Medicare for all — use formula to replace ACA
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"Praying for health shouldn’t be the foundation of a modern healthcare system. But that’s where millions of uninsured Americans still find themselves,” wrote The Los Angeles Times columnist David Lazarus Jan. 6, quoting the fears of Los Angeles resident Madelyn Gilbreath about the expected vote by Congress to repeal the Affordable Care Act (ACA).

“I just need to make it one more year and then I’m eligible for Medicare (like her husband who is on Medicare),” Gilbreath told Lazarus. “For my son, I’m just praying he stays healthy.”

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That’s a story nurses have heard before, including when a 64-year-old retired teacher asked an operating room nurse who was prepping him for heart surgery in San Diego, “can’t you wait one week until I turn to 65 and qualify for Medicare?”

 

Why should anyone have to wait to qualify for Medicare, one of the most popular reforms in U.S. history? Expanding Medicare to cover everyone remains a rarely discussed alternative to the reopening of a national healthcare debate.

Far fetched? Apparently not to the incoming President Donald TrumpDonald John TrumpFive takeaways from Cruz, O'Rourke's debate showdown Arpaio files libel suit against New York Times IMF's Christine Lagarde delays trip to Middle East MORE. “As far as single payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here,” said Trump in a Republican debate in August, 2015. That age should be the present time.

In their haste to unravel a law that was, in fact, based on conservative, market based premises, and tried out first in Massachusetts under then Gov. Mitt Romney, a number of Republicans are discovering an inconvenient truth about their dubious repeal and replace strategy.

Opinion polls consistently show some central elements of the ACA are quite popular, especially the coverage for those without prior insurance, mainly through the Medicaid expansion, and the crackdown on insurance abuses that permits people shut out by private insurers to now buy insurance.

But two of the major critiques of the ACA, especially the high out of pocket costs, with steadily increasing premiums, deductibles, co-pays and prescription drug costs, and narrow insurance networks that limit patient choice of doctors and hospitals, are very real crisis for millions of Americans.

Those are the very complaints, along with unexpected medical bills for out of network care, that working class supporters of Donald Trump enrolled in the ACA healthcare market exchanges cited in interviews with the Kaiser Family Foundation, as its President Drew Altman related in a New York Times commentary Jan. 5.

But when presented with alternatives floated by the repeal and replace crowd, including a tax credit to reduce premium costs, health savings accounts, or catastrophic coverage through large risk pools, a number of these Trump voters “recoiled, calling such proposals ‘not insurance at all’,” Altman wrote.

Exactly, they are not insurance, and they are not health coverage.

But there’s an inconvenient truth for Democrats as well.

By opting for the ACA, when Democrats, like Republicans today, owned majorities in the House and Senate as well as the White House, they abandoned an opportunity to push for a social insurance solution, updating Medicare and expanding it to cover all Americans, opting instead for an expanded insurance market plan.

The Democrats’ caution did not exactly pay political dividends. In the past eight years, they lost some 900 federal and state elections in which opposition to the ACA was a factor. Further, they relied on the same market approach to healthcare, basing our health on ability to pay and profiting off the sick and vulnerable, that created the healthcare crisis in the first place.

It’s why the Democratic Party, from Franklin Roosevelt to Harry Truman to Ted Kennedy all favored a national healthcare system, and why Lyndon Johnson, with broad popular support and a push from organized labor, succeeded in enacting a national system, Medicare for seniors and the disabled.

“If these Trump voters could write a health plan,” Altman wrote, “it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.”

There’s only one plan that accomplishes all that and more. Medicare for all would mean everybody in, automatic enrollment, complete choice of physician and hospital without insurance restrictions or surprise bills for “non-network” care, no co-pays or deductibles, and much lower administrative costs than private insurance. It would also make U.S. companies more competitive by not having high health coverage costs, the way most of the rest of the world operates.

And it’s not a foreign concept; up to 70 percent of Californians for example are already covered by a publicly financed system, primarily Medicare and Medicaid.

It’s also why the Democratic Party should not just adopt a strategy of defending the ACA, but fight for a comprehensive solution to our healthcare crisis once and for all. And they might just find one unexpected ally.

“Everybody’s got to be covered.” Who said that? Not just Sen. Bernie SandersBernard (Bernie) SandersFive takeaways from Cruz, O'Rourke's debate showdown Live coverage: Cruz faces O'Rourke in Texas debate showdown Saudi mystery drives wedge between Trump, GOP MORE, who has advocated single payer/Medicare for all for years. It was candidate Donald Trump last year in a CBS 60 Minutes interview.

Or in his book, The America We Deserve in 2000, "We must have universal healthcare. …We should not hear so many stories of families ruined by healthcare expenses... The Canadian (single payer) plan helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees.”

And, as recently as January 2015, to David Letterman on The Late Show, “A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.”

That great system can be ours too. Medicare for all.

 

RoseAnn DeMoro, executive director of National Nurses United, has emerged as one of the nation’s preeminent advocates for genuine healthcare reform and working people. Featured in profiles in The New York Times, Wall Street Journal, Los Angeles Times, and Businessweek DeMoro has also been named “America’s Best & Brightest by Esquire magazine, honored as among “America’s Most Influential Women” by MSN and one of only eight people to be cited among the “100 Most Powerful People in Healthcare” for the past 12 consecutive years by Modern Healthcare magazine. DeMoro also serves as national vice president and executive board member of the AFL-CIO.


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