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Right here's why even good medical insurance nonetheless sucks

I thought about what happened to my family after watching 20 Democratic presidential candidates go at one another in Detroit over health care this week. A number of them went on the attack against Medicare for All, which Elizabeth Warren and Bernie Sanders duly and effectively defended against the notion that people didn’t want to give up health insurance plans that they liked. On a related note, there were the ridiculously framed questions from moderator Jake Tapper, who was desperate to get the defenders to admit something that was both scary and irrelevant at the same time.

For the record, Mr. Tapper, yes, I’d rather pay less money in health insurance premiums to the government—for full coverage—than pay more money in premiums to a for-profit health insurance company that sticks me with co-pays and deductibles, tries to get out of covering care I need, and drives me crazy with worrying about going to a doctor who I thought was in-network but really wasn’t, potentially leaving me stuck paying the whole bill even though I’ve got “good health insurance.” But Tapper wanted to talk about the boogeyman word: taxes. It’s not about taxes, as Warren explained. It’s about overall costs to your family.

Let’s talk more broadly about what Warren and Sanders want to do. In order to work properly—by which I mean provide the greatest possible amount of choice to all Americans and truly control health care costs—you need a single, unified system where virtually all providers participate. For anyone who thinks that’s a bad idea, ask yourself this: how great would it be to never again have to worry about whether a health care provider is “in-network”? Remember, even when you go to an “in-network” hospital and have a procedure done by an “in-network” surgeon, how are you going to check whether the anesthesiologist who puts you under—someone you had no choice in picking—is also “in-network”? If all this “network” crap is making you as mad as hell and you’re not going to take this anymore, you’re not alone.

Just as important, having a single system that can negotiate prices for health care and prescription drug costs that are crazy-high in this country compared to places like Canada—as Bernie’s recent insulin tour demonstrated—are crucial to bringing down overall costs for all of us. Right now, the U.S. pays about twice as much for health care as a share of our economy (more, in many cases) than other wealthy countries where everyone has health coverage. Plus, they have better health care results than we do—and the disparity is worse when you look at red states that chose not to expand Medicaid under Obamacare.

As for having a choice of health insurance plans, if your costs are fully covered, do you really care who writes the check that pays your doctor or hospital? Do you say to yourself: I really need a choice between the company that writes the checks on blue paper and the one that writes them on green?

People need choices in their health care providers, not their health insurance providers. If a plan gives people a great deal of choice and access to doctors and hospitals, and it covers all medically necessary care without any co-pays or deductibles, what exactly would be the point of any private sector, ‘alternative,’ or supplemental health insurance plan? How could such a plan do better than providing full coverage with no out of pocket costs? What would there be to supplement? And please note, people on Medicare today have supplemental coverage because Medicare today doesn’t pay everything—it leaves recipients with significant co-pays and deductibles.

This whole debate is not about “taking away” health insurance that people like. It’s about ensuring that everyone has full, complete, affordable health care coverage and, just as essentially, access to the doctors they like and need. That’s how you talk about Medicare for All. Furthermore, Democrats must contrast the fact that all of their proposals—which protect health insurance for people with pre-existing conditions, and provide subsidies for those who need help paying for premiums—with those of Donald Trump.

Trump. Wants. To. End. Obamacare. Democrats need to say that over and over again. He is fighting to have the Supreme Court declare the law unconstitutional—lock, stock, and barrel. That would, just for starters, take health insurance away from tens of millions of Americans, and would make people with pre-existing conditions—who number around 100 million just among those under 65 years old—once again vulnerable to losing coverage if they change jobs. Even the most centrist of Democratic candidates like Joe Biden would not just protect Obamacare but expand on it by providing a public option open to everyone.

So yes, let’s debate which is the best approach to improving our health care system. But let’s also not allow the media or anyone else to take our eyes off the prize: reminding the American people that only one party will work to strengthen their access to affordable health care. And it ain’t Donald Trump’s.

Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh’s Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas)


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