"When they go low, we go high," Michelle Obama told the Democratic National Convention in her electrifying address last year. That phrase summarizes the stark contrast between Republicans and Democrats on the fundamental question of affordable health care. Republicans want you to have all the health care you choose to afford, even if you can't afford much. Democrats understand that affordable health care should be a fundamental right.
Having failed to pass four different bills to repeal and replace Obamacare, Republicans are back at it again. Backers of the new bill — labeled Graham-Cassidy after Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.) — claim to have 48 or 49 votes for this effort. Senate Majority Leader Mitch McConnell (R-Ky.) has asked the Congressional Budget Office to make the bill's assessment a priority. The 141-page bill was only made public on Sept. 13, but Republicans are pushing for a vote by the end of the month.
The millions of Americans who were appalled by previous Republican efforts to gut affordable health care should be alarmed once more. Graham-Cassidy employs classic conservative packaging to dress up what it is peddling. It turns health care over to the states, allowing Republicans to posture about getting “closer to the people.” Its cuts are phased in, delaying the effects until 2020 and the most destructive effects until 2027 and thereafter.
But it is the same old poison in a new bottle. The block grants to the states terminate the health-care law's subsidies for moderate- and low-income families and make deep cuts in Medicaid — not only reversing the Medicaid expansion but also cutting into the core program itself. Because the block grants don't keep up with projected inflation, they grow more inadequate over time. The bill leaves states free to let insurance companies charge higher premiums to people with preexisting conditions or to not require core benefits required under current law such as maternity care or prescription drugs. The cuts in the core Medicaid program will impact millions of seniors, people with disabilities and mothers with children. The CBO scoring is not in, but as the Center on Budget and Policy Priorities summarizes, while the CBO estimated that the last repeal-without-replace approach would deprive 32 million people of health insurance, Graham-Cassidy would likely strip an even higher number of coverage in its second decade.
Graham-Cassidy tells us much about the Republican majority. GOP legislators don’t mind that millions go without health insurance. They assume low-wage and moderate-income families should have less health-care protection than the wealthy. You get what you can afford, and you won’t be able to afford much because you’ll have to pay the rip-offs of the private insurance companies and the obscene drug prices of the drug lobby.
While Republicans were going low once more, Democrats were going high. Sen. Bernie Sanders (I-Vt.) introduced his Medicare-for-all bill last week. For Sanders, health care is a right, not a privilege. "We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can't get the health care they need," he wrote. "This is not what the United States should be about."
His bill would provide universal coverage for all, expanding Medicare benefits to include eye and tooth care. It would eliminate the private-insurance-company and drug-company rip-offs. Businesses would be free of the burden of providing health care; workers would not have to fight against constant increases in co-pays and cutbacks in coverage. Sanders would phase his coverage in over four years. To pay for it, he proposes a range of progressive taxes. The wealthy would end up paying more for health care; the vast majority about the same or less — with greater security and more benefits. Sanders is also savvy enough to realize this won’t happen overnight. With Medicare for all as the clear and aspirational goal, he supports steps that would move toward that end.
Four years ago, Sanders introduced a similar bill without a co-sponsor. This week, 16 Democratic senators joined him, including presidential hopefuls such as Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Kamala D. Harris (Calif.), Cory Booker (N.J.) and others. A majority of the House Democratic Caucus has endorsed a similar bill introduced by Rep. John Conyers Jr. (D-Mich.).
Democratic congressional leaders are wary. Moderate and conservative Democrats are uneasy in the face of Republican salvos about the "government takeover of health care." Polling shows that Medicare for all has significant popularity, but that can wilt under attack. But even Hillary Clinton, who said Medicare for all would "never" happen during the campaign, now agrees, as she wrote in her recent book "What Happened," that Sanders was right about the popularity of universal programs: "Democrats should redouble our efforts to develop bold, creative ideas that offer broad-based benefits for the whole country."
The Sanders bill is closer to the beginning than the end of the push for making health care a universal right in this country. With Democrats a minority in both chambers, it isn’t near passage. Unlike the Republican bills, it will go through public hearings and extensive amendments. Passage will require fighting off the powerful insurance and drug lobbies.
More and more Americans understand that health care should be a basic right, not a commodity that you purchase if you can afford it. We understand that the grip of private insurance companies and oligopolistic drug companies is a far remove from a competitive marketplace. And now the contrast is as clear as day. Republicans want to strip millions of health insurance, including seniors in the last days of life, the disabled and women with infants. Democrats want everyone to have the right to affordable health care. There is a choice.
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