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Groundbreaking Study Shows Why Fixing Healthcare Costs Is Still a Top Priority

And repealing the Affordable Care Act certainly won't magically lead to better outcomes.

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Conservatives want to do away with “Obamacare” because they're ideologically predisposed to buy into demagoguery about “death panels,” “government take-overs” and the supposed perfidy of the public healthcare systems that produce better outcomes for less in most of the rest of the developed world.

Some progressives also want to do away with it because it's built around an individual mandate to buy private health insurance – long the signature Republican proposal for healthcare reform (the mandate has become almost universally unpopular, but it is linked to the highly popular requirement that insurers cover people suffering from pre-existing conditions).

Their thinking appears to be that if we revert to the status quo ante, the system's deep dysfunctions – with skyrocketing costs and tens of millions uninsured – will exert so much pressure on families and businesses that it will inevitably lead to an outcry for a single-payer system. But there are big problems with their logic and a much better solution, one that wouldn't leave those who do enjoy good coverage worried about their futures: open up Medicare for everyone who wants in. And if single-payer systems are superior, doing so should eventually lead us there.

It's true that single-payer is the only scheme that will provide universal coverage while actually decreasing overall healthcare spending. But the reality is that a large share of the population is covered – retirees by Medicare, the very poor by Medicaid and a majority of us through our jobs -- and even with rising out-of-pocket expenses, they don't face the horrors of being uninsured. Many of those who aren't covered – young people, the working poor, the self-employed – are infamously difficult to organize.

But say the system does collapse under the weight of its own inequities eventually. There was a 15-year period between the last attempt to reform health care under Clinton and the passage of Obamacare. If it takes another 10-15 years to get a better set of reforms, there remains a lot of room for shifting more costs onto working families, denying more people coverage and causing more Americans to suffer needlessly. It is a classic case of throwing the baby out with the bathwater – just remember those 10 million poor people who wouldn't be covered under Medicaid, a single-payer public health program, if Obamacare were repealed.

It is also based on the ahistoric premise that once a big new social program is enacted, that's it – it's locked in stone. That was hardly the case with Social Security or Medicare, both of which have been amended again and again since their original passages in 1935 and 1965, respectively.

Understanding this leads to a better approach. Instead of throwing away a decent set of insurance reforms, and a new infrastructure for (almost) universal coverage, progressives should come together around a simple amendment: open up the Medicare system to anyone – individuals and employers -- who wants to buy into it. Kill the limited state-based exchanges for private insurance (or keep them), and retain the subsidies for households and small businesses that provide coverage, keep the Medicaid expansion intact, let kids stay on their parents' plans until age 26 and maintain the caps on out-of-pocket expenses. Throw away the bathwater, but hang onto the baby.

This might fulfill the promise of the original “Hacker Plan” ( PDF), with its "public option" that would pit a single-payer system against the private insurance industry in head-to-head competition. Those who believe – rightly – that a single-payer system is the only way to provide universal coverage while cutting overall health spending should have the courage of their convictions and embrace that competition. May the better system win.

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