How about transferring the American military budget to our socioeconomic needs at home? How about ending the continuous wars that our country has been waging throughout the world since WW2? We should swing for the fence? Funny, the NYT staff just gave Tulsi Gabbard a 2.6/10 score for the debate - yet once again she was the most searched candidate afterwards. In fact, she was the most searched candidate in America after all three debates that she was in. IMO, the most consequential exchange in the debate was between Tulsi Gabbard and Pete Buttigieg regarding American interventionism.
https://www.youtube.com/watch?v=RdYu2yXpmqo
It's great to dream big and be bold, but equally important, is the execution. You can dream all you want, but if you can make *ANY* parts of the dream to happen, then it's just empty talks. What's the use of having pipe dream when your stomach goes empty or while you're bleeding to death? When you're beggars, you can't afford to choose.
True, big dreams are inspiring. But you have to address basic needs first. If you can't even deliver on the most basic needs, then all those big dreams are just empty words.
I still strongly believe in incremental approach. It might not sound as sexy, but it's realistic. It might not be as inspiring, but it allows us the time to keep the dreams (and ability to dream) alive. Is there any wonders why most of those in the Sanders and Warren camp are mostly educated white voters? Is there any wonders why blue collar workers are still solidly behind Biden?
I beg to digress, but I can't help adding a quick word to the 12 candidates. Gabbard: Getting irrelevant. Steyer: Doesn't add any value to discussion. Booker: Non-aggressive stance to audition as VP. Harris: Unreliable flip-flop. Sanders: Extreme ego. Biden: Boring but reliable. Warren: Preachy on plans but can she deliver(?). Buttigieg: Promising star that could otherwise be another Obama in another era. Yang: Surprisingly refreshing stance. O'Rourke: Weak and lame. Klobuchar: Solid cabinet candidate. Castro: Decriminalizing illegals will never fly.
3
Agree with the sentiments expressed by Mr. Blow and as a long suffering never Trumper mark today as the beginning of the end for DJT. Mulvaney drew the short straw compelled to issue a half confession but given a few more days of testimony he will need to amend the quip pro quo to include the Bidens.
Charles, I too am looking for bold ideas but I am not so much worried about "Let them know that this will be a voyage into the uncharted for America." Because other advanced countries have already managed to tame the healthcare for all projects.
As to taming inequality, the U.S. managed that after the first gilded age. You need to tame your fellow opinion writers and reporters in print and TV who tend to look for "gotcha moments" when they can relentlessly chase politicians on taxes as if its a bad word. Its only a bad word when the taxation system is gamed by the super rich and the multibillion dollar corporations.
When the President on national TV claims he's being smart for avoiding and not paying taxes you know we have reached rock bottom.
2
Here's a catch. Medicare for all means less income for doctors. We already have a large, and growing, shortage of doctors, and a growing need for doctors. Reducing the income of doctors will decrease the numbers of doctors. Medicare for all will also decrease the income of hospitals. Hospitals are already going bankrupt, and in large swaths of the country there's a need for more hospitals. Maybe these issues need to be dealt with first.
1
If the insurance companies did not take a cut the doctors would do better. The whole issue of in network and out of network costs at hospitals are the insurance companies dictating who, what and how much gets paid - not the hospital.
3
Fantastic column! I couldn't agree more. I have been a very enthusiastic supporter of Elizabeth Warren, but I am quite certain that if she doesn't take this advice, wisdom from Charles Blow, she will lose.
"Almost none of them are policies you could institute by executive action. Almost all require acts of Congress, and Congress would likely produce something vastly different than what you propose, if they pass a bill at all."
Thank you, Mr. Blow, for using your platform to say what I've been saying in my very small corner of the world. People act as though every policy point espoused by Bernie Sanders or Elizabeth Warren would be magically transformed into reality upon their election. It's just not what would happen. People would be able to lobby their own Congressional representatives with their concerns if and when anything actually reached the floor of Congress.
4
In other words, after we all get rolled into one big Medicare for All HMO, some of us aren't going to get the care, especially specialized and expensive care, we need.
In a decade all the kinks will be worked out, and we will be in paradise. Until then, some people will die unnecessarily.
1
@Jonathan Katz America's current system of for-profit health insurers has placed millions of Americans at or below third world status. People are *already* "dying unnecessarily" thanks to this.
And millions of Americans are facing medical bankruptcy. Millions more avoid all possible medical care due to their inability to afford sky-high co-pays. Eventually, small problems grow large and they get socked will bills of hundreds of thousands of dollars, requiring cutbacks on food and utilities, even housing.
I welcome any form of universal health insurance we can force past the GOP. Once we've got it, if we can derail their voter suppression techniques and vicious, lying propaganda, we can improve it.
5
Add healthcare reform to the list with other MAJOR DISRUPTORS like the fossil fuel industry, the ICE auto industry, the major displacement of jobs by AI/robotics. We are in for tumultuous decades ahead. Here's letting you know.
Totally agree with you, Mr. Blow. Thanks for this. I hope that Senator Warren (who I respect but whom has been maddeningly evasive on health care) reads your column!
3
"Big moves come with hitches"
I'll say,
Like, maybe winning the WH and the Senate against fierce opposition?
Failing that, the wrangling here over M4A minutiae is moot.
3
The problem is not that Warren evaded the direct question about M4A and middle-class taxes. She was right to evade it; it is not a yes-or-no issue and answering yes would have just provided an attack ad clip to Republicans. The real problem is that she has embraced a mandatory 4-year transition to M4A that is politically and operationally unrealistic. She has done that because she believes she needs to pull away Bernie's progressive supporters in order to win the nomination. But the longer she runs with his M4A proposal, the less electable she becomes. The only way the Democrats can lose the 2020 election is by campaigning on a promise to force 150 million Americans off their current health insurance plans.
2
Thank you.
2
Mr. Blow,
Didn't you read the article in your own newspaper today by Lindsay Koshgarian how the US can and should pay for government sponsored Health Care for All?
3
Precisely, what Medicare for All skeptics omit in their faux concern for budgets (e.g. the trillions spent on continuous wars), is quite telling.
2
"The Affordable Care Act was passed nearly a decade ago, and there are still major issues that need to be resolved."
True, but a lot of those major issues have been manufactured by conservative operatives and GOP politicians deliberately trying to sabotage it. That said, some form of Medicare For All, whether incremental or all-at-once, is not exactly re-creating the U.S.S.R. Canada, after all, is not plagued with collective farms, gulags, and 5-year plans. But Mr. Blow is correct that Democrats need to level with voters. Failure to do so will convince many that their personal health care spending will go up drastically, and that the candidates are trying to hide it from them, much like a used car salesman telling a customer he doesn't need to see a Carfax report. Some specifics on premiums (taxes) and out-of-pocket costs, based on various income levels and family sizes, would go a long way toward gaining trust.
2
I agree with you completely. We have seen what happened when Obama compromised, virtually bending over backwards to give up more than 65% of his objectives. My biggest problem with him was forgoing his pledge about transparency, the main reason why I voted for him and the greatest test of true democracy.
That was my first vote after becoming a citizen. I'm Jamaican and lived here for over 40 years and thought it was important enough to add my vote.
3
Tell the Truth, Tell the whole Truth?
Only if anybody would know the whole Truth!
Nobody knows even half-the-truth, if at all.
Has any nation wide project ever projected Total Costs ahead of of time? Did the government know the the whole Truth about the 2008 economic disaster, or the cost of bailing out the banks, insurance corporations, etc?
How can any Presidential candidate provide the kind of information Mr Blow is asking for?
It should be suffice to know that the cost of a nation wide Medicare for All
will be substantially lower than the present costs and that
Americans will pay significantly less for their health care than what they are spending currently, and that
every American's health care is covered and that
the so called job creators (Businesses employing people) will not be burdened with humongous cost of providing health insurance to their employees! and that
Americans won't be bankrupt because of Health Care Debts!
And, Finally our Nation will join the other civilized nations who have done this already!
3
The truth on Elizabeth Warren's border plan. It will be a big loser, in the swing states. In the absence of economic collapse under Trump, it would ensure her defeat in the Electoral College. Read it at:
https://medium.com/@teamwarren/a-fair-and-welcoming-immigration-system-8fff69cd674e
Wade through the rants about Trump and look at what her plan proposes, There is no mention of enforcement at the border, because her plan will decriminalize crossing it anywhere, anytime for anybody. She does not mention the deportation of anyone. No one crossing will apparently be turned back or detained. If caught, they will let loose in the US after being given a distant court date, free lawyer and free health care. She actually does not mention deportation of felons, only mentioning "focusing on real threats". The only targets would be to "disrupt and prosecute human trafficking".
Beyond that she also plans "amnesty" for 11 million or more "illegals" already here, and for any undocumented people who come here in the future and settle down. She calls it a "Fair and Welcoming Immigration System". In total, her plan would be a huge target for GOP attack ads, and would, frankly, not seem a wise or realistic policy for border and immigration policy, or for winning the presidential election against Trump.
3
Yep, a lot of employees in the health insurance industry would lose their jobs. But thanks to global climate change and the disasters it produces, there will be lots of claims to process on the property insurance side...
Do NOT tell the truth. This will only encourage Republican enemies to pick apart your plan. Just say it will be beautiful, it will be transformative, and it will be amazing. Stay out of the weeds and talk about the beautiful lake. This is how Trump got elected. He painted horrible and beautiful pictures for Americans to visualize. This is what people want to see and hear. The truth is you don't know how to work out the details yet. So don't get us all bogged down in your sad detailed plan and who will pay for it. Paint us a beautiful picture to which we can aspire.
4
Remember kids. Because you say it during the campaign, this automatically ensures that it will be passed if you are elected.
What's a Republican? Never heard of them. Regardless they will not matter if I am elected. My mandate guarantees my proposal will be passed.
I mean, look how the Merrick Garland SCOTUS nomination turned out.
1
" the desires of the liberal heart, to the American heart, to the desire for the country to aspire to and achieve greatness."
Is that one thing or three?
Mr. Blow thinks he is America.
He isn't. He is a part of America, but only a part and that part which nurses the illusion of thinking that it is the whole.
1
Charles Blow has finally written a dumb column. I'm surprised. We have had Medicare for years so it's not like we are starting over with a "clunky bureaucracy". The experience gained can be applied to Medicare for all or to expand the system by adding age cohorts on a planned basis. Many excellent comments here!
Only the Democratic Party could possibly think that pre-emptively compromising their political goals is somehow a viable political strategy.
36
@Greg
Agreed.
Pres. O. didn't learn that lesson till his final 2yrs. in office.
Harry Reid had to ask him to stop sending Biden into congress because he kept giving away the store.
Recalling the history that he and Biden shared while working together under President Barack Obama, he also offered some criticism. Reid was not always pleased with Biden's choices to negotiate with Kentucky Sen. Mitch McConnell, and felt that some of the yielding on Democratic interests sapped their perceived leverage in the Senate. "That’s who he is," Reid said of Biden, whom he's known for 34 years. "He’s been always easy to get along with. And he was Obama’s guy to go work things out with McConnell on several occasions that I didn’t really appreciate."
The vice president’s disappearance has grown ever more noticeable as the government shutdown enters its eighth day with no resolution in sight and a debt limit crisis looms. Biden was once Democrats’ deal-maker-in-chief, designing budget pacts with Senate Minority Leader Mitch McConnell in the summer of '11 and New Year’s Eve '13.
But Biden’s deals rubbed Democrats raw. He gave up too much, they said.
“None of the deals Biden has struck have aged well from the perspective of the Democratic Caucus,” said one Senate Democratic official aware of Reid’s face-to-face insistence that Biden be excluded.
https://www.politico.com/story/2013/10/joe-biden-government-shutdown-debt-ceiling-097969#ixzz2h8pGHDRQ
3
Universal health care is a good idea, and Medicare for All could be a pragmatic solution. What is not pragmatic is thinking we can move everyone in the U.S to Medicare for All in four years, as the Sanders M4A bill does.
Our healthcare system is complex, and changes will need to be made thoughtfully over a period of time to avoid extreme disruption. For example, right now we have employer-sponsored private health insurance, and private health insurance purchased on the ACA marketplace or directly from the company. We also have multiple government health systems, including Medicare, Medicaid, SCHIP (State Children's Health Insurance Program), Tricare, the VA health system, Indian Health Service, and various state programs. What happens to all those systems when M4A is implemented? This needs to be carefully planned.
Maybe we should start by improving and expanding the existing Medicare coverage. Lower the opt-in age to sixty. Stop making seniors shop for a prescription drug plan. Instead, have Medicare Part B cover prescription drugs, and require Medicare to negotiate drug prices. (We could also limit all prescription drug prices in the U.S. to no more than 110% of the Medicare negotiated price.)
If M4A is phased in gradually over a period of years, perhaps a decade or more, it will be less disruptive. Private insurance companies will gradually shrink, and/or become government contractors to process claims. M4A can be done, it just can't be done quickly.
55
@Susan
Leave open a public option to compete with the Bloated Insurance companies, and the market will do the rest, probably within four years or so.
15
@Susan
So, how long should we take to implement universal health care, in your opinion? Another 50 years? Even if we adopt Medicare for ALL next year, it will take another 10 years to work out all the kinks. Look at the ACA which was passed in 2010. Even that limited system isn't fully done yet!
After about 10 years (time it takes to absorb all government programs into one national system) it will be just ONE National Health Care System.
2
@Susan
You are absolutely right. I have been posting similar points for the past four years. Once you start really thinking about how M4A will be implemented, not just as an aspirational argument but as a real program, you realize how many complex issues will have to be worked out. The legal and economic ramifications of different implementation approaches will have to be evaluated. Regulations will have to be written and put through mandatory public comment periods. Our tax laws will have to be thoroughly revamped. Programs to ease transitions for private insurance workers and other displaced workers will have to be created. And on and on. Remember, just creating the Healthcare.gov exchange took three years and the system crashed its first day. Anybody who says M4A can be universally implemented in four years is being totally unrealistic or disingenuous.
4
"Conservatives are never going to pat you on the back for your moderation. They will frame every proposal you put forward as a push toward the apocalypse, as an end of the American ideal, as an obvious creep toward socialism." .. Do you realize how much of a caricature that is? All conservatives think this way? Really? It's amazing how political tribalism is embraced by the likes of Blow while racial tribalism is simultaneously castigated as anathema (unless its racism towards white people of course. And yes, there is such a thing). Why can't we reject tribalism altogether?!
5
@Jack Pincus
You seem to have selective amnesia. Remember that if McCain had not turned his thumb down, voting no, the conservatives and the Republicans he’ll bent on destroying the ACA, would have taken perverse delight in throwing another 30 million Americans off health care, with NO replace plan. They were all in lock step with McConnell trying to ram it through with no real debate or chance for amendments. So please don’t try to con me about compassionate conservatives. I will never forget this historical vote and the perpetrators- your wonderful conservatives who went on to ram through tax cuts for the 1% and putting 1 trillion more on the national debt to pay for it.
9
@Jack Pincus
While you are correct in the abstract, the majority of those in gov. and media are in lockstep to do 'n think as Blow describes.
Do you agree to that descriptor?
Agreed, the brush is overly large saying "All conservatives think this way."
I just seems to be a really, really hard time finding those that don't.
5
In an ideal world every thing Charles says is on the mark. In this world, it would likely lead to not winning the nomination.
Dems should learn to tell the Truth like the GOP. Tell the truth like the Trump tax cut was designed to help the middle class
1
Didn't Carter try to do that? Just before he lost to Reagan. The voters don't want to hear how difficult it will be, they want to hear how wonderful it will be. Sorry, but that is a sad truth. You start to describe the catches, and people will see only the catches. Look at Trump. The voters didn't care about catches if his policies, they were mesmerised by improvements he offered.
"Treat voters with respect by telling them the whole truth, warts and all, instead of simply dangling jewels in their faces."
I don't recall the GOP ever telling voters the whole truth about tax cuts. Sounds like a great idea, but seriously detracts from your quality of life.
As far as insurance workers, the real victims will be the executives. It's hard to make $17 million dollars a year and then suddenly find yourself out of work.
I think it's time for a new WPA program. It can absorb all the insurance workers (not their bosses) and get opioid addicts invested in a new life.
3
@Nick R. I don’t recall Dems telling the truth about Obamacare. Where are all those reductions in health care costs?
2
In a political discussion, voters may want to know facts. But do they in practice? Consider who was elected president in 2016. Americans elected a fantasy. A candidate elected on the basis of jingles aimed at political identity and zero practical plans for his proposals. His strategy is "just do it" gone awry.
Why are Democratic candidates held to superhero standards by their party and the (current) Republican candidate held to no standards by his party? Americans need a reset thinking about elected officials. We need to value governing and leadership skills before considering political orientation. One would think this is a given but apparently not.
2
Thank you Charles Blow. I love this essay, and it resonates and shines. I hope Elizabeth Warren reads it too, and learns something. Same for Joe Biden. I agree that "voters are adult enough to handle the truth," but wise enough to know that nothing is as easy as it should be. My favorite expression in 2019 is the admonishment from writers like David Brooks, that to be civilized, you have to be able to hold contradictory ideas in your mind at the same time about something you study or care about. One possibly astute writer in the NYT after the recent Democratic Debate said, Warren was marked down by the op-ed writers who graded the debate from 1 to 10, but not necessaily by the general public. She didn't give the GOP hate machine the sound bite, this will raise your taxes. But she also appeared to not trust the public to hear the strengths and weaknesses and complexities of her big idea. She let another on the stage, possibly Uncle Bernie, yes your taxes will go up, but not by as much as your medical expenses will go down.
Meanwhile, if Joe Biden would relax a little, he will make a great president, and he could get elected, ie, win the electoral college, in this maelstrom of fake news and hate.
David Lindsay Jr. is the author of “The Tay Son Rebellion” and blogs at InconvenientNews.net.
2
If your'e going to dream big about Medicare for All, then you better dream big about how to get the thing passed. President Obama had the luxury of having a filibuster proof Senate majority of 60 Democrats in office, but still couldn't get a public option through. We will be lucky to win a simple majority in 2020. How the heck would Sanders or Warren get Medicare for All passed unless we have control of both Houses. The right wing judges on the Supreme Court would likely strike down large parts of it just like they did Obamacare. Dreaming big is fine, but at some point you have to wake up and face the real world.
1
Cancel the filibuster, and enthuse the base with proposal to improve outcome of 2022 election, if the proposal will be not passed before
Exceptionally well put Charles. I often find myself with a foot in both camps. Your article puts the missing piece of the puzzle on the table. The truth - all of it, needs to be on the table. Will these changes cost money? Absolutely! Why should we spend it and how shall we raise it?
We must lead the American public with as clear a vision of the future as we can, as you put it, warts and all. In my career as a university professor with a short side trip into administration, one major realization emerged. Students and faculty will, if the need arises, rise to almost any challenge put before them. But to get them to do so, you must be scrupulously honest with them. They can, however, tell when you fake it. Good and decent people are no different. Lay the cards on the table. Debate, really debate, the pro and cons of each policy option. Spare them the platitudes and slogans -
2
Unfortunately the only time most people see and hear the candidates is in 45 second sound bites in debates designed for drama and ratings, not nuance and information. Charles, I would love to see an in-depth interview with you and Elizabeth Warren that gives her a chance to do just as you suggest.
1
@Bruce Crabtree Make sure you ask for her plan on reducing the debt.
Hidden costs; that's what I hate. Let's just put on our big girl and big boy pants and figure out the REAL costs of our proposals and actions in the world and pay them up front. Not kick the can down the road for our children, and their children. Pay the real costs of our oil based society and its effects on the planet we call home; the real costs of our wars, including warrior inequality- the bottom half of the income population contributing more than its share; the real costs of our cheap food in health and pollution; the real costs of transforming a health care system that doesen't end up caring for enough of our people.
So, yes, say that your taxes may go up, but your hidden costs will go down as well as your overall expenses. More money and less worry; really simple when you say it out loud.
And yes, we'll have to bite the bullet, but, unfortunately or not, there are plenty of those out there to bite, and we've done it before. Victory gardens and rationing helped defeat the Nazis; we went to the moon using slide rules! We can do this, we can do the hard, the difficult, even the nearly impossible. We can do this, together.
4
I'm one of the people accused of having a "Cadillac" health plan....ie I'm a union member. Free health care or free college are great ideas I support. But it isn't gonna happen overnight! Education and healthcare are "free" in Mexico but it depends on good grades and a system mostly dependant on clinics.
I paid my student loans and pay for health insurance. Why should it all be free for RICH people too?!
Moderation doesn't matter mean we don't have the same end goal. But extreme left positions will work for Republicans at election time.
Russian voter suppression on social media worked best by using hardcore left and right sloganeering to divide Americans.
2
The 'voter suppression' on social media works best when the moderates offers nothing to improve lives of many American people, calling them to settle for the status quo.
The problem is that telling the whole truth about the future is never quite possible. For example, it's certainly not the whole truth to say that taxes will go up as a result of expanding Medicare. It's certainly not the whole truth to say, as Trump and the other Republicans, that they'll come up with "something better".
It's much easier to be accurate about facts and about the past and the present. It's certainly not the whole truth to claim that people are happy with their medical insurance. But we could say that people are afraid of losing it–that's accurate. It's certainly true that millions of bankruptcies have been caused by medical costs. It's certainly true that the ACA is hugely complex. It's certainly true that Americans who have Medicare like it. It's also true that many Americans have private supplemental insurance to accompany their Medicare. It certainly true that many other countries get better medical results than we do.
The biggest truth we can tell about the future of healthcare is that we the people of the United States can afford to take care of our people. We are not restrained by availability of resources. We can choose to make our system much more fair, much more affordable, and much less costly.
2
Many countries around the world provide access to affordable healthcare for all their citizens, but they don't all do it the same way. A nice thing about the size of our country and the nature of our federal/state system is that we can try different things at the same time.
Perhaps the candidates should propose block grants specifically for the purpose of expanding access to health care that would allow states to serve as laboratories, devising their own systems to get to universal coverage; some might opt for public health clinics, others might subsidize private insurance, others might allow buy in to Medicaid as a public option, etc. That way we could try several options and see which one turns out to work the best.
1
Unfortunately, we can not try many system at same time, because we have common market, and if you put squeeze in one state insurances and health providers will simply move to another state. The guns law are the example, when guns are flowing from the states with lax laws to the states with strict laws.
@yulia
I think those issues are very different. A gun can be purchased in one state and moved to another; health insurance cannot. People can choose to move to a state that offers better benefits, and to some extent that happens with Medicaid, but there are significant barriers to moving to another state that limit the numbers willing to do it. One must leave family and friends behind. One must be able to find housing and employment in the new state. The political and religious culture of different states varies, so people from one region are not always eager to move to another. It is likely the ones with the most generous health care plans would be the ones with the highest taxes, so there is a tradeoff. The different political philosophies is part of why I would like to see the opportunity to try different approaches. I could easily see more Republican dominated states wanting to keep private insurance plans, while more Democrat dominated states might well try single payer approaches. This might be more palatable to voters in those states, who have differing beliefs about the role of government vs. private industry.
@Nikki Even if the Dem states want to try the single-payer approach, it is very difficult to do on the state level. First of all, people are moving in and out all the time, they can move in only when they are have a serious illness, increasing the pool of sick people in the state, while are not paying the taxes necessary for single payer approach. Moreover, the state have much less leverage with health providers to low cost of the health care, because health providers also could move out of the state.
Is Mayor Pete Buttigieg’s proposal for “Medicare for all who want it” a milquetoast proposal because it is incremental in its design and conserves the private sector union and corporate health plans its beneficiaries love until they don't? I doubt it.
It is worth remembering that Medicare as we know it began small. It provided insurance to the old and infirm that private sector, profit driven insurers declared uninsurable.
The advantage of Buttigieg’s proposal is that it places a government insurance program to pay for privately provided health care in direct competition with private sector insurance companies whose business plan demands large copays, denial of coverage, limitation on providers and forms of opaque rationing.
If this competition is well designed, Buttigieg is wagering that the private sector will change its business plan and that given free choice many currently insured consumers will switch to Medicare. For this competition to be truly free, the private sector must, by law, be blocked from refusing to insure high risk patients or charging exorbitant premiums for insuring pre-existing conditions.
If that is done, this contest been Medicare and the private insurance companies can begin and a free and fair competitive market can decide whic plan consumers prefer.
3
Don't we already have this competition? People who are qualify for Medicare could choose if they want Medicare or private insurance. Seems like majority chose Medicare. In order provide the same choice for other people, the Government should have enough money to cover everybody. in Medicare, in case if everyone would prefer the Government's program. Without that you risk to have disruption when volume of people who applies for the program exceed your calculation. Moreover, Buttigieg's plan is not so much about the public option (that is actually pretty poor described: what will be premiums, what it will cover, will it have deductibles and so on), but more about expanding the subsidies, that will fuel the growth cycle of healthcare. More subsidies lead to inflation of healthcare, making insurance less affordable for people who is not qualified for them. Buttigeig learnt nothing from the mistakes of ACA.
I can’t help but feel that Mayor Pete and Senator Klobuchar are playing contrarian in order to win the votes of Medicare For All skeptics, revealing their lack of seriousness about the issue and possible ignorance about how much our healthcare system flirts with white collar crime. I’m a physician and see these moral crimes daily. It is a tragedy that Warren was hammered about the cost question, yet didn’t seize the opportunity to explain what she meant by “cost” going down, referring to total household costs. The difficulty understanding the difference between taxes raises and total cost lowering is utterly mind-blowing. It is a shame that pundits have been conditioned to use the word tax as a weapon and that so-called moderates seek a hard answer on the price tag when in actuality, initiating legislation on Medicare for All will simultaneously initiate discussions, then legislation on tax policy, military spending, and the array of industry and corporate subsidies, which will clarify the concerns of cost. How do you think our endless wars were and are paid for? Do you care to know? Lastly, I believe it is important to take a definitive step towards our end goal, Medicare for All, as the question of cost will lead to a healthy and much needed public discussion on what we actually spend tax dollars on and how we can reimagine the relationships between citizens, and government. Why should we be afraid and allow our fears to hinder the necessary steps forward?
"But we love the health insurance we have!" Really? I think what people love is that their employer pays most of it, 82% of single coverage per Kaiser Health News. They may understand that Medicare for All is cost effective for the country as a whole, but they fear it will cost THEM more in higher taxes. If the tax increase is more than the employee contribution, they lose, while the employer gets increased profits. The only way to overcome this fear is to present a realistic plan to address and overcome the problem. Should employers give a raise equal to what they formerly paid in health insurance premiums? Or some percentage?
2
Did anyone notice that Joe Biden attacks Medicare-for-All by repeatedly saying it’ll cost $30 trillion over ten years, and we can’t afford it?
Guess what, Joe? We’re now spending $3 trillion a year on healthcare, and costs are rising faster than inflation.
I guess you‘re getting tongue-tied and really mean to say we CAN afford it!
3
@Cinclow20
The CBO has already said we can't as things stand today. It would pull to much from total federal revenue. Just because we are spending that much doesn't mean it's there to spend. I have personally financed medical care. I have also written off medical costs. So have millions of other Americans. There is an extensive article in the Atlantic today that clearly breaks down how very expensive this will be.
@Lauren
We would need to find a way to transfer the money currently being paid to insurance companies to being paid to the government. A payroll tax would be the most efficient way to do that. Indeed, that would be desirable, otherwise employers would simply pocket the savings they are no longer spending on health insurance rather than giving the employees raises to pay for M4A taxes. I would also add a tax on dividends and capital gains.
I'm all for medical for everyone.
But I look at that as like building a skyscraper.
And we all should know that if the foundation is not right or precise or off by centimeters, in the long run, the building will collapse.
To fix that collapse or 'could' collapse, would take a lot of time and effort not to mention money to correct.
Growing up I watched as people (men) built houses in my newly developing neighborhood.
First, the did the measuring and put string around stakes they had hammered into the group, then they dug holes into the ground which they lay bricks and concrete.
Then after about a week or so they started something else.
Many of those homes are still in existence and standing over sixty years later.
I know that my party wants a quick fix, but if you want to build something it takes time.
I say stick with the AHCA and expand it.
Many people don't have the care they need or want because many states, RED ones, in particular, wouldn't sign up for AHCA.
People still could have gotten it, but many people listening to their POLS and especially since it was put into action by Obama decided not to get anything.
Read where one woman in Kentucky said, I love the plan, but I hate they call it Obamacare.
But keep the plan, build on it and map out a plan to make it better.
And also keep in mind, healthcare is now a thriving business.
Good advice: go big, go bold. Fortunately our country has built in checks-and-balances which can perhaps temper ideas which are "too big/too bold". Does anyone think, for example, that if Warren becomes president, medicare-for-all will suddenly become law? Going big/bold puts good ideas out there - some survive, some don't. But if they're not out there, they don't.
One doesn't need a degree in American history to know that most landmark progress in the U.S. over past century has started with big/bold ideas, initially considered too big/too bold by many. And most of this progress depended on the Democratic party. The Republican party doesn't do "big/bold" at least for any domestic issue.
1
Part of the truth that Democratic presidential hopefuls need to tell is that few, if any, of their policy ideas--grand or modest, transformational or traditional--have a snowball in hell's chance of becoming reality unless control of the senate changes hands. All this focus on winning the presidency, even if successful, will mean little so long as McConnell and company continue to play grim reaper. That simple truth is one too many progressives are choosing to ignore.
2
There is a very simple reason that the Democratic candidates cannot "tell the truth". Their policies require massive amounts of money. Taxing the wealthy will generate some of the required funds but the only way to get the rest is to tax the middle class. Campaigning on raising the average voter's taxes almost never works and it won't work this time. So Democrats will continue to be silent on revenue until the general election when they will be forced to answer. Then they lose the election and endure another four years of Republican control. RBG will never see a Democratic President.
1
There seems to be a big hole in people’s ability to understand cost. I am not an economist but I am a retired businessman.
It doesn’t matter whether you are manufacturing widgets or providing healthcare.
To ensure that you can provide an item or a service you have to analyze every step of a process and determine it’s contribution to he overall cost.
That’s why people who focus on “taxes” when it comes to healthcare get it all wrong.
If your out of pocket expenses for your healthcare decrease by $10,000 and your taxes increase by $5,000 your overall costs are $5,000 less even though your taxes went ”up”.
The end result is that you have 5,000 more in your pocket
That’s why people need to stop asking how much will my taxes go up and start asking how much will my costs go down?
Same thing goes for society as a whole.
2
"Tell the truth. Tell the whole truth. I genuinely believe that most voters are adult enough to handle the truth. In fact, I believe that not being fully on the level hurts progressives. Voters feel in their gut that all these big plans sound too good to be true. 'What’s the catch?' is the question that hangs in the head."
Honest question: why are Democrats constantly being told that they need to do this, while Republicans consistently fail to get called out on their own downright fraudulent promises? Why does failure to point out the potential downsides of their plans "hurt progressives" while Republicans skate, over and over again, when their promises get broken? "Tax cuts that pay for themselves" never actually do. "Dynamic scoring" is never remotely close to predictive. They get to claim "burdensome regulations" are "killing jobs" without being expected to defend the loss of life that will follow, say, the loosening of clean water laws. I would love to live in a world of voters who are "adult enough to handle the truth," but we actually live in one where enough citizens voted for a guy whose inability to be reliably honest is pretty much his calling card.
2
Currently Elizabeth Warren is getting flack for not saying her Medicare-for-all proposal will result in a middle-class tax increase. However, if she says it, then that will become the entirety of her proposal in the media. "Total costs will go down" is in fact a better statement of the "whole truth" of her proposal.
The challenge is not just to tell the "whole truth", but to make sure the whole truth is what is being talked about.
3
It's not like we don't have the entire developed world's healthcare systems to pull best practices from. Getting to better patient outcomes for half the cost should make the most ardent republican fiscal hawk happy. But, oh no, what we will see is continued mendacious and relentless lying from the GOP on healthcare reform. That is why the dems have to be on point with their messaging as they formulate a plan that will save billions and get us to universal health care. This is not an impossible task.
3
Let's start by separating the concept of health care from health insurance.
