By Nathaniel Smith, Columnist, The Times
For years Democrats have been saying that Obamacare, officially the Affordable Care Act (inspired, incidentally, by Mitt Romney’s program in Massachusetts) is imperfect but a good step forward while Republicans (even some benefiting from it) say Obamacare is “big government” at its worst, even though it leaves the insurance industry in the driver’s seat and transfers taxpayer subsidies to private companies.
In our change-averse country, nothing is truly new and everything builds on something else. Obamacare did not create a national health system; it made some improvements, especially in making people with preexisting conditions eligible for insurance, allowing children to stay on their parents’ policies till age 26, and reducing the number of uninsured Americans by 20+ million.
Insurance companies were a willing part of the Obamacare deal but now should we be surprised that they, like pharmaceuticals, are raising their prices? Their job is not to help sick people but to turn a profit.
In 2008-10, a “public option” was under discussion and even passed in the US House of Representatives as part of Obamacare before being shot down in the Senate. The public option would set up an insurance alternative that depends neither on insurance companies nor on taxpayer subsidies. Naturally costs and premiums would be lower because the public option would not have to please stockholders and highly-paid executives. The public option would essentially be Medicare for more people than the currently covered 55,000,000 (mostly over 65, but some younger in special health issues).
Now the public option is back on the table. A bill to establish it has been before Congress since 2013. The option has been supported by Bernie Sanders, the 2016 Democratic National Convention, president Obama, and candidate Hillary Clinton. Her web site pledges:
“Defend and expand the Affordable Care Act, which covers 20 million people. Hillary will stand up to Republican-led attacks on this landmark law—and build on its success to bring the promise of affordable health care to more people and make a “public option” possible. She will also support letting people over 55 years old buy into Medicare.“
Donald Trump’s site, on the other hand, says:
“Hillary Clinton will offer a public option on the Exchanges, driving out private health plans and leaving Americans with fewer options and eventually no choices but a government run plan.”
His list of health care specifics makes clear that he trusts money-making enterprises to hold Americans’ health in their hands. As our future health system evolves incrementally within a market framework, I doubt that private health plans will ever be “driven out” or that we will in the foreseeable future go to the sort of national system that western Europeans depend on.
But as a Medicare beneficiary myself, I would like to see more people be covered by that very workable program and given shelter from the current industry-driven insurance anarchy.
“Medicare for All” (the single-payer option ideally favored by Bernie Sanders and Elizabeth Warren) will be a long time coming in this country.
But not to move at least toward “Medicare for More” when we have the chance would be, in Bill Clinton’s term, crazy.