What’s Going to Happen with Obamacare

Eric Zuesse

Trump had offered to Paul Ryan, on January 26th, a postponement on offering an Obamacare-replacement until after Obamacare collapses of its own accord after the new (much costlier) premiums come out late in 2017, but perhaps Ryan said no to that; it’s not what happened. They didn’t take that road. 

In any case, House Republicans — and this includes Ryan their leader — naturally didn’t like Trump’s suggestion that “the Dems would come begging to do something because ’17 is going to be catastrophic price increases [which is already set to happen in the Obamacare exchanges], your deductibles are through the roof, you can’t use them, and they will come to us,” which would then mean that those same House Republicans wouldn’t be the people writing the legislation; Trump and “the Democrats” would do it and get the credit for it, which was a real fear they had about this new President, who was well known for saying that he would work with either Party or both Parties in order to get his legislation passed. So, Trump was quoted as having told these congressional Republicans, on January 26th, “But I think, congressmen, we have no choice, we have no choice, we have to get it going,” and then Paul Ryan issued his plan on March 7th, and it promptly busted. 

Trump, then, yet again, in an interview published on April 2nd in Britain’s Financial Times said, “If we don’t get what we want, we will make a deal with the Democrats and we will have in my opinion not as good a form of healthcare. … But we are going to have a very good form of healthcare. It will be a bipartisan form of healthcare.” He was repeating his implicit threat to House Republicans — his threat to Paul Ryan. 

What would happen, in such a case, if the most-supported Presidential candidate, the most popular American politician of all, Bernie Sanders, told Trump he’d endorse Trump’s opening Medicare to all U.S. citizens funded through taxes? Trump has already acknowledged that it would be vastly more cost-efficient than is the existing hodge-podge: 

On September 27th of 2016, while campaigning against Hillary Clinton Trump told CBS “60 Minutes”: “Donald Trump: By the way. Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, “No, no, the lower 25 percent that can’t afford private.” But — Scott Pelley: Universal health care? Donald Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now. Scott Pelley: The uninsured person is going to be taken care of how? Donald Trump: They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably — Scott Pelley: Make a deal? Who pays for it? Donald Trump: — The government’s gonna pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”

He was describing there the Swiss system, which instead of America’s for-profit insurance companies uses non-profit ones and then lays out in detail the criteria for all health plans that will be approved by the government, so that now there are 60 insurers there, all of which offer one or more of the authorized types of plans; insurers don’t supply any dividends and profits to investors (there are no investors) but only meet the requirements of the law, the government, so that all Swiss citizens can rest assured that the insurance company makes no difference — only the different categories of the government’s authorized plans do. Everything is the same within a given plan, except that the insurers can and do vary from one-another on price, on all but the basic plan. I’ve further described elsewhere the Swiss system, and its well-proven superiority — in every way — over America’s. More details about the Swiss system can be found here. The history of the Swiss system is here.

If such a plan were to be proposed by Sanders and endorsed by the President using his White House bully pulpit to sell it to the public, and yet fail to get almost all congressional Democrats and at least enough Republicans behind it to pass it, then both Trump and Sanders would look golden, and everyone who had voted against it would then look lousy; so, it would probably pass. And, in either case, Sanders — for his leadership in this — would be ideally positioned to beat any Democrat in the 2020 Presidential primaries, and (if polling thus far is any indicator) he’d easily beat Trump (or especially Pence) in the general election. But it wouldn’t be only his plan; it would be a compromise between his original proposal, Medicare for all, and the one that Trump described to Scott Pelley on September 27th. But that’s what any “bipartisan” plan necessarily would be: a compromise.

Sanders wouldn’t get Medicare for all, and Trump wouldn’t get preservation of the existing — i.e., for-profit — insurance companies. Instead of Sanders’s governmental insurance system, or Trump’s for-profit corporate-offered insurance system, it would be a strictly regulated non-profit insurance system — which would be based upon the Swiss model, which is already proven to be vastly superior to the American model.

