We Deserve A Better Medicare-For-All Debate

| Strategize!

Above Photo: Protesters supporting “Medicare for All” hold a rally outside PhRMA headquarters April 29, 2019 in Washington, DC. The rally was held by the group Progressive Democrats of America.

The narrow debate over Medicare-for-all’s financing has become totally disconnected from the status quo aspiring reformers want to fix (the high costs of health care in America), and it totally ignores the toll of the Trump administration’s reckless agenda to pare back health coverage in this country.

But the debate rolls on. Sen. Elizabeth Warren said Sunday she would put out a plan to finance single-payer Medicare-for-all in the next few weeks. She had little choice. At last week’s debate, debate moderators and centrist candidates used the issue as a cudgel against the senator, who has risen to the top of the 2020 field.

We’ll see what she comes up with. And it’s certainly reasonable to ask a candidate to explain how they’d pay for a fundamental overhaul of the US health care system. Prominent economists certainly doubt everyone in the middle class would be a winner under Medicare-for-all.

It’s also hard to blame trailing center-left candidates for trying to contrast themselves with a frontrunner who is close in the polls with former Vice President Joe Biden. But they might be underselling the potential costs of their Medicare “for all who want it” alternative.

Jared Bernstein at the Center on Budget and Policy Priorities pointed out last week — and mind you, he himself supports a public option — the flaw in Biden’s and Mayor Pete Buttigieg’s critique of Medicare-for-all. By their own logic, the public plan should be appealing enough to attract consumers from private coverage, which means the costs for a public option will inevitably go up. (Buttigieg has called a public plan a “glide path” to single-payer.)

Yet nobody is asking how Biden or Buttigieg would pay for their plan over the longer term, if it does grow into a program that covers almost as many people as the Bernie Sanders’s version of Medicare-for-all.

That brings us to the bigger problem: Debate moderators have framed the question in such a way — would you raise taxes on the middle class? — that drains it of all relevant context, from the high costs of the existing system to the current trendlines we’re seeing under President Trump.

Warren and Sanders have answered that question by emphasizing that new federal taxes will be replacing private insurance premiums for employers and families and that out-of-pocket costs will be nearly eliminated. It’s hard to say whether they are right that middle-class families will pay less overall for health care without a detailed financing plan, but this RAND study of a proposed single-payer plan in New York state that’s very similar to Medicare-for-all would give the candidates a case.

The study shows an almost one-to-one trade of private premiums for new taxes, with point-of-care costs cut by more than half. Overall health care costs shrink slightly, with administrative costs way down and more money spent directly on medical services.

This is the pitch Warren and Sanders are making. But they aren’t making it against an empty slate. That’s the context debate moderators miss with their narrow focus on middle-class taxes.

A few facts:

  • Premiums for employer-sponsored health insurance (which covers 150 million Americans) have increased $13,375 in 2009 to $20,576 in 2019. For workers, their share went from $3,515 to $6,015, according to the Kaiser Family Foundation.
  • The percentage of workers enrolled in a health plan with a deductible of $2,000 or more rose from just 7 percent in 2009 to 28 percent in 2019, the KFF says.
  • To put it more bluntly, the percentage of people who do have health insurance but are considered underinsured — meaning their insurance does not adequately protect them from the financial strain of a serious medical event — nearly tripled from 10 percent in 2003 to 28 percent in 2018, according to the Commonwealth Fund.

Those trendlines explain why Americans continue to name health care costs as one of their top policy concerns, even with 90 percent of people covered by some kind of insurance. And they surely help explain why the political energy for another round of health care reform remains so intense less than 10 years after the Affordable Care Act became law.

These problems are only getting worse. The uninsured rate has ticked up again, after falling for most of the last decade, since the Trump administration took over. They have willfully undermined the viability of the ACA’s insurance markets and permitted work requirements for Medicaid, causing thousands of people to lose their insurance without any meaningful effect on employment.

But none of this — the very reasons we are talking about Medicare-for-all or Medicare-for-all-who-want-it — would be evident to a viewer who hears one of the 2020 candidates asked for the umpteenth time about middle-class tax hikes. Nobody is explaining to them, in setting up the question, the cost of the system as it exists today.

It has been left to the Medicare-for-all supporters to try to steer the conversation to the broader discussion of costs, but then they are assailed by moderators and moderates alike for being evasive.

Medicare-for-all faces plenty of challenges, political and practical. Its backers should be candid about the obstacles in front of them and the high degree of difficulty in overcoming them. The public option undoubtedly does have more support, for now, with the American public than single-payer does. Other countries have found a role for private insurance in their universal health care schemes; it is not necessarily a binary choice.

America needs an informed conversation about health care costs and how we can lower them so nobody in this country goes bankrupt because of a medical event. This myopic fixation on middle-class taxes is constraining our ability to have it.

