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Is There Any Good Reason Why Dems Didn’t Just Do “Medicare for All?”


Let’s face it, as well-intentioned in many ways as the Affordable Care Act was, and as many good things that it brings to the table, it’s a seriously, seriously flawed method for achieving universal, affordable, high-quality health care coverage in this country. It has also turned out to be terrible politics (see this new poll, for example); killing Democrats politically in 2010; feeding the Tea Party monster red meat and contributing to its takeover of the House of Representatives (and thus all the dysfunction and extremism we’re seeing on budgeting, the debt ceiling, and a million other issues); and now threatening to squander what HAD been Democrats’ increasingly rosy prospects for the 2014 midterms.

The fact is, this entrenchment of the private, for-profit health insurance industry, while tweaking it in a gazillion different ways, was the wrong way to go about health care reform in this country. This isn’t “Monday Morning QB’ing,” as I argued strongly for a robust public option and was highly skeptical of this approach while it was being debated. Of course, I strongly supported – and still support – the “Affordable Care Act” approach IF the option was doing nothing at all. But still, we could have done so much better, it seems to me (and please, explain to me specifically why we couldn’t have, if you believe that to be the case).

In part the problem is the Affordable Care Act approach is overly complicated, truly a Ruby Goldberg-esque contraption if I’ve ever see one. That alone handed the Republicans an easy (albeit idiotic) talking point to bash Democrats on, that this plan was thousands of pages long and that almost nobody  had read it or understood it.

Second, let’s face it: this plan doesn’t fundamentally get at the core problem in the U.S., which is that we spend more than basically any other advanced, industrialized country in exchange for WORSE OUTCOMES. As if that’s not bad enough, this plan doesn’t achieve universal coverage, nor does it truly “bend the cost curve” as it could have (e.g., with a robust public option). What a bargain, huh?

Third, by mandating that people purchase coverage, but only from private/for-profit companies, we got the worst of all worlds: bad politics (e.g., Republican attacks and constitutional challenges, including from Virginia’s own Ken Cuccinelli on the “individual mandate,” which of course was a conservative idea to begin with but whatever…); and fundamentally bad policy (entrenching the private, for-profit health care industry without even offering a robust public option for people). Great, huh?

Fourth, in part because it was made so ridiculously complicated, health care reform took wayyyy too long during 2009 and 2010, basically sucking up President Obama’s first two years, when we also needed to be focusing on the economic recovery, comprehensive immigration reform, and – hello?!? – climate change! (also, why on earth did we spend months on end waiting for Max Baucus – huge blunder on that one). Again, I said all this at the time, so this isn’t “Monday morning QB’ing.” Today, if anything, it’s even more mind boggling. What on earth was the White House – and other Democrats, including Bill Clinton, who predicted that once the plan was passed, people would LOVE it! – thinking on this?

Fifth, the conservative Supreme Court made matters worse by making a key part of the ACA – Medicaid expansion – optional, not mandatory, for the states. So now we’re fighting THAT battle as well, including right here in Virginia, where that issue will likely take up much of Gov.-elect McAuliffe’s first year (or longer) in office.

Finally, the way the ACA is constructed, it gives Republicans at both the federal AND state levels tons of opportunities to sabotage/derail healthcare reform’s effective implementation – and boy have they done so! And now, as an added bonus, they’re gearing up the cheap-shot (but possibly effective) attacks on Democrats up for reelection in 2014, including Virginia Senator Mark Warner (see this video, for instance). Great, huh?

But, you say, the Affordable Care Act (aka “Obamacare”) was the best our political system could have produced, given the Joe Liebermans and Blanche Lincolns and other insurance industry tools of the world (not to mention absolute Republican opposition to a health care plan that was largely modeled on their own freakin’ ideas!). Except I’m not convinced this was the best our political system could have produced. Instead, why didn’t we just do this?

You only need 51 senators to pass a bill through reconciliation. But theoretically the main problem with reconciliation is that it can only be used used for legislation that affects the budget. So, a public option or Medicare buy-in would definitely affect the budget, but getting rid of insurance practices like barring people for pre-existing conditions or denying them care through rescission could not be handled through reconciliation.

