It seems entirely appropriate that as I sit down to write this I have just given two weeks’ notice at my current place of employment. One thing I am sure of. While my physical health care needs will continue to be provided by the Veterans’ Administration, my private health insurance (useful primarily for my choice of a private psychiatrist) is going away. If we lived in a social democracy this would not be a problem as I would be insured by virtue of my citizenship and residency in this country. I now call upon the entire Democratic Party to get behind single payer health insurance – Medicare for All.
Two months ago when I first spoke to this assembly, President Trump seemed paralyzed by his own incompetence. In some respects he still is and I wouldn’t be the least bit surprised to find he has resigned or been impeached within the next eighteen months. However, the Republican Party, now in unchallenged power in every branch of the Federal government, is not entirely paralyzed (though they are divided). Their House majority has passed the American Health Care Act. The Republican majority in the Senate will pass something completely different between now and the summer recess.
When the conference committee reports and the dust settles, however, we can be fairly sure that Obamacare as we have known it will no longer exist. The President will sign some form of legislation repealing Obamacare and knocking the health care legs out from under millions of people this year. It isn’t that Obamacare isn’t worth defending or that we can’t count on our elected officials to wage that battle to the last. It’s that we need a strategy for the day after.
In 2018 and 2020, everybody who was in a mood to say “Life in this country sucks, let’s overturn the applecart” will still feel that way. I feel certain that if single payer had been passed in the first or second term of President Obama, the Democratic candidate (who probably wouldn’t have been Hillary Clinton) would have been elected at the last Presidential election. As we face the next election with the healthcare part of the status quo in ruins, Democrats have an opportunity to help the people of this country overturn the applecart (in part) while preserving the most important traditions of democracy. Most of all, we have an opportunity to improve American metrics from life expectancy to infant mortality and the health of the nation in general.
Single payer would lead to two major trends lowering the cost of health care overall. First, people would be able to go to the doctor the first time they feel something is wrong instead of waiting until acute pain drives them to the emergency room. As in most fields, in health care an ounce of prevention is worth a pound of cure, and leads to a healthier, wealthier patient. Obamacare realized this goal in part. Millions of people who found themselves covered by expanded Medicaid or subsidized private insurance were able to get care at an earlier stage of whatever disorder was bothering them, which saved the system billions.
Premiums were still going up, however, because the wasteful overhead of private insurers was not touched by Obamacare. Patients as individuals and the taxpayer collectively were still paying for dozens, perhaps hundreds of separate mini-bureaucracies that processed everyone’s claims to healthcare and (crucially from an economic standpoint) advertised themselves as the best way to get healthy. Eliminating this overhead would save the system hundreds of billions per year even as replacing it with one big bureaucracy would increase the tax burden on the wealthiest Americans.
That’s one part of the drawback of single payer. The other part is that hundreds of thousands of people at the least would lose their jobs. Everyone who currently works for a private insurance company (and most with subcontractor positions such as medical billing specialist) would need to find new employment.
Democrats must be honest about the costs of single payer. We must argue from our deepest values and trust voters to share them. A new Civilian Conservation Corps, an all-out infrastructure push, or the equivalent must give hope to the people losing their jobs. The top income tax bracket must be raised into the fifties or sixties, but that is desirable anyway to discourage private employers from paying such huge salaries to their CEOs and to equalize the economy.
Hillary Clinton’s losing the election does not mean the people at large do not share our values. Indeed, 48.2% of the electorate was willing to vote for Hillary’s values – but we can do better. The Republicans won 46.1% of the popular vote because they were perceived as the party of change. If Democrats go straight out for single payer and adopt a social-democratic platform across the board, it will be obvious that we are the party of change and we will clear the 50% threshold.