Some people SAY they love their private health insurance. But what they really mean is that they love their health care.
Guess what folks: those people and facilities that provide your health care today, will still be providing your health care tomorrow. It's just a matter of who pays them, and what you hoops you need to jump through to get health care.
If you love your care, under Medicare for All, you get the same health care you love.
Under health insurance, you are paying for your health care. You might be using your income or wealth to buy an insurance policy, and agree to certain deductibles and co-pays. You might get it through work, in which case your employer is paying some of your compensation directly to a health insurer, and you get whatever set of deductibles and co-pays they decide. But make no mistake - if they're paying an insurance company $20k for your health care, that's $20k that they could just pay you, or pay the gov't, instead.
Under Medicare for all, you are still paying for your health care. You might pay a payroll tax, an income tax, or your employer might pay a payroll tax. But your employer isn't going to simply pocket the $20k they are paying for your health care. That's just not how labor markets work. You're getting your total compensation because your employer thinks you are worth it. Markets make them.
2
But before they can tell the truth, they need to gather all the facts. And the facts about Medicare for All are, well, complicated. On the one hand, perhaps (but only perhaps) funding will require tax increases. But it's also likely that, given (a) how much employers contribute to the cost of health care, (b) how much we contribute in the form of employee contributions to "premiums" or direct payment of premiums, (c) how much we pay in copayments, coinsurance and deductibles, and (d) how much is spent on admin costs paid to the middle men (insurers, their highly compensated executives, their vast infrastructures, dividends to shareholders, etc.), and incurred by providers, who are required to negotiate payment arrangements with hundreds of different payers, manage claims, collections, etc., there would theoretically be plenty of the money that is currently in the system to offset the increased costs of coverage for all of us. But the system has to be structured to capture all that money (rather than allow employers to stick the savings in their pockets or distribute to shareholders). Providers must be paid what it costs to provide care, something that neither Medicare nor Medicaid do currently, which is why commercial rates are so high, because they offset some of those losses. Medicare's admin costs are about 3%, while admin costs of insurers and providers approach 25%-30%. As to jobs, maybe those bean counters could work for the healthcare providers instead.
2
If we're going to start telling the truth, let's start with the fact that Medicare alone is not a good solution for most people. Why? Because it doesn't cover enough. People who are okay with Medicare either have the discretionary income or savings to make up the 20% they owe and pay for their Rx when they fall into the donut hole, or have a supplemental plan or are on Medicare Advantage.
I know it's worlds better than the outrageous premiums and deductibles many face under the ACA, but it's not Medicaid.
The other truth that needs to be told in the comparisons to countries with free or low-cost care is how limited that care can be. I've listened to enough interviews with KOLs and clinicians around the world to know that cutting edge medications are usually not available to the publicly insured population, or only after a stepwise treatment approach that requires them to fail a series of standard treatments, exposure to which can mean that the cutting-edge treatment won't work well or at all. It's rationing, of course, but we're already rationing our own care when we fail to seek treatment or fill prescriptions that are unaffordable.
3
@Penn All true, but under M4A all that cost sharing under Medicare will go away. It’s even better than Medicaid. The term “Medicare” for all is a bit of a misnomer. I’m sure it was adopted to emphasize that we already have a huge, functional and generally well-liked program of federally-funded health insurance in place, that it’s not some kind of impossible dream. But M4A is not traditional Medicare, it’s 100% coverage for all necessary medical, dental, vision and audiological services.
Also, what will happen to the extraordinary high salaries of doctors and other medical personnel? Would these be adjusted lower to cover Medicare for all. These doctors have huge med school debts to repay not to mention all the other health professionals who gone into hock for education. Democrats please address this!
2
This is all true, but every Democratic politician and voter should point out that the Republicans never tell the truth about their policies. As we all know there are so many examples to choose from.
1
The big bold proposals are not sound and well considered plans for addressing needs in a comprehensive manner, they are aspirational and expressive of priorities of a minority of citizens. Any electoral victory of Democrats will be a coalition of varied groups and will require support from others who do not share those priorities. Using this to impose these policies upon the rest of the country’s citizens is an interesting concept.
Can what seems to be the best way of addressing problems by sincere believers be so wonderful as to make all others accept and want to continue them? Our experience indicates that usually that does not happen. Such policies are given up because they needed consensus that never developed.
Right now, both Republicans and Democrats fervently believe that if they win an election, the rest of the people must do as they decide and hold to their decisions in the future. The give and take, compromising, to achieve sustainable policies is rejected because it diminishes the good into uselessly irrelevant results. But in fact these polarized attitudes stagnate democratic governance.
1
Charles, tell the truth. You don’t know what you’re talking about when you assert that MFA would be “majorly disruptive” and would take “a decade or more of issues before all the kinks are worked out.” In support of this, you point to the ACA. The ACA is a Rube Goldberg approach to financing health care - lots of moving parts and some of them don’t work so well and never will. By comparison, MFA is relatively simple. There are issues that need to be addressed - provider reimbursement levels being one of the more significant - but they are doable, and in fairly short order.
18,000,000 health care workers aren’t losing their jobs. Neither are people in the life insurance industry. Many health insurance workers would also still be employed to process payments to providers, since Medicare contracts with the health insurance industry right now to do that and is almost certain to continue to do so. Health insurance executives, marketers and sales will be out of business, but their skill sets are pretty portable. Sure, there will be some shift in employment, but the overall impact on finances and the economy should be quite positive for the 99%.
2
From the cinders left of what was our former country, only big ideas will lift our country and Americans. Big ideas are a matter of life and death. To Witt: Medicare for all is a great goal, but, as we know, it will be bigger than your run-of-the-mill Sisyphean challenge, but as long as the needle keeps moving forward, it will be good. Ditto all other proposals.
Today Gordon Sondland, Trump’s E.U. Ambassador will be deposed by Congress. The Times notes: “Mr. Sondland, 62, tall and bald, is far from a typical diplomat. Foul-mouthed and unafraid to bruise egos, he craves the limelight, not policy papers and the politics of quiet persuasion that are the staples of diplomacy.”
This is what passes as the “establishment” in both parties. These are the “centrists”. Why would they want to change the gravy train, even as they destroy our democracy and working families. They also champion racializing refugee children and land grabs. There’s no semblance of morality or ethics.
Honestly, in order for the any future healthcare arrangement to work the healthcare system need to get a 'haircut'. Costs are very much out of control. Regulation is needed to implement cost controls. There is no way around that fact. This adherence to some notion of 'free market principles' is foolish.
This is ridiculous. Sanders has explained over and over again how we "get there". Saying it would take ten years to complete MFA only invites the capitalist parasites in the healthcare insurance business to hang on longer. They should be eradicated – and quickly. If America can sustain nearly a thousand military bases around the world, it can care for the people at home that pay for it. Perhaps we should start with an honest discussion of our Empire and go from there. If we're truly "honest", we'll dismantle the MIC along with our hideous health insurance business. Yeah, I know. Dream on.
" Tell the Whole Truth"..........but please please please know the difference between truth and opinion.
And show me the math.
2
The Democrats did not let ISIS go free.
There is the winning election message.
1
I’ve always been lucky. First my parents, in Miami, took care of me. (Socialized medicine? I was their kid.) Then in 1966, I became a teacher, and was ‘supported’ by a generous Blue Cross plan. In 1980, I moved to Nova Scotia, Canada where I have lived ever since and enjoyed socialized medicine.
Nova Scotia is one of the three Maritime provinces. They, along with Newfoundland, are considered to be the poor stepchildren of Canada as they don’t have a robust industrial base; tourism and fishing reign. Other provinces contribute to our health plan.
I am now in the first year of my fourth-quarter century, i.e. I am 76 tears old, and medical problems have emerged. I started with ‘junior’ (walking pneumonia), and have worked up to a diagnosis of rectal cancer.
Rectal bleeding; saw GP at 3 p.m. the same day; saw referring surgeon four or five days later; was slid into the system within three weeks for six weeks of ‘gentle’ chemo and radiation.
My cost? “0”, as in zero. My only out-of-pocket expense was my travel to Halifax which is two and one-half hours away’ I travelled in on Mondays and back on Fridays in a non-profit medical van. I was doubly fortunate to stay in HFX at the Sobey’s Cancer Centre (The Lodge That Gives) which was like a resort just across from the radiation hospital. There are 32 rooms with 64 residents, and, once again, it was free.
Nova Scotians pay a 15% tax on Goods and Services as I did in my years of teaching here. It's worth it, and everyone gets it
3
The health insurance industry/AMA political machines are what they are because of cavalier American voters for the past 60 years combined with arrested development sugar/fat/smoking and chemical addicted Americans have mishandled their own health.
A top layer of the truth that no candidate of any party will get near is to tell Americans they are fat and need to get off the couch in order to get their health under their own control.
The #1 health issue and cause of most diseases in the U.S. remains obesity in adults and in children. Put the remote down, get up, take that giant bag of Doritos out to the trash can. Then keep moving that tail to take a walk, at the very least.
Jeeze. Why didn't NYT do a real break down of Bernie's Medicarie for all plan? Cause it is terrified of losing status quo that is why. Go to his website and you can get all the answers you need. Moderates are going to keep things the way they are and no improvements will be made. There is a tight lockdown on Progressives by the establishment even though progressive policies are polling at very high numbers for so called radical, and far left policies. Of course in other civilized, non dictator run countries, these same policies operate and are considered humane, normal and moderate.
And off subject but not really I can't help laughing my head off at the pundits saying Mayor Pete and Amy won the debate last night and how great they are. Why are they trying to shove them down our throats? Guess they did not read the polls. Mayor Pete is at a big whopping 5% and Amy is at 2% . Does main stream media actually think either one has a shot? No, but both candidates take money from corporations and will never challenge the status quo. Gee it is the establishment and the elites against the rest of us.
1
So, what will happen to the millions of jobs in the current healthcare- and health insurance system?
Are we exchanging the "private bureaucracy" for a "government bureaucracy"?
As a nurse in a San Francisco hospital put it: you know who are the most anti-socialists? Our Russian (-American) patients!
... Go figure, Elizabeth!
Willing to stick our necks out into the future. Prepared for the worst, and the BEST that can be, for all of us, not just some. What we have now is the worst.
1
“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” — Dr. Martin Luther King, Jr.
2
Medicare for all proponents should be able to ultimately allay fears that you may have a higher tax bill, but you'll be keeping a big wad of cash in your wallet that would otherwise have been emptied by co-pays, deductibles, premiums, and so on. If they keep on message that Americans will come out with more money on hand, even after taxes, the message will sink in.
But no one has yet to address the prominent worry about Medicare for all. Americans fear they'll need to find a substandard doctor in an overwhelmed clinic because they'll lose their primary care physicians. If someone would just take a moment to explain that their current doctors will accept Medicare, the panic will subside.
The message should be to simply switch the insurance card in your cash-filled wallet, and make an appointment with the same doctor you've come to know and trust. Then maybe we move on and keep our country out of the Party First Party masquerading as representatives of the American people.
The value of "the Truth, the Whole Truth and Nothing But the Truth" is not limited to the courtroom. This is the wisdom of Integrity in communication. nereus.com
3
Mr Blow,
You are now the second NYTimes writer I have seen who has comment on the fact that Democrats are hesitant to say "Yes, middle class taxes will rise, but..." without addressing the very clear and obvious reason for their reticence: It's feeding into a Republican talking point. Provide that soundbite to the modern right-wing media machine and they will lop off everything after the comma and blast that message non-stop across the country over every medium of communication known to man. There will be carrier pigeons in Times Square taught to squawk "Warren Says Middle Class Not Paying High Enough Taxes." Any criticism of this evasion which does not address the very real reasons for doing so and does not acknowledge the shamelessness of right wing media in distorting their opponents messages is being either naive or disingenuous. I believe you are neither, so I am confused as to how you, and the Times Opinion pool in general, have come to this point.
1
Amen. And this would apply to a number of campaign promises floated by "progressives" these days. It gives me no satisfaction to say this, as I perceive and support the need for structural changes in our nation.
2
Remember when President John F. Kennedy said something like..."I want to take American halfway to the moon...because I am not sure we can get the whole way there....."
Let's start with National Health Care for All....forget medicare for all.....5 percent profit margin for the companies providing medical insurance and services...
Vietnam Vet
3
While some journalists do go into politics, most do not.
There is a very big difference between writing op-eds and making suggestions and actually translating ideas into reality.
Dreams are cheap. Rhetoric can sell dreams.
However, grand dreams usually require grand solutions. It is a package deal. Free tuition for all, please explain who is going to foot the bill. Just the rich? Or the Middle Class in taxes. Universal health care, absolutely, but are you going to tax the Middle Class, then yes, come out and state this. A tax bracket of 70% for the ueber-wealthy, great idea and how is that going to get through Congress, not exactly home of the poor?
Jazzed up dreams with rhetorical flourishes can be sexy. Detailed solutions, i.e. the truth, can bore and frighten. So bold dreams with the truth, Mr. Blow, a contradiction and a non-starter for a politician.
"treat voters with respect by telling them the whole truth, warts and all, instead of simply dangling jewels in their faces."
I cannot imagine a better way to lose an election. Respect, certainly, but warts lose elections. Reveal the catch and depend on the integrity, courage and intelligence of voters. Politicians beware. With that policy, look for a new job.
3
Yes, and the republicans should do the same. No more lying in DC and everyone should be nice to one another and everyone should be responsible and kind. I know that you folks are naive but this is laughable. The democrats would never win another election if they leveled with the American people.
1
“Also, the federal government is a clunky bureaucracy and isn’t always efficient and effective in accomplishing small tasks, let alone large, transformational changes in the American economy and the American culture.”
—But what the heck, let’s give it a go.
“It is quite likely that there could be chaos, confusion and disappointments in the short term.”
—And the long term too.
“In fact, I believe that not being fully on the level hurts progressives.”
—As it should.
3
Did Charles Blow have anyone in mind while writing this piece? I thought of Elizabeth Warren. She has very large plans, plans that will turn parts of America upside down. When pushed to do a cost breakdown of her healthcare transformation, she evaded doing so in yesterday's debate. It is incredible that she has aroused so many, including readers here, to excitement about Medicare for All when they have no idea of the costs, to them, to the government.
So, to follow Charles Blow, Warren is not making her big plans transparent as he recommends. She's smart enough to know that cost will be the first question. Yet she is either unprepared or being disingenuous in not providing that information. And how can she be unprepared after months on the campaign trail? She may have momentum but it is partly based on hasty trust.
2
@blgreenie "when pushed to do a cost breakdown...in yesterday's debate." In 30 seconds? Warren's rivals, opponents and the media were not looking for information, but a one sentence soundbite to use inaccurately as a bludgeon. She has steadfastly answered that the costs to most Americans will be more than offset by their savings. Obviously, the costs of a Medicare for All system will come through taxes. The motivation behind the question is not for Senator Warren to admit something she is hiding, but, rather, to give others the opportunity to ignore the savings and improvements Medicare for All will bring and rant about less than half of the story.
This argument is Exhibit A of a sure-fire recipe for giving the worst President in U.S. history a second term.
They don’t tell the whole truth because they think the American people are too stupid to understand it.
What if E. Warren said, “Yes, in general, taxes will have to go up if we enact a Medicare for all. However, the total costs of healthcare for the average American will go down more than taxes will go up, resulting in a net savings. There will be no copays, no deductibles, and better bargaining with providers that will lower prices.”
Americans want honesty and truth, and that’s why so many voted for Trump. What he says and does hurts, and they falsely equated pain with truth, and took the easy truth that hurts others rather than themselves. There was no “truthy” alternative (nod to The old Colbert).
1
No. It's a typical attack on realistic Democrats to call us "milquetoasts". A huge disruptive program that nobody wants is not smart.
1
I’m with you that’s why I’m endorsing Warren/Yang
1
I disagree. You are in a dream world. Medicare for All is not popular, enough so that Trump could be reelected.
Further, I am 70 and still working. I am NOT on Medicare. I have beer access without it and a better tax situation. I also pay very high taxes. Americans over 65 who have paid high taxes will not be thrilled about higher taxes when they already have no dependents or an employer or medicare.
Not to mention, the younger crop is sick and obese and could care less. Let them reap what they sow. Why should I support their careless lifestyle? Instead of whining about health care costs, perhaps they should stop smoking, drinking, and eating so darn much bad food. Lazy lazy lazy.
1
Oh my goodness, didn’t the election of Trump demonstrate how idiotic the American people are? If Warren says “Yes Taxes will go up while costs come down” they will have the first sentence playing on a loop for the rest of eternity. She’s smart not to get caught saying it.
And NOBODY likes their health insurer. This idea that we are all clamoring to keep the horrible coverage we currently have is false, people are just afraid of new things and easily led. If they actually ever implemented Medicare for all it would be the most popular law in the history of this country.
1
The election of Trump cemented my belief that an enormous percentage of the American voters are dumber than dirt, yet you think voters are "adult" enough to handle the whole truth, warts and all, about anything? Maybe. But, you know who I am certain can't handle the whole truth and who will spin and misrepresent and fear monger and create false equivalencies and mislead those voters into total confusion? The American mainstream news media. The way the discussion about Medicare for All and taxes during this primary season has been framed and presented by the corporate media has been pathetic.
1
So Mr. Blow wants "bold", but not really that much.
Anybody but Sanders, Tulsi or Yang, the only ones that are truly "bold" with the "grandest ideas", is the message here.
Charles Blow is radical only when it comes to ranting about Trump.
So predictable.
1
Can someone explain to me exactly why the Dems if elected ro the presidency and controlling both Houses can put back higher tax rates on income and put back the luxury tax as well as lowering th bar for estate taxes? People like to pretend they have earned their money. A few have -- the rest, not so much. Unionism, a fine thing rewards people for longevity- years on the job not work done. Investing-- big joke there.. BTW if we have a finite $$ supply how do Wall St. prices and no. of stocks keep going up?
Somehow it's OK to have moved steel mills, clothes and shoe factories, drug factories, cell phone factories to China, phone call centers to India, even veggies from Latin America (no more CA avocadoes) ... and now NONSENSE about people in a totally predatory- middle man "industry" that makes nothing being put out of work by Single Payer Universal Healthcare. Normally, it's looked on as a bad thing when the cost of healthcare is around 20% of GNP, Mr. Blow. BTW exactly how many people in your hundreds of thousand. My lawyer niece had a choice of jobs when she elected to work for the health company! *maybe it's not o dire.)
Nostalgia never fixed anything. The good old days they are gone forever and they weren't so great. (PS what about the people who go bankrupt because of medical costs?)
Charles, it was obvious when I saw the headline that you were leading into comments about the comprehensive, universal health coverage plans known as Medicare for All.
Screaming in anguish is not how I like to start my day!
Why can't moderates deal with the truth that M4A, paid with a small increment in taxes, is SIGNIFICANTLY less costly than the mess we have now. No other contributions to employer plans, no deductibles, no copays, no fees, no supplementals to ensure coverage. So let's be honest. The studies, the analyses are available. Let's have some honesty from you, from Amy, and from Pete, for a change.
Disruptions? What about disruptions when an employer changes the plan? the network? the details? Or you change jobs? or lose your job?
Bureaucracy? Ask the average medical practitioner what it's like trying to justify treatment to an insurance company. Or have to deal with complex forms and reporting requirements. Or how well the average individual understands what's included in their coverage. How come we can have an efficient Medicare administration, but not one that would give Medicare for all?
These are not new proposals. There have been proposals in a number of states. There have been numerous studies. Reveal the catch? You read them!
At this point it's YOUR obligation to respond honestly. Your columns frequently cite data to back your analyses. The data on Medicare for All are there, Charles. You, of all people, shouldn't be writing a lazy column like this.
1
I have a question about the Medicare for All plan. Sanders says there will be no premiums, deductibles, or co-pays. That sounds way better than existing Medicare, which has all of those. Does that mean that the current Medicare plan for seniors and disabled will change as well? Because currently, we do pay premiums for Medicare Part B, which basically is everything outside hospitalization. And then Medicare only covers 80%, so if you have to pay a deductible and then 20% of all services if you have not also bought Supplemental insurance and Part D drug coverage. Does anyone have an answer? I was unable to find this info on the candidates' websites.
2
Good Piece by Charles. This is what Leadership is all about, having the courage to tell the people you are leading, the whole hard Honest truth, and then presenting the vision and the plan for how you will lead them forward and out of the ditch or bunker they are in. If done well, they will all be right behind you encouraging you to go charging ahead as fast as you can.
Teddy could not get up the hill fast enough, Sherman could not get to the Sea fast enough, and Patton could not get to the Elbe fast enough for the millions of followers they were leading.
25
@Peter W Hartranft
Sure, the People will digest the facts and ready for action!
Not even half of us have the interest or patience to go to the voting booth to cast our vote but we have the patience, the brains, the interest to read the detailed Health care Plan (for ALL) and go out to support the Cause? We can't even figure out what is against our own interest!
1
Be honest; the voters don't want a $30 trillion program run by the government. Be honest; these left wing programs are unacceptable to a center right or center left country.
3
Centene Corportation manages medicaid and medicare. And is funded by our tax dollars. The CEO's total compensation was over $26 million and the lowest paid vice president made over $4 million.* In addition, they are in the process of spending multiple millions of dollars for fancy new buildings in Clayton MO. And yes they are receiving tax incentives from Clayton. Remember that all of us are paying for this with our tax dollars. This is just one example of why medical costs are so high.
Personally I find these salaries outrageous.
* https://www1.salary.com/CENTENE-CORP-Executive-Salaries.html
5
The real enemy of Medicare for all is not the Republican party, it is the out-of-touch, neo-liberal wing of the Democratic party (well represented on the NYT editorial board). This piece isn't so clever - Mr. Blow wants to frame the issue in the worst possible way for progressives. It is almost obsessive their need to hear champions of socialized medicine say: "taxes will go up" (a la Mondale). Which is a strategy aimed at selling all of us on the idea that this an an impossible dream. Quite the contrary, it works in most of the industrialized world, and overall costs will go down for middle class families. Ms. Warren is right not to take the bait from these well heeled health care industry trolls.
1
Best Charles Blow column, ever.
Aim high, be honest about the fact that making these big changes will entail pains and costs, assure the voters that they are worth it, and lead.
Honesty is a powerful tool.
2
I agree so wholeheartedly! Thank you for your clarity. Tell the truth, Elizabeth Warren. and people can decide for themselves. This is the only way forward. Charles Blow, you're awesome.
1
“If your only vision is what you think can squeak through, you’re blind to the desires of the liberal heart, to the American heart, to the desire for the country to aspire to and achieve greatness.”
Exactly. Elizabeth Warren will not get her vision of Medicare for All passed through Congress—even a Democratic Congress.
But you don’t run for president with proposals that you think will pass. You run with big ideas, and Warren has the biggest ideas, except for Sanders who I’m afraid does come off as your crazy uncle.
2
Thank you, Charles Blow. for explaining that in modern society providing health care cost coverage for everyone is an essential public expense. That's not only humane and fair. It's cost effective.
To think big and act boldly on health care will be practical. It will be a way to get out of the present enormous financial waste, the bureaucratic morass.Wthh everybody covered. This is the only cost-effective and manageable wya to provide and manage health care coverage. as is done in all so-called advanced nations, except th USA The only way to go Today and tomorrow. Halth care cannot contiue as a private, for-profit, enterprise. Health care cannot be a for- profit business, determining if people who will live or die depebnding on whether they do or don't have health care cost coverage.
Public sectors of mixed economies conduct socialism for whomever politically controls them.
“The Affordable Care Act was passed nearly a decade ago, and there are still major issues that need to be resolved”
You summed it up yourself Charles. What they are talking about is free healthcare, soup to nuts, that “somebody else” pays for. And the only question is who is somebody else and will they accept the proposal?
If you think healthcare is expensive now, just wait until it’s free
Yeah, ok. But they also need to win.
So, they need some solid statements on things most American's agree with, and then dumb it down for half the country, and then rinse and repeat.
So, "strong borders," but humane and non-racist solutions.
Increase Middle-Class jobs through a landmark American infrastructure overhaul that benefits EVERY state.
Tax the super wealthy, etc.
Don't scare the voters. Instead, show the Reps/Trump as inhumane who only serve the rich. (Not a hard sell).
Stop foreign wars, but don't leave our allies hung out to dry.
Etc.
Be Smart. The Reps are being VERY smart, strategically, and have been for a while. Obama's campaign rocked - hire those people.
IF, and once we get the country back, Clean House and Fix America so this never happens again.... (The electoral college has to go!)
As always, this man is a beacon.
1
Health Care in America is not patient centered it is profit driven. Costs across the board from hospital procedures and beds to medicine are multiples of what I pay here. Go after these heartless money spinners and then Medical Coverage will be simple.
At my age I have full medical cover paid by the State. My meds cost me €2.00 no matter the price a piece. Free Hospital and MD visits and dental care. I am a duel national and offered this most secure care in later years. Compared to the USA this is heaven. Ireland is not a Communist Socialist state.
1
Oh, wow! If only!
Politicians! Treat me as if you’re my partner, not a used car salesman.
Give me the whole prospectus. The goal. The path to achieving that goal. The downside. The risk. Then I know that you’ve done your homework.
Don’t emphasize the beautiful interior while glossing over the oil leak. Or tell me your plan will make me young, rich, and beautiful, while ignoring the possibility that I may end up broke and living in a nursing home.
In the words of Joe Friday (hello, kids), “Just the facts, ma’am.”
2
Today's Democratic Party doesn't know what big and bold is, Charles.
That's their problem: They so lack courage and conviction that one man -- Donald J. Trump -- has been able to withstand their 24/7 onslaught, together with that of the entire Liberal media, over the 999 days of his administration.
Walter Mondale dreamed big in his 1984 acceptance speech - he set out an ambitious agenda to counter Ronald Reagan, and he admitted he would raise taxes. He lost 49 of 50 states in the 1984 election. Whole truth telling works best in the echo chamber of commentators on NYT articles, less well in actual elections.
1
Tell the truth. Reveal the catch.
Be bold, then compromise.
Fix things for good, not with a patch.
To the challenge one must rise.
I agree with Charlie Blow.
The Dems must grab this chance.
It clearly is the way to go.
Dream big and take a stance!
@Opinionista
Surprise !
The truth today is clearly told
In today's Times, clear and bold
By Mr. Kashgorian -- we clearly can
Have Health Care for All if we only plan
To stop disgraceful waste on guns and war
And aim for peace forevermore.
"Conservatives... will frame every proposal you put forward as a push toward the apocalypse...."
Doesn't that say it all!
And how, ironic, considering how much danger the conservatives around the president are putting our nation in at this very moment!
It will be very easy for a Democrat with a big idea like “Medicare for All” to get elected! Just promise the electorate that Mexico will pay for it—it worked for the last guy....
1
Charles Blow makes a fundamental conceptual mistake in this piece. He does not draw the crucial distinction between holding office and running for office.
President Kennedy made his moon shot speech when he was already president. If he had made it while running, he would not have been elected and he would have accomplished exactly nothing.
Big plans have a place. But you have to win the election FIRST. And that means meeting the voters where they are.
They can't tell the whole truth.
It's against party policy.
Revealing that the driving forces behind all this year's candidates are Friedrich Engels, Georgi Plekhanov, Georg Hegek, Thomas Malthus, and Saul Alinsky is not a path to victory.
Wow, Charles, thank you for your integrity! This is the first column I can recall EVER seeing encouraging politicians to dream big, LEAD, and level with voters, that, yes, this program will be disruptive, it will be expensive and you may not like or understand it at the beginning but it will be worth it in the end. So much better than, “if you like your doctor you can keep your doctor”. Thanks again for your integrity and for encouraging our elected representatives to LEAD, rather than stick their finger in the air to see which way public opinion is blowing.
I agree with Mr. Blow that "most voters are adult enough to handle the truth." However, as we saw in 2016, most isn't enough, and as a result we have a creater of fake and false in the oval office.
Oy. Listen, Medicare For All is a quicksand tactic. You have far more faith in the critical thinking skills of our electorate than is reasonable. MFA is easily communicated by foes as "socialism" - "more taxes" - "European". You cannot -- as shown by Warren's juke and jive the other night -- explain the benefits in a sound bite. It's not "go big, or go home." It's more like, "If you go big, you'll go home."
2
Right on target, Mr. Blow. I hope Elizabeth Warren reads this and takes it to heart. She should start by admitting that Medicare for All will cost the middle-class some taxes, just as the current Medicare does. We can accept it. Both for ourselves and for the greater good.
The thing we need more than anything is top re-educate the American people about the fact that they are entitled to a share of the wealth that their hard work makes possible. that is their literal work with their hands and the things they make possible via their representatives who see to infrastructure and regulatory and Justice requirements of our society. All of those things working well is what makes the climate where people get very rich.
The other thing they need to be re-educated about is how unregulated accumulations of wealth are dangerous to our nations very existence. The fact is no matter how vain and narcissistic you are there is a point after which you can no longer spend money on things for yourself. It is usually somewhere near that point that folks like the Koch Brothers start spending money on taking control of our government away from us via propaganda and paid Pols who lie to those who elect them and serve the wealthy instead. Example the $1.5T tax cut. There is no possible honest justification for it. No one needed that money more than the people of the USA.
1
I am not willing to destroy my health care and insurance so that the remaining 15% of people not in a health care system can get care. If Obamacare could not get us across the finish line, nothing will. Medicare-for-all (M4A) is an irresponsibly expensive proposal. Thank you.
3
Big ideas are often a good idea. One that isn't, is the continuing push by the democrats for open borders/mass immigration and the advocacy for illegals. It's impossible to take them seriously when they talk about "immigration reform" when they can't get past the idea that most Americans do not favor more mass immigration and specifically illegal immigration. The US, if it is to ever have a permanent effect on climate change and move to a sustainable economy, must reduce its population and the first place to do that is deducing immigration- and it doesn't matter where the people are coming from. Calling people who disagree with them "xenophobic racists" because they see no benefit and many drawbacks to adding millions to the already over populated US just give the right more ammunition.
2
Several comments have proposed a public option that they say will drive private insurance companies out of business and thus lead to M4A. I believe this is wrong for a number of reasons.
The 1st one is obvious. It is much, much cheaper to administer a program where everyone is treated the same than one that has Medicare, Medicaid, VA, Indian health, TriCare, etc, AND 1,500 different private insurance policies (not counting Part D Medicare). Not only is there vastly higher overhead for the private insurers, but the compliance costs for physicians, hospitals, & patients are enormous, at least $600 Billion every year. Choice leaves that on the table.
The 2nd one is that a public option has to cover everybody the same while private plans can develop plans that cater to the young, the healthy, & the wealthy. They can give bribes to companies to get them to buy their coverage, This would leave the old, the sick, & the poor to the public option or Medicare itself. All this would raise the cost of the public option & negate any administrative savings.
The 3rd reason is that the universal gov run plan of other countries ALL have one entity that can gather data, analyze it, & make recommendations based on medicine, not profit. If a lot of people are covered by private companies which keep their data secret, we could not do this.
See https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html
for the savings.
If adult voters were indeed "old enough to handle the truth" in 2016, either they thought Trump's Russian business was truthful OR they weren't yet old enough. Or both!
Moreover, in 2008, had we duly tabled our dreams for someone whose shelf-life would have been much more effective AFTER the dirty laundry had been done, the older HRC could've better forded the river for a far greater BHO-with-the-flow MOVE FORWARD in 2016. And we wouldn't BE in the mess we're currently in.
The media is obsessed with impelling Warren to provide Republicans a "gotcha" moment they can replay ad nauseum. Meanwhile the president of the United States is allowed to do and say whatever he pleases without any repercussions.
Warren never said it would be easy. She didn't promise she wouldn't raise taxes. She knows that overall costs will go down and refuses to let you pummel her into a Republican gimme. If she is forced to say middle class taxes will go up (even though this will be offset by no premiums, no copays, etc. so overall costs will go down), then Republicans and moderate Democrats should say the truth about their halfway measures with healthcare: that more people will die or go bankrupt. And that the system only works well for the rich. And even then, it's still better in every country in Western Europe (cheaper, better care).
