The House Trumpcare bill could be laying the groundwork for their worst nightmare: a single payer system

If House’s Trumpcare is not fundamentally altered  by the Senate, the Freedom Caucus and conservatives  will be paving the way for the GOP's worst nightmare: a single payer system.  Obamacare, which still leaves the cost of the health care system the most expensive in the world by a factor of over two times and with outcomes ranking near the bottom of the industrialized world, was designed and passed by the self interested fearfully seeking a way to head off “national health” and protecting  the private insurance industry as the preferred insurance delivery mechanism.

The solutions to the health care issues on the table , especially the unaffordability of health insurance, was constructed by the conservative think tank, Heritage Foundation, as a way to keep the “free market” health insurers central to any solution to US’s health system.   The fear was that if some solution that involved the private sector was not successful, the pressure for a Canadian or European system would gain popularity and the insurance industry would go the way of the dodo. So much pain would  be felt by consumers by the House Trumpcare version,  and whether  if the Senate upholds it or changes it, we can expect consumers  to take revenge on many GOP Representatives, all of which are up for election in 2018. By 2020, there could be enough  angry voters to look for another system and that may be a single payer system.

Romney Care , on which the Heritage Foundation proposal was patterned, was showing success and it was working well enough  in Massachusetts that Obamacare became  its template.  The basic theory was to subsidize premiums  charged by private insurers so those with lower incomes could afford them. By  mandating all of the insurers offered by anyone, government or private, to provide at minimum essential benefits and to cover those with pre-existing conditions at the same premiums prices  as everyone else. private insurers could then compete against each other to provide either extra benefits or lower cost.  The exchanges established state by state would provide that competitive market place taking into consideration the specific  conditions of each state.  The exchanges (market places) provided the mechanism to screen the eligibility of participants to get a subsidy based on their income level.   It was clear there was a group of near poor who did not even have enough income to afford even a subsidized insurance premium, but had too high an income or assets that did not qualify for Medicaid, the nearly free  free safety net system for the very poor. That was to covered by expansion and changing the qualification income  allowed by traditional Medicaid.

The Supreme Court upheld mandates requiring all to have insurance or face a penalty. The insurance theory is that the more healthy who became part of the group insured (the pool) would pay for premiums for health services they would use lightly or not at all and in turn would help pay for those who needed more care.   The Supreme Court upheld the mandates, the subsidies survived, but states could opt out of accepting federal money to expand Medicaid. Penalties were not enough to force heathy into the pool into the numbers predicted. Thirty-one states, about half of those  with state houses dominated by the GOP, expanded Medicaid, leaving a gap of coverage for many in other states and lowering total participation figures projected earlier.  

There is no free lunch, and the way to  pay for the subsidies for comprehensive coverage to make them affordable and for the Medicaid expansion were taxes on the rich and certain health related industries to the tune of $600 billion over ten years.

Obamacare has worked to a great extent. The cost of health care rose, but not as much as predictions for costs to rise without Obamacare.(called, bending the cost curve) . The result was that all government provided health costs went down, adding at least twelve years to the life of Medicare.  For those who made too much to get premium subsidies, their premiums covered better insurance, but they objected to the cost or changing providers. No one liked the mandates, having to change insurance companies or beloved doctors,  or the cost and deductibles and premiums. Otherwise nine years later, around 60% of those polled wanted it to remain when they viewed the alternative proposed by the GOP House that would have left 24 million who gained insurance under Obamacare without insurance within ten years. The uninsured rate is now the lowest in history.  This is the system the House GOP upended and only 17% of those polled approved  of it.  Removing mandates on anyone and destroying the “pool” segregating those with pre-existing conditions into underfunded pools that will increase their premiums, increasing the premiums on those over 50, so that the healthy and young could pay less, removing nearly 15 million from Medicaid expansion, making all  essential benefits optional, and the $600 billion of taxes would be relieved from the rich and the health industry. The funding mechanism for Obamacare would be destroyed. The result over ten years was that those who could afford premiums only with Medicaid or slowly reduce subsidies, or whose employers ceased offering insurance plans because they were no longer required to do it, would lose coverage, returning the US to the uninsured rate before Obamacare.  

Bernie Sanders popularized the most economical , simple and fair alternative and at least 43 % of Democrats approve it now: Medicare for All. This extremely popular Medicare program is indeed a type of single payer system, as is Medicaid. It would remove the free market system from the equation  (or reduce its  role considerably) and it would be a single payer system, similar to most  European models.

So desperate could be consumers who found they had been baited  by promises of lower premiums and better coverage and switched to a system that left them paying more for less or unable to afford any insurance at all , that by 2020 Medicare for All could be much more popular. By that time, the negative  impact on each person will have been realized or felt and dulcet promises by the GOP would have been debunked.

In the meantime, for Medicare for All to ever become law, the  political balance of Congress , Senate and House, and the stranglehold of the Freedom Caucus on the House would have to be changed  The 2018 election with an angry backlash could provide that opportunity. It depends so much upon what the Senate and any conference committee with House approval does in the next few months whether Medicare for All could be headed off . They could do it with any  replacement legislation that would address consumers’ concerns and affordable access to comprehensive insurance for the same numbers or more than provided by Obamacare.

www.washingtonpost.com/amphtml/blogs/plum-line/wp/2017/07/06/the-dumbest-criticism-of-single-payer-health-care/

https://www.theatlantic.com/politics/archive/2017/02/universal-health-care-polls-obamacare-repeal/516504/

The background and provisions of Obamacare rely on the past 9 years of columns written on the subject and the footnotes with sources of data and information tapped in writing them. Search this website for terms like Obamacare, Romney Care, Medicare for All, and other terms in this posting.
Scroll though my prior website: www.mufticforum.com for more 2011 and prior postings.