Democrats must seriously consider universal health care

Lydia Green Apr 16, 2017
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After the Republicans’ failure to pass their Affordable Care Act (ACA) replacement, the American Health Care Act (AHCA), House Speaker Paul Ryan declared the ACA "the law of the land ... for the foreseeable future," but that fact hasn't dissuaded Republicans from continuing to brainstorm ACA alternatives. The Democrats, on the other hand, have been relatively hesitant to present new ideas in healthcare reform, a seemingly reasonable position, considering their current lack of control in any branch of government, but it is precisely their current dearth of power that necessitates the excitement for the Democratic Party that a more progressive plan would generate. Now is the time for Democrats to begin seriously considering universal health care.

Universal health care is about ensuring that everyone, regardless of their income status, gender, or anything else, has access to the medical care they need. It's about guaranteeing people the basic freedom to live healthy, fulfilling lives. A person who can't afford treatment for an illness or injury is not free, since, depending on the nature of the condition, they might not be able to run, walk, go to school, go to work, pursue their dreams, or attain physical comfort. Health care policy that does not guarantee coverage for all is, therefore, an obstruction to freedom-for-all. Universal health care would be consistent with American ideals because it would increase access to such quintessentially American values such as life, liberty, and the pursuit of happiness.

The AHCA, which kept the ACA provisions on preexisting conditions and under 25-year-olds staying on their parents' plans while revamping nearly everything else, failed because it was a centrist proposal that made no one happy. Far-right and libertarian Republicans, as represented by the Freedom caucus, felt that the AHCA didn't move far enough away from the ACA, while moderates of both parties and progressive Democrats had liked the ACA and felt that Ryan's new bill was a step in the wrong direction, especially after the Congressional Budget Office released a report stating that the AHCA would leave 24 million fewer insured by 2026.

Even the ACA was somewhat of a compromise. The ACA's individual mandate aspect, which funds the insurance by requiring anyone not already covered by an employer to have ACA coverage, actually dates back to a plan proposed in the '80s by the Heritage Foundation, a conservative think tank, as an alternative to single-payer coverage (universal health care entirely funded by the government). The individual mandate has also been appropriated over the years by many other conservatives, such as Mitt Romney in his Massachusetts health care reform of 2006. Because the ACA used an individual mandate, it was supposed to be bipartisan, consensus legislation, but instead, the bill was subject to much obstructionism at the hands of the Republicans.

What Barack Obama missed in planning his bill was that Republicans always saw individual mandates as a compromise. Most Republicans, including Ryan himself, who advanced an individual mandate bill of his own to reform Medicare in 2011, only ever liked the idea of the individual mandate in comparison to more socialist options like single-payer or Medicare. The plan was always to use individual mandate reforms as a stepping stone and not an end goal. When Obama, a liberal Democrat, started his health care reform at individual mandates, he advanced a plan that no one was truly enthused about and moved everyone to the right. Having secured the center, Republicans were now free to focus on more conservative reform options.

Democrats must not let the ACA become the new left. They must learn from the failures of so-called compromise bills like the AHCA and ACA to garner widespread support: centrist reform makes no one happy. Universal health care, on the other hand, garners bipartisan progressive support. A May 2016 Gallup poll found that the majority of Americans, including even a significant chunk of Republicans, want to replace the ACA with a single-payer system. A universal coverage system like single-payer provides a cohesive solution to health care consistent with progressive and American values that people can truly get behind.

Now that the AHCA is off the table, Democrats must take this opening to advance a universal coverage plan such as single-payer insurance. There is even already a proposed single-payer bill that has been in the works in the House since 2003. Introduced by Representative John Conyers (D–MI), the Expanded and Improved Medicare for All Act would, as promised in name, install universal health care in America by expanding the current Medicare system. Such a plan would fix the remaining issues left by the ACA, ensuring that anyone with an injury or illness has the resources to heal. Such a bill would gain enthusiastic support and restore public faith in the Democratic Party at a time when the Party needs it most.

If the Democrats wait too long, Republicans will come up with a more conservative plan to generate similar enthusiastic support from their own base — enough to actually pass this time. An additional bonus of advancing a single-payer bill like Conyers' is that it would restore individual mandates to the center and force conservative Republicans to support the ACA, as a truly moderate alternative.

If the Republicans manage to pass a more conservative bill, the number insured would surely decrease. Republicans would claim such a bill as a win for their party, but in reality, it would be a loss for the American public. A nation is only as healthy as its citizens, and a nation where it is possible for a citizen to be ill and uninsured is certainly unwell.