How to make the political case for Medicare for All

Good stuff from Paul Waldman on Elizabeth Warren’s caginess on addressing how to pay for Medicare for All.  I totally get why she’s unwilling to give the “I will raise taxes on the middle class” soundbite, but, as Waldman argues (while hitting many points similar to my previous post), she could still address this far more effectively:

Unfortunately, Warren missed the opportunity to clarify not just what she supports but also why the attacks on her are so misconceived.

Some time ago, Warren made a decision to refuse to answer one very specific question, the one Marc Lacey of the New York Times asked her in the debate: “Will you raise taxes on the middle class to pay for it, yes or no?”

Warren’s position is that what matters isn’t the taxes you pay for health care, it’s your total health-care costs: taxes plus premiums plus out-of-pocket costs such as co-pays and deductibles…
But the details of the costs are something to address at an another time; for now I’m concerned with the premise underlying these criticisms, which can be described this way: Paying a dollar in taxes to fund health insurance is worse than paying a dollar in health insurance premiums.

When you put it that way it’s absurd, but that’s the premise: Raising taxes on middle-class Americans is so awful, so dangerous, so catastrophic that no question is more vital to answer, as specifically as possible, than exactly how much taxes might go up under any particular plan. That’s at a time when the average premium for a private employer-provided family insurance plan is now more than $20,000 a year.

The only problem is that while she rejects the premise of the tax question, it would be even better if she also explained why it’s important to reject the premise of the tax question.

You might say that she talks about this in the way she does because saying you’ll raise taxes is politically toxic. But when we just accept that instead of pushing back on it, we ensure that it remains politically toxic. And that’s of course just what Republicans want. They want you to believe that if you give $15,000 to the government and get health insurance in return then you’re oppressed, but if you give $20,000 to a corporation and get health insurance in return then you’re free.

To be clear, this isn’t about whether you support Medicare-for-all or something more like the public option plans that Biden, Klobuchar and Buttigieg propose. It’s deeper than that. To avoid doing Republicans’ work for them, you need to make sure everyone understands what it is you’re rejecting. Unfortunately, a whole bunch of candidates have decided that the way to attack Warren is to validate Republican anti-tax ideology.

Also, this seems like a good time to mention that the Sanders’ Medicare for All that Warren has signed up for is, honestly, just too, generous.  It would take us from having some of the worst health care in the developed world to the most generous system.  I think most of us would settle for OECD mean or so.

Ron Brownstein:

What is clear now is that the Sanders version of single payer—which Warren at the debate called the “gold standard” of health-care proposals—would cost far more than any other alternative. The new analysis found that plans similar to the one Biden, Buttigieg, and other candidates have proposed—centered on expanding a public option to compete with private insurance companies—would achieve nearly universal coverage at a cost of roughly $122 billion to $162 billion annually, depending on exactly how they are designed. Even what the analysts called a single-payer plan “lite”—requiring some co-pays and offering somewhat less generous benefits, without covering undocumented immigrants—would cost about $1.5 trillion annually, about half as much as the Sanders and Warren proposal.

Such comparisons are certain to compound the anxieties that many Democratic health-care experts feel about trying to defend in the general election a single-payer plan that would eliminate private health insurance and require such a large increase in federal spending.

“Many countries do not wrest the entire burden of every single person’s health care into the federal government,” says Neera Tanden, the president of the liberal think tank the Center for American Progress and a former health-policy adviser to Barack Obama and Hillary Clinton. “I think there are big questions about the United States moving from the most conservative health-care system to the most leftward government-run health-care system.

“There are positives and negatives to any of these options,” Tanden adds. “But one issue in a country that has more anxiety about the government’s role in people’s lives is whether it is feasible, or even sustainable over the long term, to have the federal government [grow so much] in size because the entire system of health care would be run through the government.”

We can have so much better health care than the status quo and be well short of a “gold standard” Medicare for All.  And, politically, a robust public option/Medicare for All who want it, really seems like the way to go.  Not to mention, similar systems really work to provide better care for less money in many European countries.

The right and wrong way to think about taxes

Damn, this piece from Eric Levitz is really, really good.  I need to make a point to read him more consistently.  Anyway, it looking at Joe Biden’s recent attack on Warren’s support of “Medicare for All” for raising taxes, Levitz makes some great points about how we conceptualize private versus public expenditures and how it leads us astray.  Really worth reading the whole thing, but, since you are mostly here for the excerpts…

Under the norms of mainstream political journalism, costs imposed on the American people by the private sector require no justification or defense; only costs imposed by the public sector do. [emphases mine] If you are committed to abetting the meteoric rise of private health-insurance premiums, a debate moderator will not ask you to level with the American people about how much your approach to health-care policy will cost them. If you are committed to reducing overall health-care costs by expanding the public sector’s role in medical provision, you will be ritually scolded for the extraordinary (and extraordinarily decontextualized) fiscal price of your program.

As the party that favors higher levels of taxation and public provision, Democrats have an interest in contesting this norm. Biden’s agenda may be less ambitious than Sanders or Warren’s. But he still (officially) aims to raise taxes and increase spending by trillions of dollars. A political discourse that treats taxation as presumptively suspect (even as it treats private rentierism as presumptively legitimate) will not be a favorable one for any Democratic president. Amy Klobuchar, who criticized Warren for her secret middle-class tax hike Tuesday night, is a co-sponsor of the Family and Medical Insurance Leave Act, which would finance an entitlement to paid family leave with a small increase in payroll taxes. When the Klobuchar administration pushes for that law’s passage, it will want its policy to be judged on the basis of its impact on the median family’s overall costs, not their overall tax bill. And yet, in attacking single-payer Tuesday night, Klobuchar implicitly endorsed the opposite criterion. Equating support for middle-class families with opposition to increasing their tax rates is a conservative project. There is no reason for any Democratic candidate to be advancing it — no matter their position on single-payer.

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