SundayReview | Editorial

Looking Beyond the

Obamacare Debate to
Improve Health Care
By THE EDITORIAL BOARDAUG. 26, 2017

Credit Eiko Ojala

Now that Republicans in Congress appear to

have at least temporarily abandoned their
crusade against the Affordable Care Act, it
seems like a good time for lawmakers to come
up with plans to fulfill their promises to
increase access to health care and to lower
costs.Let’s stipulate up front that congressional
leaders and President Trump are unlikely to
lead that effort, given that they narrowly failed
to take health insurance away from millions of
people. This conversation would need to be led
by senators who have committed to a
bipartisan approach, and by state governments,
some of which have already begun to take
action.Change might not come soon enough
for the 29 million people without health
insurance or the many millions who struggle to
afford high premiums, deductibles and other
health costs. But even the A.C.A., the 2010
health law also known as Obamacare, was the
product of many years of spadework and was
based on a Massachusetts health reform bill
signed into law by Gov. Mitt Romney in
2006.Obamacare has helped 20 million people
gain access to insurance, and it appears to have
helped slow the growth in health care costs.
But even former President Barack Obama has
said that there is still work to be done. The
United States spends much more on medical
care than other rich countries, like Britain,
Australia and the Netherlands, according to a
recent Commonwealth Fund report, yet its
citizens live shorter lives and suffer from more
illnesses and injuries than people in other
industrialized nations.One option that appears
to have gained support among the public is a
single-payer system, which proponents like
Senators Bernie Sanders and Elizabeth Warren
call “Medicare for All.” A Kaiser Family
Foundation poll found in June that 53 percent
of Americans favor such a system. This was
up from 46 percent, according to an average of
seven polls conducted in 2008 and 2009. But
moving to a single-payer system from one
dominated by employer-paid health coverage
would be a big leap, and in any case the
political climate is clearly not ready for it.
Many Democratic voters as well as party
leaders like Representative Nancy Pelosi and
Senator Chuck Schumer have been reluctant to
embrace the idea, and, no surprise, most
Republican voters and lawmakers oppose
it.Single-payer advocates point out that the
United States is the only advanced nation
without universal health care, which is true.
Germany, the Netherlands and Switzerland
have achieved universal coverage and
affordable health care with, essentially, more
comprehensive and generous forms of
Obamacare that require people to buy
insurance, tightly regulate insurers and provide
subsidies to the poor and middle class.State
and federal lawmakers are exploring ways to
increase coverage and lower costs. For
example, the Nevada Legislature passed a bill
in June that would have allowed people who
make too much money to qualify for Medicaid
to buy into that program. The bill, which
would have required a federal waiver, did not
become law because Gov. Brian Sandoval, a
Republican, vetoed it. But the idea has other
backers. Senator Brian Schatz of Hawaii said
on Tuesday that he would introduce a bill that
would explicitly allow states to let people buy
into Medicaid.Another approach would be to
let people buy into Medicare at some point
before they become eligible for the program at
age 65. Hillary Clinton proposed this during
her presidential campaign. Congress could also
provide more generous subsidies to help
middle-class people buy insurance on
Obamacare exchanges. At the state level, four
million people would gain coverage if Florida,
Georgia, Texas and the 16 other states that
have not expanded Medicaid under Obamacare
changed their minds and opted in.Ms. Pelosi
has said that some states could go even further
by approving single-payer systems of their
own. California, Colorado, New York and
Vermont have considered such proposals in
recent years. If one or two states moved in that
direction, it could help demonstrate the
feasibility of such an approach in much the
same way that Romneycare in Massachusetts
provided plausibility for Obamacare.
The Republican campaign to repeal
Obamacare, for all its waste of time and
energy, has at least gotten people to talk
seriously about proposals to improve the
health care system.Follow The New York
Times Opinion section on Facebook and
Twitter (@NYTopinion), and sign up for the
Opinion Today newsletter.
A version of this editorial appears in print on
August 27, 2017, on Page SR8 of the New
York edition with the headline: Looking Past
the Obamacare Debate. Today's
Paper|Subscribe

https://www.nytimes.com/2017/08/26/opinion/sunday/obamacare-universal-health-
coverage.html?ref=opinion
Opinion Editorial

grows
First posted: Friday, August 25, 2017 05:19 PM
EDT | Updated: Friday, August 25, 2017 07:47 PM
EDT

