I'm not sure we can say that to end all these needless debates, everyone should just change their minds and settle on the solutions that I consider to be the best ones. Let's all be a bit honest here and say that the left wing is never going to drop M4A. Why would they? It's popular for its base, it serves as a defining factional wedge, and you just don't maintain a policy position for 10+ years only to drop it when the momentum finally gets hot. That being said, this provides perfectly fertile ground for center-leaning candidates to propose a public option as the more pragmatic direction. The left will, likely, ultimately accept this compromise (as shown by AOC), but there is simply no universe where they are the ones heading to the middle first.
Plus - Biden claimed he was in favor of a public option during the 2020 campaign and then proceeded to ditch the idea once in office. Voters might be thinking to themselves, who can really trust any of this? They won't do it anyway!
Reading this and generally agreeing with it, I nonetheless have three major responses:
1. It reminds me of my deep dislike of Bernie Sanders. Separate from my policy and sloganeering disagreements, which are many, he is just a harmfully dishonest guy. He and members of his 2020 campaign have said, on the record, multiple times, that they all knew M4A was a pipe dream, unrealistic as proposed, and never going to happen. That that doesn’t stop him and his faction from attacking anyone who doesn’t fully endorse the same plan; which again, HE HIMSELF HAS SAID WAS IMPOSSIBLE is just such horseshit and everyone needs to know about it regardless of how they feel about M4A as a plan.
2. I disagree pretty strongly with your framing of the “a better way to debate” section. Maybe you’re right that the public watching a debate or whatever would be annoyed by a “how are you going to pay for it” response to M4A. But that doesn’t change that it’s objectively a fair question with an answer that is relevant for the public!
Yes, it’s true that we are spending a ton of money on a war in Iran that is entirely stupid. It’s ALSO true that last year Medicare was more expensive than the military. If someone is proposing taking a ~trillion dollar per year program and tripling its size while expanding its benefits…you’re damn right the pay-for matters!
And that goes doubly for anyone saying they won’t raise taxes on anyone below the 96th percentile of income because that person is simply lying to your face.
Yeah, maybe this is all too wonky and the average person’s eyes will glaze over. But my bold take is that people don’t love taxes and people don’t like being lied to by candidates. And if you are dogmatic about M4A, you’re either raising taxes on a ton of people or you’re lying to…a ton of people.
3. You claim for the electorate is, “hungry for change in the health care system.” Which *feels* true. People do seem unhappy about healthcare. But you not in this very same article 70% of people would rather keep their current healthcare than switch to a government run plan. So…are they actually that hungry for change if the context for that change means more government healthcare? Seems like…no.
I think the idea is that they're fine with their insurance, but do want cheaper and better healthcare. And distrust the ability of the government to do that
Sorry, not to be pedantic, but isn’t that a logical non-starter in the context of this piece then? Like, if they want better/cheaper healthcare but they don’t want/trust the government to make that happen…then the solution does not seem to exist in what candidates for government office are going to have to offer.
Asking a senate or presidential candidate what non-governmental levers they are going to pull to improve your healthcare would be like me demanding Steve Balmer have a plan for lowering my property taxes.
Far be it from me to expect voters to behave rationally. But “What is the government going to do to fix my healthcare without using the government” is a bridge pretty far into stupidity.
That’s an interesting notion and very possibly true. But aren’t democratic primary voters overwhelmingly likely to be the demographic of people who have rather good, employer sponsored (tax advantaged) healthcare plans?
I could be totally wrong, but was pretty sure dem primary voters are overwhelmingly from the affluent educated sect? And, more specifically, the subset of dem voters who are really locked in on M4A or something similar are almost certainly those types of people.
Obviously, it’s possible they are fed up anyway or are fed of up on behalf of the proletariat…but that’s a weirder bank shot case to me.