So, if you just want one bill you can’t go through reconciliation because you can’t keep many of the important elements of health care reform. That’s conventional wisdom. But here is a radical new idea – how about we just do Medicare buy-in for anyone who wants it and not bother to pass any regulations about pre-existing conditions or rescission or anything else.

So again, why exactly didn’t we do this? I asked a well-connected, super-smart Democratic friend this question. His answer? “I’d say it was avoided [because] of the political imperative, as people saw it, to avoid being seen as ‘big government’ or ‘socialized medicine'”

My response: Medicare is VERY popular, not seen as “socialized medicine” by most people, could have been expanded relatively easily since it’s an existing program which could have been done through “reconciliation.” Also, let’s face it, no matter what Democrats did on this, we were going to be attacked by Republicans for “more big government solutions,” “blowing up the debt” (false, according to the CBO, but whatever…facts don’t matter to the corporate media and certainly not to Teapublicans) – all their usual talking points, however false and absurd. So instead of getting the killer combo of bad politics and not-very-good policy, why didn’t we go for great policy and probably not-as-bad politics?

It was mind boggling then, and it’s even more mind boggling now that we chose the path we did. Even more mind boggling is that even the private, for-profit health insurance industry may not end up doing very well out of this supposed sweetheart bill (for them). And yes, I blame them heavily for what we’ve ended up with here, instead of a “Medicare for All” system (or at least a robust public option), which largely could have avoided the problems we’re seeing, while achieving universal, affordable, high-quality health care coverage in this country. But nooo. So frustrating.

P.S. It was the same thing with the Ruby Goldberg-esque Waxman-Markey comprehensive clean energy/climate bill as well, which by the end was a complete mess (e.g., loaded up with anything/everything the coal industry wanted). Again, bad politics and not-so-hot policy, either. Instead of that, why didn’t we just do a simple bill (probably just a few pages long) imposing a revenue-neutral carbon tax, or “fee and dividend” or whatever?  

  • Jim B

    In my lifetime the country has a history of not doing the right thing. Can we expect it will ever do the right thing about anything today?

  • K in VA

    There’s a bad reason why the Democrats didn’t do Medicare for All, and it’s called the GOP.

    Democrats thought, by mostly adopting schemes rigged up by Republicans (Heritage came up with the idea of the individual mandate, and then there’s the model of RomneyCare from Massachusetts), they could get GOP buy-in for a national health scheme. In another era, that notion might have made sense — but not with this president in office concurrently with today’s GOP.

  • scott_r

    Allowing people to opt-in to a dramatically leaner “health insurer” – aka Medicare – you would take a huge bite out of the “private sector” insurers – business, and jobs.  Yes, it’s absolutely true that we spend far too much on healthcare, due to gross inefficiencies and private profits, but look at every sector where radical elimination of superfluous middle-men has gone on – in other words anything disrupted by the web – and you’ll see entire old employment models destroyed.  

    The frog will not sit still to be cooked if we throw it in the boiling water – and our private insurance system needs to have it’s goose cooked – but if we do a gradual boil..yadda, yadda.

  • Elaine in Roanoke

    The way we allow political campaigns to be financed by large donors and money bundlers, plus the horrible situation caused by the Citizens United SC decision, practically guaranteed that no form of public option would make it into the final bill. (Medicare is our already-operational, single-payer health insurance. It also is the most efficient deliverer pf health care.It’s cost problems come from the fact that it long ago relieved the for-profit insurance companies from any coverage for the age cohort most lileky to get sick.

    There was a bill before Congress for at least three years prior to the enactment of the Affordable Care Act to make a Medicare for all option a reality. It got almost no support on either side of the aisle. Why? Any politician voting for it risked losing insurance industry contributions, etc. Our system of financing political campaigns guarantees that legislators will be beholden to big money interests. So,what do the get? They get whatever they want. We get thousands of pages to a bill that satisfies the big players in the for-profit health industry and does too little for the rest of us. It’s the same with Waxman-Markey. By the time the monied interests finish making sure they keep control and profits, then the original purpose of legislation gets lost in the process of protecting the people with power.