# The dangerous politics of Medicare For All **URL:** \ **Category:** Politics & Elections\ **Created:** [July 31, 2019, 11:19am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922 "2019-07-31T11:19:12Z")\ **Posts on this page:** 20\ **Page:** 10
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [August 25, 2019, 1:20pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/181 "2019-08-25T13:20:27Z")
> [@CarnalK](#): > > It’s not a talking point, it’s a reason you don’t need a lot of talking points on the issue. Insurance jobs are spread out so they aren’t as much of a concern as a voting block. OK, so they’re spread out and therefore we aren’t concerned about them as a voting block. Let’s try that in an election, and see how far it goes. [https://www.kff.org/other/state-indicator/health-care-employment-as-total/?currentTimeframe=0&sortModel={"colId":"Location","sort":"asc"}](https://www.kff.org/other/state-indicator/health-care-employment-as-total/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) According to Kaiser, even in WV, healthcare is 15% of employment. I don’t know what % of those people would lose their job under a Sanders “M4A” plan, but I’m sure they’ll be comforted to know that they’re spread out and aren’t a concern. What your talking point - or lack thereof, to borrow your representation of what you’re saying - implies is that these people don’t matter because they’re not an organized enough voting block. I have my doubts about how well that comes across in an election to these types of voters, and their families. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 25, 2019, 1:37pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/182 "2019-08-25T13:37:33Z")
> [@survinga](#): > > OK, so they’re spread out and therefore we aren’t concerned about them as a voting block. Let’s try that in an election, and see how far it goes. > > [Health Care Employment as a Percent of Total Employment | KFF](https://www.kff.org/other/state-indicator/health-care-employment-as-total/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) > > According to Kaiser, even in WV, healthcare is 15% of employment. I don’t know what % of those people would lose their job under a Sanders “M4A” plan, […] Well, get back to me when you do. People actually providing care are unlikely to lose their jobs so that number means nothing without knowing the breakdown. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 25, 2019, 4:36pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/183 "2019-08-25T16:36:17Z")
> [@CarnalK](#): > > Well, get back to me when you do. People actually providing care are unlikely to lose their jobs so that number means nothing without knowing the breakdown. [Linked earlier](https://khn.org/news/analysis-a-health-care-overhaul-could-kill-2-million-jobs-and-thats-ok/) by Kimstu. And some more detail [here.](https://hbr.org/2013/09/the-downside-of-health-care-job-growth) As of 2012 at least the ratio of doctors to non-doctors had grown to 1:16 and 10 of those 16 were “purely administrative and management staff, receptionists and information clerks, and office clerks”. That comes to about **59%** of those who work within the industry would be at risk of being the ones who lose their jobs, which is a good thing for overall efficiency and cost, but a hard sell to the ones who worry that the job lost will be theirs. And of the clinical workers? Many won’t be afraid of losing their job but will be aware that as the hospital and practices get paid less the pain will be shared, both by salary and more importantly by short-staffing and higher loads per provider. Some will look beyond their own self-interest and be sold on a greater good promise … but many not. How many coal miners have been sold on the idea that their industry’s job losses are worth it for the greater good? One more thing to point out from Kimstu’s link. No the pain is NOT evenly spread out. It would hurt some areas, some particularly important from an electoral college perspective, more than others. > [@](#): > > Some geographic areas would be hit particularly hard. A single hospital system is by far the biggest employer in many post-manufacturing cities like Pittsburgh and Cleveland. Hospitals and hospital corporations make up the top six employers in Boston and two of the top three in Nashville. Hartford is known as the insurance capital of the world. Where would New Jersey be if drugmakers took a big hit, or Minnesota if device makers vastly shrank their workforce? (That may be why some Democratic representatives and senators from these left-leaning states have been quiet or inconsistent on Medicare expansion.) > > Stanford researchers estimate that 5,000 community hospitals would lose more than $151 billion under a Medicare for All plan; that would translate into the loss of 860,000 to 1.5 million jobs. … What state is Pittsburgh in? Achh who cares about PA voters? Cleveland … Ohio? No need to even think about a win there. Minnesota? Meh. Suburban to much more so rural districts whose hospitals have been closing up shop as it is? Who needs 'em. ---
**Author:** ![Muffin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muffin/32/4341_2.png) [@Muffin](https://boards.straightdope.com/u/Muffin)\ **Post date:** [August 25, 2019, 9:30pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/184 "2019-08-25T21:30:28Z")
The argument that ill people there should not be single payor health care because it would terminate many private insurance jobs directly tied to billing sick people is opprobrious because it burns money for no good cause while people remain untreated and often die for lack of money. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 25, 2019, 10:28pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/185 "2019-08-25T22:28:35Z")