  • Greeley Miklashek

    Nice effort, but filled with inaccuracies, most noticeably the lack of any mention of Senator Bernie Sanders and the focus on Senator Warren’s admitted version of his plan. Here are a few more stats to highlight the problem, from a 42 years experienced now retired physician. 55% of adult Americans already have at least one chronic medical condition (aka “pre-existing condition”), and 80% of those of us over 50! We have, hands down, the worst healthcare financing system in the world, the most expensive healthcare, and some of the worst health outcomes, in spite of all of our exotic high tech medical interventions. A for-profit healthcare “industry” like ours is something from a dystopic novel of a dark future indeed, but it’s real for us Americans on a daily basis, as Senator Sanders has so accurately pointed out, when the MSM stoops to give him a bully pulpit, as 500,000 of us go brankrupt annually from medical expenses. We should be so ashamed! Our system is broken and cannot be fixed or up-graded. It must be replaced by a Universal Government Financed National Healthcare System worthy of the name. There is no alternative.

    This year Americans will spend over $3.6T for poor healthcare, if they can find and afford it, but that cost is projected to reach $5.9T by 2030. The stats in the article point out the 50% premium increases over the past decade and 100% worker contribution increases, as well as $2K deductibles. This is the hallmark of a failing system. I spent 42 years working in this system, answering to insurance companies and know-nothing “administrators” who made every possible effort to prevent me from caring for my patients, ostensibly to save money. Physicians have lost all authority in the present system and patients are suffering accordingly. Now, the for-profit system is attracting the wrong sort of students into medical practice, who quickly realize that the money is in specialization and not primary care. Thus, primary care physicians are harder and harder to find in practice. We have a broken, failing system.

    Only Senators Sanders and Warren have the correct analysis of the problems in our current “Healthcare Industry” and solid plans to replace it. All the rest is industry driven propaganda in an attempt to hoodwink the easily distracted public, and the MSM is a major part of the problem when they should be a leader toward a humane and efficient new Universal Healthcare System. Thanks for the article! Stress R Us

  • voza0db

    If you guys still want more debates… Good luck with never having a proper Health System.

    But unfortunately the root cause of Health problems is STILL NOT ADDRESSED.

    This system is built to address the outcome and not prevent it! So there’s no amount of money and resources that can keep such an unsustainable system.

  • So just what is the problem with copying Canadian single-payer health care, or the single – payer health care in effect in Europe for over 1/2 century now? They got it working just fine for their citizens and even visitors. This cannot be complicated by now, only b.s. from the USA’s government employees, mostly liars at this point, all of them, and have been for decades, especially with regard to this issue.

  • ANTONIO

    SPOT ON. Americans talk and talk and talk about taxing the middle class- obviously nobody wants that. Its not about taxing anyone, because medical care is not up for something in a portfolio. You have Medicare in the same way you have transportation, or shots at the moon. When has anyone said “If we land on the moon your taxes will go up, so that private companies can get rich”. No country can progress on that basis. You must have medical care without profit, without Wall St, without speculators, without middlemen, without bureaucracy. The government, with its trillions in the Fed, takes over, and does not reward private companies for anything. People don’t “choose the medical care they like”. That is madness. Everybody gets the best medical care from a single source, the one with the most money and least profit, the Federal Government. Shopping for medical care is not like shopping for a Louis Viton handbag. It is the public service of a developed country that is serious about providing for its people, not offering better and shittier deals according to your ability to pay. Russia does it, China does it, Cuba does it, Venezuela does it, Denmark does it, Sweden does it-shall I go on?

  • mwildfire

    Hear, hear! All good points, including the final ones coming right out and saying what the piece evades–the halfway measures proposed by Buttigieg et al are not intended as “a glide path” to universal coverage (why not just go directly there?) but as a con, a way to pretend to solve the enormous problem that is the US healthcare system without cutting out the predators and parasites causing the problem. You didn’t note that a for-profit healthcare system has problems that go beyond the question of who pays, beyond the insurance companies–like drug companies focused on coming up with slight changes to their most profitable drugs so they can renew the patents that allow them to continue charging many times their costs, and focused on profitable “lifestyle” drugs rather than things desperately needed by the world’s poor…and also pushing the US trade office to strongarm other countries into respecting piratical US patent schemes. Then there is the pressure on doctors to run patients through at the rate of four an hour (maybe it’s five now), which contributes to the mechanical reliance on prescribing drugs, rather than trying to determine causes of symptoms and actually clear up the cause/s. And medical schools financed by drug companies, which bolster this rather mindless approach, and teach nothing about diet and nutrition…

  • mwildfire

    Exactly! Much of the media tries to pretend that universal healthcare is some radical new idea that maybe won’t work. They rely on US ignorance of the rest of the world.

  • mwildfire

    Yes–something Marianne Whatsername addressed in one of the debates. Fact is, the system as is, is profitable, extremely profitable. Not only will they not countenance discussion of prevention, they don’t even really want cures–they want maintenance that requires a patient to keep returning to a doctor to get prescriptions they must keep buying.

