Let’s Work with the Republicans to Build a Real and Sustainable Universal Health Care System

Vouchers Are Coming

Republicans like Ted Cruz and Paul Ryan are now openly proposing “structural changes” to Medicare in order to avoid having its cost blow up the federal budget. They have, for example, proposed turning Medicare into a voucher program in which each person is in effect given a fixed amount to spend.  That voucher would replace the program’s open-ended commitment to pay each patients’ bills without limit. 

This Can Be an Opportunity

Democrats are justifiably horrified that our seniors will lose their health care, but if we think carefully, we can find ways to leverage the Republicans desire to limit the government’s costs to build a healthcare system that is both just and sustainable.  The Republicans will be looking for ways to obtain Democratic support for what they want to do because otherwise, they will have a difficult time persuading the voters to accept limits on Medicare, and if we know what we want in exchange for our cooperation, we may be able to make good use of this opportunity.

Democrats have nothing to lose by offering to cooperate. If we succeed in obtaining cooperation, we will be able to improve our healthcare system. If the Republicans refuse to cooperate, they will look bad, and we will look good. However, in this situation as in all situations that involve negotiation, the key to success is knowing what we what we want. We have to know what will make a deal a good one for us.

Using This Opportunity to Move toward Sustainable Universal Healthcare

The idea of placing a budgetary limit on spending is not in itself a bad idea. Several European countries – including Germany – use budgetary limits to control the cost of healthcare. However, in those systems, the budgetary limits are coupled with other measures that insure that the costs will really be reduced rather than being shifted to the patients. Without such measures, budgetary limits will end up causing great injustice and hardship by transferring the costs to the patients. On the other hand, with such measures, budgetary limits may be a part of a system that provides healthcare to everyone in a sustainable way.

Here is are some examples of the provisions that progressives might fight for to provide healthcare for everyone while supporting the goal of cost control.

•   Restore the individual mandate under the ACA

• · Fund the subsidies for insurance companie
•    Allow Medicare to bargain with the drug companies over drug prices
•    Insist that information on prices be available easily to both doctors and patients so that they can make informed choices of procedures for diagnosis and treatment.

We can also propose to reduce the cost of healthcare

•  Shifting some of the financial risk onto providers to encourage them to become more efficient. This may be done through bundled payments or other mechanisms.
•   Insisting that payments to providers be based at least in part on measures of the quality of care.
•   Encouraging the establishment of local or state healthcare cooperatives to bargain with healthcare providers
• Increasing funding for primary care to avoid excessive use of expensive emergency rooms and hospitalization
• Increasing funding for health education to reduce costs associated with the management of chronic conditions like obesity and diabetes.
•  Making the amounts of the vouchers realistic and obtaining buy-in from the patients and the healthcare providers by making the amounts of the vouchers dependent on the results of the negotiations between the healthcare cooperatives and the healthcare providers.

These are only a few of the ways that we could take advantage of this opportunity. Let us prepare to fight for what we care about rather than objecting fruitlessly. Let us move beyond mourning the fate of the ACA and develop realistic, sustainable and forward-looking Democratic health care proposals.