Somehow, with Republicans in complete control of the government, there’s been a fundamental shift in the conversation around healthcare that shows just how badly Republicans have lost control of the message.
In the last couple of weeks, as anticipation for Bernie’s doomed Medicare for All bill was building, questions have emerged: How would he pay for it? How would he sell the increased taxes to the public? How much would those taxes actually be?
These questions were asked, much to rage of Bernie’s supporters, during the primaries and they never once were answered but the good news is (seriously) that those questions have become more specific and detailed.
…the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.
That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.
In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.
Chait slams Bernie, correctly, for not having any answers. It’s not terribly fair to the left to shove single payer down the Democratic Party’s throat and then sit back and complain that they can’t get it done. Republicans did that with their promise to repeal and replace Obamacare and look at how well that worked out.
On the other hand, and this has to be driving Republicans crazy, we’re actually starting to talk about the nuts and bolts of how to do single payer. And if the progressive think tanks determine that just flipping over to single payer isn’t economically, socially or politically feasible, they’ll start producing the interim steps required to get to true universal healthcare that Republicans won’t be able to undermine.
This is important enough to repeat: We’re starting to talk, in a serious way, about how to implement healthcare as a right in the United States. Not whether or not it’s a good idea, we’re past that part and we all (except Republicans) accept that it is, but how to get it done.
We’ve gone from complaining about the broken down junker on blocks in the front yard to cleaning out the rat’s nests in the backseat, putting wheels on, popping open the hood and cracking open the owner’s manual to figure out what parts need to be replaced.
This shouldn’t be happening with Republicans in control of the executive and legislative branches but the utter lack of leadership from Trump has allowed the momentum of the conversation around universal healthcare to proceed almost unimpeded. If anything, the haphazard and thuggish attempts to repeal the ACA has given the idea even more power than it had before. Thanks…Trump?
Two notes of warning:
1. Democrats who do not like Bernie: Do not let your antipathy for the man cloud your judgement. Even if single payer turns out to be unworkable at the moment, figuring out the steps to get to it or some version of it is vital if we’re ever going to fix healthcare in this country. Obamacare was only ever intended to be a temporary fix until we could go all the way. This is a conversation worth having even if we don’t like the person leading it. Suck it up, buttercup. This is bigger than your hurt feelings.
2. Bernie followers who do not like the rest of us: Single payer ain’t happening anytime soon. Accept it. Embrace it. Get over it. Chait’s tone is dismissive but he’s not wrong about how complicated a process this will be and it will be a process. That means it will take time and there will be setbacks. It’s not like Republicans are going to suddenly stop trying to block everything we do. It will take years to figure out the best way forward and even longer to make it happen. If you’re not in it for the long haul to make sure your kids and grandkids have the healthcare you dream of, what kind of progressive are you? Suck it up, buttercup. This is bigger than your hurt feelings.
In the meantime, keep talking about single payer and the myriad other ways that the dreaded socialists of Europe have come up with to guarantee universal healthcare. Maybe one of those will work better for us, maybe we’ll come up with a novel new approach better suited to our culture. Either way, none of it happens unless we talk about it and get our asses to the polls.
There are 416 days left to the 2018 elections.
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