Health Care Reform Articles - July 21, 2017

These Americans Hated the Health Law. Until the Idea of Repeal Sank In

by Kate Zernike and Abby Goodnough - NYT - July 20, 2017

DOYLESTOWN, Pa. — Five years ago, the Affordable Care Act had yet to begin its expansion of health insurance to millions of Americans, but Jeff Brahin was already stewing about it.

“It’s going to cost a fortune,” he said in an interview at the time.

This week, as Republican efforts to repeal the law known as Obamacare appeared all but dead, Mr. Brahin, a 58-year-old lawyer and self-described fiscal hawk, said his feelings had evolved.

“As much as I was against it,” he said, “at this point I’m against the repeal.”

“Now that you’ve insured an additional 20 million people, you can’t just take the insurance away from these people,” he added. “It’s just not the right thing to do.”

As Mr. Brahin goes, so goes the nation.

When President Trump was elected, his party’s long-cherished goal of dismantling the Affordable Care Act seemed all but assured. But eight months later, Republicans seem to have done what the Democrats who passed the law never could: make it popular among a majority of Americans.

Support for the Affordable Care Act has risen since the election — in some polls, sharply — with more people now viewing the law favorably than unfavorably. Voters have besieged their representatives with emotional telephone calls and rallies, urging them not to repeal, one big reason Republicans have had surprising trouble in fulfilling their promise despite controlling both Congress and the White House.

The change in public opinion may not denote newfound love of the Affordable Care Act so much as dread of what might replace it. The nonpartisan Congressional Budget Office estimates that both the House and Senate proposals to replace the law would result in over 20 million more uninsured Americans. The shift in mood also reflects a strong increase in support for Medicaid, the health insurance program for the poor that the law expanded to cover far more people, and which faces the deepest cuts in its 52-year history under the Republican plans.

Most profound, though, is this: After years of Tea Party demands for smaller government, Republicans are now pushing up against a growing consensus that the government should guarantee health insurance. A Pew survey in January found that 60 percent of Americans believe the federal government should be responsible for ensuring that all Americans have health coverage. That was up from 51 percent last year, and the highest in nearly a decade.

The belief held even among many Republicans: 52 percent of those making below $30,000 a year said the federal government has a responsibility to ensure health coverage, a huge jump from 31 percent last year. And 34 percent of Republicans who make between $30,000 and about $75,000 endorsed that view, up from 14 percent last year.

“The idea that you shouldn’t take coverage away really captured a large share of people who weren’t even helped by this bill,” said Robert Blendon, a health policy expert at Harvard who has closely followed public opinion of the Affordable Care Act.

In 2012, when The New York Times talked to Mr. Brahin and others here in Bucks County, Pa., a perennial swing district outside Philadelphia, their attitudes on the law tracked with national polls that showed most Americans viewed it unfavorably.

But now, too, sentiment here reflects the polls — and how they have shifted. Many people still have little understanding of how the law works. But Democrats and independents have rallied around it, and many of those who opposed it now accept the law, unwilling to see millions of Americans stripped of the coverage that it extended to them.

“I can’t even remember why I opposed it,” said Patrick Murphy, who owns Bagel Barrel, on a quaint and bustling street near Mr. Brahin’s law office here in Doylestown.

He thought Democrats “jammed it down our throats,” and like Mr. Brahin, he worried about the growing deficit. But, he said, he has provided insurance for his own dozen or so employees since 1993.

“Everybody needs some sort of health insurance,” Mr. Murphy said. “They’re trying to repeal Obamacare but they don’t have anything in place.”

Five years ago, people here could barely turn on their televisions without seeing negative ads warning that the Affordable Care Act would lead to rationed care and bloated bureaucracy. The law’s supporters, meanwhile, including the president whose name is attached to it, were not making much of a case.

To win support, Democrats were emphasizing that little would change for people who already had coverage; President Barack Obama famously promised that you could keep your plan and your doctor, even as a few million people’s noncompliant plans that did not offer all the law’s required benefits were canceled as the law was rolled out.

“The best way to get something passed was to argue it was small change,” said Stanley Greenberg, a veteran Democratic pollster. “It was only when Republicans got control that people then on their own discovered that this is what the benefits are.”

Jennifer Bell, sitting outside Mr. Murphy’s bagel shop with a friend, was raised a Democrat and always supported the health care law. But it was only after she was injured in a serious car accident in 2013 that she thought to advocate for it. She used to get health insurance through her job as a teacher. Now disabled with extensive neurological damage, and working part-time in a record store, she qualifies for Medicaid, and without it, she said, could not afford her ongoing treatment.

“It’s very, very scary to think about not having health insurance,” she said.

“If the condition doesn’t kill you, the stress of having it does, in this country,” she added. “The fact that people do without health insurance is a sin, in my opinion.”

Ms. Bell, 35, joined about 2,000 others for a women’s march in Doylestown after the inauguration, and now makes calls to Representative Brian Fitzpatrick and Senator Patrick J. Toomey, both Republicans, urging them to protect the Affordable Care Act. She is working to elect a Democrat challenging Mr. Fitzpatrick, who voted against the House bill to replace the law, saying he worried about people losing coverage.

More vigorous support among the law’s natural constituents since Mr. Trump’s election has helped lift public opinion. The Kaiser Family Foundation polls tracking monthly support for the law have shown the greatest gains among Democrats and independents, with an increase of 10 to 12 points among each group over the last year, while Republicans’ opinion has remained as unfavorable as ever.

“When something is threatened to be taken away, people start to rally around it,” said Liz Hamel, the director of public opinion and survey research for Kaiser, a nonpartisan group.

There has been an increase in the percentage of Republicans and Democrats saying that Medicaid is important for them and their families; between February and July the percentage of Republicans saying so had increased 10 points, to 53 percent.

The law still faces hurdles even beyond the debate in Congress. Five years ago, Cindy McMahon, who works at the store on the vegetable farm her family has owned for nearly a century, was not intending to buy health insurance, despite the law’s requirement that people have it or pay a tax penalty. She remains uninsured (and the Trump administration has suggested it may not enforce the penalty).

“If I had to pay a penalty, it’s still less than I have to pay for having health care all year,” Ms. McMahon said. At 52, she has diabetes and says the strips to test her blood sugar are so expensive that sometimes she tests once a month rather than daily. She has not looked into whether she might qualify for the Medicaid expansion; she was not aware Pennsylvania had expanded the program.

Frank Newport, the editor in chief of Gallup, said that the area of biggest agreement in polls is that Americans want the law changed. In the most recent poll, 44 percent of Americans said Congress should keep the law but make “significant changes.” That compares with 23 percent who want to keep it as it is, and 30 percent who support the Republicans’ plan to repeal and replace it.

https://www.nytimes.com/2017/07/20/health/affordable-care-act-repeal-popularity-doylestown-pennsylvania.html?

A Republican Health Care Fix

by J.D. Vance - NYT - July 21, 2017

COLUMBUS, Ohio — Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine.

While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor.

This scenario is a simplistic version of how many conservatives view the health care market. According to them, there was a time when the market worked reasonably well: Providers competed to offer quality services and consumers shopped around, curbing prices. Then the government, with its mandates and subsidies and regulations, wounded the market, driving up costs and decreasing quality. Everyone — the poor and elderly, the businesses — lost something significant.

I happen to be a conservative, but one need not accept the right’s theories wholesale to acknowledge the sometimes negative effects of government action on health care. The regulatory approach of the Food and Drug Administration and the Patent and Trademark Office has driven up the costs of generic drugs. The subsidy for employer-sponsored coverage has tethered health care to employment in a way that virtually no economist endorses. Even the most committed progressive would have to admit that the government has injured American health care — just as the reckless government truck injured our young father.

That raises an obvious question: How do we fix health care? A patient bleeding on the pavement requires some plan for medical intervention. The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. And this is because they’re unable to accept that the government must play a role in paying to solve this problem. It’s tough to endorse a universal catastrophic coverage plan, for instance, when much of your caucus cares only about cutting government spending on health care.

This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. But that’s true when a government truck plows into a pedestrian. You break it, you buy it, and the logic applies equally whether the broken thing is an individual or a complex marketplace.

This proposition didn’t use to be so controversial, at least among conservatism’s leading lights. In his influential “The Road to Serfdom,” the economist Friedrich Hayek argued that the state should “assist the individual in providing for those common hazards of life” — among them poor health and unexpected accidents. And in his illuminating analysis of Ronald Reagan’s legacy, “The Working Class Republican: Ronald Reagan and the Return of Blue-Collar Conservatism,” the political scientist Henry Olsen uncovered some timely insights. “Any person in the United States,” Reagan said in 1961, “who requires medical attention and cannot provide it for himself should have it provided for him.”

These sentiments conflict with recent iterations of Republican health care reform. The “full repeal” bill is nothing of the sort — it preserves the regulatory structure of Obamacare, but withdraws its supports for the poor. The House version of replacement would transfer many from Medicaid to the private market, but it doesn’t ensure that those transferred can meaningfully purchase care in that market. The Senate bill offers a bit more to the needy, but still leaves many unable to pay for basic services. In the rosiest projections of each version, millions will be unable to pay for basic health care. This wasn’t acceptable to Reagan in 1961, and it shouldn’t be acceptable to his political heirs.

