The balance of power is now divided between a Democratic House and a more conservative Republican Senate. Obamacare will likely continue for now in limbo, maimed but not dead.
Obamacare’s flaws were left to languish by a Congress determined to see its demise. Even worse, Congress repealed vital portions, including the individual mandate that disrupted the basis of its functionality.
But Obamacare was a bold first attempt to expand health insurance to millions of Americans who desperately needed coverage. It is far from “socialized medicine” and is based on principles other countries have used to create successful universal high-quality and lower-cost multi-payer systems. But our toxic political atmosphere would not allow fixing Obamacare’s flaws to make it truly functional and equitable.
So, what’s next in health care reform? Medicare for all, a single-payer government system? More of the failed Republican approach of free-market principles, health savings accounts, and consumerism?
Health care does not follow the usual rules of economics. A Republican model would result in greatly contracted coverage. If combined with popular elements of Obamacare (like coverage for pre-existing conditions), which were never designed to be selectively used in isolation, it would result in unsustainable higher costs.
The American public is not yet ready for Medicare for all, presently promoted by the left hand of the Democratic Party. But if the next compromised paradigm fails, ironically, a single-payer system might be the only option remaining for a health care system left in shambles. America is the only highly developed country in the world that does not guarantee health care coverage for all people. The public will demand a different and more humane approach.
Americans are increasingly warming to the idea of single-payer. Although the results of surveys vary, a Kaiser Family Foundation poll found that 53% of the public now favors single-payer (43% opposed). The favorable response increases to 64% when termed “Medicare for all”. To no surprise, a majority of Democrats and independents are in favor, while 67% of Republicans are opposed.
Physicians are increasingly positive regarding single payer. Another Kaiser survey revealed that 56% of physicians are supportive. Doctors are tired of system complexity and bureaucratic and paperwork nightmares, and increasingly believe in the goal of universal coverage.
The most prominent single-payer plan belongs to Sen. Bernie Sanders. His Medicare for all plan is gaining significant support with Senate Democrats, unthinkable as a mainstream idea just a few years ago.
His plan eliminates Medicaid and almost all private and employer-sponsored insurance, ensuring comprehensive care to all people. It is considerably more generous than Medicare presently with no premiums, co-pays or deductibles, and covers virtually the entire continuum of medical care, including vision and dental. It includes negotiated lower-cost prescriptions and long-term care. Patients have free choice of providers and navigate a much less complex health care system.
However, the plan is enormously expensive, paid for mostly by tax increases to employers and individuals, which, according to the Kaiser poll, greatly erodes public support even though offset by virtually no out-of-pocket costs. That might be different in the future if there is no viable alternative. A less generous plan, or a government plan as an alternative choice, would be more financially and politically feasible.
The federal government now pays for two-thirds of health care costs; it wouldn’t be a stretch to get to 100%. My Medicare patients are actually quite content. Sanders’ plan is an introduction to the American public of what the future might hold.•
Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to firstname.lastname@example.org.
Click here for more Forefront columns.