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How to gin up the Base: “Repeal and Replace” – again?

Posted on | May 21, 2018 | No Comments

Mike Magee

It’s been 11 months since Sen. John McCain (R-AZ) gave the thumbs down to repealing Obamacare. But get ready for another push at “Repeal and Replace!” That’s what’s circulating within the halls of Congress right now. This has little to do with over-riding the wishes of the majority of Americans, and more to do with riling up Trump’s base for the 2018 mid-terms.

Still the fire drill will once again require a mandatory push back. If there is any silver lining, it may be that accompanying polls will likely reveal that Americans are inching ever closer to a universal approach with “single payer/multi plan” efficiencies.

During the last attack on the popularly supported ACA, veteran Health Policy expert, James A. Morone, Ph.D., made an interesting argument for single payer health care in the NEJM. In proposing a sweeping change that would directly address “the American patchwork”, assert “the norms of communal decency”, promote planning and efficiency, and empower “a righteous band of reformers, deeply committed to a cause, pushing against all odds”, he did not sidestep higher taxes on the rich.

Rather he sold into them, presenting high taxes on the rich in return for universal health coverage as “on a short list of available policies designed to push back on inequality.”

His argument boiled down to the fact that a central element to the populist anger that helped to elect Trump was our remarkable income inequality. In roughly a half-century, our separation between rich and poor that used to mirror France and Japan, now aligns with Mexico and Brazil.

Our top 1% controls roughly 40% of all wealth, while the bottom 90% manages a paltry 23%. If you’re a white family in America, you were born lucky. On average, your family is about 10 times as wealthy as your black family counterpart.

But what about taxes, and distrust of “Big Government?” Morone reminded us that major policy changes can, and have, flipped on a dime in the past. As he wrote, “Disruptive populism ended past American gilded ages, and it shows signs of challenging the current one.” With better health delivery, and more equality and social justice, we might also redirect the course of American politics and American politicians.

What Trump and his Congressional enablers are doing is fairly transparent – they are intentionally undermining the two critical pillars of American society, truth and trust. The rehashing of “repeal and replace” force one more look in the mirror for all Americans trapped within an epic American struggle over how to topple the health care status-quo, a Medical-Industrial Complex controlled and directed by members of the 1%.

The outcome hangs on whether we – the citizens – are able to discern fact from fiction.

The key question for health reform and for the future of America: Do we trust our own government to assure each of its citizens have the right to “life, liberty, and the pursuit of happiness.”

So if we must, let each of us repeat once again the principles that define why universality through a simplified, single payer methodology makes common sense for Americans today:

Universality: Health coverage is a right of citizenship.

Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government.

Local Control of Delivery: The actual delivery of services is provided by health professionals and hospitals at the local and state levels.

Health Planning a Priority: Creating healthy populations is a high priority on the federal and state levels.

Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery.

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