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.

About Steve Greene
Professor of Political Science at NC State

10 Responses to How to make the political case for Medicare for All

  1. itchy says:

    It’s been so frustrating reading that Warren “evaded” the question by simply saying “costs will not increase.” That’s exactly right, and that’s the important point, and her accusers were the ones being evasive by hoping that viewers don’t understand math.

    And she shouldn’t have to explain, but … I guess she should.

    I suppose she could respond: “If my plan raises your taxes $10 but reduces your health costs by $100, and my opponent’s plan keeps them both the same, which would you choose?”

    This assumes that she’s right and that overall costs won’t increase. I do not understand enough to know whether her plan is the best, but if the question is overall cost vs taxes, then cost is the relevant factor.

  2. samuel h brewer says:

    The positions highlighted in this post seem to be counter to the position you take in the immediate previous post in which it seemed to me you agreed with Eric Levitz’s criticism of Biden attacking Sanders/Warren/M4A. did i misinterpret your take in one or both posts?

    Also, on Brownstein’s analysis critical of M4A: Isn’t he wrong that it would cost far more than any other alternative? Wouldn’t it cost less than our current health care spending extended out through the same period? And it would cover everyone as opposed to just nearly universal coverage.
    He is very concerned about Democratic health care experts’ electoral anxieties without acknowledging that M4A has majority support in the country and far higher support among democrats. Then he quotes CAP which mis-characterizes M4A as a government takeover of the entire system of healthcare (like the NHS, popular in england or the VA, popular among veterans in the US) instead of what it is, universal health insurance (like the very popular medicare). I think they should heed Levitz’s admonishment that a political discourse that treats public provision as presumptively suspect (even as it treats private rentierism as presumptively legitimate) will not be a favorable one for any Democratic president.

    • Steve Greene says:

      I don’t entirely agree with Brownstein, but that’s the only piece I’ve seen recently that highlights just how expensive this version of M4A is. In Levitz’s full piece, I appreciate that he makes the case for a more politically pragmatic alternative.

      Seems to me that Levitz and Waldman are largely in accord. Brownstein is kind of taking the wrong approach, yes, but he’s not wrong that this particular M4A is too expensive and almost surely a bridge too far.

      • samuel h brewer says:

        Part of the point i wanted to press is: how can it be too expensive if it is in fact less expensive than what we are currently spending?

        ok i have now read the full levitz article. i spent most of the article cheering levitz excoriating dems for undercutting the legitimacy of tax financed social programs. then he lets off the gas when he says there is a case for the dem nominee to run on a public option without convincing me of what the up side is of offering an inferior product. i think it would amount to poorly playing a strong hand similar to when obama dropped the public option right out of the gate.
        democrats should not hold back from campaigning for a popular policy, M4A, which would at worst give more senators political cover to possibly end up voting for a serious medicare expansion. There is a difference between accepting half a loaf and campaigning on it. Along the lines Levitz starts out arguing, democrats in favor of M4A should simply and accurately be insisting that it would save us $2B while achieving total coverage. How many senators were for M4A before Bernie ran and lost in the 2016 primary? How many more would suddenly find a way to be in favor of it if he or Warren won their state while winning the presidency running on it in 2020.

      • Steve Greene says:

        Short version: I don’t automatically agree that Sanders’ M4A is clearly optimal. Lessons from Europe suggest that there are many other good solutions that also allow for some heavily-regulated private insurance. And you are also over-stating the public opinion popularity of M4A. Start telling everybody they have to give up private insurance and things get ugly.

  3. sam says:
    lots of interesting stuff including M4A policy views
    the number that keeps me worried is the right track/wrong track. over 60% for years. even in 2016 more than 50% of dems said wrong track. big reason i didnt think clinton was a good nominee and that trump could win. same for biden. not a good time to run establishment when most people think things need to change.

    • Steve Greene says:

      Wow! So much to unpack in all that. I don’t think it will be Biden, though. Even, still, I honestly think Trump is a much worse candidate in 2020 than in 2016. One number that stuck at at me is the pretty decent number of Republicans who said they could see losing favor of Trump (even if they are lying to themselves).

  4. Robert Smith says:

    You might say that she talks about this in the way she does because saying you’ll raise taxes is politically toxic.

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