Twice over the past three or fours years, most recently in June 2019 I warned of “not sweating the details” when it came to “Medicare for All” and the movement to ffimplement a single payer health care system.
Well the chickens are coming home to roost as the old saying goes.
The activist left, which has a ton of energy at the moment, has for the most part failed to grapple with the difficulties of transitioning to a single-payer system. A common view is that since every other advanced country has a single-payer system, and the advantages of these schemes are pretty clear, the only real obstacles are a lack of imagination, or feckless Democrats and their donors. But the reality is more complicated.
For one thing, a near-consensus has developed around using Medicare to achieve single-payer health care, but Medicare isn’t a single-payer system in the sense that people usually think of it. This year, around a third of all enrollees purchased a private plan under the Medicare Advantage program. These private policies have grown in popularity every year, in part because the field has been tilted against the traditional, government-run program.
Around one-in-four Medicare enrollees, including me also purchase some sort of “Medigap” policy to cover out-of-pocket costs and stuff that the program doesn’t cover; and then there are both public and private prescription drug plans. Medicare will pay for 80% of covered services; without a “Medigap” insurance policy purchased in the private insurance market I would be stuck with the 20%.
The most important takeaway from recent efforts to reshape our health-care system is that “loss aversion” is probably the central force in health-care politics. That’s the well-established tendency of people to value something they have far more than they might value whatever they might gain if they give it up. This is one big reason that Democrats were shellacked after passing the Affordable Care Act (ACA) in 2010, and Republicans learned the hard way when they couldn’t repeal Obamacare when they had control of both houses of Congress.
Remember how much trouble President Obama got into when he said that if you like your insurance you can keep it? For something like 1.6 million people, that promise turned out to be hard to keep. And that created a firestorm. Those 1.6 million people represented less than 1 percent of the non-elderly population, and most of them lost substandard MacPlans which left them vulnerable if they got sick. The ACA extended coverage to almost 10 times as many people, but those who lost their policies nonetheless became the centerpiece of the right’s assault on the law. They became the “victims of Obamacare.”
Under the current Medicare-for-All proposals, we would be forcing over 70 percent of the adult population—including tens of millions of people who have decent coverage from their employer or their union, or the Veteran’s Administration, or the Federal Employees Health Benefits Program—to give up their current insurance for Medicare. Many employer-provided policies cover more than Medicare does, so a lot of people would objectively lose out in the deal.
Some large companies skip the middle man and self-insure their employees—and many offer strong benefits. We’d be killing that form of coverage. If we were to turn Medicare into a single-payer program, as some advocates envision, then we’d also be asking a third of all seniors to give up the heavily subsidized Medicare Advantage plans that they chose to purchase. Consider the political ramifications of that move alone. And because some doctors would decline to participate in a single-payer scheme, which would come with a pay cut for many of them under Medicare reimbursement rates, we couldn’t even promise that if you like your physician you can keep seeing him or her.
And the term “single-payer” is itself misleading. The truth is that many of the systems we refer to as single-payer are a lot more complicated than we tend to think they are. Canada, for example, finances basic health care through six provincial payers. Its Medicare system provides good, basic coverage, but around two in three Canadians purchase supplemental insurance because it doesn’t cover things like prescription drugs, dental health, or vision care. About 30 percent of all Canadian health care is financed through the private sector.
Germany’s “single-payer” system has 124 not-for-profit insurers participating in one national exchange. About 10 percent of Germans—the wealthiest ones—opt out of the national system and go fully private, and most of them buy plans from for-profit insurers.
Now with all that as background we move to the Nevada presidential primary caucus in 5 days.
This week, the powerful Culinary Union, which represents over 130,000 employees in Las Vegas and Reno hotels refused to endorse a candidate for President. What it did do is put out a one page flyer to its members taking aim at Bernie Sanders’ Medicare for All” plan.
The Culinary Union, which provides health insurance to its members and their families through a special union health trust strongly opposes the implementation of a single payer, government run system on the grounds that it would eliminate its own health plan.
In distributing the flyer, the union was trying to provide “facts on what certain healthcare proposals might do to take away the system of care we have built over 8 decades,” Geoconda Arguello-Kline, the union Secretary Treasurer said. “We have always stood up for what we believe in and will continue to do so.”
She also noted that the union invited Sanders to its headquarters for a town hall and took him on tours of its 60,000-square-foot state of the art Culinary Health Center and the Culinary Academy of Las Vegas, a training facility for hospitality workers in North Las Vegas “to show what we have fought for and won.”
“The Culinary Union has faced some of the toughest companies who wanted to break our union, and even the President of the United States Donald Trump – and won,” she said.
Enter the “Bernie Bros.”
Immediately after issuing the flyer to its members, union leaders and the union itself came under attack from Bernie supporters.
“Its members and leadership were “viciously attacked” by supporters of Sen. Bernie Sanders, I-Vt. after the union publicly warned its members against backing a candidate in the state’s Democratic caucus who supports “Medicare-for-All.”
After the flyer was passed around, the union said it was the victim of harassing emails, tweets and phone calls.
“It’s disappointing that Senator Sanders’ supporters have viciously attacked the Culinary Union and working families in Nevada simply because our union has provided facts on certain healthcare proposals.” Turns out that Bernie supporters leveled “harassing, profane and sometimes threatening attacks on the union and its leadership” calling it “corrupt,” “incompetent” and “operating in bad faith.”
Whoops. That is not the way to endear yourself to potential voters kids.
If Bernie’s plan for single payer health care would destroy what the union has negotiated for its members, it is time to address the issue. Bernie blew it off and 2 days later attempted to rein in attacks on the union by his supporters. The union has supported the health care plans of the other major candidates on the ballot in Nevada.
Meanwhile, all of the candidates in Nevada have turned their fire on the other elephant in the room who is not on the ballot (until Super Tuesday next month), Mike Bloomberg. He has been endorsed by over one hundred Mayors of cities large and small and is now polling second among, just a couple of points behind Joe Biden among black voters in South Carolina.
Of course he is “buying the election,” using his own money while Pete Buttigieg has taken tons of money from some 40 billionaires. He has also given some $2 billion to progressive causes in support over the past decade. Guess he was “just laying the groundwork” for his purchase of the Presidency.
His support of gun control, healthcare, climate change, women’s reproductive rights, the arts and education seem to count less than Stop and Frisk and some 15 complaints about a “frat boy atmosphere” at his company over the past 20 years. No one mentions Bloomberg provides 36 weeks maternity leave.
He’s not exactly Harvey Weinstein or Jeffrey Epstein.
Beating Trump will require the Dems to carry a majority of the dozen or so battleground states. We already have New York and California no matter who we nominate. We will never have Utah, Kansas and South Carolina no matter who we nominate. The election will be won or lost in Wisconsin, Michigan, Pennsylvania, Ohio, North Carolina, Virginia and Florida.
Think about it when you pick your candidate on Super Tuesday. There is no FDR, JFK or Barack Obama running this year. We don’t always get what we want but maybe, just maybe we’ll get what we need.