Jacob Hacker Rises Again To Stop Single Payer

| Strategize!

Above Photo: By Erik McGregor

In the article linked below, The Road to Medicare for Everyone, Jacob Hacker is once again working to dissuade single payer healthcare supporters from demanding National Improved Medicare for All and is using our language to send us down a false path. Once again, he comes up with a scheme to convince people to ask for less and calls those who disagree “purists”. Hacker calls his “Medicare Part E” “daring and doable,” I call it dumb and dumber. Here’s why.

Hacker makes the same assertions we witnessed in August of 2017 when other progressives tried to dissuade single payer supporters.

He starts with “risk aversion,” although he doesn’t use the term in his article. Hacker asserts that those who have health insurance through their employers won’t want to give it up for the new system. Our responses to this are: there is already widespread dislike for the current healthcare system; people don’t like private insurance while there is widespread support across the political spectrum for Medicare and Medicaid; there is also widespread support for single payer; and those with health insurance can be reassured that they will be better off under a single payer system. It is also important to note that employers don’t want to be in the middle of health insurance. Healthcare costs are the biggest complaint by small and medium sized businesses and keep businesses that operate internationally less competitive.

Next, Hacker brings up the costs of the new system and complains that it will create new federal spending. He points to the failures to pass ‘single payer’ in Vermont and California. First, it must be recognized that the state bills were not true single payer bills, and second, states face barriers that the federal government does not, they must balance their budgets. Hacker ignores the numerous studies at the national level, some by the General Accounting Office and the Congressional Budget Office that demonstrate single payer is the best way to save money. Of course there would be an increase in federal spending, the system would be financed through taxes, but the taxes would replace premiums, co-pays and deductibles, which are rising as fast as health insurers can get away with. Hacker proposes a more complex system that will fail to provide the savings needed to cover everyone, the savings that can only exist under a true single payer system.

Hacker also confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long term care, and doesn’t require co-pays or deductibles. The system would negotiate reasonable pharmaceutical prices and set prices for services. It would also provide operating budgets for hospitals and other health facilities and use separate capital budgets to make sure that health resources are available where they are needed. And the new system would create a mechanism for negotiation of payment to providers.

Finally, Hacker tries to convince his readers that the opposition to NIMA will be too strong, so we should demand less. We know that the opposition to our lesser demands will also be strong. That was the case in 2009 when people advocated for the ‘public option’ gimmick. If we are going to fight for something, if we are going to take on this opposition, we must fight for something worthwhile, something that will actually solve the healthcare crisis. That something is NIMA. We are well aware that the opposition will be strong, but we also know that when people organize and mobilize, they can win. Every fight for social transformation has been a difficult struggle. We know how to wage these struggles. We have decades of history of successful struggles to guide us.

One gaping hole in Hacker’s approach is that it prevents the social solidarity required to win the fight and to make the solution succeed. Hacker promotes a “Medicare Part E” that some people can buy into. Not only will this forego most of the savings of a single payer system, but it also leaves the public divided. Some people will be in the system and others will be out. This creates vulnerabilities for the opposition to exploit and further divide us. Any difficulties of the new system will be blown out of proportion and those in the system may worry that they are in the wrong place. When we are united in the same system, not only does that create a higher quality system (a lesson we’ve learned from other countries), but it also unites us in fighting to protect and improve that system.

Hacker succeeded in convincing people who support single payer to ask for something less in 2009 and we ended up with a law that is further enriching the health insurance, pharmaceutical and private healthcare institutions enormously while tens of millions of people go without care. Now, Hacker rises again to use the same scare tactics and accusations that he used then to undermine the struggle for NIMA. This is to be expected. The national cry for NIMA is growing and the power holders in both major political parties and their allies in the media and think tanks are afraid of going against the donor class. Social movements have always been told that what they are asking for is impossible, until the tide shifts and it becomes inevitable.

Our task is to shift the tide. We must not be fooled by people like Jacob Hacker. We know that single payer systems work. We have the money to pay for it. We have the framework for a national system and we have the institutions to provide care. Just as we did in 1965 when Medicare and Medicaid were created from scratch, and without the benefit of the Internet, we can create National Improved Medicare for All, a universal system, all at once. Everybody in and nobody out.

We know that we are close to winning when the opposition starts using our language to take us off track. “Medicare Part E” is not National Improved Medicare for All, it is a gimmick to protect the status quo and convince us that we are not powerful. We aren’t falling for it. This is the time to fight harder for NIMA. We will prevail.

Read Jacob Hacker’s article in the American Prospect here.

