Pie in the sky is always a crowd-pleaser, which is why so many politicians are always putting it on the menu. The latest imaginary pie is health care by a single payer.
Not everyone has a taste for pie when it’s lemon, even with a thick meringue. Both Chuck Schumer, the leader of the Democrats in the Senate, and Nancy Pelosi, the former speaker and the leader of the Democrats in the House, have peddled a lot of meringue in their day, but maybe not this time.
The demand for this particular lemon pie is blunted, if only temporarily, by a last-gasp, never-say-die, eleventh-hour attempt by two Republican senators to revive repeal of Obamacare, which they must accomplish by the end of this month under the terms of the current budget.
This latest attempt to repeal, and redeem the promise shouted from the rooftops by every big-talking Republican candidate for Senate, House and White House, would eliminate first of all the Obamacare requirement that everyone buy insurance or pay a tax and that large employers provide coverage or pay crippling penalties. The new bill further repeals a tax, promoted by Democrats, on medical devices. If what ails you hasn’t killed you, Obamacare makes it as difficult as possible to buy the medical devices that might save you.
Under the plan written by two Republican senators, Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, the money collected by Obamacare to pay for expansion of Medicaid and subsidize coverage bought on exchanges, would be accumulated and granted to the several states. The states, which are closer to the people, after all, could apply the money to their own health-care schemes.
Both senators say they can corral the votes that escaped authors of previous plans by the end of the month. “There are people coming out regularly and saying they’re for it,” either privately or publicly,” says Mr. Cassidy. But not all 50 Republicans, who, given the 48 Democrats expected to vote against anything Republican, would be needed to give the vice president the opportunity to cast the majority vote. Sen. Rand Paul of Kentucky announced late last week that he is “staunchly opposed,” and stands ready to play the role that John McCain played in the most recent attempt to scuttle Obamacare, a vow loudly proclaimed over 96 months.
The Democrats sound rattled at the sudden twitching and rumbling of a prospect they thought they had killed graveyard dead. Sen. Schumer has tweeted a “red alert” to his troops: “Trumpcare is back & Senate GOP has until Sept. 30 to pass their bill. We need your votes more than ever,” and with an exclamation point. (But only one exclamation point; cries of authentic desperation usually get two or even three.)
Stopping the resurrection of repeal and replace, even a stopgap, last-gasp, never-say-die repeal and replace, would blunt the momentum in Democratic ranks for a single-payer scheme. What started as the pipe dream of Bernie Sanders and Sen. Elizabeth Warren’s Kickapoo joy juice has become a vision of a miracle in certain Democratic precincts.
Wiser heads, like those of Chuck and Nancy, want to “shore up” Obamacare. Only yesterday they sang the Democratic refrain that Barack Obama’s signature legacy needed no shoring up. Chuck, deferring to the rising demand for the single-payer scheme of Bernie and Pocahontas, says that single-payer is only one of many options. (Forget it.)
In fact, once economic reality and challenging politics intrude, as reality inevitably will, public support begins to evaporate. A Kaiser survey finds that support for single-payer drops by a third when supporters learn that single-payer would dramatically raise their taxes and give the government control of their health care.
The theoretical always sounds better than reality. A scheme for single-payer was adopted by the legislature in Vermont, where the theoretical is popular, and abandoned when economists said it would require doubling of everyone’s taxes. In a referendum in Colorado, voters rejected a single-payer scheme by a margin of nearly 4 to 1. Even in fairyland, a single-payer bill in the California legislature was put on hold when some of its proponents finally started figuring up what it would cost.
Andy Slavitt, who was director of the Centers for Medicare and Medicaid Services in the late, lamented Obama administration, worries that the sudden enthusiasm for Medicare for all could make a quick shift backward.
“This could be the Democrats’ version of the thing they promised to do for seven years and couldn’t do,” he tells Margot Sanger-Katz for The New York Times.
Pie always sound delicious, whether set before rich or poor, Democrat or Republican, but there’s always disappointment when the check arrives, and it always does.
• Wesley Pruden is editor in chief emeritus of The Times.
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