EDITORIAL

Canadians’ frustration
with border fiasco

A long line of asylum seekers wait to illegally

cross the Canada/U.S. border near Champlain,
New York on August 6, 2017. (Getty Images)
Share23
The Liberal government’s response to the crisis
unfolding at our southern border has become mind-
boggling.Prime Minister Justin Trudeau urges us to
trust our refugee system. But, as Conservative
leader Andrew Scheer put it Thursday, “the
problem is Canadians don’t have trust in the
Liberals to manage it.” Last winter, what then
seemed liked a steady flow of people crossing
illegally into Canada (a few hundred a month in
Manitoba and Quebec) was clearly more of a drip.
Now we’re seeing hundreds a day, mostly in
Quebec.Canadians have been frustrated at images
of the RCMP acting more like bellhops than
federal police officers maintaining the integrity of
our borders, particularly when it’s increasingly
clear that both legitimate and economic refugees
are among those crossing.Immigrants to Canada
who followed all the rules and waited in line to get
here feel insulted others are permitted to jump the
queue with little regard for the immigration laws
they respected.Taxpayers are upset to read illegal
migrants will receive around $650 per month from
the Quebec government and additional benefits
from the federal government, such as a dental plan
but no real plan to settle and integrate them into
Canada.

When Liberal ministers and their provincial

counterparts met in Montreal Wednesday, we were
told it was to discuss how to deal with this
situation.
We naturally assumed this would include
discussion on how to reduce the influx of migrants.
Yet disturbingly it seems no such conversation
took place.
Instead they talked about how to best serve the
needs of the migrant population and how to give
them as many services as possible.

Let’s be clear on one thing: Once refugees or

asylum claimants have arrived in Canada, we must
look after them and treat them with compassion.
We offer migrants a certain standard of care
because it speaks to who we are as a decent, caring
people. That doesn’t mean there are no gates on
our borders.

It’s wrong to cross illegally into our country, not

just because we need to ensure we know who
we’ve invited to live with us, but because we need
to ensure those who come here will succeed.The
Liberals have failed to even begin to articulate how
they’ll do that.

http://www.torontosun.com/2017/08/25/canadians-frustration-with-border-fiasco-grows
The Observer view on
Labour’s new Brexit
policy
Labour’s newfound pragmatism over the EU,
revealed by Keir Starmer in the Observer today,
is a game-changer. Now the real argument over
Brexit can begin

Observer editorial

Sunday 27 August 2017 00.04 BST

Each week that passes takes us closer to March

2019, the deadline by which Britain must have
negotiated a transitional exit deal with the
European Union, or face the economic
catastrophe of falling off a cliff-edge. Yet, as the
clock has ticked, confusion has reigned. The 14
months since the EU referendum have been
characterised by rhetorical posturing, fuzzy
logic and position papers peppered with
contradictions and questionable assertions. The
country’s two main parties have hedged their
bets and ducked and dived in relation to the
great dilemmas posed by Brexit, rather than
engage in a rational and honest conversation
about how to pursue the national interest in
extraordinary times.
So today’s intervention by Sir Keir Starmer, the
shadow Brexit secretary, is to be welcomed as a
significant development. Writing in the
Observer on behalf of the Labour party, Starmer
states unequivocally that Labour would seek to
keep Britain in the single market and a customs
union during a transitional period, and possibly
in the longer term. This is not yet a worked-
through negotiating strategy. But it represents a
pragmatic shift towards the only conceivable
transitional arrangement Britain should be
seeking, and puts clear water between the two
main parties for the first time. Theresa May’s
government insists that in 2019 Britain must
leave both the single market and customs union.
Until now, Labour’s Brexit policy has lacked
clarity. The party’s recent election manifesto
pledged to put the economy first by retaining
the benefits of the single market, while also
promising to end freedom of movement. How
that happy end-state was to be achieved was, to
put it kindly, not spelt out.
This evasiveness undoubtedly served Labour
well in the general election. But it has
undermined the party’s ability to hold the
government to account for its own shambolic
approach to Brexit. It is also politically
unsustainable, this far into the Brexit process,
when shadow ministers are unable to articulate
or agree on what Labour actually thinks.

