The Way Forward for Democrats: American Health

Democrats nationally need to congeal around a theme.  Candidates for Congress, hoping to unseat an incumbent, need a theme.

Somehow it needs to address healthcare and it needs simultaneously to make sense of the ongoing polarization and frustration.   

Suggestion:  Single Payer American Health.  Call for a safety net of healthcare, and say that the reason we are stuck with this Trumpcare mess is because of the special interest corruption of Washington politics.


The public's appetite for a reform--drain the swamp--message has not been sated.  Indeed, it has grown.  Trump  conspicuously fired people, but based on politics, not good-government reform.  He fired US Attorneys based on partisanship, and then Acting AG Sally Yates, FBI Director James Comey based on their plan to investigate his administration.  His cabinet perpetuated the swamp.  The White House is staffed by nepotism.

The big legislative story in Washington remains logjam and disfunction generally, with particular attention to Trumpcare.  Republicans stirred up political unrest criticizing the ACA and now Democrats are returning the favor.  People dislike and are afraid of Trumpcare already, and it doesn't exist. 

This is the basis for the Democratic opportunity.  American Health, a single-payer bare bones version of Medicare, available to every American, payed for by a progressive tax on all incomes.  

It is a positive message, not just an anti-Trump message.   A Democrat can say we need a basic safety net of health care, American Health, a single-payer version Medicare for every American citizen, which is what we should have had all along but could not because the special interest swamp dwellers corrupted our lawmakers with campaign donations and lobbying.  

It shifts the blame from "us" and our elected representatives, to "them" the powerful special interests who subvert our government and forced a bad healthcare system onto us, putting health insurers between the patient and their doctor.   It is overtly an anti-health insurer message.  Defenders of the status quo will want to defend patients and doctors, not health insurers.  Everyone has a lousy-health-insurer story to tell.  It defines and calls out powerful villains, ones in poor position to assert that they look out for the public interest, the special interests in the health insurance, pharmaceutical, and medical device industries, plus the Wall Street firms that do their financial work.  Their contributions are on the record.

I am positing an "economy coach" level of baseline service.  It is less.  It is unequal.  This is intentional.  People with good coverage now will insist on retaining their current privilege.  The fact that a general "healthcare for all" is less, that it requires bigger co-pays for example, is not a bug.  It is a feature.   It is not same-healthcare for all.  It is basic healthcare for all, and existing privileges for the currently privileged.

Forbes article explains privilege

People who have healthcare through employer based private insurance or Medicare or the VA will not want their care diluted.  They have VIP service and would experience getting "everyman" service as a loss.  (See yesterday's blog post, and my comment on the endowment effect.)  Democrats need to preserve inequality, at least for a time.  A "healthcare for all" benefit must be safety-net service.  Employers must be able to add back a "business class" upgrade.  Current Medicare recipients must retain Medicare privileges and status.

It will be much cheaper for employers.   The expensive and risky coverage would be taken on by the single payer system.  Employers would be supplying the upgrade only.  Employees will expect to be kept whole.

Democrats could argue this as pro jobs.  It takes the burden of healthcare off of small businesses and moves it to the general taxpayer.   It is an equity issue: Walmart pays so little that its full time employees qualify for Medicaid, so essentially taxpayers are subsidizing Walmart, but not Costco, which pays employees better.   It is pro-small-business because it allows employers to operate their businesses without the extraordinary complication of attempting to work out healthcare obligations.   It is generationally fair because it throws the job of providing basic healthcare to the general taxpayer rather than burdening the young and healthy with over-paying for health care in order to subsidize the older-but-not-Medicare population in an insurance pool--a feature of the ACA.

Taxpayers already pay via Medicaid

What services might be covered under American Health?  Generally a Medicare or Medicaid level of service ,but with higher deductibles and co-pays, and more exclusions of presumed luxury benefits, e.g. vision, hearing aids, exercise programs.  

I predict that the political sticking point of this proposal will not be the cost.  In fact, Americans are already paying for a more expensive system already, with the complicated patchwork of insurance coverage and billing paperwork, a system with high overhead and multiple gaps.   The political problem will be the fear of the currently privileged that everyone will be forced into "coach" class service and that freeloaders will get something for nothing.  A payroll tax and linking American Health to a social security number will help deal with this.  We already have a Medicare payroll tax.  People working "off the books" get less, nor nothing, an incentive to get legal.

The Democratic Message:  Get the health insurance swamp-corrupters out of the system so we can have better, cheaper, simpler, more universal health care.   These are exactly what congressmen like Greg Walden and President Trump said they wanted and were giving us in Trumpcare--benefits that are clearly false in the current system.  Democrats do not need to argue goal; Republicans have agreed on the goal.  

A patchwork of insurance and high risk pools cannot meet it, but American Health could.  Why would anyone suggest and defend an unpopular and expensive plan like Trumpcare?  They were influenced by special interests and their PACS.

Democrats can assert that they want to clear the swamp, reduce the power of special interests, cut costs, improve healthcare, and end the logjam.