But then again, it's better to pummel the person who's actually going to help us rather than those who don't care.
The best outcome for this situation, is that the person who gets nominated incorporates all the of the best parts of their competitors platforms.
If Medicare For All and UBI are not on the ticket, then this has been a really huge vainglorious waste of time.
https://www.nytimes.com/2019/10/16/opinion/democrats-2020.html
Let’s just get trump out of office, okay?
Rude, reckless, pathetic, and hopeless is the new Democratic mantra. They have selfishly compromised all decency and values. Setting an example to the citizens to behave in such a way. We will not fall to the lowest common denominator. You will have to get used to being frustrated and listening to responsible adults.
"dangling jewels"? This is how Mr. Blow portrays fighting for overdue healthcare fairness for the American people. We all make mistakes - I'm good for a dozen or so a day. Mr. Blow is gem, but not here.
He shows more concern for unemployed insurance company people than families losing all because of sickness.
Just a coincidence I'm sure, but yesterday it was Frank Bruni singing the Mayor Pete tune, and today it is Mr. Blow.
Unfortunately for them, it is Elizabeth Warren who is correct. She will fine tune her complicated answer, because that's what it is.
But when most of the industrialized world can figure out to provide good health insurance for all their people, you will never convince me that that the American people are not capable of doing the same. In the words of the great Bob Dylan, the "walking antiques" need to get out of the way, for they have been "bent out of shape by societies pliers".
I often disagree with everything you say, but you have hit the nail on the head with regard to health care. There's 18 million workers, and our health care costs of $3.2 billion is nearly all salaries for them. Cutting costs involves either reducing the number of people with these jobs, or cutting salaries. There's no free lunch.
"I genuinely believe that most voters are adult enough to handle the truth."
Charles, you must be relatively new to this country.
4
Well said, Charles!
Social Security and Medicare went through hell when proposed, yet it has proven itself to be a life saver for older Americans, efficient, portable and you can keep your own physician. The same will be true for Medicare for All.
The jobs issues can be solved because Medicare for all will require many more employees than it now has. In every State there are Social Security Administration offices, not just in D.C.
I agree that private insurance should still be offered to anyone who would prefer private insurance.
As far as paying for it. Use the same payment method we now have. Companies and employees now contribute to Medicare, that should continue, but the premiums can be raised by 1%. Companies will no longer have to pay a portion of insurance costs to its employees, which will reduce their costs. Employees will not have to pay the premiums, which in more cases than not, change every year as do the co-pays and they bear the brunt of these increases, not the companies. I know that is what happened to me.
If the greed of private insurers had not raised the costs so much that millions of people cannot afford it anymore, than I say they brought it on themselves. I remember when Blue Cross Blue Shield was a non-profit insurer. No longer the case.
The ACA is a temporary fix. The long term fix is Medicare for All.
1
Warren is incredibly intelligent and knows she can't say these numbers allowed. MFA is projected to cost 34 trillion over its 1st decade. The wealth tax is only projected to raise 2.75 T over a decade. We would have 31 trillion to raise over that same decade. It would eat more than 2/3 of TOTAL revenue the CBO projects the federal government would raise. (Don't forget - we still have social security, other social programs, education and of course defense....) This isn't a very heavy lift - it's a pretty impossible one. At least without steeply raising taxes on the middle class, too.
https://www.theatlantic.com/politics/archive/2019/10/high-cost-warren-and-sanderss-single-payer-plan/600166/
I can think of no surer way to re-elect Trump than to have the Democrat nominee tell well over one hundred and fifty million Americans that their private health insurance will be taken away and they instead will have a health program created by and run by countless government bureaucrats. What could possibly go wrong?
"I am not one of the nervous Nellies who believe that Democratic candidates shouldn’t dream big and pitch big," Charles Blow writes. "'Dream small' is a dream killer."
Wotta load of hooey! Is this the same Charles Blow who loudly endorsed "pragmatism" throughout 2016, lacing into Sen. Bernie Sanders and complaining about "politicians who have historically promised much and delivered little"? (Feb. 10, 2016).
Now, Charles Blow is all for "moonshots," "visions." and big "dreams." I for one wish that he would figure out what he wants and believes. Or at least take a few minutes to write a second draft before publishing his columns.
I'm one progressive Democrat who firmly believes that Medicare-for-All, while economically quite feasible, is political kryptonite. Why? As noted here, you're talking about a radical restructuring of one-fifth of the U.S. economy affecting millions of jobs. The chaos that will cause is more than should be done. Second, there are very powerful forces like the entire private, for-profit health insurance industry, the pharmaceutical industry, and probably many hospital associations that will put immense financial resources and political pressure to defeat it. Medicare, which I'm on, still costs me money and doesn't even cover drugs unless you buy into Part D. Third, Medicare's reimbursement rates are considered so marginal that many physicians opt out of it and most hospitals could not survive on those fees. Finally, why should Democrats embrace a losing approach to health insurance reform when there's a much simpler approach to the goal of universal coverage in the public option. That preserves the fundamental capitalist system of a free market and consumer choice and avoids the "socialist" label. Health care was the winning issue for Democrats in 2018 let's not snatch defeat out of the jaws of victory by turning it into a losing issue.
1
This column is spot on. I would not even consider supporting a proposal that appears on its face to be too good to be true. That changes, however, if the "pipe dream" comes with a price tag (NO MATTER HOW HIGH) that is fully explained and reviewed (preferably by a reputable CPA firm).
With any purchase decision, most of us will pay more for "quality" if ultimate value is shown to be there in a reasonable amount of time and all possible cost contingencies are identified in advance and their likelihood to occur fully explained. With that information, voters can make that decision. We will not rely on generalities offered by politicians.
This was not done prior to enactment of the Affordable Health Care Act. And when some of the promised results proved not to be true, the result was the birth of the Tea Party. Full disclosure is the only path forward.
Joe Keenan
3
The problem with "Medicare for All" is that the way it's being framed now is an all-or-nothing switch from the existing system, such that it is, to a full-on MFA. To do so in this manner renders the cost probably totally incalculable as we just don't know. To me it would seem that a better approach would be a gradual transition. How would this be done? By lowering the eligibility age incrementally. For example, in the first year, the eligibility age could drop from the current 65 to 62. In the second year, the age drops to 59. And so on. Yes, it would take some time to fully onboard everyone into the system, but it would give us a chance to see if going this route is both pragmatic and cost effective. It would give us time to construct an alternative if it doesn't work out and would be far less disruptive than trying to totally upend what we've got.
2
One day, perhaps, we will see a candidate who will have no fear of NOT being elected, who wants to be president but only if he/she can campaign on their own terms.
Those terms? Telling the truth, the whole truth and nothing but the truth; speaking freely without worrying about a "gaffe"; being themselves; not allowing handlers tell them what to do, what to say and what the polls tell them to say, what policies are most popular.
I am not holding out hope but just maybe one day..
I couldn’t agree more. But that said, candidates also face the very real difficulty of having video clips of their words being taken out of context and used in Republican advertising. As soon as Elizabeth Warren says what we all know is true, that taxes will have to go up to pay for her Medicare plan, that video clip will be played out of context again and again to scare voters.
Informed voters may be able to handle the truth. But elections often hinge on the misconceptions and anxieties of ill-informed voters.
3
Tell the truth? Please. Not one single question and no discussion in the debate last night about climate change, the single most important issue facing us as far as a great deal of people are concerned. And after millions of people joined in mass protests to demand action from world leaders. Not too encouraging.
2
Exactly, Mr. Blow, and thank you for saying it so plainly and honorably. Everything worth doing comes at a cost. More than anything else, Medicare for All would give every American peace of mind and a sense of belonging and having worth in the society and economy of our nation. "All lives matter," in other words. Your physical pain matters. Your mental pain matters. It matters that you are well enough to work and care for your family. It matters that you live as long as possible to reach those "golden years" you have earned. This is not just about medical care. Relieving the constant, underlying stress and anxiety of paying unforeseeable medical bills and the acute stress when major illness or injuries happen will go a long way toward restoring our fractured families, communities and nation. I believe it will reduce the gun violence we all are subjected to and the loss of lives to alcohol and drug addiction and suicides, which cost us billions of dollars. Will it be cheap and easy? No. Is it worth doing anyway? Absolutely.
2
Agreed, Mr. Blow. By all means our leaders and lawmakers should think big, as long as such thinking is accompanied by concise, rational and believable explanations and cost estimates that even the dumbest American voter can understand. Case in point: Medicare for All. To counter the Republican argument that it's "socialized medicine we cannot afford," it would be wise to point out that any increase in Medicare payroll tax deductions would still be far less than the cost of private health insurance. If voters who now have employer-provided or employer-shared private insurance want to keep it, by all means let them and simply add a public option to those who don't. That public option will eventually kill off most private insurance except for the wealthy, who don't care what it costs, or as a supplement to cover what Medicare doesn't. Remember all the oppositon to Medicare when President Johnson signed it into law in 1965? Try to take it away from any Medicare recipient now.
4
Before I can make a decision on Medicare for all it would be helpful to have some details.What happens to the people already on Medicare ? They have paid into the program for their entire working life . Are they now going to have taxes raised and pay again ?
2
Big Dreams?
Sure.
Now, show me the Electoral College majority for M4A and other BD's!
Not to mention the winning path for those Dems proposing said ideas.
"Bold ideas aren't necessarily good ideas" - Amy Klobuchar.
3
An excellent analysis and, in my opinion, quite accurate. "Medicare for all", "Green New Deal" and any other progressive legislation the candidates propose are aspirational and will not survive intact as it travels through Congress. Modifications will be made until the final result is acceptable to the majority. That is Congresses job. It is up to us, the voters, to elect Senators and Representatives who support our ideas. Aiming high is a good idea as it is certain whatever is proposed will be watered down until the majority can live with it.
Uninformed voters is a great disservice for the government ability to proceed with any new policy proposals.
Being told half-truth for years resulted in a rightly deserved reckoning this country is going through.
I thought we should learn very important
lessons...I still hope we will.
I once again agree with Charles, go full steam ahead, be bold and tell the truth in the process.
2
too right. all the pearl-clutching from the left about big plans give me heartburn.
Such proposals, as Charles writes, "require acts of Congress, and Congress would likely produce something vastly different than what you propose."
But it's the vision that sells. We need a leader who plans ahead.
"There are hundreds of thousands of people working as life and health insurers. What happens to those people if we eliminate private health insurance?" Those people probably represent a very small fraction of health insurance costs. They are not the ones getting multi million dollar salaries and billion dollar parachutes.
It's funny but my four favorite candidates are the two East Coast liberals and the two midwestern moderates: Bernie, Elizabeth, Amy and Pete. Warren sank a bit in my esteem the other night when she wouldn't budge from the use of the word "cost"; and Bernie came up a bit because he is one of the only candidates who seems to be able to say our taxes may go up to pay for "Medicare for All" (or Medicare as an option); but our premiums are going to go down. Take out the profit and parachute margins and they will probably go way down.
Remember from our history books that old slogan from the Revolution: No taxation without representation? Well that is exactly what a health insurance premium is.
Elizabeth may know (of course she knows) this is part of her slogan regarding costs are going to go down, so she should just admit it.
This all just goes to the success republicans have had in demonizing the very idea of taxes.
We need leaders who take stands. Those stands must be communicated and a dialogue is required. Warren is doing that in a broad range of areas, and it is values-based.
We should expect all sorts of blowback, some of it good criticism, some of it pure nonsense. That's the dialogue.
Re: the "hundreds of thousands of people working as life and health insurers," they're going to be disrupted regardless. If there is anything AI will be better at than humans, it is the underwriting, claims processing, and customer service that these organizations perform. They will be hollowed out in any case (ask Mr. Yang.) Today's enterprise software is downsizing large white collar finance departments by an order of magnitude.
There are many complex trends in play.
The first thing Americans have to do is to end healthcare being a profit making industry in providing it to the vast majority of Americans. Of course, you could pay a for profit clinic for a procedure like plastic surgery for a face lift (not medically necessary) or for insurance for extra coverage for a private room, dental and vision care including glasses, physiotherapy and other health related services, and for prescription drug coverage. But the care that most of us need would be covered under a system that is run for the good of all, recognizing that healthcare is a human right, a necessity, not a luxury.
This is more than doable at a cost about half of what the US spends now to get worse outcomes on such indicators as child mortality and others as compared to other first world countries. You have to be willing to take on the healthcare and insurance industries as well as big pharma to get this done. You are the only wealthy country that does not have such a system. Taxpayers will pay less in taxes than the amounts they pay to insurers for coverage that is often denied.
In Canada, prescription drugs are gratis for seniors. No more choices between food and drugs. And they are cheaper here, but our system will not withstand Americans' day trips to fill their prescriptions on a continuing basis. The problem of exorbitant drug costs has to be solved at home.
One wonders if the power of the healthcare, insurance and pharma industries is why this has not happened.
2
The question of how will Medicare for All be funded is misguided. A better question is who pays for our country's health care costs now, and under any new system how will that change. I do think people will be able to understand that currently companies, individuals, and the government cover our healthcare costs, and that will be the same in the future. It's just a matter of how the money is transferred and spent. If someone is currently paying $2,000 in payroll deductions and will have $2,000 in taxes in a new system, people can do the math.
A follow-up question is whether a new system will take costs out of the overall healthcare system so that the $2,000 in taxes in the example above is only $1,900.
A mature debate on the issue would cover these questions.
6
Hears how the medical cost question should be handled by Warren. The honest way is to mention that the US spends 17 or 18% on healthcare. Much more per person than any other developed nation, who by the way have universal healthcare, without superior results. The middle class pays for healthcare thru lower pay from their employers who redirect the monies to pay premiums. Thus a government paid for universal healthcare would result in lower cost to companies. Without a healthcare tax on companies they could potentially pocket the saving and let government cover the cost and then the middle class would end up paying. Instead Universal healthcare would presumable be phased in over time and thus a corporate tax could be phased in over time and the healthcare cost savings could be split between employees and the companies with no new direct taxes on the middle class. Bottom line everyone with a job pays for healthcare already and it’s a fiction that they don’t.
Another way used in the corporate tax cut debate is to claim something to the effect that the saving resulting from universal healthcare would be redirect in corporate investment and the economy would grow at a faster rate covering the cost of the program. Probably a fiction but conceivable given fewer deaths, healthier population, longer work lives etc.
1
@Tom And we're still going to spend the same amount of money on administrative costs because the Federal Government is a jobs program for union workers.
It's that simple.
The Democrats want to take the 5 million people pushing paper (that the federal government mandates) and turn them into union employees of the federal government pushing paper (that the federal government will still mandate from doctors, hospitals, clinics, individuals, companies, etc..).
And here's the real intellectual dishonest of the Democrats appeal to run away from ObamaCare as fast as they can.
20% OF THE POPULATION CONSUMES 80% OF THE HEALTHCARE COSTS.
So..Democrats want to raise taxes on 100% of the people pledging it will lower their healthcare costs, but it only lowers healthcare costs for 20% of the people. The other 80% of the people who get their private insurance yanked and pay huge tax increases will never use that 'free healthcare' nor benefit from it.
Here's the other big kicker. 50% of the people in this countyr already pay no fedreal income taxes. Obamacare was supposed to give them free or subsidized health insurance and guess what? They chose not to buy "FREE" health insurance.
Anyone want to guess why?
It's called copays and deductibles.
And now they want to give free healthcare to illegal aliens who don't pay federal income taxes?
Democrats are like Thelma and Louise...hellbent on driving right off the edge of that cliff.
"There are hundreds of thousands of people working as life and health insurers. What happens to those people if we eliminate private health insurance?"
This is why the green new deal has a jobs guarantee in it - for workers in the health and extractive energy industries who will be displaced by change.
1
My experience as a change agent was in private schools, as a headmaster. I was hired in part to make significant change, on a scale about one-billionth the size a president would have.
Though I loved the job, the teachers, parents, trustees, and especially the students I worked with, and tried my best to explain what the changes were about -- I found modest success, huge resistance, and in one case was terminated by those who hired me.
The point -- big ideas can shrink to minuscule realities when meeting head-on with human, political practicalities. While I would love Medicare for all, what works in other countries may not work in the U.S., where our capitalist mindset is bent toward rugged individual choice, even with liberals. Telling the whole truth in advance, which can be valuable, can also give resisters a lot of details to nit-pick to death.
If Republicans had one Democratic item to attack, it would be universal healthcare. And it would rile up a whole bunch of the voting population to vote Republican or stay home.
Think big works best when the climate has a significant minority of people willing to think big with you (think climate change, and the slog that's been!). Minus that -- the reluctant, resistant majority will beat you to death with their obstinance.
3
"I genuinely believe that most voters are adult enough to handle the truth." It seems like every bit of evidence we have points to the exact opposite notion.
5
@Nick: What every bit of evidence points to is that we've had over 40 years of the preaching that taxes are theft and that tax cuts are a government sacrament.
There was a time when those in the American electorate knew that if they wanted or needed a public service that they would pay taxes to get it.
We need to start somewhere to undo the bill of goods that's been being pushed by the political right in the USA for decades now.
4
Yes, unfortunately it seems that Americans cannot handle the truth, or even process any information more complex than the most dumbed down soundbites thrown at them by the pandering politicians.
1
@Nick
What exactly is this evidence you refer to?
Another truth the Democrats should own, is that trial lawyers are the Democratic Party's principal campaign contributors, and that trial lawyers profit very handsomely from medical malpractice litigation, the threat of which forces physicians to pay hundreds of thousands a year for malpractice insurance and order numerous, often duplicative but always very expensive tests to shield themselves from liability. In a government-run healthcare system, the principle of sovereign immunity would do away with malpractice lawsuits. That would save huge amounts of money, but destroy a huge source of Democratic campaign cash.
6
Excellent article Charles. Both Amy and Mayor Pete can level with the American public and that is what we want. We don't need leaders to tell us what we need; we need leaders to listen and then help create plans that work for us all.
8
I will also add that until and unless the statement, "If this is what you want, taxes is what will be used to fund it," is repeated again and again we will continue to be living the nightmare we're in now where taxation is a third rail topic and considered actually illegitimate by many.
Public services are available via only one funding mechanism, taxes (and I include "fees" loosely as a tax). Quoting Oliver Wendell Holmes, Jr., "Taxes are what we pay for a civilized society," and Sheldon H. Laskin, "Progressive income taxation is based on the very reasonable principle that those who have benefited the most from living in an ordered society should contribute the most to meeting the social needs of the nation."
There was a time when all adults knew, in their bones, the absolute truth of both of the above assertions. And it didn't matter their political stripes. They argued over what was actually needed and wanted, but not about the fact that if it was agreed that something was needed or wanted that taxing to get it and pay as you go was what you did. We need to get back to that rock solid concept and teach the electorate that you can't get something for nothing and endless tax cuts for those who least need them aren't helping anyone other than those lucky few who get government largesse.
17
@guyslp
Yep... I saw that bumper sticker on a small compact car, driven by a young fellow who probably still needs his government to have his back: Taxation is theft.
That meme republicans have used to destroy America needs to be proved wrong
1
Go big and bold, and remember that you are going to need a very strong president and presidency to make it happen. To that end, be careful that the current impeachment efforts don't weaken the office of the presidency.
2
While we are talking about telling the truth, this applies to critics of the "Big" ideas as well. Amy Klobuchar needs to stop being deliberately misleading by saying things like "149 million people will loose their private health insurance" without mentioning that they *all* gain good, if not better single-payer health insurance. She deliberately leaves the impression that all those people are going to be kicked out of health coverage to scare people and that is why it *is* a republican talking point. Probably also why shed gets defensive about people calling it that.
Also, I am old enough to remember the Harry And Louise ad campaign that killed Clinton Care. So essentially trying to corner Elizabeth Warren into saying "raise taxes" on camera so that the right-wing attack machine gets its video footage is naively giving them a gift.
That said I liked the way Bernie handled it by saying "yeah taxes will go up but costs will go down". Both of them could also point out that the danger of health care bankruptcy will vanish too.
8
@Jonathan from DC: But, as you noted, Bernie is actually saying what needs to be said.
Taxes will go up, but what you pay out of your own pocket (your part of your premiums and your co-pays for a very great many things) will disappear. The net cost savings for any given individual with private insurance, whether through an employer, the ACA, or the private market would most likely be very substantial. Both of these things need to be stated plainly as part of the equation.
There are other benefits, such as the removal of the specter of bankruptcy secondary to unanticipated health issues (and let's mention death related to same, too, because as someone who's worked in healthcare I can tell you that many die because they simply cannot afford care). Healthcare should be considered a basic human right in any country such as ours that has the ability to provide it to all.
6
@Jonathan from DC
Great article, Charles,
I hope someone gets to Amy and tells her
that she is being divisive and misleading.
And yes, I remember the Harry and Louise
adds and how they were successful in killing a health care plan.
In fact, I think it would be fun to chase down the real Harry and Louise and find out how much they paid out on their real health care costs but they're probably dead by now because their insurance didn't cover their cancer treatment.
Charles, your ambition is laudable. There are issues with it you don't mention. One is that members of Congress who, as you rightly say, will be the ones who translate vision into law, need to be elected. In the house that is possible but sadly, in the Senate it is not. One of the main reasons that is the case is the fault of our founding fathers who planned for an agrarian economy and population distribution. The other, which they could not foresee, is the profound ignorance of voters resulting from disinterest, poor education, a herd mentality and now the plethora of misinformation in the media. Given the current divisions in our society, transparency is essential but incremental change is the way to go. Moving on to transparency, it should go way beyond costs and structural changes to the issue of culture. Central to that is the notion that unskilled labor can guarantee a living wage in the Digital Age. It cannot.
3
One president in my life time did exactly what you propose Charles, he told the whole truth. Intelligently described in detail the problems we faced and offered clear solutions without sugar coating. That was President Jimmy Carter who was not re-elected, despite no scandals, no corruption, etc.
This is primary season where a variety of big ideas are floated to get the public to dream big. Although you don’t mention anyone, Elizabeth Warren and her refusal to admit that “we” tax payers will have to contribute to Medicare for All is your target. Elizabeth has not said or implied that Medicare for all would be absolutely free, she’s making the point that the COST to consumers/taxpayers will be less than we are paying now.
Unfortunately pundits and some of her opponents want to use the tax increase as a reason to not provide universal healthcare to everyone and effectively ignore the fact that despite any tax increases, the overwhelming majority of the US taxpayers would pay much less OUT of Pocket for Medicare for All than our current system and NEVER worry about having appropriate health care coverage.
The argument that union members have negotiated superior health care coverage - IF they did they were forced to give up something else of value, like better wages. I imagine union members and their negotiators would prefer that health care coverage not be part of the bargaining process so they could focus on truly negotiable issues. Healthcare Should not be negotiable.
6
Yes, there will be all kinds of job disruptions. There are now. We do have to do something.
The whole truth involves a discussion of the role of government. I believe the proper role of government is to build a framework in which the population can prosper. The framework involves physical and social infrastructure, which includes education, healthcare and rule of law. As I interpret our post WWII history, the US improved our society in this way, then let Americans choose to do what they would. IMO, the key to growth were the FDR policies, including support of unions, that equalized income in a way that is historically rare. The US took in more in taxes as a percentage of GDP because more workers got paid a living wage.
Americans recognize the state of our infrastructure. How we do it seems to be the big hang up. In the real world, the cheapest, most efficient way would be through governments, addressed as a single problem.
This is the Green New Deal. Rebuilt the infrastructure of America with American workers, leaving behind a modern frame work in which our kids can thrive, as we did from the work of the last generation.
Problem is, it is too socialist.
Dems need to redefine socialism.
2
If you want the whole truth about health care, ask yourself why corporate America is still buying health insurance. They love to get expenses off their books, and they are really good at getting their way with the government. They must want to keep buying insurance for their employees, or they wouldn't keep doing it.
It gives them leverage over employees, and makes it harder for small businesses to compete with them. To corporate America, those two advantages are well worth the costs of paying for health insurance, or they wouldn't keep doing it.
2
" start with middling ideas, and your compromise will end up as right-lite."
This describes my observation of the last 6 decades of Democratic strategy. A slow creep well to the right of the middle. Only a dramatic reboot is going to get anywhere near back to anything like the middle. "Give them an inch and they'll take a yard" I've seen enough already.
The whole truth is, we need M4A. Our current system costs the average citizen 20% of their total income. This includes premiums, deductibles, and co-pays once the deductible is met. This 20% cost for healthcare would be eliminated in a national healthcare program.
Yes, it's obvious taxes will go up to shift the costs from individuals to the government.
It's not obvious to most conservatives and independents (and people who don't have chronic conditions) that overall costs would go down because we would regulate pricing on prescription drugs, hospital stays, major testing like MRI/CT, and healthcare facilities. We would save by having fewer people processing insurance claims. The administrative hassle of dealing with 30 insurance companies who all want to avoid paying the drs for services, will be almost eliminated.
There will need to be a significant carrot & stick program to get businesses to convert their employee health insurance savings to increases in pay, to recover the loss of employment compensation value. Particularly for union employees who sacrificed pay raises/took cuts to have good health insurance.
Almost every other industrialized nation does this. It's not rocket science. It won't bankrupt the country either. It won't stop pharmaceuticals or hospitals or drs offices from making a profit. We don't have to pay like other countries. We could still be fair and ethical to doctors & hospitals.
1
The problem is that these ideas should not be labeled BIG ideas, lets just call them ideas and analyze them. Are the ideas BETTER? That's how we should judge them.
Also, long term, a conservative, safe idea, staying more in the status quo, could be more risky and dangerous than a so-called big idea. An example is continued push for fossil fuel consumption. Short term it's conservative, keeps status quo, doesn't upset the economic apple cart; long term our planet warms beyond recognition, destroys the economy, creates havoc, possible extinction. Perhaps the BIG ideas are the most safe, most economical, dare I say most conservative, long term.
3
If something sounds to good to be true. it is usually not. Sanders and Warren feeds you the cool-aide, you can have things for free and a tiny sliver of the people will pay for it. Take Health Care, for example.Their promise is that you can have anything you want, from whomever, you want, wherever you want and it will be free. They will do it by eliminating Insurance companies and including everyone in Medicare, from cradle to grave, paid for by who? Both of these Left wing Socialists say the costs will go down so much that there will be only a slight tax for most people, the greatest part coming from the uber rich. That is absolutely not true. Notice, neither S or W tell what their program will look like on day one, changing Medicare from 85 mil to 330 mil. Neither seems to have support from Provider groups. No doubt there would have to change Medical Care from Fee For Service, to Salaried MDs employed by large groups with a considerable drop in their incomes. Almost certainly, many MDS and other providers will opt out and form a Private Health Care system requiring Private Insurance. The NHS(new Medicare) will divide the country into regions, administered by Insurance companies and there will be many restrictions both for the Providers and Recipients, as to what, where and to whom one must go for care. It is the only way that costs can be controlled. That is why neither Sanders or Warren will tell this truth. To good to be true? It most certainly is not.
3
@bahcom Warren expects government management to mitigate the cost of health care to lower costs. I'd like to see how that works at the VA.
She was cagey about the cost, but she implied that the tax would cost less than health insurance. I'd like to see a more clear analysis, but here's the rub: she's demanding single payer to get a better bargaining position for the public option. Single payer isn't going to happen, and she knows it, but she can't admit it or she won't be able to bargain.
@bahcom
I'm confused. How do the rest of the industrialized countries do it? We're not as smart as them? It's not communism - it's common sense.
Then say it. "This is a plan. This is what I want. I can't make it a promise because Congress gets a vote. But it tells you who I am, and I do promise to try to do it."
4
There is a lot to be gained with a more efficient and lower priced health care. The major burden for all this inefficiency is the employers. It would be in the interest for them to get a cheaper system for the employees. Why do politicians not open a discussion with employers and employees because the current private insurance system is not as ideal as is often said and the cost for all this inefficiency and corruption is in the end paid for by the employees. The lie is repeated over and over that the millions of people with private insurance are happy with it. Of course major changes in any industry is to begin with painful and the health care industry no exception but really necessary.
@Shend
I’m in Facebook groups for my two autoimmune diseases, groups that are not restricted to Americans. I’ve noted that where the FDA has approved a new, highly anticipated drug, Americans’ access is dependent upon insurance coverage. However, patients in nationalized healthcare expressed frustration that their national system was dragging their heels, ultimately leaving them with no choice but to wait and hope that any of them would be able to get it.
This is one reason why I favor Pete Buttigieg’s idea to offer Americans the choice to opt into Medicare, and if it’s good, people will gravitate toward it.
I had fabulous employer based coverage, but now am required to be on Medicare. Even with my employer-negotiated and funded Medicare contract, my costs are three times as much as before; had I been required to join regular Medicare my costs would have been TWICE my increased amount.
Pete is right; Medicare for All will scare away a lot of people who like their current insurance.
2
That would be an amazing finesse, to provide all those details about costs, disrupted economies, loss of legions of jobs, and still win a majority of hearts. That sounds more dangerous than inspirational. I'll bet most ordinary citizens, left and right, aren't turned on at the thought of being someone else's project.
2
The whole truth is taxes. All this stuff is nice, but you get what you pay for. If you want Denmark (which is really, really nice), then you have to tax everyone 50%. If you want Norway (which I work in and is also really really nice), then you have to pay $25 for inferior burger, fries and drink, nationalize the oil business, tax 50%, and put everyone's taxes on the internet.
If you want a different system than ours, then it is disruptive, by definition. The question is how much.
The whole truth also involves what you get. The Dems are awful at explaining the benefits. They do their laundry list thing. The Scandinavians buy a level of life security for their whole society. Instead of putting their energy into worrying about making it to the next week, they can put energy into doing stuff they want.
Living wage, no worries about healthcare, education, retirement, 4 weeks paid vacation for everyone by law and balanced budgets.
And their country's infrastructure looked pretty good to me. Especially the snow ploughing.
I would have gladly given up 50% of my life's salary for all that.
9
Charles, who worried about the steel workers and factory workers when we signed NAFTA and admitted China to the WTO? Who fretted over the longshoremen during containerization? Who protected middle management hollowing out by computerization?
I agree the candidates should be frank about costs and taxes. Especially because, while taxes will rise, obviously, we also have every reason to expect costs to go down $1 trillion a year isn’t chump change.
What we should not do is become Luddites about health insurance companies. Those white collar workers will find other jobs. Some will join Medicare as federal employees or contractors. The overpaid executives and risk-shifters will have to find honest work.
2
Mr.Below yes you should be concerned with the displacement of millions of Insurance company workers, but your reasoning is flawed. Should Henry Ford been told to wait before producing automobiles because it would cause worker displacement in the wanton maker industry, blacksmiths, saddle makers etc? A progressive government would make provisions for retaining these workers into more productive industries that really benefit society.
3
@Ken
Mr. Ford was a private business person whose disruption of the transportation industry faded in across decades. The federal government could no more tell him not to go into business than they could tell Samuel Morse and Western Union to stop building the transcontinental telegraph which put the Pony Express out of business.
Contrast that with a federal government whose implementation of a single payer system has not been defined. Hundreds of thousands of health industry workers will be displaced. If the new healthcare is expected to streamline to reduce costs, then not all of these workers can be absorbed by the federal program. While it is easy to think only about highly paid CEOs and feel little sympathy, there are far more working class schlubs who will be looking for work.
We hear, from Sanders especially, that anyone who wants a job will have one. Where? In what industry? If re-education is necessary, who pays for that? Will workers need to relocate across country and if so, who bears that cost? Any contributions to these expenses by the feds has a price tag and voters should be told where those funds will be found. Taxing the 'tippy-top' only gets you so far, Ms. Warren.
This article isn't about the right or wrong of single payer healthcare, it is about demanding honesty in how painful that transition WILL be. No candidate is talking about that in real terms, only vague references and quick asides that negate how messy their proposals really are.
1
Tell the truth? Please. Not one single question and no discussion in the debate last night about climate change, the single most important issue facing us as far as a great deal of people are concerned. And after millions of people joined in mass protests to demand action from world leaders. Not too encouraging.
