Senate Republicans
delayed their Obamacare repeal vote until after the July 4th Recess. If activists are foolish enough to hope that delay really does mean demise this time (ignoring
the painful lesson from the House Bill) then Obamacare will be repealed. Because at this point,
Republicans really have no reason not to go ahead.
Repeal delivers on their
decades-long clearly stated goal of dismantling the Great Society, and going further to restore the
Hobbesian American Society that existed
prior to the New Deal.
Repeal delivers
a huge tax cut for their wealthy donor base, which will in turn be used to
help fund midterm campaigns and mitigate blowback.
Sure the repeal is
unpopular, and likely to become more so as the effects become known to the public, but
gerrymandering and
voter suppression offer a level of protection.
Opposition will bring a primary challenger from the right, funded by those tax cuts. And 2018 is a long way away. Why face certain defeat in the primary when you can take your chances in the general?
Protests have been heart wrenching...
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YouTube VideoBut they’ve also been strangely muted, considering the carnage to come. Joan McCarter has been a force here, and other activists are protesting around the country, but at the time of writing, there is not a single diary on the recommend list about Obamacare Repeal, and Obamacare Repeal has all but slipped from the national news headlines.
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This moment when the bill is "dead" and there's "no news" to cover is the most dangerous time for Trumpcare opponents.
— Matthew Yglesias (@mattyglesias)
July 2, 2017Then, something even more disquieting happened...
Instead of defending Obamacare over this Fourth of July recess, which is the reality of the moment, healthcare activists(1) ramped up pressure for Single Payer... in California.
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BREAKING: #SinglePayer healthcare activists stage sit-in in front of @Rendon63rd's office! CA wants #SB562!#MondayMotivaton#4thOfJuly2017pic.twitter.com/OD84sYGhRI
— RoseAnn DeMoro (@RoseAnnDeMoro)
July 3, 2017It’s no secret that some healthcare activists on the left have long believed that Obamacare somehow prevented single payer. Of course the reality couldn’t be further from the truth. And I do believe we can forgive lay activists for conflating Single Payer with Universal Coverage(2).
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#CBOSCORE: Senate GOP healthcare bill leaves 22 mil MORE uninsured: https://t.co/dUwXl4ofLxOnly #SinglePayer covers all! #saturdaymorningpic.twitter.com/FBHHezywTE
— RoseAnn DeMoro (@RoseAnnDeMoro)
July 1, 2017
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Maybe I'm thinking about this wrong. Maybe we should be using the fact that nobody on the far left knows what single-payer is.
— Jeff Fecke (@jkfecke)
July 2, 2017If you’ve been misled to believe that Single Payer equals Universal Coverage, it’s not that difficult to believe that Obamacare somehow prevents Single Payer. Eliminate Obamacare, and the path is then paved for Single Payer, right?
Another theory is that Democrats could’ve passed Single Payer in 2009, but sold out to go with a system that preserved the private insurance industry. There was even a conspiracy theory that Obama campaigned on single payer(3), only to sell out when he got to the White House. There’s no better person to debunk this theory than Sen. Bernie Sanders himself.
“I would say that in the Senate, there are at most 10 votes for a single-payer plan,” Sen. Bernie Sanders, I-Vt., a self-described democratic socialist, who isn’t shy about his own preference for that kind of solution, told Salon this week. “In the House, I have no idea but it’s a small minority … It’s absurd to say, ‘Mr. President, go forward and make your bill single-payer,’ when you’ve got 10 percent of the Congress supporting you.”
The truth is there weren’t enough votes for a public option, let alone Single Payer, back in 2009(4). But failure to start with single payer (didn’t have the votes), and then the failure of the public option (didn’t have the votes), led to a sense of betrayal on the left, of which President Obama to this day is keenly aware. Repealing Obamacare would perhaps erase this sense of betrayal and allow activists to start fresh with a more popular approach.
Those are the generous interpretations…
Even Forbes(!) is reporting on the death toll from Obamacare repeal. The rescission notices will send forth post haste. Then will come the local news stories. Then will come the bodies. This isn’t hyperbole.
President Obama famously (or infamously, depending on your point of view) struck a bargain with the hated private insurance industry to pass Obamacare. The same (and still just as hated) private insurance industry returned the favor under Trump by not lifting a finger to protect Obamacare.
Obamacare was not just a policy success, it was a strategic success -- Obamacare occupied all the healthcare policy bandwidth to the left of what would allow the private insurance industry to survive. Blow up Obamacare, and there’s no middle ground anymore; it’s a single payer style approach(5), or a return to life before Obamacare. Even conservatives understand the terrain. And based on the near Universal hatred of repeal, a return to life before Obamacare isn’t going to fly. Even if you strike Obamacare from the public record, two things will still have been accomplished(6):
Establishment of affordable healthcare as an American right, not a privilege.
Rendering once common private insurance practices (rescission, lifetime caps, preexisting conditions, etc.) unacceptable.
Which would mean Republicans, and the much despised private insurance industry, are going to be in for a very rough 2018 and 2020 should Obamacare be repealed. And let’s be honest, there’s something tempting in that scenario...
But there are enormous structural (let alone political) challenges to implementing “single payer”, the least of which is that there are a myriad of different approaches all under the loose definition of “single payer”, and Democrats would have to get behind one. Believing single payer is just universal coverage and forgetting the details won’t cut it once Democrats have control of the House, Senate, and Presidency for a short window. Legislation needs to be drafted and agreed upon well ahead of such time.
Of course, single payer, from a health delivery and human rights perspective, is utterly superior to Obamacare, and it would cost less too. But it will also be far more disruptive, especially since the vast majority of Americans are provided health insurance by their employer and are relatively happy with it.
The costs of those plans too are largely obscured in one’s paycheck, making it difficult for the majority of people to see the real savings against the higher taxes required for single payer. This needs to be overcome well before a single payer plan is attempted so people can clearly compare the costs.
Finally, single payer would take time to implement, let alone the legal challenges and delays. And while it has always been touted as constitutional, if you think the Gorsuch Court would just allow what amounts to an eminent domain seizure of the private insurance industry…
Enacting Single Payer will be easy, they said.
...meanwhile, the death toll and suffering will be very real. Senator Bernie Sanders, a huge Single Payer proponent, and someone with whom I am often at odds, understands the real need for Obamacare.
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In the short-term, to improve the Affordable Care Act, we should have a public option in 50 states and lower the Medicare age to 55.
— Bernie Sanders (@SenSanders)
July 3, 2017In other words, Obamacare is a vital bridge to keep people alive, reduce suffering, and prevent bankruptcy until such time we can achieve a superior health plan. So please, if you have the spare time, call your Senator and tell make your voice heard.
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As Trump Tweets, McConnell is buying off Senators to uninsure 22 millionIf these are your Senators, get to them & tell them not to kill us pic.twitter.com/xCQyQB0YML
— LOLGOP (@LOLGOP)
July 1, 2017But if you’re hoping the suffering will be necessary to achieve your political goals, then health care was never your concern.
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(1) Wouldn’t it be nice if they spent half their energy on protecting Obamacare, which does exist and is Nationwide, and half on California Single Payer, which doesn’t remotely exist yet, and would benefit only California?
(2) As Executive Director of National Nurses United, the Largest U.S. Organization of Nurses, which entails Roseann to a $350,000 yearly salary, you’d think differentiating between Single Payer and Universal Coverage would be a part of her job.
(3) Obama campaigned on a plan very similar to Obamacare, except without an individual mandate.
(4) Today would be a very different story.
(5) Or an approach to the left of single payer.
(6) Well, those two things, plus all the lives saved and medical bankruptcies prevented.