As the coronavirus pandemic continues to wreak havoc on people’s lives, President Joe Biden has been on a victory tour to promote the American Rescue Plan, a hefty $1.9 trillion spending package that not only sends direct stimulus payments to struggling Americans, but also greatly expands health care options through the Affordable Care Act (ACA). “We’re becoming a nation where health care is a right and not for the privileged few,” said Biden in his remarks at a hospital on the campus of Ohio State University. Eleven years after the ACA was first passed into law as President Barack Obama’s signature health care reform, it has survived relentless Republican attacks in the form of legal challenges and defunding attempts. Preserving and expanding it under Democratic leadership certainly constitutes a win against Republican obstructionism and a refusal to offer better alternatives. But this latest strengthening of the ACA is first and foremost a victory for the health insurance industry.
The American Rescue Plan includes tens of billions of taxpayer dollars to substantially lower premiums for insurance options purchased through the ACA health exchanges. Additionally, it covers 100 percent of the cost of COBRA coverage for those who have been laid off during the pandemic. Even the New York Times characterized it with the headline, “Private Insurance Wins in Democrats’ First Try at Expanding Health Coverage.”
Dr. Paul Song, co-chair of the Campaign for a Healthy California, and board member of Physicians for a National Health Program, explained to me in an interview that, “that’s money that’s just going to the private insurance industry.” He asked, “why not say to anyone who lost their job during the pandemic and lost their health care coverage, that you would automatically be enrolled in Medicare until you found your new job?” Such a move would cost significantly fewer taxpayer dollars but would have boosted the arguments in favor of a Medicare for All program, which centrist Democrats like Biden have vehemently railed against for years. Ironically, insurance industry loyalists cite high costs as central to their opposition to Medicare for All.
A new poll by Morning Consult and Politico finds that a majority of Americans—55 percent—support Medicare for All. Strangely, the pollsters headlined their results by saying, “Medicare for All Remains Polarizing.” Nearly 80 percent of all Democrats support it, and even among Republicans, more than a quarter back the idea of a government-run health plan for all.
As Biden touts the success of the ACA (without mentioning the high cost of supporting it), a growing number of Democratic lawmakers are refusing to fall in line. Congresswoman Pramila Jayapal (D-WA) dismissed the health care subsidies in the American Rescue Plan, saying, “I don’t think this was the most efficient way to do this,” and had instead called for exactly what Song suggested: that unemployed Americans sign on to a Medicare plan rather than their former employer’s plan.
Jayapal recently introduced the Medicare for All Act of 2021, which was co-sponsored by more than half the House Democratic Caucus. Her office released a statement explaining that the bill “guarantees health care to everyone as a human right by providing comprehensive benefits including primary care, vision, dental, prescription drugs, mental health, long-term services and supports, reproductive health care, and more with no copays, private insurance premiums, deductibles, or other cost-sharing.”
Dr. Song is hopeful, saying there is “more momentum every year” for such a program. Whereas in previous years Democrats like former Congressman Joe Crowley would have railed against Medicare for All, “they’ve all been voted out by the AOCs, by the Jamaal Bowmans,” said Song, referring to the freshmen representatives from New York who in recent years ousted centrist incumbents like Crowley from their party in primary challenges. Now, “for the first time, the entire New York delegation has supported Medicare for All,” he said.
The timing for a bold and comprehensive health care plan is ideal. According to Axios, Biden “loves the growing narrative that he’s bolder and bigger-thinking than President Obama.” Democrats are looking to distinguish themselves from Republicans in willingly spending what it takes to care for a population battered by the pandemic after years of austerity measures that have whittled away safety net programs. Criticism of Medicare for All from a cost perspective will not only be deemed hypocritical, but it will also sound Republican-like in its callous calculation to prioritize private interests ahead of human needs.
According to the advocacy group Public Citizen, the U.S.’s private health insurance-based system put the nation at such a deep disadvantage during the pandemic that according to a new analysis, “millions of Americans have contracted COVID-19 unnecessarily and hundreds of thousands of deaths could have been prevented.” This estimate is not based on people dying because they did not have health insurance. On the contrary, the government rightly stepped up to ensure that COVID-19 related treatments for the uninsured would be covered by taxpayers (yet more proof that lawmakers are willing to cover everyone’s health care costs if the crisis is dire).
Rather Public Citizen found that our entire health care infrastructure failed because “hospitals focused on profit and revenue were unable to respond to COVID-19 while safety net hospitals faced closure.” The patchwork of private health insurance systems and limited public systems left the nation in a confusing mess at a time when streamlined approaches to a deadly pandemic required systematic testing, contact tracing, and now, vaccine distribution. In contrast, as per Public Citizen, “Countries that had more unified systems were better able to roll out testing, track the spread of the disease via a central information hub, and intervene appropriately.”
Given the fact that Democrats require either some Republican support or an end to the Senate’s filibuster rule in order to pass any major legislation, Jayapal’s bill is likely to remain aspirational. However, newly seated Health and Human Services Secretary Xavier Becerra may be able to offer another pathway to a government-run health system. Backers of such a system ought to take heart from Becerra’s confirmation hearing where the likes of Republican Senator Mike Crapo (R-Idaho) said to him, “Your long-standing support for single-payer, government-run health care seems hostile to our current system from my perspective.” Of course, Becerra said what he had to in order to win confirmation and toed the Democratic party line by responding that he would be enacting President Biden’s agenda, not his own.
Still, according to Dr. Song, “Secretary Becerra has been very public in saying that he thinks states should be afforded waivers, and now he has the ability to do that.” One of the positive aspects of the ACA is that states have the right to apply for federal waivers and that the HHS secretary oversees the granting of such waivers. According to the New York Times, “Because these waivers do not require congressional approval, they could become a crucial policymaking tool for the Biden administration,” regardless of which party controls the Senate.
“States like California could set up their own state-based health care system if it at least met the standards determined by the ACA,” explained Song. Just like their federal-level centrist Democratic counterparts, California Governor Gavin Newsom (and before him, Jerry Brown) spoke out in favor of Medicare for All while they were candidates only to back off from taking a strong stand on the issue once they had the power to do something about it. Newsom, who is facing a Republican-led recall effort, is now facing a push from his Democratic colleagues in California’s legislature to keep his promise on health care.
Regardless of how we arrive at a government-run health care plan, there is growing momentum for it. Scientists worry that the next pandemic is just around the corner. Instead of throwing taxpayer dollars into the pockets of private health insurance industry executives, a government-run plan would not only be more efficient and cheaper but also save lives—which is ultimately what should be the most important consideration.
This article was produced by Economy for All, a project of the Independent Media Institute.