Michael Moore's column in today's New York Times, "The Obamacare We Deserve," is a clear and effective prescription for improving Obamacare as 2014 begins. We all know and understand the weaknesses, and the flawed genesis, of Obamacare; it was hatched by conservatives to benefit the insurance industry. It was also, perhaps, the only politically feasible option at the time.
Things have changed since the ACA was passed. Twenty states that resisted expanding Medicaid are discovering that they're missing out on federal funds. And a few states have begun to explore versions of public options. These are positive trends. As Michael Moore puts it, let's "build on what there is to get what we deserve: universal quality health care."
Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.
In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)
All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.
There's a lot to be done on the state level. Let's get organized, and make 2014 the year to make Obamacare the healthiest possible system instead of the only alternative to the GOP "plan" ("Don't Get Sick, or if you do get sick Die Quickly.")
One place to start is the Kaiser Family Foundation's "Status of State Action Around Expanding Medicaid" site, which will come to life in the next couple of weeks as state legislatures reconvene.