Hi there.
For the better part of a century, most Democratic Presidents have pushed for major expansions to healthcare access. Truman presented a plan for universal healthcare in the 1940s, but was blocked by a Republican Congress and ferocious lobbying firm from interest groups concerned that it would force white, racist doctors to treat Black patients. Lyndon Johnson created Medicare and Medicaid. Clinton pushed for universal healthcare and, like Truman before him, was blocked by a Republican Congress. Obama famously made the Affordable Care Act the hallmark of his presidency, creating Medicaid expansions, protecting patients with preexisting conditions, and improving access to insurance.
Now, Joe Biden hopes to make his own modest mark on the healthcare system, though he’s leaving the details to Democrats in Congress, particularly Senator Bernie Sanders. Sanders and his colleagues are planning to reform healthcare for seniors in their upcoming $3.5 trillion budget bill.
At the center of these efforts is an expansion of Medicare, the government-provided health insurance for seniors. Sanders hoped to lower the age of eligibility for Medicare, but that seems unlikely. Still, most Democrats are pushing hard to finally include vision, dental, and hearing coverage in Medicare. Frankly, it’s a travesty that it wasn’t already covered. After all, nearly 20% of all seniors have lost all of their natural teeth, primarily due to lack of dental care. And pretending that our eyes, ears, and teeth aren’t connected to our overall wellbeing is simply cruel.
That’s why this is a wildly popular idea. Even a majority of Republican voters support this sort of Medicare expansion— although it is painfully obvious that not a single Republican in Congress will support it. But because this is a budget reconciliation bill, we don’t need support from Senate Republicans to get this done— we simply need all fifty Senate Democrats to approve it. That seems likely, but not guaranteed.
The problem, as The Upshot explains, is that many interest groups representing dentists remain deeply skeptical of the plan, worried that it will affect their bottom line because Medicare negotiates lower prices than private insurance companies (not a bad thing, in my opinion). So because some seniors are affluent enough to have dental access now, dentists may suddenly earn less revenue from those same patients who are now being offered a cheaper government option. In other words, greed is what stands in the way of Medicare expansion. These interest groups don’t care that more people will have access to dental care— they just don’t want to have to charge a bit less. This goes back to the frustrating fundamental debate over whether healthcare is a right or a privilege— and I will never understand the viewpoint of those who say it’s the latter.
So the concern is that pressure from interest groups will convince moderate Democrats like Joe Manchin and Kyrsten Sinema— who have already made it clear that they want the bill’s price tag lowered— to put Medicare expansion on the chopping block.
The other issue around Medicare expansion— this one more purely political— is that if we do pass it, there could be a long lag between final passage and actual implementation, perhaps past the 2022 midterms or even the 2024 presidential elections. That’s why, according to the Washington Post, the White House is exploring stopgap measures to give seniors money for dental care until the Medicare expansion takes effect.
That’s not the only healthcare reform effort on the table, though. Senator Ron Wyden, chair of the Senate Finance Committee, is spearheading an effort to include drug pricing reforms— though that has far less chance of passage, thanks to the lobbying capacity of Big Pharma. More hopeful, though, is a plan to increase ACA funding— lowering the costs of Obamacare insurance packages and even finding ways to directly provide Medicaid expansion benefits to the dozen obstinate states (including my home state of Mississippi) that have refused to enact the ACA’s Medicaid expansion. There’s also talk of subsidizing home health care, providing an alternative to nursing homes— currently, close to a million Americans are on waiting lists for home health care. (President Biden has taken a surprising interest in home health workers since assuming office.)
We’ll likely have a much better idea about what aspects of this plan will make it to final passage very soon. Politico reports that Speaker of the House Nancy Pelosi has instructed House Democrats to work out disagreements with their Senate counterparts in the next week— and Pelosi rarely fails to manage her own caucus.
Lastly, I know that my newsletters can sometimes have an air of doom-and-gloom. There’s a lot wrong with our society, and I think it’s immoral to ignore those problems. But at the same time, I’m often annoyed by people, usually on the left, who pretend we’ve made very little progress in the last, say, century. Nonsense. It’s disrespectful to the memories of Martin Luther King, Jr., and Medgar Evers and Malcolm X and James Baldwin and John Lewis and Fannie Lou Hamer and Harvey Milk to pretend things haven’t changed. That’s why Reason has compiled an impressive list of ways society has improved in the twenty-first century alone. Cheers to that. (Though I’m more thankful for things like marriage equality than the increased consumerism Reason celebrates.)
Thank you for caring enough to read.
Be safe. Drink water. You are loved.
Talk to you tomorrow.