With Trump coming into power, I think Biden’s temporary increase of ACA subsidies will expire after 2025. This will make a lot of people drop out of the exchanges, and will increase the ranks of the uninsured. Trump’s next four years will chip away at the ACA, and likely leave us worse off than we are now.
“Medicare for All” died on the Cross when Bernie lost the primaries in 2016 and 2020. There’s just no appetite, politically, for it in the US. It goes against the culture of this country, where almost nothing is uniform. Everything is a patchwork. And anything that smacks of a big government national program is derided as “soshulizm”, often by the very people that themselves are on Medicare and Social Security (the average US voter is a policy moron).
So, where do we go from here? If we still have the ACA in 2029, the Dems need to make the enchanced subsidies more permanent without a sunset date. Force the GOP to do something to lower them, as opposed to an automatic sunset date. Also, I think the next time the Dems come into office, they need a sales pitch on expanding Medicare to people that want it. Not “Medicare for All”, but maybe “Medicare for Whoever Wants it”. Make is available to all children, if their parents sign them up. Make it available to anyone over 60. The only we we’re going to get to anything approaching UHC is making small incremental changes over time. This would be my next incremental change.
One thing about Medicare is that it does have a powerful political constitutency, elderly voters. So, if we gradually expand it, I don’t think we’ll get the pushback that we did on the ACA. The ACA was a very good program. But there isn’t a powerful group that backs it, so it will always be in danger of being clipped back or partially reversed. With Medicare, I think that won’t happen.
“The way forward on the Health Care front in the US” is probably going to be patronizing the black market or going to other countries to get actual medical care instead of “alternative medicine”.
If Medicare is privatized, the companies that run it will minimize spending on actual healthcare while maximizing spending on management salaries and profits.
In practice I actually have seen Medicare Advantage plans work as they should from the large health care providers side anyway. There are “quality” goal targets set with decent pots of money contingent on hitting certain targets. Investing in prevention, keeping your panel of patients as healthy as possible, pays in these cases. This is especially the case for identifying those most likely to get sickest in the near term and aggressively preemptively providing the resources to prevent that.
But just because it can work well like that doesn’t mean it always or even most often does, especially with the lack of regulation that is expected in the near term. I’m not optimistic.
Here’s a gift link to a two-year-old New York Times article about how the insurers do their very best to extract as much money as possible from Medicare Advantage, mostly by submitting inflated bills; overdiagnosing patients, for instance.
Article unread I will stand by my personal experience and observation that it can work well, without debating whether or not it usually does. (There is a clear incentive to correctly code and get credit for all the risk factors that patients of your panel have. Overdiagnosing would be fraud. Accurately diagnosing better than you bothered to do before is getting credit, and payment, for the work you do.)
And no argument from me that as likely to be implemented with little oversight and regulation in the coming years that it won’t work well hardly ever.
My guess is that it’s a lot cheaper to for giant companies to commit fraud and then fight any prosecution. Whatever financial penalties they’re eventually issued probably pales in comparison to the false profits. (Am I cynical? Perhaps.)
Considering how far to the right this country has moved, I don’t see national health reform anytime in the next 10-20 years. But I’m constantly wrong about politics so who knows.
What’ll probably happen is states (and cities) will expand health care. Maybe a few states may even look at medicare for all. But even that probably won’t happen. They’ll just say they want to do it, then not actually do it. Democrats on the state level have been using that strategy for decades.
An alternative to medicare for all is medicare extra for all. It would provide universal coverage and drastically reduce the rates of underinsured. But again, I don’t see it happening on the federal level. Something like it may happen on the state level though.
Its basically the same kind of system the OP was talking about. It would be a medicare like program that anyone could buy into (you could pick it instead of your employer insurance if you wanted).
Correct me if I am wrong @Northern_Piper but my impression is that medicare came to Canada starting in one province, Saskatchewan, with an NDP (think Bernie Sanders) government and it worked so well the whole country wanted it. I know that doctors in Quebec went on strike at first, but now the doctors are on board.
Yes, it started in Saskatchewan, with a socialist government.
It was so popular that the federal Conservative Prime Minister appointed a commission to look into it nationally. (The PM was from Saskatchewan). He appointed a Justice of the Supreme Court of Canada to conduct the inquiry. (The Justice was from Saskatchewan.)