6
@Martha
Yes there could have been more discussions about climate change and the gutting of our environmental protections. The moderators could have been more inquisitive and ask them their positions on those topics. Think of all the jobs that could be created if we had more investments in solar and wind.
3
This is why I am still bullish on Bernie Sanders, despite the fact he is not the frontrunner in the Democratic primaries: he gives the vision but works to explain the costs and potential pitfalls. I very much adore my own Senator, one Elizabeth Warren, and will have no qualms voting for her in the general election; but sometimes she still tries to evade a straight question when a straight answer is called for. She needs to change that or Trump may eat her alive.
10
Brave of you Mr. Blow and a needed corrective aimed at a certain pair of Senators in our party primary, primarily the one from Tom Brady land. It is particularly brave to say that most of the grandiose proposals will never be enacted as proposed but instead in modified form.
Where I think you are the victim of unrealistic thinking is your sanguine belief the whole universe of investors, managers, employees and health care providers, and patients happy with their current health care will meekly acquiesce to the siren song of "transformation". This, I suggest, is the reason for evasion on the part of some candidates in our field.
5
It is remarkable to me that there is a vigorous debate among commenters to this article as to whether the Democratic candidates should “tell the truth” about their policies.
One the one hand are those who say that these “truths” will be distorted by opponents, dumbed down by the media, and ruin otherwise attractive 30 second sound bites. So don’t do it.
On the other hand are those who imply that voters—out of conservative bias or foolishness—will reject those policies. So don’t do it.
They generally fall into the camp of: one cannot govern if one does not win. So win first and then try to implement the policies.
Surprisingly few argue that hiding the truth about these polices is: wrong; will leave one without a mandate for implementation; avoids the give and take that might improve the policies.
Remarkable.
3
Agree and disagree. The aspirational can be inspirational, but ultimately I'm more interested in what CAN be done than what a candidate might like to do. Maybe that's just the hyper-practical Asian in me.
I agree about candidates telling the truth, particularly when the answer is clear. That's part of why I thought Elizabeth Warren did such a poor job in the debate, resorting to desperate and obvious semantic hopscotch to dodge, over and over, a yes-or-no question that everyone already knew the answer to.
12
I fully agree with the dream big and work to get enough out of a reluctant Congress idea. But on the issue of healthcare workers, most doctor office and hospital staff will still be needed. But the percentage that works there trying to navigate the Byzantine labyrinth of competing health insurers and cost containers, will have to look for new work. Of course, a Green New Deal might need paper pushers and the like, or they can retrain as solar panel installers, of other jobs in the expanding environmentally friendly business world.
I would remind people that most seniors like Medicare, and it doesn’t cost all that much. Also, restructured systems can become more non-profit HMO like, which are usually much more cost effective, and provide good healthcare. And, a big bonus with the change to a national healthcare system, as long as you’re in the USA, you are never out of area of coverage, worrying if your insurance will pay for the care you need away from home.
5
While it’s true that a few million people people will just have to look for new work, to not have a plan for that transition and, more importantly, for those people is insane and un-Democratic. We’re the party that cares about people, right? The vast majority of these people are billionaires or even people with $100K salaries, but are admin assistants, claims clerks and folks who code & input doctors’ notes into claims — among other lower-mid level tasks. So yeah, they need a plan that’s honest & honest about their futures.
1
@Clarissa -
Actually, I agree, we do need a plan. But that plan will have to be developed because it depends on what will actually pass Congress. Once there is a working start to the legislation, the effort should be to include in that legislation the support for those office workers being left behind (anyone making six figures or more should be ok).
That is something that is too often not done for employees in the US. Just look at Lordstown. It devastated the city as all those good paying jobs went away. The ripple effect on other businesses was also painful. A lot of people cut back on going out to eat, for instance.
Doing the most for the most is always a worthy goal.
But it is never free. For example, if you're a member of a union with a great health plan, Medicare for all could mean losing that plus increased taxes.
If Democrats don't address these types of issues, Republicans will do it for us. It will undermine support plus look like Democrats are helping one group at the expense of others, and not being honest about it.
8
@Talbot
As a Union spouse, with supposed great healthcare, we still pay a huge amount out of pocket.
We do have "some" vision and dental coverage. But we are still limited to whom ever the employee/union decide will be the provider. Who is in "network". What will next year be...? Lose the job and lose the healthcare. Unfortunately, many Unions are bargaining away these benefits for new/younger members. Too expensive.
And...as being a major negotiated benefit, M4A would actually allow us to negotiate for Salary instead.
M4A automatically covers dental, vision, hearing, mental as well as long-term care, inhouse care, and even general overall health care. M4A is a win, win.
I can't lose my coverage. Everyone is always IN network. I can go ANYWHERE.
And...we can negotiate for MORE PAY~!
Which is why most Unions as well as the AFL-CIO, have passed resolutions in support of Medicare for All.
https://jacobinmag.com/2018/06/medicare-for-all-health-care-unions/
1
A healthy nation exists because it plans on how best to do it for all.....In the worlds most democratic country the wellbeing for all appears to be formulated by the capitalistic goals of insurance corporations. Amazing in a country so rich, that at this cross road so many have to do a 180 turn and live with hope until medicare. while so many can say yes whatever it costs.. Given that a democratic choice may now be possible a future has consequences . That is the elite can decide to be fair to all or follow the road of might is right. Does getting off the ladder that leads to a nation’s health for all mean so much to a majority that the choice at the vote is not egalite but a bullet.
“
1
The American voter writ large, can't handle the truth, if they could Hillary Clinton would be President. Half of us want to be told fairy tales, i.e. "we're bringing coal back", and even as adults, as it was when we were kids, a nice fairy tale helps us sleep better at night.
4
@TY Sadly, I'm afraid your right.
Mr. Blow, I agree with you that Democrats must distinguish themselves from the worst of the Republicans. If they cave to fear, we will have Trump for four more years. Biden, for instance, would lose badly to Trump.
However, people such as you and me may not like this, but it is true: people vote from the hip, from their emotional connection. Telling the truth will not be effective as a lecture or confession. It has to be sexy to succeed. Democrats need to figure out how to remain sincere but not overly earnest in their appeals to voters. I wish Americans were more reflective in their thinking and practices but it is not the case. So how do we balance appealing sound bites with truth? We have to win. EW all the way!
2
Are you really arguing that inefficiency and inequality are "employment engines" and that eliminating them would be "a jobs hiller"? That the federal government is "a clunky bureaucracy" prone to "chaos, confusion and disappointments" that "[v]oters should be warned about"?
Sounds very much like you're buying into the "government is not the solution to our problem; government is the problem" mantra to me.
1
Although Mr. Blow does not directly name her, this column is about Elizabeth Warren's refusal to answer "yes" to the question of will she raise taxes.
The following is a direct quote made by Mike B. of Boston in a similar article posted earlier by NY Times columnist Frank Bruni.
"The reason Warren doesn't outright say taxes may go up but overall costs for the public will go down is not because she doesn't trust the American people, it's because she doesn't trust the politicians sharing the stage with her, and she doesn't trust the media covering the event. And she shouldn't trust them, because they will warp her message and make it into a gotcha moment. Instead of focusing on the "costs will go down" they will focus on taxes going up. Warren was smart not to fall into that trap".
If we want to be fair to Ms. Warren, please remember this is very likely why she refused to say "yes" to the question posed to her.
4
@Richard Phelps
It is also about Sanders who DOES tell the truth, as hard as it is to hear and risk telling it.
THAT is and always has been Bernie. Honest to a fault.
The man is authenticity. With a history to back it up.
2
More than that: the question itself. Was a single question put to her about the plan itself? What it would do? What it would mean to one’s family or the economy? Why she’s committed to it?
No, the lead question was, will you “admit” — admit, as if it’s known and she’s lying — that taxes will go up, with no consideration of premiums saved or attendant benefits.
There’s no reason universal healthcare need be financed by a payroll tax. It could be financed by a tax on the employer. That’s up to congress.
The candidates do not explain and the media does not ask a few basic questions about Medicare For All: what happens to the hundreds of billions paid each year by employers large and small for their employees’ insurance ... does it go away and they get heavily taxed instead? How much does the for-profit middleman (insurance companies) take from the pie and how much can we expect costs to decrease ... which should be easy to figure given Medicare’s specific costs now.
Plus, to address Joe Biden’s claim of most of the federal budget going to health care, how much will we spend over the next 10 years under the CURRENT system? More than Bernie’s $30 trillion? Without that figure, Biden’s complaint is meaningless.
Hard to believe reporters after all this time fail to ask such basic questions.
Private insurance should only be allowed if it's nonprofit.
4
@DL
Profits could be limited, as they are with utilities.
Then what would distinguish them would be services.
2
"Conservatives are never going to pat you on the back for your moderation. They will frame every proposal you put forward as a push toward the apocalypse, as an end of the American ideal, as an obvious creep toward socialism."
AMEN! When will Democrats understand that it doesn't matter how timid or moderate the proposal. Conservatives will refer to it as socialism because they know how toxic that word is to most Americans.
The ACA was market-based, yet Democrats foolishly let Republicans get away with branding it as socialism.
Democrats cower too much to accomplish anything, big or small.
8
@LilyB45
I am a liberal, not a Democrat. However, given a chance, the Dems can accomplish much. The last chance they had was the first 2 years of Pres. Obama. Keep in mind that they had a supermajority for only a short time due to the seating of Sen Franken and death of Sen. Kennedy.
1
Like Warren is? Tell the truth? Well, buddy you can't handle the truth be cause she's going to raise taxes on the middle class, the disappearing middle class, to cover the costs of Medicare for all. Taxing the billionaires is a good sound bite, but there aren't enough of them to pay a day's worth of coverage.
5
Her point is we are paying trillions now, much of it to for-profit middlemen. The status quo is killing tens of thousands and bankrupting many more each year. Obamacare was always meant to be adjusted going forward, like any huge program in our history. Medicare has overhead of a couple of percent, and yes we pay subsides to keep it that low. But it’s far better than the ridiculous, for-profit system the big insurers and Big Pharma have created. Warren has a point: overall costs matter to each of us. Other advanced countries pay a third of what we do with better results. It has to stop.
In simpler terms, Charles is calling out Senator Warren for her deceptive proposals. She may In fact be lying by omission of the details Charles struggles use that term when it involves a member of his beloved Democrat party. In listening to her, it is hard to understand why she can’t say that taxes will go up ( the money does need to come from somewhere) but that people’s overall costs will decline if that is what she believes. This really hurts her credibility.
Also, how will she eliminate private insurance. Will she make it illegal ? Will she fine companies that offer it? Will she jail people that do find a way to keep it ? What are the transition plans ?
Details do matter. They do make supporting a pipe dream possible.
1
Today Gordon Sondland, Trump’s E.U. Ambassador will be deposed by Congress. The Times notes: “Mr. Sondland, 62, tall and bald, is far from a typical diplomat. Foul-mouthed and unafraid to bruise egos, he craves the limelight, not policy papers and the politics of quiet persuasion that are the staples of diplomacy.”
This is what passes as the “establishment” in both parties. These are the “centrists”. Why would they want to change the gravy train, even as they destroy our democracy and working families. Yet, they also champion racializing refugee children and land grabs. There’s no semblance of morality or ethics.
From the cinders of our former country, only big ideas will lift our country and Americans. Big ideas are a matter of life and death. To Witt: Medicare for all is a great goal, but, as we know, it will be bigger than your run-of-the-mill Sisyphean challenge, but as long as the needle keeps moving forward, it will be good. Ditto all other proposals.
2
In other words, in your self-righteousness you prefer an approach that has always failed in democratic societies. You confuse the personal virtues of forthrightness, transparency and courage with political acumen. We celebrate FDR and LBJ, among other successful leaders, not because they put their heads in the meat-grinders of their day, but because they pursued good policies in clever, crafty, and emotionally knowledgeable ways. Don't give us a fool of a candidate who blusters and rants but can't get anything actually done; give us a poker player.
3
There are too many of them and most don’t seem strong enough to win.
Maybe it’s time for some of them to pair off and run as President and VP and figure out how to stand apart but especially to make sure they can beat Trump.
"majorly disruptive"?!! There is a reason the United States has employer funded medical care and it is not primarily for the employees' benefit. Medical care is a scandal which ought to be the subject of scripted television shows, but all of the Democratic candidates are counting on the Republicans to save their bacon. If the President loses, could be there will be no excuses. Pelosi and the Forty Thieves might even give the country what the people would then deserve. Not even Shonda could save us.
2
This is not an 'uncharted voyage'.
Every other rich and not-so-rich country has made this voyage in their sleep.
The only reason America has the single greatest Healthcare Rip-Off in the world is that the Greed Over People party refuses to let Americans be healthy and have any money left in their pockets.
America spends twice the OECD GDP average to take lousy care of its citizens.
We get about half the healthcare product in the USA for twice the price versus the healthcare experience in foreign countries.
We spend an extra $1 trillion annually on healthcare extortion, price gouging, CEO/executive pay, shareholder dividends and excessive procedures that aren't necessary.
Medicare For All would be cheaper because the government could finally regulate profit, greed and sociopathy out of healthcare like other countries do.
And there can still be supplemental insurance for those who want it.
Healthcare is an easy problem to solve; copy what every other country does.
United States 16.9% of GDP
Switzerland 12.2
Germany 11.2
France 11.2
Sweden 11.0
Japan 10.9
Canada 10.7
Denmark 10.5
Belgium 10.4
Austria 10.3
Norway 10.2
Netherlands 9.9
UK 9.8
New Zealand 9.3
Australia 9.3
Portugal 9.1
Finland 9.1
Chile 8.9
Spain 8.9
Italy 8.8
OECD - Average 8.8
Iceland 8.3
Korea 8.1
Slovenia 7.9
Greece 7.8
Israel 7.5
Czech Republic 7.5
Ireland 7.0
Lithuania 6.8
Slovak Republic 6.7
Hungary 6.6
Estonia 6.4
Poland 6.3
Latvia 5.9
Mexico 5.5
Luxembourg 5.4 %
28
@Socrates Great comment. Note also that undocumented Palestinians in Israel have better health coverage than US citizenens in the US.
2
What happens to all the jailers when we end mass incarceration,
What happens to all the weapons makers when we regulate guns
What happens to all the lobbyists....
5
You want to tell the truth about Medicare-for-all? Then you have to bring in the element of time. As Charles Gaba pointed out in his now-famous 2016 blog post, a transition to Medicare-for-all will take decades to achieve.
The existing system is like an ocean liner; it cannot turn on a dime. There are too many obstacles: thousands upon thousands of legal contracts to be abrogated or litigated, new regulations to be written, a huge new bureaucracy to be built, and many trillions of dollars found to enroll the entire population. Then there's the politics of it: 146 million Americans have private insurance, and many will be reluctant to give it up.
The best we can humanly achieve is to do it in steps, one or two years at a time, first the 64-year-olds, then the 63-year-olds, and so on, as Senator Kennedy proposed long ago. That is what a public option does; it starts a process that can lead ultimately, over several decades, to universal care.
If we were starting from scratch, as the Brits did after World War II, it would be another matter. But we are not; we already have in place vast, entrenched public and private systems.
Sen. Kennedy’s original proposals have been updated in a modern public option proposal, known as Medicare-for-America. It is simply and clearly described here: http://tinyurl.com/y39vbv8k.
Charles Gaba’s famous blog post is a must-read if you want to understand this complex and challenging issue. It can be found here: http://acasignups.net/node/3085.
6
"Telling Americans the truth" about the costs of social justice programs also involves truth telling about other aspects of our federal budget.
Most Americans don't know that the combination of tax cuts initiated by Bush, Obama and Trump total close to 10 trillion dollars!
The Fed's big banks bailout pumped about 4 trillion dollars into their coffers.
Real military spending including the VA costs for veterans is over 900 billion a year. Obama's nuclear weapons program will cost 1 trillion over 10 years!
And this is all occurring in an economy where 40% of Americans have less than $500 in a savings account that they could immediately tap for an emergency.
People forget that the preamble to our constitution states in part that one of the core reasons we formed this government was to "promote the general welfare."
Bernie and Warren are the two candidates that see how this has been perverted to "promote the corporate welfare."
The Trump administration has simply accelerated this shift of public money into greedy private hands.
If we do not act now to reverse this trend our (the average American's) future is in serious trouble.
Vast inequality didn't just happen. It is not the result of good minds hard at work. It is the result of years of manipulating our entire political economy, tilting it toward the wealthy. It is a class war and most of us have been on the loosing end.
Frustrations can turn to the right, or the left. The Dems offer our last hope. Don't blow it!
3
Unbridled cutting of the Tsongas in Alaska the largest temperate untouched rain forest on earth. all This as climate change acclerates. I live on the marsh on the coast and I see the rising tides. We so need avision.
2
Tell those 18 million people that their business is 'rightly' going to be disrupted, even eliminated. Would you happily accept your fate when people think you 'rightly' need to stop writing because they think you're wrong or toxic?
Will you hire people to scare people out of their health-care workplaces because they are resisting your 'right' call to eliminate them?
Did Mao do the right thing, sending shopkeeper to re-education camps, because they had to be 'rightly' eliminated for the great ideal of socialism?
1
Please folks give serious thought to Pete Buttigieg becoming the Dem. candidate. He doesn't yell bumper sticker solutions to complex problems. My sincere hope is he will be the candidate!
2
Call me cynical but until Democrats take control of both houses of Congress nothing minor or major will get done.
1
Most of the time, Mr. Blow irritates me to pieces with his pontificating on evil racism, when in my opinion tribalism is intrinsic and indelible to human nature, unfortunately. But THIS article is great. And yes, where progressives invite America to embark on a grueling trek towards medicare for all, they need to concede all the difficulties and downsides. If they do not, Americans will smell a rat and never buy in. Nor should they.
1
What happened to the hundreds of thousands of people working as farriers? Or blacksmiths? Or chimney sweeps? Or laundresses? Or telephone operators? Or telegraphers? The hundreds of thousands of people now working for private health insurers will do what workers in outdated -- and updated -- industries have always done. They do something else. As to the truth? Telling it, the whole of it, will never get anyone hired by anyone for any job. Least of all, a politician.
1
Amen. We're so disillusioned I think we forgot how to dream big. And tell the truth!
Time to once again point out the ignorance?/stupidity?/dishonesty?/hypocrisy? of people on both "sides" of the issue.
Let's do the very simplified math:
Say the total cost of an employer-provided policy is $20K...however it is split with employee.
But that is pre-tax dollars. Say the tax rate is 25%.
We eliminate the tax subsidy, so the employee now "gets" $15K.
That means $5K goes to the general fund, which can be used for all purposes... infrastructure, education, *or* paying for healthcare for poor people.
It also means people will have to decide how much to pay for health insurance... will they give up their iphones and stuff to pay for the $20K policy they had before?
Now, does anyone think that either the Bernie/Warren children *or* the phony "anti-socialist" people would vote for this change in policy?
The current policy is why the US has worse health care at twice the price... people keep asking this, when the answer is obvious. If you got an employment-based tax subsidy for housing, housing would be twice as expensive and even flimsier than it already is.
But both "sides" keep ignoring this fact and repeat the same talking points, back and forth. Do the math on this policy issue, and you will understand the problem with making any kind of transition.
Please, anyone who would vote for this change, speak up!
Many comments have proposed a public option. They predict that this will drive private insurance out of business and lead to M4A. There are several reasons this will not work.
The 1st one is obvious. It is much, much cheaper to administer a program where everyone is treated the same than one that has Medicare, Medicaid, VA, Indian health, TriCare, etc, AND 1,500 different private insurance policies (not counting Part D Medicare). Not only is there vastly higher overhead for the private insurers, but the compliance costs for physicians, hospitals, & patients are enormous, at least $600 Billion every year. The private option leaves most of that on the table.
The 2nd one is that a public option has to cover everybody the same while private plans can develop plans that cater to the young, the healthy, & the wealthy. They can give bribes to companies to get them to buy their coverage, This would leave the old, the sick, & the poor to the public option or Medicare itself. All this would raise the cost of the public option & negate any administrative savings.
The 3rd reason is that the universal gov run plan of other countries all have one entity that can gather data, analyze it, & make recommendations based on medicine, not profit. If a lot of people are covered by private companies which keep their data secret, we could not do this. See
https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html
to see how this would impact prices.
2
You want to tell the truth about Medicare-for-all? Then you have to bring in the element of time. As Charles Gaba pointed out in his now-famous 2016 blog post, a transition to Medicare-for-all will take decades to achieve.
The existing system is like an ocean liner; it cannot turn on a dime. There are too many obstacles: thousands upon thousands of legal contracts to be abrogated or litigated, new regulations to be written, a huge new bureaucracy to be built, and many trillions of dollars found to enroll the entire population. Then there's the politics: 146 million Americans have private insurance, many of whom will be reluctant to give it up.
The best we can humanly achieve is to do it in steps, one or two years at a time, first the 64-year-olds, then the 63-year-olds, and so on, as Senator Kennedy proposed long ago. That is what a public option does; it starts a process that can lead ultimately, over several decades, to universal care.
If we were starting from scratch, as the Brits did after World War II, it would be another matter. But we are not; we already have in place a vast, entrenched public and private system.
Sen. Kennedy’s original idea has been updated in a modern public option proposal, known as Medicare-for-America. It is simply and clearly described here: http://tinyurl.com/y39vbv8k.
Charles Gaba’s famous blog post is a must-read if you want to understand this complex and challenging issue. It can be found here: http://acasignups.net/node/3085.
Charles, I am glad you've finally listened to your children and rethought your mistaken opposition to Bernie Sanders from the last election cycle. We all grow, and you are growing. Thank you!
1
How are we going to pay for it! How are we going to pay the 740 billion dollars per year to fund the military! Can any of you out there tell me where the money is going to come from?!
Treat Voters as adults. Don’t just say what you think they want to hear, speak your mind, and speak your heart. It’s simple.
Let the other side say what they will to their Collaborators and Cultists. We can’t control that, or them.
VOTE. It’s the only thing that counts, pun intended.
A good essay that overlooks one huge fact: People dislike change; they hate big changes.
We like continuity, simplicity, and homeostasis in most things. Sure, a rare vacation might be exciting, but we live in, and like, a routinized world, where it's safe, comfy, predictable, and understandable, where we feel like we have control, where the best surprise is no surprise.
Ask any student if they like pop tests; ask any employee if they like big changes; ask anyone if they like the process of moving.
We're hunkered down in our foxhole and don't want to charge out into the unknown. I don't even like opening my mail: Oh, no, now what?
I think Mr. Blow just had an overcaffeinated idea and, facing a deadline, ran with it. He did a good job; his idea, however, is unearthly. Maybe in a parallel universe.
1
It is ludicrous to expect Warren to detail a complicated plan with many hypotheticals and many alternative routes to implementation. Degrading the debate into yes or no answers is NOT telling the whole truth! It simply provides opportunities for the misinformer in chief to trigger his Republican lemmings into action.
Having said this it maybe a good strategy for Warren to seek out Dr. Fine, former RI Department of Health, who has sketched out one way of getting to Medicare for All by first drastically reducing the costs. Better health care for all with dramatically less expenditure.
Dr. Fine's proposed to establish of a network of Health Stations for every 10 to 15 thousand citizens to provide prevention through free primary care and through support and education for healthful living. Farmers markets, cooking lessons, access to swimming pools and exercise, all can save money by averting catastrophic illnesses.
According to detailed calculations by Dr. Fine, primary care is only 5% - 10% of the health dollar but it can reduce acute health through prevention by 1/3. This means 1/3 less cancers, 1/3 less diabetes, 1/3 less heart disease and therefore 1/3 less hospitals and 1/3 less super expensive treatments that bloat health care profits.
Ask yourself can we afford both metaphorically AND literally not to have primary care free for all?
I hope the Warren people, and all the democratic candidates are reading the New York Times and seek out advice from Dr. Fine.
1
>>Start with your grandest ideas, and any eventual compromise is likely to end up in the middle; start with middling ideas, and your compromise will end up as right-lite.>>
Mr. Blow's column and sentiment is dead-on accurate. Our history since Reagan has been one of right-lite because their were no bold progressive Dems until Bernie Sanders lit a fire under their britches. Puleeze, stop with the middling.
4
Dream big or dream little - whatever wins just do that.
If we go single-payer, a future Republican government will have ubiquitous power to decide upon what healthcare cost is covered how much. Do we really want to sign off the healthcare of the politically disadvantaged: women, minorities, immigrants, disabled, transgender, by giving the government unquestioned monopoly over everyone's health? I don't think Danish women have to worry about losing their rights to choose. Can you imagine what a pregnant teen will face if every doctor she sees is effectively a government employee??
Why isn't ANYONE talking about this?!!
51
@Iowan I have been asking this exact same question - what will happen to my birth control and reproductive health care if Republicans control my health care? Let alone more “controversial” healthcare (in the minds of Republicans) for minorities like the ones you mention This is my biggest concern with medicare for all, and NO ONE is discussing it.
15
@Iowan
Because there isn't a comforting answer. There is no way possible to spin this as positive.
2
@Iowan "The Government" already allows the Catholic Church to impose health care restrictions upon the general public -- not only reproductive health, but end-of-life care, too. Any health care system with which the Church is affiliated is allowed to restrict care to comply with the tenets of the Ethical and Religious Directives as promulgated by the United States Conference of Catholic Bishops. It's a frightening set of rules.
8
Thanks, Mr. Blow, for a perfect prescription to re-elect Trump. You can stand on principle all the way through 2024 with Trump, I’ll take pragmatic, and end this fiasco presidency.
Why M4A? Why not VA coverage for all?
Seriously, in Great Britain they have essentially what is VA coverage for all - the entire health system is nationalized, all hospitals, clinics, doctors, etc. are government owned and run, just like our VA. The British NHS is absolutely beloved by the citizens as evidenced in polling. Everyone is covered, no one ever gets a bill, and healthcare costs in Britain is less than half it is in the U.S.
I say VA4A.
28
@Shend
Have you ever been to a hospital in Great Britain? I have. I brought a friend in for a severe ear ache and we waited for 11 hours to be seen. Not exactly great service. I also lived in GB as an ex-pat and I can tell you with 100% certainty that anyone with wealth supplements their NHS coverage with private specialist doctors. Also, take a look at how healthcare coverage was impacted in GB during the 2008 recession. The funds available in the plan went DOWN, significantly, leading to a deterioration in the healthcare experience of many citizens. Longer wait times, more rationing of care and medicine. It happens.
That's something that few supports of universal healthcare ever talk about. The funding of the plan comes from tax revenues, which are subject to earnings of citizens and corporations. So what happens when income and earnings are down? The pool of fund shrinks, sometimes a lot. How do you make that up? Either you raise taxes or you ration certain types of care.
14
@Shend
If it achieves the same results as M4A you can name it whatever you want.
By the by...our VA system is also a work in progress.
Care to guess who negotiated the largest and most formulated changes to the VA in recent history?
Yep, that mensch, Bernard Sanders. https://www.politico.com/story/2014/06/bernie-sanders-john-mccain-va-deal-107491
Which is why The American Legion honored Bernie with The American Legion’s Patriot Award. https://www.legion.org/veteranshealthcare/224431/sanders-miller-receive-legions-patriot-award
Which is why The Brookings Institute wrote a White Paper Report on Bernie's VA Negotiations. https://www.brookings.edu/research/profiles-in-negotiation-the-veterans-deal-of-2014/
McCain famously said of Bernie after the bills passage:
“I obviously am in strong disagreement with him on his basic philosophy of the role of government, but as far as an honest individual, to work with, to reach agreement, I respect Bernie Sanders.”
He added: “I will also say to anyone who will ask, Bernie Sanders is an honest man. He’s an honest man and his word is good. Once we reached an agreement, that agreement stuck. And now he’s brushing his hair, which is really a remarkable thing.”
10
@John
Have you ever been to an ER in the states?
Waiting 3, 4 or 6 hours to be seen isn't uncommon here either.
And then you get a $5,000+ bill in the mail for your troubles, even if you have private health insurance.
14
A bit amusing the Mr. Blow doesn't practice what he preaches. He never tells us what he thinks the "hidden truths" are regarding Medicare for All or Green New Deal.
The "hidden truth" is that UK, Germany, France, et al spend 10% of GDP on health care using Medicare for All type plans vs. US spending 17% of GDP to support insurance industry. 7% of GDP savings is huge. That truth?
We await the "hidden truths" Mr. Blow.
1
Good piece of writing Mr. Blow. Your points are accurate and relevant. I hope the politicians heed your advice.
1
Mondale did that. Even told the truth he'd raise taxes. Then he lost 49 states to Reagan.
The fundamentals of the voters who will determine the 2020 election have not changed.
Yes, dream big be bold, aim high... Just don't shoot yourself in the foot.
87
Thank you Charles. Living in France, I never cease to be amazed that progressive policies like affordable healthcare for all, federally mandated paid vacation time, affordable childcare, and affordable higher education, which Western Europeans have benefitted from for decades, are considered “pie in the sky,” or worse dangerous “socialism-creep” by so many in the US. All of these things could massively improve the quality of life of ordinary Americans if only they would elect candidates who know it’s time for America to catch up with the rest of the world’s “caring” democracies.
113
@Susan It's also because our record on public health care, the VA, Indian reservation hospitals, and Medicare run nursing homes is very poor. We also spend 5% of GDP on the military whereas France spends less than 2%. France provides universal health care at an effective average tax rate of 56%, vs. America's 36%. In short, we can have MC4A, but it will need to be much better run, and cost a lot more than most think, or are willing to pay for. Of course, if we spent 3% less of GDP on the Pentagon, we could have many more European like programs, but not even the most liberal Dems are for that, which is more than strange.
7
@Susan Since you live in France, you might be aware that under French law abortion on demand is limited to 10 weeks. New York by contrast allows such abortions for 24 weeks or more than twice as long.
It is perfectly possible in New York to kill a healthy fetus with developed organs just because you want to. No questions asked.
Whether this is good or bad I leave to you to decide. But Americans are so math-challenged that no one even knows the difference between 10 and 24. We shove them both under the umbrella of "reproductive rights."
1
@Susan
We in this US of A are easy to be brainwashed to act against our own interests!
That's why we fall for all the nonsense like "creeping to Socialism", "Individualism", Personal Responsibility", etc. Only that these values don't apply to those who milk the system!
5
I am a big supporter of Elizabeth Warren and I also understand the health insurance industry much better than the average American (I worked in a related industry). The one and only thing that has bothered me about Warren is her coyness at admitting the potential tax cost of single payer coverage. At the same time, I know why she's being coy. If she admits there's a tax cost, her opponents will focus only on the tax cost, ignoring the other side of the equation, the end of insurance premiums (and, if the system is designed right) deductibles, copayments, and coinsurance costs. She knows her opponents want to scare people, and talking openly about the tax cost (rather than emphasizing overall savings, which is what's she's doing instead) could end up derailing her plan.
Personally, if I were in her shoes, I would say something like: "Right now, if you have private insurance, you're paying a few hundred dollars a month in premiums. Your employer is also paying about twice as much as you are. And when you go get care, you're paying hundreds or thousands in deductibles, copayments, and coinsurance. If we go to single payer, all those costs disappear. You still may pay some premium—it will vary based on your income—but instead of that premium going to some insurance company's profits, it's going to go to the Medicare program."
How does that sound?
5
Well said, Charles! Let’s get our best dreams before America but be frank about the costs and impact.
Charles, I personally agree with what you say. I want to see big changes in this country.
However in these dark times we have driven ourselves into the weeds and just getting back on the road looks to be difficult with the firehose blast of lies and half truths that come at us each day.
How did Roosevelt accomplish huge change?
How do we communicate the truth and how do we as a country find the courage to move forward to a better future for all?
Mr. Blow urges the Democrats to tell the whole truth, and I applaud him for that. But the whole truth is something that the Democrats can never admit: their programs rarely work, always cost more than advertised, usually result in a reduction in our liberty and, worst of all for Dems, cost lots and lots of money and therefore taxes will necessarily be raised substantially on the middle class (which is where the bulk of potentially taxable income is earned). If the Dems were to tell these truths, they would not be elected but would be rightfully run out of town.
