We are Having Both the Right Conversation and the Wrong Conversation
Medical Care Front and Center
Among the more viable Democratic candidates for president, there are few differences on key issues. At least not in terms of priorities and goals. There are differences in how those goals can best be achieved. I start out with that statement to warn Democrats. Intertribal warfare over How should not lead to the What getting lost in the battle. As President Obama recently said, let’s not get too insistent on ideological purity. One area where that risk looms large is health care.
A lot of Americans agree on the essential points. But leading the national election platform with a fight over Medicare for All? This seems to me a self-inflicted wound. It is a wound made all the more grievous by putting ALL the attention on cost. We are not discussing outcomes and hidden costs in the current system (if one can call what we have now a “system).
Give Elizabeth Warren credit. She is justifiably known as the person with a plan for everything. Much of what I have read of her various plans is serious and well thought out, including costing. Medicare for All was a huge gap in that record. She rose to the challenge to address it.
Honesty compels me to say that I think something like Medicare for All is the way to go for many reasons. Honesty also compels me to say that trying to mandate it or doing the transition too fast is a political looser and operationally tough at best. Recall the glitches and problems rolling out Obama Care. That was a piece of cake compared to what this transition would entail.
Let’s Examine Some Key Points
- A lot of dust is being kicked up over the total cost Warren estimates. It IS a lot, but compared to what? If one adds up what we are spending now among individuals, companies, and government, Medicare for All actually comes out close to the same amount, with much less overhead and everyone covered. Yes, it is a big increase in government spending. And yes, it is also LESS than we spend now. That point seems to get overlooked. By the way, the NY Times had a great graphic showing how that spending is currently broken out and how it likely would change under Medicare for All. Take a look:
- I get that we want healthcare costs to not be a burden, but people tend to undervalue and use poorly things that are completely free. With commonsense guidelines on what people can afford, modest fees and some copays seem like better management. This could also help lower overall the costs to the government of doing all this.
- Way too little of the conversation is about outcomes. Americans pay much more than the citizens of any other developed nation and get worse outcomes. Much of that lies at the feet of an overly privatized system. Too much overhead, too many middlemen, too much administration. Moving toward a single payer system would eliminate much of this and enable the government to enforce better standards. Obama Care made a good start on this, rewarding outcomes over procedures, but we have a long way to go.
- People should hear more stories from those in doctors’ offices and others trying to deal with dozens of insurance companies and countless other entities. On average, you and I are paying about 17% overhead for this. Medicare is in the range of 3%. The current private based system is absolutely nuts.
How to Snatch Defeat from the Jaws of Victory
Two issues could lose this fight for Warren, for the election, and for America. Both are avoidable:
- Making this a mandatory change takes the discussion away from medical outcomes and wise spending, making it into a discussion of freedom of choice. Most people really have no idea how good or bad their insurance is in terms of coverage and value. How could they? Yet, a large percentage of us “like our coverage.” Give people a good option, get the details out, and let them choose. In fairly short order, most will figure it out.
- Doing this too quickly will cause a massive systems crash. A change of this scope is huge. It will take time to get it right. Build in longer timelines for people to change over, do changes by region, and look at other options to phase in. Doing so raises the odds of getting it right from the start.
Consider also pacing the effort because of the jobs that will go away in the insurance industry. Overall, that is a good thing, but we need plans to ease the pain for all those folks as their industry dries up.
I have not mentioned Bernie Sanders here. Why not? After all, he “wrote the damn bill.” I have not mentioned him for several reasons.
One, although he has been candid enough to indicate we all likely would pay more taxes for this (offset by other savings), he has not laid out the math in any detail. In fact, he said recently that he did not think he had to do that. They could “work it out after the election.”
Two, even if he were to win election, I judge Sanders’ ability to get the necessary legislation passed to be extremely low. His legislative record of doing the homework and building coalitions to pass legislation is thin, to use a kind description. Warren’s career in government is a lot shorter but more substantive.
Three, I think Sander’s likelihood of being the nominee is exceptionally low. He is in the top tier but sliding down. He is almost no one’s second choice. His base is shrinking.
Time to Chose on The Fork in the Road
To reiterate, all the candidates are clear we need meaningful medical coverage for all. Let’s hope Warren can make the transition to a plan that all the polls show Americans want overwhelmingly. That is, Medicare for All who Want It, and reforms to make private supplements useful, transparent, and affordable. If Warren does that, essentially joining the moderates on this issue, we have the outline of a winning position – and good policy. I think she can do that intelligently and still hang on to her base.
Speaking of Warren, it is helpful to know where she comes from, what in her personal life explains her policies and approaches. The best thing I have read on this was an article in a June edition of the New Yorker. It is a fine read and reminds one of what about Warren can appeal. Check it out:
This is a winning issue for Democrats. Several of the elections on Nov 5 reflected that. It would be a shame for it to become a loser simply out of willful blindness. May we not let the perfect be the enemy of the good.
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