It is true, as Republicans argue, that health care costs too much. And it is also true that Obamacare has failed to take care of this problem. But if Republicans fail to accept some baseline provision of care, we’ll find ourselves mired in internal contradictions — arguing, for instance, that a bill that cuts subsidies for the poor somehow makes care more accessible. We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other. This is not conservative; it is incoherence masquerading as ideological purity.

Many problems — the monopolization of provider networks, a regulatory framework that forces Americans to overpay for generic drugs — require both a positive Republican vision and a more robust majority to carry it out.

But devising that vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.

https://www.nytimes.com/2017/07/21/opinion/trumpcare-obamacare-solutions.html?

Republicans’ Push to Overturn Health Law Is Back From the Dead

by Carl Hulse - NYT - July 19, 2017

WASHINGTON — The Republican health care push was declared dead Wednesday morning. By afternoon it had a breath of life. Legislation in Washington can assume Frankenstein-like qualities.

On the cusp of a humiliating and politically disastrous defeat, President Trump and the Senate majority leader, Mitch McConnell, took extraordinary resuscitative measures on Wednesday to pump oxygen back into their badly fading effort to overturn the Affordable Care Act. They somehow managed to stave off its imminent demise.

It may be only a temporary reprieve, but a fight that seemed finished just hours earlier was renewed and headed for a pivotal vote next week.

With his reputation for being a master of the Senate at grave risk, Mr. McConnell, a Kentucky Republican, extended a new offer to wavering Senate colleagues leery of scrapping the health care law. He backed away from his earlier insistence that the Senate focus on a plan to repeal much of the existing Obama-era law and allow a two-year window for its replacement — an iffy proposition given the difficulties that Republicans are currently having coming up with a consensus health care policy.

Instead, his new selling point was that senators should simply vote next week on a motion to open a rollicking health care floor debate and then let the amendment chips fall where they may — a case of creating national health care policy, which makes up about 20 percent of the United States economy, on the fly.

“What I’m telling you is no harm is done by getting on the bill,” Mr. McConnell told reporters outside the White House after a lunch where Mr. Trump hosted most Senate Republicans. “Wide open for amendment.”

“There’s no way that I, or anybody else, could prevent members from having amendments that any 51 of us can pass and change the bill,” he said by way of encouragement. “But we cannot have a debate until we get on the bill.”

Whether that will be enough to entice Republicans who feared that health insurance proposals crafted by the leadership would do damage to states like Ohio, West Virginia, Maine and Alaska remained to be seen. But there was no rush of outright rejections, and lawmakers planned to assemble with White House staff members to explore options that could win them over.

At the lunch, Mr. Trump mixed threats of political retaliation against Republicans who crossed him with pleas to move ahead with a long-promised repeal-and-replace legislation, urging senators to remain through their August recess if necessary. It was a stark change from his earlier promise to let the health care law collapse and let its beneficiaries face the consequences.

“My message today is really simple,” Mr. Trump told them. “We have to stay here; we shouldn’t leave town, and we should hammer this out and get it done. And not just a repeal,” he said, conceding he had backed that idea before. “I think the people of this country need more than a repeal. They need a repeal and a replace.”

That was good news to Senator Shelley Moore Capito of West Virginia, who had been one of the first Republican senators to balk at moving ahead on an outright repeal plan, along with Senators Susan Collins of Maine and Lisa Murkowski of Alaska.

“I’m glad @POTUS agrees that we cannot move to repeal Obamacare without a replacement plan that addresses the needs of West Virginians,” Ms. Capito said on Twitter.

It is difficult to say how much she and other Republicans — whom Mr. McConnell described as having “some difficulty in getting to yes” — were persuaded by the president’s appeal. But with several days remaining before a vote, Republicans were finding it hard to resist the call to at least make the effort to find some resolution, though many were very skeptical of the chances for success.

The window remaining before the vote also allows both opponents and proponents of the Republican health proposals to step up their pressure on key lawmakers, and they will face an assault.

A coalition of conservative advocacy groups took a harsh line against Republicans who were threatening to derail the health care effort, promising to initiate primary campaigns against them. They noted that all Republican senators who were then in office had voted for a vetoed 2015 repeal plan that would be on the floor next week and that the party had campaigned endlessly on its promises to kill the Obama health care law.

Jason Pye of the group FreedomWorks put Ms. Capito and Senator Rob Portman, the Ohio Republican who had expressed reservations about earlier Republican plans, in the “Senate traitor caucus.”

“Our activist community in Ohio and West Virginia are not going to take this laying down,” he said.

Leaders of the coalition also heaped criticism on Mr. McConnell, questioning his commitment to pushing the health legislation across the finish line. Ken Cuccinelli, president of the Senate Conservatives Fund, referred to Mr. Trump’s pledge to drain the swamp and characterized Mr. McConnell as the “head alligator.”

Mr. McConnell has regularly feuded with the outside groups and gleefully beat back their electoral challenge to him and other Republicans in past elections. Still, it was striking how much fire Mr. McConnell came under, given his push to get some repeal legislation on the floor as well as delivering a Supreme Court seat filled by a conservative — a top priority of those on the right.

The fate of the Republican effort remained precarious, but Mr. McConnell issued a stern warning to any colleagues hoping to dodge a tough vote: They would not get the chance.

“We’re going to vote on the motion to proceed to the bill next week,” he declared.

If it is defeated then, it might be very hard to resurrect.

https://www.nytimes.com/2017/07/19/us/politics/republicans-push-to-overturn-health-law-is-back-from-the-dead.html?

Trump Demands That Senators Find a Way to Replace Obamacare

by Julie Hirschfeld Davis, Maggie Haberman and Thomas Kaplan - NYT - July 19, 2017

WASHINGTON — President Trump ordered senators back to the negotiating table on Wednesday for a last-ditch effort to repeal and replace the Affordable Care Act, just one day after angrily accepting the measure’s demise and vowing to allow President Barack Obama’s signature domestic achievement to crater.

Mr. Trump, staring down a high-profile defeat on an issue that has confounded him and defied Republican consensus, told the party’s senators they must not leave Washington without acting on a measure to roll back Mr. Obama’s health law and replace it with something better. Simply repealing the bill without an alternative would increase the number of people without health insurance by 17 million in 2018, a figure that would jump to 32 million in 2026, according to the nonpartisan Congressional Budget Office.

At a White House lunch, Mr. Trump warned the senators that any who stood in the way would be telling voters that they backed the current, “failed” program.

“I intend to keep my promise, and I know you will, too,” Mr. Trump told them, trying to resurrect a measure that appeared dead on Monday night, after a third and fourth Republican senator declared their opposition. That death was followed on Tuesday by an 11th-hour effort to force a vote on repealing the Affordable Care Act without a replacement, but that, too, failed when three Republican senators came out against it.

The budget office report underscored on Wednesday why the idea of repealing the Affordable Care Act without a replacement lost traction so quickly. Not only would the number of uninsured jump, but average premiums for people buying individual health insurance policies would increase by about 25 percent next year and 50 percent in 2020. By 2026, premiums would double.

The president’s demands for more negotiations amounted to his fourth position in three days on the health care bill. He began the week supporting a Senate effort to overhaul the law, but when it became clear late Monday that Republicans would fall short of the votes for that measure, he abruptly declared that lawmakers should simply repeal the law and start from a “clean slate” on an effort to replace it — an approach he had previously ruled out.

Facing still more opposition for that strategy, he said on Tuesday that Republicans should “let Obamacare fail” and blame it on Democrats. But by nightfall, Mr. Trump was scheduling a lunch with Republicans at the White House, designed to pressure them to redouble their efforts to find agreement on a full-scale replacement, back where he started.

Mr. Trump usually steers clear of policy details and has grown impatient with the painstaking behind-the-scenes bargaining that has marked the health care negotiations. But he said on Wednesday that he was hopeful that the Senate would deliver a bill that he could sign.

“I think that we’re going to do O.K. — we’re going to see,” he said in an interview in the Oval Office, just after his lunch with senators in the State Dining Room.

He was blunt about the obstacles and the difficulty of the negotiations.

“It is a very narrow path winding this way,” Mr. Trump said. “You think you have it, and then you lose four on the other side because you gave” concessions to another faction of senators.

“It is a brutal process,” he added. Mr. Trump conceded that the very nature of what he had promised to do — eliminate Mr. Obama’s health care program, which serves millions of Americans — made the effort an uphill slog.

“Once you get something, it’s awfully tough to take it away,” Mr. Trump said.

There is still little evidence that returning to the negotiating table on a replacement will win over the four Republicans who have declared their opposition.

The health care bill drafted by Senator Mitch McConnell of Kentucky, the majority leader, would repeal major provisions of the Affordable Care Act, including penalties for people who go without health insurance; make deep cuts in projected Medicaidspending; and establish a new system of subsidies to help people buy private insurance.

The measure has faced resistance both from conservatives concerned that it did not go far enough in eliminating the current law and from moderates who feared it would lead to losses in insurance coverage, stingier plans and higher health costs.

