Republicans are once again engaged in an unlikely to succeed, last-ditch effort to fulfill a years-long promise to repeal the Affordable Care Act, also known as Obamacare. With victory in sight, Democrats are reopening the health care battle with a push for government-run, single-payer health care led by Senator Bernie Sanders (I-VT). This is a mistake.
It’s true the Affordable Care Act, which preserves a system of private health insurance, has shortcomings that are inherent to its market-based structure. Costs of insurance and medical care will always remain higher in a multi-payer system than in a single-payer system due to the inefficiencies associated with having multiple payers (employers, states and the federal government) and the difficulty of ensuring that all healthy people buy insurance.
These are problems that the “Medicare for all” proposal that Sanders released last Wednesday would likely fix. But the problem with Sanders’ plan (besides its lack of details), is that it’s ideologically out-of-step with American political traditions; it will not pass, and it will divide Democrats.
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The Affordable Care Act is a uniquely American solution, tailored to our traditions of individualism and limited government. The Obama Administration understood that in order to fulfill liberal aspirations for universal health care, it had to meet the conservative insistence on a market-based solution that is consistent with American political ideology.
And though Republicans revile the law that bears the name of its arch-nemesis, Obamacare is, in fact, the conservative alternative to government-run health care. The individual mandate, on which the success of the law rests, is an idea hatched by a conservative think tank.
Obamacare is also largely modeled after the Massachusetts health care plan that Republican Mitt Romney signed as governor in 2006 (both employ an individual mandate, expand Medicaid and offer subsidies to the poor). The passage of the Affordable Care Act is owed centrally to the Obama Administration’s strategic choice to wed liberal and conservative ideas — if it had not done so, the insurance industry and the public would not have gotten on board.
There is no reason to think that American political ideology is dramatically different enough now to make a single-payer system more feasible than it was just a few years ago.
A single-payer plan is also doomed to fail in Congress because it provides too many easy attack points for Republicans. Though the concept is enjoying more popular support than in years past, numerous polls show this support decreases dramatically when the issue of the government’s role in the system gets introduced into the discussion.
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Republicans will, of course, bring this issue and others to bear. These include longer wait times, less choice of providers and higher taxes, which will all be part of the plan and are frowned upon by many Americans. Republicans will find it easy to not only build opposition to the plan but to once again cast Democrats as being outside the boundaries of American political traditions.
Rather than scrapping legislation that works well and took an enormous amount of time and political capital to implement, Democrats should focus on the achievements that have been made by the ACA and continue to make improvements. Under the law, 20 million Americans have gained health insurance, and the uninsured rate is under 9 percent.
It is true that the law has its imperfections, but potential fixes are well-known and relatively straightforward: a higher penalty for not buying insurance, a public option and larger subsidies to help consumers buy insurance could all help expand access to affordable plans. These are issues that Democrats should certainly continue pressing.
While Senator Sanders is right on the policy — a single-payer system would cover everyone and likely create long-term savings for households and the economy, he is, perhaps sadly, wrong on the country. Rather than snatch defeat from the jaws of victory, Democrats should find solace in having passed the most significant piece of social legislation since the 1960s.
Natalie Spievack ([email protected]) is a senior majoring in political science and economics.