Health care remains the nation’s central issue


Anyone who watches or listens to daily news broadcasts encounters a steady stream of government officials insisting that the economy is improving steadily and that the lives of average Americans are getting better. It is surely a contradiction, however, to say that the economy is flourishing when large numbers of the citizens who make up that economy are struggling to make ends meet.

In Nassau County, the percentage of families living at or below the federal poverty level ranges from a low of 3.19 percent in Garden City to 13.5 percent in Freeport. But even seven years ago, an income of $25,000 — the poverty threshold — was less than half of what a family of four actually needed. A 2011 study, carried out by the Washington think tank Wider Opportunities for Women, showed that a single parent with two children and an income of $57,000 living in the Northeast was still living in poverty. A family of four needed more than $67,000 per year to qualify as middle class.

So what is the solution? First, benchmarks need to reflect reality more accurately. When governments perform statistical sleight of hand, as with poverty and unemployment rates, families, including many considered middle-class, suffer. Second, the rapidly rising cost of health care, which is overburdening many middle- and low-income families, needs to be reined in.

Under the Obama administration, the U.S. took a step forward by insuring millions of Americans who were previously without health care. The Affordable Care Act of 2010, while imperfect and at times mired in bureaucracy, was a godsend to so many. Last June and July, the Republican-led Congress attempted to repeal and replace — and then simply repeal — Obamacare. If not for a single vote by Sen. John McCain, the maverick Republican from Arizona, it might have succeeded in doing so.

Make no mistake: Congress could very well attempt to nix the ACA once again. We presume that Republican lawmakers are waiting until after the midterm election to check the country’s temperature. If Republicans are victorious in congressional races and maintain control of the House and Senate, expect them to revisit repeal and replace — or at least repeal.

Voters can also expect universal health care to become a campaign issue this year and in subsequent years. Sen. Bernie Sanders of Vermont, who electrified the Democratic Party in the 2016 presidential campaign, introduced the Medicare for All Act last year, and a third of the Democratic Senate caucus supported it, indicating that the party may be moving away from the more centrist Obamacare to the more liberal universal health care. Sanders is weighing a 2020 run at the White House.

No matter what, health care should remain at the forefront of our national — and local — discourse. Americans spent $3.4 trillion on health care, or some $9,500 per capita, in 2016, the last year for which complete figures are available. At 18.3 percent of GDP, that is more than double the average of $3,850 among other countries that are members of the Organization of Economic Cooperation and Development. Yet Americans aren’t healthier than in other developed countries, and many remain uninsured or marginally insured. At the same time, young people may opt for low premiums, assuming they will not make use of their coverage, which could be disastrous if they end up needing it.

Nearly all industrialized nations have adopted some form of universal, single-payer coverage. This does not preclude the possibility of private care, nor does it automatically put health insurance companies out of business. That is potentially good news for Nassau County, since more county residents work in health care than in any other sector.

The U.S. already has two single-payer systems that have worked well for many years: Medicaid and Medicare. Expansion of these programs to include all Americans could provide a higher standard of coverage for a larger percentage of the population, potentially ensuring a healthier and more competitive workforce.

This is not to minimize the complications of converting to a single-payer system. There would be many. Doctors would have to change the way they run their practices, and accept lower levels of wealth than at present. And the health insurance industry employs millions nationally; those workers would need to be assured they would keep their jobs. But continuing along the present road of ever-increasing premiums could, in the long run, bankrupt both small business owners and the middle class, which are increasingly having trouble affording their insurance.