3
To the poor health insurance workers: You have chosen to work for companies that are wasting vast sums of our medical dollars and whose demise can't come quickly enough to stop harming the American public. Find another occupation.
Ask the telemarketers who lost their jobs (because we as Americans decided that we were tired of being bothered by marketing phone calls) last decade what they did and do that.
3
For those who are concerned with any particular piece of legislation that is proposed by a Democrat, remember he or she is not a dictator. Any legislation has to be approved by the three branches. They are just talking about the areas that are crying out for redress and you can be sure, unlike now, they will get a hearing when they take over the Senate.
1
@Donald Forbes
This is true, but at the same time, most presidential candidates will feel obligated to use all of the power of the presidency to push through the platform they were elected on. It’s too late after someone wins to object to their policies. There were people who voted for Trump who thought “build a wall” was a metaphor, but we ended up with a government shutdown over it.
President Obama put most of his efforts in his first two years--when Democrats controlled House and Senate--into health care reform. All he got was the ACA that was basically Romneycare based on private insurance. Why in the world are Democrats, Elizabeth Warren in particular, risking the reelection of Trump by pushing plans that most Americans do not want and that could not pass any conceivable configuration of Congress in the next decade? And it's not just health care: all the free stuff puts off most voters and is not going to pass Congress. Republicans spend a lot of money on polling and act on the results. Democrats might give it a try.
2
Plan on running against Pense. Set your strategy now.
Republicans are betting that Trump will be gone before the election. By his own hand. Trump will avoid releasing his financials and will avoid impeachment. He’ll run away crying foul.
It’s Pence. And I’m not sure if I should be more afraid than the current situation. A presidential Pense is like Rick Perry in Texas. Powerful allies will run the office.
1
I would dearly love to support this advice, and in a country where the media was dedicated to covering policy, I would. But that’s not what I see and read every day. It’s all about sound bites and the horse race. Elizabeth Warren will give you the whole truth if she’s given enough time and space to do so. I say let’s drop the shallow, staged debate format and offer the voters an alternative that consists of in-depth discussions of policy alternatives, economic costs and benefits, and an expert interviewer or two. Until we get something like that, asking politicians to tell the whole truth is asking them to shoot themselves in the foot because almost nobody is reporting anything like the whole truth.
9
I have a question.
Whether it’s “Medicare for All” or “Medicare for All Who Want It” the thing that is missing from the arguments on the sticker price is - what is the employers share of the cost. Today many employers pay a substantial part of the employees health insurance cost. I realize that the employers contributions vary, but rarely is it zero.
When I read the huge dollar figures for what single payer will cost .... I want to know what part will be paid by employers? If I make $40,0000 annually and my employer contributes $1,000/month for my insurance, that is equivalent to 30% of my salary.
If we go Medicare for all, either my employer contributes this 30% for each employee or they give me a 30% raise which offsets the increase in my taxes which pay for my new health coverage. Employers should be legally mandated to contribute.
5
@Mark O RN There's a lot of these types of questions Warren refuses to answer.
What happens to healthcare workers is a big one. The other is who pays to keep small hospitals and health clinics open that already are on the bring. Mandated Medicare a la Warren and Sanders would devastate them and require hundreds of billions each year to sustain to avoid a health care disaster.
1
Few people will welcome confusion, chaos, uncertainties into their lives, especially where there is no guarantee of improvement. Have you had to take the job that is there instead of the job you wanted because the one you wanted and had went away from a political power grab or similar abuse of power? Sewing a promise of hardship, stumbles and changes on the fly will not keep the crowd in your corner. Not many living paycheck to paycheck want to pay for generations in the future, willingly we can stop destroying, but building beyond our comfort is not easily undertaken. Look into your savings account and find your risk tolerance.
1
If you want the whole story, give people longer to speak at debates, and prepare the audience to digest complex answers.
The debate and sound bite formula we use to evaluate candidates makes it almost impossible to describe the intricacies of managing something as complex as a country.
11
“In theory, this is a prudent move that would translate into the most coverage for the most Americans.”
The laws of economics apply to nationalized healthcare. We have neither the tax dollars nor medical infrastructure to support true Medicare for all. We have not enough primary doctors as it is.
If medical services come without cost, they will consumed imprudently and further drive up costs.
I cannot fathom a world where Americans expect government to provide them medical services. Medicare is bad enough; we ought to phase it out and social security with it. Those too imprudent to save for retirement will not prudently manage their government stipends. The piper must be paid: we must make those who make bad decisions pay for them. It is called adult life.
1
@EWG - Several other countries support a universal, government run healthcare system with fewer physicians per capita, e.g. Japan.
You should look at the systems in place in all other developed countries to see that your objections are wrong.
3
@EWG
The average income in the US in 2019 is $46,800, some put it at $46, 600. The income of the lowest 10% of earners with just a high school degree is roughly $22,000 and the lowest 10% of workers with just a bachelor's degree is $34,580. What % of these salaries do you think it is prudent to save for retirement? 10%? 20%?
How much will be left to live on after saving for retirement? how much savings will there be to live on in retirement?
It's easy to criticize as imprudent, but it is morally shameful to do so.
You live in a make believe world of selfishness and moral superiority. These people are not just bad decision makers, they struggle just to survive. If we add medical costs to their lives I cannot fathom how they could manage any semblance of a normal life.
1
Too much change too fast is always painful. Warren should concentrate on one "dream" at a time. Don't try to achieve medicare for all while simultaneously going to war with America's most successful businesses and business people. I agree with these goals but it's a losing formula for a campaign.
American voters outside of liberal bastions love to vote like they're rich even when they're poor.
3
This is probably the wisest and most significant "advice" provided for Democratic candidates, and really, all Democrats. Thank you Charles Blow. Yang's major appeal is that he says, trust the people. People cannot make good decisions unless they are informed. Telling them the truth will get the best result. But, also, in the short and long term it will also get an extremely important element in any "big" project and forward looking vision - the people's trust. Trust of the people. It is only through gaining people's trust that Government can do "good" for society and that universal health care - for example - can become a reality. Ten years may be a more reasonable transition time than four years as suggested by supporters of Medicare for All. Inform the people, disclose the difficulties, and then listen and act on the informed opinions of people. Great advice here. I hope it will be taken.
2
Bravo, Charles Blow!
I've long believed progressive politicians have unveiled proposals that make great sense, but pull their punches when conservatives question or poke maliciously at the ideas.
Consider, just for one example, the "train wreck" complaints emanating from John Boehner as the ACA was coming into effect.
The ACA wasn't then perfect, nor is it now, but I don't recall Democrats rising to point out that the medical insurance practiced and prevailing pre-ACA were the "train wreck."
Progressives need to stand up and shout back at that kind of rhetoric.
Not least because Boehner himself recognized that the ACA would become substantially more popular as more and more people discovered the benefits, no matter how flawed, were substantially better than unfettered private "insurance."
8
I believe that the whole truth can be more complex than the soundbite that is being asked for. For instance, Medicare for All and that it WILL cost less than what the private insurance market is offering.
So to the moderates, we realize that you're suggestion of explaining that one in 3 minutes or less is what is dishonest.
5
Good column- lol...because it reflects my views! Any legislation on the scale of reformation of our health care system will be a giant endeavor. But I want someone in the Oval Office, in administrative offices, that will fight, and fight hard for that- dream. For the big idea. Not someone that will cave, compromise, deal away parts here and there so that the end result is unrecognizable. It’s what goes on behind those closed doors that will matter.
And as you say, there are fears of what bungling a giant bureaucracy could do as the single arbiter of medical care. One size will never fit all- watchdogs, revisions will always be necessary. But I’d rather it be government- we’ve seen the disaster private medical care has given us.
But equally, I want disclosure, specificity, on stage, of donors. The big donors. The measure of what a candidate will do behind those future closed doors can be somewhat determined by what they are saying, doing, promising, behind the doors now.
And frankly, Warren’s tax on those top billions? Way low.
And while we’re on specificity, those that think legislation can deliver campaign finance reform are selling their own pipe dream. Constitutional Amendments will be required. Who will fight, tooth and nail, for that mountain climb?
3
On the issue of Medicare for All and raising taxes, I don't think Sen. Warren is avoiding the question. She's avoiding the deceptive spin in the question. She says plainly that costs for the middle class will go down under her plan, and the truth is that's what's important. Taxes alone are not what's relevant to this issue--but it's easy to deceive people with simplistic statements about raising taxes and "taking away" their current insurance (as Pete Buttigieg did). That false simplicity is what Sen. Warren is avoiding, that and allowing the media, or her opponents, to manipulate her into framing the issue falsely. As currently managed, the debate format does not allow for nuanced replies, but the debate moderators--and the media generally--could contribute to a more meaningful discussion by framing the question in a more sophisticated and less incendiary way.
20
A good piece by Charles Blow, once again.
And please, Democratic candidates. UInderstand something. America wants the health care fiasco fixed. Most Americnas realize the GOP has no interest wnatever in fixing it. They also understand that ANYTHING the Democratic Party succeeds in doing will be better than the hatefest Trump and his Wall Street friends are currently running against the working poor, minorities and women.
So stop trying to score points off each other on the minutiae of health care reform. The Democrats should not be providing the GOP with material for attack ads against their successful candidate. Nor should candidates be getting their supporters so fired up they will stay home rather than support the party's candidate in 2020.
4
When your lying flat on your back in a hospital bed in genuine pain and discomfort and you are on the phone trying for hours and days to get a straight answer over something that may mean thousands of dollars in medical debt; that’s when you’ll really understand what a ludicrous and dysfunctional system we have.
I would offer similar pay federal jobs to all private insurance employees who are not in sales, marketing, or positions that don’t contribute to direct patient care. I don’t recall anyone in the healthcare industry wringing their hands over the millions of jobs sent overseas in the last 30 years.
13
"I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody."
Obama, 2003
“There are countries where a single-payer system may be working, but I believe that it is important for us to build on our traditions here in the United States.”
Obama, 2009
All I would add to Blow's excellent advice to the candidates: if you don't sincerely support the popular policies, then sit down and shut up.
3
The election will not be decided by voters like you Charles. It will be decided by moderate voters. If the Democrats nominate someone that is just as divisive as Trump (Warren or Sanders) with different demons, these moderates will anguish over their vote and Trump will likely get re-elected. Klobuchar said it well when she highlighted the difference between a big dream and a pipe dream. We are a divided nation and we need a unifier not an alienator.
2
@Jim Sherriff I'm not sure you're correct. A stronger argument could be made that the election will be decided by those Obama voters who refused to vote in 2016, in particularly high numbers in Wisconsin, Michigan, and Pennyslvania. I don't believe, after 4 years of Trump, that there are that man people undecided. Either you will vote for Trump or vote against him, even if you don't love the Democratic candidate. Lefties like myself do this ALL the time in slightly larger numbers than those that sat out--no reason to think moderates can't do it f someone to their left is nominated.
5
@cjp The definition of moderate is not precise but roughly 30% of likely voters identify themselves as independents or moderates. The left and the Trump base are each between 30 and 40% of the voters and their votes are pretty much locked down. The voters that are not locked down, the 30% in the middle, will decide the election.
The elephant in the room is the rampant opaque and usurious prices charged by the healthcare providers. There is no other industry in the US where the customers are kept in total darkness about what they can be expected to pay for their treatment at hospitals and clinics. Price comparison is almost impossible. The complexity of deductibles, co-pay, in and out of network providers enables our healthcare to extract the most from the consumers. Nowhere in the world do patients pay as much as we do in the US with such mediocre outcomes.
I agree that we need to totally transform our inefficient and ineffective healthcare system. Sen. Warren is well advised to create a few simple charts that distill how the overall costs will be reduced by medicare for all, who will pay for it, and how much will it likely cost the various economic quartiles of the society. More importantly, how will the existing millions of people currently employed in the usurious unproductive healthcare sector be retrained?
Special interests are well entrenched, and will derail any and all kinds of reform (death panels, Sarah Palin, anyone?). We need more transparency and plans that address the risks we face as a nation if we do nothing to address the economic disaster waiting to happen.
5
Win the war on language.
Any proposal has to have multiple catch phrases that will catch fire and burn down the opposition.
The Republicans are superb at this: remember Death Panels? Death Tax? Pro-Life? Patriot Act? Iraqi Freedom? and Obamacare? The last, while liked by Mr. Obama, managed to convince a good share of the public that the ACA and Obamacare were different.
It's sad, but if we can't explain stuff nowadays in 2 words (see above), we lose to Fox News. Just don't do another "Mission Accomplished."
1
@Mike S. I must disagree. Democrats have long been able to turn a phrase.
Income inequality.
Climate change.
Social justice warriors.
Easy to remember, impossible to afix a definition.
The biggest truth that needs telling and full explication, is that single payer health care, free quality college and quality truly affordable new housing (built constantly and available on a yearly basis) is fundamental to the quelling of racism and the righting of our ship of state and the creation of a truly equitable society.
Truth telling means the right Democratic candidate needs to step up and say that the only folks who will be paying the costs necessary to achieve the above are the hyper-wealthy. These billionaires (now numbering 585 according to Forbes) have a net worth of over $2.7 Trillion dollars. That is far more than most nations on earth combined.
There is more than enough wealth among these 585 billionaires to fully pay for health care, college and a housing revolution and for these same billionaires to stay billionaires.
That's the major single truth that needs telling over and over and over again.
Does this truth mean that so-called more liberal billionaires like young Mark Zuckerberg or Elon Musk Jeff Bezos or Bill Gates won't protest just a little?
Sure. Of course. It takes courage to be a Democrat. But we need to take our wealth back from the billionaires who we have appallingly propped up so that we could sit in front of our televisions and order popcorn delivered.
5
We should ALL be invested in our own health care according to what we earn. Let's talk about the benefits, not just the costs. One thing is certain: medicare for all cannot be worse or more expensive than what we have now.
The rich are not the enemy. Making them the enemy is a losing message. The sad fact is that when we attack corporations they simply relocate to greener pastures abroad. We need them more than they need us.
"the federal government is a clunky bureaucracy and isn’t always efficient and effective"
No, it is the system of private insurance and health care that is clunky, inefficient and ineffective. We know this because other countries do the job far better and more cheaply with government control, and also because of the efficient way that Medicare works.
In this statement, Blow is not telling the truth, he is repeating the talking point of those who oppose change.
6
Thank you for this.
It's great to have big ideas -- but if you can't explain how they will work (particularly to the people who are most likely going to end up paying for them) -- you're going to have a problem getting them to, well, work.
Medicare for All is a great soundbite. But Medicare isn't a panacea. There's a reason we're flooded with commercials at this time of year for Medicare supplement plans. It's because basic Medicare isn't as broad in coverage as people seem to believe it is. Even Medicare seems to urge people to sign up for private "Medicare Advantage" plans -- administered through private insurance companies.
There are co-payments and deductibles. There is separate prescription drug coverage. There are coverage "donut holes."
To me, the biggest problem with Medicare for All is that it treats the problems we have with delivery quality, affordable healthcare as a problem that insurance can solve.
It can't. Insurance isn't meant to cover "everyday" expenses. It's meant to be there when you have an unexpected health event. We need a solution that encompasses tort reform, addresses the cost of medical education, thinks about whether for-profit facilities make sense, considers long-term care.
We can do all of these things, but it will take time. Continuing to try to patch the mess we've made isn't a good long-term solution.
3
It's a Norma Desmond moment. Some time between my youth and old age Americans became afraid of thinking big. As a nation, we have created a "Christina's World" where fear and self-doubt reign. It's long past the time to put on our big boy pants and start approaching the future with anticipation not dread. When Trump and his enablers are removed, hopefully we can regain our vision and our courage.
6
The true problem is the super majority, which gives the GOP blocking power, even with a democrat-controlled house and senate. Until we abolish a loophole that destroys the popular vote, we will never have positive change.
8
After seeing the last debate ( Amy and Pete seemingly the only clear eyed ones) and Charles' column today, painful as it will be to me and moderate progressives, Trump will be elected only if not thrown out by the Senate first. Moscow Mitch and Barr, BTW where is he, are in control. Demo Fire Brands will only be kindling to Trump and the rest of his adoring crew.
2
I agree with Mr. Blow's argument here. One of the reasons I still feel I can't support Elizabeth Warren as enthusiastically as I do Bernie is that whenever faced with the question of whether taxes would go up with Medicare for All, Bernie says yes and Liz avoids the question. I love Sen. Warren and I wish she would have more courage with her answers to these questions. I have no illusions that many of these progressive policies regarding healthcare, climate change, economics, etc. will hurt some in the short term. But I also believe our current status quo has failed us and in the long-term, the progressive policies will help solve or mitigate many of our country's and the world's problems. While I don't have kids to worry about, I have a niece and nephew whose futures I do care about and I'm willing to feel some pain for their future's sake.
I hope the progressive candidates read Mr. Blow's column and take it to heart. Trump pretends to be straight, yet he's completely phony. I think Americans are ready for a president who is straight and real about both the good and the bad. I know I am.
5
I like the BOLD approach as well CHARLES BLOW! I agree!
As DEMS we are not good at selling this but the truth can be delivered like adding cherry flavor to kids medicine.
Health INS for ALL is the right way.
It eliminates PROFIT and ADMIN costs from robing the money pool that is supposed to heal people.
Could someone say this please?
Instead of SANDERS saying taxes will increase say what WARREN says - cost will go down even as the place your money goes will shift!@
JOBS will be moved (not lost) to go GREEN if we have DEMS running the show and doing it right. It will be an impressive fight because we only need to overcome OIL and PRIVATE INSURANCE companies to do it. Only a small task if not for the tremendous momentum of the old rich folks holding on to their wealth VS saving the USA or the WORLD.
2
Charles is absolutely right. You don't start negotiations with your fall back position. The choice we are making is who will
use the bully pulpit of the Presidency to change the paradigm and save our democracy....a strong advocate for progressive goals or someone who is fine with the way things were back in the days of triangulation or even in the ancient history of the Obama administration?
All those centrist leaning candidates on the stage Tuesday night comprise the "No we can't" cabal. A President can't make the sweeping changes by fiat, but she/he sure can frame the conversation.
4
Michael Steele made a comment yesterday regarding Warren's reluctance to answer the Medicare for All raising taxes question more directly. Mr. Steele's claim was that by avoiding the direct answer, Warren was trying to deprive the Republicons of a significant talking point that could be used against her, and Dems generally in the 2020 elections. I believe this is likely true. What this says to me is that, despite all the inflamed rhetoric, we have not yet had a legitimate debate about health care, and the costs, in this country. Until we do have that debate, we are stuck with what we have and all the associated problems. Warren, and Bernie, and all the Dems need to get out in front of this, and let folks know that this will be a process to get to where quality health care becomes a human right, and not an extravagance for the wealthy, or an economic threat to the middle class in times of health crisis. A large part of that process will be the transition, which will involve ALL of us (not just the insured). Your paycheck deductions will change, but the money will be going to healthcare services for ALL, not into the pockets of predatory insurance company administrators. That will be a bargain worth taking.
3
Harry Truman was first President to try and pass universal health care and failed. Despite total opposition, President Obama succeeded in passing the most major heath care initiative by any President. It was based on the worst health care law ever passed by President Reagan- EMTALA which had no funding source but forced anyone who was uninsured or illegal to go to an ER and be treated by the hospital until stabilized. The paying patients would subsidize the care. This led to Romney care which is basis of Obamacare when Massachusetts hospitals ran out of funding to comply with EMTALA.
Bernie and Warren are correct that our health system is broken and inefficient. WHO puts US as number 35 in efficiency of health care.
Thinking big means backing up Obamacare so it is more effective and restoring the necessary mandates for employer and individual contributions. A public option is also necessary to offer a low cost alternative to for profit insurance.
Thinking big does not mean giving free heath care to all with no mandates which actually is what EMTALA is; and it is pure socialism.
Warren's proposal is just demagoguery and not thinking big.
Democrats have some great ideas, but in general, aren't very good at explaining those ideas. It's time to establish a Department of Messaging to ensure that these ideas are conveyed effectively and efficiently.
3
In terms of telling the whole truth, Democrats should start by telling American voters that every country with universal health care, finances its health care system with a 20% VAT (or value added tax), basically a sales tax, on all goods and services, in addition to all other income taxes, property taxes, wealth taxes, estate taxes etc. VAT is impossible to avoid, so provides the predictable revenue stream needed to underwrite something as costly as national healthcare. So threshold issue for American voters: if you want the same healthcare system enjoyed in Europe, are you ready to pay 20% extra for everything you buy - every car, every haircut, everything?
4
@Richard They also neglect to acknowledge that many countries with a universal healthcare system, like England's NHS, still allow citizens to buy private insurance to piggyback on the public tax-funded care; the benefit being that private insurance can shorten queue times & increase access to specialists. I see the need for improvements in healthcare in the US but I'd like a heavy dose of honesty about how it would work and I don't buy that it would be 100% paid for by billionaires. Maybe the first year or two but (insert Thatcher quote here).
I would remind Mr. Blow that it is the corporate owned media that is partly responsible for this state of affairs. The issue of health care in America is complex. Townhalls, in-depth coverage and analysis, comparisons to systems in France, Germany, Japan, etc.-are all the correct means to discuss this issue.
But what do we get instead? Mediocre corporate framed debate questions, sound bytes and fear mongering- all contributing to further brainwashing of the public on this issue.
One other thing: Buttigieg, Klobuchar and others fall right into the hands of corporate dominated media on this. They know FULL WELL why Warren and Sanders are taking their positions. They understand how out of control health care costs, profiteering and weakly written laws allow consumers to be bought off and divided- all the while bringing the overall system down or subject to threats by men of Trump's ilk. But instead of delicately addressing these issues- they thrust forward with political talking points. I don't know who they think they are fooling- but certainly not me or the progressive wing of the party- or any one that can think about issues.
4
Tell people that prescription drugs make up 10% of all healthcare costs in the U.S., and that reducing drug prices to the same prices that Canadiens pay will reduce total healthcare costs by 3% annually.
Tell the people that getting rid of all the insurance companies means that all of the work that the hundreds of thousands of insurance workers will now have to be done by new government employees, and will at best will save perhaps 5% in total healthcare costs, and more that more than likely will increase healthcare costs overtime.
Just like Republicans continually spout that getting rid of taxes and regulations is the magic bullet to having a booming economy, Democrats, which I am one of, are convinced that getting rid of insurers and forcing drug companies to offer the same prices as Canada or Europe will result in Americans having universal healthcare that costs the same as Canada and Europe is just not grappling with reality.
Also, it would be nice to see Democratic candidates state how they will force colleges and universities to reduce their tuition costs, and not just talk about how they plan to throw more taxpayer money at the problem. College is not a financing problem, it is a cost problem. Just like healthcare.
1
@Shend --
The biggest administrative savings from implementing a single payer system will be at the PROVIDER level.
I used to go to an ob-gyn practice that had more people on staff to deal with insurance issues than they had medical practitioners. Imagine if they were dealing with ONE company, with everyone covered by the SAME rules. That would be a tremendous saving right there.
1
@Shend. Universities are kingdoms unto themselves. The professors are fairly compensated, the administrators are way over compensated. The athletic departments bring in a lot and spend a lot. A lot of these coaches make millions per year.
If you want free college, somebody is taking a pay cut.
Amen. Ditto for climate change. The successful candidate must channel FDR big time.
2
@John Marksbury
Is that the FDR who compromised with racists and misogynists so that 75% of the population continued as second-class citizens (de facto and de jure) until the 1960's?
That's how FDR got things done... incrementally. And his goal was to defend the status-quo of capitalism, not create a "socialist" utopia.
I agree with treating voters like adults but it is a time-honored tradition to dumb down the political message. Just look at how Trumpian drivel still gets applause. Forty percent of the population just cannot handle adult messages. They cannot digest big ideas and they certainly cannot stomach policy specifics. Just like in school, where it is a challenge for teachers to teach to the top and not the bottom, it is scary for candidates to preach to the top. But, that is what I long for. Let's have an intelligent candidate explain a good plan in language that is fit for educated adults.
4
"Tell the truth. Tell the whole truth. I genuinely believe that most voters are adult enough to handle the truth. In fact, I believe that not being fully on the level hurts progressives."
Great advice. Let's remember that the (quite possible) reason that "people want to keep their private health insurance" is that it reduces having to deal with change.
Now, everyone is defending how wonderful their private insurance is, but just a few years ago they were complaining about rising premiums, co-pays, deductibles, loss of insurance with job loss, pre-existing conditions causing a denial of coverage, and care restrictions.
Let's face the basic facts. We don't like having our health care tied to employment. We don't like being rejected for pre-existing conditions. We don't like wanting to avoid seeing a doctor to save on co-pays, or facing large deductibles for the first several uses of our doctors.
We don't want to have to deal with bankruptcy from lifetime limitations in coverage. We don't like an administrator telling us that a service is or is not covered. We don't like that we have to search through a number of plans to determine the best one for an undetermined future illness.
Let's not lump change with "it must be bad" just because it might take some adjustment. The ACA came about due to these problems and limitations.
1
Bravo, Mr. Blow. With the benefit of 70 years knowledge behind me it seems obvious where we are heading. Let us make the jump. Let us leave a world that is much the better for our grandchildren. Let us also understand that the Republican Party opposes universal health care because its success would be yet another nail its coffin, depriving it of both a signature issue and of big money from insurance companies.
2
I agree that we need to put forward bold ideas. It is actually easier to make big changes than small ones, because the public is bored by small changes and you can't build momentum behind them. Activists get behind big changes. Technocrats discuss small changes. I'm a fan of technocrats, but most people's eyes glaze over hearing about policy minutiae.
Americans like BIG and would rather have greater good or greater evil than lesser evil.
1
I agree with this article in principle. But the fact is that the Republican candidate will claim that if, for example, Warren is elected, people will lose their employer provided health insurance on January 21, 2021. And some voters will believe it. Candidates can have large aspirations, but they should articulate the steps and reasonable timeline to get there. Trump's strategy is to freak out voters. There's no percentage in increasing that freak out with proposals that cannot be passed immediately anyway.
2
I know the example is about healthcare, but I can't help to think about the climate crisis. Democrats not only need to dream big but we need to do big on this climate crisis. And tell the truth which is that business, as usual, will not cut it. We need systemic change. We need to conserve. Our lifestyles will be impacted - less meat, less flying, fewer children. Tech can only do so much. Tech will not save us entirely. Moderation and half measures are not enough. Our house is on fire. We need to act like it.
2
Democrats need to ditch Republican frames, among which is the "but the taxes" refrain. Taxes are the engine of government. There was a time when paying taxes was considered a patriotic duty. Warren is attempting to reframe the health care argument and the other Democrats need to get on board. Oh by the way, to be grammatically correct, it's the Democratic Party, not Democrat Party. That's another Republican frame.
6
@Cherie Miner That's what happens when Betsy DeVos has been Secretary of Education for high on 3 years; grammar and critical thinking fly out the window.
Several comments have raised the question of what to compare the $32 TRILLION estimate of the 10 year cost of M4A to. I can answer that. First of all note that that estimate included huge startup costs and comes from a Koch funded institute. There are several lower esteimates,.
The CBO has computer that we spent $3.65 Trillion on healthcare in 2018. So if we make the ridiculous assumption that costs will not increase in 10 Years, that comes to $36.5 TRILLION in 10 year. more than the cost of M4A.
Medical inflation has been running at between 3.5% and 5%. Let's take the lower figure. Compounding the costs of our present system over 10 years that comes to $51.4 TRILLION. So M4A will save about $15 TRILLION over 10 years.
5
@Len Charlap . The point is we have to be honest. Not just the Koch funded study found the $32trillion estimate. Many will have to pay more, and not just the wealthy. The question is what kind of a country do we want to have, a moral imperative on health care. https://www.theatlantic.com/politics/archive/2019/10/high-cost-warren-and-sanderss-single-payer-plan/600166/
1
@Kelle - That article you refer to is misleading. It doesn't look at the bottom line. The $34 TRILLION 10 year figure it gives is just the increase in federal spending. It neglects the enormous savings in private insurance premiums which would go to zero.
I think my computation is more honest than that. I looked at the bottom line. I used the highest bottom line estimate I could find and the lowest figure for medical inflation.
Sure, like most things there will be winners and losers, but looking at the bottom line shows there would be a lot more winners than losers. And if you look dollars, you will see that most of the lost money comes from the well-to-do.
2
The whole truth, Mr. Blow, is that every other developed country in the world has seen to it its populace is covered by government health-care. The reason we "can't afford it" is because large corporations have avoided paying their share of taxes (which progressive lawmakers will put an end to), in the case of Amazon no taxes at all, and we're too busy fighting and paying for wars in the far corners of the world where we don't belong.
The eighteen million you mention working for health-care (a highly unsubstantiated number) might easily be employed in working and administrating an improvement in the nation's infrastructure, which has been allowed to deteriorate to a disgraceful degree.
5
I totally agree with your thinking but what you are discussing is the contents of the next inaugural address.
In this primary campaign true honesty will be cropped and taken out of context by Republican spinmeisters in targeted adds where the Democratic candidate won't have an opportunity to rebut and reframe. I am not taking anything away from the American people, yes they will respond favorable to being talked to as adults. But like everything in like timing has the utmost consequences. Inauguration Day 2021 will make the propitious moment.
4
Agree.
The Public Option was, not so many election cycles ago the radical, socialist/communist idea that would bankrupt the nation and destroy the sacred doctor-insurance company-patient relationship.
Now it is considered middle of the road.
Thanks Bernie.
3
Thank you Mr. Blow. Democratic "moderates" have enabled Republican extremists for the last forty years by not offering real solutions to the problems of ordinary people, instead frequently coming all too close to taking the places of that nearly extinct species, the moderate Republican. What I find inspiring about Senator Warren is that she is one of the Democrats who identify real problems that have serious consequences for ordinary people, and then suggest policies that actually would solve those problems. As Mr. Blow says, this is the sort of platform that Democrats should run on, that will inspire voters and produce the turnout needed in 2020 not only in the presidential election, but at all levels.
2
This is very true. Seems like to get to the highest office in the land, you have to say the grandest things. It's not to different then going to a job interview, and trying to land that dream job. Who is bold enough to take on this task and successfully make it out the other side with the coveted position?
1
It is not a case of "Dream smaller" to tie one's dream to a strategy on how to accomplish the dream.
Repubs respond to moderation because they must. Consider the mainstreaming of gay marriage just a few years after Obama and the majority of the country disapproved of it. Steps happen quickly in a digital age with a willing populace.
The implementation of "bold" change usually requires gov't dictum that takes choice away from citizens by decree of "elite politicians." Repubs raise money and votes on such Dem proposals of instant change. The wiser heads in the Dem debate did not want to lose gun safety changes they believed put at risk by the proposal of confiscation.
Bills to insurance co-pays to $500 and funding reduced reduce premiums by gov't subsidy with corresponding tax increases on cap gains, stock transfer tax, etc. can make ObamaCare more popular. Offering to let people buy in to Medicare will require insurance companies to get much better or people will abandon private insurance to buy in to Medicare. Single payer will evolve quickly, provided McConnell is removed from power.
Not "milquetoast." A method to deliver big dreams requiring steps rather than a Star Trek transporter.
3
@JT - John Tucker
OBAMACARE is a sop to the insurance companies. People seem to think it's fine for sick people to pay as much as possible so that dividends can be paid to shareholders. This is ALL NEW POLICY put into place post Ronal Reagan. Lots of spiked lemonade out there.
BTW people who have the point of view that nothing should change, will vote for Trump anyway. Biden is too old. (Trump thus far has kept us out of s couple of wars-- maybe... )
Call me a Nervous Nellie, but I don’t detect much actual knowledge of health policy from Sanders or Warren. Both deal in bullet points and anecdotes, but not there’s not much substance.
At root, health policy is about three things: financing, benefits, and cultural fit. MFA proponents stress benefits, resist (and sometimes resent) attempts to discuss benefits, and are dismissive of fit issues.
So, where’s the vision?
