I was at a gathering last night, surrounded by a mix of progressive and conservative friends. Most of us had not seen each other since before the election and there was a reluctance to jeopardize friendships, so political talk was avoided. However, I did have a small discussion with a small group of Trump supporters about healthcare, and I found an interesting viewpoint I had not expected.
All of us are assuming the Affordable Care Act is gone, or will be soon, based on Republican efforts. The primary problem these voters saw with Obamacare is that it did not lower healthcare costs to the consumer. To be fair, the only mechanism in the ACA to reduce the cost of healthcare is the introduction of a purely commercial marketplace, assuming the competition would drive the consumer costs down–standard Neoliberal doctrine, except that it hasn’t worked in this case.
The conversation went momentarily to the stated Republican solution to allow insurance companies across state lines, which makes the same assumptions about freeing the competitive market to offer their services to a larger pool of consumers. There are not now any Federal barriers to selling health insurance across state lines, and new legislation would mandate State insurance commissions to open their space to nation-wide carriers. Setting aside legal and technical issues, this would work as well (or poorly) as the Affordable Care Act because it assumes open competition is the fix-all.
Then I heard this: ‘As much as I hate the thought of the government running anything, I think we should leverage our collective purchasing power to drive down costs from health providers and big pharma.’
What my friend was describing is the primary advantage of a government run healthcare plan, and there are already two Federal programs doing this successfully. Medicare and TriCare (the health insurance plan for our active duty and retired military.) Both negotiate and cap fees paid to providers; and both take the profit premium out of the equation. If either one of these were expanded to include working, non-military U.S. citizens we would have a new baseline of cost-effective service that would force commercial insurance carriers and healthcare/pharma providers to show greater value to us all at a lower cost. Moreover, we would truly be leveraging our collective purchasing power to drive down costs.
This is single-payer healthcare and is something Democrats and Progressives have advocated for a long time.
It is likely in the new Republican controlled House and Senate, there will be bills floated and discussed to privatize Medicare and/or replace it with a voucher system. If this is done, we will have effectively neutered our government’s ability to negotiate and deliver more cost-effective health insurance coverage.
So, the conversation with my friends drifted off to other topics, but I was satisfied there is a crack of agreement among us all that the government should play a more proactive role in reducing healthcare costs for all Americans, and maybe a single payer health system should be given another look. It works in Canada. Why can’t we do it here?
We didn’t get around to discussing improving the overall health in America. From my experience, conversations with conservatives are hyper-focused on reducing the costs of the healthcare mechanism; just the current system for providing care to people who are not healthy. Another driver of healthcare costs in the United States is the rapidly increasing frequency of chronic health issues like obesity, heart disease, hypertension and type II diabetes. Our current healthcare system is inadequate for reducing the rise in demand for the treatment of these health issues.
Perhaps this is the real issue progressives should address and champion?
What are your thoughts?
-J Miller