Democrats Need to be Clear and Honest on Health Care

Medicare for All- what the hell does that mean? Is it socialized medicine? What does it cost? Is it Medicare Advantage? Does the rest of the world have it? Will taxes go up? Will private insurance go away? Once you dig under the buzz words, you realize it’s not quite that clear what this plan is. There could be serious differences between the Democratic candidates on how to do it.

First off, understand the politics- the idea of Obamacare polled really well in 2007 and 2008, when it was buzzwords, talking points, and the abstract, but was a political death sentence by 2010. Calling it “Medicare” polls very well, but understand that this government health care expansion will be a lot different than a health program for seniors. Here are a few facts to understand:

  1. “Medicare for All” is cheaper than our current system, but maybe not for you. A “Medicare for All” government plan is cheaper than our current health care system costs in total. That doesn’t mean *you* would save. For millions of Americans right now, they get their health insurance given to them, or at a greatly reduced cost. If you are currently insured by your employer, or you are on Medicare, or you go to the VA, or you get Medicaid or CHIP, you probably get your insurance mostly free, or already paid into it, or are only paying a portion. If you’re going to expand Medicare to everyone in America, there’s at least a chance that everyone will have to pay more in taxes (better than a chance, but you get me). If you’re getting free or very affordable insurance now, but your taxes would go up for “Medicare for All,” it will cost you more. So yes, this system would be cheaper, but you might pay more.
  2. If you’re expanding health car under Medicare, you have to lift the cap on payroll taxes. Medicare is financed by the payroll tax. If you’re going to insure tens of millions of more people under the Medicare program, you would have to increase the cap on payroll taxes from the first $132,900 it is at this year. This would not effect people making less than $132,900. It would effect wealthier people. If you don’t acknowledge the tax increase is a part of this though, you’re lying.
  3. It’s not “Medicare.” You pay into Medicare through the payroll tax throughout your working career, then receive the benefits when you enroll. For most people, you pay in for about 40 years, then receive the benefits for ten to fifteen years (about life expectancy). Under a program that covers everyone, you would be both paying in and receiving benefits at once. Fiscally, this is an entirely different program. Medicare was created to provide care for elderly, more expensive people, to get them out of the insurance pools, and keep them cheaper. Expanding Medicare to everyone is a very different program.
  4. Almost every developed nation has universal coverage, but not that many have pure single-payer care. If you look across Europe, everyone lives in a country with universal care. Not everybody lives in a single-payer system. Many countries, like Poland for instance, cover all the basics and then lets you buy beyond that for your needs. Everybody in all of these countries can go to the ER with a broken bone and get their care covered. But you don’t just get everything. Some nations have coverage caps, some have limited coverage, and some have other forms of hybrid systems.
  5. Eliminating all private insurance companies or not is a big policy difference. When Senator Harris said she would eliminate private insurers on CNN, some people called that a minor detail. It’s not. Eliminating all private insurers means a fully government run, single-payer system. It means you’re not going to manage the Medicare system through private insurers, or leaving some parts of the system to private insurers. That might be preferable. It’s not minor though.
  6. There are other options, including Medicaid. If the goal is universal insurance, you don’t have to it through Medicare, or even a single-payer system. Some states, most notably Nevada, have considered expanding Medicaid to cover more of their non-Medicare eligible citizens. By leaving Medicare to seniors, the idea is that you’re covering more or all of the cheaper population together, without messing with the Medicare program. Medicaid is able to get comparable outcomes for recipients to Medicare, and do it cheaper, because it’s not covering more sickly seniors. Expanding Medicaid, or expanding it and increasing ACA subsidies for private care, are just a couple of other options beyond “Medicare for All.”
  7. This isn’t socialized medicine. While conservatives may try to scare you by calling this socialized medicine, it is not. This isn’t a takeover of the doctors and hospitals. It’s a potential takeover of the insurance. This is a pretty big difference.
  8. This is super expensive. The cost estimates of this plan are between $3.2 and $3.5 trillion dollars per year. This is over 75% of the entire federal budget right now. You can’t do this with just a few cuts to Defense Spending. The cost of this program is about 450% of the Pentagon Budget. You don’t get there cutting waste. You get there with tax increases.
  9. There are other problems created by killing the insurance industry. So if you get rid of private insurance, what happens next? Where do the workers in that sector of the economy go? Do we hire them all into the government? Do we pay them all unemployment? Do we pay for them all to be re-trained? How about all the retirement funds, public and private, that own stock in insurance companies (likely your’s does)? How do we fix that? There’s unforeseen side issues that come from nationalizing insurance. What’s the plan for them?
  10. The Devil is in the details. When President Obama began his 2010 overhaul of the health care system in 2009, a large majority of Americans supported it. By 2010, they supported it. Then everyone hated the ACA until Trump wanted to repeal it in 2017. Why the swings in mood? People will want to know how any plan effects them. Will they be able to keep their plan? Will their taxes go up? Will they lose their years of paying into the system? The details matter. They move public opinion. Where they aren’t clear, they assume the worst.

The assumption that current positive polling on “Medicare for All” will remain if it actually has a chance to happen are silly at best. If this is the road Democrats want to go down, they better line up all the details, and be honest about them. Failure to do so cost them the Congress in 2010, and could hurt them in 2020 or 2022 now.