By Andy Slavitt
JAMA Forum, August 30, 2017
This current debate isn’t over as long as the administration clings to talk of repealing the ACA. Still, the movement toward a single-payer system or another variant is beginning. There will be much written about the ideas that will shape our future. Whatever those ideas are, if we want them to succeed, we must begin now to create the ingredients for successful legislation finally worthy of our country.
Democrats Should Negotiate with the GOP on Health Care
By James C. Capretta
RealClear Health, August 30, 2017
While in office, President Obama often remarked that the ACA relies, at least in theory and to a degree, on the Republican principles of markets and private insurance. He was right, even if he failed to note that the ACA also includes levels of governmental control and federal spending that Republicans were never going to support. If Democrats are willing to abandon dreams of single-payer and stick with a framework that features competition and consumer choice, it should be possible to find common ground with Republicans while moving even closer to the enrollment of all Americans in a health insurance plan.
By Don McCanne, M.D.
Andy Slavitt and James Capretta both support moving forward with health care reform, though one might be considered center-left and the other center-right. So where are we headed?
Republicans support less government and more markets and competition. In contrast, there has been a surge of Democrats voicing support for a government single payer program. But what is the actual record of Democrats?
Since the neoliberals assumed control of the Democratic Party, they have supported market solutions – first with the failed Clinton effort, and then with the Affordable Care Act and their marketplace insurance exchanges of private plans. Even well established government programs are shifting to the private sector with an expansion of private Medicare Advantage plans in the Medicare program, a massive transfer of Medicaid to private Medicaid managed care organizations, and even transferring care of VA patients into the private sector through the Veterans Choice Program.
In his full article (link above), Slavitt states, “Our goal should be to develop policies that we have real-world experience with, so we can avoid think-tank fantasies that either overstate the power of free markets or fail to see the unintended consequences of government intervention.” That’s very neoliberal of him.
Capretta states, “If Democrats are willing to abandon dreams of single-payer and stick with a framework that features competition and consumer choice, it should be possible to find common ground with Republicans while moving even closer to the enrollment of all Americans in a health insurance plan.” That’s very conservative of him.
The pro-market, pro-corporate views of the neoliberals place them in the same camp as the conservatives in regard to financing health care. Many Democratic politicians have given token tribute to single payer, even to the extent of signing on as co-sponsors of Conyers’ single payer bill – HR 676. But several of them qualify their support by describing single payer as being merely an “aspiration” but not a practical consideration at this time when we need to be supportive of the Affordable Care Act. More private Medicaid managed care. More private Medicare Advantage plans. More private VA care. More private plans in the ACA marketplaces. Introducing a public option that is public in name only since it would be designed along the model of private plans while being prohibited from competing “unfairly” and would be financed without government funds – crapola insurance.
There is a night and day difference between financing health care in the marketplace through private insurance and financing it through a government national health program. One is framed around businesses and the other is framed around patients. Today the conservatives and neoliberals are offering us only the business approach supervised by the medical-industrial complex.
Harold Pollack is a highly respected health policy expert from the University of Chicago who sometimes drives us at PNHP a little bit crazy with the legitimate concerns he expresses about the politics and logistics of single payer, even if none of it is insurmountable. But he said something interesting the other day: “Republicans’ failed repeal-and-replace effort has solidified the consensus around universal coverage and provided an exemplar process for radical policy change. A lot of Democrats are saying: ‘If they can try doing this with something so unpopular that would hurt tens of millions of people, why can’t we do something on that order that would be popular and help tens of millions of people?’”
Yes, why can’t we? Not just the Democrats, but all of us. Like maybe single payer.
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