ObamaCare After Obama

The morning of the recent Republican debate, the U.S. Census Bureau reported that the number of uninsured Americans in 2014 had dropped by about 9 million from the year before. This was thanks, of course, to the Affordable Care Act.

So it did cross one’s mind that at least one of the Republican presidential candidates might lend a kind word to ObamaCare. After all, some of the largest gains in health coverage were among moderate-income families, a group including much of the Republican base.

A futile hope. Not even Govs. John Kasich of Ohio and Chris Christie of New Jersey — who, to their credit, had accepted the law’s expansion of Medicaid coverage in their states — offered a shred of praise. Instead we heard vows to basically blow it up, the main difference being the number of dynamite sticks to use.

Grudging appreciation for Obamacare has also extended to significant parts of the Democratic base. In the 2012 election, many Democratic candidates actually avoided discussing it. You see, a flood of anti-Obamacare propaganda — which Democrats had neglected to counter — caused support for the program to swoon in the polls.

The new Census Bureau numbers show that African-Americans and Latinos have enjoyed an especially sharp rise in health coverage under Obamacare. And that makes it painful to contemplate these groups’ dismal turnout in the 2014 midterm elections.

Back then, the newly won guaranteed health coverage was under grave threat. Republicans had tried to repeal Obamacare dozens of times. Had a case before the U.S. Supreme Court gone badly, the program could well have been destroyed.

You’d think that low-income Americans would have marched to the polls waving Obamacare flags. Problem was their so-called advocates had moved on to immigration and income inequality and saw the elections as an occasion to blame Democrats for what they held was inadequate progress. They forgot there was something precious to defend — and that Obamacare was a huge advance against said inequality.

Nowadays, Hillary Clinton not only is waving the flag but has hired a brass brand to march behind it. We await the details of her proposals for improving the program. Same goes for Joe Biden, should he choose to run.

Sen. Bernie Sanders, the Vermont independent seeking the Democratic nomination, gives Obamacare two cheers but not enough credit. In a recent CNN interview, he said he wants a “Medicare-for-all single-payer health care system.”

Expanding Medicare to everyone happens to be a super idea. But we must note that Medicare is not single-payer. It is a multi-payer program combining government and private coverage. As such, Medicare is more like the top-ranked French and German health care systems than it is the good, but not-as-good, Canadian single-payer program.

Because Medicare has strong public support, Medicare for all can be imagined. It would be a very hard political sell, however. Recall that Democrats couldn’t even get the “public option” past Congress. That was to be a government-run health plan to compete on the new insurance exchanges with the private ones.

Sanders’ own Vermont tried but failed to put together a modified single-payer health plan. If Vermont can’t do single-payer…

Suffice it to say, it would take a master politician to get a greatly expanded Medicare passed in this country. A master politician Sanders is not. But may his vision live on.

Happily, Obamacare now seems safe. Its imperfections well-documented, it remains a work in progress. But whoever is the next president should be grateful to have a universal health care program on which to build.