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| Facebook comment regarding my blog post |
Heads up to supporters of Medicare for All. There is a potential generation gap.
Seniors like Medicare. For some, even progressive liberals, "Medicare for All" raises concerns of continuity of care and political viability.
An Elizabeth Warren supporter comments.
Alan Weisbard is a college classmate, as was the author of yesterday's Guest Post. We are all about 70. Alan supported Bernie Sanders in 2016 and is currently most favorably impressed by Elizabeth Warren. On a left-right political spectrum, I would characterize Alan as "far left but practical, deeply concerned about fairness and justice."
Alan had a distinguished career as a legal scholar. He retired from the University of Wisconsin as professor of Law, Bioethics, and Jewish Studies. He split his career between the academy and service on a number of bioethics commissions at both federal and state levels. He is a graduate of Harvard College and Yale Law School and an elected fellow of the Hastings Center.
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| Alan Weisbard |
Alan Weisbard Guest Post
As many of us know from personal experience, employers can switch insurance carriers and insurance plans can drop providers (or providers can disassociate with plans) more or less at will, consistent with contractual terms. Under Medicare for All, one can reasonably assume a greater, not lesser, degree of continuity with preferred providers. For most people (depending on taxing provisions), the combined tax and premium costs are likely to go down; it is probably impossible to know how much of the previous employer costs for health care will be turned into higher wages for employees. In theory, all of it, but who knows what the real world will bring.
While Peter Lemieux [author of yesterday's guest comment] and I may have some differences in our starting points and analyses, I think we come to the same conclusion on the politics: Warren and Bernie should gently move toward something like Mayor Pete’s Medicare for All who want it, at least as a transitional strategy toward universal participation in some form of single payer system (which might preserve a limited role for highly regulated private insurance, as instrumentalities or supplements to a common core). I would like to see this disappear as a point of difference among Democratic candidates in the coming debates and primaries.
For what it's worth, I wonder if the different Democratic candidates could agree to treat illicit border crossings as misdemeanors rather than felony offenses, and to attend to the legal consequences of that (no separations of families, etc.). I think that achieves most of the goals of “decriminalization”, without using that politically incendiary scare term.
My hope is that some reduction in rhetorical and detailed policy differences would allow the candidates to focus their attacks more on Trump and the Senate Republicans and less on one another."
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I share Alan Weisbard's concerns.
Yesterday a blog comment presumed that I oppose Medicare for All. I don't, but I have concerns that it will be an operational and political disaster. Too much, too disruptive.
1. It re-arranges one sixth of the American economy and I expect screwups.The ACA rollout was a bad first impression of government competence.
2. I like having options so I don't feel stuck with one system. I can move from ATT to Verizon. I can fly United or Alaska.
3. I like progressive taxation but I understand that it has political consequences. Currently the tax rate of essentially 3% on earned income does not create big opposition. But if health care for everyone is paid for by the progressive tax system, then highly paid professionals and the truly wealthy--i.e. the political donor class-- will be paying much more than they do now, and working and middle income people will pay less.
That is politically defensible, and indeed the intent. But it changes the system.
Instead of mentally "paying for ones own future health care," one would be paying for health care for everybody, and that powerful donor class will be visibly subsidizing health care of others, including people who make very bad lifestyle choices. Some will be smokers who need cardiac care and alcoholics who need liver transplants.
They will be the new poster children of Medicare for All, and it willl stick in people's craw. Medicare for All will get strong political pushback that doesn't exist for the current Medicare system.
6 comments:
Alan Weisbard makes a lot of sense.
Peter, you seem to have some erroneous mental blocks. You are missing the bigger picture.
If other western nations can do this, why can't the USA?
What is all of this about the "donor class"? We are Democrats. Do you have evidence for your claims about the "donor class"?
Do you know how insurance works? All insurance? We already pay for each other's bad habits. I detect classism in your words. Are you saying that impoverished people have more bad habits? Evidence? If true, why would that be? Could it be because of the lack of adequate health care, education and housing?
Americans also already pay for our lousy health care at over-used emergency departments. Also, have you heard of Medicaid?
Our current system leaves many Americans needlessly suffering and underproductive due to chronic, untreated medical problems. Apparently, some people are ok with that. Now that is sick.
"Mental blocks."
"Classist"
"Sick."
And yet you hide behind anonymity?? Sneaky. I hope you are proud of your political courage.
Yes, I know something about the donor class. They were my clients for 30 years, people who were essentially upper middle class. They show up at fundraisers to give money to candidates that the anonymous author above also supports. They buy tables at Democratic dinners. They are aware of where their taxes go. Some taxes are more popular than others. Social Security and Medicare are more popular than taxes for Food Stamps. That doesn't make progressive donors bad. It makes them pretty much like everyone else, i.e. they are generous but they don't give away more than half their income.
Yes, we pay for other people's bad habits. But that is why car insurance companies make drivers with accidents pay more than safe drivers. People shop for lower rates and car companies that don't do that bleed their good customers. Ask yourself, Ms./Mr. Anonymous: do you voluntarily pay high auto insurance rates out of a sense of social responsibility, realizing it would be discriminatory not to embrace the bad driving of others, so you happily stick with a high risk pool even though you might qualify for a safe driver discount? So I will put the premise to you: could it be they drive dangerously because of the lack of adequate education and it is class-ist to think that you are somehow better or more worthy of lower auto rates just because you don't drive drunk, fast, and distracted.
