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.

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On Democratic Socialism

The Democratic Socialists of America hate when you focus on the word “socialists” in their name. They will remind you they’re not Bolsheviks, not North Korea, and Not Cuba. They would like you to focus on the word “Democratic.” They fashion themselves to be more like what they believe to be an FDR Democrat. They believe in a big, active government. They want the government to not “seize the means of production” as Karl Marx wanted, but to implement more “soft socialism” measures like Social Security and Medicare. There are harder line elements that are actual Communists, but for the most part Democratic Socialists simply want you to know they are progressive Democrats, and not capitalists.

This may seem harmless, and on policy it mostly is. Every Democrat running for Federal office in the country this year is supporting Social Security and Medicare, calling for a more expansive government role in health care, talking about a fix for student loan debt, calling for some kind of increase in the minimum wage, and decrying the GOP tax cuts for the rich. It’s unanimous, basically. On the policy side, the difference between moderate Democrats and Democratic Socialists is a degree or two of detail. No matter how much Alexandria Ocasio-Cortez attacks a Tammy Duckworth, find me more than a small hand full of issues where their disagreement is more than “how much further” one will go than the other.

The problem, of course, is that AOC and the DSA want you to believe the differences between them and mainstream Democrats is extreme. They are ready to have an ideological war with Democrats to enforce their rigid ideological view of what is and isn’t acceptable. If a Democrat is for a Medicare buy-in plan (also known as the “public option”) instead of “Medicare-for-All,” they’re a neoliberal. If a Democrat is for an immediate increase in the Federal minimum wage to $10.10 or $12, with gradual increases to $15, they’re a corporatist. They ran around calling Sharice Davids, a Native-American lesbian “the establishment” in the KS-03 Primary, without ever considering how ridiculous they sounded. They also never seemed to comprehend that maybe their positions are simply a little bit too much for a white-collar suburban district in Kansas to swallow. Democrats probably can’t elect a majority to Congress that is as ideologically pure as they are. They’ve bought into the untrue myth that most independent voters are actually leftists like them- when they’re generally less engaged, bland moderates that don’t want their taxes to rise or their services to be cut. Instead of being allies to electable candidates in moderate districts, AOC and the DSA have made it their mission to support expensive, pointless, and damaging primaries across the country.

The bigger issue I have with the DSA crowd though is not rhetoric, particularly since I don’t disagree with their ideals, or entirely hate most of their positions. It’s the larger ideals behind re-branding the American left as “socialists.” I don’t support Marxism becoming our organizing ideology economically, and neither really do they. Whether or not they know this, what they are calling for is a mixed-capitalist economy, which is what Democrats have supported and Republicans have opposed since 1930. By branding themselves as “socialists,” they are casting themselves in the same net as Venezuela, Cuba, North Korea, Mao’s China, or the old Soviet Union, when in reality what they want is some sort of hybrid of FDR and French Socialists. They are casting themselves in with global leftist leaders at a time when most of them are inept clowns. Maduro is overseeing a failed state, Corbyn is celebrating Palestinian terrorists from the Munich Olympics, the French Socialists didn’t even make the Presidential run-off, the German left is invisible, and the Israeli left has ceased to even matter. I’m not sure any of these folks actually represent the American Left in any way, but they’re not the comparisons any functional person should want.

When we get down to it, the chief beef the DSA crowd has with the Democratic Party is the decision under Presidents Clinton and Obama to highlight “identity politics” over class identity. In choosing what to make “non-negotiable,” Democrats have chosen to put their focus on Civil Rights and “social issues,” while choosing to compromise on taxation, the minimum wage, and Wall Street regulation. The DSA folks don’t seem to agree with this approach, not because their social conservatives, but because they have different priorities. This is a healthy debate to have, provided you don’t have Twitter trolls calling their opponents “neoliberals” and Jane Sanders calling for Hillary to be jailed. Their rhetoric has become toxic.

I’m not a fan of AOC, Bernie Sanders, or the DSA, but it’s not so much of a reflection of policy difference as it is a rejection of their rhetoric, degree of extremity, and priorities. I don’t think labeling the left as “socialists,” or even really anti-capitalist is helpful. I don’t think embracing failed leftists abroad is the look the Democrats need. In short, the policy differences may be slight between mainstream Democrats and more ideological leftists, but the gap is big enough for me to want to note “I’m not them.”