6
I remember the day HRC was campaigning in Ohio and speaking about climate change, declaring (more or less), "we are going to put a lot of coal miners out of work, so we'll need to do a, b, and c." I admired her bold, up-front honesty at the time. Have voters become more open-minded and better informed since then?
5
I too remember how the rest of that comment revealed her compassion for them as well as the willingness to dig in to finding solutions.....and the right sliced and diced her comment into that one phrase and lied about it to claim she was gleefully dissing coal miners. Just like when Obama talked sympathetically about how no wonder people in certain conservative areas clung to their guns and religion when so much had been taken from them and the GOP turned that into a diss with the willing help of their base, so ready to believe the worst of those they’d been taught to demonize.
1
Well, to tell the whole truth requires one to know it and, taking the health care example, nobody, least of all politicians know what will be the important ramifications among the various espoused plans. Such possible ramifications need to be studied by experts who would report to us the advantages and pitfalls that each plan might exhibit. Then, of course, after being put in practice the plan would have to be adjusted pending actual results.
And yes, I do find it humorous the way the presidential candidates act as if they will have dictatorial powers. Just look how much President Obama didn't accomplish when the Republicans decided to be obstructionists; they wouldn't even hold hearings on some issues - can you imagine ! I guess maybe some candidates are thinking of declaring a national emergency, which gives them special authority, so they could fund their border walls and such.
9
It's the corporate media and the healthcare industry who are not honest being honest with voters. Pundits and lobbyists have no problem excusing sky high health insurance premiums but any candidate who mentions higher taxes instantly gets portrayed an unelectable pariah. And since this piece seems to be directed, puzzlingly, at Elizabeth Warren, please keep in mind that the minute she says she will raise taxes in order to institute a robust national health care system without the burden of high premiums, will be the end of her campaign. Remember Walter Mondale in 1984? He was honest about raising taxes and lost in a landslide.
Warren, like Sanders, and unlike most of the media and political class, understands that any increase in taxes will be more than offset by a national health service without high premiums and little to no out of pocket expenses.
9
@MarkusA "Remember Walter Mondale in 1984?"
Millennials have no clue who you are talking about.
They would have to go back to the 70's, understand the the oil embargo, gas lines, crazy inflation and rising interest rates, to understand why Reagan won in 1980. Reagan turned around the country and really brought back the American spirit. Mondale's platform basically said, let's go back to the way things were, before Reagan. This is much like today.
Biden is the only Democrat that wants to keep Obama's memory alive. The others recognize, Obama didn't get much done. Obama did cause the party to lose 1100 elected office holders over 6 years.
If people have nothing, they'll vote anyone that promises to improve their station in life. At the other end of the food chain, there is not a hunger to surrender most or all what they have.
Don't forget to ask, "Are better off now, than you were 4 years ago?"
Mr. Blow, I believe what you say to the core. It makes sense. In these days of spin spin spin, walking back statements, assignation, alternative facts, science denial and out right lies - the truth will never let you down. We may not get what we need, but eventually it will bear fruit. And the fruit at the top of the tree can be the sweetest!
2
If the several hundred thousand jobs in the private health insurance sector, that will be lost if M4A is enacted, are in electoral swing states, then the election is lost already. Plenty of Democrats will vote for Trump rather than a Democratic nominee that promises to eliminate their jobs.
3
I agree so much with this column. And I'm prepared to get trashed for writing this, but this is one reason I'm missing Marianne Williamson from these debates. There are far, far bigger questions we need to consider and address:
What kind of nation do we want to be? What is a good society for mothers and children? What kind of people do we want to be? How do we grow our souls in such a toxic (materially and spiritually) society? How do we deal with the 40% of the American public - our neighbors, our families - that is willing to embrace, or at least still support, such a reprehensible president?
At an earlier debate, she said (paraphrasing) that we can't only focus on treating illness and sickness, but we have to address why it is that so many of us are so sick? That includes looking at not just our health care policies, but our food and agriculture policies, our environmental polices, and our chemical policies.
When she said that, I felt something shift in my head and my body. There's something remarkable about hearing a politician (or at least someone running for office) who speaks a truth that is so obvious, and yet one that no one in political life, or in the media, is willing to speak. Someone who makes clear the connections that others seem dedicated to hiding.
I immediately donated to her campaign, and she has been my number one choice since. If you want big ideas, and truth telling, I don't think we can do better than Marianne Williamson.
6
Looking back on the very rocky start that Obama Care suffered I wonder why there aren't smaller test markets to iron out the kinks?
1
Because smaller markets often don’t reveal how the larger would work, are more easily smothered by industry and other forces and are often jus5 a waste of time if something is worth doing. Many of the “kinks” in the ACA at start were more like monkey wrenches thrown into the works by the GOP.
1
Totally agree. Candidates can also better explain what is so wrong with the current system that we need the change. What are the costs of maintaining the status quo? With regard to health insurance workers that Medicare for All would displace, I seem to recall that Bernie Sanders did have a plan for them.
1
I’m as far from an expert on health care as you can get, but it seems like a no-brainer that offering a public option is the best first step toward reform. Why do you think the GOP fought tooth-and-nail against it a decade ago? Right, because it would have revealed the implausible lie behind the “socialized medicine” baloney that has been thrown at us with great success by entrenched interests who fear a future where their cash cow has been roped and slaughtered.
4
This is the trap of democrats. To think small and start negotiating from the middle. Then the republicans take them to the cleaners and we wind up further to the right despite being a liberal country.
If Amy Klobuchar, Joe Biden, Pete Buttigieg think they will win the middle of the country and that will propel them to the presidency they are sadly mistaken. When three of the youngest and most liberal representatives (AOC and her trio) back Bernie Sanders, it would be a grave mistake to think they will reflexively vote for any democrat who wins the nomination. See Hilary 2016.
Big Bold Ideas has got to be the mantra of democrats in this election. It is the best chance to make trans formative changes since FDR.
Don't blow it by going centrist. And tell the truth, the whole truth and nothing but the truth.
9
There is one absolute certainty with any plan for health care: it will not give you everything you want for yourself.
Want access? No problem. But we might have the practitioner you see be poorly trained and not up to his or her task.
Want good quality care? Perhaps, but who decides what quality care is? Drink like a fish and your liver dies. A new liver might not be available for you. Need plastic surgery because you are not pretty enough? Not covered.
The essence of any general plan for health care is the need to deny coverage to many people some of the time whether you choose Medicare for All, ACA-plus or a return to the fee for service maelstrom.
We need to start from this position and seek to find consensus on the plan with the most coverage we can afford with the best available care for the most people.
For the visually inclined designers of a health care system, draw a triangle and label the three vertices as FAST, GOOD and CHEAP. Below the triangle, add the caption: CHOOSE ANY TWO. Decisions, like elections, have consequences.
3
@Doug McNeill
Most people don't get really sick until they are old and Medicare seems to work just fine for them. No reason it shouldn't work just fine for the young uns... at less cost as they are less sick.
It is obvious to me that Warren is furiously resisting giving the Republicans a soundbite to use against her. Bernie's definitive declaration that he will be raising taxes only sounds frank in the context of a Democratic debate; when it comes to a general election it would be used against him big time with people on the right and in the middle. Now she has to refine her response about her health plan so she can make a more eloquent case that her motivation to reduce overall costs is the gold standard, and not seem to be dodging the tax question all the time. Warren has consistently said that her Medicare For All plan would reduce costs for the middle class and raise costs for the wealthy. If she were to arrive there by pushing a tax that increased the middle class tax burden while greatly reducing their overall expenditure on health care, why is she insincere for characterizing that as a reduction in costs rather than a tax increase for the middle class, which could be taken out of context and used to hammer her later?
5
Mr. Blow,
I agree that telling the truth is the right thing to do, but disagree that, as you say "...voters are adult enough to handle the truth". From my perspective, a lot of voters only hear what they want to hear, and disregards the rest (apologies to Paul Simon). The 'rest' is that truthful message we should all handle, but instead ignore.
7
You make a compelling argument that most reasonable people agree with. However, Democrats will achieve nothing if they're not first elected to office. As we are all aware, there is a "misinformation industrial complex" on the right that is unfortunately all too effective. Campaigning on a platform that promises to take away everybody's employer provided healthcare is almost certainly a losing strategy. (Leaving aside the merits of such a plan or whether it would even be politically possible.) Pete Buttigieg has the most politically feasible approach to achieving universal coverage - 'Medicare for all who want it'. And considering the monumental lift that was required to pass Obamacare, even his proposal will require extraordinarily adept political skills and a dogged persistence on the part of all Democrats.
4
Wow. How nice to hear someone talk about the displaced workers. I've been screaming about that for ages.
Now, what about the billions of dollars in health insurance employers are now paying? Am I going to get that in my pay check once I'm paying taxes for healthcare? Is the employer going to have to kick that into "the pot" for healthcare for all? Is it somehow going to contribute to the public welfare?
Or as I most fear, are employers just scot free and that money goes back into their bottom line or wherever else they'd like to put it--new home for CEO/new yacht/bonuses for the C-suite?
Someone needs to figure that out as well.
And tell me what it's going to cost. I guarantee it will cost me more and there will be others like me, but that's okay if it means a child with asthma can get an inhaler or a diabetic doesn't have to ration their insulin. I pay for education for all when I have no children in school. I can pay for healthcare for all.
Go ahead. Dream big. But recognize some things are going to have to be incremental. That's just the way it works. The ship of state is huge. And it takes time to re-direct her.
4
@mj
There have been people screaming for ages since time began about displaced workers. And the world moved forward, anyway. What's the point in asking what the employers will do with the money they don't spend on health care insurance? Someone is bound to benefit, no?
1
As a Democrat, the problem with dreaming big is that we depend on the open, free mainstream media where truth is respected and both sides are examined critically.
The Republicans, on the other hand, have FOX, Talk Radio and the Drudge Report. They create their own reality on an as needed basis.
Remember 2004? War hero John Kerry was made to look like a traitor because of "Swift Boat" lies. Dan Rather lost his job because he accurately reported that young Bush got his National Guard service as the result of the father's influence.
And Bush got reelected despite having made one of the worst blunders in US military history - the Iraq war. That's the power of Conservative media.
Democrats will always act in moderation because the mainstream media by its nature supports moderation. Until we get a FOX of our own, we'll just have to deal with the real world where things happen incrementally and moderately.
2
Big and bold are nothing more than catch words. If the Warren/Sanders big and bold Medicare for All remains part of the platform should either capture the nomination, big and bold will be a losing proposition in the 2020 election. If big and bold means a "political revolution" then big and bold will lose. I appreciate the passion displayed by Warren and Sanders but this election will be decided by moderate swing voters who do not have the palette for big and bold political revolution.
5
@nzierler There are no moderate swing voters. This is a totally polarized country -- there are people who lean right and people who lean left, and in any given election, depending on their level of enthusiasm or disdain for the politicians who theoretically represent their interests, either show up to vote or don't. Anybody who tells you otherwise is selling something.
7
Since my existence is questioned: Hi. My name is Steve and I’m a moderate swing voter - or I’d like to be. While I live in a blue state, I’ve voted for Republicans. I get tired of the lack of nuance in our discourse today, and I feel I have no place to go. Here’s some examples - the people who cross the border illegally are law breakers. I would increase immigration overall, in all categories, but we can’t reward law breakers. Forever wars are ridiculous wastes, but once we are there, like in northern Syria, and once we make promises, like to the Kurds, we are committed and need to see things through. We need to talk to the Russians. They are too important to ostracize. However, I am a proponent of containment and think that the same logic that guided us through the Cold War must be applied against the Russians today. I’m pro-choice, mostly. But I think abortion should be rare, and I get squeamish as the term of pregnancy advances. On guns, I think buybacks are dumb. Won’t people just use the money to buy more - whether legal or not? On the other hand, something must be done to figure out why the stats show what they show - that we Americans are a murderous bunch. We’ve got to do something.
For me, policy will unfortunately take a backseat to competence and sobriety. We need true leadership first. That’s why I will swing towards the adult in the room - whoever s/he turns out to be, and that’s not Trump.
But they do have a palette for rude, reckless, self serving autocrats?
There's nothing wrong with dreaming big. The problem is how the candidates are going to make those dreams a reality if any of them win the presidency. It's not easy dealing with apathetic voters and a determined opposition that want to turn those dreams into a nightmare.
2
Climate change is not some sort of gravy train for big gov't. Major changes that are going to have major impacts on the society and the economy are going to happen. None of the candidates want to walk blindly into the catastrophe like Trump and the GOP. The "lets economize" on this huge problem is just acquiescing into dangerous wishful thinking. The death of Ted Kennedy led to the insurance industry friendly ACA. The ACA was a success compared with the laisse faire system left by the GOP. The victory of the plutocratic forces in the economy over the past 30 years has reached a dangerous stage as with climate change. The public needs to realize that wealth is a national asset that has been privatized to the USs detriment. The numbers are devastating. The top 1% control 35% of the wealth. That is unacceptable.
2
@c harris, Look, we're not going to be a society bereft of cars and trucks, shiver in the cold darkness, and eat grass. So take your climate change argument somewhere else.
Go ahead and ask 150 million Americans to give up their employer paid, private health insurance on the promise it will all get worked out in about a decade and see how that goes. Only one outcome is possible but cross your fingers and toes and hope for a different one. Best advice I have heard from this columnist to date.
6
You understand that “employer paid” for most still means a large part of the cost is born by the worker? It’s the rare plan without employee premiums, deductibles etc. and more and more jobs are doing away with it or performing sleight of hand by requiring all to work less than 30 hours.
1
@GregP As a physician for almost 40 years, there is nothing I can imagine that is as inefficient and irrational as our private health insurance system.
1
As we should have learned by now, it is not the product but the packaging. Republicans are masters at propaganda, labeling Democratic policies as "socialism" at every turn. Democrats must respond by challenging the label and highlighting how many of the programs government has provided for decades provide services for all, regardless of any ability to pay for the services through taxes. Ask someone who opposes any type of universal medical care plan if they support public education. Invariably they will say of course. But is it more important to educate a poor child than to keep that child alive? Point out how Medicare and Medicaid work, or Social Security, or police protection or the myriad of services the government provides to every citizen regardless of wealth or ability to pay taxes. Go to the heart of the philosophical issue- what basic services should a government insure for all citizens. If a voter will not acknowledge that the answer must at least include minimal food, housing, education and medical care, presenting big dream ideas will be meaningless.
11
Mr. Blow,
Why not come clean yourself and state what you are really saying? That Elizabeth Warren's continued dodging of questions related to middle class taxes and funding for her litany of new or expanded social programs is problematic at best and an election killer at worst. Anyone who can add and subtract can easily see that Ms. Warren's plans to tax the wealthy and corporations will fall woefully short of what's needed to cover the costs of medicare-for-all. Then add in forgiving college debt, free childcare, expanding social security, the New Green Deal and various other programs and the bill starts to touch upwards of $80+ trillion dollars over a decade. Warren's wealth tax is estimated to generate $2.75 trillion over the same period......yet she refuses to answer a simple yes or no question on taxes.
And to all those who defend her by saying she's politically savvy not answer the question - just stop. Bernie Sanders has answered the question truthfully dozens of times and his campaign is doing just fine.
15
@John
Bernies Sanders was not the one in the last election that had to face the Republican propaganda machine. If he wins the Democratic primary, he will face the full blast of it. Can he take it?
Yes, I am 100% for the Democrats dreaming big while also telling the whole truth, but since we are being totally honest here, let's not be naive. The format of the debate does not lend itself to nuanced conversations about policy, it's about gotcha moments and catchy sound bites. If Elizabeth Warren wins the nomination but loses the general election it will not be because Trump and the Republicans had coherent and intelligent arguments against her healthcare plan, it will be because they brought out their tomahawks, war paint, and war whoops. After all, we are talking about Trump here, does anyone really think we are going to get intelligent debate? Maybe the Democrats should take a cue from the Republicans, have big ideas and say the Mexicans will pay for it. It's dishonest but at least its a winning strategy.
6
Before I retired, I thought going onto Medicare would be a big step down in my choices and overall coverage. I was wrong. Medicare is better than my very good employer based policy. The problem is that the providers are paid MUCH less. Having worked in healthcare for 40 years, I know every provider carefully monitors the "payer mix" to be sure they are not accepting too much Medicare. How is this sustainable in a Medicare for All system? Private insurance supports the shortfalls of Medicare. I want someone to explain the math.
4
@JDS Health care providers-- doctors, many hospitals--will make less money. But, sure, the math is tricky. So, let's just continue to let people die for lack of decent health care in the richest country in human history. That's a plan.
2
@JDS I wonder the same thing, but I also know there are numerous examples to follow with all the other countries that already make such a system work. While the UK is a fully socialized system where the doctors work for the government, I believe Canada and some of the Norwegian countries have systems similar to Medicare for All.
We don't have to reinvent it. Just follow the best practices of numerous other successful systems.
2
@JDS
The U.S. Bureau of Labor statistics shows that general practitioners earn on average over $214,000 a year. What would they earn on a Medicare-for-all system? Half that? Poor babies.
1
“What happens to all those workers when we, rightly, reduce our health care spending and restructure the American health care system?” The workers will remain and hopefully more will be added to handle more Americans having access to health care. What will be reduced/eliminated with Medicare For All is profiteering by health insurers and pharmaceutical companies.
6
@John Rice
Please explain exactly how those displaced workers will remain and more will be added when everything I've read indicates that there will be far less healthcare related jobs overall under a universal healthcare system. Not to mention that wages for the jobs that remain are likely to be less than what those workers are getting at private companies. The Government never pays more than private companies, which is why the best and brightest too often opt to seek their fortunes elsewhere. So again, I ask you, where will these jobs come from?
2
Are you saying that everyone working in private health insurance now will be automatically employed by the Federal government to ensure Medicare For All works properly?
@John
Worrying about displaced workers is probably the reason why so many people continue to smoke tobacco. And trade in bathtub hooch.
What Warren and Sanders fail to acknowledge is that the true moonshot is changing how the American public sees government. They dream of putting their side in power, and would do so by “fighting” those who disagree. Pete Buttigieg dreams bigger, by having the audacity to believe it’s possible to persuade those who oppose progressive policies and to reverse the 40 year long rightward movement of the political center. At a time when the entire world seems to be careening to the far right, the project of moving the political center by persuading Middle America that progressive values are their values is something Warren and Sanders seem to consider impossible. They are mired in the political battles that have in many ways caused the polarization we have today. Buttigieg is mistakenly characterized as a “moderate” because he addresses moderates and even conservatives and explains progressive values in a way that makes sense and diffuses polarization. Which is a bolder vision, one in which progressive policies are fought for in a way that alienates all opponents and thus strengthens the opponents’ resolve to dismantle those policies, or one in which the political landscape is altered and opposition to progressive policies is disrupted?
6
@Margaret Speas I fail to see how proposing bold, progressive changes to health care, education, taxation, is failure to persuade "Middle America that progressive values are their values" while treading tired "moderate" ground is promoting progressive values.
2
You want the truth about MedicareForAll? Several extensive studies , including one commissioned by the Koch Brothers , have shown enormous savings while ensuring everyone is covered for their healthcare needs . In addition both the House and Senate bills expand coverage to include dental and vision as well as close gaps that force people to rely on supplemental coverage .
Worried about the impact on health insurance company workers ? There are generous accommodations in both the House and Senate bills to help displaced workers transition and unlike coal miners and newspaper printers these workers have transferable , in demand skills.
Worried about disruption? Surely you jest . Nothing is more disruptive as well as morally and fiscally indefensible than our current prohibitively expensive, Byzantine healthcare system designed to center corporate profits and keep people subservient to employers while leaving millions and millions of Americans out in the cold .
Medicare has been in place since 1965 . It covers our oldest , most expensive to care for segment of the population. It’s wildly popular .
All the hand wringing about expanding it to cover all Americans is coming from powerful interests looking to protect their profits and certainly not out of concern for a pressing life and death societal need . We need a complete paradigm shift in how we view , and how the media covers , this critically important issue affecting each and every one of us .
40
@Paul G Knox All excellent points. And it is columns like this one which made me decide to let my subscription expire at the end of the month. I am tired of the pundits here pretending to be on the side of the readers while maintaining plausible deniability about really wanting to preserve the status quo. For any other readers who have perceived the decline of this paper, particularly after getting rid of its Public Editor position a few years ago, I urge you to consider doing the same.
5
After about five minutes of online research, I found out the following. In 2018, total average costs in the U.S. exceeded $28,000 for a family of four In 2016, total medical costs were $10,348 per person. Costs are rising 3-4% per year.
What does an average Canadian pay? About $5,789 .....The "average" Canadian family, consisting of two adults and two children, earning about $127,000, will pay about $12,000 a year for public health care.
We need to offer a public option and keep a private insurance option; those who say they love the latter will soon find out they are paying more so that CEO's and big pharma can earn multimillions. Over time most people will go to a public option.
17
@Bonnie -- Yes. And note that this is exactly the position taken by Mayor Pete.
2
@Bonnie
But will the system hold up during such a gradual transition? There is an argument for rapid change though painful.
Which hurts more, pulling a band-aid off fast or slowly?
1
If the cost of your home owners insurance or the cost of roofing your home went up at 4 or 5 or 9 times inflation for two decades the public would be screaming for government run home insurance or government run roofing. The healthcare industries greed has to end.
6
Sorry but I am not willing to let healthcare go into disarray for a decade even if it will be "free".
5
@Kohl It won't be free. But it will be affordable for everyone, not just the people who can pay the high prices for-profit providers and insurers demand.
1
Health insurance should be available to all Americans. Private health insurance cost is increasing so rapidly that Americans cannot afford it. If government takes over that sector, it also needs to implement new policies to control prescription drugs and cost of hospitals. However this article addresses one of the potential consequence of the government taken over health insurance. The article does not say that the government will need to hire staff to handle it. And also it does not say that in the past the country have allowed consolidations of the private sector such a banks, the country today has 6,000 or 7,000 less banks than in 1980. Another example is the airline industry. Lots of jobs were lost in those consolidations so that some companies can make more money. Why criticize a potential initiative in health insurance when it will allow Americans to have better health insurance?
4
Healthcare in America appears to be issue number one , still.
This means that the system is really broken .
Almost two thirds of Americans already are covered by government healthcare ( Medicare, Medicaid,VA, federal workers , Native Americans etc ) , the remaining third is either privately insured or totally uninsured ( still many millions ) .
One third of America’s healthcare costs are spent on red tape !
The federal government and private insurances are unable to come up with a system that is affordable and accessible for all.
I believe a single healthcare, even privately run, would save money and bring fairness and justice in this chaotic field.
Beside the money spent in red tape, let’s not forget all the out of pocket money ( huge amount) being spent by each citizen, together with the highest insurance premiums in the world and the most costly prescription drugs worldwide .
After over a trillion dollars is being being spent every year , the end results are meager , with America ranging only about in the 40th position according to WHO .
Now it is time for a drastic change and get anything health related out of Wall Street.
5
Reality has a strange way of remedying grandiose ideas. Obama swore ACA would work as the healthy millennials would offset the cost of the chronicle ill, which never happened. In the real world economics drives success or herald failure. Tax and spend Democrats still can’t find a way to circumvent this fact.
4
The reason it didn’t happen was because the GOP fought the penalty, encouraged the young to not buy in and blocked the Medicaid expansion, leaving a hole of unaffordability among other things. If they had got on board what was in fact a compromise built on a Republican idea and encouraged buy in it would have gone much smoother. And in fact it has far fewer problems than its detractors claim.
2
Whether Democrats go big or moderate, it is the sad truth that it is the Republicans that pass tax cuts for the wealthy and big business which increases the deficit that will be leading the we can't afford it charge.
5
This is the only column that Mr. Blow has written that wholeheartedly disagree with (I am a Blow junkie). In all facets of life, moderation is the right remedy. It is no different with the Democrats' proposals. The ACA exists and helps millions who previously had no health insurance, and has worked precisely bc a single payor healthcare proposal was not pursued. President Obama knew this and the ACA has provided millions with lifesaving benefits that would not exist had a single payor system been pursued. Not saying shooting for the stars is a bad thing, but moderation always wins the day, humans thrive on consistency and stability, not radical change.
5
Thank you for writing this. There is an added benefit to telling the truth - it spurs useful discussion and debate and encourages refinement of rough ideas into smart and just policies.
6
Well, actually there is a good reason not to go big: most American voters don't like big changes. Remember what happened to Democrats in the House after Obamacare was enacted? Also remember that ANY change toward more social programs, worker and consumer protections, gun control and environmental protections, to name a few, represent drastic changes from Trump Administration policies.
I would argue that more moderate changes, by Democratic Party standards, is the key to winning the 2020 election. After all, that is the primary objective. If we don't win the election, then the possibility of enacting any legislation is zero.
6
Cogent points to bring to the forefront of the Democratic contenders conscience at this point in the presidential race. I agree completely that the milquetoast version of Dem candidate is about as exciting as the morning dose of Metamucil to keep regular, necessary but definitely not exciting. The country is in free fall under the corrupt Trump administration & the GOP Congressional emasculation under Trump's threats to destroy their careers if they fall out of line.
So many Americans have lost faith in the political process but even worse in the vibrancy of our democracy as it appears more & more to be in decline. Most people are struggling to stay afloat without losing their financial footings with just one medical emergency away from total bankruptcy due to job loss or the unaffordability of health insurance. Meanwhile the GOP is giving away the future to corporations & billionaires through tax cuts & simultaneously undermining the central tenets of the Affordable Care Act.
Big structural change is needed to restore our country back to health instead of letting it die from oligarchical blood draining & anti-science subterfuge. Personally I'm not concerned about health insurance jobs as this industry wasn't concerned about denying coverage to people dying of various ailments all in the name of profit for their industry. Just like all the other jobs being phased out by robotics & automation, they too will have to retool & find new opportunities within the new economy.
8
Elizabeth Warren, when she discusses how she will pay for what she proposes, needs to share the simple truth:
The money is there. It is already in available
budget monies. Automatically. Period.
And that's it in a nutshell. She doesn't have to majically come up with monies to pay for her projected spending. The money is there.
6
Elizabeth Warren is the most astute candidate running for president. She is keenly aware that anything she says in front of a camera can be turned into a meme and run endlessly by her opponents. Not saying, “Taxes will rise on the middle class,” is simply not handing that free meme to the opposition.
Instead Warren compares current health care costs to families to the costs she has computed under her plan. It’s honest and complete. It stresses the benefits. Gosh, when JFK announced he’d spend oodles of money send a man to the moon, not only didn’t he stress the cost, he didn’t have any benefits to list! He basically said we’d do it because we’re the coolest kids on the block.
We did the moon thing, and, you know what, I think we can provide basic health care too. Warren is playing it exactly right.
11
@Victor Unfortunately she boxed herself into a corner by trying to co-opt Bernie's supporters on this issue. By not coming clean on the details she avoids those opposition memes but comes across to potential supporters as shifty. The longer this drags out, the more its going to look as if she's been forced to 'fess up when she actually does. If the plan is that good then she has to come clean on the details. Who will pay how much does matter. Will those already on or nearing eligibility for medicare suddenly find themselves with new taxes for something they thought they'd already earned? Ask any self-employed person about the impact of the Affordable Care Act on their premiums and you'll get an earful on why the details matter.
4
@Pete Bartolik - Why isn't there this much concern, scrutiny & hand wringing over Trump & the GOP's increase in military spending? Since Trump lost the popular vote & took the oval office, the defense budget has grown by $133 billion, or 23%. Where were all the op-eds & public comments on this massive waste of tax payer dollars? How about Fox News coverage & viral memes by the Alt Right? How about the waste of taxpayer dollars for a $220 million surveillance drone to be shot down for being in Iranian air space? All this while Trump says he doesn't believe in wasting money in the Middle East?
6
Well said Charles. What we need is leadership and not leaders who base their views on the polls.
5
“The sad truth is that inefficiency and inequality can sometimes be employment engines, requiring an ever-growing universe of workers to adjust to a system that doesn’t work as well as it should. Fixing the system can not only eliminate waste in terms of cost, but also in terms of labor. It can be a jobs killer. Progressives should confront this paradox head-on and tell voters how they plan to address it.” For a long time I have felt that health care is heavily parasitized. It appears that the administrative costs far exceed the actual costs of the health care being delivered.
I am a senior citizen and can recall the time when the doctor came to the house to tend to the sick. I can recall how scandalized my parents were at the news that the cost of stay in the hospital had reached the unimaginable sum of $100 a day. Now a trip to the emergency room can exceed ones annual Social Security income. Thank heavens for Medicare. I don’t know how we would survive without it.
As noted, it will be difficult be difficult and disruptive to overhaul healthcare in this country, but the path we are on is unsustainable. We have to move forward and tackle this big problem.
12
Perhaps the folks proposing these transformational changes should be honest about the elephant in the room: Barring some miraculous transformation of the Senate, Medicare for All will not happen in the next presidential term, no matter who's elected.
5
@Sam The transformation change we need to see is a 180 about the obesity and poor health in our country. Did you know that obesity is linking to poor executive function, lack of planning, and general impulsivity. That's why when you walk into a room of successful professionals, most will be slim. It's the same skill set. Also why although I try to be kind, I stay far away both professionally and socially from overweight people. It's a tell for other dysfunction.
@Mary Rivkatot
So our dysfunctional system can be blamed on fat people instead of on Republicans' kowtowing to greedy billionaires and corporations?
Who knew it was so simple?
1
What I want to see and what would be the most honest and the most helpful in making a decision is a side by side comparison. The headline reads MEDICARE FOR ALL WILL COST 32 TRILLION. The public is horrified. But what will the alternatives cost. The current system? The Republican plan (or more accurately the lack thereof). It is disingenuous to make something look so terribly expensive and then not show the figures for the alternatives.
9
How about cheap government health insurance for those who don't smoke, don't drink, are not overweight? Why should people like me who take care of ourselves and resist temptation have to subsidize the people who do not? Every year mandatory physical (like the one I did when I got life insurance at the cheapest rate - the first time I was truly rewarded for taking care of myself).
Incentivize, incentivize, incentivize; don't just tax uniformly and spend...
3
@Walker
What you write is not just bad science, it transforms healthcare into a moral issue in which you decide which people are like you, "who don't smoke, don't drink, are not overweight" because you "take care of ourselves and resist temptation". You're deserving, others aren't, and you don't "have to subsidize" bad people.
Your plan with its "Every year mandatory physical" means everyone who fails a physical in any given year loses their insurance. It's not the same as how life insurance works, and it doesn't "incentivize"; it's all stick and scientifically wrong, so it’s inherently cruel.
All Americans of Native American decent whose families evolved in desert ecosystems would be ineligible for your plan as they have incredibly high rates of obesity because they have a genetic mutation which allows them to survive in an environment of intense dietary scarcity. If they do everything that “healthy” and supposedly good people like you do, they’d still be bad people because they'd fail your mandatory physical.
They’re not alone. Famed Neuroscientist Rachel Yehuda, Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, has proven that if a woman, for example, survives even a short period of intense trauma and starvation she typically only survived because the gene controlling food metabolism actually mutated while she was starving. The mutated gene is passed to any children the woman has who will be obese if they eat a healthy diet.
3
@Walker - The US food supply is designed to make people sick. Sugar & toxic fat are added to all processed foods & corn, the main staple of the American diet, is genetically modified which causes weight gain (for both humans & the livestock it is fed to) & insulin spikes. Not to mention the food deserts in high poverty neighborhoods which only stock junk food & no produce or healthy proteins. There's a reason that the poor in America die on average at least 10 years earlier than their wealthier countrymen. When you have limited money to spend it is difficult to find an organic food store that carries healthy food & there aren't any Whole Foods stores available even if they could afford it. Attack the food industry instead of the poor victims of food poisoning.
2
@Walker "How about cheap government health insurance for those who don't" take selfies in dangerous situations, drive recklessly, practice unsafe sexual behaviors, misuse legal or illegal drugs willingly, don't get the necessary hours of sleep a day, don't vote the way you do, read books that offend you, wear hairstyles that offend somebody, are not 'woke', work in a non-PC job, wear fur, drive a gasoline powered vehicle, overshare, don't share enough, ..........that would certainly save you paying almost ANY taxes, right?