  • kevinzeese

    While I appreciate Sen. Sanders and Sen. Warren running on Medicare for all, the details matter. Their rhetoric is good but the actual bill they have co-sponsored needs improvement.

    Our healthcare campaign, Health Over Profit for Everyone, provides resources on the House and Senate bills. See http://healthoverprofit.org/national-improved-medicare-for-all-bills/

    This summary and critique of the Sanders-Warren bill may be useful to understanding it. See
    http://healthoverprofit.org/wp-content/uploads/2019/07/PNHP-response-Sanders-2019-bill.pdf

  • And it – capitalizing on citizen ignorance – works, for this helpful issue among many. Such is the isolationist ignorance of most Americans, hence the power of the MSM with their lies and disinformation / misinformation / b.s. The best thing an American can do for themselves to inform themselves is to travel worldwide, even a little bit. Experience wipes out ignorance forever.

  • mwildfire

    Not necessarily. Many people take foreign vacations (at unconscionable cost in greenhouse gas emissions), in which they jet from city to city, seeing all the official sights and photographing themselves in front of all the usual locations, staying in fancy hotels, and never have a real conversation with anyone who isn’t in the tourist trade. They return with no more knowledge than they had when they left, other than a few trivia bits.

  • chetdude

    “Other countries have found a role for private insurance in their universal health care schemes”

    Here’s the MAIN reason that won’t work here. Other countries do NOT have a set of laws written by corporate lawyers and a perverted interpretation of the “Constitution” engraved in stone by SCOTUS that WILL NOT ALLOW US TO REGULATE PRIVATE INSURANCE COMPANIES AS STRICTLY AS THOSE OTHER COUNTRIES DO!

    Leaving the private, USAmerican insurance monopolies in the picture colluding with their corporate friends in the medical center industry and Big PhRMA would continue the driver of the system as the Profit Motive uber Alles…

  • chetdude

    HR1384 is the Canadian system that the Canadians would LOVE to have!

  • chetdude

    Exactly – the default “treatments” of expensive surgery and drugs (with side effects that require more drugs) are MUCH more profitable than cures and preventive maintenance, and for our system, corporate Profits are king…

  • chetdude

    I prefer we start with HR1384, incorporate some of the best features of S.1129 and improvements exposed during hearings, etc. and FORCE 218 House votes and 51 Senate votes and 1 White House Vote to pass it…

  • chetdude

    Don’t you love it when the MSM and nay-sayers blather on about the mythical “Middle Class” without defining who that is, what income levels that represents and the fact that the REAL “middle class” has been rapidly dwindling here in vulture capitalist USAmerica…

  • voza0db

    If HR1384 was named Warcare for All Act of 2019 it would certainly had bi-partisan support. Since it is about Health only some Dems are cosponsors!

    From 234 DEMs only 118 are on board!

  • dopfa

    The US spends 32 MILLION DOLLARS AN HOUR ON WAR! Any discussion about medicare for all should centered around that fact.
    https://www.nationalpriorities.org/interactive-data/trade-offs/

    voza0dp, you’re right on about the “warcare act.” The corporate government ALWAYS finds money for slaughtering people in other lands, but freaks out when We the People want our tax dollars spent on “promoting the general welfare.”

    We could also take half of the DHS budget and put it toward healthcare instead of warfare against We the People. I recall one publicized DHS purchase about eight years ago was 470 million hollow-point bullets, 1.5 for each person in the nation. They’ve used our tax dollars for war against our own citizens, as well as war against the entire world.

    Capitalism (the love/lust for money), is the scourge of the Earth. It’s crazy how many “Christians” are staunch capitalists, even though the God of their sacred book tells them in no uncertain terms, “The love of money is the root of all kinds of evil.” They’re living examples about just how evil it is. Their creed is greed and their god is the almighty dollar.

  • chetdude

    Just to be accurate:

    The remedial sick care system costs $3.4 Trillion per year and climbing. That amount is more than sufficient to finance HR1384 – Medical, Dental and Vision Care for EVERYONE in the country with no extra charges when accessing care and a $200 a year LIMIT on drugs.

    The entire bloated war machine including the extensive national security snooper state and domestic spying operations (social control) costs about $1.25 Trillion per year (and climbing).

    The bloated war budget is only 36% of what the for-profit sick care industry costs.

    While it’s a blatant symptom of the underlying disease – USAmerica’s REAL slogan is not “e pluribus unim” but rather is Profit Uber Alles it’s not enough to impact the cost of sick care.

    However, the bloated war budgets could easily finance a REAL Green New Deal of transformation to a sustainable society worth living in, College without Debt, improved Social Security/UBI and a Department of Peace engaged in Restorative Justice instead of a Department of Offense creating “terrorists”.