David Leonhart makes the case in The New York Times that if Republicans destroy the ACA, they may unwittingly give us Medicare for all. Leonhart suggests that Democrats in Congress may realize that Medicare for all is the only viable alternative to a conservative health care system like the ACA. What would it take?
Leonhart bases his thesis on the belief that once Congress bestows benefits that improve people’s lives, it’s very difficult to take them away. Taking away these benefits would mean losing public support. And, some would argue that that’s why the Republicans have failed to repeal the ACA as of now.
Yet, to be clear, Republicans really did want to kill the ACA and take away significant benefits. Powerful conservative forces, including the Koch brothers’ Americans for Prosperity, the Heritage Foundation and the House Freedom Caucus, kept the Republican leadership and Trump from repealing the ACA because of the replacement plan, which was not conservative enough; these conservatives wanted the ACA repealed but did not want a new plan with coverage for people with pre-existing conditions or for dependents of working people to the age of 26 or coverage of essential benefits.
And, the Freedom Caucus may yet get what it wants, even though there likely would not be the votes in the House and the Senate for their agenda. Republicans may succeed at killing the ACA through lack of adequate funding or administrative oversight of its provisions. It seems pretty clear that the Republican leadership is very much intent on gutting or cutting the ACA, so long as there’s a way to pin the ACA’s demise on the Democrats by arguing the ACA model was unsustainable.
Will public pressure lead to a replacement plan? As Leonhart acknowledges, “passing major social legislation is fantastically difficult,” because it tends to mean that powerful corporate forces see their profits shrink in the process, through taxes and reduced revenues. It’s also difficult because even when the legislation will improve people’s lives, many people like the devil they know and fear change.
But, Leonhart posits that people will insist on a replacement to the ACA if the ACA goes down. He believes that Congress will feel pressure to replace it since the public now counts on government health care coverage, And, if Republicans in Congress don’t feel that pressure, when Democrats are next in power, they should enact Medicare for all.
Democrats should recognize that Medicare for all is the only health care system that will withstand the test of time because it provides automatic coverage, offers people the choice of doctors and hospitals they want and need, and controls costs. Medicare (and Medicaid) work well, have overwhelming support across the political spectrum, and staying power. In sharp contrast, Republicans will always have the power to undermine a conservative health care system like the ACA.
We all should now see that the healthcare marketplace does not work like the marketplace for consumer products and services. Health care competition does not drive down prices. And, the federal government can innovate and drive system improvements in ways that the private health care marketplace has not and cannot. The question is not whether Medicare for all is the way to go but whether Democrats will have the spine to take on opposition from the medical industrial complex.
Here’s more from Just Care: