CNN’s Senior Congressional Reporter Manu Raju just made a tweet announcement that I’ve been anticipating for months and months now. Senate Majority Leader Mitch McConnell can’t get the votes from his own caucus to repeal Obamacare.
MCCONNELL tells senators: He will delay the health care vote until after the recess to solicit more support from GOP senators
— Manu Raju (@mkraju) June 27, 2017
I’ve written piece after piece about how Trump miscalculated when he made the decision (if it really was a “decision” at all) to try to govern with zero Democratic votes. In a last ditch effort to win over wavering members of his caucus, Mitch McConnell finally said something approximating the truth:
Mitch McConnell is delivering an urgent warning to staffers, Republican senators and even the president himself: If Obamacare repeal fails this week, the GOP will lose all leverage and be forced to work with Chuck Schumer.
Working with Chuck Schumer should have been Trump’s starting point because he promised to protect Medicare and Medicaid. He promised not to leave people dying on the streets. He promised people would get excellent and even more affordable access to health care. If he wanted those things, the last people to rely on would be ideological conservatives.
Trump was too stupid to understand this up front, so he went along with a plan that not only would break some of his more important campaign promises but which is polling just above the ebola virus. Maybe Trump doesn’t realize it, but one major reason he won over so many Obama Democrats is because he distinguished himself from ordinary Republicans like Paul Ryan who have built their entire careers around destroying the safety net.
But his strategy was idiotic for another reason, which was that it should have been obvious that the Republican Party can’t operate as a unified borg anymore. They basically ran John Boehner and Eric Cantor out of town because they couldn’t get behind their leadership and forced them to go running to Nancy Pelosi for help over and over again.
I know Josh Marshall can’t quite believe his eyes, but this shouldn’t have come as a surprise. Mitch McConnell is a master legislative tactician, but he isn’t a wizard. There never was a way to square the circle between Trump’s campaign promises, the needs of moderate Republicans from states that expanded Medicaid, and the unhinged anti-Obamacare rhetoric of Trump and the hard right.
Marshall is correct to caution that this isn’t the end and that McConnell will keep working. He may cobble together something in the end. But unless he comes up with a plan that won’t strip 15 million people of their health care next year that still does pretty much everything the House Freedom Caucus would like to see in a repeal bill, he isn’t going to be able to reconcile any Senate bill with the House version. And if that were possible, he would have presented that bill already.
Meanwhile, the Republicans have succeeded in doing real damage to the health care exchanges, to the point that they can’t just give up and move on to other things. That’s why he’ll need to start talking to Schumer. And the Republicans will discover, once they start exploring that route, that the Democrats have all the leverage because they’ll be expected to provide almost all the votes.
McConnell tried using this stark reality as his final cudgel to beat his caucus into line, but they wouldn’t budge.
They’ll go into their recess and have to endure the fury of pretty much everyone who is engaged on health care, regardless of what angle they’re taking on it.
Trump has an opportunity now to recalibrate how he wants to govern, but it’s probably far too late for him to provide an olive branch to the Democrats. As I predicted, his presidency is going to crash and burn this summer.
I would still caution not taking anything for granted. We have some breathing room, but that is all. The Zombie Trumpcare bill appeared to be dead in the House and it somehow got revived and passed. We’ll see what happens when the July 4 Recess ends. Apparently the bill will be rewritten and re-scored by CBO. Yertle the Turtle will be trying to find ways to buy off the waverers in the meantime. Be hopeful but not complacent. This ain’t over yet.
Is there a draft single-payer health care bill in the Congressional Democratic caucus that would be simple, wildly popular with the public and something the “Trumpublicans” could be forced to compromise on by claiming a “bipartisan victory”?
It would have to take effect immediately and have positive benefits for there to be any political benefit?
Given the obviousness of this particular impasse among Republicans, I hope some Democratic Senator or Representative has thought of this.
And yes, to do the whole country we are talking a total cost of $4 trillion a year that would rapidly save $600 million the first year and settle in at an annual cost of $2 trillion a year adjusted for general inflation. But no insurance premiums. Businesses lose a major fringe benefit cost. No co-pays or deductibles. Everyone gets health care, including the health insurance company billing and claims people laid off as a result.
If Congress delivered it, Trump would sign it because (1) it’s yuuuge; (2) it’s a WIN; (3) Trump’s name would ever be associated with health care reform. No matter the “conservative principles” he would dance over to do it.
Do Democrats have the bill? Do Democrats have the chutzpah? Do Democrats have a tough negotiator?
Or does the “S” word make them quake in their shoes?
That is the opportunity that might be presenting itself. It would be worth it if someone was prepared to win big for a change instead of strategizing how to not lose.
This based totally on the fact that Democrats don’t actually need to vote for any Republican bill if they can’t get their caucus together. No bill means Obamacare continues by default.
You’re deluding yourself if you think single-payer would be popular in the abstract.
See how it fell apart in Vermont for more information about the difficulty of convincing people to put up with that level of disruption and uncertainty.
That is the Catch-22, isn’t it. Single payer in practice proves to be a huge money saver. But single-payer in the abstract always gets shot down in the legislature by the politicians supporting it not having thought through the mitigation of the disruption and uncertainty. But other major disruption and uncertainty — bank collapse after fraud — does not merit the anxiety over abstractions. Only giving people health care that is gratis at the time they need it. This line of thinking has gotten so bad that the idea of toll roads is making a comeback.
I’m not deluding myself. I’m arguing that Democrats should force through something in the style that Republicans do disruption. Do it and see what happens.
And I’m betting if single-payer actually happens as infrastructure based on health care as a right, it will be wildly popular. My clue on this is how hard insurers and the GOP have fought for 80 years to keep it from happening.
It is interesting that Democratic supporters have difficulty with this whole idea and have developed that difficult since Daniel Patrick Monyihan shot down Hillarycare.
It is also interesting that there has never been a straightforward single-payer healthcare bill proposed, one that is simple enough for voters to understand: hey, we’re paying our doctor, hospital, dentist, and vision bills out of government funds gotten from progressive taxation. No idiot is making a profit on it and likely to run off with the funds if your state doesn’t have an insurance commissioner. No hired nurse will be arguing why you don’t deserve to have your procedure paid for. No care is going to cost you more because you are “out of network”. With no anxiety about being paid, physicians can practice independently again and don’t have to pool funds for billing and collections staff.
There is a lot of disruption and uncertainty in the current health care system. That’s why any proposal must be simple, and must not have hidden fees and gotchhas. There is no requirement for government to hold corporations harmless in the legislation they write. They regularly screw the competitors of the corporations whose lobbyists are not their buddies.
No delusion here. Just huge doubt that Democrats ever intend to deal with health care on the level; the same sense that one gets about Republicans and actually reducing the number of abortions.
No, eighty years of propaganda and jury-rigging the health management system and health insurance system and health finance system have given people the idea that government can’t understand the health care issue.
That seems to be an intentional failure of politicians.
Oh, I see that Jim Messina has rushed back from his Tory victory to save his baby from the clutches of Mitch McConnell. Those kind of politicians.
And just to be sure everyone understands, cause you know, someone is going to ask you, include how much you will increase taxes with supporting information like how you covered that $4 trillion nut, plus how much we will all save. Careful here since corporations pay for a good deal of it now and from what you say the government will take it over. (call me a skeptic but that 15% bullshit won’t work. Most health care comes from corporations.) And while you are at it what do you intend to do with the people in the corporations, and insurance companies and investors who have just been jettisoned. Ignoring them will leave a lot of pissed off people out there and some of them have money.
I would dearly like to see single payer. But that 80 years you talk about has to tell you something. There are people out there who don’t want it or as you said there has never been a straightforward bill proposed. Fairy dust isn’t good enough.
