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 Even worse, Congress repealed vital portions, including the individual mandate that disrupted the basis of its functionality.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 it was a bold first attempt to expand health insurance to millions of Americans who desperately needed coverage.
Obamacare is far from “socialized medicine” and is based on principles other countries have utilized 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 (such as coverage for pre-existing conditions), which were never designed to be selectively utilized 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 may be the only option left 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.
The Americans are increasingly warming to the idea of single-payer. Although the results of surveys vary, a Kaiser Family Foundation poll found that 53 percent of the public now favors single-payer (43 percent opposed). The favorable response increases to 64 percent when termed “Medicare for All.”
Not surprisingly, a majority of Democrats and independents are in favor, while 67 percent of Republicans are opposed.
Physicians are increasingly positive regarding single payer. Another Kaiser survey revealed that 56 percent 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, insuring 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 costs; it wouldn’t be a stretch to 100 percent. My Medicare patients are actually quite content. Sander’s plan is an introduction to the American public of what the future may hold.
Richard Feldman, M.D., is an Indianapolis family physician and the former Indiana State Health commissioner. Send comments to awoods@