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Now Labour has at last made a choice and
deserves credit for adopting the only short-term
position that makes sense. Negotiating a
transitional deal is all but impossible to achieve
within 18 months, given that talks on the deal
cannot even start until the UK and EU have
reached agreement on three complex and
contentious issues: the financial bill Britain will
owe the EU on exit; the rights of EU citizens
living in Britain and British citizens living in the
EU, and who will oversee them; and
arrangements for the Irish border. Any deal will
also require unanimous support from every
other EU nation, and ratification by both the
European parliament and European council.
British negotiators should be focusing on the
immediate and critical substantive issues, such
as the Irish border, then turning their minds to
the long-term settlement; not wasting time and
energy on the impossible task of negotiating a
transitional deal. This means, as Labour
suggests, we must seek to keep all our economic
arrangements and relationships with the EU
intact for a period after we give up membership
of the EU’s political club. This is necessary to
allow the time and space to negotiate a final
deal. Yes, keeping the economic status quo,
while giving up our power to shape the rules
that govern it, is very much a second best to full
membership of the EU. But there is no way
round that.
A transition period, by definition, comes to an
end. What comes next? Here, Labour has also
markedly shifted its tone. Starmer explicitly
leaves open the door to remaining in the single
market and a form of customs union, so long as
a final deal includes arrangements for managing
migration more effectively. This is, for now, a
sensible position: Britain may well have more
luck negotiating some more significant brakes
on freedom of movement now than David
Cameron did prior to the referendum. The EU
today is more self-confident and less blighted by
existential fears than the EU of two years ago,
thanks to an economic upturn and the failure of
far-right nationalists such as Marine Le Pen in
France and Geert Wilders in the Netherlands to
gain power.
Labour has clarified its stance and opted for a
Brexit approach that is practical. Compare and
contrast with the Conservatives’ chaotic journey
without maps. In recent days, ministers have
published several position documents intended
to clarify Britain’s negotiating strategy for a
transitional deal. Together they give the
impression of a government that continues to
cling to the fantasy that Britain can, in the now
notorious words of Boris Johnson “have its cake
and eat it”. Philip Hammond and Liam Fox
jointly wrote two weeks ago that Britain will
leave both the single market and the customs
union at the end of the Article 50 process. But
there is no realistic acknowledgement in these
papers of the gigantic difficulties that this would
create. On issues from the Irish border to
customs arrangements, the government has
simply stated what it wants, no matter how
unfeasible its demands. There was, at least, a
significant concession on the European court of
justice: the government seems to have conceded
that the UK will continue to be affected by EU
law.
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The government’s approach so far to the historic
question of Brexit borders on the irresponsible.
Yet, still, ministers continue the deceitful
charade, while every day the uncertainty
deepens for businesses making investment
decisions and EU citizens living in this country.
Last week the government celebrated a report
indicating falling immigration figures. But those
statistics are in fact a sign of a spluttering
economy in which industries such as food
production are suffering from a lack of workers
and the NHS is unable to recruit enough doctors
and nurses. New research from KPMG suggests
that this is the shape of things to come, with
significant numbers of younger, better-educated
and better-paid EU nationals considering
leaving the UK.
That Labour has finally screwed its courage to
the sticking place on Brexit could be a game-
changing moment. Next month the EU
withdrawal bill returns to parliament for its
second reading. The bill’s provisions on the
European court of justice would effectively
make Labour’s transitional proposal to stay in
the single market all but impossible. So, not
before time, battle must and will be joined in the
House of Commons. It’s now down to
moderate, pragmatic Conservative MPs to break
ranks and rally behind Labour to bring some
sanity and realism to the Brexit process. If this
parliament votes to sacrifice Britain’s economic
interests on the altar of Conservative party
unity, history will not remember it fondly.
https://www.theguardian.com/commentisfree/201
7/aug/26/the-observer-view-on-labours-new-
brexit-policy