You haven’t looked at what the employer subsidy is these days. But it is part of that $4 trillion that will go to $2 trillion and will be recaptured in taxes on corporations overall. Which means the freeloading corporations, who are not currently providing health care fringe benefits, will have to cough up their share just like the healthy people who don’t hold insurance did in Obamacare.
The people who don’t want it are the corporations and the wealthy who were conservatives under Theodore Roosevelt, conservatives under FDR, and are the conservative wealthy backers of the GOP today.
It was the medical interests during the Progressive Era and the New Deal who didn’t want a Public Health Service (UK style). The specialists lined up against Medicare and Medicaid; indeed, some of them are still in Congress. And one for-profit health insurance company dictated the shape of Obamacare. And just recently changed their name because of their association with drafting Obamacare.
All that is really immaterial to the current moment in which some Democrats might sign on to Trumpcare for less than a total single-payer system. Or more optimistically, Democrats standing in unity might frustrate the attempt to repeal Obamacared in any form and cause Price to undertake a strategy of sabotage.
Apparently the only pissed off people who count in the US are the ones who have money. They get pissed off by private deals all the time and call it “accepting the risks”.
Are you talking about deductions for insurance and FICA? If so, yes the employer gets to pay more tax, but so does the employee.
I really don’t see why the corporations are opposed to single payer. When they did away with preexisting condions that about did away with the handcuffs. I’m wondering why they would not want to be done with it.
Yes I recall how the AMA and others opposed insurance. That is not surprising since it is all about money to many of them. Same as Trumpcare. These guys are using it as part of a two for. First Obamacare and then tax reform.
I am hoping the dems do not sign on to Tumpcare in its current form. But there is something to be said about having a base to work from, like Medicaid. That is a single payer system, albeit often run by insurance companies.
I tend to think the fastest way to get to single payer is perhaps a gradual expansion of Medicare and federalizing Medicaid. But to get there we need to get power,back.
The traditional answer to the which tax question is to eliminate the income cap on FICA tax liability so that the people who have been dodging a major part of FICA taxes now participate in a common infrastructure.
It is sad when providers prioritize the right to print money over adequate compensation for their services and universal coverage. It shows how deep capitalism has undercut the respect for life in its faux concern for liberty.
Republicans agreeing to join the Democrats to pass a single payer bill out of congress?
Are you on drugs?
Actually, not at all.
I didn’t say they would. I just recommended that Democrats be ready if they get truly desperate to “repeal Obamacare”.
And I pointed out Trump’s propensities if presented with a Hobson’s choice about it.
I really think to have any chance, it has to be fully explained. Who saves what money? And what happens to it? What replaces it? Some of this like Medicaid is simply the government and the funds get repurposed.
And I also think you will need to talk about the insurance companies. This will take away a big chunk of their business including Medicaid and support to employers. What will you do about them? They all have investors and they would expect to be bought out., as will the employees. That could kill the whole thing.
When we talk about single payer, it all sounds great, but we have no idea how to make it happen.
Sorry, Republican legislation moves through corporations and ends their businesses without making them whole.
Insurance companies deal in a market environment that they have shaped for too long. The environment is changing, even with repealing Obamacare. Tough for them.
Protect investors? What a staggering thing for a Democrat to say when workers have been fed to the wolves for the last 30 years?
Insurance companies ARE the inefficiency in the health care system. A $2 trillion inefficiency.
Fine. The insurance industry and all its employees are an evil empire and must be destroyed. Might as well take down Big Pharma while we’re at it; they’re evil too. All just a bunch of evil profit-seekers sucking the people’s lifeblood away.
Which changes not one whit the fact that those industries own a significant chunk of this country’s economy, have large institutions as well as individuals of varying wealth invested in them, and thereby exert political power sufficient to kill any attempt to put them out of business without recompense. And all the “But things ought to be…” hand-waving in the world doesn’t change that reality.
So did the telecommunications and IT industry in 2001. That didn’t stop massive layoffs of IT people. Is this a free market economy, or are only certain industries insulated from it?
And if the GOP did not accept a single-payer bill, they couldn’t repeal Obamacare unless they got their factions together, could they?
Are the health insurance industry lobbyists working to prevent repeal of Obamacare, which provided them a larger market?
I would remind you that property rights mean something in this country. You simply cannot steal valuable assets, no matter how ” staggering” you think it is to object to it.
Property arguments are always really policy arguments with a hidden premise. Even more so when talking about taxes.
What property are we talking about here? No one has a right to expect a living in a free market economy, right?
No business has a right to expect a profit either, right?
No one is ending the private insurance market, or the employer-subsidized insurance market. They likely will fill “prestige” niches for high premiums and Cadillac service options.
But people in southwestern Virginia would start getting health and dental care convenient to them.
They could be so desperate to repeal Obamacare they would literally die in five minutes if they don’t do it and they still wouldn’t provide one single vote for single payer. Do you even live in this country?
If Democrats stand together and Republicans are still split, then they couldn’t repeal Obamacare, could they?
I didn’t say Congress was a pushover; I said that the GOP caucus would face a Hobson’s choice. I also said that Trump’s narcissism might work to Democrats’ advantage if lightning struck and Congress passed a single payer bill.
It is a high upside, low downside, low probability situation for Democrats and thus worth a serious try to frame a good single-payer bill.
There’s no upside. Telling Republicans that they can get their Obamacare repeal by passing single payer is like telling them they can replace the anchovies on their pizza with razor blades.
Total health care cost in the US in 2015 was $3.2 trillion or just shy of $10k per person per CMS. That includes everything including drugs, dentists and nursing homes. Medicare and Medicaid are 36% and employer plans are 49% per Kaiser. Do you really want to dump all employer plans?
I like the idea but the super big questions are how will you pay for it? And how do you get enough votes? This sounds like a massive effort, something the party would need to adopt first.
How are you paying for it now? People are running up bills and going bankrupt; providers are holding the bag and overcharging the rest of their patient base to make up the difference. Even after Obamacare, that has not changed, and it’s because of deductibles, co-pays, out-of-network pricing, and any number of nickel-and-diming strategies (now associated with Obamacare) that make patients go nuts. Do you not understand that that is where some of the anger has come from? Have you not had to deal with a medical system business office recently? Or are you so affluent that you never experience this problem because your finances can handle it?
Yes, I do really want to dump employer plans so long as the health care provided is comparable. Employers use fringe benefits as golden handcuffs to keep good employees in bad situations.
I think the capitation value is around $11K per person in 2017; that and the current population was where my roughly $4 trillion estimate came from. The $600 million right off the top comes from removing insurance companies with their 15% indirect costs (above the 85% medical cost ratio) from the system.
And you bet that I would like for the nurses who are in the business of denying coverage to be able to go back to caring for patients instead of being Scrooges. I kinda think most of them would like that disruption if the workplace issues that drove them to take that insurance job were taken care of.
The way the US healthcare system is currently being run needs some major disruption to moves to towards care and away for profit-uber-alles.
You know what prevents medical bankruptcy?
I am living evidence of that, btw. Went through a medical bankruptcy pre-ACA. Family went through an even worse crisis than the one that bankrupted us last year, and no major worries other than getting healthy. I realize mileage varies from state to state, and that those with employer health plans have different experiences than those who don’t. But I will say that with my current employer, the plan we were on saw quite an expansion of in-network options, and that was huge for us. Now I will say that even worse than employer health plans is actually going through bankruptcy. It makes staying in a bad situation seem the least bad of options, when one thinks about credit ratings and such. I stayed in a crap job several years longer than I should have mainly because I was convinced I would never survive a credit check if I tried to move elsewhere. Never want to live through that again.
Good single-payer prevents it from ever being an issue at all.
