Attorney General William Barr's cursory summation of the long awaited Mueller Report appears to have emboldened President Donald Trump.
During the immediate aftermath of the report's release to the Justice Department, Mr. Trump, among a number of ill-considered and counter-productive moves, decided to throw his administration's support behind the ruling of Texas District Court Judge Reed O'Connor, invalidating the entire Affordable Care Act.
By re-opening the "repeal and replace Obamacare" discussion, Trump blindsided most, if not all, of his supporters in Congress, who would rather not revisit a debate that effectively concluded when Senator John McCain famously killed the final attempt at repeal in the Senate by dramatically voting "thumbs down."
Perhaps by design, the administration's renewed effort stands in starks contrast to the political debate among many Democratic candidates contending to win the chance to compete with Mr. Trump in next year's election, promising "Medicare for all." This attempt at establishing universal healthcare, still a radical left-wing pipe dream in 2016, now appears to have moved into the mainstream.
The December ruling by Judge O'Connor is being appealed in the U.S. Court of Appeals for the 5th Circuit in New Orleans, one of the most conservative appellate courts in the country, almost guaranteeing that it will eventually end up before the Supreme Court. In a new filing, signed by three Justice Department attorneys, the administration held that the decision of District Judge Reed O'Connor should be affirmed, and that the entirety of the ACA should be validated. While a court victory would fulfill one of the president's campaign promises, it would potentially eliminate healthcare for millions of people with preexisting conditions, and for people who get their health insurance on the exchanges or through Medicaid expansion.
"This lawsuit is as dangerous as it is reckless. it threatens the healthcare of tens of millions of Americans across the country," said California A.G. Xavier Becerra, one of 21 Attorneys General from Democratic states stepping in to oppose the administration's decision and defend the ACA law.
While the heated heathcare debate appears to be re-emerging after Mr. Trump's announcement, the confrontation between proponents of private health insurance and supporters of single payer, government-run healthcare has been going on for a hundred years or more.
U.S. efforts to achieve universal healthcare coverage began with progressive healthcare reformers who supported Theodore Roosevelt for president in 1912. This attempt did not go anywhere when Roosevelt was defeated. Franklin Roosevelt initially included a national healthcare program in the Social Security Act of 1935. He removed it when he encountered opposition from the AMA and others.Harry Truman tried in 1945 and again in 1947. However, the opposition quickly labeled his proposals "socialized medicine," which, given the sentiment of the time, killed it. Lyndon Johnson did manage to achieve incremental progress by passing Medicare and Medicaid in 1965. Bill Clinton made a failed attempt with "Hillarycare" in 1993. Subsequently, Barack Obama succeeded in passing the Affordable Care Act in 2010, the adoption of which has led to contentious partisan arguments ever since. Although not perfect, implementation of ACA led to a reduction of the number uninsured citizens to roughly 28 million.Nevertheless, political opponents in Congress voted more than 60 times to attempt to repeal this law, something President Trump apparently intends to pursue again.
Supporters of universal access to healthcare argue that healthcare is a right, and should not be run like a business. They point out that the U.S. is the only developed country in which the population needs to worry about the cost and coverage of healh insurance.Comparisons are made with countries like Denmark and the United Kingdom.
In Denmark the underlying principle of its healthcare law is a "government obligation to promote the health of its population and prevent and treat illness, suffering and functional limitations. This includes ensuring high quality care, easy and equal access to care, service integration, choice, transparency, access to information and short waiting times." (Karsten Vrangbaek, "The Danish Health Care System," University of Copenhagen).All Danish residents are automatically entitled to publicly financed healthcare, largely free. Its system is 84.2% publicly financed, supported by an 8% national health tax. Healthcare spending per capita - 2014 numbers - is $5012 per year, about half of what it is in theU.S.
The U.K. picture is very similar. Its National Health Service, a single-payer system paid for with payroll taxes, guarantees care for all, and includes everything from ambulance rides, emergency room visits to long hospital stays, complex surgery, radiation and chemotherapy. It also spends less than half of what Americans spend per person on healthare, yet, life expectncy in Britain is higher than in the U.S. The NHS remains the most popular institution in the U.K., more popular than the military or royal family. A 2014 report by the Commonwealth Fund concluded that the U.K. was ranked as having the best healthcare system in the world overall. ("Mirror, mirror on the wall, 2014 update: How the U.S. healthcare system compares internationally.")
The arguments in favor of universal healthcare are powerful. While an erstwhile pipe dream may have gone mainstream, articulating the pros and cons of adopting a Medicare for all system, and actually getting a law enacted may look easy compared to implementing it.Yet, many seem to think that we are collectively moving closer to a Medicare for all system, which would signify a seismic shift, affecting the lives of of millions, and nearly one-fifth of our economy.
Killing Obamacare without offering a suitable replacement won't get us there.
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