Mr. Trump dispatched administration officials to Capitol Hill on Wednesday night to lobby wavering Republicans who have not yet pledged to support the measure, some of whom have publicly aired their reservations. Mr. McConnell said the goal was to get them to agree to vote next week on a procedural motion simply to open debate on the bill, but the final language of that measure had not yet been determined.

“There’s no way that I, or anybody else, could prevent members from having amendments that any 51 of us can pass and change the bill,” Mr. McConnell said. “But we cannot have a debate until we get on the bill.”

The Trump administration also offered the insurance industry an olive branch, approving the payment of a month’s worth of subsidies to insurers that help poor customers with out-of-pocket health care expenses.

The president has never been completely engaged with the health care repeal-and-replace efforts. He was largely absent from House attempts to craft a bill earlier this year, weighing in at the end when the effort appeared on the verge of collapse to issue an ultimatum.

Then, too, he initially reacted with angry resignation to the failure by House Republicans to reach consensus — “It’s enough, already,” he said after leaders scrapped a vote because they could not muster a majority for the measure — only to change course later, urging lawmakers to strike a compromise, and celebrating lavishly in the Rose Garden when they did.

He has occasionally cajoled members of Congress, primarily through his Twitter feed, but he has seemed hesitant at best. White House advisers have been divided on how involved he should be, leaving Mr. Trump to weigh in sporadically. And his impulse has been to keep members of Congress at an arm’s length, reverting to blaming and threatening them when it appears they are not bowing to his preferences — and even privately criticizing their work product, as he did when he called the House-passed bill “mean.”

“I think it’ll be very bad for them” if they don’t support the health bill, Mr. Trump said of lawmakers in the interview on Wednesday.

At lunch, Mr. Trump used a combination of humor and thinly veiled threats to pressure senators to do what he was asking.

“Look, he wants to remain a senator, doesn’t he?” Mr. Trump said of Senator Dean Heller, a Nevada Republican who was seated beside him and who has been outspoken about his concerns with the proposal. “I think the people of your state, which I know very well, I think they’re going to appreciate what you hopefully will do.”

In private, Mr. Trump was sharper, according to a person briefed on the closed-door lunch, telling Mr. Heller that if he opposed the health care effort, he would lose the Republican nomination for his Senate seat, which would bar him from seeking re-election next year. The person spoke on condition of anonymity because the discussion was private.

Mr. Trump also alluded to two Republicans, Jerry Moran of Kansas and Mike Lee of Utah, who had come out against the measure Monday night, saying he had been “surprised” because the senators were “my friends.”

“My friends — they really were and are,” he said. “They might not be very much longer, but that’s O.K.”

Senator Bill Cassidy, Republican of Louisiana, said Mr. Trump was “trying to add momentum back to a process” that had stalled.

“We’ll see,” he said. “I like to think that we walked out with a sense of momentum.”

At the White House, senators said, they discussed a proposal added to the Senate bill at the request of Senator Ted Cruz, Republican of Texas, that would allow insurers to sell policies that violate the Affordable Care Act if they also sell policies that comply with the benefit mandates and other requirements of the law.

A study by the Department of Health and Human Services, cited by Mr. Trump, said the proposal would increase enrollment and reduce premiums in the individual insurance market. But those figures are at odds with projections by insurance actuaries outside the government, who have called Mr. Cruz’s proposal unworkable and warned it would lead to higher premiums and terminations of coverage.

https://www.nytimes.com/2017/07/19/us/politics/donald-trump-obamacare-health-care-republicans-senators.html?

BERNIE SANDERS WANTS TO EXPAND MEDICARE TO EVERYBODY — EXACTLY WHAT ITS ARCHITECTS WANTED

BY JAID ZILANI - THE INTERCEPT - MARCH 31, 2017

Bernie Sanders doesn’t just want to play defense on health care — he’s introducing a bill that would expand the Medicare program to everybody in America, creating a single-payer health care system.

Such a system would wipe out inefficiencies in our current, private insurance-run system, and polls very well — yet it is opposed by the health care industry and the Democratic and Republican establishments that relies on them for campaign cash.

But creating a “Medicare-for-all,” single-payer health insurance system for all Americans would be fulfilling the dream of those who created the Medicare system in the first place in 1965.

Medicare’s architects ended up compromising with Congress and establishing a system that offered public-run health insurance just for the elderly, but they never intended for only retirees to benefit from the program.

Retired senior citizens carry pro-Medicare signs in an undated photo.

Photo: Bettmann Archive

Medicare’s Roots and a Vision Unfulfilled

Yale political scientist Theodore Marmor, commenting on Medicare, once wrotethat no “other industrial democracy” other than the United States “has compulsory health insurance for its elderly citizens alone, and none started a program with such a beneficiary group.”

The reason Medicare was offered only to senior citizens is a tale of legislative compromise, not intellectual intent.

Since Theodore Roosevelt ran on a platform of health insurance for all industrial workers as a presidential candidate for the Bull Moose Party in 1912, offering government-backed health insurance to workers has been a progressive cause. Franklin Roosevelt proposed guaranteeing a right to health care shortly before his death; his successor Harry Truman worked hard to pass a form of single-payer health insurance, but was defeated in Congress after a smear campaign led by the American Medical Association that associated the president’s plan with the Soviet Union.

Thus reformers decided to focus on the most sympathetic part of the population, which the health insurance industry had the least interest in covering: the elderly.

Robert Ball was the commissioner of Social Security under presidents Kennedy, Johnson, and Nixon, and one of the officials who was involved in the push to create Medicare. In 1995, he wrote a short history of how the Johnson administration and its allies in civic society passed Medicare for the journal Health Affairs.

For persons who are trying to understand what we were up to, the first broad point to keep in mind is that all of us who developed Medicare and fought for it — including Nelson Cruikshank and Lisbeth Schorr of the AFL-CIO and [Under Secretary for Health, Education, and Welfare] Wilbur Cohen, [long-time Social Security administration official] Alvin David, [the Health Insurance Benefits Advisory Council’s] Bill Fullerton, [Social Security Administration officials] Art Hess, Ida Merriam, Irv Wolkstein, myself, and others at the Social Security Administration — had been advocates of universal national health insurance.  We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expected Medicare to be a first step toward universal national health insurance, perhaps with “Kiddicare” as another step.

After the passage of the initial program, Johnson administration officials didn’t wait long before calling for expanding health coverage. Johnson explained to Congress in his 1968 State of the Union address that he wanted a “child health program to provide, over the next five years, for families unable to afford it, access to health services from prenatal care of the mother through the child’s first year.” Cohen was tasked by the president to design the program, which Ball refers to above as “Kiddie Care.”

The war in Vietnam and Johnson’s fraying political coalition made Kiddie Care a vision that remained unfulfilled. Today, the United States continues to have the highest infant mortality rate in the industrialized world.

All that Sanders is trying to do is fulfill the original promise of Medicare, by expanding it to everyone.

https://theintercept.com/2017/03/31/bernie-sanders-wants-to-expand-medicare-to-everybody-exactly-what-its-architects-wanted/

TRUMPCARE IS DEAD. “SINGLE PAYER IS THE ONLY REAL ANSWER,” SAYS MEDICARE ARCHITECT

by zaid zalani - The incept - July 18, 2017

Thanks to a pair of defections from more GOP senators late yesterday, the Republican plan to repeal and replace or simply repeal the Affordable Care Act is dead — for now.

But the health care status quo is far from popular, with 57 percent of Americanstelling Gallup pollsters in March that they “personally worry” a “great deal” about health care costs.

Many health care activists are now pushing to adopt what is called a “single payer” health care system, where one public health insurance program would cover everyone. The U.S. currently has one federal program like that: Medicare. Expanding it polls very well.

One of the activists pushing for such an expansion is Max Fine, someone who is intimately familiar with the program — because he helped create it. Fine is the last surviving member of President Kennedy’s Medicare Task Force, and he was also President Johnson’s designated debunker against the health insurance industry.

Fine, now 91, wrote to The Intercept recently to explain that Medicare was never intended to cover only the elderly population, and that expanding it to everyone was a goal that its architects long campaigned for.

“Three years after the enactment of Medicare, in Dec. 1968, a Committee of 100 leading Americans was formed to campaign for single payer National Heath Insurance.  The campaign leaders were UAW pres. Walter Reuther, Dr. Michael DeBakey, Nat. Urban League Pres Whitney Young and Mary Lasker, a leader in the formation and funding of NIH,” he wrote.”The NY Times and other newspapers gave front page play to the announcement of the campaign for ‘Medicare for All’ but the Committee gained even more attention when, shortly before xmas, pres-elect Nixon, emerging from his doctor’s office in San Diego, denounced us as socialists who were trying to create a problem when none existed.”

Fine noted that this movement towards single payer has “risen and fallen over the years,” reaching a high point in the early 70s when former Democratic Massachusetts Sen. Ted Kennedy’s bill covering all Americans with government health insurance had 36 co-sponsors.

But the Democratic Party decided to go a different direction, turning instead to private insurance to cover Americans. Fine said he met with former First Lady Hillary Clinton’s health care task force in the early 1990’s, and advised them to incrementally expand Medicare, starting first with children and then lowering the age for the elderly.