If Sanders would want to propose to Trump something along these lines, he could add for special appeal to Democratic healthcare-consumers — i.e., for patients who favor the Democratic Party — in his proposal a public-option (i.e., a government-provided) insurance plan, so long as it won’t be competing against the other (the non-profit) ones, but perhaps instead it would be paying a fixed percentage of any year’s excess of income over and above expenses, into the general revenue, that’s to say, into taxes. The government, then, would be serving like a residuary charity, whose beneficiaries are the general public — which is what any government is supposed to be, regardless. Then, if Trump won’t accept that proposal, Sanders could ask Trump what in Trump’s proposal Trump would be willing to sacrifice in order to get Sanders to sacrifice such a public option. And together, they’d offer the negotiated plan to both Parties in Congress, as a truly bipartisan compromise.

The instance where Trump told Pelley that Trump wants a government-funded universal health insurance system, isn’t the only instance where Trump had proposed a taxpayer-funded universal U.S. healthcare insurance system. On January 15th, he told the Washington Post: “We’re going to have insurance for everybody. … There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

The Swiss system is neither socialistic (government-provided) nor capitalistic (for-profit and investor-based) but is instead non-profit and strictly regulated by the government; and it’s already proven to work far better than the capitalistic American system, and equally well (overall) as do the more socialistic health care systems that are provided in all industrialized countries except for the (bottom-of-the-barrel) United States (which is by far the most-capitalistic — investor-corporate-“private” as opposed to governmental-“public” — of all systems in the industrialized world).

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Investigative historian Eric Zuesse is the author, most recently, of  They’re Not Even Close: The Democratic vs. Republican Economic Records, 1910-2010, and of  CHRIST’S VENTRILOQUISTS: The Event that Created Christianity.

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  • kimyo

    Sanders — for his leadership in this — would be ideally positioned to beat any Democrat in the 2020 Presidential primaries

    get a grip – sanders will be 80 years old in 2020.

    plus, he sold us out. he didn’t contest obviously fraudulent vote counts in brooklyn, california and beyond. he had a ‘deal’ with podesta. ‘everyone is tired of hearing about your emails’.

    it’s always ‘get thee to the voting booth’ with you, despite copious evidence which clearly shows that your vote serves only to maintain the fiction of electoral representation.

    somehow you’ve already managed to forget his statements to the guardian (which you wrote about here).
    Sanders on Trump and the challenge for the left – full transcript

    Sanders: For a start, what we know to be a fact, is that Russia played a very heavy role in attempting – successfully, I think – to impact our election. That is unacceptable. The evidence is that they have done it before and they will do it again.

    There’s no question but they did do that. They had many many, hundreds and hundreds of paid employees. What the exact mechanism is, who paid them may not be clear, but there were people working with the approval of the Russian government trying to undermine American democracy.

    What we don’t know and what absolutely needs to be investigated is whether or not there was direct collusion between the Trump campaign and these Russians.

    • Eric Zuesse

      I agree with everything you’re saying. But it’s irrelevant. My only assumptions in this article are that Sanders is sincere about wanting the U.S. to have a non-commercial healthcare system replace the existing commercial (or for-profit) one, and that Trump wants Trump’s name to become attached to whatever system will replace the self-destructing Obamacare. That’s not really a hell of a lot to assume.

      As to whether Sanders’s age ought to be a factor, he would be 80 at his inauguration, and, according to the latest available published information (surviving American men who were 80 in 1987, http://www.nejm.org/doi/full/10.1056/NEJM199511023331824#t=article ) would have a 58.4% chance of surviving 5 years or more, and would have a life-expectancy at that age, of 7.0 years, which, if he were to have as VP the person who nominated him at the 2016 Convention, Tulsi Gabbard, would also mean that the replacement if he were to become replaced would be at least as good as the elected President.

      • kimyo

        if we’re going to put forward a champion to fight for sensible health care, shouldn’t it be someone trustworthy?

        sanders is trustworthy in the way that brian williams is trustworthy. his ‘sincerity’ is akin to trump’s ‘drain the swamp’ or maddow’s ‘boris and natasha did it’. he is just another participant in wrestlemania 2017.

        he sold you out. admit it and move on. stop lionizing him. he is obviously NOT WORTHY!!!!

