Shared from the 7/3/2019 Houston Chronicle eEdition

EDITORIAL

Health care remedy

Medicare for All needs to add public option while keeping private insurance industry.

The bruising body blow Medicare for All received during last week’s Democratic presidential debates actually may have helped it. That’s after critics pointed out how to improve Bernie Sanders’ idea: Use the Affordable Care Act to build a health care system with both a Medicare-like public option and private insurance.

Sanders’ strong showing in pre-debate polls, where he typically trailed only former Vice President Joe Biden, suggested that Sanders’ signature proposal to replace all private insurance with a federal program similar to Medicare had been embraced by many of his debate competitors.

So, the response was surprising when moderator Lester Holt asked the 20 candidates chosen for the two-night debate, “who would abolish private health insurance in favor of a government-run program?” Only four raised their hands: Sanders, Sen. Elizabeth Warren, New York Mayor Bill de Blasio, and Sen. Kamala Harris, who insisted a day later that she had misheard the question and should have kept her hand down.

With almost all the Democratic candidates saying they don’t want to kill the insurance companies, that is unlikely to be part of any version of Medicare for All that survives the campaign. Any revised plan will more likely propose the peaceful co-existence of both government and private insurers.

That’s not the revolution Sanders wants, but it makes sense. Remember the harsh criticism President Barack Obama received after retreating from his promise that under the ACA, “If you like your health care plan, you can keep it.” Millions of Americans do like their health plans and don’t want to give them up. Especially not for something that seems so nebulous.

Each Medicare for All proponent puts a different spin on it. No one knows what it will cost. Sanders did admit Thursday night that middle-class families would pay more taxes for a much bigger Medicare system, but he said the health care they receive will cost less: “People who have health care under Medicare for All will have no premiums, no deductibles, no co-payments, no out-of-pocket expenses.”

The Vermont senator didn’t mention that many small hospitals in rural areas may close if forced to rely only on Medicare reimbursements, which often fall far short of what insurance companies pay them.

Former Colorado Gov. John Hickenlooper stressed Thursday night that it would be a political mistake for Democrats to take private health insurance away from 180 million Americans.

Sen. Michael Bennett of Colorado said universal health care should be the goal, but “I believe the way to do that is by finishing the work we started with Obamacare and creating apublic option.”

New York Sen. Kirsten Gillibrand defended Sanders’ Medicare for All bill, saying she wrote the section that calls for a four-year transition to a single-payer system that replaces insurance companies.

But a four-year transition won’t keep people from getting angry over losing their private insurance. Speaking of angry people, how about the half-million people who work in health insurance offices who will have to find another line of work under Sanders’ plan?

He’s right in saying America’s current health care system stinks. He’s right to point out that health insurance companies that call themselves nonprofits are paying CEOs millions of dollars ayear while their customers are trying to scrape up the money to pay excessive premiums, copays and deductibles.

The insurance companies’ avarice isn’t so much the federal government’s fault as it is the fault of individual states, where insurance commissions have failed to provide the rigorous regulation that industry needs. It’s the states’ job to do something about that, but the next president and Congress can help by giving the insurance companies the real competition that Obamacare couldn’t provide.

Obamacare’s supporters bought off the insurance companies with promises of lucrative subsidies and an influx of new customers. Any thoughts of strengthening the ACA after it became law were dashed when the Republicans took control of Congress and crippled Obama-care in their vain effort to kill it. Fortunately, Obamacare lives.

If a public option is added to the law and if funding is restored to renew outreach efforts dismantled by the Trump administration, the ACA could provide the alternative for consumers that stops insurance companies from being so greedy. If the insurance companies don’t change their ways, many Americans, given the option, will choose Medicare for All — or at least, Medicare for the Many.

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