Yes, but Obamacare is what we’re currently worried about protecting. Good single payer is a future dream, and one that only gets further out of reach if Obamacare is dismantled.
So give the GOP a Hobson’s choice. Obamacaare or Single-payer: choose (or unify your caucus).
By the way, unifying their caucus puts the onus of repealing Obamacare on them alone.
That’s not the jist of the question. You need to know the financing today and how you will change it. Who pays and by what mechanism. Are you planning to increase taxes. If so how much? You can get angry all you want but that won’t sell the first vote.
Ironically the only real glide path to single-payer that doesn’t involve catastrophic disruption is to introduce a public insurance option to the exchanges that slowly out-prices competing private plans, or to expand medicare eligibility over some period of time until it’s open to all, again out-pricing private plans. Both of these approaches require Obamacare to be operational. There’s no plausible path to single-payer that includes a full repeal of Obamacare.
Personally I like the idea of expanding medicare, perhaps a little at a time. Plus Obamacare already has a single payer Medicaid. That needs to be expanded in all states. This route gets it in the public without a huge clusterfuck. That can also ease private insurers out of the business. I am not sure how corporations should be handled. But a little at a time.
Like Pete Stark’s Americare
It’s a good plan. Note that it would likely be introduced in the form of a public option on the exchanges:
As an aside my workplace is eligible to purchase insurance on the exchanges and it’s been a godsend. The unsubsidized policies we can buy now are significantly better and/or cheaper than what was available from a broker on the small group market before the exchanges launched. There are certainly flaws in Obamacare but it’s really a vast improvement over the previous status quo.
Medicare Advantage plans provide what should be basic Medicare coverage, but isn’t because Congress wanted to create a market within Medicare.
Basically you are correct. Eliminating the age restriction from Medicare and using the current billing system is the best glide path to single payer.
I am just asking whether any Senate Democrat has a bill in his pocket should that opportunity present itself.
I seriously doubt anyone has a fully-fleshed out bill since there’s less than zero chance of it getting a hearing in the current congress. But “medicare for all” is a simple enough slogan to run on.
Yes, indeed. A simple enough slogan to run on as long as you never intend to enact it.
You need huge majorities to enact it. We won’t be there for a while.
Or policy unity and the ability to carry out a power play.
Too much too fast – what, are we suddenly going to pass a single payer bill without ourselves holding hearings, town halls, etc.? It took much of the public seven or so years to warm to Obamacare, let’s take things one step at a time or we’ll lose whatever good faith we’re building right now.
Anyone who has had a health emergency in a country that has single payer healthcare knows it works. You can only do that persuasion by putting it in place.
BooMan is right. It is the abstract discussion that has been the killer for 80 year.
If it comes down to TrumpCare or Single Payer, how would you choose?
Defeating Trumpcare does not preserve Obamacare. The dementors will be back.
The public never warmed to Obamacare because there was seven years for McConnell and his gang to set expectations and scream and holler at each foul-up.
Who’s building good faith? What’s being built is fear of losing what little Obamacare and its changes provide. There is no good faith that Democrats in power will make it better unless they are putting forward proposals for making it better now, which I must have missed.
I think you need months, if not years, to build nationwide support for single payer. One of the biggest obstacles to obtaining Obamacare, and also one of the biggest impediments to its destruction, is that people who have something prefer to continue having that thing rather than being thrust into the unknown. The average voter has no idea how his/her quality of care, access, costs, etc. would change under a single-payer system. And, if both parties are proposing some different system than what exists today, much of our support on this issue will erode. After all, most people have some experience with the Trumpcare scenario (US healthcare prior to Obama) and learned to tolerate it. They would prefer the familiar to the completely unknown or, at best, you’d have a 50/50 split between people who would prefer Trumpcare and those who would prefer single payer without further education.
