The Only Health Insurance Option Left

Less than two days after being released publicly, it appears that Senate Majority Leader Mitch McConnell's health insurance bill, the Better Care Reconciliation Act, is d.o.a.  Five senators have already announced their opposition to the bill as presently drafted.  A half-dozen or more have expressed concerns.  Since the doubters include both Tea Party types and moderates,  McConnell is in a bind.  If he offers compromises to win over the Tea Partiers, he will likely lose some moderates.  If he offers compromises to satisfy the moderates, he will likely lose some Tea Partiers.  It looks virtually impossible for him to get at least 50 votes. 

The Senate will vote soon on this bill--which is basically tax legislation that cuts taxes for the rich and funds those cuts by taking away health insurance coverage for a lot of mostly poor people--and it will either pass (unlikely) or fail (likely).  If it fails, what then?  Obamacare is struggling, with insurers pulling out of exchanges and premiums rising sometimes dramatically.  The Trump Administration and the Republican Congress have created so much uncertainty that health insurers apparently feel compelled to raise rates sharply.  Whether or not any replacement for Obamacare is passed, this uncertainty will remain, and rising premiums may force many people to drop insurance coverage. Thus, the number of people losing health insurance will rise under the Trump Administration even if Obamacare survives.

Forcing people to go uninsured is political anathema in America today.  Whether or not the Republicans like it, Obamacare established the baseline principle that all Americans are entitled to comprehensive health insurance coverage at an affordable cost.  Both Republican and Democratic voters subscribe to this principle, and legislators who violate the principle do so at the peril of their re-election.  But with Republican machinations making Obamacare increasingly unworkable, a replacement will have to be found.

Realistically, the only option left is a single payer system, with private insurance available as an optional supplement.  Private health insurance doesn't work well, especially when it comes to covering the poor, the sick (i.e., those with prior medical conditions) and the elderly.  That's why Obamacare is unwieldy and the Republican alternatives are worse.  We've already figured out that single payer is needed for the elderly, and established Medicare.  It works well.  Medicare can be supplemented by private insurance coverage and often is.  Sure, Medicare has long term funding issues.  But have you noticed how premiums demanded by private health insurers are going through the roof?   It's hard to believe that a government funded program would be more expensive.

Essentially all other advanced industrialized nations have single payer health insurance systems (or national health care, like the UK system), with per capita costs that are far lower than America's and better health outcomes overall.  No other advanced industrial nation has the extremely expensive and increasingly dysfunctional mish-mash of private coverage that America has.  Single payer systems are imperfect, and the availability of optional private supplements can ameliorate many of the imperfections.  The current Republican White House and Congress won't adopt a single payer system.  But their failure to do anything intelligent with health insurance coverage will push America toward the only realistic health insurance option remaining.