Been away awhile, lots of work, summer, etc. Had a few thoughts on Medicare-For-All, turned into something a bit longer, so I thought I’d post it. Hope you enjoy.
Thrilled to see the excitement over the Medicare-For-All bill introduced yesterday. I support universal healthcare and am happy to see Bernie Sanders continue the fine work of people like Ted Kennedy, Hillary Clinton and especially John Conyers, who has been proposing single-payer, Medicare-for-All type legislation since 2003. The Trump administration has not advanced any meaningful policy, just worked to roll back protections we put in place for the climate, for women, for immigrants, for campus rape victims, for senior citizens, for student debt holders, for minority voters, and for children, so it’s fun to have some actual policy to write about for a change instead of just having to scream about how it’s not really cool to hurt people for corporate profit, or even worse, no reason at all except fear and loathing.
This bill offers some of the most comprehensive coverage of any government-sponsored health care system in the world, covering all doctor visits, specialty or primary, all hospital stays, basically everything including dental and vision, and all free at the point of service. These are lofty and admirable goals that would certainly make life easier for people who use the healthcare system if implemented well.
I do understand, and expect the senator does as well, that this current bill is not meant to become law (there is currently no activist push to get Republicans on board, just Dems), and is more means of moving the conversation forward, and also a litmus test for Democrats, a way to determine whether or not they are “on board” with single-payer. This sort of political theater is normal and expected, but not of much interest to me, especially since my senators already back the legislation. This is not to say I disapprove, I’m sure this kind of thing is both necessary and effective. It’s just not all that interesting to me.
What does interest me is policy and health care. I would very much like to see Senator Sanders succeed where others have failed and see the US adopt a system where equal, affordable, comprehensive coverage is available for everyone regardless of their standing. Here are the issues I see that need to be addressed to properly implement a system like this. I hope the senator and his policy folks can find a way to address these needs and put together a serious proposal.
Second, and almost just as hard as the first, is addressing the shortage of resources. We’ve been facing a shortage of health care professionals that drives up costs and waiting times. We just can’t make doctors and nurses appear out of thin air. I don’t have many ideas here, but it’s an important issue that has gotten even less attention than insurance industry job losses.
Third is the issue of getting rising health care costs under control. Some of this would be alleviated by the stronger bargaining leverage over providers afforded by a single-payer system, but given the stratospheric rise of costs recently, it’s almost a certainty that more should be done, and we need innovative solutions.
Last, and by far easiest, is paying for it. I have read the white paper, and the numbers don’t really add up. Which is fine for a bill that is not meant to pass. I understand why there is no payment system committed to here. At least some of the provisions used to fund the bill will be unpopular with at least some people, and there’s no need to commit to unpopular policies and give critics of the bill’s supporters attack ammo. But without some kind of structure in place or any numbers to point at, opponents will just be able to scream about massive tax increases they make up out of thin air and proponents will not have much ammo to fight them with, and there is no practical way to advance the bill politically when it gets to the stage of debating the nitty-gritty.
Look, we all know the money is there. There is no shortage of money. But we still have to show our work on that.
It’s like this:
Waitress: Here’s the check.
You: This is no problem, I have plenty of money.
Waitress: So, cash then?
You: I’m sure the people here don’t mind kicking in.
Waitress: So you’ll be splitting the bill?
You: There are a number of different options.
See, eventually you have to put something in the little black folder.
Thanks for reading.
Would be nice if the Democratic leaders in the House, Senate, and the leader of the Party agreed with you and me and over 50% of the American people that health care ought to be a citizen’s right (and not something that will never, ever happen).
15 Senators co-sponsored this and more than 50% of the Democratic caucus in the House. This is the highest amount of Congressional support the policy has ever received. It’s obviously a baseline to build on, but your glass half empty view of Bernie’s substantial accomplishment of getting every 2020 Senator on board with this shouldn’t be dismissed as mere optics.
