I was going to put this up as an addendum to an earlier post, but I changed my mind and decided it could stand on its own. Ryan Cooper has a tremendously competent look at Bernie's proposal and why it makes such good politics for Democrats, despite opposition from the party's two clueless-- and failed DC leaders, Schumer and Pelosi. "The plan," he wrote, "would be phased in over a period of four years. In the first year, traditional Medicare would be expanded to cover dental, vision, and hearing aids, as well as people over 55 or under 18, while others would be able to buy in if they wish. In the second year, the age qualification would be lowered to 45, in the third year to 35, and then in the fourth year, everyone remaining would be included. This upgraded version of Medicare would also be a lot more generous in terms of access. There would be no cost-sharing, except for prescription drugs. It is, as Paul Waldman argues, probably best understood as an opening bid-- a symbolic maximal demand rather than the usual pre-compromised [see failed Democratic leaders Schemer and Pelosi] Democratic fare.
We spend $3.2 trillion per year-- literally twice as much as the OECD average as a share of the economy. We pay enough in health-care taxes alone-- that is, the government revenue that goes to Medicare, Medicaid, the VA, and a few other things-- to cover a Canada-style Medicare-for-all system for the whole U.S., and then that much again in private money. In other words, if we could simply copy-paste Canada's universal health-care system into America, taxes would actually go down.All that means is that America doesn't have to worry much about costs; it has to worry about allocating existing spending properly. We already have a gigantic pool of resources dedicated to health care-- about half private and half public. We just have to adjust that spending so it can support a single-payer system.So on total spending, for example, BernieCare would have contradictory effects. No cost sharing would make going to the doctor much easier, which would increase spending, while on the other hand it would bring prices down a lot, cutting outlays. It's impossible to know for sure which effect will predominate until detailed studies can be done (and probably not for sure until it is actually implemented). But the fundamental reality is that we are already putting up way, way, way more than enough to pay for a really excellent universal health-care system. Any resource problems we run into along the way-- and there is sure to be quite a lot of disruption during the transition period-- can be solved by adjusting the pot of health-care resources around.For example, Sanders' funding options present several ways you might finance Medicare for all and leave almost everyone money ahead. Administrative savings alone (due to the fact that Medicare is vastly more efficient than private insurance) would run to something like $500 billion per year. Negotiating drug prices might free up another $113 billion. Meanwhile, a 7.5 percent new employer-side payroll tax would raise $3.9 trillion, while cutting health-care expenses per employee by $9,000 on average. A new 4 percent income tax would raise another $3.5 trillion while saving a family of four making the median income about $4,400 after getting rid of premiums....[T]he basic strategy is clear: cut out waste, get prices down, add a few new taxes, and use the resources thus freed up to cover every single American. Even if those details need to be adjusted, it definitely can work, and it will be a spectacular improvement.That brings me to the politics. Centrist liberals have long been against Medicare for all, because milquetoast, incremental politics rules out such sweeping changes by definition. Hillary Clinton, for example, does not like Sanders' bill, pointing out that fears of people losing the health insurance they have through their employer helped kill her effort at health-care reform in 1994. President Obama, fretting about this same thing, incautiously promised that "if you like your plan, you can keep your plan" under ObamaCare, which while true for most people was not true for millions of others, simply because you can't make large changes to the health-care system without having that effect. That broken promise enraged people.The truth is that while employer-sponsored insurance is okay for most people who have it, it is also terrible in many ways. First and most importantly, it means that if you lose your job, you lose your coverage-- and perhaps so does your family. That is a huge problem both for people who lose employment-- there were 60 million job separations in 2016 alone-- and for people who are stuck in terrible jobs for fear of losing coverage (or "job lock"). Second, employer-based coverage has been getting worse over time, with the same increasingly higher co-pays, premiums, and deductibles, plus narrowing networks, that have afflicted the ObamaCare exchanges.The way to get over people's fears of losing their (increasingly lousy) coverage is to promise them something so good that people can be certain they'll end up better off. The prospect of guaranteed, generous coverage at a reasonable price, that works everywhere and can never be taken away, that would abolish medical bankruptcy and the hell of insurance paperwork, fits that bill. What's more, most people are already very familiar with Medicare, and so will be resistant to scaremongering from conservatives and the insurance industry.Fear of change and knee-jerk moderation is the thinking that made American health care such a disaster in the first place. But at some point America is going to have to rip off this band-aid. BernieCare is an excellent starting point.
A personal note: I retired early from my job at Time Warner, where I worked as the president of one of their divisions, Reprise Records. The platinum-plated health insurance policy that was part of my employment contract was the same for all presidents and chairmen; it has been negotiated and re-negotiated by top attorneys over the years and I was just lucky enough to have it, I thought. Supposedly it is the best private insurance money can buy. When I retired I was allowed to keep it-- via Cobra, which eventually I had to pay for and which is quite costly-- until Medicare kicked in. I was afraid that my coverage would plummet once I was forced onto Medicare. That was very foolish and very ignorant. Pay attention to my next sentence. Medicare is better-- MUCH better. Soon after Medicare kicked in, I was diagnosed with a rare but treatable form of cancer. Two years of treatment went beyond two million dollars. I never got so much as a question or a throat clearing from Medicare. (Medicare Part D-- Republican Medicare, the drug part-- totally sucks and needs to be scrapped entirely and redone and it is currently the bane of my existence, Medicare itself... better than the best thing corporate chief executives get.) I know that no one will believe me-- but I'm not exaggerating. Forget partisan anything; do whatever you can to get Medicare expanded (and improved in the ways Bernie is proposing); it will eventually save your life and the lives of those you love.As for the politics of this... a random race: CA-49, Darrell Issa's seat in northern San Diego County and southern Orange County. Doug Applegate came within a handful of votes of beating Issa last time. He's expected to wipe Issa out in 2018. And part of the reason is healthcare. Doug, a former Marine Colonel who saw who single payer works in the military, aggressively supports Medicare-For-All. Issa voted for TrumpCare, which would rip health insurance away from 22 million Americans. CA-49 voters will decide.
