Donald Trump campaigned promising to "repeal and replace" Obamacare. He has now discovered that insurance reform is more complicated than he realized. Congressional Republicans, happy to pass irresponsible repeals when they could count on a veto from President Obama, cannot agree on a replacement now that it will have real political consequences.
Trump sensibly said that replacement and repeal should be simultaneous. Simultaneity meant that repeal would be delayed since there was no Republican consensus on a replacement. But delay was preferable to the mess a mere repeal would cause.
Obamacare insured millions of additional people. 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 and the most unpopular part of Obamacare, mandatory purchase of insurance, is eliminated.
The obvious way to escape from this dilemma is to enact a single-payer system — an improved Medicare for all — financed by general taxation. 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. And it would save Americans a lot of money.
Medical providers would no longer need huge staffs — now costing about $80,000 per year for every doctor — to bill dozens of insurance companies. Readers familiar with TV's Doc Martin may remember that this irascible English doctor has only one employee.
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 insurance companies use to figure out reasons for not covering people.
The situation presents an opportunity for Donald Trump, a world-class opportunist. Imagine him explaining to supporters, often economically disadvantaged, 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 have to bite their tongues and support him. Support would also come from many of the voters, Republicans and independents, 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, would be uniquely able to explain why inevitable criticism of his proposal by the medical-pharmaceutical-insurance complex is rooted in self-interest and misleading. He could explain why the taxes to pay for Medicare for all will cost Americans with average or especially lower incomes less than they now pay, directly and indirectly, for medical care.
Critics might note that Medicare for all, by making insurance more efficient, would cause immense unemployment among non-medical people currently working for doctors, hospitals, and insurance companies. But Trump could correctly reply that people will take the money previously spent to support these administrators and spend it on other things, thereby creating an equal number of new jobs in other industries. Any unemployment created by this reform would be temporary, and implementing the reform during a booming economy would mitigate even this damage.
Although most congressional Republicans have opposed a single-payer system, if Trump convinces public opinion many Republicans in Congress would have to vote for it. If single-payer failed to pass, Trump could urge voters to unseat those who opposed it in 2018.
Conservative public opinion may already be starting to turn around to support an improved Medicare for all. Charles Krauthammer — a trained psychiatrist as well as a nationally syndicated columnist — spoke favorably of it recently. And conservative columnist George F. Will — Princeton Ph.D. in political science — has just indicated that it is probably the best way to escape from the complex inadequacies of Obamacare. One of my own columns, published in 2009, urged conservatives to reconsider their knee-jerk hostility to a single-payer system, so perhaps I was a little ahead of the pack.
If President Trump decides to endorse an improved Medicare for all, I recommend that— after previous quiet consultation — he invite Senator Bernie Sanders to the White House so the two of them could make a dramatic joint announcement. This could be political theater on a Shakespearean scale and, hopefully, one of the high points of the Trump presidency.
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 is Professor Emeritus of Political Science and Computer Science at Adrian College. He received his PhD from Johns Hopkins University in 1966, and has been a National Merit Scholar, an NDEA Fellow, a Woodrow Wilson Fellow, and a Fellow in Law and Political Science at the Harvard Law School. His college textbook, "Thinking About Politics: American Government in Associational Perspective," was published 1981 and his most recent book is "The Case of the Racist Choir Conductor: Struggling With America's Original Sin." His columns have appeared in newspapers in Michigan, Oregon, and a number of other states. To read more of his reports — Click Here Now.
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