Republicans for Single-Payer Health Care

By David Leonhardt
The New York Times, March 28, 2017

Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer.

That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept.

You’ve no doubt heard of that conservative system. It’s called Obamacare.

So if voters like government-provided health care and Republicans are going to undermine private markets, what should Democrats do? When they are next in charge, they should expand government health care.…


The Republican Waterloo

By David Frum
The Atlantic, March 24, 2017

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act. Democrats in the House were displeased by many of the changes introduced by Senate Democrats. But in the interval after Senate passage, the Republicans had gained a 41st seat in the Senate. Any further tinkering with the law could trigger a Republican filibuster. Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

Over the next seven years, Republicans would vote again and again to repeal the Affordable Care Act. Total and permanent opposition to the law would become the absolute touchstone of Republican loyalty.

Some of the conservatives who voted “no” to the House leadership’s version of repeal may yet imagine that they will have some other opportunity to void the law. They are again deluding themselves. If the Republican Party tripped over its own feet walking across this empty ballroom, it will face only more fearsome difficulties in the months ahead, as mid-term elections draw closer. Too many people benefit from the law — and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters — and especially by enough Republican voters — to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

Whatever else the 2016 election has done, it has emancipated Republicans from one of their own worst self-inflicted blind spots. Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism — and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

What I would urge is that those conservatives and Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.…

Asking whether more Republicans can support single payer is probably not the best question. A better question would be, what sort of health care system do Americans want and how can we achieve that?

The intense political divide in this nation really played out during the debate over the Affordable Care Act. Opponents were vociferous in condemning the program, pointing out its various deficiencies – high premiums, limited choice of health plans, loss of personal physicians, narrow provider networks, high deductibles and other cost sharing creating financial barriers to care, and endless other complaints.

Supporters were not quite as animated but were very rigid in insisting on protecting the gains that ACA brought us. In a nation that was already highly politically polarized, the two sides congregated around the two dominant political parties – Republican and Democratic – even though many classified themselves as independent. The camp supporting ACA aligned behind the Democratic candidate – Hillary Clinton. The camp opposed to ACA aligned behind the Republican candidate – Donald Trump. But as is so often the case, things are not so simple.

The left was actually a divided camp with very strong support expressed for Bernie Sanders, to a large extent because of his spirited advocacy for single payer Medicare for all. When Clinton won the nomination, the neoliberal faction enthusiastically supported her and ACA. The progressive faction lost their enthusiasm since the hopes of enacting single payer essentially vanished, leaving us with a mediocre, unsatisfactory model of reform – ACA. Many of them stayed home on election day.

But what about the right? They were divided as well. The conservatives were emphatically opposed to Obamacare, wanting it to be repealed, with some of them even opposing any replacement. Moderate Republicans supported repeal and replace. Trump promised that his replacement would cover everyone, provide better care, and cost less. That message resonated, giving him enough votes for an electoral college victory.

However, the replace of repeal and replace turned out to be a fraud. The Republican leadership in the House tried to pass legislation that would reduce the government role in health care by cutting back on Medicaid, greatly reducing the numbers insured, reducing subsidies that had helped to make plans affordable, and reducing taxes on the wealthy that were paying for many of the improvements brought by ACA. This is certainly not the replacement that most Republicans wanted and thought Trump would bring us, though a few mean-spirited, heartless conservatives were quite satisfied with the proposal. It was easy for most Republican legislators to walk away from this ill-conceived model of reform, and there certainly was no clamor to try to extract other ideas for reform when the leadership’s policy cabinet had been emptied. The status quo was not satisfactory, but it seemed that the only good ideas were in the camp of the political opponents (though there were some lousy ideas there as well).

In spite of the political divide, both sides are largely in agreement that the deficiencies of ACA, listed above, are a problem and require correction. Many, especially on the Republican side and amongst the progressives, are convinced that the ACA model should not be sustained because it is inefficient, too expensive, and not very amenable to legislative patches. Also there is broad agreement that the Republican replacement proposal would only have made things worse.

The awakening that is taking place is that the popular Medicare program has been functioning well, though it needs improvements (which are quite feasible), and that other nations really have provided truly universal, comprehensive coverage at much lower costs – like Canada’s Medicare, for instance. A large minority of Republicans do believe that we should join the rest of the civilized world “in ameliorating and alleviating our common human vulnerability to illness and pain,” in the words of David Frum.

Medicare is our most efficient, effective and affordable model for reform. Both sides need to step back for perspective. The neoliberals in the Democratic party need to acknowledge the superiority of improved Medicare for all and join with the progressives. The moderates in the Republican party also need to make the same acknowledgement and support the model as well. The Trump independents who wanted a better health care system should learn from the process that unfolded this past month and dig up the Trump statements on how single payer systems work well. It would not take much to convince him that single payer Trumpcare would bring to the nation our health care salvation. Even conservatives who care can come on board after giving thought to the concepts presented by David Frum (next to last paragraph above).

Just don’t bother doing it through the dominant political parties. Do it in the streets or anywhere else citizen action can gain traction.