> [@DSeid](#): > > [Linked earlier](https://khn.org/news/analysis-a-health-care-overhaul-could-kill-2-million-jobs-and-thats-ok/) by Kimstu. And some more detail [here.](https://hbr.org/2013/09/the-downside-of-health-care-job-growth) > > As of 2012 at least the ratio of doctors to non-doctors had grown to 1:16 and 10 of those 16 were “purely administrative and management staff, receptionists and information clerks, and office clerks”. That comes to about **59%** of those who work within the industry would be at risk of being the ones who lose their jobs, which is a good thing for overall efficiency and cost, but a hard sell to the ones who worry that the job lost will be theirs. And of the clinical workers? Many won’t be afraid of losing their job but will be aware that as the hospital and practices get paid less the pain will be shared, both by salary and more importantly by short-staffing and higher loads per provider. Some will look beyond their own self-interest and be sold on a greater good promise … but many not. How many coal miners have been sold on the idea that their industry’s job losses are worth it for the greater good? > > One more thing to point out from Kimstu’s link. No the pain is NOT evenly spread out. It would hurt some areas, some particularly important from an electoral college perspective, more than others. What state is Pittsburgh in? Achh who cares about PA voters? Cleveland … Ohio? No need to even think about a win there. Minnesota? Meh. Suburban to much more so rural districts whose hospitals have been closing up shop as it is? Who needs 'em. You’re mixing different issues, much of which I didn’t address at all but you sound like you’re rebutting me. Yes, you’ll need some talking points about lower salaries and maybe less of certain procedures. I don’t know how much of that admin/management staff is directly tied to the private insurance industry but it’s certainly not all of them as you assert. Hospitals will still need receptionists and an HR department. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 25, 2019, 10:44pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/186 "2019-08-25T22:44:31Z")
> [@Muffin](#): > > The argument that ill people there should not be single payor health care because it would terminate many private insurance jobs directly tied to billing sick people is opprobrious because it burns money for no good cause while people remain untreated and often die for lack of money. They aren’t making that argument. They’re saying that those job losses are a political pitfall that must be addressed. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [August 25, 2019, 10:53pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/187 "2019-08-25T22:53:23Z")
> [@Muffin](#): > > The argument that ill people there should not be single payor health care because it would terminate many private insurance jobs directly tied to billing sick people is opprobrious because it burns money for no good cause while people remain untreated and often die for lack of money. People with private health insurance have better outcomes in the US than people who are uninsured or people with Medicaid. Studies have shown this ad nauseum. So, we’re supposed to get rid of an industry that’s associated with better outcomes for the population it serves? Private Health insured people have better mortality than uninsured. > **[Health Insurance and Mortality in US Adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/)** > > Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.Methods. We conducted a survival analysis with data... Women with private insurance have better outcomes with breast cancer than uninsured or those with medicaid (not that I have a problem with medicaid, but it’s better to have private insurance): [https://www.nejm.org/doi/full/10.1056/NEJM199307293290507](https://www.nejm.org/doi/full/10.1056/NEJM199307293290507) Also, children in Southern California have better access to care if they have private insurance vs government-funded insurance: > **[Inequality of access to surgical specialty health care: why children with...](https://pubmed.ncbi.nlm.nih.gov/15520090/)** > > There is a tremendous inequality of access to surgical specialty health care for children with government-funded insurance when compared with those with commercial insurance in Southern California. Physicians indicate that this disparity is related... I can post these kinds of studies day and night… ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 25, 2019, 11:00pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/188 "2019-08-25T23:00:36Z")
People with insurance have better outcomes than people without insurance. I stand amazed. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 25, 2019, 11:39pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/189 "2019-08-25T23:39:51Z")
> [@CarnalK](#): > > You’re mixing different issues, much of which I didn’t address at all but you sound like you’re rebutting me. Yes, you’ll need some talking points about lower salaries and maybe less of certain procedures. I don’t know how much of that admin/management staff is directly tied to the private insurance industry but it’s certainly not all of them as you assert. Hospitals will still need receptionists and an HR department. Not rebutting, attempting to answer: what percent of people in healthcare are at risk of losing their jobs under MfA? The estimates given in those links are overall as a result. Working for a hospital’s HR department or as a receptionist does not save your job if the hospital folds, which many community hospitals have been doing already and which predictions are many more will as payments get squeezed. Direct ties are not the issue, fear for job and income security is. Let’s do one more to actually put it as that percent. In 2016 there were “there were [21.8 million](https://www.healthaffairs.org/do/10.1377/hblog20180502.984593/full/) people working in health care settings or in health occupations … 14 percent of all jobs in the United States.” 2 million of them, almost 10%, will be lost, and many many more will be worried that it will be their job that is lost, or salary cut, or work demands increased. Those voters (and their families) will consider their own self-interest at least as much as they will consider the possibility that it will result in a greater good. Be scornful of that fact **Muffin** if you want, but it is a real _political_ consideration, even if you have only disdain for such considerations. And let’s be real here. MfA will _not_ get passed even with a highly unlikely narrow D majority in the Senate (you won’t get every D to vote for it and no Rs will cross the aisle on it). The question is what advocating for it accomplishes, for good or ill, politically, vs building on the huge successes of the ACA with Medicare for all who want it and other improvements. Medicaid as is is not a fair comparison to privater insurance btw. Many providers do not take it (limited access) and if they did there would still be a huge selection bias with those on Medicaid much more likely to be experiencing other challenges associated with lower income … “the social determinants of health” and structural factors. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [August 25, 2019, 11:43pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/190 "2019-08-25T23:43:19Z")
> [@CarnalK](#): > > People with insurance have better outcomes than people without insurance. I stand amazed. Also better than those on Medicaid. There was a randomized study in Oregon that found putting uninsured people on Medicaid had very disappointing and meager results. > [@Muffin](#): > > The argument that ill people there should not be single payor health care because it would terminate many private insurance jobs directly tied to billing sick people is opprobrious because it burns money for no good cause while people remain untreated and often die for lack of money. Again, this is politics. It’s wildly and inarguably inefficient to have military bases spread around the country, but have you seen the political firestorms that break out any time anyone tries to close some of them? NIMBY! ETA: Also, you are either strawmanning us on the other side, or are guilty of the fallacy of a falsely excluded middle. We are talking about getting everyone who is currently uninsured coverage, but without single payer. Much less efficient, but it doesn’t jeopardize anyone’s jobs, and it still covers everyone. Patching holes rather than tearing off the roof and starting over. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [August 26, 2019, 12:38am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/191 "2019-08-26T00:38:06Z")
> [@DSeid](#): > > In 2016 there were “there were [21.8 million](https://www.healthaffairs.org/do/10.1377/hblog20180502.984593/full/) people working in health care settings or in health occupations … 14 percent of all jobs in the United States.” 2 million of them, almost 10%, will be lost, and many many more will be worried that it will be their job that is lost, or salary cut, or work demands increased. > > Those voters (and their families) will consider their own self-interest at least as much as they will consider the possibility that it will result in a greater good. Be scornful of that fact **Muffin** if you want, but it is a real _political_ consideration, even if you have only disdain for such considerations. > > And let’s be real here. MfA will _not_ get passed even with a highly unlikely narrow D majority in the Senate (you won’t get every D to vote for it and no Rs will cross the aisle on it). The question is what advocating for it accomplishes, for good or ill, politically, vs building on the huge successes of the ACA with Medicare for all who want it and other improvements. QFT. Great, great post. In summary, it won’t get passed; or if it does, it will provoke a huge political backlash. So insisting on the Democratic nominee championing it is either pure virtue signaling or a completely unrealistic idea of what can actually be accomplished in the next Congress. It’s one thing to take a greater downside risk if there’s a bigger potential upside. But there is very unlikely to be a bigger upside here and the downside is that we end up with the same as, or less than, we have now. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 26, 2019, 1:10am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/192 "2019-08-26T01:10:01Z")
> [@DSeid](#): > > Not rebutting, attempting to answer: what percent of people in healthcare are at risk of losing their jobs under MfA? As I said, I was only talking about job losses in the insurance business. A switch to M4A will cause a massive shakeup and lots of things will have to be done to calm fears. That will depend on exactly what M4A is because no one’s plan seems to literally be Medicare for all. The only point I was making was that losing medical insurance jobs isn’t very politically worrisome because the jobs are diffused and it’s a profession with very little public sympathy. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 26, 2019, 1:29am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/193 "2019-08-26T01:29:45Z")
WEIRD. Because I could swear that in response to a claim > [@](#): > > According to Kaiser, even in WV, healthcare is 15% of employment. I don’t know what % of those people would lose their job under a Sanders “M4A” plan you had stated > [@](#): > > Well, get back to me when you do. I gave you the percent and the estimates of how many would be concerned that they or theirs would be of that percent of those employed in healthcare. I noted that the job losses would be of more impact in some states than others and specifically in a few more electorally important states. It was the actual question. Not sure why in that context anyone would give a flying fuck about job losses specific to the insurance business and only that but you do you man. Meanwhile - How would you go about calming those fears during an election in which it was noted, accurately, that these voters in these key states would be at significant risk of losing their jobs or if kept making less and/or working harder, in a disruptive fashion, for the greater good? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 26, 2019, 2:29am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/194 "2019-08-26T02:29:53Z")
> [@survinga](#): > > People with private health insurance have better outcomes in the US than people who are uninsured or people with Medicaid. Studies have shown this ad nauseum. So, we’re supposed to get rid of an industry that’s associated with better outcomes for the population it serves? > > Private Health insured people have better mortality than uninsured. > > [Health Insurance and Mortality in US Adults - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/) > > Women with private insurance have better outcomes with breast cancer than uninsured or those with medicaid (not that I have a problem with medicaid, but it’s better to have private insurance): > > [https://www.nejm.org/doi/full/10.1056/NEJM199307293290507](https://www.nejm.org/doi/full/10.1056/NEJM199307293290507) > > Also, children in Southern California have better access to care if they have private insurance vs government-funded insurance: > > [Inequality of access to surgical specialty health care: why children with government-funded insurance have less access than those with private insurance in Southern California - PubMed](https://www.ncbi.nlm.nih.gov/pubmed/15520090) > > I can post these kinds of studies day and night… 1. Re: insured vs uninsured outcomes: so you’re surprised that having access to health care results in better outcomes than not having access to health care. Duly noted, but most of us aren’t surprised by the bleeding obvious. 2. Re: insurance vs Medicaid: so you’re surprised that funding top-tier ongoing health care including preventative services results in better outcomes than the care from an artificially limited substandard tier, the patients of which have typically had spotty to non-existent health care for much of their lives due to poverty. Duly noted, but again, most of us aren’t surprised at all. 3. Re: all of the above, including the claim that “children in Southern California have better access to care if they have private insurance vs government-funded insurance”: be prepared to be surprised again, because residents of Canada on average [live longer healthier lives than Americans](https://www.reuters.com/article/us-health/canadians-live-longer-healthier-than-americans-study-idUSTRE63R6B520100429) despite living under the yoke of evil “government-funded insurance”! In point of serious fact, better health outcomes in Canada are largely _ **because of** _ a lifetime of guaranteed access to health care with no monetary obstacles to such access. The same results generally hold for most European countries, too. I have no doubt that you “can post these kinds of studies day and night” but without the proper comparative context your implied conclusions are worthless. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [August 26, 2019, 2:49am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/195 "2019-08-26T02:49:23Z")
> [@wolfpup](#): > > 1. Re: insurance vs Medicaid: so you’re surprised that funding top-tier ongoing health care including preventative services results in better outcomes than the care from an artificially limited substandard tier, the patients of which have typically had spotty to non-existent health care for much of their lives due to poverty. Duly noted, but again, most of us aren’t surprised at all. Wait, so now the majority of Americans on private health insurance are correct to like it and to want to keep it? Because they are getting such top-tier care, including preventative services? You can’t have it both ways. :dubious: > [@wolfpup](#): > > 1. Re: all of the above, including the claim that “children in Southern California have better access to care if they have private insurance vs government-funded insurance": be prepared to be surprised again, because residents of Canada on average [live longer healthier lives than Americans](https://www.reuters.com/article/us-health/canadians-live-longer-healthier-than-americans-study-idUSTRE63R6B520100429) despite living under the yoke of evil “government-funded insurance”! In point of serious fact, better health outcomes in Canada are largely _ **because of** _ a lifetime of guaranteed access to health care with no monetary obstacles to such access. And again, I want to see the health comparisons of well educated middle class Canadians with well educated middle class Americans. If the Canadians still come out significantly ahead, that is impressive. If not, you are making a collectivist utilitarian argument that will not only not fly in American politics but will be political poison. If you want to lament that American voters are so selfish, go right ahead. But that is the political playing field we are dealing with. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 26, 2019, 3:19am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/196 "2019-08-26T03:19:04Z")
> [@SlackerInc](#): > > Wait, so now the majority of Americans on private health insurance are correct to like it and to want to keep it? Because they are getting such top-tier care, including preventative services? You can’t have it both ways. :dubious: There’s no “both ways” here. You are once again mischaracterizing what I said. Properly administered single-payer, as in Canada, is generally equivalent to top-tier insured care in the US and in many ways vastly superior, particularly in the absence of any co-pays or deductibles and the unconditional nature of coverage. In the US, “government-funded” coverages like Medicare and Medicaid are the poor cousins of insured care, and this is by design, at the behest of the insurance lobby and Republican “free-market” ideologues. And if this causes people to believe, as an ingrained part of US health care culture, that government-funded health care coverage is always limited and substandard, well, that’s a bonus side effect that health insurers are going to exploit to the max! > [@SlackerInc](#): > > And again, I want to see the health comparisons of well educated middle class Canadians with well educated middle class Americans. If the Canadians still come out significantly ahead, that is impressive. If not, you are making a collectivist utilitarian argument that will not only not fly in American politics but will be political poison. If you want to lament that American voters are so selfish, go right ahead. But that is the political playing field we are dealing with. I’m not lamenting the fact that they’re selfish, I’m lamenting the fact that they’re stupid, because they seem happy to pay twice as much as necessary for health care while being stuck with often enormous out-of-pocket costs for the dubious privilege of having insurance bureaucrats stand between them and their health care providers. I’m quite familiar with insurance companies as I have to deal with them on house insurance and car insurance, and I’m horrified that anyone would have to deal with their critical medically necessary health care that way. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [August 26, 2019, 7:30am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/197 "2019-08-26T07:30:27Z")
Selfish, stupid, whatever you want to say: their vote counts just as much regardless. And if you follow American politics at all, you should not be surprised that it is not the most rationally presented, wonky argument that wins out. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [August 26, 2019, 11:36am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/198 "2019-08-26T11:36:03Z")
> [@DSeid](#): > > WEIRD. Because I could swear that in response to a claim you had statedI gave you the percent and the estimates of how many would be concerned that they or theirs would be of that percent of those employed in healthcare. I noted that the job losses would be of more impact in some states than others and specifically in a few more electorally important states. > > It was the actual question. > > Not sure why in that context anyone would give a flying fuck about job losses specific to the insurance business and only that but you do you man. > > Meanwhile - How would you go about calming those fears during an election in which it was noted, accurately, that these voters in these key states would be at significant risk of losing their jobs or if kept making less and/or working harder, in a disruptive fashion, for the greater good? I was talking about insurance industry jobs the whole time. The context is all my posts leading up to the one you just quoted. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 26, 2019, 1:19pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/199 "2019-08-26T13:19:57Z")
> [@wolfpup](#): > > … I’m lamenting the fact that they’re stupid … **SlackerInc** is exactly right and you do keep trying to have a different conversation than what this op is about, trying to convince other posters how wonderful the Canadian system is compared to the American one, while whether it is, or is not, is not the question at hand. The question of the op, the one the rest of us are having, is the Elections forum question about its elections impact. In this context, for example, the issue of whether or not so many American voters would not vote for a gay candidate that one could not win, is not a discussion about how that _should_ be an immaterial bit of information and those who think that way are ignorant and prejudiced … the discussion and debate is whether or not the statement is true. So you think American voters are stupid. Well, looking at who our president is that is a hard thesis to argue against. But whether or not a … lack of enthusiasm … for a disruptive revolutionary approach to improving our healthcare system by forcing everyone to give up what they currently have (be it private or Medicare or whatever) for an attempt to get to a system similar to the one in Canada, causing rapid significant job losses pay cuts and job stresses across the healthcare industry, is or is not stupid, the reality is it would be politically idiotic to have that be the flag to wave. _Politically_ the GOP has weakness on healthcare with the unforced error of continuing to try to repeal the ACA. The ACA in fact has delivered quite a lot. Politically a Democratic candidate should be leveraging that GOP weakness, not arguing that they agree the ACA is so horrible that it should be scrapped and replaced. Politically you leverage their weakness by pointing out how many of the current issues with the ACA are a result of intentional GOP kneecapping trying to sabotage it with voters’ healthcare problems as cynical political civilian casualties. Politically you remind voters that the ACA was a compromise that could pass at the time and that it should be improved upon with specific ideas of how … ideas that are less disruptive and ones that allow them to have choices about it. **CarnalK** the discussion was regarding the 2 million jobs estimated to be lost across healthcare, how that was where much of the cost savings would occur, which is good, but how the threat of job loss could be of political consequence nevertheless. You were responding to **Slacker** ’s comment > [@](#): > > … those 2 million people, in a demographic that is highly likely to vote, from being out of a job they spent years learning how to do will be intense and focused but reverberate throughout entire families and friendship groups. Your responding that “Insurance jobs are spread out so they aren’t as much of a concern” is most generously understood to mean the impact of these job losses across healthcare that would occur because of the removal of the insurance industry are so spread out as to not matter so much politically. An incorrect statement but one that actually has relevance to the discussion. Because how many jobs are lost literally ONLY by those directly working for an insurance company is not what was being discussed or the item that matters. That would have been a stupid non-response to Slacker’s comment about the 2 million voters who would lose their jobs that they had spent years developing skills for. You really meant _that_? Okay. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 26, 2019, 4:52pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/200 "2019-08-26T16:52:06Z")
> [@DSeid](#): > > **SlackerInc** is exactly right and you do keep trying to have a different conversation than what this op is about, trying to convince other posters how wonderful the Canadian system is compared to the American one, while whether it is, or is not, is not the question at hand. The question of the op, the one the rest of us are having, is the Elections forum question about its elections impact. > > In this context, for example, the issue of whether or not so many American voters would not vote for a gay candidate that one could not win, is not a discussion about how that _should_ be an immaterial bit of information and those who think that way are ignorant and prejudiced … the discussion and debate is whether or not the statement is true. > > So you think American voters are stupid. Well, looking at who our president is that is a hard thesis to argue against. > > But whether or not a … lack of enthusiasm … for a disruptive revolutionary approach to improving our healthcare system by forcing everyone to give up what they currently have (be it private or Medicare or whatever) for an attempt to get to a system similar to the one in Canada, causing rapid significant job losses pay cuts and job stresses across the healthcare industry, is or is not stupid, the reality is it would be politically idiotic to have that be the flag to wave. > > _Politically_ the GOP has weakness on healthcare with the unforced error of continuing to try to repeal the ACA. The ACA in fact has delivered quite a lot. Politically a Democratic candidate should be leveraging that GOP weakness, not arguing that they agree the ACA is so horrible that it should be scrapped and replaced. Politically you leverage their weakness by pointing out how many of the current issues with the ACA are a result of intentional GOP kneecapping trying to sabotage it with voters’ healthcare problems as cynical political civilian casualties. Politically you remind voters that the ACA was a compromise that could pass at the time and that it should be improved upon with specific ideas of how … ideas that are less disruptive and ones that allow them to have choices about it. **DSeid** , I don’t really disagree with this, and contrary to how it might appear to you, I do believe that Democrats should put forward a cautious transitionary approach mainly built around introducing a public option to the ACA. I understand that people are fearful of revolutionary changes, and I think Sanders’ all-or-nothing proposal that would ban private insurance is a serious mistake. But, having said all that, Democrats should also pursue fact-based policies and fight back against some of the falsehoods and fearmongering that the insurance industry has been promulgating about UHC for decades, like the stuff that I refuted in [post #194](http://boards.straightdope.com/sdmb/showpost.php?p=21825474&postcount=194). What’s next, accusations of death panels, or people dying in Canada due to wait times, or – per Republican mouthpiece Betsy Mccaughey and the AHIP lobby – people in the UK allegedly having to go blind in one eye before they get treatment for the other? This is the kind of scaremongering disinformation that has been going on for years and that Democrats need to strongly oppose. In fact you yourself seemed to be buying in to some of this by citing how well Medicare Advantage works with the aid of private insurers, when the fact is that MA works just because capitation and outcome-based management are good ideas, and the insurers are strictly held in line by their contractual obligations to CMS. Ultimately the government could almost certainly do it better themselves, but that’s neither here not there as we might as well acknowledge that in the US – the world’s foremost hotbed of free-market ideals – private health insurance will always be around and the best we can hope for is a public/private two-tier hybrid where hopefully you guys have governments with enough integrity to protect the public tier from being reduced to a lowly second-rate system thrown like a bone solely to the poor and indigent. This is precisely why Canada strictly prohibits private insurance for medically necessary services, even though countries in Europe, with a much stronger sense of social solidarity, manage just fine with limited participation in a private insurance tier. [Previous page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=9) [Next page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=11)