis-MS]. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.

As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to persuade the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.

Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli “dished the Whigs” in 1867 (by radically expanding the franchise) and joins the single-payer side.

Talk about disruption? About kicking over the furniture? That would be an American Krakatoa.

While Krauthammer views this prospect with gloom, I for one would be delighted. I have long supported a single payer system and Bernie Sanders’s proposal of expanding Medicare to cover all would be the simplest way of getting there.

So for the first, and perhaps the only, time, I sincerely hope that Krauthammer is right.

Comments

  1. Siobhan says

    Of course, being able to pick and choose only what we need goes against the entire concept of what makes insurance affordable, by spreading the costs and risks over a large population of sick and healthy alike. Eliminate that, and what you have is each person being stuck with the costs of their own treatment, which is fine of you are rich. And that is, of course, the point, the dream of Republicans.

    What baffles me is that their own argument doesn’t even work on their own principles. Hospitals have to absorb every single medical bankruptcy that gets filed, but under single-payer they are guaranteed to get paid. So how much of the American healthcare expense is just bills that can’t get paid?

  2. says

    After the humiliating debacle in which Paul Ryan and Donald Trump had to pull their health care bill from the floor

    There are two strategies, when you encounter a humiliating failure:
    1) fix the problem, and succeed
    2) become emotionally immune to humiliation

    Ryan has already been at 2) for some time. Ditto Trump. We may think it was a humiliating defeat for them, but they probably just think of it as “friday.”

  3. Chiroptera says

    …to other things dear to their hearts that hurt the poor and middle class….

    Other things? I think that hurting the poor and middle itself is the thing that’s dear to their hearts.

  4. rhebel says

    “Of course, being able to pick and choose only what we need goes against the entire concept of what makes insurance affordable, by spreading the costs and risks over a large population of sick and healthy alike. Eliminate that, and what you have is each person being stuck with the costs of their own treatment”
    I do have one exception to this. Why does my insurance have to support “alternative medicine” that has no scientific evidence that it has any positive medical benefit beyond that of the placebo effect? I do get frustrated knowing that my insurance dollars are paying for acupuncture, reiki, etc.

  5. says

    I was going to ask what the heck a “moderate Trump ally” was, but you already beat me to the punch by pointing out there are no moderate Republicans.

  6. deepak shetty says

    Ha, ha! Good one, Charlie! But why stop there? Why not go further? Why should those who do not have cancer pay for the expensive chemotherapy, radiation, and surgical treatments of those who do?

    I don’t think any conservative actually stops at lactation services(don’t these assholes have spouses, sisters mothers, friends who are women even if they are completely devoid of empathy for strangers?) – If you are poor and have a serious illness you should either suffer or die (probably both)

  7. flex says

    rhebel wrote,

    Why does my insurance have to support “alternative medicine” that has no scientific evidence that it has any positive medical benefit beyond that of the placebo effect?

    Because the insurance companies make money on them. There is no other reason.

  8. jrkrideau says

    @ Mano & 5 Tabbylamp

    In most Western countries many left-wing US Democrat would be considered right-wingers.

    @ 7 flex
    rhebel wrote,
    Why does my insurance have to support “alternative medicine” that has no scientific evidence that it has any positive medical benefit beyond that of the placebo effect?
    Because the insurance companies make money on them. There is no other reason.
    ————————–
    Sounds reasonable to me. I live in a place with a single-pay system for basic healthcare; reiki and chiropractic are not on the list of approved treatments. Governments tend to want to control health costs when those costs are coming out of general revenue.

    Strangely enough though, the last time I checked, about five years ago, your doctor could prescribe a beer or glass of wine when you were hospitalized and it was covered under the health plan. How that slipped through the cracks I don’t know but it’s been like that for over forty years.

  9. Brian English says

    I’m sorry, but a conservative with the surname ‘Krauthammer’ Isn’t that just a satrical name progressives use against conservative foe, or a cypher for conservatives who hate Nazis?

    Behold Krauthammer, hammer of the poor (and Krauts)! (Think Charles Martel or Malleus Maleficarum – hammer of the witches).
    I need more evidence that that’s not a stage name.

  10. flex says

    jrkrideau wrote,

    Strangely enough though, the last time I checked, about five years ago, your doctor could prescribe a beer or glass of wine when you were hospitalized and it was covered under the health plan.

    That’s not all that unexpected. Alcohol in small doses, or controlled amounts, can help relax you. And relaxation has multiple benefits. I’ve heard a number of doctor’s say that if the affects of over-drinking weren’t so bad, they would suggest a few drinks a week to help with blood pressure. My wife tells the story of her grandmother who’s doctor prescribed cigarettes to get the woman to sit down and relax for 10 minutes a day. This was before Hill’s studies were published in the 1950’s.

    To expand on my previous post a little. Insurance companies make their money by selling policies (and sometimes by denying payment if you don’t abide by their hidden, arcane, rules). So they have a real incentive to create policies which people will buy. Particularly policies which corporate clients will purchase, as that’s where the real money is. The people who purchase insurance policies for corporate clients, i.e. work in the HR office, are not medically trained and have the same set of weird beliefs which are common in society. Some of these people, and some of the people who work in corporations, believe in reiki and I know dozens of people who believe that chiropractic is real medicine.

    I ask them why they need repeat visits for years when 2-3 months will a physical therapist will clear up any issues? The answer I get is that one trip to a chiropractor makes them feel better for a couple weeks while a physical therapist will make them work hard for 2-3 months. Since the chiropractor’s visit is paid for by their insurance, they’d rather take the easy way (which never solves the underlying problem). Human beings are not good long-term thinkers, even about their own health. (See alcohol consumption above 🙂 )

    Through the miracle of the free market, if one insurance company starts offering policies which cover things which are not medicine but appeals to the beliefs of the people buying the policy, all the insurance companies will. They have to, or they will lose business. So it does really come down to maximizing their profits, not about insurance to cover medical problems.

  11. Heidi Nemeth says

    Medicare (Part A) covers some of the health care costs for seniors in the United States – in particular, hospital visits. But it does not cover all medical costs. It doesn’t cover doctor visits, dentist visits, mental health, eye care or prescriptions. For those services seniors must buy Medicare Parts B, C and D. And they may still have coverage gaps.

    In contrast, Medicaid, for poor people, covers all health care. We need to expand Medicaid for all, not Medicare.

    Both Medicare and Medicaid require participants to choose insurance companies which administer their plans. Insurance companies? To what purpose?

  12. doublereed says

    Krauthammer is 67. He gets Medicare. So for him to whine about government insurance or whine about healthcare being a right is obvious bullshit.

  13. jrkrideau says

    From a quick look at Wiki, Krauthammer has lived in two countries with single-payer systems (Canada & UK). Either ideology beats experience (quite likely) or he was young and/or healthy enough not to realize how they worked.

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