Viewpoint: Trump attack on Obamacare could drive Americans toward Medicare for All


The non-exoneration of Trump’s complicity in Russian meddling in the 2016 election has unleashed his vindictiveness to erase anything with Obama’s name, so it is not a coincidence that a day after Attorney General Barr’s whitewash of the Mueller Report was released, Trump’s DoJ announced it would support the lawsuit to overturn Obamacare. Trump boasted that it is only a matter of time before this travesty is completely swept away and ludicrously christened the Republican Party as the “party of great health care.” But later tweeted there would be no replacement until after 2020 when he is presumably re-elected and Republicans are back in full control of the House and Senate.

But his political machinations could backfire, as everyone — not just the tens of millions for whom Obamacare was their lifeline to obtain health care — realizes what Trump intends to take away: affordable insurance for the 100 million with pre-existing conditions; lifetime caps; the 80/20 requirement that required 80 percent of the premium to go to patient care; enabling children up to 26 years old remain on parents’ policies; freeing workers from indenture to employers by making insurance available separate from employment; no more free annual wellness exams, preventive services or vaccinations.

And everything from laboratory services, rehabilitative services, maternity care, pediatric services, ambulatory patient services to mental and behavioral health treatment would be expensive add-ons (so each person would have to be able to predict what ailment they would suffer, and being a woman would again be a “pre-existing condition”).

The concern over the irresponsibility of Trump and the complicity of the Republicans is elevating anxiety to such an extent that there is growing trumpeting for Medicare for All (single payer) or at least a public option, where individuals under 65 can buy into Medicare — anything that will nail down health care. Trump’s latest attack on Obamacare will likely give momentum to such policies while galvanizing voters to send Republicans packing.

The Republicans’ ploy is to brand the very concept that “health care is a right, not a privilege” as an attack on personal liberty and capitalism itself, and a slippery slope to Venezuela-style socialism.

But Medicare for All essentially replaces the middle man of for-profit, private health insurance, not private doctors or hospitals or the ability for patients to choose their doctors.

Medicare is extremely popular and has not resulted in the nationalization of the health care industry (1/6 of the economy). Essentially, Medicare utilizes 97 percent of its premium for actual patient care versus 80 percent as private insurers do (capped under Obamacare but as much as 33 percent before).

The other fear being mongered is that Medicare for All will raise taxes — that might be true, but on balance, consumers would save money because it replaces the health insurance premiums that have that extra 20 percent built in — effectively cutting health care costs 17 percent right off-the-bat, and with improved efficiency and the ability to negotiate or cap fees and rates (putting realistic limits on what drug companies can charge or profit), even more.

More savings would come from wellness and prevention programs (that Trump would eliminate) and the fact people have access to early diagnosis and treatment — and prevent the spread of illness, a public health issue.

The real concern of Republicans and those who believe health care should be a privilege is that there won’t be enough doctors or facilities (shortage of 46,000 primary doctors forecast now).

But the underlying problem can be solved by government investment in more doctors (NYU Medical School just went tuition free, eliminating the prospect of $200,000 in debt that keeps many from pursuing medicine; another idea is loan forgiveness for those who fulfill gaps in care), more physicians assistants and registered nurses empowered to take charge of care; more technology like tele-medicine and gene therapies; more clinics (not shut down Planned Parenthood which serves 3 million people).

At the heart, though, is the essential value that health care is a right, not a privilege. And there are less dramatic alternatives that could achieve the same goal of universal health care.

One is not to replace employer-based health care, but creating alternatives for those who lose their employer-sponsored health insurance. That is the Obamacare (Affordable Care Act) approach of government sponsored exchanges, where people below income threshold can get subsidized insurance.

Before Obamacare, more than 50 million people did not have health insurance, and tens of thousands each month were losing their health insurance as they lost their jobs to the Great Recession, 20,000 people a year died unnecessarily for lack of access to health care. (As Congressman Suozzi says, “Mend it, don’t end it.” And whatever happened to that bipartisan Congressional committee that was supposedly doing just that?)

Another is to create a public option — a Medicare-style system that would be available and could be competition for private insurers.

Another is to allow for Medicare buy-in, especially for those over 50 who lose their jobs and would otherwise have to self-finance for 15 years.

On the other hand, there needs to be sensible controls on costs — as well as transparency in prices, especially drug prices.

Drug prices should be regulated like a utility — allowing for a fair return on investment, profit, salaries and such, but not a “what the market will bear” when what is being sold is life or death.

The American people who actually fund the research that Big Pharma uses to make its ‘breakthroughs’ make them not only stakeholders but shareholders and their share of profit should be returned in the form of lower prices.

The latest assault on health care could backfire on Trump while demonstrating how morally bankrupt and cruel his administration is and how crucial it is to vote Republicans out of office.


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