Imagine a bill that would establish a national health insurance plan, a "medicare for all" system. How long would it take to create such a bill, let alone build such a system?
For example, how many new federal employees would be needed to operate it? Are there scores of dedicated, progressive college grads out waiting for low-paying jobs in a vast (it would be vast) bureaucracy?
But let's stick to the bill. Has such a bill ANY hope of being adopted by ANY possible Congress in the next decade?
If it actually got both written and passed, would the present Supreme Court allow it, or condemn it as unconstitutional overreach?
And even if it did get past the Congress and the Court, how long before, as is inevitable, the GOP again holds the White House, or the Congress, and goes to work to sabotage this grand new system, just as they are presently sabotaging the entire federal government?
Anything created by one party will eventually be controlled or run by the other party or its appointees.
This is why evolution is better than revolution. It works SO much better. The more revolutionary, the less hope of success.
2
LBJ in 1964 won 61.1% of the popular vote. This remains the highest percentage won by a US president since 1820. He dis this by running on the basis of his "Great Society." He got most of it done. The civil rights act ( which lost him the Deep South in 1964 making his record victory all the more remarkable), the voting rights act, the fair housing act, Medicare, Medicaid, Headstart, Foodstamps (now SNAP), NPR and PBS were all parts of his Great Society. He thought bigger than most dared to think. I presume you would have told him how to deliver his message. He might not have finished reading your column.
11
@James Ricciardi Nixon won in 1972 with 60.7% of the vote and 49 states. So what does that tell you? The country was less divided and not influenced by a biased media. The issues stood on their own, not as political agendas. Today, the Party not in power seeks a power that is both absolute and permanent, at any cost
3
@hawk I agree. But no Democratic presidential candidate will win if they do not find their own voice. I am reminded of a line of the great Argentine poet, Jorge Luis Borges, "thou shalt not magnify the worsip of truth: for at the day's end there is no man who hath not lied many times with good reason."
4
@hawk I misread your comment. I now denounce it. It is Trump and the GOP who seek permanent and absolute power.
Speaking of dreams, in 1914 Thomas Edison and Henry Ford had successfully invented an electric car that worked. Ford stated that the electric car would replace all gasoline engine cars in the near future. Then something mysterious happened.
Suddenly their electric car disappeared from view and was never heard from again. What happened was a secret but suspicions were that the petroleum industry got to them and put an end to the electric car.
In today’s world, large corporations have a strangle hold on the country and the citizens. Amazon and Facebook have enormous control over our lives.
Some things never change!
3
"Fixing the system can not only eliminate waste in terms of cost, but also in terms of labor. It can be a jobs killer. Progressives should confront this paradox head-on and tell voters how they plan to address it."
I suspect they don't know themselves. For me, the danger of the most sweeping changes focuses on all the "good " stuff, the putcomes, without ever considering costs, both financial and emotional.
Remember Obama care? Remember the legislative battles, the legislative turmoil, a demogoging campaign that so soured the public, it seemed our healthcare systems would fail completely.
All this to say, vision is great, but don't let the Republicans define your plan, forcing you to admit you can't let the perfect be the enemy if the good.
1
If people level with voters, the truths they utter will be used by opponents to beat them bloody in front of the electorate. The necessity of raising taxes to pay for expansion of health care, for example, has been used to beat many politicians bloody, so to discuss it is to give sound bites to the opposition. This makes discussions of issues almost impossible, which is its purpose.
In reality, any major changes in our health care system will affect all sorts of prices and taxes, and looking at what happens to one tax is a joke. But saying this is ducking the issue.
So the voters punish politicians who level with them about some unpleasant topics; if they really wanted politicians to be honest, they would try not to do this. Politicians respond to this by giving more-or-less convincing impersonations of honesty.
The truth is that voters punish honest politicians and should stop doing so, and telling this to the voters, with examples of how the voters have punished honest politicians, must be part of telling the whole truth. And many voters will punish politicians who tell them this.
This is why telling the whole truth is not a good idea. We should perhaps go back to lying like used car salesmen, with a pitch that will gain office. This has worked very well for Republicans, but Democrats have trouble pulling it off, since they are still attached to reality.
5
Although Mr. Blow does not name her directly, he is obviously referring to Elizabeth Warren's refusal to answer the question repeatedly asked by her debate opponents, "Answer yes or no, will you raise taxes."
Rather than criticize her for not answering with a "yes" she deserves credit for having the wisdom, intelligence, and savvy to refuse to answer it.
If she had answered "truthfully" with a yes, every Republican leaning adversary would immediately be quoting her out of context stating that "If you elect Elizabeth Warren, she will "raise your taxes".
7
@Richard Phelps if that is the truth behind her plans, Warren needs to own that truth. She needs to communicate relentlessly to the American voters, that everyone is going to see robust tax increases, the middle class as well as the wealthy, so that her plans may be delivered. She needs to boast of those tax increases, as a badge of honor needed to rebuild the American Dream.
3
@Richard (Good name Richard)! While taxes the average American will pay with a single payer health plan may go up, overall costs will go down. I know this is hard for many people to understand, but it is critical for those who disfavor a single payer health plan to realize that their overall out-of-pocket expenses will not go up because the amount they now pay for health insurance will go down. And yes, you probably are covered by your employer, but there are costs associated with that as well. The drug companies and insurance companies are not in business because they want to give you adequate health care; they are in business in order to make a profit.
4
@Richard Phelps
it is the reason Dr. Fine former director of the RI Department of Health has repeatedly said:
"in the US we do not have a Health Care System but Health Care Profit Centers.
Mr Blow is being unhelpful framing it as a yes or no question. The Republican smear lemmings are waiting to be triggered into action.
1
Great and true analysis-- come together, talk about the benefits and the problems regarding M4A-- if we have an honest conversation about a big idea, verses a pantomimed performative show, then we will get much closer to ensuring every American gets the healthcare that is their God Given right.
I rarely agree with Charles Blow,
but I do on these issues.
Very disheartening to hear many of the Democratic
candidates watering down the changes that Americans need.
Thank You,
Charles.
6
@John Brown
Agree. I watched debate and lost respect for Klobuchar and Butigieg. They attacked Warren and accused her of dishonesty as they shamelessly and opportunistically piled on in hopes of gaining "centrist" footing in the race. Talk about same-as-it-ever-was politicians. No thanks!
1
I don't believe I've read a column that I agree with more completely. I hope all Democratic candidates will heed it.
6
Thank you for being a good steward of public trust, and an equal opportunity political watchdog. I was uneasy at the waffling during the last Democratic candidates debate (Tues., Oct. 15th.) Even though the candidates appeared to be calling out each other for not telling the whole story, they seemed to be using this as a tactic to further their own agendas and get plugs in for their support sites. Even CNN, sponsor of the debate, was framing the candidates reactions in this way. Did anybody say, “You are right for calling me out, I will correct that”? Anyone?
So Democrats: to be a good leader, you need humility. So far, I see not much of that in the public arena. And I expect more. Show me some respect, people. I need to know the facts; then I can decide. If you reveal all, nobody can come from behind and blindside you for not telling the truth. In order to win this campaign, you need to be better than your opponents. Better. And be bold. We deserve as much. Thank you.
1
I am a senior citizen on Medicare. Medicare pays about 80% of most medical bills. The other 20% is paid by my secondary health insurance, which is private and operates like any private insurance company. I pay premiums for that coverage. Without secondary insurance, I would have much greater medical costs than what I pay in insurance premiums.
If that is how Medicare for All will operate, the health insurance companies will still be in business, although not all people will buy secondary insurance.
20
@Barbara
I agree that the additional cost of Medicare Advantage supplemental insurance that many of us pay who are currently on Medicare needs to be addressed in discussions about medical coverage reform. Reforms should also include changes to the current inadequate coverage of long term care in the existing Medicare program.
4
Thank you for the vote of confidence in the electorate to be able to comprehend the trade-offs in the health care reform discussion.
With respect to the following:
"What happens to all those workers when we, rightly, reduce our health care spending and restructure the American health care system?":
One small proposed amendment for consideration:
We (Sanders, Warren, others) are not proposing to reduce our healthcare spending, but rather to redirect it.
2
I think Mr. Blow is sensing what I've felt for the last two debates, and what I feel every time I scan through the Warren/Sanders fan-person comments: there are only so many "true believers" and Warren/Sanders have pretty well tapped them out.
If support for MfA is to grow, we supporters need to stop preaching to the choir and come up with arguments that demonstrate how single payer will work. Where is the math for the assertion that overall costs will go down? Don't point to other countries—do the math here, in the U.S. How much is going to come from progressive taxes, how much is going to come from redirected employer contributions, how much is going to be saved when 330 million people bargain for better deals with the health industry, how much will be saved when administrative costs of the private industry are cut and replaced by a much smaller government bureaucracy...? I'm tired of hand waving, of more stories of people who have lost coverage, and promises like "I will not sign a bill that increases costs" that sound like a typical hollow political campaign promise. Show some numbers.
Personally, I don't care that much what the numbers say. Universal health care is a right and the government of a society as rich as ours has a moral obligation to make that a reality. But I'm part of the choir—the already convinced. Other people are not yet convinced—they obviously need other arguments.
12
@Yojimbo
Unfortunately, Americans have a bad habit of voting against their own interests. Exhibit A: Donald J. Trump is president of the United States. American Dreamers who identify with their oppressors refuse to support a progressive tax system because they wouldn't want Uncle Sam picking their pockets after they've made their pile. It's almost impossible to awaken an American dreamer.
3
@Yojimbo
Here is the medicare for all plan written by UMass economists about this:
https://www.umass.edu/newsoffice/article/depth-analysis-team-umass-amherst
Much of what are called "catches" is merely opposition propaganda based on false premises. About one-third of our health care spending is wasted on private profit and redundant work; the question put to advocates for ending this waste: "But, how will you pay for it?" is nonsensical.
Better questions would be: "How will you make the transition?" "How long will it take?" "How do you propose handling some of the fallout and making sure the benefits are shared?"
It should be obvious that electing Warren or Sanders would not immediately change the health care system, but would set in motion vast improvements that would evolve in consultation and action from Congress, and in view of the powerful health care lobbies.
Internecine attacks such as seen against Warren by Amy Klobuchar at the debate are disingenuous. Klobuchar would still be a player in the Senate in a position to effect the enactment of health care reform.
Truth about the future is a difficult concept. I would settle for more truth about the present situation.
12
All the Democrats really need to do is to be honest about the cost of their grand plans. Even if they fib just a little and underestimate the costs of Medicare for all, they will neither take the presidency nor the senate. If they tell the true costs and the impact on the middle class, then they are doomed in the House as well. Keep thinking big and losing seats. But only if you are honest about the costs.
1
As someone who has been chronically ill all her adult life, and has had every type of insurance from employer based to exorbitantly priced self insurance until the insurance company dumped me, then none for too long except my own pocket, followed by mercifully, Social Security Disability, and now, finally Medicare, I feel I can speak somewhat to this issue. The main thing both Bernie and Lizzie have tried to get across is that even if you have insurance your employer contributes to or pays for, and you think it’s not bad, that means you haven’t been badly injured or critically or chronically ill. In other words, you don’t cost them money. Sure you see your PP, (GP) now and then, and for your children, pay your premiums, copays, stay in network and are very skeptical about Medicare for all.
As Charles points out so accurately, changes in insurances never go easy, as anyone who has spent six weeks trying to straighten out a typographical wrong code for blood tests can attest. But, please, just think about how you will be treated if you, your spouse or children have serious or life threatening diseases or injuries. From experience, you will be treated very badly by the private insurance company. They will try to treat you as cheaply as possible, throw you out of the hospital, deny any costly treatment, especially new, costly drugs, unless you’re so near dying you get into a drug trial which they don’t have to pay for. All the while, profiting $100 billion a year.
78
@ElleJ Public or socialized medicine is often a disaster for the chronically ill. Such systems also have to operate within budgets and other constraints. They will often take the cheaper method even if it is less effective and more intrusive. They too develop bureaucracies. Their mandate is for the general welfare of their population. The chronically ill are not "general" anything. Why do you think that in so many countries with socialized medicine people take out additional insurance.
10
@Joshua Schwartz
You just made that up.
It is actually less expensive to give good care, because when your give bad care, the patient gets far sicker.
A dozen other countries get BETTER care for HALF the COST per citizen, because they make decisions based on Best Practices, instead of corporate profits.
Corporat insurers randomly deny care based on what they think that they can get away with, and force sick people to spend days on the phone trying to get covered.
Best Practices is patients and providers using peer reviewed research to make decisions based on what maskrs people healthy. In the long run this costs HALF as much
2
There was an interesting dynamic with Warren and Sanders when the question was asked of Warren if the middle class would pay more taxes fro medicare for all. Warren said "expenses" for the middle class would go down and wouldn't budge from that statement. Sanders said first, a list of everything middle class Americans would Not have to pay...premiums, co-pays, out of pocket expenses, and then said yes they would pay more taxes, but those taxes would be less than what they were paying for private insurance. That can't be any more clear.
Both were correct. Warren was not willing to be quoted as saying taxes for the middle class will go up. Because while that is true, it is not the whole picture. The whole picture is expenses will go down.
Sanders said what the others wanted Warren to say.But it is disingenuous to frame the question in a way designed to make a straightforward answer be misinterpreted. A misleading gotcha question.
For all the naysayers...you are correct about congress. While republicans hold the senate nothing good will pass. But Warren and Sanders are going to make corruption an issue. They are going to work to not only gain control of both chambers, but gain control with Democrats who are also not corrupt, as the republicans (and democrats) they replaced were. Transforming the Democratic party is the key to transforming American politics, to ending political control by the financial elite, to draining the swamp.
42
I can't quite make head or tails of Mr. Blow's claim that "the federal government is a clunky bureaucracy and isn’t always efficient and effective in accomplishing small tasks, let alone large."
The indivdual tax contribution out of European pockets to run public heatlh care is considerably lower than the premiums paid to private corporations by the average US citizen.
All European states have bureaucracies that are perfectly capable of running efficient, cost-conscious public health sectors at less expense to the average family than the American enterprise-based solution.
Does Mr. Blow believe that the American administration is singularily incompetent?
73
@Non-US
Same thing down under.
My father hit his head and had the option of surgery in the public or private system. The public and private hospital in his area are across the street from each other.....the same doctor would do the surgery, in whichever system he chose to go through...on the same day. No delay, no lesser surgeon. Same parking lot.
BUT, he had the guarantee of a private room in the private hospital...so it won out. But really.....public health systems around the world are admired and valued and not at all second rate.
23
@EC
Thank you, Non-Us and EC for your comments. I am an expat who daily gives thanks for my new county's strong social safety net.
5
The comments here reflect confusion over what Medicare for All even means. Obfuscation is the tactic of the side that doesn’t want change. The devil is in the details, so candidates, please level with us. The people who thought the ACA unaffordable similarly low ball their substantial buy-in to Medicare. It isn’t cheap to attain or to maintain.
I began Medicare coverage at age 65. By that time I had paid $17K into the fund, and my employers had matched that. Now I pay $465 quarterly to the government for Plan A, plus $250 monthly premiums for a commercial supplemental Plan B (level F) and Drug Plan D. My husband pays the same, so $10-12K out of pocket annually for a couple.
My point is, you still have to budget for your sizable part in the system, and many people simply don’t, despite how important it is to their quality of life. We need to hear more plain talk about the numbers, and each citizen’s personal responsibility. Medicare is mandated, as any risk pool has to be, but it is insufficient coverage on its own. Seek out the details and prepare wisely.
7
Maybe Mr Blow is correct that sometimes "the federal government is a clunky bureaucracy and isn’t always efficient and effective in accomplishing small tasks, let alone large." But as I get some health coverage from the VA, for a service related condition, and the rest from a PPO plus medicare through my civilian retirement, I can see how both the private and the government sectors work. The VA wins, hands-down for courtesy, speed, and ease of communication and access. (And if I lived in Los Angeles I would get my electricity from a government owned utility, but I get mine from PG&E. Enough said.)
34
@CA
Also, anyone that has worked for a large corporation knows that they can also be clunky and inefficient. (Just became you fire everyone, didn't mean that you are actually doing the same thing for less money. Often it just throws the business into chaos, and often the point is to sell the company off for parts, not make the company more successful.)
Since Medicare has less than 4% administrative overhead, and private insurers have more than 14% administrative overhead, in the case of healthcare, the government IS proven more efficient.
Too many Democrats repay r Republican propaganda that is not true.
Government is your Constitutional Republic. Stop letting Republicans tell you that our Republic is our enemy.
Our democracy is not the enemy!
I agree in the importance of transparency because otherwise people make assumptions and they typically assume the worst. However, people also have incredibly short attention spans and complex problems typically require complex solutions. It challenging explaining such things in a sound bite or a Tweet.
Elizabeth Warren has a reputation at being incredibly skillful at explaining complex topics at a level that most people can understand. However, doing that in sound bites, especially when certain terms (such as taxes) trigger people, is a skill that even she hasn't yet acquired. Actually, I'm not so sure it's a skill that anyone can acquire.
What I do know is that the public keeps electing people who give them simple answers to complex problems that can't be answered with simple solutions, especially the solutions they tend to suggest, which typically involves scapegoating and oppressing segments of the population.
I wish I had the level of faith in the public that Charles M. Blow has, but I lost that faith a long time ago and I do not see it coming back any time soon, if ever. As behavioral economist Dan Ariely says, people are predictably irrational.
12
@Mark Baer
'I wish I had the level of faith in the public that Charles M. Blow has, but I lost that faith a long time ago and I do not see it coming back any time soon, if ever. As behavioral economist Dan Ariely says, people are predictably irrational.'---BINGO! Correct. Love Charles voice, and I agree--Dream Big is where it's at, considering we are in a crisis. Telling Americans the truth will not win fans. Americans hear tax increase for the wealthiest among us as--"Oh no--they are going to raise my taxes; I won't support that--or free-stuff" Americans have a terribly difficult time with complexity and are so hyper-sensitive to sound bites, they turn-off to the big dreams that could actually HELP THEM! Very depressing.
@Mark Baer: It takes a sophisticated vocabulary to compress complex concepts into one-liners, and a sophisticated vocabulary to understand them as well.
Big bold liberal ideas will lose an election. And they're just pipe dreams anyway. There's no way any of the Warren/Sanders agenda will get past a Republican Senate and even if the Dems find a way to take that house back it will be with blue dogs from red states. The political revolution/big systemic change crowd will just scare the bejesus out of otherwise conservative suburban women who have had enough of Trump. This is the way the Dems find a way to lose.
12
@Dave Cieslewicz Did you notice how the last presidential election turned out? You are advocating for a repeat of 2016. Let's not do that.
I'd invite anybody criticizing progressives and calling them absolutely, definitively, certainly unelectable in swing states to take a look at the polling data we have available so far. Then, look at bipartisan favorability ratings of Elizabeth Warren and Bernie Sanders and compare them with Hillary Clinton's. Next, watch some videos or read some transcripts of Joe Biden, the only moderate candidate with a realistic chance of winning the nomination barring an remarkable comeback by Buttigieg, and compare them with Bernie's or Warren's. If there's any non-anecdotal evidence that progressives are doomed, with 0 chance of winning, in especially WI, MI, PA but even FL or OH, I'd love to see it.
8
@Chris You have a point there, from polling data. How did polling data work out in 2016 in terms of predicting who won the election? The contravailing data is that few if any progressives have flipped governorships, senate seats or house seats from red to blue. They have won in solid blue states and congressional districts. I look at someone like Sherrod Brown, who I consider progressive. He supports fixing health care, but not Medicare for All. Health care is the third rail of politics. To save money, Medicare for All will not only require eliminating millions of jobs in the private insurance industry, it will also require reducing reimbursement to hospitals and medical specialists. Cutting prices of drugs is easy, politically, by comparison. Two Democrats in my lifetime (70 yo) have delivered big time on health care: Obama and LBJ, both moderates.
4
There IS no "catch" with Warren/Sanders Medicare for All. Middle-class tax-payers will pay more in taxes but save much, much more than that from no insurance premiums, co-pays, or deductibles. What's so hard to understand about that?
145
@Fred White I agree and I'm not sure why this is so hard to explain. On a Medicare for All I pay more taxes. What I wouldn't pay is insurance premiums, co-pays and deductibles. And understand my company offers the catastrophic plans or now called "High deductible" For the lowerest deductible my premium would be over 400 a month and I would still have a deductible over $3000. And I would have an out of pocket max - per year - each and every year - of almost $7000. I'm really sure my taxes would not be going up that much and I'd actually get health care instead of health insurance - they are not the same.
11
@Fred White
Really? All middle-class payers? So, a public school teacher in New Jersey through their very strong teacher's union over the years has acquired gold plated insurance coverage and pays just 5 -10% of the premiums for that Cadillac coverage (for example, NJ public teacher healthcare plan covers orthodonture just to give an idea of how comprehensive coverage is there).
I am really skeptical that everyone of the 153 million middle class Americans getting employer provided healthcare are going to come out ahead on the Warren Plan. See Above.
4
@Fred White So why doesn't Warren say this? By being evasive on this point, she undermines herself.
5
It would take real leaders to address the issues you have brought up. They would have to focus. They would have to disappoint. They would have to battle the bullies, from Trump to Sanders and all the rest, who have limited our choices to their own versions of political correctness. Good luck!
1
The main task of Dems in this crucial election is to prove they support the public interest. Show the contrast to the GOP's alignment with private interests---in health care, taxes, gun safety, tuition, infrastructure, etc.
Otherwise, if Dems stay within our centrist 'guidelines' then Trump's worst damage to our country is to make the opposition party even more cautious and careful than they've already been.
Then voters may over-idealize the Dem candidate, as the Great Anti Trump. Then we'll still have to wait for what we deserve---proper Representation for our Taxation that any democracy should guarantee.
Charles--- if the health care "sticker price" is so high, then why aren't citizens in dozens of countries with generations of HC for all marching in the streets in colored vests, pushing their govts to repeal their universal plans funded with taxes? Why don't they want a US style high profit HC system?
And re jobs---in dozens of democracies, what jobs are people in who here would work in our HC industry?
ACA has major issues to be resolved--- when will NYT columnists start explaining the solutions? Then voters will be informed & less vulnerable to self serving propaganda from the politicians allied with big insurance and pharma.
All our media people telling voters about HC politics have great insurance they can well afford. But still fan public fears that HC for the rest of us is a 'big problem.'
10
@Meredith: Public sectors of mixed economies were invented to conduct socialism.
1
@Steve Bolger
Mixed economies are, by definition, neither capitalist nor socialist. They are mix of both. And of the developed countries that implemented the policies you describe, none are less free than we are, all enjoy greater health, better medical outcomes, and longer life spans. Your boogie-man is nothing but a red herring.
5
@D_E
Countries with mixed economies have more freedom. The freedom from fear.
1
Truth (one reality, or let the facts fall where they may), couth, and competence (let's do the math) should be part of the message carried by any Democratic candidate.
Sen. Warren might be less specific and say that it's a big problem, we've got to cover everybody, the answer may be Medicare for everybody who wants it. Eventually much of the profit and fat admin costs of private insurance might be herded into a supplemental market such as Medicare already has (the prescription drug benefit is administered that way).
Ms. Warren explains things well and projects the possibility of starting to deal with complex issues. She could point out that we've turned into a society where groups of people with coverage/care tend to feel they deserve it but other groups don't. We've got to make things a less unequal; we all have an interest in getting to a more rational system.
We also all have an interest in the health of everybody else. It was Eleanor Roosevelt who said "society is only as healthy as its least healthy individual".
Think of our improved productivity, if health coverage/care weren't a job determinant for so many people. How much more civil and less neurotic would our national and individual life be if everybody always got treated for conditions that make us miserable? Things that lurk in the background now, sometimes for years and multiple generations? Physical health is mental health and the other way around
2
The ACA would have worked quite a bit better if it had actually been implemented fairly in all states. Many states did not implement the medicaid expansion and the GOP and the president did whatever they could to hobble the ACA. They will do that again. It doesn't matter what you expect to do you can't promise it will work as long as there is a GOP senate. Almost any system can work if implemented and used in a way that intends the success of said system. That is not what we do in the US. We have the GOP and they will work to undermine anything that could be good for the people.
Whatever you promise should be tempered with the truth that the GOP will work to make everything fail.
4
Heath care spending as a percent of gdp is about 18% in america and 10% in other deveped countries.
That isn’t a reason to avoid Medicare for all it is the reason to do it ASAP. Lots of more productive ways to spend 1 trillion a year.
Yes you read that right.
51
@Dg
Exactly. It turns out that making decisions based on what makes people healthier is LESS EXPENSIVE than making decisions based on what makes billionaires richer.
What a surprise! NOT
1
When bargaining or making deals - ethical ones as opposed to Trumpian ones - we start high. When happy with a B in college to maintain your GPA, go for the A. In politics, when aspiring for affordable and accessible health care, start out with the ideal goal. With sound negotiations, and if the individuals involved are prepared to listen and learn, well..success can become a reality.
I will admit that as a retired RN and with a once vibrant husband who now has advanced Parkinson's Disease, I am very focused on universal health care. I watched last night's debate and observed how Elizabeth Warren was being attacked by a few of her competitors. Now, I would like a more definite and specific answer from her, too, when it relates to the projected cost to us for Medicare for All. But, in spite of that one glitch, her poll numbers have been soaring. The reason? She is passionate about making our lives better across the board. She is a leader, and she is trusted. I am looking at my small library as I type this. On a shelf is a book titled, The Audacity of Hope. I think I will read it once again. Thank you, President Obama.
18
Don't fall into the trap. You are pretty clearly aiming at Elizabeth Warren here. The catch is that just talking about taxes (increases or decreases) is deceptive, and she's right not to answer the question. Her error is not beginning with "That is just the wrong question." And then continuing with exactly what she said. That is crystal clear and accurate and treating voters with respect.
56
Moonshots imply "never been done before". Many countries have better healthcare for cheaper costs than the United States.
The only "moonshot" analogy that might work here. Is that going to the moon in another thing the US can't currently accomplish but could in the past.
9
The big dream and the whole truth both are that we will have to simultaneously turn the Senate and the White House Democratic next year if we are going to see legislative progress.
4
Even the moderate Democratic candidates have climate plans that will be quite disruptive. There is no longer any incremental approach to climate change that can work, it there was it is now way too late. There is no realistic option that isn't big and bold. And there are many people whose jobs are related to fossil fuels who will need to find other areas of works. Unlike the health care debate, the Democrats largely agree on what to do on climate change and it is big and bold and then some.
4
This is harsh but the leftist pundits driving this silly debate on Medicare for All don't matter. Only the voters do. They've spoken. They don't want a new health care program that will be disruptive, with a decade or more of issues before all the kinks are worked out. This is an insane idea. Warren's Medicare-for-all proposal will increase taxes on the middle class. That's why she was attacked by Buttigieg, Klobuchar, & O’Rourke. Warren's ideas are interesting but implementing them will be impossible. If you want a "Medicare for All" that can be an option, just not the only option. Everyone pays for public school no matter what. If you want to send your kid to a private school you have that option but you still pay for the public. Healthcare should be the same way. It doesn't have to be one or the other. A large public pool with the ability to go private is the best scenario. If the Democrats nominate a progressive candidate they will lose in 2020. There is no progressive majority in America & never will be. The numbers are simply not there. And there certainly is no progressive Electoral College coalition in America that could get to the needed 270 votes. This point can't be emphasized enough: almost every progressive candidate in whom Democrats invested tremendous time, money, & emotional energy in 2018—Beto in Texas, Gillum in Florida, Abrams in Georgia— lost. You have to actually be elected before you can put forth big bold ideas. Progressives don't understand this.
21
@Bill Brown The electoral map and general election polling right now doesn't support your assertion, unless you accept as a given that Trump will both be the nominee and overperform in swing states by 5 percentage points relative to where he's at now. Clinton lost by 70,000 votes in 3 states, and lost the election. Her deep unpopularity hurt her more than her policies. I don't buy that you can definitively say that it's impossible for a much more popular and politically savvy candidate can make up that difference because of their stance on a single issue.
13
@Chris You as well as progressive pundits are missing something. If Warren is indeed the nominee she will come under mind-boggling scrutiny that will make last night look like an Easter Egg hunt. Not just from the GOP & Fox News who will hit her with everything they have 24/7 but the mainstream media who will have to ask will this work? Warren is an impressive candidate. But she is unelectable. She is for reparations. In poll after poll, the majority of American voters are against this. Reparations are the only issue that would compel independent swing voters to hold their nose & vote for Trump. Voters are also strongly against any legislation that would increase the flow of illegal immigration. But Warren is for policies that not only decriminalize illegal immigration but encourage it. Her position on immigration guarantees the Democrats will lose the working-class vote. She & her allies are on the wrong side of these issues. That point can't be emphasized enough. Mainstream voters will NEVER cast their ballot for any candidate who supports increased illegal immigration and reparations. It doesn't matter where Warren stands on healthcare & other issues. She has disqualified herself from serious consideration by her stand on these two extremely polarizing problems. I know people will say that she is leading Trump in all major polls. The only poll that matters is on election day next November. If she is the nominee she will lose. A moderate gives us the best chance to win.
3
@Bill Brown
LOL!!! Yeah, American (masochists) love their inadequate, over-priced health care where deductibles and monthly premiums are like paying a second mortgage. Who wouldn't love that?!!!
As I’ve said before, one has to distinguish between Fantasy and Reality. If Warren is your candidate, my bet is Trump will get re elected. She is too far left to win. But if she did win, the best case scenario is we hold the House and the Republicans keep the Senate which means all of these amazing grandiose ideas never are passed by Congress and never get enacted. How about a grand vision to fix our 3rd world ailing infrastructure. That is an idea most voters could probably get behind. Free College and Free healthcare are not realistic and won’t help us win.
11
@Josh
Yeah Josh--You bet the Criminal Enterprise of Mafia-Don will get re-elected, because Americans loathe democracy, ethics and the rule of law, huh? In addition, the freaked out masses who are deeply worried about big, bold ideas adore being masochists too; after all, why support policies that attempt to save the planet from the abyss of Climate Change and offer Universal Healthcare like every other developed country! YIKES!! Let's make sure there are NO BIG IDEAS because we can't handle changing a thoroughly corrupt system that is strangling us.
Telling the truth about progressive policies is a recipe for not getting elected; Senator Warren's staff knows this. The American people want free stuff; they don't want higher taxes and struggles with the medical system.
If Trump is re-elected president next November, will you be writing columns that start with "Well, at least we were honest with the American people". I didn't think so.
Progressive ideas are transformative BECAUSE they go beyond what the people want. You put them into law by whatever means necessary, then wait for the people to see their goodness. Read some Woodrow Wilson, a giant of the progressive movement; he was no believer in the wisdom of the people. He knew that our system of government had far too many checks and balances for a truly progressive government, and as such Progressives needed to subvert democracy at times to best benefit the people.
Would we have the right to abortion if we left it to the people?
Would we have gay rights and gay marriage if we left it to the people?
Would the civil rights movement have been as successful if we had let the majority decide?
FDR put in place Social Security, a pay-as-you-go income transfer from young people to old people, and called it a savings plan. It's still popular today, and we still pretend it's a savings plan. Don't knock dishonesty.
Holier-than-thou paeans to honesty aren't going to transform this country. Wilson and the Roosevelts would hold you in contempt for your naivete.
3
@Tom Meadowcroft The ideas you mention - abortion, gay rights, civil rights - had and have considerable support. They are saddled with loud protest movements, however.
Why don't we start by expanding Medicare to age 55. This would widen the pool of Medicare recipients, add a healthier (on average) group of people to it, thus reducing the average cost of care per individual. Most recipients would find Medicare to be better than what they had. Then we could expand it further to age 45. By then the public clamor "Let's include everyone" would be enormous.
63
@Howard This is part of Sanders plan.
3
@Howard
I would add children whose parents want to opt in. Children should never be cut out of health care.
