The United States has painted itself into an Obamacare corner. Obamacare has enough good elements that repealing it would harm millions of people. Keeping it in its present form will harm other millions and inflict serious economic damage. But it is impossible to reform Obamacare, since Republican politicians won’t support changes that prolong its longevity.
To escape this mess we need a magician who can pull a political rabbit out of their hat, and the best person to do this may be Hillary Rodham Clinton. If Mrs. Clinton decides to run in 2016, she should come out in favor of replacing Obamacare with a simple single-payer insurance system financed by general taxes.
The Clinton campaign should make this proposal its centerpiece and seek to persuade all voters, Democrats and Republicans, that Medicare-For All would be in their interest.
Such a campaign would have many advantages. For one thing, the claim would be true. Taxes would have to go up, but the increase for the average person would be more than offset by reductions in individual premiums, in money withheld from wages by employers in order to pay insurance premiums, and in co-pays and deductibles. Mrs. Clinton could point out that people should care more about what medical care costs them than about whether they are paying for it through taxes or by more convoluted and indirect means.
A single-payer system, unlike Obamacare, would cover everybody. Unlike Obamacare it would not force individuals and employers to make complicated choices between plans with different coverage, costs, and in-network doctors and hospitals. Unlike Obamacare it would not need to determine individuals’ continuing eligibility for subsidies, since the tax system would implicitly take care of this. Unlike Obamacare, Medicare-For-All would not motivate employers to reduce the number of full-time employees in order to avoid the mandate.
Politically, Hillary Clinton could appeal simultaneously to Republicans (by openly acknowledging Obamacare’s defects) and to Democrats who have soured on Mr. Obama and on Obamacare. She could capitalize on her expertise gained from her failed effort to design a national program during the first Clinton administration. She could admit learning from that experience that a national system must be simple and understandable.
If Hillary Clinton campaigns on a single-payer platform, the usual vested interests will attack her. But Americans have become suspicious enough of corporations (not least hospitals, insurance, and pharmaceutical companies) that she should be able to turn the tables on them by pointing out the inefficiencies of the current system, the bloated compensation to corporate executives, and deceptive marketing. Many doctors, who used to oppose single-payer insurance, have changed their minds because of frustration with the current system..
If Americans understand where their bread is really buttered, they will support a single-payer system. As a presidential candidate Hillary Clinton will command the national attention necessary to persuade people that such a system would truly be in their interest.
The campaign should be completely honest about the insurance issue. It should frankly admit that single-payer is no panacea and would have some drawbacks as well as advantages. But that is true of all policies, and the real question is how the advantages and disadvantages net out.
By making Medicare-For-All her central platform plank, Mrs. Clinton can help the U.S. escape from the Obamacare corner into which it has painted itself. Even if she loses the election, she will have increased national understanding and paved the way for eventual progress. Win or lose, she has an opportunity to make a real difference.