“They had the money but not the interest in the idea,” he lamented, “instead spending a year developing a complex bill that was DOA on [Capitol] Hill.”

Shortly after Trump won the nomination to be the Republican Party’s presidential contender, Fine wrote to his campaign to offer him a plan to expand Medicare. “Start with Medicare for children and all military vets (half are already under Medicare because they are over 65), then 60-65, etc. etc,” Fine said he advised. “An important conservative result: the VA hospital system would became available to all, for services and for badly-need additional training hospitals for young doctors.”

After the death of the Senate healthcare bill yesterday, The Intercept reached out to Fine for comment about where Congress should go next. “Single payer is the only real answer and some day I believe the Republicans will leap ahead of the Democrats and lead in its enactment,” he speculated, “just as did Bismarck in Germany and David Lloyd George and Churchill in the UK.”

Otto Von Bismarck, a conservative German leader known as one of the fathers of the welfare state — the Social Security Administration even maintains a webpagehonoring him for establishing the first public retirement program in the world — helped establish the foundations of the modern German health insurance system in 1883.

David Lloyd George was a member of the British Liberal Party (the successors to the Whigs, not to be confused with the Labour Party) who was inspired by Von Bismarck’s work in Germany. He spearheaded the passage of the National Insurance Act of 1911, which created a system of health insurance to cover industrial workers.

And although Winston Churchill was not the driving force behind the establishment of the United Kingdom’s National Health Service, he both supported it in theory and later prevented his fellow Tories from strangling it during his 1951 to 1955 tenure as prime minister.

All three are examples of conservative politicians coming to terms with popular demands for the government to act to prevent their citizens from being financially destroyed by sickness and injury. It remains to be seen whether the GOP will learn the same lesson.

https://theintercept.com/2017/07/19/trumpcare-is-dead-single-payer-is-the-only-real-answer-says-medicare-architect/

Inspiring Little Fear in Senators, Trump Struggles to Sell Health Bill

by Glenn Thrush and Maggie Haberman - NYT - July 20, 2017

WASHINGTON — President Trump thought he could sell balky Republican senators like Ron Johnson of Wisconsin on the Senate health care bill through pleasantries, cajoling and, ultimately, some Oval Office muscle.

But Mr. Johnson could not be charmed. He could not be outbargained. And he could not be scared into supporting the measure for the sake of a president whose inability to bend fellow Republicans toward his political will has become a liability for his young presidency.

As the brash Mr. Johnson reminded one associate recently, while Mr. Trump may have stunned the political world in 2016 by winning Wisconsin in the election, Mr. Johnson got 76,000 more votes in the state.

Fear is perhaps the most powerful motivating force in politics, and fear of a powerful president is the surest lever to move a lawmaker from a “no” to a “yes” on a presidential priority. But over the past month, Mr. Trump scared no one into supporting the bill to repeal and replace the Affordable Care Act. He has proved simply too unpopular nationally — polling at 36 to 40 percent approval this week — too weak in many senators’ home states, too erratic and too disengaged from the details of governing to harness his party, as other new presidents have.

Mr. Johnson, still angry at the Republican establishment for abandoning his long-shot re-election bid, may come around when Senator Mitch McConnell, the majority leader, holds a make-or-break procedural vote next week in a bid to revive the health care effort.

But the votes of other senators have become more elusive. They have come to believe that their constituents, even the most conservative ones, are more loyal to them than to Mr. Trump.

The starkest demonstration of Mr. Trump’s weakness came on Monday when Mr. McConnell and his stunned team learned that Jerry Moran, a typically reliable and evenhanded conservative from Kansas, felt safe stiff-arming Mr. Trump on his top legislative priority, announcing that he opposed the bill.

“Right now, nobody’s afraid of Trump, and that’s a real problem,” said Rob Jesmer, the former executive director of the National Republican Senatorial Committee and once a top aide to Senator John Cornyn of Texas.

“But the truth is that he hasn’t really tried,” Mr. Jesmer added. “Where is he on local talk radio? Where is the trip to Kansas to say, ‘Hey, Jerry, we’re really close on this and could use your help’? It’s what he does well, getting out there and making the case. I don’t get why he hasn’t been more engaged.”

A Republican senator, speaking on the condition of anonymity because he wanted to preserve his relationship with Mr. Trump, put it more bluntly. The president, he said, scares no one in the Senate, not even the pages.

“He has limited experience in government and politics, he lacks a deep and experienced team, and his poll numbers are disastrous,” said Senator Richard J. Durbin of Illinois, the Democratic whip, as senators from both parties grappled with the sudden collapse of Republican-only health care talks.

“It’s more or less impossible to sell a program when you have those conditions,” he added.

Yet Mr. Trump still commands loyalty from about 85 percent of Republican voters, and many of them have spent seven years energetically supporting candidates who promised to demolish the health law, President Barack Obama’s central legislative accomplishment.

Mr. McConnell’s motivation for holding a vote on the deeply unpopular bill is to foster fear. Many of the nays, including Mr. Moran, want the issue to disappear; Mr. McConnell wants to put them on the record supporting the perpetuation of the Affordable Care Act.

“There are a lot of senators who have never served under a Republican president,” said Josh Holmes, a former top aide to Mr. McConnell who remains close to his team. “They are quickly learning that failing to govern when you are elected to do so has consequences.”

Mr. Trump has not displayed the same sense of urgency, Republicans say. And for all his public bluster, he despises private confrontation. He might actually be a little too nice, one top Republican Senate aide said with a laugh this week.

After Speaker Paul D. Ryan canceled the first scheduled vote for a repeal-and-replace bill, two top advisers urged Mr. Trump to show wayward House members that they would pay a price for challenging the president. But Mr. Trump ultimately stood by the leadership and declined to target anyone.

Mr. Trump expressed his pique to aides when Senator Rand Paul, a Kentucky Republican, announced his opposition to the bill on the grounds that it preserved too many elements of the existing law. But when it came time to make the case personally, Mr. Trump opted for a putter over a cudgel.

Mr. Trump asked Mr. Paul to play golf — to clear his head — offering to play with him personally, if it meant getting him off TV bashing the Senate bill, according to three Republicans with knowledge of the exchange.

The president’s attempts to use force have backfired.

His team has talked with a possible Republican challenger to Senator Jeff Flake, Republican of Arizona, who has raised questions about the bill. So far, Mr. Flake has not changed his behavior.

When Dean Heller, a Nevada Republican who opposed the Senate’s first repeal-and-replace effort and who faces a tough re-election battle next year, a Trump-allied political action committee ran ads against him. But under pressure from Senate leadership, Mr. Trump himself expressed his desire to have the ads pulled from the airwaves, and they came down soon after.

And Nevada’s Republican governor, Brian Sandoval, who is far more popular in his state than Mr. Trump, never backed off his opposition to the health measure, even after a phone call from the president and a series of one-on-one meetings with senior administration officials at the National Governors Association meeting last weekend in Rhode Island.

Mr. Trump, to exert pressure, sat Mr. Heller next to him during an awkward opening at a White House meeting on Wednesday with Republican senators convened to rekindle interest in voting on a clean repeal of the health care law before the August recess.

The president began with a barbed joke, urging the senator to back his third push for a Senate repeal.

“You weren’t there. But you’re gonna be,” the president said. “You’re gonna be. Look, he wants to remain a senator, doesn’t he? And I think the people of your state, which I know very well, I think they’re gonna appreciate what you hopefully will do. Any senator who votes against starting debate is really telling America that you’re fine with Obamacare.”

Other senators were visibly stunned by the lightly veiled threat.

Mr. Heller blushed, laughed and remained politely noncommittal.

https://www.nytimes.com/2017/07/20/us/trump-republicans-obamacare.html?

3 Things Trump Is Already Doing to ‘Let Obamacare Fail’

by Haeyoun Park and Margot Sanger-Katz - NYT - July 19, 2017

After the collapse of the Senate Republican plan to repeal and replace the Affordable Care Act, President Trump declared that his plan was now to “let Obamacare fail.”

Even without Congress, President Trump has already started doing three things to undermine important provisions of the health law, and there are a few more things he could do.

What Trump can do	Status
Weaken enforcement of the individual mandate.	In progress
Impose work requirements for Medicaid recipients.	In progress
Fail to do advertising or outreach.	In progress
Make tax credits for premiums less generous.	Proposed
Defund subsidies that help people pay out-of-pocket costs.	Not in progress
Redefine essential health benefits.	Not in progress

In progress

1. Weaken enforcement of the individual mandate.

How this hurts Obamacare: Fewer healthy people may sign up for insurance, driving up prices for those who need it most, like older people and the sick.

The Affordable Care Act requires all Americans to buy health insurance or pay a penalty, with exceptions for people with hardships.

While Mr. Trump cannot eliminate the mandate, as Republicans in Congress sought to do, the Internal Revenue Service has said it will continue accepting tax returnsthat do not say whether a filer has been uninsured, weakening its enforcement of the provision.

The administration could also allow for more exceptions, making it easier to avoid the tax penalty. It could instruct the I.R.S. to scrutinize people’s returns less closely. And it could signal publicly that it does not care about the mandate, which may cause people to be less likely to sign up, even if they later get hit with a tax penalty.

In progress

2. Impose work requirements for Medicaid recipients.

How this hurts Obamacare: Many people who gained coverage through Medicaid expansion may not be able to afford insurance or participate in the program.

Under the Affordable Care Act, 31 states expanded Medicaid coverage to poor adults who were previously uncovered. And Republicans in Congress sought to sharply curtail federal support for the expansion, likely causing many states to end it.

Mr. Trump cannot unilaterally prevent states from expanding Medicaid in the future. He could, however, allow states that apply to impose work requirements or charge premiums for more Medicaid beneficiaries, through a process that lets the government waive the normal Medicaid rules. Those changes might make it difficult for as many poor Americans to access the system.

In March, the Health and Human Services Department said it would be open to states’ proposing work requirements for Medicaid recipients.

In progress

3. Fail to do advertising or outreach.

How this hurts Obamacare: Without outreach, the number of Americans who learn about the Affordable Care Act and sign up for coverage could dwindle.

During last year’s Affordable Care Act sign-up period, the Trump administration pulled advertisements and outreach off the air that encouraged people to sign up for health insurance under the law.

In the last few years, large number of consumers generally signed up just before the deadline, and sign-ups for health plans in states managed by the federal government were down slightly compared to the same period the previous year. Lower signups tend to mean higher prices, since the sickest customers are more likely to investigate their insurance options, regardless of government outreach.

The administration could keep quiet again when open enrollment begins this fall. The Department of Health and Human Services, which is in charge of administering the Affordable Care Act, has also been circulating bad news about the program.

Proposed

4. Make tax credits for premiums less generous.

How this hurts Obamacare: Many customers may end up with plans with higher deductibles and co-payments.

The Affordable Care Act gives tax credits to middle-income Americans to offset the cost of premiums. Those subsidies are based on a particular plan, meant to cover 70 percent of the average customer’s medical bills.

Mr. Trump has proposed making the credits apply to a slightly less generous plan for all Obamacare customers. The size of the changes is much smaller than reductions proposed in the Republican health care bills, but still means that many customers will end up with either more expensive insurance or plans that have higher deductibles and co-payments.

Not in progress

5. Defund subsidies that help people pay out-of-pocket costs.

How this hurts Obamacare: Insurance companies would take a big financial hit, since they assumed they would get the subsidies when pricing their plans.

Obamacare provides subsidies to help insurance companies reduce out-of-pocket costs, like deductibles and co-payments, for lower-income customers. Insurance companies price their plans assuming payments will be based on how many eligible customers they serve. The House and Senate health bills would have eliminated the subsidies, allowing insurers to charge those customers higher deductibles.

Mr. Trump could effectively defund the subsidies if he stops the appeal of a lawsuitthat was started under the Obama administration. President Barack Obama’s lawyers had appealed a court ruling that said the subsidy payments were made without proper congressional authority.

Removing the subsidies this year would cause insurers to lose money right away, and could cause some smaller insurers to go bankrupt. Removing them for next year would cause insurance premiums to spike, and might cause some carriers to exit the markets.

The White House has declined to say whether it will continue to pay the subsidies.

Not in progress

6. Redefine essential health benefits.

How this hurts Obamacare: Customers with health problems may end up with really high insurance costs.

Under the current law, all insurers must offer 10 categories of essential health benefits, like maternity treatment and hospital care. Conservatives considered the requirements too restrictive.

Congress tried to loosen these rules by letting states apply to waive them. Republicans in the Senate also tried to let insurers get away with offering plans that don’t meet the rules as long as they offered ones that did.

Mr. Trump cannot eliminate the 10 broad categories of benefits, but his administration has some discretion on how the categories are defined.

For example, the administration could redefine preventive care in a way that eliminates a current rule requiring insurers to cover every form of contraception that is approved by the Food and Drug Administration.

https://www.nytimes.com/interactive/2017/07/19/us/what-trump-can-do-to-let-obamacare-fail.html?

If Dr. Trump Were Your Surgeon ...

by Nicholas Kristof - NYT - July 20. 2017

It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet.

“We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly.

“Er, doctor?” Janet says. “I think my heart is on my left side, not the right.”

“Let me double-check,” Dr. Trump replies, and he hurriedly moves the stethoscope over. “Who knew health could be so complicated?”

He looks into Janet’s eyes, holds her hand in his own, and says in a silky voice, “Beautiful Janet, you’re in such great shape.”

Janet, creeped out by the doctor’s inappropriate bedside manner, pulls back her hand and tightens her gown around her neck. Dr. Trump doesn’t notice and continues: “Your heart is a disaster. You need a new one, and that’s why we suggest a transplant. We don’t happen to have a replacement ready for you, but never mind.

“Normally we do ‘remove and replace,’” Dr. Trump adds. “But in this case, if we can’t settle on a replacement, we’ll just do a flat removal. Nothing to worry about. Huge benefits. Huge!”

Dr. McConnell tries to smile reassuringly, but succeeds only in looking constipated. “Once your heart is out,” he explains, “there’ll be new urgency to solve the problem.”

Janet’s eyes have grown wide, so Dr. McConnell attempts reassurance: “Anyway, I’ve never found a heart necessary.”

Janet bites her lip. “You know, you’re the only doctors who ever said my heart had to come out,” she says. “My previous cardiologist, Dr. Obama, tweaked my diet and medications, and it was ticking along fine.”

“NO, it’s a disaster!” Dr. Trump bellows. “That Obama — it’s all his fault. Don’t listen to any other doctors!”

“I just want to be informed,” she says softly.

“Horrible idea!” Dr. Trump says, and then he pats his pockets down. “What did I do with my phone? I have a thought for a great tweet: ‘A closed mind is a terrible thing to waste.’ I know I had my phone during my last surgery, because I tweeted, and then I set the phone down — oh, no! I bet I left it ——”

“In the operating room?” Janet asks.

“In the patient.”

Janet gulps, and her anxiety increases as a peal of thunder is followed by a shrill alarm sounding from a patient’s room somewhere down the corridor. Very politely, she explains that maybe she doesn’t want surgery after all.

“Fine!” replies Dr. Trump. “Go ahead and die. Your heart is failing. It’s a disaster. And it’s all their fault.”

“Pardon?”

“It’s the Democrats,” Dr. Trump says, and a flash of lightning captures his eyes rolling crazily. “We may be running the hospital, but they’re to blame.”

“Don’t you have any other patients you need to see?” she asks. “And maybe you should put that scalpel down?”

“Don’t you see?” Dr. Trump says, as a thunderclap shakes the hospital. “You’re going to die anyway. All Obama’s patients are dying. I’ve always said, let the patient fail.”

“But I’m not failing,” Janet replies firmly. “I’m fine. Just a little nervous watching you with that scalpel.”

Dr. Trump shakes his head. “No, you’re imploding,” he insists. “I can see it. You’re self-destructing.”

“Help!” Janet calls out. “I can’t breathe.”

Dr. McConnell looks sadly at Dr. Trump. “I knew this would happen. But maybe it’s time to move on so we can work on our hospital tax plan? You know, if we just make the medical assistants and custodians pay a surcharge, we can give a break to surgeons. The result will be a leap in innovation that will benefit everybody.”

“Help!” Janet cries weakly.

Dr. Trump looks down at her and shakes his head as she lies gasping. “So sad but inevitable,” he says. “She was bound to implode. Always going to fail. That’s what happens when you get a Kenyan-born doctor. The patient dies on her own.”

“But, but,” Janet tries to speak, “the problem is that you’re stepping on my oxygen hose. You’re the problem.”

Dr. Trump steps more firmly on the hose. “Poor Janet is imploding right in front of us. Democrats created the mess. We’re not going to own it. I’m not going to own it.” He checks for a pulse, finds none, and doesn’t realize he’s checking in the wrong spot. “O.K., Dr. McConnell, I’m just going to FaceTime my buddy Vladimir, and then on to the tax plan?”

“Take my heart,” Janet moans in her last breath, and a thunderclap drowns out her death rattle. “You need it.”

https://www.nytimes.com/2017/07/20/opinion/republican-healthcare-trump-surgeon.html?

Joining Single-Payer Chorus, Al Gore Says For-Profit System Had Its Chance

"The private sector has not shown any ability to provide good, affordable healthcare for all. I believe we ought to have single-payer healthcare."

by Jake Johnson - Common Dreams - July 19, 2017

On the heels of what appeared to be Trumpcare's final collapse on Monday and in the midst of growing grassroots demands for Democratic lawmakers to embrace a "bold" agenda, former Vice President Al Gore said at an event on Tuesday that he believes the United States should move toward a single-payer system that guarantees healthcare for every American.

"I believe we ought to have single-payer healthcare." 
—Al Gore"The private sector has not shown any ability to provide good, affordable healthcare for all," Gore said at Borough of Manhattan Community College, where he was promoting his new climate change documentary. "I believe we ought to have single-payer healthcare."

As the Huffington Post's Alexander Kaufman notes, Gore has in the past unenthusiastically expressed support for single-payer.

