The basic economics of U.S. health care makes that easier said than done. Before the ACA, the U.S. stood out from the international pack on health care in two very unpleasant ways. First, it spent a far larger share of gross domestic product on health care. Second, it was the only advanced industrial nation that left vast swaths of its population uninsured. These two doleful facts remain true, although the fraction of Americans without health insurance fell from 13.3% in 2013 to 8.8% in 2017, according to Commerce Department data.
There are several ways to get more people covered. One is to adopt a system in which the government provides or pays for universal coverage—the British or Canadian model. This won’t happen soon in the U.S., not even as Medicare for All.
A second route, advocated unsuccessfully by President Clinton in 1993, is to mandate that every employer provide health insurance to its workers. This approach might seem natural in the U.S. context because so many workers already receive health insurance that way. But the employer mandate has fatal flaws. It wouldn’t cover the nonworking population, and it would impose heavy burdens on small businesses.
For these and other reasons, many economists in the Clinton administration—including me—favored an individual mandate. But that idea was dead in the water in 1993 because it had been advocated by the Heritage Foundation starting in 1989. It was therefore a “right wing” idea.
There are problems with an individual mandate, too. For one, the high cost of U.S. health insurance means that many low- and moderate-income families cannot afford to buy policies on their own. For another, if for-profit insurance companies are made to lose money by covering people with pre-existing conditions, the government must also force young healthy people, who tend to have limited medical expenses, into the insurance pool.
Fortunately, both problems are easily solved—conceptually, that is, not politically—by mandating that everyone buy a policy and providing subsidies to the needy. Massachusetts legislators understood this in 2006. They also knew they were not writing on a blank slate; many citizens received health insurance through their jobs and didn’t want to lose it. Hence the hybrid system that became known as RomneyCare.
If this short description reminds you of the ACA, it should. The two plans are not identical twins, but there is a family resemblance. In 2010 Democrats didn’t follow in the footsteps of Romney Republicans to make them look good; they designed their plan that way because under the constraints of precedent, the underlying logic practically forces you there.
Keep that in mind: If there ever is a TrumpCare, an unlikely proposition, it’s bound to resemble RomneyCare and ObamaCare—no matter what the president claims.
Trump surprises Republicans — and pleases Democrats — with push to revive health-care battle
A surprise move by the Trump administration aimed at striking down the Affordable Care Act thrust the partisan battle over health care into the middle of the 2020 campaign on Tuesday, handing Democrats a potential political gift on an issue that damaged Republicans badly in last year’s midterm elections.
In a new court filing, the Justice Department argued that the ACA, also known as Obamacare, should be thrown out in its entirety, including provisions protecting millions of Americans with preexisting health conditions and allowing young adults to stay on their parents’ health-care plans.
President Trump praised the move during a lunch with Senate Republicans, and suggested the GOP should embrace a new congressional battle over health-care policy ahead of the 2020 elections.
“Let me tell you exactly what my message is: The Republican Party will soon be known as the party of health care,” he told reporters before the lunch. “You watch.”
.. Trump spent much of his time at the Senate lunch talking about health care, according to several senators present.
“If there’s a message to be learned from 2018 on policy, it’s health care,” Sen. Lindsey O. Graham (R-S.C.) told reporters after the lunch Tuesday. “Let’s become the party of health care.”
“He thinks that that’s the one area where we’ve fallen short and he wants to see us address it,” said Sen. John Neely Kennedy (R-La.). “He made that very clear.”
“If you’re a Republican thinking about 2020 right now, you want to be on offense on health care, not defense,” she said. “And the only way to do that is to make the focus on what Democrats want to do — on Medicare-for-all — rather than making it on what the president and the White House are suggesting.”
.. A federal judge in Texas ruled in December that the law’s individual mandate “can no longer be sustained as an exercise of Congress’s tax power” and further found that the remaining portions of the law are void. He based his judgment on changes to the nation’s tax laws made by congressional Republicans in 2017.
.. “It is highly unusual for the Department of Justice not to defend duly enacted laws, which the Affordable Care Act certainly was,” Collins said. “This decision to even go more broadly in failing to defend the law is very disappointing.”
.. “I think Obamacare should be gone,” he said. “We’ve got to cover people with preexisting conditions apart from Obamacare, which is what I talked about a lot.”
.. There would be ripple effects throughout the health-care industry and insurance landscape as well. Those with workplace plans could be affected, as employers would be allowed to scale back certain medical benefits, and people with preexisting conditions buying coverage on their own would no longer be guaranteed access to coverage at no extra cost.
