The U.S. healthcare system is broken.

Healthcare in America: Pay more. Get less.

Americans are sicker, die earlier, risk medical bankruptcy, waste time and money, distort labor markets, burden employers, and people hate it.

Let's fix this.

Alexander the Great cuts through the Gordian Knot

We spend more than enough money. We need to spend it better.

Most expensive by far

Worse outcomes by far

In 1996, when my college classmates and I were about 46 years old, I attended a class reunion. Graduates are mid-career. The lawyers, professors, writers, and finance people told me they loved their work. But doctors grumbled. They had regrets. They told me they spend too much time dealing with insurance gatekeepers and billing documentation, not patient care. The system was broken, they said.  

Everything that was broken then has gotten far worse. Everyone knows this: Democrats, Republicans, providers, employers, healthcare analysts, and anyone who has gotten sick in Europe and experienced healthcare there. We had a government shutdown over this consensus. Everyone agrees that we are patching a broken system.

Ten years ago, when presidential candidate Bernie Sanders campaigned on Medicare-for-all, the consensus for change did not exist except among a minority of Democratic voters. People who had private health insurance didn't want to give it up. They had "business class" tickets in the healthcare airplane and feared a downgrade to "coach." Labor unions opposed Medicare-for-all because a health plan was a hard-fought union benefit. Medicare-for-all seemed like loss and people hate losing what they have, even if something better is offered. Insurance companies lobbied against it. Republicans could have seen this as a business-benefit issue. After all, why should healthcare be the burden of employers? It made them less competitive than developed-country competitors where healthcare a public benefit. But Republicans stuck with their insurance company patrons, who called Medicare-for-all "socialism." 

Plus there is the free-rider morality problem that bothered Americans. Even if everybody would be better off, Medicare-for-all would mean that less-deserving people would get healthcare -- how unfair! Of course, public schools mean education-for-all, and parks and streets and national defense are socialized for the benefit of all, but not health care. It is different somehow. Institutions that benefit from the medical industrial complex have the resources to keep a majority in Congress in opposition and people thinking that health care is a consumer good, but schools, streets, parks, and the military are not.

I think the political mood has changed. The drip of rising costs changed what is possible. I don't think a president or presidential candidate would claim that the current American system deserves the A-plus-plus-plus-plus grade that Trump gave our economy. People know better.

My presumption is that change toward Medicare-for-all would come from the political left, and that partisanship would solidify Republicans to be in opposition. But they would be defending a weak hand, rather like trying to tell people in California, New York, Massachusetts, and Austin that homes are cheap and affordable. At some point people cannot be sold what they know not to be true.

Oddly enough, Trump might be the change agent here. Trump is impulsive and he doesn't care who he offends. Trump is willing to make abrupt change, to our trade agreements, to our foreign policy, to our relations with Russia, to our sensibilities regarding pardons and grift, to public ownership of private businesses, and to immigration. Americans have become accustomed to bold enlargements of executive power and Trump likes having the power. It is a new era in American politics. Trump could sell it to MAGA. I expect Republican legislators would go along as dutifully as they go along with Trump on everything else. It would be "Trumpcare."

Heads up to Democrats: Don't be knee-jerk opponents if Trump does something good. Let him score the "win." When Medicare-for-all gets branded "Trumpcare," don't protest. Trump and Republicans will take better care of it if it is named after Trump.

But the notion of Trump doing something bold and dramatic, and then aggressively selling it, can be a point of inspiration for Democrats. Trump changed the political environment. Now the American public is accustomed to bold, disruptive executive action. Trump would not pussy-foot with half-hearted, tentative, incremental change. Trump would know he had a great issue, because people are ready for change and they like seeing Trump smash through a stuck status quo.

If Trump could do it, so could a Democrat. The public is ready for this.

[Note: To get daily delivery of this blog to your email go to: https://petersage.substack.com and subscribe. The blog is free and always will be.]