US Senator and 2016 Presidential candidate Bernie Sanders has proposed legislation that would expand Medicare to cover the medical needs of all Americans. As a policy solution, this “public option” would certainly simplify the intricate web of private and government insurers Americans utilize to pay their medical bills. It would also ensure Americans are able to pay for healthcare, even when they cannot afford it. In the wake of the GOP’s failed attempts to provide health insurance reform and dissatisfaction with the shortcomings of Obamacare, support for universal healthcare and a single payer system has been growing inside the US. To enact “the Medicare for All Act of 2017,” several political hurdles would, however, have to be overcome.
Not only do conservative Republicans control the House, Senate, and White House, older voters, who rely on Medicare and represent a large voting block, must be convinced that Medicare expansion will not undermine their access to affordable medical care. Like all healthcare and health insurance reform efforts, proponents must also convince legislators and American citizens that the economics of such policy changes are viable. Where older Americans will primarily be focused on any threat to the Medicare system, taxpayers will be concerned about the cost of expanding the program. Healthcare providers will, in turn, be concerned about reimbursement rates. For consumers, the loss of the benefits that comes from choice will be an issue.
Fears among seniors may well be assuaged by sound economic policy. To that end, the Sanders plan calls for 2.2% tax increase on all incomes, a 6.2% levy on employers, and an unspecified additional tax hike on wealthier Americans. For poorer businesses and communities suffering from income inequality, the 6.2% tax is a steep price to pay, which may cost workers wages. Imposing a tax on wealthier individuals, just because they happen to be wealthy, in order to explicitly pay for the healthcare of Americans who cannot, is somewhat unjust. Taxes are paid to support the common goods government undertakes. Paying for the health insurance of all should be the responsibility of all, thus the progressive tax hike should be pursued. If the goal is simply to pay for a Medicare expansion, the Sanders’ tax scheme can, of course, be adjusted.
Unfortunately, Medicare for all is unacceptable to those who currently control the US government. Democrats can, and will, use the proposed Medicare expansion in future elections in order to attract voter support for the Party brand. In the wake of Hillary Clinton’s loss in the 2016 Presidential Election to Donald Trump, Sanders’ popularity has been cemented. Many people believe Sanders would have won the election, if Clinton had not clinched the nomination. Some even believe, Clinton, who was favored by the Democratic establishment, stole the election from Sanders. In truth, any efforts by Clinton and Democratic insiders to suppress competition likely pushed out far more attractive alternatives to Clinton and helped Sanders gain popularity.
In many respects, Sanders, who is a self-proclaimed democratic socialist, is as much an establishment outsider in the Democratic Party as Trump is an establishment outsider in the Republican Party. Sanders and Trump should, therefore, be as far part on the issues as possible. Sanders is, however, the political enemy of Clinton, due to his willingness to resist the will of the Democratic establishment, while Trump is also the political enemy of Clinton. Sanders is the enemy of Trump’s enemy. Given Trump controversial nature, he has proven time and time again his capacity to do the unexpected. Trump is also a businessman who will do whatever it takes to accomplish his objectives.
Trump is started to recognize that he cannot achieve legislative victory with Republicans alone. As such, there is an opportunity for Trump to work with Democrats on healthcare reform. Recently, Trump decided to reject the will of his adopted Republican party to side with Democrats on Hurricane Harvey relief aid and a debt ceiling increase. He has also signaled to Democrats his willing to raise taxes on the wealthy. If the goal of “Medicare for All” proponents is to guarantee universal healthcare, and not necessarily push their public policy solution or use their campaign to achieve election victories, there is room to find a solution.
The most unpopular aspect of Obamacare, which guaranteed the viability of the private insurance market, was the individual mandate. If they were serious, Democrats and Republicans could be united to immediately remove the individual mandate with a clean bill addressing just that issue. The problem with the legislative process is that lawmakers try to address too many issues in a single bill. Just as the Hurricane Harvey relief package focused solely on two issues that a majority could support, a similar approach needs to be take on healthcare reform. As such, individual Democrats and Republicans could also come together to establish a public option, which could be underwritten by private insurers to avoid threatening Medicare and to create options for consumers, while allowing consumers to purchase supplemental coverage from private insurers.
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