The competition for the Democratic Party nomination between Hillary Clinton and Bernie Sanders is definitely heating up as we start the primary election season. Although it lacks the venom of the Republican fight, Hillary and Bernie have some serious disagreements on the issues (unlike Hillary and Barack Obama back in 2008) which will give voters more of a real choice of whom to vote for.
Hillary, citing her pragmatism, wants to make incremental changes to our government to make improvements. Bernie believes the system is broken and nothing less than revolutionary change is going to effectively address our problems.
Nowhere is this contrast more evident than their positions on how to improve health insurance for Americans. Hillary feels that working with the Republicans to improve the Affordable Care Act (better known as Obamacare) makes far more practical sense than trying to replace it with a more controversial single payer system that Bernie (and I) advocate.
For those not familiar with what ‘single payer’ insurance means, here is a brief explanation. In the US, health insurance (for those under 65) is purchased from a network of private insurance companies. By contrast, a single payer system uses the government to take the place of the private insurance companies. It alone collects premiums (in the form of taxes) and it alone pays benefits when needed to its citizens.
Contrary to conservative rhetoric, single payer (along with the dreaded Obamacare) are not a “government takeover of healthcare”. The actual providers of the care do not work for the government (as opposed to those working for the Veterans Administration).
In the US, single payer as a political position is too hot to handle except for the most liberal politicians (such as Bernie Sanders). But despite its reputation in the US, single payer is the de facto standard for health insurance in most of the rest of the industrialized world. And for good reason! Single payer systems are much more cost-effective due to their lower overhead and lack of a profit motive compared to private insurance - and all of its citizens are covered! As still another dubious example of American Exceptionalism, only Americans among those in the industrialized world are subject to financial ruin just for getting sick!
So can such a seemingly controversial idea as single payer work in the US? Well, it does already in the form of Medicare for those over 65! Advocates like Sanders just want to expand the Medicare program to all Americans. Yes, Medicare does have its problems but it does work despite only covering the oldest and sickest among us. Adding all of the remaining younger and healthier people to the risk pool can only make the program more viable.
So circling back, can Obamacare be improved to offer the same advantages as those provided by a single payer system as Hillary is advocating?
Let’s start out by saying that Obamacare was a great step forward for America because it addressed the problem of those with preexisting conditions not being able to get insured. And Obamacare has recently celebrated a milestone in now insuring over 90% of Americans! Whoopdee doo!!
But in a nation of over 300 million, that means we have about 30 million who are still without health insurance in addition to many millions more who are underinsured. A couple of weeks ago, 60 Minutes reran a story about what is known as the Health Wagon, essentially a large repurposed Winnebago winding its way through Appalachia back roads to provide free medical care to its many people who despite Obamacare, still do not have access to health insurance.
Many of those stepping aboard the Wagon were obviously quite sick from neglect because they couldn’t afford a doctor. Some eventually died because help came too late. It was heartbreaking to watch. Here is the video link so you can watch this if you haven’t already. All I could say to myself out loud over and over was, “We can do better than this!”
So finally, what about the politics around all of this? Whatever the merits of an idea, it is unfortunately politics that often determines what turns a dream into reality.
It has been said that single payer is impossible in the present political environment so pursuing it is little more than tilting at windmills. But when it comes to trying to improve Obamacare, the Republicans in Congress have made it quite clear that their obsession is not to improve Obamacare but to destroy it. Sorry, Hillary!
So if the half loaf requires just as much political heavy lifting as the full loaf, why not just go for what we want and need in the first place? And as long as Obamacare is still around to serve as a placeholder, we have nothing to lose by going for what’s best for our nation as a whole!
It is worth noting that the great social advances in our history such as Civil Rights, the end of slavery, and women's suffrage were also at one time, politically impossible. But if enough of us can mobilize behind a truly important cause like making access to affordable healthcare a right for all Americans, we can move mountains! Giving up is just not an option!