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Tags: 2020 Elections | Barack Obama | Healthcare Reform | single payer | obamacare | insurance

In-Depth Study, Not Rhetoric Will Reform Healthcare

on the  road to healthcare reform

(Marko Bukorovic/Dreamstime)

By    |   Tuesday, 13 August 2019 03:31 PM

Democrats seeking the presidential nomination argue hotly about medical insurance. Some favor building on Obamacare, others propose a "public option" so people can "buy in" to Medicare, still others want a full single-payer (Medicare-for-all) program.

They may all be making a big mistake.

As would Donald Trump, if he puts forward a proposal knocked together by his campaign people.

The medical-pharmaceutical-insurance complex is a sixth of the national economy.

Major changes without study, analysis, and discussion would be folly.

Individual candidates are in a poor position to do the necessary work.

For 10 years, I have studied and written about the medical insurance problem. It soon became obvious that designing a better system runs into many conflicting economic and political considerations. Unsurprisingly, given this complexity, most of the Democratic candidates seem to have a mixture of good and bad ideas.

Sound bites to maximize voter support will not be helpful in sorting out the sense from the nonsense here. It is hard for voters to think clearly about policies while subjected to intense propaganda from spin-doctors for insurance companies and other corporations with major interests at stake.

Voters need to focus on the personal character, temperament, and experience of the candidates rather than their policy proposals, many of which would be dead on arrival in Congress anyway.

The Democratic contenders should stop bickering about specific solutions to this problem. Instead, they should pledge that, if elected, they will ask Congress to establish a high-powered non-partisan Commission on National Medical Policy.

The candidates should also promise that if elected they will support tweaking Obamacare to make it work better, but will make no major changes in it before the commission reports its recommendations.

The commission would study the major countries that have national health insurance programs, perhaps with special attention to countries like Switzerland and Taiwan that adopted such programs most recently.

It would analyze the respective advantages and disadvantages of these various national systems.

It would also invite testimony from all interested groups in the U.S., including the medical and health care professions and the drug and insurance companies, although these interested parties should not be represented in the commision's membership. 

The Commission would be asked to draft a proposal — appropriate to American circumstances — as far as possible incorporating the strengths of these other systems while avoiding their weaknesses. Hopefully, the Commission's recommendations could command bipartisan support in Congress.

Since the devil is always in the details, Congress should then develop the necessary changes in law with full due process of legislation: committee hearings, expert testimony, public input, markup of the bill in open committee meetings.

We should not expect to establish a perfect medical system. Any possible system will have some defects and incorporate numerous compromises, given many conflicting interests and considerations. Services covered must be limited to some extent since some medical technologies are too expensive to provide them to everyone who might benefit.

The commissioners must be willing to follow the evidence wherever it leads.

If it leads, as I expect, to some kind of single-payer system, the fact that this might put private insurance companies out of business should not be a deal-breaker. Perhaps they could still sell other kinds of insurance.

Perhaps not. But life is tough.

A country which has survived the bankruptcy of airlines, auto companies, and banks should not hesitate to put the insurance companies out of their misery if the public welfare requires this.

Jobs lost at the insurance companies and medical billing departments would be be replaced with new positions created by the money people would otherwise have been spending on healthcare.

If the new system is single-payer, most people will pay higher taxes.

Contrary to the claims of some Democratic contenders, there are not enough rich people to "soak" to pay for it without doing this. But the tax increases would be more than canceled out for the average person.

People would no longer pay insurance premiums and deductibles. Nor would they be paying very substantial amounts indirectly, as they do now when their employers pay lower cash wages so they can write the check for workers' insurance.

If the system is not single-payer, it will force people to make complex choices that may be beyond most of us. And it may, like the original Obamacare, include mandatory purchase of private insurance — a tax in everything but name.

Over 2,000 years ago, Aristotle compared the constitutions of the various Greek city states in his effort to determine an ideal form of government. It would likewise be intelligent for Americans to study other countries' experience before enacting major medical reforms.

Paul F. deLespinasse is Professor Emeritus of Political Science and Computer Science at Adrian College. He received his Ph.D. 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 in 1981 and his most recent book is "Beyond Capitalism: A Classless Society With (Mostly) Free Markets." 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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If the system is not single-payer, it will force people to make complex choices that may be beyond most of us. And it may, like the original Obamacare, include mandatory purchase of private insurance — a tax in everything but name.
single payer, obamacare, insurance
Tuesday, 13 August 2019 03:31 PM
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