"I think we've reached a point where the entire healthcare system is in impending crisis," Gore said in 2002. "I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan."

Gore is one of the most prominent Democrats to speak publicly in support of a Medicare-for-All type system as Republicans attempt to move ahead with their long-shot effort to repeal Obamacare without a replacement. Others who have recently endorsed single-payer include Sen. Elizabeth Warren (D-Mass.) and Sen. Kamala Harris (D-Calif.).

In recent months, public support for Medicare for All has surged, leading some commentators to argue that it is the "inevitable" successor to the prevailing for-profit healthcare model.

Progressive groups leading the resistance against Trumpcare have repeatedly emphasized that it is not enough to defend Obamacare. An ambitious alternative, activists have argued, must be the end goal, given the deep flaws within the current healthcare system that make it one of the worst-performing in the industrialized world.

As Sandro Galea, dean of the Boston University School of Public Health, argues in an analysis for the Harvard Business Review, "there is no reason to think that the status quo is immutable." 

"It did not, after all, come about organically; it is the product of years of influence strategically wielded by powerful stakeholders in business, medicine, and politics," Galea continues. "These stakeholders were able to advance their agenda in large part because Americans had not come to view healthcare as an essential collective right. This is changing."

As Common Dreams reported on Tuesday, a coalition of more than a dozen progressive groups is seeking to pressure Democratic lawmakers to change along with this surge in public support. Backing Medicare for All, these groups argue, would build a firm and extremely popular foundation for Democrats to run on in 2018.

"Simply put, the Democratic Party is a strong midterm wave and a little inter-party soul-searching away from a chance at finally fulfilling the left's greatest healthcare dream, and unlike the GOP's healthcare dream, it would actually help millions rather than hurt them," concludes Bustle's Chris Tognotti. "While it might not be easy, or entirely without risk, it's at the very least an issue worth fighting for."

https://www.commondreams.org/news/2017/07/19/joining-single-payer-chorus-al-gore-says-profit-system-had-its-chance

Health Victory Opens Way to Better Care for All

by LeeAnn Hall - Common Dreams - July 19,2017

Today, we have a lot to celebrate. We saved health care for 23 million people – and for our whole country.

Yes, it was the months of tireless effort by opponents of the Trump-Republican health care repeal effort that set the stage for the legislative defeat that Senate Majority Leader Mitch McConnell was forced to acknowledge Monday night.

Our sustained grassroots pressure derailed legislation that would have dismantled Medicaid, hiked our premiums and deductibles, and hurt people with pre-existing conditions – all while giving a $600 billion tax break to drug corporations, insurance companies and the ultra-rich. It also quashed a “plan B” by Republican leaders and the Trump administration to move an outright repeal of the Affordable Care Act without a replacement in hand, in a gambit to get Democrats to embrace some form of “compromise.”

Since January, dozens of organizations representing millions of Americans have fought relentlessly to defeat this repeal-and-replace scheme. In all, People’s Action member groups, working in partnership with the Health Care for America Now coalition, pulled off hundreds of protest actions and town halls – including 100 in June alone. We generated tens of thousands of calls to Congress and engaged thousands of our members in sharing their personal health care stories – making what was at stake for our families and lives hard to ignore.

We’ve won another important battle, but this fight is far from over.

Republican leaders are right now working to gut Medicaid through the budget process now underway. And President Trump is renewing his threats to “let Obamacare fail,” with all of the consequences that would have for people needing health care and affordable coverage.

We need to make sure Democrats stand strong, and that Republicans know they will pay dearly for any future political actions that put our health care at risk.

Here’s what we must do in the weeks ahead:

• Tell lawmakers it’s not acceptable for any person to lose their health care. We need to make health care more affordable. Not a single person should lose coverage or face higher costs under any health care legislation. Also, insurance companies and drug corporations should not be given any more power or opportunities to price-gouge us.
• Fight for real health care solutions. There’s plenty Congress can do right now to start fixing health care as we drive toward Medicare for all. Create a public option in every state. Lower the Medicare age. Negotiate lower prices with drug corporations and make prescription drugs a public good. Eliminate deductibles. Say no to the misguided plans that Republican leaders like House Speaker Paul Ryan are trying to push to privatize Medicare, ration Medicaid and cut spending on vital health services.
• Remind Democrats that it was people – not politicians – who beat back health care repeal. This is not just a story of defections from the GOP’s far-right flank. The grassroots firestorm showed that Trumpcare is deeply unpopular, and that unpopularity disarmed Republican leadership attempts to get the votes they needed to take away our health care. With our pressure, we not only let Democrats know that repeal was unacceptable but made key Republicans back away, too.

Our lives were on the line, so we put our bodies in the streets – and stopped a political bulldozer. We’re going to have to keep up that winning pressure until health care is a public good available and affordable for every person in our country.

https://www.commondreams.org/views/2017/07/19/health-victory-opens-way-better-care-all

Why Obamacare won and Trump lost

by E.J. Dionne, Jr. - Washington Post - July 20, 2017

The collapse of the Republican effort to repeal the Affordable Care Act is a monumental political defeat wrought by a party and a president that never took health-care policy or the need to bring coverage to millions of Americans seriously. But their bungling also demonstrates that the intense attention to Obamacare over the past six months has fundamentally altered our nation’s health-care debate. 

Supporters of the 2010 law cannot rest easy as long as the current Congress remains in office and as long as Donald Trump occupies the White House. On Wednesday, the president demanded that the Senate keep at the work of repeal, and, in any event, Congress could undermine the act through sharp Medicaid cuts in the budget process and other measures. And Trump, placing his own self-esteem and political standing over the health and security of millions of Americans, has threatened to wreck the system.

“We’ll let Obamacare fail, and then the Democrats are going to come to us,” Trump said after it became obvious that the Senate could not pass a bill. But if Obamacare does implode, it will not be under its own weight but because Trump and his team are taking specific administrative and legal steps to prevent it from working.

“I’m not going to own it,” Trump insisted. But he will. And if Trump does go down the path of policy nihilism, it will be the task of journalists to show that it is the president doing everything in his power to choke off this lifeline for the sick and the needy. 

To the surprise of some on both sides, the debate brought home the popularity of Medicaid, which for the first time received the sort of broad public defense usually reserved for Medicare and Social Security. The big cuts Republicans proposed to the program paradoxically highlighted how it assisted many parts of the population. 

This creates an opening for a new push to expand Medicaid under the ACA in the 19 states that have resisted it, which would add 4 million to 5 million to the ranks of the insured. 

Republicans also found, as they did during the budget battles of the 1990s, that when they tie their big tax cuts for the wealthy to substantial reductions in benefits for a much broader group of Americans, a large majority will turn on them and their tax proposals. For critics of the GOP’s tax-cutting obsession, said Jacob Leibenluft of the Center on Budget and Policy Priorities, this episode underscores “the importance of making clear the trade-offs of Republican fiscal policy.” To win on tax cuts, the GOP has to disguise their effects — or pump up the deficit.

One Democratic senator told me early on that Republicans would be hurt by their lack of accumulated expertise on health care, since they largely avoided sweating the details in the original Obamacare debate after deciding early to oppose it. This showed. They had seven years after the law was passed and could not come up with a more palatable blueprint.

The popular mobilization against repeal mattered, too. With Republican senators discovering opposition to their party’s ideas in surprising places, pro-ACA activists drove two wedges into the Republican coalition.

One was between ideologues and pragmatic conservatives (Republican governors as well as senators) who worried about the impact of Senate Majority Leader Mitch McConnell’s designs on their states. 

The other divide was within Trump’s own constituency, a large share of which truly believed his pledge to make the system better. They were horrified to learn that they could be much worse off under the GOP proposal. A Post-ABC News poll this month found that 50 percent of Americans preferred Obamacare and only 24 percent picked the Republican bill. Trump’s approval ratings are dismal, but the GOP plan’s were even worse. Defectors in the Trump base may have been the silent killers of this flawed scheme.

And that is why a scorched-earth approach from the president would be both cruel and self-defeating. Americans now broadly support the basic principles of Obamacare. Republicans, including Trump, would do well to accommodate themselves to this reality.As long as “repeal Obamacare” was simply a slogan, what the law actually did was largely obscured behind attitudes toward the former president. But the Affordable Care Act’s core provisions were always broadly popular, particularly its protections for Americans with preexisting conditions and the big increase in the number of insured it achieved. The prospect of losing these benefits moved many of the previously indifferent to resist its repeal. And the name doesn’t matter so much with Obama out of office.

https://www.washingtonpost.com/opinions/why-obamacare-won-and-trump-lost/2017/07/19/84639b08-6cbf-11e7-96ab-5f38140b38cc_story.html?

Dr. Carol Paris: We Must Make It Toxic for Politicians to Not Get on Board with Single Payer

by Amy Goodman and Carol Paris - Democracy Now - July 19, 2017

As the Republican healthcare bill collapses, Senate Majority Leader Mitch McConnell says he’ll now try to push through legislation to repeal the Affordable Care Act and wait until after the 2018 midterm elections to propose a replacement. Meanwhile, proponents of a single-payer healthcare plan are organizing to urge Congress not only to stop the effort to repeal Obamacare, but to pass a bill that would guarantee Medicare for all. We speak with Dr. Carol Paris, president of Physicians for a National Health Program. She was arrested Monday during a protest against the Republican healthcare bill.

