Wednesday, November 5, 2014

What the election means for reform, especially single payer

New Republic
November 4, 2014
This Is How the New GOP Senate Will Try to Dismantle Obamacare
By Jonathan Cohn

Most Republicans know that they can't repeal Obamacare anymore. They'll
start with a symbolic vote for outright repeal. From there, (Ted) Cruz
says, Republicans will go after Obamacare provisions "one at a time."

Here's what the GOP has in mind, based on conversations with health care
experts and lobbyists:

Repealing the individual mandate

Repealing or modifying the employer mandate
changing the threshold to 40 hours
could propose raising (50 employee requirement) to 100 full-time

Eliminating "risk corridors"

Repealing the device tax

Abolishing the Independent Payment Advisory Board (IPAB)

Introducing "Copper Plans"
50 percent actuarial value


Comment by Don McCanne

New Republic's Senior Editor Jonathan Cohn, an astute and very
well-informed observer of the health care reform scene, provides us with
a quite plausible response of the new Republican majority in the next
session of Congress. They will likely fulfill their promise to introduce
legislation to repeal the Affordable Care Act (ACA), though knowing that
the effort will end with either a filibuster or a presidential veto. The
real action will take place over individual provisions of ACA.

Some of the less objectionable measures they propose could be included
in other bills as part of the legislative compromise process. Other less
desirable changes could avoid filibuster by being tacked onto
reconciliation bills, and avoid veto by being added to must-sign bills
((e.g., bills to prevent shutting down the government).

Since the Republicans have never formed a consensus on the replace part
of repeal and replace, it is unlikely that they will try to enact some
of their proposed measures such as eliminating the tax preference of
employer-sponsored plans, or selling plans across state borders to avoid
effective regulatory oversight. Such efforts would create new problems
that would be unpopular - not an approach they would likely take when
they have their eye on the White House in two years.

So how does single payer activism fit into all of this? With one caveat,
there should be no change in our mission to educate our colleagues and
the public on a vastly superior alternative - a single payer national
health program. As patients experience the deficiencies of our current
dysfunctional system, they have to understand that it doesn't have to be
this way - that everyone can have their choices in essential health care
without having to negotiate financial barriers to that care.

During the next session of Congress, it is clear that we will not see
any movement on single payer legislation. Even if a wave of Republican
Enlightenment were to flood Congress and they decided that single payer
really was the preferred model, they would not allow President Obama to
receive any credit by signing the bill, but rather would wait until a
Republican President took office in 2017. Lest this seem like a fantasy,
F.A. Hayek supported "a comprehensive system of social insurance."

Our education process is two-fold: 1) describing the very positive
features of the single payer model, and 2) exposing the severe
inequities and deficiencies of our fragmented system which has only been
perpetuated by ACA. The former is obvious, but the caveat applies to the

Until we can move forward on single payer, it is important to take care
of what we do have. We should not criticize the efforts of those who are
still in the process of implementing ACA. They are doing the best they
can under current laws and regulations. If Congress tries to enact
measures that are clearly detrimental we should join our friends in
opposing such actions. If beneficial patches to ACA are proposed, we
should not oppose them merely because they perpetuate ACA, but rather
support them as transitional improvements until we can achieve single payer.

But this is where we have a problem. We need to let the public know why
these measures are inadequate - how they merely perpetuate our highly
flawed system. But we must make a clear distinction between our efforts
to make our health care system work well for everyone and the efforts of
some members of Congress who would destroy as much of ACA as they can,
and walk away leaving too many people exposed to yet more health and
financial insecurity. When we are accused of helping the enemy of reform
by opposing ACA we have to correct that misperception by letting them
know that we support ACA as a transitional program that provides some
relief until we can enact single payer, but that we cannot accept
decades of incremental changes to ACA that can never lead to a rational,
comprehensive system of health care financing.

Based on the simplistic messages that carried the election, it is
obvious that we have a formidable task ahead of us. Our messages are not
simple, but they need to be clear. Everyone can have affordable, high
quality health care, but we do not have that with ACA nor would we with
the anticipated Republican actions. We have to let people know.

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