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Current Affairs

A Magazine of Politics and Culture

Caring For All

The response to Trump’s “Medicare for All” op-ed that we probably shouldn’t have written…

“Hit them where they’re strong.” That’s the political approach Karl Rove, veteran Republican campaign strategist, employed to convince the majority of the American people to vote for George W. Bush for President not once, but twice. It’s a brilliant political strategy because it forces the opposition to defend strengths they had all but taken for granted, and in the process, expose their own weaknesses.

So, when the Trump team published an op-ed last week attacking Medicare-for-All, they were admitting the strength of this policy as a clarion call for Democrats this Midterm election. Hit them where they’re strong.

The Trump administration knows that Medicare-for-All is a popular policy. A recent poll showed that 70 percent of all Americans support the policy, including a full 85 percent of Democrats (a slim majority of Republicans even polled in favor). And in a year where Democratic turnout, driven by, well, everything that’s happened since 11/9/2016, is likely to be high, Trump will do anything to turn out his base or risk losing his majorities in both houses of Congress. How do you turn them out? Do exactly what Trump has done for his entire, albeit short, political career: Scare them. Psychology tells us that loss aversion—the fear of losing a thing you already have—is a more powerful motivator than the potential for gain. For an op/ed bashing Medicare-for-All, this leads to a classic Trumpian play: Take a policy that guarantees universal access to healthcare for all Americans, and spin it as a scary policy that will actually take away your healthcare.

Let’s get the obligatory fact-checking out of the way, shall we?

The Trump op-ed says “the Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised.” In fact, current versions of the plan would actually add benefits to Medicare, like dental and vision, and would make care more affordable for seniors by eliminating most co-pays and deductibles.

Here, Trump plays to the refrain we’ve heard about Medicare for a long time now from both sides of the aisle: Medicare is becoming unsustainable. That’s true. But it’s exactly why we need Medicare-for-All.

How can including more people in Medicare both strengthen it and add benefits? While that may sound counterintuitive, there’s a perfectly good explanation. To be sustainable, any insurance system requires there to be more money paid into the insurance pool than is drawn out. Older people are usually sicker than their younger counterparts. That means their healthcare costs are higher, and they cost the system more. Younger people are usually healthier, and spend far less on healthcare every year. Right now, aside from a few other special groups, Medicare only covers those over 65—those who, by dint of age, are sicker and most costly. Young people are left to the private market or Medicaid. Moving younger, healthier people (and their insurance dollars) onto Medicare increases the pool of money in the system, making sure there’s enough for seniors, too. So, yes, by putting more money into the system from people who use less healthcare, Medicare-for-All will actually make Medicare more sustainable, and improve benefits for older folks.

Because Medicare-for-All will cover comprehensive benefits and eliminate most out-of-pocket costs, it will also do away with the need that too many seniors have for the “Medicare Advantage” plans Trump refers to. (“The first thing the Democratic plan will do to end choice for seniors is eliminate Medicare Advantage plans for about 20 million seniors.”) These are essentially private managed care plans that fill the gaps in traditional Medicare: They charge lower out-of-pocket costs, or they offer additional benefits like dental coverage. In exchange for filling these gaps, these plans reduce the choice seniors really want: the choice in what doctors you see. This is where traditional Medicare shines today, and where Medicare-for-All would shine tomorrow: Nearly all doctors would accept Medicare-for-All (similar to Medicare today), greatly increasing the choices Americans have when it comes to their healthcare.

Medicare-for-All won’t outlaw private health insurance. (“Democrats outlaw private plans…”) Current versions of the proposal only prohibit sale of private plans that offer duplicate coverage of services already covered under Medicare-for-All. And because the benefits under these proposals are generous, this makes private insurance simply unnecessary for most people. This makes the system more efficient: Free-market dogma assumes that private companies will always be more efficient than the government, but that’s just not true when it comes to health insurance. In fact, private health insurance is way less efficient than Medicare today. First, every insurance corporation has its own overhead costs. So instead of one overhead in a single-payer system like Medicare-for-All, you have redundant overhead costs for every single insurer in the system. That creates more overhead overall, inflating the costs of healthcare. Second, insurance corporations have one primary goal: make money. So while traditional Medicare has administrative overhead around 2 percent, private insurers can skim up to 15 percent off the top of every healthcare dollar, which either goes straight to profits or covers the other costs of running healthcare like a big business. That’s how their CEOs make tens of millions of dollars, after all. That’s money we all pay—a source of deep inefficiency.

And let’s face it, nobody really likes their insurance company, anyway. Most of the time, even if you have Cadillac private health insurance, you usually have to pay a co-pay every time you see your healthcare provider, rack up bills until you hit your deductible, and fight with your insurer to cover major costs like hospital stays or surgery. Private insurance is a headache.

Medicare today isn’t perfect either, but the fact remains that Medicare-for-All would provide better coverage than pretty much any private plan today.

And Medicare-for-All costs less than our current system. If this sounds too good to be true, take a moment to remind yourself just how broken and expensive our current non-system already is. Reminder: Our healthcare costs per person are almost double what other high-income countries pay. One in six dollars spent in the American economy is spent on healthcare.

But none of that will stop you from hearing, over and over, scary-sounding numbers about how expensive Medicare-for-All will be. Republican attack ads fixate on what the plan will add to the federal government’s budget—but not how much it will save the average American family. Everyone knows that you can’t figure out whether something is ‘worth it’ just by looking at its price. For example, if you’re in the market for a new car because your old one costs you $1500 a month in repairs, you can’t just fixate on the price tag for the new one. You have to consider the trade-in value of your old car—plus what you’ll save on repairs.

And so it is with Medicare-for-All: Healthcare costs would go up for the federal government, but costs would go down even more for employers, state governments, and most importantly, families (remember: You wouldn’t need to pay premiums to private insurance companies anymore). Even estimates from the Koch-funded Mercatus Center have shown that Medicare-for-All would save the American people literally trillions of dollars. So yes, Medicare-for-All is expensive. But it’s a lot cheaper than the current system.

A major way that Medicare-for-All saves money is by repairing the broken incentives in our current system. Today’s system rewards big hospitals and big insurers with massive profits when they collude to keep prices high. They use their size to negotiate pay rates for services and procedures in bulk that drive small providers and insurers out of the market. That’s caused massive consolidation among both hospital systems and insurance providers. Who suffers? People—the ones who get healthcare and the ones who provide it. Independent physicians can’t compete with the big health systems, and doctors are increasingly being driven to work for huge conglomerates that take away their autonomy. This loss of competition also jeopardizes the ability of healthcare workers to secure fair working conditions and a living wage. Meanwhile, patients suffer because profit-seeking oligopolies on both sides of a healthcare payment leave us with less choice and higher costs.

Medicare-for-All solves the consolidation problem by taking the profit motive out of the insurance system and setting fair reimbursement rates for everyone, which neutralizes the monopoly power of hospitals and brings down costs. And by allowing the single payer—Medicare—to enforce fair labor standards, Medicare-for-All supports the workers who actually provide our healthcare. Negotiating bulk discounts on prescription drugs to stand up to the pharmaceutical industry and save Americans money is just icing on the cake.

These arguments may win the policy battle. But they could lose the political war. We fear that this article plays right into Trump’s hands: He wants Democrats to lose themselves in detailed arguments about why Medicare-for-All is actually good policy. The fact that the arguments are sound makes no difference to Trump. In defending a strength, we expose our own weakness: a tendency to turn technocratic, as if the right to healthcare could be won by intricate argument alone.

When we lose ourselves in a complex policy debate, we forget why Medicare-for-All is good politics. The reasons are very simple: Too many of us don’t have healthcare. We spend too much on healthcare. And we hate our healthcare experience. Medicare-for-All solves all three of those problems. And that’s what every progressive ought to be saying right now.

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