Math and Big Government

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Bernie Sanders is a political quagmire to me. He has ideas, some of them really good, that I agree with. It’s like, what actual Democrat/liberal is against expanding access to health care through the Medicare system? No one that’s honest. What Democrat is actually against making college affordable? If you again answered no one, you’re right again. The problem with all of these ideas is two fold- costs and politics. You simply can’t spend on into forever without any regard for actually ever paying those bills. You have to have a plan to finance these big ideas, and it has to be a plan that can pass Congress. This is where politics are hard, because you see, the public doesn’t want to pay higher taxes, so they are naturally skeptical when you either come out and tell them they need to pay higher taxes, or propose lots of new government spending and claim that taxes won’t go up. A skeptical public votes out Congress, and Congress people don’t want to be voted out of office. As a result, it’s not that easy to get Congress to vote for big government plans, there are real limits to a President’s power of persuasion here. Frankly, you shouldn’t want to see your members voted out of Congress for the purpose of just passing a bill or two, as we see the repercussions of losing elections now in the era of Trump’s Republican Congress.

Anyone who just throws out big proposals, big ideas without all the details and nuance to back them up, shouldn’t be taken seriously. This goes for Paul Ryan and his magic math on the tax cuts. It went for George W. Bush’s magic war theory, that we could pay for his Middle Eastern nation building all on the credit card. It’s true now with some of the ideas that Bernie Sanders is throwing around as his agenda. It is not a sufficient answer to say “tax the rich, cut defense spending,” when talking about how you’re going to finance big plans, because we all know those things are really tough to do- if they were easy to get past Congress, Democrats would have done them long ago. Even modest tax increases on the rich and modest cuts to Defense Department spending would be met with fierce opposition, and would be very difficult to pass- let alone creating $3.2 trillion annually to give everyone Medicare. Obviously higher taxes for the rich and a re-assignment of budget priorities is needed to make these policy goals happen, and it’s worth fighting for, but don’t pretend that this can be done easily, and that it’s a very simple solution. It’s not.

I have trouble taking Senator Sanders seriously though. He called the middle-class tax cuts portion of the GOP’s tax bill good on CNN the other day. In fact, he said Congress should have made them permanent. Is that position without merit? No, not at all. At the same time as he’s saying that, and then trying to claw back his statement, one of his financing ideas for single-payer health care (Medicare for All) is a 4% premium on every household in the country- a middle-class tax increase, even if it is a good idea. These positions don’t square. Sure, households might save money on health insurance premiums that exceeds their tax increase, perhaps, but that doesn’t mean we’re not raising taxes- and that’s assuming the 4% premium on every household would cover the costs- a subject of great debate. Not everyone is going to want to pay higher taxes to finance a national health care system, even if it will make costs cheaper for them or others. That’s just political reality.

My chief beef with Bernie Sanders is not the ideas he espouses, but the lack of reality he attaches to them, while criticizing Democrats for making tough decisions to try and pass things. I think back to his disaster interview with the New York Daily News in April of 2016, during the Presidential Primaries, where he was clearly unprepared to discuss the details of his plans for the nation. What happens to the employees of the “big banks” when you break them up? Who breaks them up, and under what authority? How exactly do we finance single-payer health care and free college education? If defense cuts are part of that plan, what happens to the people who work in manufacturing defense weaponry? Here he is again, after correctly admitting that his health care plan would require a tax increase, saying a middle-class tax cut is a good idea- it’s as though no actual facts or plans matter at all here. Now, Bernie is not the first political leader in this country to propose a bunch of stuff and not have the details down, so I could give it a chance- he’d clearly have to compromise, make deals, and come to a concrete plan once in office. The problem with Bernie is that he’s also built his political brand on not being compromising, of being entirely values driven, and spending literally his entire political career in Congress being a critic of the Democratic Party that he chooses to not join- for compromising, making deals, and getting to concrete plans in the end that are not always perfectly progressive. I either have to believe that he’s not serious, and won’t get things he proposes done (on purpose) to play politics, or that he’ll fail because he has no clue how to actually govern, or in the best case scenario, that he’ll be totally hypocritical in his process arguments, and will make deals and play politics with the best of them.

So no, if you’re proposing any form of expanding access to health care through government action, this tax bill is not helpful. The temporary and small middle-class tax cuts in it are not worth the damage they’ll do, especially because having less tax brackets now will make it harder to change tax law in the future. There, I said it for him, just in case you didn’t think he was playing politics like everyone else.