That’s the wrong question. You should be asking: What passage in the Constitution explicitly allows such a program?
In a Constitutional Republic, there are two rules of thumb that shape almost everything else.
A citizen can do anything that is not explicitly illegal.
The government can do only what is explicitly allowed.
Thus freedom is preserved.
Regarding your second question–
FDR decided that he was going to flat-out ignore the Constitution. And a great many people were happy to let him do so. The situation has not improved since.
I agree with this. Having been on Medicare for four years now, I find it far too complicated and inefficient for me to want to expand it to everyone. I would much rather a new single payer system were invented or borrowed from somewhere that has it already in use, and replace Medicare and private medical insurance with that. I think it would also be useful if it were created via a constitutional amendment, so that conservative politicians could not de-fund it to score political points. This would also answer Flyer’s point, which I just read.
It would put out of business thousands upon thousands of people who make their living devising, selling, billing and accounting for medical insurance. Perhaps such a program should include re-training and soul transplants for these people so they can function in the new system.
Because the Constitution, as famously said, is not a suicide pact. Nor are the Founding Fuckups secular saints to be worshipped and adored. The Constitution is a worthy effort, to be admired. Not to be worshipped.
Are there any justices on the SCOTUS right now that will say the federal government can do things without finding some justification in the constitution? You might argue that their logic is strained, but would any of the Supremes say “the constitution doesn’t allow this, but I think the federal government needs to be able to do it anyway”?
From that standpoint, the question that was asked is the wrong one. You don’t ask: Does the constitution forbid this? when dealing with federal powers. You ask: Does the constitution allow it?
I’ll repeat what has already been said: how exactly is Medicare as it exists now constitutional, but not Medicare that covered everyone? Is the answer simply that Medicare is a benefit that is earned as a worker? But so long as we craft the future plan for covering everyone in the same way, allowing workers to pass on their Medicare benefits to their children, I don’t see how it would necessarily be any different. It would completely screw over people who weren’t paying in to Medicare, but they’d presumably be eligible for Medicaid. Which…how exactly is that constitutional, but not Medicare for all? Is the Federal government rife with very popular programs that simply have no legal basis? Is that what’s driving strict constitutionalists so mad?
And you see, this argument or some variant of it is what will inevitably arise - likely from some fraudulent goons at the Federalist Society - if and when the Democrats pass a MFA plan. It’s a clearly bullshit argument, and, as I’ve said before, it’s basically the singular issue that, if struck down by a partisan SCOTUS - would guarantee that the Dems would add more Court seats.
I don’t agree with this rationale, but it seems so prevalent today that I seriously think the US wouldn’t be able to create a public school system in today’s political climate if we didn’t already have one. We seem to be willing to endure all sorts of societal ills just to spite others.
Although I think I agree with your sentiment … I don’t understand it!
Are you saying that you don’t agree that higher-income people would need to pay higher taxes to achieve Medicare-for-all? Or are you saying that you, as a higher-income person, would be happy to pay such higher taxes? Or are you saying that lower-income people should be happy to use their political power to raise taxes on the rich?
Because “Medicare for all” is an ambiguous moral belief rather than a specific policy proposal, there aren’t going to be many arguments for or against, other than the vague ones about more or less government involvement that we’ve all seen a million times.
Universal healthcare is hard to implement successfully at the state level because businesses can simply move their offices and their jobs elsewhere. That’s not impossible at the federal level, but it’s harder to do, especially since no other country on earth has as much purchasing power.
But there’s no denying that a universal healthcare regime - Medicare for all or whatever we want to call it - is going to be damn expensive. There can be no delusions about that. It would only be possible to pay for it with major tax hikes, and with cuts in spending elsewhere in the budget. It wouldn’t make sense to cut SS or other federal entitlements to pay for Universal Medicare, so that would leave us with one option: cut military spending.
Well I’m not sure about that. I think Medicare for all means expanding eligibility for Medicare to everyone, not just those who are of retirement age. That’s at least a policy bullet point.
But I do agree that we need a better explanation as to how this is going to actually work. I think the only way it does work is to raise income taxes on individuals and businesses rather substantially, and to cut military spending. And I don’t think the current establishment or even the anti-establishment have the desire to go that far yet.
Cutting military spending as a funding source is just a pipe dream. Not because of politics, but because it is not actually even close to what we need. Let’s go back to the above. Total healthcare expenditures in the US are 3.3 trillion dollars. The government via Medicare/Medicaid covers about 1.2 trillion already. That leaves us a 2.1 trillion dollar gap. Insurance overhead is maybe 100 billion at the max, so for easy math, we can say we’ve got to come up with 2 trillion dollars. So, let’s pretend that we decide that the world is at peace and we all learn to love each other. US defense spending is 600 billion a year. If we eliminate the military completely, we still have a 1.4 trillion dollar gap. In a more realistic scenario, say we cut defense spending by 1/3. We still need to come up with 1.8 trillion dollars. The only realistic way to do it is major tax hikes, probably about 60% higher than we’re paying now. For me, I paid about 4800 in insurance and about 10 grand in taxes last year. If you factor in my deductibles and out of pocket, i break even, so im all in favor of it. The people that would get reamed are young singles. Of course, you could somehow play with a different progression on the rates. Regardless though, cutting military spending wouldn’t do anything other than make an unpopular proposal even more unpopular.