The bill doesn’t matter. It really doesn’t. The reframing of the debate and the goals is what matters, and the progress made on that since last year is truly staggering, imo.
I think Ezra Klein has a great take on this today and shows some of the ways in which this could go down. A perfect, all-encompassing bill will never exist, and one never needs to.
I agree that the bill does not matter. What does matter is the growing number of Democrats willing to return as the party of the working class and reject the failed notion of neoliberalism and a meritocracy.
Again-a majority of them are moving in this direction. I take the glass half full look that the Bernie approach to progressive politics is rapidly becoming mainstream within the party while the centrist approach is rapidly fading from view.
A bill absolutely matters. Now we have something concrete to defend, critique, improve, etc.
That was a great article and I was going to link to it before I saw you did. Agree 100%. This bill won’t pass-it’s about building a new party consensus. But if and when we retake Congress we need to get the details right.
I assumed Klein was going to take his usual slightly-left-of-center wonkish post and talk about all the things that aren’t “realistic” about the bill. I was pleasantly surprised. There is a difference between politics and policy and I think this push for single payer understands that. A perfect bill that can make an overnight switch to single payer does not and cannot exist. Setting the goal of single payer is the point and it is fundamentally different than the goal of market-based universal coverage. As Klein alludes, there are a lot of ways this could roll out. A public option, Medicaid expansion, a Medicare buy-in age adjustment, or Medicare negotiating drug prices. All of these things can happen with minor disruptions to the current system and can test all sorts of cost saving measures. 10-15 years from now it could be a situation in which a much smaller % of Americans are on private insurance and then full single payer makes sense. When your position is that single payer will “never, ever come to pass,” you can’t build the political support for the move in that direction.
I think this approach applies to nearly every issue and Democrats should take note. Also, and potentially more importantly, there’s little evidence that the voting public cares at all for punishing politicians who support “unrealistic” plans. In fact, there’s more evidence of the opposite.
Thanks for this. I’d like to see more realistic bullet-biting on the part of advocates, and less hand-waving past the inevitably huge political and policy challenges.
I obviously agree with your concerns and have written several threads on this. We don’t want another Vermont. That said, I don’t see as much hand wringing here. I think comparisons to the GOP false promise of repeal and replace are false equivalency. This is a detailed roadmap for what we want to accomplish. It gives four different possibilities for how we get there. So no, it’s not a bill ready to sign. It is a start to a serious conversation-which the right never had on health care.
Republicans (and some Democrats) will attack this as a huge tax increase. Democrats would be wise to get ahead of this by crafting a narrative illustrating how much our an ordinary working class paycheck gets deducted for insurance premiums, co-pays, and deductibles versus how much will be deducted to cover Medicare for All and show the working class that they will have more in their checks on payday, not less.
Yes.
In addition, it’s worth highlighting the SIGNIFICANT cost savings that employers will incur by not having to pay the employer’s premium for group health coverage. This will help us call out employers who attempt to simply pocket those decreased costs.
The total amount that employers incur as “payroll expenses” will go down dramatically. My prediction is that most employers will just pocket those lower costs, just like they will simply pocket any corporate tax increases that the GOP jams through congress.
Bernie’s proposal has a mix of millionaire, corporate, and payroll tax increases that are largely progressive in scope to figure out who pays what share. I think for transitions it actually won’t be that disruptive for the broad majority of middle class taxpayers. It won’t be a huge initial difference, it’s just that now the premiums go to the single payer plan as a tax contribution.
In 10-15 years as costs start getting contained it’ll likely be a fairly big difference as health costs go down and the ease of access becomes normal. Enrolling in an HMO, as I am doing now, is always a pain in the ass. Getting rid of that pain is hugely underrated selling point.
Where the transition will be painful is for groups like Partners and Big Pharma that are making huge profits off the status quo. Converting that monstrosity to single payer is the real challenge. And I haven’t seen a good plan for that yet.