Health care for all has only one option

After dozens of votes to repeal "Obamacare," Republicans in Congress have gotten their wish. They have the votes to repeal the Affordable Care Act, but they now face the reality that repealing the act does not improve health care. The repeal leaves huge gaps in health care and eliminates many popular aspects of the Affordable Care Act, such as protecting patients from being punished for having pre-existing conditions.

The reality has hit the GOP leadership: They can't just repeal Obamacare. They have to replace it. A proposed replacement was rolled out this week, but the Congressional Budget Office has found that the GOP health care plan leaves an additional 24 million Americans without health insurance. That figure frightened some less ideological Republicans, and votes to pass the GOP plan are dissipating.

The GOP plan is under attack from the left, as Democrats decry numbers of people who are left out of the new plan, and from the right, as far-right Republicans complain that the new plan is just warmed-over Obamacare.

Maybe this is an opportunity for a bold new approach. Both the Obama plan and the new GOP (Paul Ryan) plan are built on an inherently flawed premise — that America has to keep its network of employers paying premiums for employees and insurance companies paying the bills (or part of the bills) for U.S. healthcare. This system leaves out the unemployed, under-employed and just plain unfortunate. Obama's plan, like the one Hillary Clinton tried to push through during her husband's first term, tried to force the uncovered into buying insurance. Obamacare used tax penalties and government subsidies to make people get health insurance. It increased the percentage of people with healthcare but still left many people uncovered. The new GOP plan uses the same basic strategy but uses incentives to get people to buy health insurance rather than penalties and subsidies. It would leave even more people uncovered.

Perhaps the time is right for a new strategy — one that was rejected in earlier debates, but the only one that will truly cover "all Americans," which President Trump promised the GOP plan would achieve. That option is "single-payer," which is the model nearly all Western democracies use to provide truly nationwide coverage. In this option, all Americans would pay into the system, just as we all pay into Social Security and Medicare, and a federal agency would disburse payments to health care providers. Overhead would be sharply cut with just one agency handling accounts payable rather than hundreds of insurance companies, many of whom pay their CEOs multi-million salaries.

Taxes would rise, but health insurance premiums would be eliminated for both employees and employers. How much does the average worker pay for health insurance? $500 a month? $1,000 a month? How much do employers pay? That amount (or less) would be collected in taxes and used to pay for health care of everyone. The uninsured, who are a drain on the system now, would be eliminated. Taxation could be designed to be fair to all, with the lowest-income paying lower taxes and the most affluent paying more. Making the healthcare tax a separate form of tax on both employees and employers just like Social Security and Medicare, would keep the system transparent. Some co-pays would be appropriate to keep the public from abusing the system.

This is the only way everyone would be covered. Everyone would share the risks in a risk pool of 300 million-plus people. Insurance companies would fight for their survival, but the advantages of this system is too great to allow one interest group to sabotage it.

Single-payer health insurance has an opening

President Trump declared before his inauguration that his promised replacement for Obamacare would have a goal of "insurance for everybody." While that doesn't sound much like what Republican members of Congress have been saying for the past eight years, it does sound quite a bit like "single-payer" health insurance, which is the model most western democracies have in place to cover "everybody" with insurance backed by the government with payments to providers by the government entity that oversees health care.

Canada has this plan. Great Britain has this plan. France, too. Generally speaking, the citizens of those countries support their national healthcare plans. It's simple. It's more efficient than the dozens of separate private insurance providers and the thousands of individual businesses that pay insurance premiums for their employees. But whenever a similar system is suggested for the United States, conservatives complain that it's "socialized medicine." Well, yes, but so what?

America's messed-up system, which has given the United States the dubious honor of spending the largest portion of its gross domestic product on health care of any western democracy, evolved from labor union contracts. When World War II wage freezes took pay hikes off the table, the unions targeted health insurance as a way to increase worker benefits. Soon, employer-paid health insurance became an expectation of job seekers.

The 2009 Affordable Care Act attempted to keep the private insurance and the employer payments in place while guaranteeing coverage to all or almost all Americans. It didn't work perfectly, but it did reduce the number of uninsured Americans.

With the dominant GOP promising the repeal the Affordable Care Act and replace it with ... something, it's time to give the single-payer option a chance. It won't be cheap, but what we have now isn't cheap, either. Add what employers pay to the employees' "share" of the premium and the co-pays and deductibles employees pay, and it comes to large number, which could be replaced by health care taxes on employers and workers that would be approximately equal to what they now pay.

Cost savings from having a single organization paying all the bills (like Medicare) would result in cost savings. Instead of thousands of health insurers taking a cut of the money flowing to health care, on entity would cover all health care bills. With the federal government paying the bills, pressure on pharmaceutical companies, hospitals and other providers to reduce costs would result in a decline in health care costs.

If Trump is for it and his party controls Congress, why shouldn't it happen?