        • cettel

          Obviously, I don’t expect perfection.

  • joeymac

    None of your proposed solutions address the main problem with American healthcare; excessive costs and unneeded procedures by surgeons and specialists.

    In the 1960s, in Brooklyn, NY, I could visit by family GP for a flat charge of $6.00. A visit to a hospital emergency room, to the best of my recollection, cost about $20.00. Medical practicioners didn’t “push” expensive drugs as a matter of course.

    Sometime after Medicare, grifters learned to soak Oldsters for charges, who didn’t object because “the Government is paying for it.” This started to push up costs for everyone who then demanded insurance to cover potential costs.

    Near universal insurance for workers was a gold mine for for doctors, because, generally people didn’t object to the higher costs because “the insurance is paying for it.” Also, doctors, by exploiting the inherent trust placed in them, could order unneeded surgeries without worry about getting paid exhoribitant fees. I know of three attempts (on different people) to do a unneeded mastectomy on people close to me. I happy to say that my nagging that they don’t blindly accept a doctor’s word and get other examinations allowed them to keep their boobs.

    Due to the rampant greed in our society, the only viable system is the UK model which has the the lowest per-capita costs in the industrial world, sustains a healthy population, and everybody (even visitors) is covered.

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  • oncefiredbrass

    Tort reform Definitely Has to be Part of the Quotient….Make Frivolous Lawsuits pay all Legal Fees. There are Obviously Times When Doctors Screw Up and Should Be Sued, but Most of Them are Junk lawsuits with Dirt-bag Clients & Sleazy lawyers out for a Big Payday!

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  • seesee2468

    Unfortunately the Swiss system is very expensive, as is the Dutch system. Both are much too expensive to import into the US. The private strangle-hold over medical insurance simply must be broken if the US is to make significant progress, especially in the profit-hungry US. The only reasonable system for the US is single payer, and in the US that means Medicare for All — actually, we would probably have gotten it in 2009 if Ted Kennedy hadn’t unfortunately died before the debate began. Many polls show that a majority of Americans support Medicare for All, and it is not at all impossible in the US. All we need is positive thinking, a strong will, and dynamic political leaders. Once Medicare for All is achieved, it will quickly become very popular, and the rich can also buy private insurance if they want.

    We need more concrete reporting on how single payer works in other big capitalist economies. Perhaps the most instructive is the Japanese model of national health insurance. The Japanese economy is large-scale, and Japanese corporations love national health insurance because they don’t have to bear the burden of ensuring their workers, and absenteeism is also reduced. And national health insurance covers even foreigners who want to join. All big hospitals are non-profit, and the Ministry of Welfare issues a fat book of standard prices each year for all medical and dental operations and drugs, so base prices are much lower than in the US, and doctor salaries are also lower because of the price controls. All a person needs to do is show her or his insurance card to any hospital or clinic, and 70-90% of the cost is paid by the insurance, though you have to pay the co-pay, usually modest, on the spot. Everything is computerized, so there is no waiting except for major surgery and no paperwork, and you can visit any doctor or dentist you like whenever and wherever you like, and even preventive health visits are covered. The Japanese government and Japanese corporations know that a healthy populace is also happier and more productive, and the system is quite popular. South Korea and Taiwan also have somewhat similar programs. In all three countries national health insurance is believed to play a major factor in their generally robust economic growth.

    Likewise, most US corporations could surely be persuaded of the great value to the US economy of Medicare for All, which would end up saving them a lot of money and time. It is only the insurance companies that would need to make major adjustments. The change will not be easy, but it can be done. That is why I believe Bernie will never give up his demand for Medicare for All and will not betray the American people by working with Trump unless Trump is willing to take at least the first steps toward Medicare for All, such as lowering the entry age for Medicare to 45 or 50. The only problem is the Democratic elite, who want big donations from the insurance industry. They might betray the American people and work with Trump for a streamlined private system or for a puny “public option” that wouldn’t work well because of its small size and because it would become a collection point for all the most needy patients. Single-payer needs to be large-scale in order to work well.