December 15, 2017

Guest Column: Sanders’ single-payer, fringe or mainstream

By John Margolis

That was an impressive event starring Sen. Bernie Sanders last week, reflecting impressive political progress for him and his allies.

Just a couple of years ago, Sanders couldn’t get a single co-sponsor on a bill to create a “Medicare-for-all” single-payer health care system.

Now he has at least 15, including Vermont colleague Patrick Leahy. Over in the House of Representatives, Vermont’s Peter Welch and more than half the Democratic caucus favor it.

Was it just yesterday that this single-payer health care business was little more than a fantasy of the left-most sliver of the body politic?

No, but it was only a couple of years ago, before Sanders began his unlikely run for the Democratic presidential nomination. He didn’t get it, but he got his points across. Some were enthusiastically received, none more than his declaration that “health care is a human right,” which should be provided to everyone.

Thanks to Sanders (and to Donald Trump?) universal health care has moved from the fringe to the mainstream. Two years ago, a Democrat who endorsed the idea risked ridicule. Today Democrats who hesitate to endorse it risk losing their bona fides as progressives. Sanders and his allies have gotten a great deal of what they wanted.

It’s time for them to beware.

Not because there is anything inherently wrong with Medicare-for-all: a universal, government-run, single-payer health care system. That’s how most democracies finance health care, spending less than the United States, and ending up at least as healthy.

But whatever the merits (or flaws) of Medicare-for-all, getting to it can be politically treacherous. In this country, messing with the health care system is bad for a political party’s health. It sickened the Democrats under Bill Clinton when they failed to change it, and weakened them under Barak Obama when they succeeded. Then it enfeebled the Republicans this year when they tried to reverse Obama’s Affordable Care Act, which got popular only when it was in peril.

Why would Democrats now think they can re-enter this thicket and emerge unscathed?

Especially because there are some truth-in-advertising problems with Sanders latest version of Medicare-for-all. What he has proposed is Medicare cubed, or perhaps to the 10th power. It would cover far more services than Medicare does, at a lower cost (effectively zero) to the patient.

To pay for all this, as Sanders acknowledged, taxes will have to go up. Whose and by how much his proposal does not say. It does not say anything about how it would finance itself.

This is neither all that unusual nor grounds for dismissing the bill’s potential benefits. Members of Congress often propose legislation intended to start a discussion, not to be passed as written.

Still, the absence of any financing apparatus in the legislation provides opponents with ammunition to call it unrealistic. And the acknowledgement that taxes would have to rise is politically treacherous.

Vermonters especially should know that. What scuttled former Gov. Peter Shumlin’s dream of statewide universal health care was the intolerable tax increase that would have been required to pay for it. Creating a single-payer system for the whole country may be less complicated than doing so for one state; the federal government controls its currency and has infinitely greater resources. Still, the system would have to be financed, and people would have to be convinced that financing it would not cost them more than it would help them.

Not an easy task. Half of the American people (and more than half of the voters) get their health insurance through work (theirs, their spouse’s, their parent’s, whatever). They don’t all love it; they complain about the cost, the paperwork, the limitations. But by all indications most of them like it well enough. They are likely to resist efforts to replace it, which is what Sanders’ Medicare-for-all would do.

Sanders, arguing that the present system was “not designed to provide quality care to all in a cost-effective way, but to provide huge profits to the medical-industrial complex,” claims that people would pay less under his plan, that any tax hikes would be more than offset by eliminating insurance premiums and out-of-pocket payments.

Maybe, but it’s a tough sell. As Sanders noted, that “medical-industrial complex” will spend big bucks to convince voters that Medicare-for-all will hurt them. In this effort, scruples are not likely to be a major factor. Remember Harry and Louise, the stars of the multi-million-dollar ad campaign created by the health insurance industry in 1993 to defeat President Clinton’s universal health insurance plan. Reasonable people can debate whether those ads were merely misleading or downright dishonest. No one can doubt that they were effective.

That’s because of what the psychologists and economists call “loss aversion.” For most people, the pain of losing a five dollar bill is stronger than the joy of finding one, and scaring people about the possibility that things could get worse is often easier than convincing them that things can get better.

Bernie Sanders and his Medicare-for-all allies offer hope. Their opponents will raise the specter of fear. In that contest, fear usually wins.

Jon Margolis is the political columnist for VTDigger.

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