Wednesday, January 27, 2016

Don't worry. It will be reflected in my bill.

That's what Lady Mary Crawley's presumably pricey, Harley-Street specialist said when she thanked him for making an early morning house call to save Anna's pregnancy in last Sunday's episode of Downton Abbey. Quality medical care like that was expensive in 1925 London. Anna likely could never have afforded it on her own. That remained the case in the UK for another 2 decades until the post-war Labor Government introduced the National Health Service. 

Unfortunately, it has remained the case in the US for even longer. In 1965, seniors at least got Medicare. Then, in 2010, the US finally passed the Affordable Care Act ("Obamacare"). Still, for various reasons, even with the ACA there remain very many uninsured people in thus country. And the ACA itself, while perhaps the best that could have been achieved, is itself certainly flawed.

Hence the appeal of candidate Bernie Sanders' push for a "single-payer," "Medicare for All" alternative. Nothing about that idea is new, of course. Once senior citizens got Medicare, it was only logical to envision extending it to more and more people o all ages. President Nixon reportedly was prepared to propose this in 1973. But Watergate got in the way, much as Vietnam had earlier undermined any prospects for Medicare's expansion in LBJ's Great Society. Eventually Vietnam and Watergate, together with the other political pathologies of the 60s and 70s, set the stage for the disastrous election of 1980, that turned LBJ's optimistic Great Society into Ronald Reagan's depressingly diminished society.

So, when "Obamacare" finally came, it was not the "single payer" approach of, for example, the neighboring kingdom to the north of us. It was, rather, a market-based approach based on ideas earlier generated by right-wing think tanks and full of compromises. Obviously the idea was that only such an approach could achieve sufficient support to pass. And that was probably right - although by 2010 no Republicans were supporting it anyway. 

For all its faults, "Obamacare" has been a blessing to many Americans who couldn't get adequate health insurance before but have it now. But Bernie Sanders is certainly correct that this greater access is far from perfect and that a "single payer" plan like "Medicare for All" would be far better. 

The fundamental problem with what we have now is that it still retains private insurance at the heart of the system. It is still as much about some people making money off health care as about health care for all. But as long as American society continues to treat such profit-making as morally and politically acceptable, such incremental improvements in access may be the best we can actually hope for.

So that is why in the end Bernie Sanders is wrong. Of course, a "single payer," "Medicare for All" would be better, but achieving it is way beyond the limited capacities of our morally impoverished politics.

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