I want to build on Betty’s post from late last week regarding universal coverage.
I’m grateful to Gillibrand for stating outright that a market-driven system will never achieve affordable, universal coverage, so the public aspects of the ACA will have to be expanded to move in that direction. President Obama and the Democrats who worked on healthcare reform during his first term knew that, which is why they built in Medicaid expansion nationwide, a provision the SCOTUS sabotaged.
Anyhoo, the whole thing is worth a read. Love it or hate it, I think Lemieux is correct when he says single payer is becoming a core part of the Democratic Party platform, at least as an objective. The disagreements will arise around how to get there.
If the disagreement is over how to get there, then it is a disagreement on pragmatism. How will something work? How does ERISA interact with each iteration of reform? What does Hyde and Hobby Lobby mean in this context? How is funding stabilized across the macro-economic cycle? How are transitions managed? What are the edge cases and why are they difficult?
Slogans have to translate into legislative text and then draft regulatory rules. 1,001 different questions need to be raised, examined, and answered. That is a long, ugly and loud process through which nothing pristine will emerge. And we need to be realistic about that process.
Yep. Paper tiger votes for Medicare-for-all are the Dem version of Repeal ACA. Berners will be furious when it doesn't magically happen.
— (((drbloor))) (@docbloor) August 11, 2017
We recently saw how easy votes are to take for complete repeal of the ACA when there was no consequence to that vote. The inverse is true of any single payer vote when there are not 218 single payer voters in the House, 51 or 60 single payer votes in the Senate and a single payer signer in the White House. 218-49-1 or 218-51-0 coalitions are meaningless and anything that comes through that process except for mechanical feasibility studies have little value.
So if the goal is universal coverage, we need to get grinding through the boring policy work of figuring out what exactly that means and how exactly would it be implemented with what set of trade-offs.