(COMMON DREAMS) Amy Goodman, June 22, 2017 — President Donald Trump’s long-promised repeal of Obamacare, or the Affordable Care Act, edges closer to reality, as the Senate releases its secretly written version of the House’s American Health Care Act—the very bill that Trump first championed, then recently reportedly called “mean.†The Republican majority in the Senate is intent on passing the bill before the July Fourth holiday. Obamacare has led to tens of millions of Americans getting at least some health insurance, but it has problems of its own. Since health care represents one-sixth of the U.S. economy, the political debate between the very bad Republican bill and the less bad Obamacare may create an opening for the sensible solution enjoyed in just about every developed nation outside the US: single-payer health care.

Single-payer is already in practice in the U.S., and is immensely popular. It’s called Medicare, the taxpayer-funded program that guarantees health care for seniors and people with permanent disabilities. Public polling soon after World War II showed widespread support for the proposal; Medicare became law in 1965. Trump, in his notorious June 2015 campaign announcement in which he attacked Mexicans as “rapists,†also promised: “Save Medicare, Medicaid and Social Security without cuts. Have to do it.â€

If the current bill continues on its trajectory and gets passed, Donald Trump will have to decide if he is going to break that promise. While the bill has to first pass the Senate and then go through a process in which the Senate and House bills are reconciled, it will, at the very least, massively cut Medicaid.

The reason why many opponents call Trumpcare “wealth care not health care†is the elimination of an Obamacare tax on the wealthiest Americans. They’ll get a tax cut, while tens of millions will lose insurance. Others will remain unable to afford it, or will be forced to buy hollow plans that offer minimal coverage, or plans with enormous deductibles and copays. People with so-called pre-existing conditions will find themselves virtually uninsurable in most states. A recent study by the Kaiser Family Foundation estimates that there are over 52 million non-elderly people with pre-existing conditions. Kaiser specifies “non-elderly,†as the elderly, covered by Medicare, can’t be excluded because of pre-existing conditions.

Currently, 57 million seniors and people with disabilities are on Medicare, out of a U.S. population of 320 million. There is no rational reason why Medicare couldn’t be expanded to cover all Americans, regardless of age, from birth to death. This is what single-payer health care advocates call “Medicare for All.â€

Medicare for All would maintain the current system of private and nonprofit hospitals, doctor offices and all the other familiar aspects of the U.S. health system. The single most important difference is that health insurance companies as we know them would cease to exist. Insurance companies don’t actually deliver health care. They act as administrators, processing bills, making unconscionable profits off people’s pain and paying enormous executive salaries. The savings would be extraordinary, and the system would most likely be as popular as Medicare is today.

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