By Paul F. deLespinasse
Statesman Journal (Salem, Ore.), Feb. 2, 2017
Donald Trump promises to “repeal and replace” Obamacare and has said that replacement and repeal should be simultaneous. Let’s hope he insists on simultaneity. Repeal would be delayed since there is no Republican consensus on a replacement. But delay is preferable to the mess caused by a mere repeal.
Obamacare insured millions of additional people. And some parts are very popular, especially its ban on denying insurance to people with preexisting conditions. But insurance markets would be destroyed if this ban is retained but the most unpopular part of Obamacare (mandatory purchase of insurance) is not also retained.
The obvious way to escape from this dilemma is to enact a single-payer system — an improved Medicare-For-All — financed by general taxes. Nobody would have to buy insurance, but everyone would be insured. People would not have to choose between incomprehensible policies with different coverage and doctor “networks.” Patients would no longer “churn” between different types of insurance, each with its own network, as incomes change. People would no longer have to document their finances in order to qualify for subsidies.
Medical providers would no longer need huge staffs — now costing about $80,000 per year for every doctor — to bill dozens of insurance companies.
Conservatives bemoan duplicated government programs and administrative bloat. But we now have separate government agencies for insuring poor people, retirees, veterans and Native Americans. We also have private bloat: back-room staffing at medical providers and huge staffs that insurance companies use to figure out reasons for not covering people.
This presents an opportunity for Donald Trump (a world-class opportunist). Imagine him explaining to his supporters (often not economically advantaged) why a system covering medical bills with only nominal co-payments, no deductibles and no out-of-network doctors would be strongly in their interest. Or explaining to black Americans how an improved Medicare-For-All would do more for minorities than any other conceivable government program.
If Trump were to propose Medicare-For-All, Democrats in Congress would support him, and so would many of the voters who supported him.
Medicare-For-All would not require establishment of a new bureaucracy since Medicare is already a going concern. Indeed, it would allow elimination of the organizations now covering the poor, veterans and Native Americans.
Trump, knowing how to get national attention, will be uniquely able to explain why inevitable criticism of his proposal by the medical/pharmaceutical insurance complex is self-interested and misleading. He can explain why taxes necessary to pay for Medicare-For-All will cost average (and especially below-average) Americans less than they are already paying (directly and indirectly) for medical care.
Although most congressional Republicans have opposed single-payer, if Trump convinces public opinion, many Republican congressmen would have to vote for it. If single-payer failed to pass, Trump could urge voters to unseat those who opposed it in 2018.
It took red-baiter Richard Nixon to restore U.S. relations with China. Can a Republican president bring us Medicare-For-All?
Paul F. deLespinasse of Corvallis is professor emeritus of political science and computer science at Adrian College. He can be reached at firstname.lastname@example.org.