Bernie’s “Medicare for All Act” doesn’t do that, as far as I can tell. It envisions a system with “no premiums, deductibles or copays for medical services,” covers dental care, and bans providers from “dual-practice within and outside the Medicare system.” Those might or might not be good ideas but they aren’t how Medicare works.
From a tactical perspective, I think a lot of proponents are way underestimating the absolute shit-fit that will ensue when the details get fleshed out. Most people with health insurance like their current plan, which is a very real and powerful feeling even when it’s based in near-total ignorance of what their insurance covers, how much it costs, and how easy it is to use. The insurance cabal has induced something like Stockholm Syndrome in Americans, such that we’re absolutely terrified of losing our health insurance, no matter how shitty it is. If the eventual plan looks anything like the Sanders bill, there will be a massive national panic attack when people realize that OMG their “good” insurance is going away. Imagine the Obamacare hype times ten. I’m not sure it’s possible to get through that in one bite.
I think the Right Honourable Lord is correct. The best hope was the public option under ACA: the Federal government would collect premiums voluntarily and compete with private insurance companies, keeping them honest and serving as insurer of last resort. According to the Wikipedia article, this option was abandoned when Joe Lieberman threatened a filibuster. Since we’re not in the Pit, I’ll just that Lieberman is not completely an asshole for whom I retain the slightest smidgen of respect.
The first big problem with your numbers is that billing and insurance related overhead has been estimated to be closer to $500 billion and maybe more.
An even bigger problem with those numbers is that they don’t take into account the efficiencies and cost controls that become possible with a single-payer Medicare for all model. Just look at any other country in the world with universal health care for cost comparison numbers. None even come close to the US for per-capita health care costs.
Here’s the real problem. In a properly managed system total costs would come way down but the distribution of those costs would be radically different. One of the signature characteristics of UHC is a simple common rate structure that isn’t based on individual risk factors, but on the aggregate population, but one way or another that rate structure has to be tied to income. It doesn’t matter if it’s funded by taxation, or partly subsidized by taxation, or some sort of progressive fee structure or subsidy arrangement – no matter how you slice it and dice it the one demographic that ends up bearing the brunt of the costs is the very wealthy. This also happens to be the one demographic that has no worries about getting the best health care today. It’s also the demographic with the most political power. There’s no national health care plan despite the fact that it makes sense for almost everyone except those who largely control the political system – go figure!
You may be right about the Supremes, but that says more about them than about the rationality of that argument. Did the Constitution authorize the federal government to spend billions of taxpayer dollars to explore space and put a man on the moon? What federal power allowed this sort of nonsense?
There was no Constitutional problem enacting Medicare back in saner days, and there is no Constitutional problem with expanding it. The problem is the one I noted above: that those most influential in the political system have nothing to gain from universal health care and are going to be dinged for the costs, and they have a lot of ideologues who pander to them, currently in control of both houses of Congress and about to get ironclad control of the Supreme Court.
I think the best way to implement Medicare for All would be to do it gradually. Let people keep their private healthcare plans, but also allow Medicare as a public option.
Newborn babies would automatically be enrolled in Medicare. They too could chose private healthcare when they reach adulthood, but I think inertia would result in most of them sticking with the government plan.
Many caregivers in the US will not accept Medicare or Medicaid. In many places, people who purchased plans under ACA discovered that not only was it not affordable, but no local medical providers or facilities would accept it. The plans they paid for became an albatross, because either they had to pay out of pocket or take a day off and drive long distances to see a doctor. If a single-payer system was implemented in the US, the scarcity issues we already have will become much, much greater. Many doctors will not be able to continue to practice because they can’t function when the government underpays them. Whenever the government pays for healthcare, demand increases, because many people no longer have to concern themselves with costs and therefore want to see a doctor for every sniffle. How can the government address the scarcity? Rationing. Remember “Death Panels”?
I suppose the government will also try to increase supply of medical personnel by offering to pay for people’s medical school and eventually, all the other programs, but that will mean young people will have to be willing to indenture themselves to government service for a long time.
Not really, the issue in Vermont is because the US health care system is so bloated and poorly run that it costs 18% of GDP (as opposed to 8-12% of GDP in other wealthy nations).
So when Vermont tried to figure out how to fund medicare for all, the payroll taxes and income taxes were so high that they feared it would cause businesses to leave the state.
That isnt’ an argument against single payer by any means, it is an argument against letting our bloated system continue. Sadly, the best time to do single payer would’ve been in the 40s, 50s or 60s when health care was 3-6% of GDP. Not the 18% it is now.
This is despite the fact that the medicare system would have seen medical prices decline by 25% over a decade compared to doing nothing (because single payer offers a wide range of cost saving mechanisms. Bulk negotiations, streamlined administration, comparative effectiveness, lower reimbursement, etc), they still decided to do nothing.
Claiming ‘taxes would go up too much’ is an argument against single payer is like claiming ‘the bills will be too high’ as an argument against hiring a plumber when your homes foundation is cracking. The issue isn’t the solution (single payer) the issue is the problem (our bloated health care system).
But having said that, there are fears because our system is so bloated that the tax hike will intimidate businesses.