Transcript

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: Senate Republicans are trying to regroup after their latest efforts to overhaul or repeal the Obamacare failed, dealing a sharp setback to Donald Trump and the GOP’s seven-year quest to kill President Barack Obama’s signature healthcare law. The defeat shook financial markets Tuesday. The dollar fell to a 10-month low over doubts that Trump could push other domestic policy priorities, such as tax reform, through a divided Congress. Expressing disappointment, Trump suggested he might let insurance markets created under Obamacare go under, and then try to work with Democrats on a rescue.

PRESIDENT DONALD TRUMP: I think we’re probably in that position where we’ll just let Obamacare fail. We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us, and they’re going to say, "How do we fix it? How do we fix it? Or, how do we come up with a new plan?"

AMY GOODMAN: The Senate Republican plan to repeal and replace the Affordable Care Act collapsed Monday night after Republican Senators Jerry Moran of Kansas and Mike Lee of Utah announced they would not support the latest version of the bill, ensuring Republicans would not have enough votes to pass it. Their announcement came at the same time President Trump, who has heavily backed the Senate bill, was meeting with seven Republican senators who did support the measure.

The legislation would have cut $700 billion from Medicaid. It faced opposition from all Senate Democrats, a slew of governors from both parties, the majority of the healthcare industry, the American Medical Association, hospitals, doctors, nurses, patient advocacy groups and the U.S. Conference of Catholic Bishops.

Speaking on Tuesday, House Democratic leader Nancy Pelosi applauded voters for standing up in town hall meetings and demanding their representatives reject the Republican bill.

REP. NANCY PELOSI: The president, in a statement, said today his healthcare proposals were defeated because he didn’t have the cooperation of any of the Democrats and some of the Republicans. No, he has never really been about increasing access, lowering costs, improving benefits. That’s what the Affordable Care Act is about. So, the reason the Republicans in the leadership—in the Senate found themselves in the situation there is is because people have spoken out.

AMY GOODMAN: Senate Majority Leader Mitch McConnell said he’ll try to push through legislation to repeal the Affordable Care Act next week, and wait until after the 2018 midterm elections to propose a replacement.

Meanwhile, proponents of a single-payer healthcare plan are organizing to urge Congress not only to stop the effort to repeal Obamacare, but to pass a bill that would guarantee Medicare for all. On Tuesday, former Vice President Al Gore became the latest prominent Democrat to speak in favor of single payer.

AL GORE: The private sector has not shown any ability to provide a good, accessible, affordable healthcare for all. I believe, for example, we ought to have a single-payer healthcare plan.

AMY GOODMAN: Well, for more, we go to Washington, D.C., where we’re joined by Dr. Carol Paris, president of Physicians for a National Health Program. She was arrested Monday at the Hart Senate Office during a protest against the Republican healthcare bill. In March, she spoke out during a Donald Trump rally where she lives in Nashville.

Dr. Paris, welcome to Democracy Now! Can you talk about your latest arrest, what you were calling for? Now, you got arrested Monday right before the Republican healthcare bill collapsed. But talk about what you were calling for then and still calling for today.

DR. CAROL PARIS: I’d be happy to. The reason that I decided to get arrested was to really make it clear that, as physicians, we not only oppose any bill that is going to be hurtful to Americans—and this bill clearly is hurtful, leaving 22 million people off of insurance—but we also champion and advance Medicare for all. That is really the plan that’s going to accomplish what both President Obama and President Trump have said that they support, which is better benefits, lower costs and more coverage. It’s just that the ACA hasn’t been able to accomplish that, and neither is what the Republicans are doing. Clearly, that’s not going to accomplish it. So, what, you know—but the only thing that’s going to work is moving forward now to Medicare for all. And so that was the messaging on Monday: Kill the bill, Medicare for all.

AMY GOODMAN: Senator Bernie Sanders said on MSNBC’s All In show last night that while the [Affordable] Care Act is not perfect, it shouldn’t be—it should be improved, not destroyed. He laid out his suggestions for how.

SEN. BERNIE SANDERS: What we need to do is, among other things, in my view, lower the cost of prescription drugs, save consumers, save the government substantial sums of money. What we need to do is provide for a public option in every state in this country. What we need to do is lower the cost, lower Medicare eligibility from 65 to 55, and then begin the process of doing what every other major country on Earth is doing, and that is guaranteeing healthcare to all people as a right, through a Medicare-for-all, single-payer program.

AMY GOODMAN: So, Dr. Carol Paris, if you can parse that out? First of all, is that what you are calling for? And explain what this would mean, what it means to save Obamacare and then move forward with single payer or Medicare for all.

DR. CAROL PARIS: What it means to save Obamacare, or to save the ACA, is to continue the cost-sharing subsidies, to continue to support Medicaid expansion. But I absolutely don’t agree with Senator Sanders that the way forward is to have a public option and lower the Medicare age from 65 to 55. That is more incremental steps, and it absolutely fails to accomplish what a national single-payer, Medicare-for-all plan does, which is put everyone in the same risk pool. That’s how we garner the half-a-trillion dollars, $500 billion, of savings in administrative waste and profit of the for-profit insurance industry. If we create a public option, we’re just creating another opportunity for the insurance companies, the health insurance companies, to put all the sickest people in the public option and keep all the healthiest young people in their plans. So, no, I don’t agree that doing this incrementally is a good idea. We really need to go forward now to a national, improved Medicare for all. And really, the bill in Congress, HR 676, Congressman Conyers’s bill, is the way we need to go.

AMY GOODMAN: So what exactly would it look like? I mean, you have, on the one hand, President Trump saying, "Let Obamacare fail." First, tell us what that would mean, and what it would mean if the government lets Obamacare fail, and then what it would mean to institute Medicare for all, how you go about doing this.

DR. CAROL PARIS: Letting Obamacare fail, I think, is what the president has implied that he could do pretty easily. The next cost-sharing subsidy payment is due out Thursday. And if he doesn’t continue to fund that, the insurance companies are going to go into even more chaos and uncertainty. And what that’s going to translate into is increases in premiums, not just for people on the subsidies, but everyone in the individual market is going to see their insurance premiums go up by double digits—I’ve heard as high as even 52 percent. So, that’s what’s going to happen if—in the short term, if the president just allows the ACA to languish and fail.

How do we go forward to a Medicare for all? Well, we passed Medicare in 1965. And in one year from the date the bill was passed, in one year, it was implemented. And it happened with a computer system in 1965 that was a whole lot less sophisticated than what we have right now. So I think what we are lacking is the political will to make it happen. We sure aren’t lacking the popular will to have it happen. The American people want this. And what I’m seeing is a growing interest—I live in Nashville, Tennessee, and that’s a—that’s a red state. My congressman, Jim Cooper, is a Blue Dog Democrat. He’s never supported HR 676 in the past. And this year, he became a co-sponsor. I was really glad to hear that Al Gore, another Tennessean, is saying we need a national, improved Medicare for all. This is coming from legislators and former legislators in a red state. That makes me very proud to be from Nashville.

AMY GOODMAN: Well, also, Elizabeth Warren of Massachusetts has expressed her support for single payer. But we don’t see that movement in the Senate or the House, even with 676, which has been introduced for years. It would take political capital on the part of many senators and congressmembers to push this forward.

DR. CAROL PARIS: It would. And I think the way we’re going to do this is, we’re not going to wait around for our members of Congress to say, "Now it’s politically feasible." If we wait for that, we’re going to be waiting for the rest of my life, your life and many more lives. What we have to do is more of what is happening in Congress right now. It’s like Occupy Congress. And that is, having the American people join in a movement of movements. I got arrested. I was sitting in the paddy wagon with four other people, including three young millennials, incredibly energetic young people, and we discovered that we all represented different organizations and didn’t know anything about each other’s organizations. And yet, we had all been arrested together, championing—opposing the BCRA and championing Medicare for all. So, it’s going to take a movement of movements, and it’s going to take the American people making it toxic for our elected officials not to get on board with this.

AMY GOODMAN: Well, Dr. Carol—

DR. CAROL PARIS: We have to take the lead, and they will follow.

AMY GOODMAN: Dr. Carol Paris, I want to thank you for being with us, president of Physicians for a National Health Program, arrested Monday at the Hart Senate Office Building during a protest of the Republican healthcare bill.
https://www.democracynow.org/2017/7/19/dr_carol_paris_we_must_make

New Poll Shows Nation Moving Left on Healthcare, Embracing Medicare for All

by Jake Johnson - Common Dreams - July 20, 2017

The poll, conducted by the Associated Press in partnership with the NORC Center for Public Affairs Research, shows that 62 percent of public believes it is "the federal government's responsibility to make sure that all Americans have health care coverage."

As AP's Ricardo Alonso-Zaldivar and Laurie Kellman note, this is a dramatic shift in popular attitudes over a very short period of time.

