Republican efforts to repeal and replace America’s Patient Protection and Affordable Care Act (a.k.a. Obamacare) have featured one political miscalculation after another. After six-plus years of basing much of their electoral strategy on repealing Obamacare, the Republicans finally find themselves in control of both houses of Congress and the White House. After more than fifty Republican-led votes to repeal Obamacare—harmless while they were in the opposition—the consequences of repealing Obamacare (e.g., the loss of health insurance for millions of Americans and loss of coverage for preexisting conditions) have become clear to the American public. And the American public decided it does not like what the Republicans are offering, which is essentially “repeal” without “replace.”
Overpromising was a central feature of Donald Trump’s campaign for the presidency. He was going to build a big, beautiful wall and make the Mexicans pay for it. He was going to unleash a secret plan to defeat ISIS. He was going to cut taxes and balance the budget. He was going to bring manufacturing jobs back to the US. He was going to impose tariffs on China and Mexico. And he was going to repeal Obamacare and replace it with something really terrific. We know what has happened to these promises so far: absolutely nothing.
Unfortunately, Donald Trump and the Republicans aren’t the only ones making unrealistic promises. Sen. Bernie Sanders (I-VT) has now decided to get into the act—and, sadly, he seems to have developed a following among Democratic heavyweights.
Several weeks ago, Sanders introduced his “Medicare for All” bill (a.k.a. Sanderscare). According to his web site,
Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
Although this may sound wonderful, there are more than a few holes in the proposal.
The bill itself does not specify the sources of the money to pay for this program, leaving the financing to future legislation, although the Sanders website says it will be paid for by a combination of increased taxes and cost savings. Given that voting for a tax increase is often the quickest way for a Congressman to be unseated at the next election, this may not be a winning strategy.
An even bigger problem, according to observers like Catherine Rampell of the Washington Post and Jonathan Chait of New York magazine, neither of whom qualifies as a Republican or a conservative, is that more than 150 million Americans already have employer-based health insurance and many are largely satisfied with it. So moving them to a new system will be both costly and, quite possibly, unwelcome. According to Chait:
That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.
Like much of Sanders’ presidential platform, Sanderscare is long on promises and high-sounding rhetoric, but light on details.
A reader might wonder about the value of spending any time at all bad-mouthing a proposal that has no chance of becoming law, given that the Democrats are in the minority in Congress? The problem is that the Sanders proposal—unlike a similar effort he made in 2013–immediately gained 16 co-sponsors among the Democratic minority in the Senate, including potential presidential candidates Kirsten Gillibrand (NY), Kamala Harris (CA), Elizabeth Warren (MA), and Cory Booker (NJ). This is a troubling development, suggesting that these Democratic heavyweights have learned very little from the bad behavior of Donald Trump and his Republican colleagues in Congress.
Rather than jump on the bandwagon with a deeply flawed and gimmicky proposal, Democrats should get behind the sort of serious bipartisan effort championed by Sen. John McCain (R-AZ) in what he termed “a return to regular order” of hearings and bi-partisan negotiations. Such negotiations were going on between Senate Health, Education, Labor, and Pensions Committee chair Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) before Senate Leader Mitch McConnell (R-KY) put an end to them.
There are many bipartisan, incremental steps that can be taken to improve and strengthen Obamacare. Serious legislators, like Alexander and Murray, are on the right track. Democrats who aspire to be president should get behind these efforts, rather than mimic the over-promising, under-developed, all-or-nothing models of the Republican proposals or utopian, impractical solutions offered by Sanderscare. Voters should require nothing less from their leaders.
Featured image credit: Rally to Save the ACA by Molly Adams. CC-BY-2.0 via Flickr.