May I suggest you grow some political courage and re-write your comment using your name and address. Or continue to hide out and throw out snotty little comments. Your call.
Some people have specific reasons for choosing the anonymous option. If you don't want any more anonymous comments, please say so.
I think my comments were direct but not disrespectful. So if something seems classist, or racist, or sexist, we are not allowed to point that out?
"Mental blocks" is not vulgar or an obscenity. I am surprised this offends you or hurts your feelings. How would you put that? I am open to suggestions.
Social Security has buy-in across a broad group of people. Rich and poor, Democrats and Republicans. It is in fact skewed toward overpaying the poor and underpaying the relatively wealthy, but that is hidden and, in fact, prosperous people get some of their money back, and there is some illusion of proportionality, i.e. the more you pay in, the more you get.
Medicare is a payroll tax, which is visible. Everyone who earns money sees it coming out, and it is a flat rate. No one know how sick they will be at age 65+, so there is an element of mystery. Still, you pay in and you get something. So, like Social Security, it has broad buy-in.
Medicare for All is a fundamental change. I actually think it is a good idea--like free public education from pre-K to 12+, but that fundamental change from a pay-for-yourself into a pay-for-everyone creates a big political risk. We have seen that taxpayers have been willing and eager to reduce financial commitments to higher ed and they starve public education, especially in places where public education is mostly used by poor people, with prosperous people sending kids to white "religious acadamies.". It is objectively true and observable that Americans are reluctant to pay for benefits they think goes to others, especially the "unworthy" others or others of a different social status.
There is some talk circulating by Democrats that has 1. normalized name calling in the form of "racist", "classist", "homophobic", whatever. It feels good to call it out and it nicely delegitimizes the person accused. It is especially fun when the person accused is guilty of being white, or male, or prosperous because in that case white patriarchal class-ist behavior is presumably inevitable. After all, as a prosperous white male it would be just so typical to deny the built-in inevitable prejudice.
Making the accusation anonymously has the benefit of protecting the accuser from having his or her own supposed built-in inevitable prejudices revealed. After all, since identity defines built-in prejudice, then if the critic must him or her self be a SOMETHING. If the accuser were understood to be coming from the position of a Trump-loving anti-Muslim Republican officeholder, then the naming and identification of prejudice has context, because it comes from a place.
I think I am objectively fair and reasonable in saying that prosperous people whose taxes will go up will resist it and object. Republicans feed on that emotion. I think we an be certain it will happen. But by calling my argument "classist" the anonymous person de-legitimizes my argument. Not that I am wrong, but "who am I to argue that" since I am a supposed class-ist.
I am OK with anonymous comments, although I prefer signed ones. I don't like anonymous ones that, instead of arguing the merit argues the delegitimacy of the argument based on the presumed prejudice of the author. One might argue that who would better understand the donor class than someone who donates a lot of money to politicians, but by framing that position as "class-ist" rather than "knowledgeable" the anonymous name caller cannot be challenged and evaluated his or her self.
And no one said they wanted people to suffer, so accusing people of that is a straw man argument, and then calling that behavior "sick" amplifies the insult. I consider that snotty and said so. My own sense is that the anonymous author would not have so gratuitously set out that little dishonest insult if they had had to "own" what he or she said. But, anonymously, one can attribute bad morals to another and feel "no harm not foul." But there is harm, to the other person, just not to the author.
The argument that most other western industrialized nation-states have a health care for all system is true, but leaves out an important factor. When Sweden, UK, etc. established these programs they were all essentially ethnically and racially homogeneous. Their citizens were all part of the same tribe. Also, most of those nations had unapologetic socialist political parties which established the programs.
We have none of those factors - we are ethnically and racially diverse, and regrettably divided, and our politics is for the most part (with my sympathies to my fellow Ashland bubble dwellers) center-right, not center left.
There is also a myth in our country that government programs are a priori inefficient and corrupt, and the private sector is efficient and effective. I spent my early career as a Federal employee and my later career as an insurance broker. The inefficiencies in the government programs I saw were small potatoes compared to the insurance industry - the distribution system for insurance is itself a massive waste of money and energy. The expense accounts, the exorbitant bonuses, the stock options - all going to a select group of already highly paid and coddled executives is a corruption in and of itself.
But alas, most citizens are unaware of all that. What they see are teachers and other civil service workers in their communities with pensions and benefits they don’t have and get resentful. They don’t have a clue of the massive wealth of the 1 percent. Or if they do, they maybe believe that the Horacio Alger story will become their own.
Until our fellow citizens become disabused of these myths, and unteather from racism and ethnocentrism, health care for all will be a very long haul.
Remembering U.S. History:
Medicare (1965, President Lyndon Johnson) and Social Security (1935, President Franklin D. Roosevelt) both faced fierce political opposition at the time. Many of the same arguments made today were used in opposition to these programs. Bold and brave political leaders got the job done. Today's seniors are the beneficiaries. Lucky for them.
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