We can see it now, the smiling faces of more than forty Democrats and Republicans in the House of Representatives who are working on fashioning a compromise for health care after the apparent defeat of “Repeal and Replace.”
I wish that I did not think that terms like compromise and bi-partisan mean capitulation for the Democrats. However, recent history shows that this is almost a certainty. A fundamental difference between today’s Democrats and Republicans is that the Republicans never lose sight of their locked-in ideological positions. When it comes to health care policy, almost all Republicans march lock-step to the mantra of repeal and replace the Affordable Care Act. The meanness that undergirds the policy positions of so many of their members is reflected by their efforts to cut coverage, raise costs and disenfranchise the poor.
Democrats seem to be happy just to be able to talk with Republicans. Other than Bernie Sanders, we hardly hear any Democrats clearly state that they support a system of Medicare-for-All. This should not be an outlandish position; it is completely consistent with the policies of the New Deal and Great Society. Medicare-for-All is a system that is based on compassion. It is a commitment to preserve and expand the social safety net for those among us who need it most.
The new bi-partisan group in the House that is promoting health care compromise is called the Problem Solvers caucus. Sounds like a good idea, but what exactly is it that they want to do?
The four items that they have identified as part of their agenda may sound reasonable on the surface. However, it’s important to keep in mind that these suggestions are all based on preserving and protecting employer-based health insurance and ensuring the financial well-being of insurance companies.
For health care to work in a society, two, and only two, vital moving parts must be of central concern. The first is the people – citizens seeking preventive and curative health care. The second is the providers – doctors, nurses, hospitals, clinics, etc.
Insurance companies only muddy the waters. They position themselves between the demand for health care (people) and the supply of health care (the providers). Insurance companies exist because of the naïve belief that they provide competition in health care which results in better service at lower cost. What they in fact do is design policies to maximize their profits while elevating premiums and reducing services. They continue to exist because they lobby well, particularly among Republicans, but also many Democrats, as witnessed by the key role of insurance companies in the Affordable Care Act.
As reported by New York Magazine, here are their four suggestions from the Problem Solvers caucus, and reasons why these suggestions provide band-aids at the expense of necessary reform:
The bipartisan working group also wants to change Obamacare’s employer mandate so that it applies only to companies with more than 500 workers. Currently companies with at least 50 workers can be hit with a tax penalty if they don’t provide coverage to their workers.
Problem: Millions of American workers are employed by companies with fewer than 500 workers. If those companies do not provide coverage, then the workers are left in the individual market with no group bargaining power. With Medicare for All, everyone would be on an even plain. Also, perpetuating employer based health insurance (a) raises costs for American businesses, and (b) keeps parasitic insurance companies in business.
The group also wants to create a federal stability fund — dollar amount unspecified — that states can tap to reduce premiums and other costs for people with extremely expensive medical needs. Both the Senate and House repeal packages contained similar pots of money.
Problem: why should states have anything to do with health care? As witnessed by so many states opting out of Medicaid expansion, as provided in the Affordable Care Act, empowering states with health care responsibility puts an irresponsible guardian in charge of citizens’ rights to health care. Also, states, particularly in the South, have shown much less regard for human rights than the federal government.
The bipartisan proposal also calls for scrapping Obamacare’s medical-device tax, an idea that has received bipartisan support in the past.
Problem: Let’s keep in mind that with Medicare-for-All, the program could largely be funded by an expanded payroll tax for the wealthy. There would not be a need for nickel and dime taxes.
Finally, the working group is seeking greater flexibility for state innovation. Obamacare already allows state to seek waivers from coverage rules, but the lawmakers want additional guidance on how states can take advantage of them.
Problem: As we previously said, empowering states disempowers individuals. State innovation is code language for states to engage in races to the bottom. The losers are those who most need the safety nets.
Currently, we are a long way from legislating Medicare-for-All. It’s also possible that there will be a temporary hibernation of the Republican calls to Repeal and Replace the Affordable Care Act.
So, it makes sense to look for compromise. The ideas that the Problem Solvers Caucus is suggesting may in fact help ameliorate current conditions in the health care market. To the extent that it is possible, fixes should be made.
But Democrats should not lose sight of the knowledge that the concept of a health care market is a construct of parasitic business interests at the expense of consumers and health care providers.
Before Democrats engage in “problem solving,” it would be best for them to clarify what they really want and ensure that their final goals will not be jeopardized by dancing with the Republicans.