In June, as the fight over the repeal of the Affordable Care Act reached its climax, then-White House spokesman Sean Spicer delivered a warning. “It’s not a question of Obamacare versus the AHCA,” he said, referring to the GOP alternative, the since-failed American Health Care Act. The question, Spicer said, was between repealing Obamacare and moving to single payer.
History may prove him right. The battle over the Affordable Care Act is over. The fight for what comes next will begin in earnest on Wednesday with the introduction of Sen. Bernie Sanders’ bill to create a universal Medicare program, the most fleshed-out single-payer proposal ever introduced in Congress.
The campaign for the Vermont independent’s bill will start with the backing of at least 15 Democratic cosponsors and 24 progressive and healthcare advocacy groups, numbers that will only grow in the coming days and weeks.
The bill starts by sweetening the pot for seniors who may be wary about welcoming the rest of the country into their warm pool. It eliminates copays and deductions, except for name-brand drugs when generics are available, and adds dental, vision, and hearing aid coverage to Medicare where it didn’t exist before — huge benefits that have long been a goal of public health advocates.
At the same time, people aged zero to 18 would be eligible for the coverage in the first year. In year two, the eligibility age would be lowered to 45. The next year, it would drop again to 35. In year four, the age restrictions would be eliminated.
The history of the expansion of the New Deal shows that once benefits have been enacted, they are difficult to take away. Opponents of Social Security, Medicare, and Medicaid have been working to cut or privatize all three since the day each was enacted, but instead each has grown over time. (The major exception was Aid to Families with Dependent Children, better known as welfare, which was repealed in 1996.)
By phasing in coverage, Sanders makes universal Medicare harder to repeal, and also easier for the public to understand. Everyone gets that transitioning when one turns 65 to Medicare is a relatively painless process. Under Sanders’ plan, people would begin transitioning, after the first year, at age 45 instead of 65. That’s not complicated.