The fundamental reason why health care in the US is subpar is because of its capitalistic approach: insurers have a built-in incentive to limit health care. Any improvements must therefore either eliminate this impediment, or work around it. MFA eliminates this impediment and would therefore be my top choice if it could be enacted, but it does come with some downsides: a degree of economic disruption and added unemployment due to the elimination of the entire health insurance sector, possible tax increases, and potential increases in wait times since there would no longer be any economic disincentive. I agree with the author that for various reasons—some completely illogical (people have shown a penchant for voting against their own self interest lately) that MFA is not viable politically at this point. So that leaves two approaches: (1) improving and building on the ACA, or (2) the creation of a public option. Regarding (1), the primary problem with the ACA as it now exists is the cost of insurance, which is why subsidies are a part of it. In order to reduce the cost of health care, the ACA must evolve beyond this. This evolution could include capping provider payment rates, making the cost of procedures site-neutral (same cost anywhere), and addressing drug costs. Something must also be done to encourage more healthy enrollees, which could include auto-enrollment (collective rebub gasp), or late enrollment disincentives (higher rates if you delay). Another improvement would be to require standardized plans (Biden made this optional). However, the best improvement to the ACA would be to add the second approach—the public option, in which the governemnt offers its own insurance plan. This offers many built-in advantages over any private health care plan. First, the government is not profit motivated, and so all else equal the cost of insurance would be less. Second, the government would be able to negotiate down both drug and procedure prices. Third, anything the public option does to lower costs would cause private insurers to do the same in order to stay competitive. Fourth, if MFA is truely the best option (and I believe it is), then the natural evolution of the public option will be to gradually force out private insurance, thus getting us to MFA in a more orderly fashion.
What I find annoying, is that the Medicare for all proponents pitch it like that is all a person needs to avoid big medical bills. Since medicare by itself does not have an annual out of pockets maximum, unless one purchases private gap insurance, you could be staring down some huge medical bills.
I'm not sure we can say that to end all these needless debates, everyone should just change their minds and settle on the solutions that I consider to be the best ones. Let's all be a bit honest here and say that the left wing is never going to drop M4A. Why would they? It's popular for its base, it serves as a defining factional wedge, and you just don't maintain a policy position for 10+ years only to drop it when the momentum finally gets hot. That being said, this provides perfectly fertile ground for center-leaning candidates to propose a public option as the more pragmatic direction. The left will, likely, ultimately accept this compromise (as shown by AOC), but there is simply no universe where they are the ones heading to the middle first.
Plus - Biden claimed he was in favor of a public option during the 2020 campaign and then proceeded to ditch the idea once in office. Voters might be thinking to themselves, who can really trust any of this? They won't do it anyway!
Reading this and generally agreeing with it, I nonetheless have three major responses:
1. It reminds me of my deep dislike of Bernie Sanders. Separate from my policy and sloganeering disagreements, which are many, he is just a harmfully dishonest guy. He and members of his 2020 campaign have said, on the record, multiple times, that they all knew M4A was a pipe dream, unrealistic as proposed, and never going to happen. That that doesn’t stop him and his faction from attacking anyone who doesn’t fully endorse the same plan; which again, HE HIMSELF HAS SAID WAS IMPOSSIBLE is just such horseshit and everyone needs to know about it regardless of how they feel about M4A as a plan.
2. I disagree pretty strongly with your framing of the “a better way to debate” section. Maybe you’re right that the public watching a debate or whatever would be annoyed by a “how are you going to pay for it” response to M4A. But that doesn’t change that it’s objectively a fair question with an answer that is relevant for the public!
Yes, it’s true that we are spending a ton of money on a war in Iran that is entirely stupid. It’s ALSO true that last year Medicare was more expensive than the military. If someone is proposing taking a ~trillion dollar per year program and tripling its size while expanding its benefits…you’re damn right the pay-for matters!
And that goes doubly for anyone saying they won’t raise taxes on anyone below the 96th percentile of income because that person is simply lying to your face.
