It won't happen overnight, and it won't happen with one bill, and it certainly won't happen until we have the Senate and the White House, but it is only a question of "when," not "if."
December 17, 2018

On Friday, Republicans broke the Affordable Care Act, and with it, the protections for people with pre-existing conditions. Even if the judge's ruling is overturned on appeal, it doesn't matter because their evil agenda of denying health care to people like my son and your loved one with a pre-existing condition has been laid bare.

We did it their way; now they're going to play by our rules. Obviously, it's not going to happen until Democrats take back the Senate and the White House, but then it WILL happen. It may not happen in one fell swoop, but it will happen.

As Wendell Potter says in the video from Sunday's AM Joy, "[Medicare for All] is not only viable, it's a matter of when, it's not if. "

He added, "If you look at the current system and project out ten years, this is a system we can't afford and you can save trillions of dollars by moving to a Medicare for all type system."

If you've been reading my writing on health care policy for the past ten years or so, you know that I argued then and argue now that the pre-existing conditions protections are the heart and soul of the ACA. In order to move to universal health care, exclusions for pre-existing conditions had to be a thing of the past. The minute that piece breaks, everything breaks.

That's where we are now. The moment that activist judge in Texas dropped his Friday night ruling just ahead of the deadline for enrollment in the ACA, declaring that insurers could once again discriminate against people with pre-existing conditions, Republicans broke the pact. The pact was this: We would try it their way, with the whole private insurer as the center of the care cycle. The government would guarantee their losses, subsidize their premiums, and try to force the cost curve downward. If all the moving parts stayed intact, we could achieve near-universal coverage.

But when a Republican judge broke the pre-existing conditions part of that pact, the whole thing shattered and now they're going to do it our way. (Even the reactionary editorial board at the Wall Street Journal acknowledges this.)

We're not going to listen to the excuses, the whining or the screaming any more. We are now at the same inflection point we were at when Medicare passed. At the time Medicare passed, care for the elderly had been left to the states and was wholly inadequate and uneven, thanks to conservatives' mean-spirited desire to deny health care to the poor and elderly, and the inadequacy of state programs. So now we move to the next obvious square in health care policy: Medicare for All.

Here's how I can imagine opening salvos:

  1. Legislation forcing negotiated drug prices
  2. Open Medicare buy-in for ages 55-65
  3. For states which did not expand Medicaid, cover their uninsured poor people under Medicare, funding their costs with the funds which would have gone to the states to help with their costs

Don't allow anyone to say it can't be done. It can. And over time, it can be expanded.

What ideas do you have? Let's brainstorm in the comments and see what we can put together.

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