When the report came out, recommending a national medicare system, the federal government had changed. The new Liberal government instituted Medicare nationally.
So, a Socialist, a Conservative and a Liberal walk into a bar run by a Saskatchewan judge …
I think the way to get something like this is incrementally. Like you said, maybe at some state levels, and gradually you see more and more states adapt it. If Dems ever get control of congress & the executive, maybe they can lower the eligibility age for medicare to 60, or make it available for all children…
The thing that spooked the public with Bernie’s “Medicare for All” was the “for All” part. Let’s do it “for More”…“Medicare for More”;…That might get more support.
One of the obstacles to any such reform in the US would be the perception that it would benefit “those people” just as much or even more that it would benefit us. I think that attitude goes a long way to explaining why the US social policies are so retarded.
FDR and Truman tried to create a UHC system, but southern democrats were opposed to it for fear it would lead to integration.
Congressional Environment
Large Democratic majorities existed in both the House and Senate. However, worried that major health reform
would defeat the entire Social Security proposal and believing NHI might be forwarded later, Roosevelt did not
include major health reform in his proposal. The Social Security Act was introduced and passed in both houses
with a wide margin in 1935. The second push for NHI, coming from the Technical Committee on Medical Care
and momentum from a National Health Conference held in the summer of 1938, also failed. By 1938, southern
Democrats aligned with Republicans to oppose government expansion, in part to protect segregation, making
additional New Deal social reforms nearly impossible to pass.
Congressional Environment
Challenged by the transition from a war-time economy, Truman lost the public’s confidence. The Republicans
gained the majority in both houses of Congress in 1946, creating the perception that the President was a lame
duck. Truman then campaigned in 1948 promising to extend the New Deal and targeted the Republican Congress
for opposing NHI. Not only did Truman win the election with a mandate from the people for NHI, but Congress
also swung back to a Democratic majority. It was not enough, however. Southern Democrats in key leadership
positions blocked Truman’s initiatives, partly in fear that federal involvement in health care might lead to federal
action against segregation at a time when hospitals were still separating patients by race
Its also worth mentioning that when social security was originally created, it excluded labor fields where large numbers of black people worked. Vocations like agriculture or housekeeping. Those jobs were only given SS benefits later.
But like other components of the New Deal, the origins of Social Security were rooted in racism. The Act initially omitted large categories of workers of color from retirement benefits and unemployment insurance. When Congress held hearings on the bill in 1935, the NAACP testified that a provision insisted upon by Southern politicians to exempt agricultural and domestic workers would disproportionately exclude Black workers. It was none other than Charles Hamilton Houston, architect of the legal challenge to the “separate but equal” doctrine resulting in Brown v. Board of Education, who objected on behalf of the NAACP and warned Congress that the bill would exclude “Negro sharecroppers and Negro cash tenants, who are just about at the bottom of the economic scale.”
Despite the NAACP’s opposition, the Social Security Act passed with these exemptions intact. As a result, 65 percent of African Americans throughout the country were ineligible for benefits, with an even higher percentage of African Americans in the South excluded from the program. The NAACP’s Charles Hamilton Houston described the law as a “sieve with the holes just big enough for the majority of Negroes to fall through.” The exemptions were finally repealed in the 1950s, but they had significantly worsened the economic gap between Blacks and Whites.
Now they talk about benefits for illegal immigrants (Latinos) and benefits for lazy people in the inner city (black people) as reasons to oppose the social safety net
Realistically, the Supreme Court has largely ruled that ACA is unconstitutional and that health care should be run by the states. Tax breaks for health insurance issued by employers is also, likely, the cause of American health care costs being double that of the rest of the world.
The way forward is to transfer existing programs to the states and ending everything Federal. And note that, that’s not a proposal made out of desire, it just is the way forward. And, yes, that would mean that some states will be better than others.
The other way forward is to hire boring, non-entertaining, trustworthy people to office and give them to freedom to deliberate and vote in private. As long as politics is a game and a sport with gambling, daily stories, drama, and excitement then neither team can let the other team win. There’s too much money and passion in it to do anything else. The size and dimensions of the field need to be set and unchanging or it’s just not a good game.
We’ve past the point of new, meaningful government action (at the Federal level) on pretty much any front. The only solutions are to handle things locally or solve that problem.