I write this as a person who considers the U.S. health care system to be the worst in the developed world. It costs too much, fails too many people. “Go Fund Me” has become the “I need life-saving medical care, please help me” alternative health care system. People are dying because they can’t afford insulin, a life-saving medicine whose inventor purposely did not patent it precisely because it is a necessity for human beings with diabetes. Basic health care should be a right, especially in a nation that Conservatives bill as the richest and most powerful in history. That it is not a right, that people die daily because they can’t afford health care, is beyond shameful.
But I don’’t support M4A or any single-payer system because I don’t believe we can ever get the necessary public support, let alone legislative support, for such a system. Just as importantly, I think a national insurance system that blends the public and the private, which is the standard in most industrialized nations and was the goal of the ACA, is more sustainable and better for women.
So why do I think M4A is a bad idea? A very bad idea?
BACKGROUND OF THE ACA
One of Candidate Obama’s key campaign pledges was to reform our health care system. It was, per the polls, a very popular position. He even adopted Hillary’s idea of a Public Option.
Democrats won an astounding victory in 2008: White House, House and Senate. For a very brief time, Democrats even had a Super-Majority in the Senate.
For reasons I won’t go into, I was glued to C-SPAN during that pivotal year of 2009, glued to all the hearings on the financial crisis and health care reform. I watched all the committee hearings, all the mark-up sessions. I watched speeches by Representatives and Senators. I watched the third-party presentations. It was not a pretty sight.
Democrats did everything humanly possible to get Republican support. Many Republican amendments were accepted. The resuting ACA could have been written by The Heritage Foundation. But it failed to get any Republican support. Crafting legislation that must get a majority of House and Senate members is not easy under the best of circumstances. Doing so when one Party’s position is a unified “no way, never, ever” is a minor miracle. Those who didn’t watch the process underestimate just how much skill it took for Nancy Pelosi to pass the ACA, even with a solid Democratic majority. Senate passage hung by a thread. The death of one man, Senator Kennedy, almost doomed it.
So then what happened? The major, historic Democratic win in the House in 2008 was followed by an historic loss in 2010, and the ACA was very much a major reason why. Those voters who went for Obama in part because of the ACA? They either didn’t turn up in 2010 or decided they preferred their own health care insurance and voted for Republicans. Yes, Republicans and Conservatives lauched a major disinformation campaign (the “death panels”), aided and abetted, as always, by a feckless media, which they would certainly repeat. But that doesn’t matter. It happened and only fools would pretend it couldn’t happen again.
PASSING HEALTH CARE REFORM
Elizabeth Warren wasn’t a member of Congres at the time, but Bernie Sanders was. He didn’t contribute much to the crafting of the ACA — he spent most of his time complaining about the fact that it wasn’t a single-payer system — but he certainly knows how many hours were spent in the Senate debating every single line of the resulting legislation. Unless he’s chosen to wipe the experience from his memory, he is being not only naive but dishonest in pretending that M4A is an “easy call”.
Let’s be clear: Democrats lost their House Majority in large part because of support for the ACA. 2021 House Democrats, assuming we get a majority again, let alone the Speaker, are not, repeat not going for a repeat performance in 2022.
QUESTIONS/ISSUES M4A SUPPORTERS MUST RESPOND TO
So, instead of demanding that Sanders and Warren explain the financing, we should be asking the more vital questions:
1. The U.S. health care system is about 17% of GDP and employs over 2M people. How exactly do they plan to dismantle it without destroying the economy and throwing millions of voters onto unemployment?
2. Why should any 2021 Democratic Representative from a purple or red district risk re-election by voting for M4A given the history with the ACA? And how does either candidate expect M4A to pass the Senate without a Super-Majority (especially given the slim chance of our winning even a simple majority)?
3. The ACA has been under repeated attack in the Courts. SCOTUS now has a very Conservative majority. The Federal courts are being stuffed with Conservative idealogues. Republicans have voted to repeal the ACA, in both the House and the Senate, over 60 times. The Trump Administration has used every tool it possesses to undermine the ACA. We can assume that any future Republican Administration would do the same to M4A, especially given the decades-long obsession of both Republicans and Conservatives to privatize Medicare.
4. Do not let Sanders or Warren get off the hook with a “it will be so popular, Republicans wouldn’t dare” answers. England’s National Health Service, implemented after WWII and widely considered to be a gold standard among single-payer systems, has been under serious attack for the past several years. Think about that. Hard. A health care system that can be dismantled when government changes hands is not one we should place our sole faith in.
5. Why should women not fear a single-payer system under control by Republicans who deny the right of women to control their own reproductive systems? They Hyde Amendment has been in effect for decades, was not repealed even during Democratic control of all three branches of government. In Missouri, the government is now tracking womens’ menstrual cycles. A single-payer system under Conservative control will deprive women of safe, affordable health care. You can count on it.
PUBLIC OPTION
These are my reasons for favoring the addition of a Public Option to the ACA. I think it is the only major expansion to our health care system that is potentially achievable. It can be sold, assuming that Democrats learn the “art of the deal”, on the basis of free-market competition. If the Public Option is unappealing, citizens will continue to choose private insurance in the ACA marketplace. If it becomes popular, the private health insurance companies will need to offer more attractive policies or go out of business. This is the essence of competition.
We should, of course, fight for other changes to the ACA: the ability of the government to negotiate drug prices, free basic health care for, say, every child under the age of 10 (choose your break-off point), and some mechanism for ensuring that everybody, regardless of income, has access to basic, essential health care. Incremental changes have a chance. A major overhaul does not. Any candidate who argues it can be done is either lying or too naive to be in the White House.
PRIVATE INSURANCE IS A SAFETY NET
It is extremely distressing to make this argument, but in our polarized nation, in a country where the rights of women are under concerted attack even by “never-Trumpers”, a healthy private insurance industry is the only protection that women have against Conservative control of the health care system.