Yeah, maybe this is all too wonky and the average person’s eyes will glaze over. But my bold take is that people don’t love taxes and people don’t like being lied to by candidates. And if you are dogmatic about M4A, you’re either raising taxes on a ton of people or you’re lying to…a ton of people.
3. You claim for the electorate is, “hungry for change in the health care system.” Which *feels* true. People do seem unhappy about healthcare. But you not in this very same article 70% of people would rather keep their current healthcare than switch to a government run plan. So…are they actually that hungry for change if the context for that change means more government healthcare? Seems like…no.
I think the idea is that they're fine with their insurance, but do want cheaper and better healthcare. And distrust the ability of the government to do that
Sorry, not to be pedantic, but isn’t that a logical non-starter in the context of this piece then? Like, if they want better/cheaper healthcare but they don’t want/trust the government to make that happen…then the solution does not seem to exist in what candidates for government office are going to have to offer.
Asking a senate or presidential candidate what non-governmental levers they are going to pull to improve your healthcare would be like me demanding Steve Balmer have a plan for lowering my property taxes.
Far be it from me to expect voters to behave rationally. But “What is the government going to do to fix my healthcare without using the government” is a bridge pretty far into stupidity.
On point #3, I took it as "Dem primary voters are hungry for change, and if you can't win a primary you can't do anything."
That’s an interesting notion and very possibly true. But aren’t democratic primary voters overwhelmingly likely to be the demographic of people who have rather good, employer sponsored (tax advantaged) healthcare plans?
I could be totally wrong, but was pretty sure dem primary voters are overwhelmingly from the affluent educated sect? And, more specifically, the subset of dem voters who are really locked in on M4A or something similar are almost certainly those types of people.
Obviously, it’s possible they are fed up anyway or are fed of up on behalf of the proletariat…but that’s a weirder bank shot case to me.
Let's start by paying for Medicare/ACA that we haveby replacing the wage tax with a VAT.
The fundamental reason why health care in the US is subpar is because of its capitalistic approach: insurers have a built-in incentive to limit health care. Any improvements must therefore either eliminate this impediment, or work around it. MFA eliminates this impediment and would therefore be my top choice if it could be enacted, but it does come with some downsides: a degree of economic disruption and added unemployment due to the elimination of the entire health insurance sector, possible tax increases, and potential increases in wait times since there would no longer be any economic disincentive. I agree with the author that for various reasons—some completely illogical (people have shown a penchant for voting against their own self interest lately) that MFA is not viable politically at this point. So that leaves two approaches: (1) improving and building on the ACA, or (2) the creation of a public option. Regarding (1), the primary problem with the ACA as it now exists is the cost of insurance, which is why subsidies are a part of it. In order to reduce the cost of health care, the ACA must evolve beyond this. This evolution could include capping provider payment rates, making the cost of procedures site-neutral (same cost anywhere), and addressing drug costs. Something must also be done to encourage more healthy enrollees, which could include auto-enrollment (collective rebub gasp), or late enrollment disincentives (higher rates if you delay). Another improvement would be to require standardized plans (Biden made this optional). However, the best improvement to the ACA would be to add the second approach—the public option, in which the governemnt offers its own insurance plan. This offers many built-in advantages over any private health care plan. First, the government is not profit motivated, and so all else equal the cost of insurance would be less. Second, the government would be able to negotiate down both drug and procedure prices. Third, anything the public option does to lower costs would cause private insurers to do the same in order to stay competitive. Fourth, if MFA is truely the best option (and I believe it is), then the natural evolution of the public option will be to gradually force out private insurance, thus getting us to MFA in a more orderly fashion.
What I find annoying, is that the Medicare for all proponents pitch it like that is all a person needs to avoid big medical bills. Since medicare by itself does not have an annual out of pockets maximum, unless one purchases private gap insurance, you could be staring down some huge medical bills.