Democratic Candidates, Pressured by Party Base, Split on How Liberal to Be
Presidential aspirants test waters on health care, environmental policy; ‘bring on the tension’
Looming over the intraparty debate is the question of how best to beat Mr. Trump. Former Delaware Gov. Jack Markell, an ally of Mr. Biden and several governors considering entering the race, said “the only way that Trump can win is if the nominee is too far to the left.” Asked his definition of “too far left,” Mr. Markell said it is “the giving-everything-away-for-free lane.”
The contest already is being framed by ideas to the left of those that Hillary Clinton campaigned on in 2016. The biggest names of the party’s opposition to Mr. Trump—Ms. Warren, Ms. Harris, Mr. Sanders and Sen. Kirsten Gillibrand of New York—all support a single-payer health care system, free college at public universities and the Green New Deal.
Mr. Biden and Ms. Klobuchar represent a continuation of the politics that elected Mr. Obama. Both have spoken of the need to either restore the former president’s policies dismantled by Mr. Trump or build upon them.
Sen. Cory Booker of New Jersey and Mr. O’Rourke are staking out space between the party’s two poles.
Ten of the 16 announced candidates have endorsed Mr. Sanders’s Medicare for All proposal, and six back his proposal for free public university tuition. Six co-sponsored legislation to provide federal paid family leave, and eight support the Green New Deal.
Some Democrats are endorsing multiple solutions without ruling out any. Several candidates who support Medicare for All also are calling for incremental health-care improvements. Ms. Warren also has called for a public option to buy into Medicare, and for simply improving the Affordable Care Act.
Mr. Booker, who has said he would work with Republicans when possible, has proposed a “baby bond” program in which the government would create savings accounts which would provide $1,000 at birth, and up to $2,000 annually, to every child in the U.S.
.. Enough hard feelings remain from that fight that one of the biggest applause lines for Mr. Booker on a recent swing through the state was his pledge not to attack fellow Democrats.
.. “The Democratic platform already leans progressive. Our candidate doesn’t necessarily have to blow that horn,” said Marjie Foster, the Decatur County Democratic chairwoman. “We need to allow the American people to catch up with the progressive mind-set. If we try to push too hard, we will lose those who are slowly working their way left.”
.. “The litmus test is we need a candidate who can build a coalition to win,” said Mr. Scholten, who is considering a Senate bid in 2020. “If Klobuchar can do it with her message, that’s great. If Bernie can do it with his message, that’s great too. I think it could be someone from either side.”
Netanyahu Rivals Team Up Against the Prime Minister for Israel’s Elections
Centrist candidates strike an alliance in a bid to unseat the prime minister
If elected, Benny Gantz, a retired Israeli army chief, and Yair Lapid, a former TV anchor turned parliamentarian, agreed to take turns at running the country, they said in a statement Thursday. Mr. Gantz would serve as prime minister for the first 2½ years, and Mr. Lapid would take over for the rest of the four-year term.
The agreement between the centrist politicians is a result of several weeks of discussions amid questions over whether the two men could put aside their personal ambitions to unite against Mr. Netanyahu.
It also comes at a vulnerable moment for Mr. Netanyahu, who is expected to be indicted on corruption charges later this month. He will have a chance to defend himself in a hearing before charges are formally filed, and he has vowed to stay in power and to fight them. He doesn’t have to resign unless convicted. Mr. Netanyahu has denied wrongdoing..
Opinion polls project a tight contest, but some indicate that Mr. Gantz’s Israel Resilience party and Mr. Lapid’s Yesh Atid party could together secure more seats in Israel’s parliament than Mr. Netanyahu’s Likud.
“The new ruling party will bring forth a cadre of security and social leaders to ensure Israel’s security and to reconnect its people and heal the divide within Israeli society,” the parties said in a statement.
The two parties also said they would add former Israeli army chief Gabi Ashkenazi to their slate. Mr. Ashkenazi is seen as an important player in attracting votes from the right, which will be important if Messrs. Gantz and Lapid are to unseat Mr. Netanyahu.
Both Mr. Gantz and Mr. Lapid are running as anti-Netanyahu candidates, while emphasizing a commitment to addressing social problems in Israel like education, housing, health care and traffic.
Mr. Netanyahu’s Likud party said the election would be a choice of “either a left-wing government of Lapid-Gantz with preventative support from the Arab parties, or a right-wing government with Netanyahu at its helm.”
As an alliance became more likely, Mr. Netanyahu issued statements and videos painting Mr. Gantz and Mr. Lapid as weak and leftist, while describing himself and his party as strong and right.
.. “For the first time since 2009 we have a competitive race for the premiership,” said Yohanan Plesner, president of the Jerusalem-based Israel Democracy Institute. “The main question is whether this new list can lure or be attractive enough for some center right and soft right voters. This is probably the question that will determine the outcome of the election.”