USA TODAY International Edition
Focus on saving Obamacare, not on single-payer dreams
Democrats have long suffered from an inability to present messages that are simple, appealing and understandable.
That is one of the biggest reasons Sen. Bernie Sanders of Vermont has had so much success. In his overly simplistic world, there is virtually no problem of economics or federal spending that isn’t the consequence of the rich getting richer and that can’t be addressed with higher taxes.
His latest manifesto is a $1.38 trillion Medicare-for-all proposal, funded largely by taxes on businesses and upper-income wage earners.
Unlike Sanders’ bid for the 2016 presidential nomination, this effort has wide backing in the Democratic Party. Sixteen of his fellow senators have signed on as co-sponsors, shifting attention to a single-payer system at the very time the Affordable Care Act remains in peril.
The Senate might vote this week on the Graham-Cassidy plan, the Republicans’ latest cruel and cynical repeal-and-replace effort to deny tens of millions of Americans of their health insurance. In fact, Sens. Lindsey Graham and Bill Cassidy will debate Sanders and Sen. Amy Klobuchar tonight on CNN.
Might we suggest that saving the ACA (also known as Obamacare), and pursuing bipartisan fixes, should be a much higher priority at this moment than pursuing political pipe dreams about Medicare for all?
To be sure, there is something to be said for the single-payer approach employed in Sanders’ plan. In today’s highly fragmented world of insurers, none has the leverage to say no to the constant price hikes demanded by hospitals, drug companies and other providers.
But whatever good that would come from the new pricing power in Sanders’ proposal would be offset by the soak-the-rich, makehealth-care-free philosophy that underpins it.
The subsidization of care — a family of four with $50,000 of income would pay just $466 annually for a policy — would leave patients with little reason to care about the costs they were incurring and could lead to shortages of popular services, as occurs in some single-payer countries.
More important, the taxes imposed — including a new 6.2% payroll tax for employers, higher rates on investment income and a top marginal rate of 52% — would be punishing to the economy and U.S. competitiveness.
A better approach to harnessing the pricing power of a singlepayer — or at least a more consolidated market — would be to experiment first at the margins. Allowing Medicare to negotiate directly with drug companies, rather than farming it out to numerous intermediaries, is a nobrainer.
Providing a Medicare-like public option alongside private insurers in ACA exchanges is another idea worth trying, particularly in any counties that go down to one or zero sellers. Allowing people 55 and older to buy into Medicare at the actual cost to government is another option.
But now, even with the Graham-Cassidy measure on life support, is precisely the wrong time for Democrats to be focusing on Berniecare.