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Missed opportunity for true health care reform, maybe not too late

Objective data show that the only moral and economic solution to our health care crisis is a transformation from the current market-based multi-payer health insurance system to a single-payer system (Medicare for All). Hundreds of billions of dollars would be saved annually due to decreased administrative costs ($300-400 billion); better drug price leveraging ($100 billion); improved preventive care, quality, and choice; and elimination of ‘uninsured’ costs ($40 billion). A single-payer system would result in universal medical and dental coverage, cost-effectiveness, improved quality, enhanced choice and career flexibility, elimination of an overhead stranglehold on business competitiveness, a stimulus to our economy, and job creation.

Anti-fraud and tort reform should be included, each potentially saving $40-50 billion; the latter would neutralize legitimate charges that its omission is hypocritical in a bill touted as comprehensive reform.

Why the business community and Congress have not embraced single-payer reform is mystifying because it is a win-win for all (except for insurance and pharmaceutical companies). One would expect that Republicans and Democratic voters more concerned about fiscal responsibility and access, respectively, should support it. In the absence of leadership teaching about the issue, ideology bias clouded Republican judgment, and perception of idealistic unrealism led to Democratic giving up. For Congressional representatives, more cynical explanations may be more accurate because they should know better. Objective assessment of the evidence cannot be reasonably expected in the face of conflicts of interest from acceptance of significant PAC funding.

There are positive aspects to the proposed bills, including expansion of coverage via Medicaid and subsidies, and community rating precluding adverse risk selection for ‘pre-existing conditions’. These should be enacted rapidly in concert with anti-fraud and tort reform and with funding by removing the tax exclusion for employer-sponsored health insurance for high income earners.
This deficit neutral strategy would allow breathing room to tackle transformational reform, because on balance, the negatives outweigh the positives in the current bills: Expansion of coverage and universal community rating do not go into effect for years after which millions will remain uninsured and more without dental care; Medicare funding for safety-net hospitals is diverted to insurance companies also gifted a mandate bonanza of millions of healthy young customers; funding is inequitable because of taxation of Cadillac policies rather than high-income earners; and accounting gimmicks are likely to lead to unrealized fiscal assumptions.

The Public Option considerations, deleted from the Senate bill, would have addressed few Americans and transferred costs for sicker enrollees to the public. As state programs have not led to economically sustainable universal coverage, these would probably not ‘bend the curve’ nationally either. That Vermont received special consideration, in the company of Nebraska, does not validate the virtues of the proposed bills nor should it lead to the lauding of our representatives’ ingenuity. Most notably, enactment of the bills will usurp real reform, resulting in investment of additional hundreds of billions of dollars in a failed system. We will have ‘won a battle’ but ‘lost the war’.

In early December, Senator Sanders submitted Senate Amendment 2837, proposing to replace most of the Senate bill with language from his previous single-payer bill (Medicare for All) (S. 703). The Amendment was scheduled for a floor debate but was withdrawn after negligible Democratic support. In the absence of co-sponsorship, I presume Senator Leahy would not have supported it.

I believe Vermonters should request that Senator Leahy: (1) explain why he did not co-sponsor Senator Sanders’ Amendment; (2) inform Senate leadership he will vote against the current bills, forcing consideration of true reform (including Medicare for All); and (3) explain how representatives’ acceptance of PAC funds does not cloud objectivity, create a conflict of interest, and professionally necessitate recusal from voting (unless funds were ‘returned to sender’).

This was a missed opportunity for promoting Vermont values of fairness and reasonableness, securing a legacy of enlightened leadership, and marginalization of industry special interests. But it is not too late because each Senator currently has effective veto power. Rather than relinquishing the Vermont representation’s power to lead by automatic caucusing and putting Party ahead of Country, Senator Leahy can force leadership back to the drawing table, providing an opportunity for truly transformational reform to be debated.

History would judge such courage generously.

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Daniel Freilich is a physician, naval officer, and Democratic candidate for the U.S. senate from Vermont.