Something that is really key about this that I don’t see journalists addressing when questioning candidates, probably because they feel it will sound petty: it’s not at all just a question of whether people believe that the MFA replacement will be just as good or better than what they have now. If their union negotiated hard for this benefit or a “Cadillac health plan” was something that attracted them to take their white-collar job, equalizing everyone under the same national plan will take away their feelings of getting something significant there, unless the bill requires employers to substitute a pay raise or other benefit equal to the now redundant employer health plan—and I am sure it does not.
Sadly, behavioral economics studies show that people would rather get a five dollar an hour pay cut while their neighbors get a $10 cut, than get a five dollar raise while their neighbors get a $10 raise. (These numbers may not be exactly accurate, but the gist is there.) People care more about their relative wealth than their absolute wealth, which is why they get so upset about income inequality: if they are doing a little better and the rich are doing a lot better, they feel like they are doing worse.
So as unsatisfying as it would be for the progressive left, the best thing Democrats could do for now is to offer a universal benefit for anyone who is not insured, but make it less generous than a good union or white collar plan. Then the centrist voters we need can feel they are doing something nice for those who are struggling, without feeling like they have lost ground in terms of having something better than the “unfortunates” have.
I’ll add that Medicare-for-All is also dangerous because it reinvigorates conservatives who might be put off by Trump’s personality and quietly sit this upcoming election out. There are probably a fair number of conservatives, be they Republicans or Independents, who are probably content to let someone like Joe Biden win and assume that nothing is lost by sitting the election out and forcing the Republicans to hit the reset button.
Medicare-for-All, however, is a game-changer. It gives those Republicans a reason not to sit at home, even more of a reason than voting against liberalism because of “bathrooms” or “gays” or “illegals.” Medicare-for-all is a pocket-book issue, and it’s one that doesn’t get much traction outside of progressive utopia. But worse than that, whereas moderate, centrist Democrats might shrug and say “Not impressed, but I’ll vote for Warren anyway,” conservatives now have a reason to go to the polls. Progressives would be giving conservatives, even moderate conservatives, a reason to show up at the polls, to vote AGAINST something, and it’s not just a social issue, but an economic and deeply personal one.
Dangerous it may be but there’s no denying that popular support for a more modernized and universal health care system is growing. The issue was considered mostly a pipe dream just a few short decades ago and the accessability and affordability problems aren’t improving with the free market calling the shots. Discussing the issue won’t turn off the new generations of voters who will dominate US politics in the future.
Short answer to the OP – private insurance could still exist, just as a “top up” to MFA. Employers could offer a private insurance plan that gives employees with Cadillac plans the bells and whistles they’re used to, it would just cost them a lot less. It’s true that the employers would probably end up pocketing the savings rather than passing it on, but that’s capitalism for you.
I was surprised in the debate last night how everyone was talking about MFA would “ban” private insurance. Maybe I haven’t been paying attention but that can’t possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Why did all of the candidates allow this talk of banning private insurance go unchallenged?
I gather the gist of what they were saying was that MFA would be mandatory, and therefore everyone would be kicked off of their current plan. But isn’t that necessary for a single payer system to work? Aside from Warren and Sanders, everyone on stage was against MFA and in favor of a public option. But isn’t a public option subject to the same issue we have right now with Medicare? That is, private insurers get to make billions in profits off relatively healthy people while government programs are forced to cover the uninsurable at taxpayer expense?
Steronz, what you are saying is logical—but while I have not read all the fine print, what I have read conveys two problems:
One is that many commentators seem to indicate that Bernie really does go further than most other countries in getting rid of private health insurance. The problem with him is that he doesn’t just want to get everyone healthcare, he wants to really stick it to corporations as much as possible.
The second problem is that his proposed plan would have so many “bells and whistles”, there would be none left to supplement. Which of course would be unworkable fiscally, but that is what he is proposing: no premiums, no deductibles, no copays even for prescriptions, any doctor, etc.
ETA: You ask about the “same problem with Medicare”, but voters don’t see Medicare as a problem. They like it, which is why Bernie (emulating a “West Wing” character named Santos) called his single payer plan that even though it’s not really like Medicare at all. (Santos had a much different and more accurate approach despite using the same name, one I’m surprised no Democrats are copying: simply delete the age requirements from Medicare laws.)
Universal healthcare doesn’t have to mean MFA. Germany (I think?), Switzerland (I think?) and some other northern European countries have achieved universal coverage using private insurers.
As far as I can tell, there are three ways to achieve universal coverage:
Government as provider (UK’s National Health, US’s VA hospital system)
Single Payer (Canada, Medicare)
Private health insurance, with mandates, coverage requirements, and subsidies (Obamacare if done right, some European countries)
They all have pluses and minuses, but if implemented properly, can all provide universal coverage with better outcomes for less money than our mess of a system.
Moving from private coverage mostly through employers to MFA would be a giant move and Sanders shouldn’t require purity on that – he and Biden can argue why their method is better without implying or saying outright that it’s their way or the highway. I could see boosting Obamacare rules, while adding a public option (optional buy-in to Medicare, for example) and if people prefer that, they can go that way. If MFA really would be better, then more and more people could choose the public option and the final transition would be easier. However, if employers and unions continue to provide better coverage, as long as people are covered, it’s better than we had a few years ago.
What you’re saying is that some people might resent if other people got something easier than they themselves did. Which, yes, really is something that would likely happen. Jesus told of such a situation in his parables. But, as in Jesus’ parable, the people who would be whining about such a thing have no reason to complain, as they got what they agreed to and deserve, and someone else benefiting doesn’t in any way hurt them.