For many people with employer provided insurance much like Medicare is for many people when they retire. At least single payer how Canada has it which is similar to our current medicare. Only 80% of approved charges are covered, prescription drugs cost significantly more, no dental. That is why those who can afford it on Medicare have supplemental insurance or Medicaid picks up those costs. Take all of that into account and for many retirees their health insurance costs increase significantly when they go onto Medicare.
Now if we are going to have single payer like many progressives envision it (covering almost everything with few cost sharing provisions) then we will be covering a lot more than current Medicare does. For that matter a lot more than what Canada currently covers.
Given all of that there needs to be an honest assessment of the costs. And that honest assessment needs to take into account that taxes will increase but initially wages increase to match those tax increases because companies will pocket their health care savings for profit.
There also needs to be an honest assessment of whether other systems might be a better way of reaching universal healthcare in this country. Personally I think both the German and Dutch systems would be a better route.
The German and the Dutch systems rely on very strict and uniform regulation of insurance companies, something state regulators were unwilling to do when Obamacare was going through Congress. The GOP tries to get around this with its “sell from any state” provisions, but that moves in exactly the wrong way — toward selling from the states with the least regulation against fraud and other abuses.
I’m Canadian. There is no such thing simple (or wildly popular) single payer healthcare plan. Our system is incredibly complex. Furthermore it is always a political issue. Always. In every Federal and Provincial election. If medical professionals and hospitals aren’t screaming for more money, patients are complaining that the waitlist for their hip replacement is too long.
How can Schumer negotiate with the donald? Why would he trust that the donald would not say one thing to his face, tweet something else that night, and spin anew in a Fox interview in the morning? I think the senator to watch is Paul…is he sale?
Rand Paul seems merely to be playing Libertarian Nihilist, MD, a role he prizes so highly. He is incoherent (as usual) and has no “plan” for anything other than status quo collapse.
Blathering Rand and Master of the Senate Mitch. Has any state failed the nation more thoroughly than KY? Heckuva job!
Rand Paul is so full of shit his eyebrows are brown.
.
I’m going to be thinking of the South Park episode “You’re Getting Old” (where everything begins to look and sound like crap to Stan Marsh after his 10th birthday) every time I see Rand Paul now. That’s about all Paul has managed to spout for years.
No wonder Arthur adores him, eh?
There are no negotiations. Either McConnell has the votes or he needs Democrats to vote for something.
The issue for Schumer is what is the Democrats’ price for bipartisanship. In my comment above, I advocate that it be single-payer and that Democrats hold hard to it or let Obamacare repeal fail. That should be fairly easy to understand how it works.
To make the single-payer demand credible there would need to be a bill. To sell the bill to the public, it would have to be simple and upfront with how the finances work. No patient/doctor/insurance/government/employer complicated cost-splitting.
And Democratic unity would have to withstand the hissy-fit of the GOP screaming “Socialism”.
All of the coy GOP Senators are for sale, especially Paul.
I don’t think it’s been that idiotic. They need to flip maybe 1-2 votes and they get what they want. The House maniacs would in all likelihood fold in such a scenario. Pressure needs to be maintained until this thing is as dead as dirt.
I watched Schumer at the podium. He was terrible. The message coming out is TrumpCare, McConnellCare is terrible. This condition, that condition for our participation. The Republican position is Obamacare is a failed system.
So I wanted Schumer to name a problem or two with the ACA (as examples) and suggest the fixes that the Dems think would work.
People want to be for something, not just against something.
Reminds me of Clinton running about how terrible Trump would be, but not offering another vision. Rinse and repeat with this. What’s the vision?
Someone above said “single payer.” Obamacare is Romneycare writ large. It’s basically a Republican business-friendly, free-market plan with some underpinnings in place. It can sell.
Also, I remember Obama warning the R’s that they are risking getting boxed in by their rhetoric. They sure have been. So how can they save face on the “repeal.” Let them call improvements to the ACA whatever they want, so long as there’s more coverage, fairer prices, etc — whatever else is wrong with the ACA.