  • chetdude

    I skimmed Hacker’s article. It’s riddled with fallacious assumptions among the worst being

    A) What is “political reality” today will be “political reality” tomorrow – NOTHING good will pass in Congress and be signed by the pResident without a better class of pResident and Congresscritter…

    B) All of his suggestions” continue to allow the corporate for-profit sick care industrial complex to set costs/prices that accommodate huge profits – that will continue to fail to lead to affordable or accessible or effective care for the vast majority of people in USAmerica…

    C) That “we can’t afford” comprehensive, universal, Medicare for All when the truth is that HR676 is the path of least resistance to something we can sustainably afford…

    D) And maybe most glaring of all (again), that old canard that 60 votes will always be needed in the Senate to do anything substantive when the truth is that rules of the Senate can be changed with 51 votes on day one. Again, see A…since the run of the mill democrat of the last 40+ years has bought into the “good ole’ boy” filibuster in the undemocratic Chamber and is also paid NOT to do what is necessary and would be extremely popular but rather what their campaign bribers want…

  • kevinzeese

    All excellent points.

    I especially appreciate the first falsehood you point to: “political reality” today will be “political reality” tomorrow. If that were true we would never make progress. Slavery was impossible to repeal, women voting was impossible, civil rights was impossible — those are a few of many examples of many tranformative changes that were impossible becoming impossible to stop. That is our job as a movement: to turn the impossible into the inevitable.

    And, your last point, people should no better than what Hacker claims. The Republicans just radically changed the tax laws with massive tax cuts for corporations and wealthy individuals with just a majority vote. There are procedures in the senate for 51 vote passage of laws (actually 50 plus the vice president). In addition, our job is to build national consensus so that no politician or candidate can oppose National Improved Medicare for All. If we do our job we will be able to achieve more than 60 votes.

    It is evident that Hacker is an academic not an activist who does not understand how political movements change the political culture. We can do the same on healthcare. The first step is demanding what you want and organizing for it. Hacker says he wants single payer but he always urges people to organize for less than we want. That is no way to achieve what we want. Join us at Health Over Profit for Everyone, http://www.HealthOverProfit.org.

  • chetdude

    THAT’S what I’m talking about — I love the way those graphics at HealthOverProfit tell the better story. (Love Dr. Flowers’ powerpoint too!)

    I think we’ll get more converts by telling those easy to understand true stories about what Health Care will look like when we finally get it for ourselves. I’m going to try to post more of that than just continue to harp about what’s so obviously wrong with what we’ve got…

    Thanks, Kevin…

  • Fishmael

    Good article, and good responses — thanks! Surely Hacker has written stuff before, and a pattern can be found to his perspective; yes? no? (By the way, I am NOT so much a ‘purist’ in argument, to shy away from ‘ad hominem’ approaches — this is a mistake, to my sense of things. We just should NOT rely solely on such presentations.) Is he REALLY a ‘progressive’ on many issues? What’s his ‘street cred’? I will make two points more.

    + One NEVER goes into ‘negotiations’ with an ‘easy gimme’ only. To do so is stupid. To recommend to do so is also stupid. To recommend that the current ‘system’ can be patched up, and leave huge numbers of folks without adequate (and preventive) medical access, is immoral.

    + A lot of opposition to NIMA is ideological, and some from the notion of protecting all the power currently vested in the moneyed few. But I can also understand that there are some, higher up in our pirate-enterprise system, that can see a lot of ‘worker strength’ following from being able to be unshackled to employment, by health-insurance needs. There is both schadenfreude and practical power-dynamics to consider.

  • chetdude

    I posted the link to HealthOverProfit elsewhere for another activist to view and he thanked me for the link but also responded: “The link should have targets to make it easy to share on Facebook and Twitter.”

    I don’t do Facebook or Twitter so I didn’t notice… 🙂

  • Jay Hansen

    Corporate and market “Democrats” must be exposed, isolated, and neutralized. It is time to say ‘no more Mr. Nice-guy’ and make it stick.

  • Jay Hansen

    It’s a basic rehash of the same arguments used to say Hillary was the only viable candidate. The DNC is heavily invested in losing.

  • chetdude

    I think the bottom line is the self-fulfilling prophecy that they need Plutocrat/Corporate big bucks to “win”…

    The Sanders campaign exposed that myth when he went from 60 points down as a near unknown to nearly upsetting the Chosen One (and becoming the most popular politician in the nation) by using a combination of policies and programs that fit most USAmerican’s system of Values using $27 contributions from millions of people…

  • Jay Hansen

    Across the board, right you are.

  • gininitaly

    Here is the root of all the health care usury in this country and it has been for over a hundred years. Of course they want you unhealthy, sick and badly insured, because the pharmaceutical/medical industry is making double what it would anywhere else and they’re willing to pay billions to make sure it stays that way.