2
With the real Moonshot, when Kennedy proposed we go to the moon he indeed warned how hard it would be, how expensive, and how long it would take. And we chose to do it, knowing all these things. I’m with Charles. Let’s not underestimate ourselves!
11
@K. Hayes
Indeed! Over and over again, in mid-century America--we were all about BIG ideas, BIG investments, etc. and we were the envy of the world. We had sane, caring politicians who believed that Making America Great meant investing in its people and infrastructure. That is who we were. Were FDR, JFK and LBJ alive today, they would be--rightly--horrified! Sadly, it was a libertarian Republican, Ronnie Reagan, who poisoned the mind of Americas with his mantra, 'govt. is bad.'
Bravo for describing obstacles to what
might replace ACA, now on life support, which would
need far fewer insurance cost overseers + managers,
and threaten, most importantly, the stocks of the private
insurance companies.
In many ways we are hamstrung by the for profit
companies that have accumulated political power
with their profits. This is why net neutrality is currently DOA. Similarly, any serious effort to constrain
carbon energy extraction runs into the powerful
oil lobby.
This is the mirror image of why the Soviet Union collapsed
from within since its enormous state enterprises with all
its political influences among party policy makers, and reinforced by an out of touch ideology that justified it all,
became too big to reform.
The size of the American industries that are strangling us
in their need to maintain profit margins for the sake
of staying attractive to the investor class is the principal
obstacle to any "think big" plan. Most Americans who
are not caught up in progressive fantasies of omnipotence
are well aware of who's calling the shots, and they take
all this dream big rhetoric as disconnected from reality. So,
it's just not serious.
Lay out ambitious policy agendas grounded in the underlying
political realities. Explain how workers in fields to
undergo massive streamlining or demand reductions will be absorbed elsewhere. Give a realistic time frame and cost to it all.
This is what should have been worked out in 2017-18.
7
@bl Great comment. Thanks.
I find comparisons to France and other countries more than a stretch. Saying that they have it and therefore we should have it too sounds to me rather adolescent. This country needs a better system but to upend what we have to implement something completely new, something that would remove health insurance from those who are employed arbitrarily seems, on the face of it, terribly unwise. Those who eagerly tell pollsters that they want it are not informed about all the disruption. In the case of Warren's followers, they don't know a cost breakdown of her plan, she won't tell them. Look before you leap.
7
@blgreenie "This country needs a better system but to upend what we have to implement something completely new, something that would remove health insurance from those who are employed arbitrarily seems, on the face of it, terribly unwise."
It would be but Medicare for All doesn't do any of that. It gives everyone health care coverage vs. "remove health insurance" from working people.
We do look before we leap, look at Canada, Germany, France, Italy, Japan, Norway, Nethelands. No one uses the crazy expensive and ineffective US system.
15
@blgreenie
"Removing health insurance from those who are employed." Already happens now on a regular basis when employment changes - lay-off, firing, employer closes or leaves town, retirement, find different employer, etc. So this is an old problem and is manageable.
However, would be huge improvement, seems to me, if medical insurance was a given for each citizen, and not primarily an employment benefit.
Agree wholeheartedly with Charles Blow's advice to aim high - the moon even. Is a "moderate" someone who can accept a significant percentage of citizens without adequate medical insurance? What, then, is acceptable - 5% uncovered, 15%, what %? Waiting for a "moderate" answer.
4
@slama
Not to overlook employer decision to change, reduce or even drop employee medical insurance.
1
At some point big transformational plans must include technical details of how to implement them. But those details cannot be properly covered in a debate with a dozen participants (which averages to 15' per candidate). Warren is right to avoid mentioning raising taxes as opposed to emphasizing that the effect on net income on middle and lower class workers will be to increase it or at worst neutral. As soon as she says taxes will go up it will become a meme for right wing attacks. In a debate between 2 or 3 candidates she may find a way of pointing that out more clear explains that increasing taxes will not decrease income without providing the attack sentence the GOP can use against her. She will eventally have to acknowledge that achieving "Medicare for all" will be heavy lifting and not possible in one step, it will take years of working out details of how to get to that goal. Interim solutions must be passed first.
4
@Serban
Bernie Sanders' bill as written phases in Medicare-for-all over 4 years.
The only people who really have to fear Medicare-for-all are the wealthy and corporations who possess insurance company stocks.
The same doctors will be practicing the same specialties under Medicare-for-all and in truth its a tax cut for corporations and even small businesses who will no longer have to deal with providing healthcare to their employees.
10
GREAT piece. The American system was revolutionary because it implicitly posited that our affairs were not to be governed by the arbitrary dictates of monarchs, prelates or military tyrants, but instead by reason and evidence. And reasoned self-governance is impossible when dishonesty, both large and small, is normalized.
We'd do well think of honesty as a patriotic requirement.
4
"The sad truth is that inefficiency and inequality can sometimes be employment engines, requiring an ever-growing universe of workers to adjust to a system that doesn’t work as well as it should. Fixing the system can not only eliminate waste in terms of cost, but also in terms of labor."
It's always about whose ox is going to be gored. And gored oxen scream loudly.
But they scream a little less loudly, and even tend to adjust, when the goring is not so sudden, when it's gradual.
Which is why the winning position on health care is phased in Medicare for all who want it/public option which, if done right (shown to be more administratively efficient and cheaper than private insurance), would shift a lot of people into said Medicare option through their own or employers' choices over some years, eventually shrinking private insurers and breaking the employment/insurance connection (which I bet makes the US more globally competitive and promotes entrepreneurial energy).
And since there will still be room for private insurance in Cadillac level and/or supplemental form, the oxen may be leaner, but they will survive, and we'll all be better off overall.
16
I used to train people on process improvement - we would always say "aim for the sun and you might hit the moon". Yes indeed - think big. Big ideas scare lots of people, but paradigms are not shifted by small thinking. I loved Obama as president (and even more as a person), but his negotiating style - giving half of what he wanted away before he even began to bargain - did not serve us well. Lots of the country may need to be dragged kicking and screaming toward necessary change - but it is those bold heroic politicians that have the courage to do so that will be remembered...and absolutely essential. The world's future depends upon it.
82
@CSL "Process improvement" executives hire you or consultants so they have someone to blame if the ideas are a disaster, meanwhile they take credit for the good ideas. Have seen it over and over in the corporate world, and by the way isn't that part of the job description for executives, process improvement.
2
@MDM You are spot on. I trained hundreds in Lean Sigma on how to do improvement projects with the knowledge that the higher ups did it to check a box - they had no budget - or patience - for the projects to finish and deliver. One of the reasons I am glad to be out of the corporate world - it is NOT set up for success
1
@MDM
Process improvement works when it is done the right way. It fails when it is a catch phrase that management uses as an excuse to do what they wanted to do any way.
The right way to do process improvement is from the bottom up.
When you go to all of the employees and ask them what is good and bad about the system, and ask for their input on how to fix the system, and give them the tools to measure, analyze, and improve the system, then a consensus can be reached on the best way to improve the system. Just as important, everyone understands why the change is being made and is motivated to make it work.
The workers are closest to the work. They understand it better than anyone. That is a valuable resource that most American companies waste.
On top of that, employees that feel listened to and who have a say in how things are done are more motivated, because that is very important to most people.
1
After Trump, the nation needs to heal. That doesn't mean Democrats should become Republican-lite. But it does mean first pursuing policies that enable us to turn down the rhetoric and begin speaking to each other like neighbors again.
Fast, radical transformation has a terrible history. Let's be mindful of that.
6
@Mad Moderate
Who has proposed fast, radical transformation?
Bernie Sanders' bill as written phases in Medicare-for-all over 4 years.
Can you name a fast, radical transformation in this country to support this "terrible history" you mention?
@Mad Moderate
We are in the middle of a fast radical transformation right now(toward fascism). Any attempt to halt it is going to appear abrupt and extreme. Warren is a FDR Democrat.
Providing health insurance for employees is only feasible for large employers. I am sure businesses would prefer to be out of the health insurance market. It would make American business more competitive with foreign businesses that do not have to pay for employees health insurance. Also, what about the savings to employers when they don't have to pay for employees health insurance? Any savings should be passed on to employees as wage increases.
I have Medicare plus private supplemental insurance and a basic drug plan. It costs me a total of $410 per month! Private insurance will still be needed to cover the extras that Medicare doesn't cover. Also, Medicare Advantage plans are provided by private insurance companies.
4
My opinion won't be popular in this forum, but here it is.
You believe there could be "chaos, confusion, and disappointment in the short term" but that most people are "adult enough to handle the truth." I don't.
I do believe that voting out Trump is the most important task of modern times. If we do so, we have four years to regroup and move forward.
5
@bnyc
Respectfully disagree.
The most important task of modern times is getting corporate money out of politics. We need to sharply tax corporate lobbying, make it easier to put politicians in jail for corruption and enact term limits for Congress.
Getting rid of Trump does nothing to fix the problems that got him there in the first place.
7
You say things like "I am not one of the nervous Nellies who believe that Democratic candidates shouldn’t dream big and pitch big, transformational ideas". However, you fail to explore any "transformational idea" and list the upsides and downsides. Platitudes won't transform a reckless idea into a "bold" idea.
Saying that something like single payer healthcare will be "disruptive" is unhelpful. Repaving a local road is disruptive, building a national mass transit rail system and making everyone give up their cars and use it instead is far more than disruptive.
Let's talk actual "bold" Democratic plans. Decriminalizing crossing American borders is bold, but it's a terrible plan. It alone guarantees Trump's reelection no matter how eloquently a Democrat tries to explain it.
The left-wing publication Mother Jones analyzed Elizabeth Warren's immigration platform and found it "de facto open borders", (their words) in, "Are Democrats Now the Party of Open Borders?"
"No one will ever be deported-except, presumably, for serious felons, though Warren doesn’t even say that...The Border Patrol (can only) focus on...screening cargo, identifying counterfeit goods, and preventing smuggling and trafficking, (they) will not be permitted to patrol the border looking for illegal crossings, if border officers happen to apprehend someone, they'll be released immediately."
It's bold, but so is jumping off the roof of a twenty story building. It's why anyone would advise against doing it.
17
@Robert B
Can you provide some evidence of any Democratic candidate saying or suggesting Americans would need to give up their cars? Bernie Sanders has said in debates that open borders is a bad idea.
While America has spent trillions on the military to move sideways China has built an infrastructure that puts us to shame.
If you don't complain about the cost of the military than you don't have a leg to stand on when you criticize spending at home.
“It’s easy to pay for something that costs less,” Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlingon, Vermont, where Pollin unveiled the paper for the first time.
According to the 200-page analysis of Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act of 2017, the researchers found that “based on 2017 US healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses.”
2
@D W
There is more to medical care than cost. There is quality of care to consider, and access to care. And I hear no discussion about that. Where are the clinicians, quality experts, and the health service researchers who we will need to move these ideas forward. Economists are a small part of what we will need.
3
The costs are everything and will determine their election.
Now, when you do transformational change, you have a range of expectations: (best case, worst case and most likely). What happens if the plan drifts towards worst case? Why is the transformation preferable to the status quo? Are there other, less glitzy options, that will still get the job done?
Remember, compromise also is part of making transformational change.
1
There are millions of people who use Medicare Plan B - where the government gives private health insurers (I believe) $800/month to manage and maintain a health care system designed for seniors within their plans. It seems to me that Medicare for All or Access could offer various levels of care in the same way - a basic plan that is managed by the government, a Plan
B approach which will be managed by a private health plan and a combination of Medicare coverage and private insurance. The healthcare insurance industry should be just fine setting up plans and managing costs.
As far as additional middle class costs - the employee already receives insurance from his/her employer - about $20K/year for a family, split 70/30. That money would go into Medicare instead of a private insurer and would probably be less, since Medicare is 95% efficient and private insurance is regulated to 80% efficiency - sounds like a 15% reduction in rates to me.
2
I absolutely agree. Warren's sidestepping of the questions about taxes is an error that sounds like a lie. She needs to learn to respect the whole of her plan with the truth and respect the people she is talking to.
3
For once, I agree with Blow. Yes, Dems should be forthright - even if the change they propose involves contentious issues. The problem - at least with Medicare for All - is not so much that the issues are difficult but rather that the requisite tax increases are simply unpopular - even in liberal states. Remember that Medicare for All lost by over 60% in Colorado (even as Hillary won) and it was similarly tabled in Vermont when officials recognized the dearth of support for a 9% increase in payroll taxes and 11% increase in income taxes.
"But costs will go down", liberals cry. Even this is subject to scrutiny. About half of Americans receive their health insurance through their employer. Of the total premium averaging around $2,000/yr, the employer typically pays over $1,300. Another 35% of Americans receive health insurance either through Medicare of Medicaid - and they typically pay little to nothing. Are the middle class taxes required in Medicare for All really going to present a better deal than the 85% of Americans who currently receive either free health insurance or heavily subsidized by their employer ?
Sure, liberals will point to the high deductibles. And that's true. But the average out of pocket is only about $700. But Medicare for All is consistently unpopular for most Americans when they realize the taxes they'll need to pay. Remember that the typical European single payer country charges a 20% VAT (or sales tax).
5
@Alan Backman
Medicare for all saves money and best of all Sanders' plan taxes the wealthiest disproportionately. Sure taxes will go up, but the net positive is so ridiculous detractors have no leg to stand on. Corporations and the wealthy will do their best to put out misinformation, but the truth is we spend double per capita for healthcare compared to the rest of the western world and are the only ones foolish enough to not guarantee healthcare as a human right.
“It’s easy to pay for something that costs less,” Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlingon, Vermont, where Pollin unveiled the paper for the first time.
According to the 200-page analysis of Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act of 2017, the researchers found that “based on 2017 US healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses.”
3
@Alan Backman
If you get insurance through your employer, and 1300 of the 2k sticker price comes from your employer, you are still paying for it because that is 1300 fewer dollars that your employer can pay you. You pay either way, you are just arguing about whether the money shows up in your pay check first.
10
OK, I got it, this is aimed at Warren. You want her to say that middle class taxes will go up under Medicare for All. You want her to feed a talking point to her Republican opponents. That way she will be Honest.
Thanks for doing that service on behalf of the insurance companies. Why don't you be Honest!
Meanwhile, every civilized country on earth is able to get this done. I'm not making this up; I lived in the Netherlands and France in the 90's. Any American who lived there then would have been absolutely floored at how easy it all was. My second son was born in Amsterdam.
A very large percentage of Americans are already on government health insurance, either through Medicare, Medicaid, military insurance, or government employee insurance.
You want her to stick her neck out to get it chopped off, but I don't remember you calling on Trump to do the same when he promised "phenomenal" health insurance, presumably phenomenal for the insurers.
Even weirder, you're saying that if we make health care efficient, then the people who have jobs as a result of inefficiency will lose them. I really don't know where you're going with this.
Why are you, and so many other pundits, trying to talk down the system that works in every other advanced country? Please explain yourself to your reading public.
243
@Alan Backman But the point is, the total cost is far less for these countries, which means the total cost for individuals and families is far less. US pays about double as a percent of GDP than the civilized countries. If polls in the US are focused only on tax rates, they miss the point. We can do this far more efficiently, and everyone will be much better off. The rest of the world is proof.
Mr. Blow's column is a myopic view that I am surprised he would even submit, because I am certain he knows better.
And, to you, Mr. Backman, nobody's health care in this country is free or nearly free TO THE COUNTRY. We are all paying for it.
92
@Incontinental and Alan, I have lived in both France and the Netherlands. Neither has single payer. The NL has multiple not-for-profit insurers who cannot compete on premium or basket of benefits. France has parallel public and private systems.
While I believe that M4A that keeps fee-for-service medicine (which the Netherlands does not have, but the French private system does have) is a bad idea and threatens the success of any insurance regime. That said, incontinental's take on Blow's piece is spot on.
10
@Incontinental If Warren is the nominee she will come under mind-boggling scrutiny. Not just from the GOP & Fox News who but the mainstream media. Right now no one has taken a hard look at her proposals to determine if this is financially doable. It isn't. Her proposed legislation to tax households with a net worth of $50 million or more draws on analysis by Emmanuel Saez of UC Berkeley. But this same economist, as well as other respected economists, say Sen Warren’s proposed wealth tax would be more difficult if not impossible to enforce than existing federal taxes because of the ways in which the wealthy can under-report their true assets. Plus the current make -up of Congress makes it highly unlikely that any of these proposals would ever see the light of day. Plus millions of Americans DON"T want to give up their private insurance for a public option that may or may not work. They don't want a new health care system with a decade of issues before all the kinks are worked out. If the Democrats nominate a progressive candidate they will lose in 2020. There is no progressive majority in America. And there certainly is no progressive Electoral College coalition in theUS that could get to the needed 270 votes. This point can't be emphasized enough: almost every progressive candidate in whom Dems invested tremendous time, money, & energy in 2018—Beto O’Rourke in Texas, Andrew Gillum in Florida, Stacey Abrams in Georgia— lost. A moderate give us the best chance to win in 2020.
11
To even approximate affordability, health care will need to be re-thought from top to bottom. Like other countries, America will need to start triaging health care by age - we may not be able to treat cancer in 80+ year olds - whether they were a President or a janitor.
We will need to adopt healthier lifestyles - the vast majority of Americans will need to have NORMAL BMIs, unlike today, where most folks are at least overweight. We need to address gun violence, drunk driving, reckless behavior on our streets, etc.
Doctors needs to understand the efficacy and risks of what they prescribe.
For individuals, it is unethical to ask others to pay for my health care unless they are leading a healthy life style - it is unfair to ask others to pay for folks' recklessness.
We all need to "own" this situation and do what we can to improve it.
2
@CDN Huh? 80+ year olds can be treated for cancer with standard therapies and pay for the cutting edge therapies - nothing wrong with that.
I agree with you about mandating healthier lives. It will make the mood of the country better.
1
@CDN And who will be deciding which people get how much treatment?
Nothing wrong with encouraging self care but mandating it? If I find out that you knew that cancer runs in your family, I don’t want to have to pay for any cancer care your child might need because you still decided to have children.
And they accused Obamacare of containing ‘death boards.’
A fundamental fallacy is that the plans put forth by the moderate candidates aren't actually really huge. Providing a public Medicare option available to anybody who wants it was completely unachievable when the Democrats had a supermajority from 2009-2010. Making community colleges free and public 4-year college affordable to all while trying to address the cost drivers would reverse 4 decades of built up problems. Dealing with the student loan crisis in a structural way instead of a giveaway is still monstrously difficult and incredibly valuable. Those on the far left who claim that ideological purity do so at the peril of their party and of the country.
3
@Roy If it weren't for those voices on "the far left", we still wouldn't be discussing *any* path forward on these issues. Thank Bernie, Warren and "the squad" for getting the discussion started. Hillary "We'll never have single payer health care" Clinton sure didn't help.
The message about how to pay for universal healthcare is a simple one, and it doesn't at all require handing the other side an easily-edited lie of a soundbite about raising taxes.
"Universal healthcare will be paid for by the same people who always pay: the American people. And they will be paying far less."
192
@Nirbo
The larger the pool, the less cost for each case. Plus, there won't be the huge profits raked off by people who contribute nothing to the actual health care.
24
@Nirbo
Right. And Warren should say, “Yes, taxes on the middle class will go up, but total costs will go down.” Avoiding speaking the truth isn’t going to work for her long term.
13
@Cass And the Republican commercials will quote this as (in a deep, booming, scary voice): "Elizabeth Warren says 'taxes on the middle class will go up'". They'll also put together a montage of her saying "taxes on the middle class will go up" like 20 times in a 45-second ad. Will it work? Definitely. The only question is will it work with 0.1% of the voters or 1% or 5%. Anything greater than 1% might flip the handful of in play states and give us 4 more years of the presidential dumpster fire,
I agree she should be honest but I also know honesty will be used against her. Sigh
25
“Instead, these proposals are statements of principle, and framing of goals, sketching a vision.“ True. But the in the age of Trump, the biggest, boldest thing anyone can do is tell the truth about the nation’s many complicated, un-soundbyte-ready problems. If only the candidates were a buffet from which one could choose the qualities needed to build an ideal truth teller. I’d pick Biden’s Rolodex, experience and compassion, Warren’s ability to explain a problem, Yang’s analysis of automation, Bernie’s stamina, Castro’s and Beto’s passion, Harris’ prosecutorial skills, Booker’s moral imagination,Klobuchar’s integrity, Gabbard’s military experience, and Steyer’s wallet. In the absence of such a super-candidate, I have been leaning toward Biden as the man who combines the greatest number of the above qualities. But he hasn’t been as quick on his feet as he needs to be. I’ll hang in there with him until the next debate, though.
1
If Americans can't accept a lot of disruption then we are finished because any ambitious plan to address climate change will cause a lot of disruption. This is the worst crisis we now have to deal with and it must be addressed immediately, delay is no longer a viable option. Right now it appears people are choosing to face catastrophic climate change rather rather than face short term disruption perhaps knowing that the people who are going to pay the real price are under 20 or have not been born yet. The health care insurance issue does present a choice when it comes to disruption. This system could continue imperfect as it it or a system where the government is single payer could be adopted and it would be very disrupting. For politicians who want to go for Medicare for All and address climate change they do need to tell the voters that these two programs will affect tens of millions of jobs. And there programs should contain money to help people who lose the jobs to make a transition. Personally I would put off a major health change and focus on climate because if climate change isn't addressed eventually health care insurance and everything else will hardly matter. Like Jay Inslee argued climate change should be the first priority. I am not buying Sanders' promise that all his issues would be top priority. That really is pie in the sky.
3
@Bob
With you on climate. But it's important to note, climate change is a health issue. Guaranteeing healthcare as a human right to all people will improve our ability to respond to disasters and mitigate the suffering we will face. On this issue, we will have to walk and chew gum at the same time.
You say "personally I would put off a major health change." Would you feel the same way if you were uninsured or underinsured?
1
@Bob Why aren’t we examining military spending? American taxpayers are supporting the military. Let’s talk about how we want our tax dollars spent, open up the whole discussion, no sacred cows.
About those jobs: many -- most? -- are jobs that should not exist. How many people are employed in the business of denying the insured benefits for which they have paid? My sister worked at a medical insurance call center for several years; the job was not to solve customer problems, but to get them off the phone as quickly as possible to move on to the next call. She eventually quit because she was tired of being reprimanded for taking the time to actually resolve a customer's difficulty.
263
@Franki
It's appalling and misleading for anyone to claim they are "happy" with their private health insurance.
I personally can tell stories for the anguish and frustration my family endured with Untied Health Care and Blue Cross.
They are not in the business of paying for coverage. Their business goal is to maximise profits. When the CEO of Aetna and UHC collect over 15 million /year in salary and bonus, it means one thing: they are profiting off our sickness.
Good luck calling them asking why they refuse to pay for certain medication or procedures? The excuses book is ready: you have to use generic drugs. This particular procedure is not covered under your plan.
But if you are a week behind your monthly payment, they will call you 24/7 threatening to cancel your policy.
38
@Franki
"About those jobs: many -- most? -- are jobs that should not exist."
Well that will be a great comfort to people who have learned to give tests that will no longer be duplicative. Or admins who support executives. Or cafeteria workers that feed employees in these companies or people who do billing or coding or mop floors or...
Your comment is callous and narrow. No one cares about the CEO's. They'll be just fine. But what about everyone else?
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@mj
Adding HC coverage to an additional 130 million people will still take millions of paper pushers. Those providing services to them will still be employed too.
Callous and narrow is allowing the current HC system to continue, allowing millions to go bankrupt, pay twice as much as any other OECD country, and accepting the deaths of 45,000 Americans as just the cost of business.
You point fingers and call names.
Check the mirror Kettle.
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First: there is no reason why any incarnation of universal health coverage HAS to get rid of private insurance. The UK still has both the NHS (government subsidized) and private......both still work.
Second: as a retired RN with 30+ years in Hospitals, I doubt that any form of universal health coverage would destroy jobs in the medical industry. Actually, it would probably create more. The last 20 years of my career I spent as a civilian RN in a military hospital on a large Navy base. THAT is "socialized medicine"....the patients and their families pay nothing. And it works very well and employs as many people as "private" (ie, hospital corporation owned facilities) do.
Third: we can fund it by taxing the 1% appropriately (Amazon hasn't paid taxes in years) and by cutting into the military industrial complex.....after all, just how many times over do we need to be able to destroy the world?
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@RLiss Just to clarify, everyone in the UK has access to the National Health Service; private insurance offers largely supplemental services rather than a comprehensive alternative although the very rich can use it exclusively. Since Thatcher, UK governments (Tory AND centrist Labour) have systematically run down the NHS, depriving it of essential funding, privatizing about 6% of it. This is all the more reason to get a more progressive Labour government elected this fall.
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@RLiss One of Charles' best articles. First, I believe Charles was referring to insurance employees as well in the total number of people that would lose jobs. If I recall correctly, that is more than half of the healthcare industry employment. Yes it probably would add jobs to healthcare hands-on providers with our aging population. Warren's dilemma is trying to explain all of this in 30-seconds during a debate. She should create a short video and timeline on her website to show more details and talk more about our healthcare dinosaur. Even positive change is hard for people; 'the devil I know and such is more comforting than the one that awaits me.'
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@RLiss
Actually to implement Medicare for All and replace all the other insurance plans that cover Americans today - private which varies in each state, Medicaid, Tricare, current Medicare for the elderly and for the disabled, Obamacare. various state programs - it is estimated to require two to three million new government employees. That doesn't eliminate current government and private health industry employees who must stay on the job during the transition.
And it'll take far more than four years, and even eight years.
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Mr Blow there is a flaw in your logic. Liberal progressives do not elect the president. The entire nation does. The issue isn't about not dreaming big. It's about presenting proposals that a majority of the nation will support.
Everything in this world happens incrementally. You want to build a nice house? First the roads and sewers must be installed. Then the foundation is poured. Then the framing goes up. Then the building is sheathed. Then the inside is built out.
Healthcare reform must be handled the same way. Each step must be designed to accept the next phase. Otherwise, nothing fits together and the place falls apart.
The real problem with healthcare, which no one addresses, is fee for service. We have way too many people doing way to many procedures and all charging way too much for them. Until that is addressed, costs will never go down. Market efficiencies cannot take place where there is no market, only total inelastic demand coupled with monopoly pricing power.
The candidates can't tell the truth because they don't know the answers. Healthcare operates like a cartel. We all pay a tribute in the form of insurance premiums to get much lower pricing. Go uninsured or out of network and get charged 10 times as much. That's the punishment the cartel levies on us for not feeding the machine with premiums.
The only way to break the cartel is incrementally. We can't let the place fall apart. Sorry if you find that uninspiring and uplifting.
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@Bruce Rozenblit
You do realize that in a single payer system, the health insurance provider doesn't exert "monopoly pricing power" because it doesn't need to make a profit, right? That's kind of the point.
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@Bruce Rozenblit I'd buy into these comments if there were early indicators that Warren and Sanders were behind Trump in early general election swing state and/or nationwide polling.
There are no such indicators.
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Completely agree with your critique. Dream Big and Tell the Whole Truth is a great title for an inaugural address but a terrible strategy for getting there -- the great majority of voters (who don't read these pages) are going to be voting on pocketbook issues, not on dreams.
Maybe that's not inspiring, but winning in 2020 will more than make up for it
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It's not that I fear losing with bold ideas. It's that I don't like some of these bold ideas. The wealth tax will be hard to enforce, will cause some billionaires to move to tax havens, and may be overturned by the Supreme Court. Instead, use the system we have in place to sharply raise taxes on interest, dividends and capita gains on the ultra-wealthy.
Switching to single-payer health care is a good long-term goal, but can't be done overnight (my state looked at it and bailed after realizing the cost). Not only would health insurance workers be affected, but everyone with better than average health insurance that they bargained for will be hurt and unhappy. Mayor Pete and Klobuchar and Biden have better ideas than Warren and Sanders on health care. Let's be realistic for a change.
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@A Realist
What ideas does Pete and Klobuchar have that are superior to medicare for all?
They support Obamacare and the deeply flawed status quo that brought Trump to office in the first place.
“It’s easy to pay for something that costs less,” Robert Pollin, economics professor at the University of Massachusetts Amherst and lead author of the new analysis, declared during a panel discussion at The Sanders Institute Gathering in Burlingon, Vermont, where Pollin unveiled the paper for the first time.
According to the 200-page analysis of Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act of 2017, the researchers found that “based on 2017 US healthcare expenditure figures, the cumulative savings for the first decade operating under Medicare for All would be $5.1 trillion, equal to 2.1 percent of cumulative GDP, without accounting for broader macroeconomic benefits such as increased productivity, greater income equality, and net job creation through lower operating costs for small- and medium-sized businesses.”
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all civilized work has a "medicare for all" type of health system.
Medicare is always here and so another public health system; run by the Veteran Administration.
Why should be so difficult and disruptive as you fear?
For the people working in the medical private industry they can be reabsorbed by the new system and in part can find another job like everybody when something happens to their employer.
The candidate should be more explicit? Warren? Sanders? Yes may be but as you say a bold proposal is a proposal and congress can change it so why go in the millesimal detail?
For who is going to pay Warren was pretty explicit when she said that the costs for the middle class will not go higher. That is the results of the expenses paid now and the expenses paid in the future, including eventual taxes.
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@Mur Exactly!! It’s called math. We have such an entrenched attachment to paying for health insurance (foisted on us, in part, by persuasive media campaigns; the evolution of health ins is a whole other conversation we should have). We’ve forgotten that the bottom line is the cost for our health CARE. You go to the doctor, you pay for your visit. Done. Now we also pay health insurance companies. Please let’s rethink the whole concept to find a solution that what works for us, not the middle man. And why, when we talk about costs, don’t we talk about the military budget?
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@J "people want the 'freedom' to choose their health insurance" is the biggest lie the insurance companies have foisted on us Americans. Nobody cares who the insurance company is. Your employer chooses the company/companies and negotiates price, coverage, co-pays, etc and the employees choose who in their family gets covered. This is how Hobby-Lobby got to not some cover birth control methods, by negotiating with the insurance company. It has to be more expensive for the insurance company to cover a pregnancy, birth, and another child than birth control for a year. What did H-L give up to pay for that, or pass onto employees in the form of higher copays, deductibles, or whatever.
What people want is to choose their doctor, clinic, etc if there is a choice in their location, and get treated responsibly, timely, and effectively. They want their pain to go away and health restored. M4A, single payer, any way to get that at no or a small cost to the user will work.
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One problem w/ your approach is that it takes time for the candidates to explain all the ramifications & the debate format doesn't allow for that kind of nuance but most of the electorate learn about the proposed policies from those forums.
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The growing pains in transforming medical care is why I don't back Warren's plan. It is too big a change to implement top down all at once, I think it would be a disaster in the short-to-medium term. I like Mayor Pete's plan and his way of talking about it. Makes sense, it's doable and likely can be passed into law. If I am afraid of Senator Warren's plan, just think what conservatives will make of it next year. I truly fear many people would stick with Trump or sit out the election overall it Warren is the nominee and she sticks with her proposal.
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@John in Georgia Please describe the growing pains of Warrens plan and how it would be a disaster. How is Mayor Pete’s plan doable?
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@John in Georgia I think Mr. Blow's point (and I think he's correct) is that if we start with a bold idea like Warren's plan, after the usual Washington compromise it will probably end up like Mayor Pete's plan. If we start with Mayor Pete's plan... we may end up with no change at all.
Remember how Obama had the chance to include a public option and then removed it in an attempt to gain some Republican support? Remember how much Republican support that won him? Zero votes.
The idea that it's advantageous to play to the middle isn't accurate. Think about FDR, who also took charge during difficult times. He promised big changes. And he made them. That is what inspires people. And that is what inspires people to vote.
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@J Warren wants to eliminate private insurance. We cannot throw millions of people off of their current healthcare plans when we don't yet have a medicare system that can cover all Americans and partner with all healthcare providers. There has to be a transition period. Buttigieg's plan makes sense because it retains current private insurance while we build on the current medicare system. People can then choose to enroll in Medicare and if it works for them, eventually Medicare will be the dominant insurer, with private plans as an option for those who want it. In most countries with a NHS, private plans still exist as an option.
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