I think the way they do this in European countries that have kept private health insurers in the mix is to require insurance companies to cover everyone (like Obamacare) and require everyone to be covered (like Obamacare) so you don’t have negative selection. They may have also capped profitability of private insurance, but I’m not sure. That’s not as bad as it sounds – treat them like a utility – they get guaranteed, but modest, profits. I don’t know if they’ve done this.
Anyway, if they all were required to cover everyone and provide some acceptable minimum standard of coverage, then they would be mostly competing on price and service and that should help keep their profits in a reasonable range anyway – capitalism and all that.
Completely agree. And this is actually what Obamacare does already (insurance companies must spend something like 85% of premiums on actual healthcare), but the problem is that it doesn’t extend benefits far enough. Or if you are Bernie Sanders, the problem is that they are allowed to make any profits at all. (We haven’t even mentioned how threatening his plan is to anyone who works in the health insurance industry, which is a lot of people.)
But the owner of that vineyard did not have to get the majority of votes in an election from those workers. This is politics, and although I agree with you that this kind of psychology is wrongheaded, sometimes we have to appease wrongheaded views for the greater good. And giving everyone at least basic healthcare, not to mention getting rid of the abomination that is President Trump, definitely qualifies as “greater good”.
Everyone agrees that health care providers and insurance companies are failing to provide affordable healthcare, but hardly anyone agrees on what the solution is. As much as I found them to be annoying little party poopers, I kinda found myself agreeing with Ryan, Delaney, Bullock, and Hickenlooper: MFA is a structural seismic shift that’s not going to be supported.
Like it or not, our political system only shifts tectonically when there’s a major and obvious crisis and a complete systemic failure; otherwise, incremental change is how this country moves forward. If you don’t like that, then support candidates who are going to simultaneously work on reinvigorating democracy at the national and local level.
Any plan that still allows for someone to go broke due to illness is a non-starter. This doesn’t happen in Canada, UK, Germany, etc. This means no co-pays - period. (Not talking about prescriptions here, that’s a separate argument).
Copays are unlikely to make people go broke. And they can always do it like federal student loans, letting people owe the copay money if necessary and slowly taking repayments out of their paychecks on a sliding income scale.
ETA: Assigning some financial responsibility to patients and incentivizing them to shop around is actually an important method to “bend the cost curve” without rationing care, which is guaranteed to provoke a political backlash.
Co-pay for my rheumatologist is $50 when I walk in the door, for my GP $25 when I walk out the door. I wonder why one guy is allowed to charge a larger co-payment.
It’s the deductibles that are the killers – deductibles, exclusions, and “out-of-network” provisions. One thing that might actually get bipartisan support is to eliminate this “out-of-network” loophole bullshit. Providers themselves should be forced to work only with approved network providers. Patients shouldn’t find out that their surgeon was “in network” but their anesthesiologist or that their ambulance trip wasn’t. That’s just all kinds of wrong.
Yes, but Jesus’ parable wasn’t about votes. The disgruntled vineyard workers may have outnumbered the pleasantly-surprised workers 3-to-1 or 5-to-1, but that didn’t matter in the parable.
In this MFA situation, the “disgruntled workers” do get to vote and express their annoyance.
I’m not following you here. Unions negotiate for better health care, and employers use “Cadillac plans” as a way of attracting better candidates. If MFA were put in place, unions and employers would throw up their hands and proclaim, “Now there’s nothing we can negotiate for or offer to make our union/company more attractive to employees”?
I find that very unlikely. Unions will negotiate for and employers will offer something else. It may be higher base pay, but I think in many instances it can be more paid time off, or another benefit. Why would there need to be a requirement for employers to do something? There was no requirement for them to offer better health insurance, but there were competitive reasons for them to do so.
I’ve said before that I see no real reason why supplemental private insurance would not be available with a MFA system. There are a huge variety of plans available for those on Medicare now, and they have to be very profitable or insurance companies wouldn’t spend the vast sums they do to market their plans.
What I’ve been mulling over is this: Provide MFA, allow private supplemental insurance, but make such insurance taxable compensation to employees. Those rich union plans, and Cadillac plans for the lucky few are being largely underwritten by all of us since premiums for such plans are deductible to employers and not taxable income for employees.
I think Democrats get too deep in the weeds discussing the particulars of policies in the campaigns while Republicans get away with bumper sticker platitudes. Keep it simple, say “we’re on your side, we’re going to build upon the ACA, expand Medicare to cover more people but still allow regulated private insurance for those that prefer it”. Then fucking stop right there. Just let the voters know that Democrats are going to fight for them and get them health care as best they can, fleshing out all the details and debating potential weaknesses of each embryonic solution only plays into Republicans’ hands.
I’m pleased that so many of the candidates are pushing back on the idea of abolishing private health insurance, for all the reasons stated upthread.
To emphasize the point, I suggest changing “Medicare For All” to “Medicare For Anyone.” If you want to stick with your private plan, feel free. If you want Medicare, it’s available.
I strongly endorse what BLD said, although he is not living up to his name.
Right, but I’m not talking about what will happen in future negotiations, but rather what was already won in previous ones. Those Cadillac health plans (which as you note are unfortunately tax deductible) will go poof when MFA takes effect, but will not necessarily be instantly replaced with a pay increase of the same size. And because of that tax deduction, if employers even give their employees the amount they were paying on their behalf in premiums (which is no guarantee), that will increase the employees’ tax hit.
But this would not be a thing under the bill Bernie wrote, and which Warren is also supporting. MFA isn’t really Medicare at all, but a “Cadillac” single payer plan (something that exists nowhere else in the world) co-opting Medicare branding. There are no premiums, no deductibles, no copays even on prescriptions, and everything under the sun is fully covered. It’s the worst of both worlds, because it could never work fiscally, and the prospect of it is damaging to Democrats.
