Slouching Toward Single Payer

GOP Inaction on Repeal Creating Opportunity for Democrats
By Brian Joondeph, M.D.

Remember back in 2012 when then Vice-President Joe Biden told us, “Bin Laden is dead, General Motors is alive”? The good old days. Also around the time Senators John McCain and Lisa Murkowski promised to repeal Obamacare. Along with a bunch of other Republicans seeking reelection to Congress.

            Fast forward to 2017. The new catchphrase is “GOP is dead, Obamacare is alive.” At least their credibility is dead. Not only Obamacare repeal, but also tax cuts, immigration enforcement, balanced budgets, reduced spending, and so on.

            Repeal and replace, as a promise was simple enough on the campaign trail. We heard this promise in 2010, when voters gave the House to Republicans. We heard it again in 2012, when voters gave them the Senate.  Despite controlling Congress, Obamacare remained alive and well.  Candidate Donald Trump, along with most Republican members of Congress, promised repeal and replace last year.

            Eight months into the Trump administration, Obamacare is still kicking. Congress had three bites of the apple this year and each time came up with a worm instead.

            Graham-Cassidy didn’t even earn a Senate vote this week after three promised GOP defections. Too bad they didn’t vote. Why? How about getting the Senators on record with a yea or nay vote? Votes that they could be reminded of during their next campaign.

            Republican lassitude is not lost on voters, as Luther Strange learned last week. Sen. Bob Corker noticed too, choosing to do nothing as a private citizen rather than as a U.S. Senator. Congress may not want to repeal Obamacare, but the voters do.

            Many want a simple repeal, similar to what Congress passed multiple times, certain that their virtue signaling repeal bills would be slapped down by an Obama veto. Now that the veto threat is gone, so are the votes for repeal. It won’t happen.

            What’s next? Waiting in the wings is Bernie Sanders’ “Medicare For All” bill which has the support of 17 Democratic senators, more than a third of their caucus. On the House side, Rep. John Conyers has his own version of single-payer with 119 co-sponsors, more than half of the Democrats’ House caucus.

            America is already drifting toward single-payer. Medicaid, Medicare and the VA are all single-payer health insurance plans. And the Democrats are ready and waiting to take advantage of Republican chaos and an imploding Obamacare.

            Perhaps this was the plan all along. It was then Sen. Barack Obama who once said single-payer is the goal, but “we can’t get there immediately.”

            If President Trump cannot get anything done with his own party in Congress, maybe he calls his new buddies Chuck and Nancy. Just as John McCain always extolls, “reaching across the aisle.”

            Suppose Donald, Chuck and Nancy cook up a two-tiered system, something for everyone? A public option and a parallel private option. Just as most developed countries have. The public option covers everyone. Think of Medicaid for all. A bare bones catastrophic coverage plan available to all Americans. With minimal or no out-of-pocket costs to patients but with the tradeoff of long wait times for care and limited treatment options.

            The private option allows individuals to purchase medical insurance or actual care directly, what they want and need, nothing more. Insurance without mandates and regulations. No subsidies, tax breaks or government assistance. Pure free market.

            Think of K-12 schools. Public schools available without cost to all students. For most a good education. And a private school option for those who desire and have the means. Pay the private cost or default to the public option and pay nothing.

            Pros and cons to each system, but both are separate and distinct, each doing what it’s designed to do. Rather than an amalgam of both systems, which is what we have with Obamacare, Graham-Cassidy, skinny repeal or whatever the witches and warlocks of Congress conjure up.

            Something for both the right and for the left. Free market for the right. Universal coverage for the left. Perhaps the only way to get past the current logjam in Congress. If Republicans continue to twiddle their thumbs and do nothing, they may soon find themselves in the minority. Leaving Bernie in charge.

            If the Democrats control Congress, make no mistake, they will pass single-payer. No defections. They will change procedural rules such as the filibuster if necessary. And they will accomplish what the Republicans are unable to.

            In the meantime, Obamacare is alive and it’s the GOP on life support.


Brian Joondeph, M.D., is an ophthalmologist who practices in Colorado. A version of this article originally appeared at The Health Care Blog.