"As recently as March," they observe, "the AP-NORC poll had found Americans more ambivalent about the federal government's role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not."

This most recent poll also found:

• Only 22 percent of Democrats want to keep Obamacare as it is, and 64 favor changes to the law.
• 80 percent of Democrats believe it is the federal government's responsibility to ensure coverage for all.
• 80 percent of Americans believe Republicans should work with Democrats to improve Obamacare.
• 13 percent of Americans support the Republican plan to repeal Obamacare without a replacement, a proposal the Congressional Budget Office (CBO) estimates would leave 32 million more Americans uninsured.

These latest survey results are consistent with increasingly vocal grassroots support for a Medicare-for-All style system that "leaves no one out." Prominent Democrats have joined the groundswell of enthusiasm; former Vice President Al Gore and Sen. Elizabeth Warren (D-Mass.) are two of the more notable figures who have openly advocated a move toward single-payer in recent weeks.

"There is a significant increase in people who support universal coverage," Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. "The impact of the debate over dropping coverage looks like it has moved [more] people to feel that the government is responsible for making sure that people have coverage."

This soaring support for Medicare for All at the grassroots has been bolstered by recent analyses showing that a single-payer system would be more affordable than the current for-profit system—a fact that refutes President Donald Trump's baseless claim on Wednesday that single-payer would "bankrupt our country."

All of these factors, argues welfare policy analyst Matt Bruenig in a recent piece for Buzzfeed, amount to an irrefutable case in favor of moving beyond Obamacare to a healthcare system that ensures universal coverage.

"Now that the Republicans have failed [in their attempts to repeal Obamacare], the time is ripe for a serious single-payer push," Bruenig writes. "Policy institutions need to work hard to hammer out the details of a single-payer plan, and the Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters."

https://www.commondreams.org/news/2017/07/20/new-poll-shows-nation-moving-left-healthcare-embracing-medicare-all

Health Care in a Time of Sabotage

by Paul Krugman - NYT - July 21, 2017

Is Trumpcare finally dead? Even now, it’s hard to be sure, especially given Republican moderates’ long track record of caving in to extremists at crucial moments. But it does look as if the frontal assault on the Affordable Care Act has failed.

And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains.

Unfortunately, some of those gains will probably be lost all the same: The number of uninsured Americans is likely to tick up over the next few years. So it’s important to say clearly, in advance, why this is about to happen. It won’t be because the Affordable Care Act is failing; it will be the result of Trump administration sabotage.

Some background here: Even the A.C.A.’s supporters have always acknowledged that it’s a bit of a Rube Goldberg device. The simplest way to ensure that people have access to essential health care is for the government to pay their bills directly, the way Medicare does for older Americans. But in 2010, when the A.C.A. was enacted, Medicare for all was politically out of reach.

What we got instead was a system with a number of moving parts. It’s not as complex as all that — once you understand the basic concept of the “three-legged stool” of regulations, mandates and subsidies, you’ve got most of it. But it has more failure points than, say, Medicare or Social Security.

Notably, people aren’t automatically signed up for coverage, so it matters a lot whether the officials running the system try to make it work, reaching out to potential beneficiaries to ensure that they know what’s available, while reminding currently healthy Americans that they are still legally required to sign up for coverage.

You can see this dependence on good intentions by looking at how health reform has played out at the state level. States that embraced the law fully, like California and Kentucky, made great progress in reducing the number of the uninsured; states that dragged their feet, like Tennessee, benefited far less. Or consider the problem of counties served by only one insurer; as a recent study noted, this problem is almost entirely limited to states with Republican governors.

But now the federal government itself is run by people who couldn’t repeal Obamacare, but would clearly still like to see it fail — if only to justify the repeated, dishonest claims, especially by the tweeter in chief himself, that it was already failing. Or to put it a bit differently, when Trump threatens to “let Obamacare fail,” what he’s really threatening is to make it fail.

On Wednesday The Times reported on three ways the Trump administration is, in effect, sabotaging the A.C.A. (my term, not The Times’s). First, the administration is weakening enforcement of the requirement that healthy people buy coverage. Second, it’s letting states impose onerous rules like work requirements on people seeking Medicaid. Third, it has backed off on advertising and outreach designed to let people know about options for coverage.

Actually, it has done more than back off. As reported by The Daily Beast, the Department of Health and Human Services has diverted funds appropriated by law for “consumer information and outreach” and used them instead to finance a social media propaganda campaign against the law that H.H.S. is supposed to be administering — a move, by the way, of dubious legality. Meanwhile, the department’s website, which used to offer helpful links for people seeking insurance, now sends viewers to denunciations of the A.C.A.

And there may be worse to come: Insurance companies, which are required by law to limit out-of-pocket expenses of low-income customers, are already raising premiums sharply because they’re worried about a possible cutoff of the crucial federal “cost-sharing reduction” subsidies that help them meet that requirement.

The truly amazing thing about these sabotage efforts is that they don’t serve any obvious purpose. They won’t save money — in fact, cutting off those subsidies, in particular, would probably end up costing taxpayers more money than keeping them. They’re unlikely to revive Trumpcare’s political prospects.

So this isn’t about policy, or even politics in the normal sense. It’s basically about spite: Trump and his allies may have suffered a humiliating political defeat, but at least they can make millions of other people suffer.

Can anything be done to protect Americans from this temper tantrum? In some cases, I believe, state governments can insulate their citizens from malfeasance at H.H.S. But the most important thing, surely, is to place the blame where it belongs. No, Mr. Trump, Obamacare isn’t failing; you are.

https://www.nytimes.com/2017/07/21/opinion/republican-sabotage-obamacare-trumpcare.html?

Repeal of the ACA failed, now Congress must focus on fixing it

by The Editorial Board - Bangor Daily News - July 21, 2017

John McCain embodies the American ideal of service and dedication. His brain cancer diagnosis is a sad and upsetting development and we join many others in wishing him a full and speedy recovery.

If we can sympathize with the health woes of a rich, well-connected man, we should be doubly sympathetic to a single mom without insurance who faces a similar diagnosis, or to an elderly nursing home resident who long ago drained his bank account paying for care.

This lack of sympathy for the health care plight of average Americans doomed Republicans’ efforts to repeal the Affordable Care Act, which they derisively dubbed Obamacare.

The standard was simple: To repeal the landmark insurance reform law, it needed to be replaced with something better, not a plan that would cost many Americans much more for health insurance and leave millions more without coverage. Rather than try to meet this standard, Republican leaders in Congress, and President Donald Trump, focused simply on repealing the ACA because it was passed by a previous administration. They then added in a gutting of Medicaid and tax breaks for rich people.

Reasonable Republican senators, like Susan Collins, who actually talked with residents in their home states and heard their concerns about an ACA repeal, couldn’t go along. They couldn’t leave their constituents with insurance plans they couldn’t afford or put nursing homes and rural hospitals at risk of going out of business.

So, on Monday, a Senate bill to repeal the ACA and replace it with a more expensive and skimpier plan was left to die by Senate Majority Leader Mitch McConnell. He then turned his attention to simply repealing the ACA with no replacement.

That plan lasted less than a day. It collapsed when three Republican senators, all women — Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska — said they would oppose such a move. Sen. Angus King has long opposed repealing the ACA, as has Rep. Chellie Pingree. Rep. Bruce Poliquin voted for a House repeal bill, which the Congressional Budget Office said would leave 23 million more Americans uninsured than if the act stayed in place. Poliquin has avoided questions about his vote.

“I do not think that it’s constructive to repeal a law that is so interwoven with our health care system without having a replacement plan in place,” Collins said on Twitter Tuesday morning. “We can’t just hope that we will pass a replacement within the next two years. Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets.”

“I have recommended … that the Senate Health Committee begin to hold hearings to examine ways to fix the many flaws in the ACA so that it will work better for all Americans,” Collins wrote.

This, of course, is how the process should have worked from the beginning.

One multi-partisan effort is already underway. Democratic Sen. Joe Manchin of West Virginia has reached out to former governors, like himself, who now serve in the Senate to talk about health care reform. King, a former Maine governor and an independent, has joined the group.

GOP Sen. Lamar Alexander, chair of the Senate Health Committee, said that panel will hold hearings on stabilizing the health insurance market.

These new efforts must focus on lowering overall health care costs and bringing young, healthier people into the insurance market.

Trump’s plan to let Obamacare simply die and then blame Democrats is absurd, uninformed, irresponsible — and heartless. The American people are counting on Trump and Republicans, who control both chambers of Congress, to put in place laws and policies that help them. So far, Trump and Republican leaders in Congress have been more focused on undoing Obama-era policies and giving tax breaks to the wealthy simply for the sake of undoing Obama-era policies and giving tax breaks to the wealthy.

The apparent demise of their shoddy health care legislation is a wake-up call. The American people are paying attention and are increasingly willing to speak out about thinly veiled attempts to leave them with worse health insurance.

It is past time to listen to the disturbingly few reasonable Republican voices in Washington and to get to work improving the ACA, not simply trying to kill it.

http://bangordailynews.com/2017/07/21/opinion/editorials/repeal-of-the-aca-failed-now-congress-must-focus-on-fixing-it/