Why Medicare for All is so hard

Nice column from Paul Waldman arguing that Bernie Sanders has laid the marker down on health care and that other Democrats now need to respond.  What I really liked about Waldman’s piece, though, is that he laid out why Sanders’ approach is so politically difficult and why a more gradual “Medicare for Anyone” i.e., those who want it, but not mandatory may be far more feasible (definitely my favored approach):

Now let’s consider the policy and political questions. Barack Obama used to say that, if we were starting from scratch, he’d favor a single-payer plan, but since we aren’t, he didn’t. Sanders essentially argues that if you believe a single-payer plan would be superior, then that’s what we should shoot for, whatever the obstacles…

As Waldman details, on a pure policy level, it makes a helluva lot of sense.  But nothing occurs on a pure policy level.  There’s always politics.  And in this case…

But the most important reason we pay so much is prices. Why does an MRI cost more than $1,000 in the United States, but only around $200 in Australia? The short answer is regulation: If the government can say, “This is what we’ll pay and no more,” then providers have to accommodate themselves to that, and it turns out they figure out how to do it. There aren’t a zillion imaging centers making doctors rich in the U.S. because we just need more scans than Europeans or Asians do. They’re there because in our system, there’s so much money to be made.

Which of course means that there are a lot of wealthy, powerful interests who will do anything to prevent stricter regulation, whether through a single-payer plan or something else. [emphases mine] So, as the other candidates consider precisely what they want to advocate, they’re wondering about potential opposition both from interest groups and from ordinary people afraid of rapid change. One reason some gravitate toward Medicare For Anyone plans is that, while they would constitute a significant change, they wouldn’t be as sweepingly disruptive to the entire system as a single-payer plan would…

The advocates of Medicare For Anyone believe that because it would be voluntary, it would be less susceptible to the “Democrats are gonna take away your coverage!” attack that will inevitably come from Republicans. That might or might not be true in the end, but it’s certainly possible. Sanders’s counter is that nobody really likes their insurance; what they like is their doctors. He may be right about that, but it doesn’t mean people aren’t still powerfully afraid of losing what they have, even for something that promises to be better.

I’m quite sure Republicans and many entrenched interests would fight like hell against a Medicare for Anyone approach, but, I do believe that many people really are afraid of being forced to change their health insurance (even it they were forced into a better system) and that that matters a lot.  Anyway, just get every damn American affordable health insurance.  And whatever gets us there, I’ll happily take.

%d bloggers like this: