# 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:** 4
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [August 2, 2019, 2:55pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/61 "2019-08-02T14:55:09Z")
> [@SlackerInc](#): > > So this putative median voter is not so great. She is a 60-year-old married white lady in the Milwaukee suburbs who voted for Bush at least once if not twice (for sure in 2004 even after Abu Ghraib, waterboarding, etc.) and she voted for Trump last time, or maybe just stayed home because she didn’t like either candidate. But she did vote for Obama twice, although her husband voted for Romney in 2012 after voting for Obama in 2008. > > And she is definitely gettable for Democrats in 2020, but only if we don’t make her too nervous about the changes we are planning to make. Like me, she has a good Blue Cross/Blue Shield plan through her husband’s employer, and it has taken care of her and her family with no real problems. > > She sees reporting on the news about people who still don’t have health insurance, and feels a little bit sorry for them. Just a little, like she feels for the charity cases her pastor talks about at church. She would like the government to provide at least a basic health plan for these people, although maybe not as good as the “Cadillac plan” her husband’s union negotiated for. After all, that was a tough negotiation—and why should her tax dollars pay for something just as good for people who don’t even belong to her husband’s union? That’s not fair, she thinks. She and her family have worked hard to get a little bit higher on the ladder than most people, and johnny-come-latelies shouldn’t just get to catch all the way up without working as hard (as far as she is concerned, regardless of how hard they actually work). What happens if we make your sample voter (who is, I point out, only 5 years from Medicare – and if you don’t think that affects her thinking, you don’t know many older people) aware that other people who don’t even belong to her husband’s union are paying in part for that Cadillac plan? Would she find that unfair? Most people are resistant to understanding such things, and – let’s face it – most don’t understand how the tax brackets work. So perhaps the easiest way to drive this home is to make health insurance premiums for employer-sponsored programs taxable. The typical employee-plus-one total premiums in Wisconsin run to a tad over $13,000 annually (I’ll give a link if you like, but I’m lazy today). So let’s say the Cadillac plan is running $15,000. If she and her husband are in the 22% tax bracket, their taxes on this benefit would be $3,300. If she and her husband have to pay this amount, would she still be so proud of her situation? ---
**Author:** ![The\_Other\_Waldo\_Pepper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/the_other_waldo_pepper/32/12370_2.png) [@The\_Other\_Waldo\_Pepper](https://boards.straightdope.com/u/The_Other_Waldo_Pepper)\ **Post date:** [August 2, 2019, 3:17pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/62 "2019-08-02T15:17:06Z")
> [@SlackerInc](#): > > As I say, maybe that makes her a really shitty person. But she’s not as shitty as the people who are definitely going to vote for Trump no matter what, and what really matters is that _we can get her vote if we promise, cross our hearts and hope to die, not to mess with what she already has_ (even if in some ways we might end up breaking that promise later—shhh). I think I despise that idea, and the post you wrapped around it; and I think _she’d_ despise that idea, as well as the post you wrapped around it, and won’t trust you when next you come around trying to win her over with a cross-your-heart promise you already figure isn’t the truth - shhh - but you don’t figure you can sell her with truth, you figure you have to tell her that, uh, if she likes her plan, she can keep it? You recommend _that,_ knowing it ain’t true, as the approach? ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [August 2, 2019, 3:28pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/63 "2019-08-02T15:28:19Z")
There are structural problems with the economics of our healthcare system that need to be addressed and I’ve never seen any proposal that does anything but talk about who’s going to pay the bill. The principles of supply and demand economy are deeply distorted in our current healthcare system, because in most cases the bills aren’t being paid by the people receiving the goods and services. Imagine a restaurant that charged you one “all you can eat” price, but that paid their chefs by the piece for everything you ate. And those chefs got to advertise and market their food. Those chefs would have a business model that revolved around getting you to eat as much as possible. Now I’m not saying the majority of medical care isn’t necessary. But when I had cataract surgery in both eyes, they insisted on doing it as two surgeries and I had a total of 17 assorted pre-op and post-op visits in addition to the surgery cost. I owed co-pays on all. And I had to pay some anesthesiologist twice, for something that was like, as they put it “a glass of wine to relax you”. I could have suggested a cheaper way to accomplish this. 😃 But there is a thriving industry that wants you put you in a doctor’s office as much as possible and get you to take as many medications as possible. I used to have a Cadillac plan, and I got a lot of physical therapy and psychotherapy when I was on that plan. But when I dropped back to a cheaper plan and had to pay $60 a session for this, I decided I didn’t need it all that much. The high deductible insurance everyone loves to hate provides what insurance should, protection against a devastating event. The insurance model isn’t designed for ordinary care, but ordinary care has become cost prohibitive. And the ordinary care part of the policy is the part the consumer perceives that they need. They don’t think too much about the catastrophic care part because most of them never use it. Some employers had add-on policies that covered workers from “first dollar” to the amount of their deductible. Then some employers just started offering the just add-on policies as insurance. Cheap insurance that appeared to pay for everything. And the customers loved it. Unless something happened and they actually needed it. Frankly, in a lot of ways insurance is like buying a car you probably will never drive. People might really like a car that sits in their garage all day because they’ve never once had to drive it. It may seem presumptive to tell them that they are wrong and their car sucks. But they can be wrong. It seems to me that all the healthcare plans revolve around who’s going to pick up the tab for our fundamentally broken system. But I’m afraid unless the underlying system is reformed and reined in they are all doomed to fail. ---
**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 2, 2019, 3:28pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/64 "2019-08-02T15:28:52Z")
> [@The\_Other\_Waldo\_Pepper](#): > > I think I despise that idea, and the post you wrapped around it; and I think _she’d_ despise that idea, as well as the post you wrapped around it, and won’t trust you when next you come around trying to win her over with a cross-your-heart promise you already figure isn’t the truth - shhh - but you don’t figure you can sell her with truth, you figure you have to tell her that, uh, if she likes her plan, she can keep it? You recommend _that,_ knowing it ain’t true, as the approach? Worked for Obama (Obamacare is now popular, but it would never have gotten passed at all without that fib). > [@Anny\_Middon](#): > > What happens if we make your sample voter (who is, I point out, only 5 years from Medicare – and if you don’t think that affects her thinking, you don’t know many older people) aware that other people who don’t even belong to her husband’s union are paying in part for that Cadillac plan? Would she find that unfair? > > Most people are resistant to understanding such things, and – let’s face it – most don’t understand how the tax brackets work. So perhaps the easiest way to drive this home is to make health insurance premiums for employer-sponsored programs taxable. > > The typical employee-plus-one total premiums in Wisconsin run to a tad over $13,000 annually (I’ll give a link if you like, but I’m lazy today). So let’s say the Cadillac plan is running $15,000. If she and her husband are in the 22% tax bracket, their taxes on this benefit would be $3,300. > > If she and her husband have to pay this amount, would she still be so proud of her situation? So…you are proposing that Warren promise to raise her taxes first to make the Cadillac plan a kind of toxic asset she will be glad to get rid of? 😕 Frying pans and fires come to mind. Fair point though that it might be better if she is like 54 instead of 60. ---
**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 2, 2019, 3:34pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/65 "2019-08-02T15:34:51Z")
Ann Hedonia, I agree with your take. I have for years advocated that we give everyone a much cheaper HDHP/HSP combo as a kind of birthright. If their employer gives them supplemental insurance beyond that, OK. But as practical and efficient as my idea would be, it seems to have no purchase in the body politic, so I don’t mention it that often anymore. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [August 2, 2019, 3:50pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/66 "2019-08-02T15:50:06Z")
> [@SlackerInc](#): > > Ann Hedonia, I agree with your take. I have for years advocated that we give everyone a much cheaper HDHP/HSP combo as a kind of birthright. If their employer gives them supplemental insurance beyond that, OK. But as practical and efficient as my idea would be, it seems to have no purchase in the body politic, so I don’t mention it that often anymore. Yeah, suggesting someone might not need a doctor immediately for every little thing is kind of the third rail, isn’t it, and it seems beyond the pale to suggest a little watchful waiting for minor issues and problems that are known to sometimes be self-resolving. But that is the result of a lifetime of conditioning by the medical industry. My young nephew ( who was living with me at the time )went to the ER on News Year Day because he felt nauseous and his heart was racing. I tried to tell him he was experiencing his first hangover and he just needed to rest and wait it out, but he wouldn’t hear it. ---
**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 2, 2019, 3:58pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/67 "2019-08-02T15:58:27Z")
Yeah, when I floated it here, the umbrage was flying fast and furious. You would have thought I was suggesting the poor eat their children instead of wasting taxpayer money on food stamps. :rolleyes: ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [August 2, 2019, 5:33pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/68 "2019-08-02T17:33:21Z")
> [@Northern\_Piper](#): > > No premiums - Canada - check > > No deductibles - Canada - check > > No copays (for doctors / hospitals) - Canada - check > > Any doctor (if you mean no networks?) - Canada - check. > > Doesn’t seem unworkable here. And yes, there isn’t much left to supplement in primary health care. They have a special tax which is called a Premium, so you cant say No premiums. Deductibles and copays? Well, yes Canada has them- sorta: [https://www.aimseducation.edu/blog/us-vs-canadian-healthcare-differences/No](https://www.aimseducation.edu/blog/us-vs-canadian-healthcare-differences/No) prescription drug coverage. \*Canadian universal care doesn’t cover everything, however. Though the CHA dictates that medically-necessary services are covered at no cost, there is no distinct definition as to what “medically necessary” means specifically, leaving each province and territory to decide. In Canada, regular visits to primary care doctors, hospitals, and diagnostic services are covered by Provincial Health Insurance. However, there is some cost sharing when it comes to other services, like ambulances, prescription/over-the-counter medications, dental care, vision care, and long-term care facilities. This does pose a bit of an issue for people who have large out-of-pocket expenses, but the government does provide a tax credit to ease this burden. Private Health Insurance to Fill In the Gaps Another somewhat contentious issue is private health insurance. Just like in the United States, private health insurance may be offered by employers. Canadians are also free to purchase private coverage to help defray from the cost of care which is not covered by the universal services (For instance, prescription drug plans help people pay for medications they need to take on a regular basis). Just like in the US, most of these private insurance companies are for-profit.\* Canada also does not cover prescription drugs. ---
**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 2, 2019, 7:35pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/69 "2019-08-02T19:35:34Z")
Health care in Canada is managed by the provinces according to federal standards. It is only fair to say federal regulations don’t mandate prescription drug coverage, except during hospitalization where it is indeed required. There’s a variety in provincial drug plans and your quote does not seem to recognize that. > **[Provincial and Territorial Public Drug Benefit Programs - Canada.ca](https://www.canada.ca/en/health-canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription-medicines/provincial-territorial-public-drug-benefit-programs.html)** > > Links to provincial and territorial public drug benefit programs in Canada ---
**Author:** ![KidCharlemagne](https://avatars.discourse-cdn.com/v4/letter/k/ed8c4c/32.png) [@KidCharlemagne](https://boards.straightdope.com/u/KidCharlemagne)\ **Post date:** [August 2, 2019, 7:59pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/70 "2019-08-02T19:59:56Z")
> [@SlackerInc](#): > > 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. This is true and the reason why the arguments that taxing the rich will send them to the right side of the Laffer Curve are so fricking stupid. The hedge-funder in Greenwich would be happier making 20 million and his next door neighbor making 15 then he would with both of them making 30. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [August 2, 2019, 8:01pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/71 "2019-08-02T20:01:40Z")
> [@CarnalK](#): > > Health care in Canada is managed by the provinces according to federal standards. It is only fair to say federal regulations don’t mandate prescription drug coverage, except during hospitalization where it is indeed required. There’s a variety in provincial drug plans and your quote does not seem to recognize that. > > [https://www.canada.ca/en/health-canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription-medicines/provincial-territorial-public-drug-benefit-programs.html](https://www.canada.ca/en/health-canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription-medicines/provincial-territorial-public-drug-benefit-programs.html) Yes, some provinces have drug plans. But _Canada_ does not. ---
**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 2, 2019, 8:19pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/72 "2019-08-02T20:19:43Z")
All the provinces have drug plans, they just aren’t all universal coverage. Afaik, they all cover low income and seniors. And as mentioned, drugs in hospitals are covered universally, which I think is an important point. But I think I generally agree with your point that Canada’s system isn’t utterly free for all medical necessities. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [August 3, 2019, 12:16am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/73 "2019-08-03T00:16:58Z")
> [@CarnalK](#): > > All the provinces have drug plans, they just aren’t all universal coverage. Afaik, they all cover low income and seniors. And as mentioned, drugs in hospitals are covered universally, which I think is an important point. > > But I think I generally agree with your point that Canada’s system isn’t utterly free for all medical necessities. Sure, and in fact Medicare has a sorta drug plan, too. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [August 3, 2019, 12:50am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/74 "2019-08-03T00:50:40Z")
You know what I don’t hear so much of, lately? News stories about some poor dumb schmuck getting lawyered out of their health care by an insurance company. Got tired of that in a big damn hurry! People who thought they were covered going broke because they won’t let a loved one just die. And some did, didn’t they? Bound do happen, the cold equations don’t allow anything else, some died. Its the efficiency, stupid! Around the world, well off countries do well, even poor as shit countries do better than they would have! The best balance between risk and protection is the widest possible grouping, _Très_ duh, _mais non_? Even Obamacare, that mutant mechanism, half steam engine, half computer, does better than what we had! Who knows what we could achieve just by _improving_ it. We’re the Americans, we figure out how to do stuff. If not us, who? If not now, when? ---
**Author:** ![Saintly\_Loser](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saintly_loser/32/4045_2.png) [@Saintly\_Loser](https://boards.straightdope.com/u/Saintly_Loser)\ **Post date:** [August 3, 2019, 1:11am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/75 "2019-08-03T01:11:36Z")
> [@steronz](#): > > Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Canada permits the purchase of private insurance for goods and services not covered by the provincial plan(s), but not supplemental coverage for more or better service for items that are covered by the public plan. I think one can get supplemental coverage for, say, a private room in a hospital. One can also purchase vision care or dental insurance. Or drug coverage. But the basic Canadian plan is a cradle-to-grave plan, covering everyone, and providing the same level of coverage for everyone. It seems to work pretty well. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [August 3, 2019, 1:55am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/76 "2019-08-03T01:55:53Z")
> [@CarnalK](#): > > And as mentioned, drugs in hospitals are covered universally, which I think is an important point. In the USA, one is overcharged for drugs one normally takes at home when they are provided by a hospital. ---
**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 3, 2019, 2:02am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/77 "2019-08-03T02:02:26Z")
That doesn’t sound very cool of them. And for the record, in Ontario at least, it includes medications that you’re on that have nothing to do with your hospitalization. When you’re in there, it’s covered. ---
**Author:** ![Eonwe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eonwe/32/240_2.png) [@Eonwe](https://boards.straightdope.com/u/Eonwe)\ **Post date:** [August 3, 2019, 4:05am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/78 "2019-08-03T04:05:22Z")
> [@SlackerInc](#): > > in the privacy of the voting booth, _she is going to vote to keep every scintilla of what she has_. Even if that means sacrificing millions of other people to medical bankruptcy. Even if it will condemn many decent, hard-working people to an early death (though she will try not to think about that part too much). And even if it means suffering through Trump on TV for another four years. . . . so she’s a conservative then? Won’t vote for any change that requires her life to change, unless it means more free stuff for her personally? Doesn’t sound like there’s a chance in hell she’ll be voting for any Dem ever. Certainly not when we face real economic, social, or environmental crisis. Candidates who honestly and sincerely appeal to the voter who insists on keeping every scintilla of what they have are not candidates that can do anything positive for the nation. ---
**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 3, 2019, 11:34am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/79 "2019-08-03T11:34:33Z")
My mother and sister report that dental, vision, hearing aids, and prescriptions are not covered. Plus there is private supplemental insurance, as noted upthread. So Bernie is in fact planning to offer something that does not exist there, and probably not anywhere. It’s important to remember that he is really more interested in sticking it to insurance companies than in just giving people health coverage. And as long as Elizabeth Warren does not deviate with her own plan, that is what she is stuck with as well. > [@KidCharlemagne](#): > > This is true and the reason why the arguments that taxing the rich will send them to the right side of the Laffer Curve are so fricking stupid. The hedge-funder in Greenwich would be happier making 20 million and his next door neighbor making 15 then he would with both of them making 30. Good point. Yet another reason why the Laffer curve is completely stupid. > [@Eonwe](#): > > . . . so she’s a conservative then? Won’t vote for any change that requires her life to change, unless it means more free stuff for her personally? > > Doesn’t sound like there’s a chance in hell she’ll be voting for any Dem ever. Certainly not when we face real economic, social, or environmental crisis. > > Candidates who honestly and sincerely appeal to the voter who insists on keeping every scintilla of what they have are not candidates that can do anything positive for the nation. I said right up front that the American voters who are decisive in national elections are not great people. But we have to curry favor with them to win even if it is nauseating. Would you prefer to just be pure and lose? How many people get healthcare that way? And if you think swing voters are not as shitty and selfish as that, look again at the poll numbers I linked. Only 26% would support MFA if it would “lead to delays in some people getting certain medical tests and treatments”. 26% is actually a large number of people. Many tens of millions, and I’m sure you are one of them. But it’s not enough to keep from giving completely shellacked by the Republicans in the election—in which case you end up without half a loaf, or even a crumb of a loaf. Fortunately, candidates don’t have to honestly and sincerely appeal to such voters. Doing so dishonestly and insincerely is fine as long as it gets the job done. ---
**Author:** ![The\_Other\_Waldo\_Pepper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/the_other_waldo_pepper/32/12370_2.png) [@The\_Other\_Waldo\_Pepper](https://boards.straightdope.com/u/The_Other_Waldo_Pepper)\ **Post date:** [August 3, 2019, 11:44am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/80 "2019-08-03T11:44:38Z")
> [@SlackerInc](#): > > Doing so dishonestly and insincerely is fine as long as it gets the job done. Seriously, why do you keep saying the quiet part out loud? [Previous page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=3) [Next page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=5)