Now you understand why I uncorked the single-payer discussion.
Complication causes eyes to glaze over; that’s what’s terrible.
But all Schumer has to do at the moment is make sure that absolutely no Democrat at all votes for repeal of Obamacare without significant real improvements in it.
Two examples: in-network/out-of-network must go away; patients must not be burdened with huge out-of-pocket costs that exist with 80%-20% formulas for major surgery. There are lots of people who who cheer both of those.
Is to add the Medicare buy-in option for 55+ that Lieberman trashed at the last minute during the ACA negotiations. It would take some pressure off of rising individual market premiums.
Yeah, that’s easy to understand, simple to implement, and would be a huge improvement. It would save money for medicare by making the pool healthier and younger, and it would do the exact same thing for premiums on the exchanges.
“Forced to work with Chuck Schumer…”
Whatever can such a thing mean to Addison McC at this point in the long-running HCR battle? There is no political basis for any imaginable “bipartisan” approach.
The Repub party and Der Trumper have vociferously campaigned against the “calamity” and “disaster” of Obamacare for 8 years now. Trumper has slandered and defamed Obamacare about as thoroughly as any politician (humor me) could do—as has virtually every elected Repub. Trumper has already instructed Doc Price to destroy the machinery of Obamacare, which he has been diligently accomplishing.
The health insurance markets have been spooked, and know there is no regulatory regime which can reasonably be expected to exist even 12 months from now. Insurers/hospitals/providers cannot now imagine how to draft the years-long contracts, which is what they all heavily depend upon. This area of the economy is in permanent chaos, thanks to Repubs’ refusal to accept defeat and the efforts of the incompetent white electorate to (knowingly or unknowingly) keep this war going by giving the gub’mint to Repubs.
The only possible “bipartisan” approach was to examine the Obamacare areas which had not worked as expected and patch them. Look at ways in which the exchanges had not met expectations, fix the drafting errors that Repubs began lawsuits over in hopes of destroying the Obamacare regime based on a typo. That is what a serious and functioning nation would have done.
But it’s preposterous to expect the “conservative” barbarians led by McConnell and Ryan to say, after all this water over the dam: “Never mind, Obamacare works!”, while having their two-bit Fuhrer actually turn the executive branch 180 degrees towards strengthening the machinery. Impossible as a matter of “conservative” principle, political survival and (now) industry reality.
Obamacare has been fatally slandered and lamed, single payer is pie in the American sky, the “free market” both cannot work and is a wasteland of predatory insurance CEOs, and the Repubs have no conceivable health care finance “plan” beyond repealing any tax levied on plutocrats and wrecking a (long despised) public insurance scheme for the less well off. Those are the options that the CEO of FailedNation, Inc. has to work with going forward–even assuming good faith, of which Der Trumper has none.
The political basis is this.
How much do Republicans want to repeal Obamacare (in name)?
How solid are Democrats in opposing anything McConnell proposes?
How willing are Democrats to take significant hostages for a “bipartisan” vote?
What is the biggest political hostage that Democrats could take from the Trump administration?
What makes the GOP crack? That’s sort of the question now that they are split vulnerably.
How about this: medicare for all in exchange for the tax cuts the Republicans are pushing, and we call it Trumpcare.
How do you pay for it?
Why is “How do you pay for it?” suddenly a Democratic question when the cost shifting from profits and waste to taxes and savings has been patiently explained for over a decade?
How do you pay for a bloated military?
Are you implying it is not a legitimate question?
In fact my answer matches yours. I am interested in monkeydog’s answer.
Not having the tax cuts occur and keeping the Obamacare subsidies to support a single-payer solution would do it. Plus there would be the 15% indirect cost savings on the health care expenses that did occur plus any savings to providers from the certainty and immediacy of payment.
On the cost side, there will be expansion of Medicare IT systems to accommodate the entire population.
I thought it was pretty obvious in monkeydog’s comment.