The recent decision by the Trump administration to seek to overturn the entire Affordable Care Act is just one more example of the degree to which the current occupant of the White House is unfit for the office of president.
The ACA is far from perfect, as we have noted here on several occasions. Yet since its enactment seven years ago, an estimated 20 million additional Americans have gained health insurance coverage, reducing the level of the uninsured in America to a historic low. Nearly 200,000 Minnesotans are among those who have gained affordable coverage under the law.
But President Trump now wants the courts to declare it unconstitutional in the wake of a decision by a conservative federal district court judge in Texas, which would very likely have the effect of throwing the majority of the newly-insured Americans back into the ranks of the uninsured or underinsured.
President Trump, naturally, claims that he’d replace the ACA with something better, just as he claimed during the 2016 campaign. But when given the opportunity to actually propose an alternative, President Trump and his Republican allies in Congress punted. The truth is, President Trump has no idea how to fix health care. That’s not just our opinion, it’s the view expressed by Republican leaders in Congress, who have made it clear to the White House that they are washing their hands of any effort to upset the ACA applecart. Congressional Republicans got the message on healthcare this past November— Americans don’t want less access to health care and they’ll punish politicians who threaten to take away a benefit that millions of Americans now rely on.
President Trump, of course, is planning to run for re-election with the message: “Promises Made, Promises Kept.” And Trump ran on the destruction of the ACA, or Obamacare as he derisively calls it, so he’s ready to send the torpedoes no matter the consequences to millions of Americans.
As with almost everything Trump does, it’s a matter of ego over empathy. He’s happy to rob millions of their health care coverage for a bit of bluster in a stump speech.
The ACA does need fixing, and if President Trump and Republican leaders were willing to work constructively toward that end, they might find a willing partner in the Democratically-controlled House. Trump won’t do that, of course. He’s a bomb thrower, not a fixer.
Trump’s reckless decision on the ACA gives the Democrats an opening, and it’s one they should take by outlining how to expand coverage to all and make health care less costly in America. We can’t afford to spend twice as much as the rest of the world for lackluster health outcomes while still leaving 25 million Americans uninsured.
The Democrats shouldn’t shy away from a Medicare-for-all type solution because the government is the only entity powerful enough to implement the kinds of changes necessary to get the spiraling costs of care under control. Let’s be clear— the reason that Americans pay so much more for health care is that the profit motive drives so much of the decision-making here in the U.S. Drug companies charge Americans twice what they charge Canadians for pharmaceuticals because the government here allows that to happen.
Shifting to a single-payer system doesn’t have to be disruptive. A phased approach could allow individuals and small businesses to buy into Medicare, much like the public option originally proposed for the ACA. In that case, adding to Medicare’s enrollment would likely improve the program’s fiscal outlook while providing a more affordable option for many. Gradually stepping down the eligibility age for Medicare over a decade or so would ease the transition. There’s nothing magic about 65 after all.
Those who say that a switch to a single-payer system would be expensive are misunderstanding key facts. A Medicare-for-all system would ultimately save money on overall health care spending because of administrative savings and because Medicare pays providers about 40 percent less than private insurers. And, finally, allowing Medicare to negotiate drug prices would lower the cost of pharmaceuticals. Even studies from conservative think tanks have projected overall savings from Medicare-for-all.
The Democrats shouldn’t be content to play defense on health care. They need to recognize the limitations of the ACA and push for bolder solutions in response to Trump’s attacks on the program. It’s time for a party that is both progressive and strategic as it works to find real solutions to what ails health care in America.