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Still hope for health care?

During the Democratic primary, as Bernie Sanders battled Hillary Clinton for the nomination, a strong disagreement emerged over health care.

Sanders — who has supported a single-payer health care system similar to those in Canada and Great Britain — asked voters why America can’t do the same thing.

Clinton replied that she supported the progress made in extending access to health insurance under the Affordable Care Act, and wanted to expand that legislation to cover more people.

Clinton’s approach is consistent with history. In the 1990s, she was working on a “managed competition” plan that some of the larger insurance companies found quite favorable, although their smaller competitors objected. That plan was never consummated.

By the way, Donald Trump pledges to repeal the entire Affordable Care Act. Although Trump once had kind words for single-payer health care in foreign lands, he’s come out against it for Americans.

So, now the election is a choice between Clinton’s extend-the-ACA and Trump’s kill-the-ACA.

But what if it didn’t have to be?

There is a plan that would take the existing Medicare system and gradually extend it to all Americans. (In fact, that was the original idea when President Lyndon Johnson signed the law in 1965.)

The fact that most Americans are already familiar with Medicare is one of its chief selling points as an alternative to insurance-based coverage, says Dr. Ed Weisbart, chairman of the Missouri chapter of the Physicians for a National Health Plan.

A single-payer system is vulnerable to being attacked as “socialized medicine.” But under Medicare-for-all, doctors and hospitals would still compete with each other in the open market to offer care, Weisbart said.

But the Medicare program could use its purchasing power to lower costs, say, by negotiating with drug companies to lower prices on mass purchases of prescriptions. In fact, that’s where Weisbart says the expansion ought to begin.

This is not just a theoretical idea, either: It exists in legislative form in HR 676, the Expanded and Improved Medicare for All Act, a bill from Rep. John Conyers, D-Mich. There are 62 co-sponsors, although none from Nevada.

Rep. Dina Titus, the lone Democrat in Nevada’s House delegation, said she hasn’t signed on to Conyers’ bill because she agrees with Clinton — build on the success of the ACA. Implementing a Medicare-for-all system, she said, would require rolling back some of the hard-fought gains of the ACA.

But the real issue here is pragmatism, Titus said. In a Republican-controlled Congress, the only ACA-related bills that get votes are those seeking to repeal it, in whole or in part. Medicare for all has virtually no chance of passing with the GOP in charge, Titus said.

But can’t the same thing be said for the Democrats? When the ACA was introduced, the idea of a single-payer approach was rejected almost out of hand. A public option within the law was similarly tossed (couldn’t get the votes, majority Democrats said).

It’s not likely a President Hillary Clinton is going to invest much time and energy in a Medicare-for-all approach, especially when she’s never shown much interest in such a plan during her long career in politics. And it’s even less likely that Trump would move on the idea.

But approaching health care in the same way we’ve always done it — by finding new and exciting ways to funnel money to insurance companies — will produce only more political fights, more campaign contributions to fuel anti-reform efforts and less real change for Americans who pay too much and get far too little when it comes to their health care.

Steve Sebelius is a Review-Journal political columnist. Follow him on Twitter (@SteveSebelius) or reach him at 702-387-5276 or SSebelius@reviewjournal.com.

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