Now Is Not The Time For Democrats To Push For More Radical Changes To Health Care

With Cassidy-Graham being introduced in the Senate today as the Republicans' latest attempt to destroy the ACA and gut Medicaid and Bernie Sanders' proposal of a single payer plan coming out as well, I guess we have to talk about health care again.

No matter where you stand on the progressive spectrum, I think everyone can agree that universal coverage is the goal. The question is how that gets delivered. Nancy Letourneau has a nice, concise write-up of the multiple Democratic proposals to achieve universal coverage, breaking it down to four separate and sometimes overlapping options: single payer, Medicaid as option on public ACA exchanges, Medicare buy-in or option on public ACA exchanges, and the multi-pronged Medicare/Medicaid/VA buy-in. You can read her piece for a snapshot of all those options.

In the end, I think most progressives would prefer to see the end result be a single payer system but, on the whole, I'm pretty agnostic which plan Democrats want to implement next. From a political perspective, however, I really don't think that now is the time to start pushing even more fundamental changes to the healthcare system. Democrats are finally in a place where the public broadly supports the ACA and see the Republicans as trying to take health insurance away from them. Having Democrats put out a healthcare proposal that significantly changes the way health care is delivered and giving Republicans the chance to snipe away at the details again strikes me as essentially giving away a political advantage it has taken years (and Republican help) to create. Instead, we should be pushing to expand coverage and focusing on the fact that the GOP wants to take health care away.

As an article in the NY Times today puts it, "single payer" may turn out to be a similar black hole for the Democrats as "repeal and replace" was and is for the Republicans. While I don't think that is entirely true, I do think that disrupting the health care delivery system for millions of Americans as well as the drastic changes in the tax code in order to pay for it is not something Americans are really prepared to confront right now. Frankly, I'm guessing they are getting tired of the whole health care issue.

I know I'm probably just a risk-averse old man, but I really think that Democrats should focus on expanding coverage through minor additions to the ACA, allowing Medicare or Medicaid buy-ins on the public exchange. Once you achieve universal coverage, it will be far easier to change how that will be paid for and move to a single payer. Doing otherwise right now, seems like it's simply throwing the political advantage Democrats have on health care away just as we head into the critical 2018 and 2020 elections.

I know that lots of people will disagree with this point of view but, especially in 2018, Democrats need to win elections. Let's tackle health care again in the run-up to and after winning the 2020 election.