Democratic Voters Expect The House To Pass Medicare For All Before 2020... So Why All The Foot-Dragging?

Washington Post columnist Paul Waldman thinks the media Is badly botching the Medicare-For-All debate. He's correct. As background in how the media can screw tyhings up, he cited the Iraq War in 2003 and the way it gave just "minimal attention to Donald Trump’s spectacular history of personal corruption in 2016."

Fortunately, correcting the mistake is easy, if we’re willing to give a minute or two of thought to some rudimentary math and logic. I speak of the question of universal health coverage, particularly in the form of Medicare-for-all (in its multiple variations).

Before we proceed, there’s a number I want you to remember: $50 trillion. Keep that in the back of your head.

Right now, this debate is being framed in part as a disagreement between a bunch of Democrats peddling pie-in-the-sky notions on one side and more hardheaded and realistic critics (including but not limited to Republicans) asking the tough questions about affordability on the other. That framing is completely and utterly wrong, and even journalists of good faith are falling into its trap.

So for instance, former New York mayor Michael Bloomberg says “I think we could never afford that” when asked about providing universal coverage. The government might provide coverage to the uninsured, he says, “But to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time.” Likewise, former Starbucks chief executive and potential presidential candidate Howard Schultz dismisses the idea, saying, “It’s unaffordable.”

The fact that these two highly successful businessmen-- whose understanding of investments, costs and benefits helped them become billionaires-- can say something so completely mistaken and even idiotic is a tribute to the human capacity to take our ideological biases and convince ourselves that they’re not biases at all but are instead inescapable rationality.

Let me explain. There are any number of reasons you might oppose universal coverage. I happen to think they don’t add up to much, but you can make a case. Maybe you just don’t think it’s government’s job to make sure people are covered. What you cannot say, however, is that a universal system is unaffordable.

That’s because there is one thing you absolutely, positively must do whenever you talk about the cost of a universal system-- and that journalists almost never do when they’re asking questions. You have to compare what a universal system would cost to what we’re paying now.



It isn’t easy to be perfectly precise about this, because there are multiple forms a universal system might take. But there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-VT) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.

That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade.

Again, you can criticize any particular universal plan on any number of grounds. But if it costs less than $50 trillion over 10 years-- which every universal plan does-- you can’t say it’s “unaffordable” or it would “bankrupt” us, because the truth is just the opposite.

I've made this analogy before, but it's as if you were heating your house by burning $100 bills in your fireplace, and I said, “Gee, maybe you should buy a new furnace; you can get one for a few thousand dollars,” and you replied, “Buy a new furnace? What are you, crazy? I could never afford that! Burning the $100 bills is the only reasonable thing to do."

We have a natural tendency to assume that someone who says something is unaffordable is being, if perhaps a bit of a downer, at least logical. Who tells you things are unaffordable when you’re growing up? Your parents, who say, no, our next car will not be Ferrari, and you can’t have an Xbox. It makes you mad when you’re a kid, but when you grow up, you realize they were right.

But right now, it’s the people who say universal coverage is unaffordable and want to continue with the status quo who are suggesting something outlandish. Which is why, whenever someone says a universal system would be unaffordable, the appropriate follow-up question is: “If we don’t change, we’re going to spend $50 trillion over the next 10 years. How do you propose to pay for that?”

There’s another follow-up question we should be asking, because universal coverage isn’t some kind of novel idea no one has tried before: “If universal coverage is so unaffordable, how come every other industrialized country on earth manages to afford it and spends less on health care than we do while insuring all their citizens? What do they know that we don’t?” Let me offer you a chart:

To repeat, every other country on that graph has universal coverage, the thing that people such as Bloomberg and Schultz believe is unaffordable. They do it in different ways-- Great Britain has a single-payer system, while Germany has private but tightly regulated insurers-- but they all cover everyone and, on average, they do it for half of what we spend. It’s great that Schultz’s company offers health insurance to its employees in the United States, but he should know that Starbucks stores in other industrialized countries don’t have to, because the government takes care of it.

That doesn’t mean that achieving universal coverage will be easy, or won’t require lots of policy choices, or won’t need tweaking over time as it evolves. If anyone characterizes it as something simple to implement, they aren’t being honest either. But if we’re going to talk about the cost-- as we should-- we absolutely have to talk about the cost of the current system.

No one would claim that moving to a system of universal coverage, whether through single-payer or something else, wouldn’t be a profound change. But we have a bias toward the assumption that change is impractical while maintaining the status quo-- no matter how pathological the status quo may be-- is if nothing else reasonable and practical.

In this case, it isn’t. Maintaining the status quo is a choice, a choice that will cost us $50 trillion. That’s the single most important fact to keep in mind as we talk about cost, and the people who have already forgotten it ought to know better.

Right now, these are the only members of Congress who have signed on to co-sponsor Pramila Jayapal's new Medicare-For-All bill. Many who signed on last cycle, knowing there would be no vote, refused to sign on this cycle, like Donald Norcross (New Dem-NJ), Don Beyer (New Dem-VA), Filemon Vela (Blue Dog-TX), Brad Sherman (CA), Katherine Clark (MA), Sanford Bishop (Blue Dog-GA), Nita Lowey (NY), Adam Schiff (New Dem-CA), Marc Veasey (New Dem-TX), Ted Deutch (FL), Pete Viscloskey (IN), Darren Soto (New Dem-FL), Jim Cooper (Blue Dog-TN), Al Lawson (New Dem-FL), Ed Perlmutter (New Dem-CO), Jerry McNerney (CA), Lou Correa (New Dem-CA), Anthony Brown (New Dem-MD), John Yarmuth (KY), Gregory Meeks (New Dem-NY), Cathy Castor (FL), Brian Higgins (NY), Jimmy Panetta (CA)... And that's just a few of the 2017-18 co-sponsors who aren't co-sponsoring (so far) this year. If your congressman or congresswoman isn't on this list, please call-- 202-858-1717-- and ask why. And freshmen who campaigned on Medicare-For-All (or even the more amorphous "swingle payer" but who aren't on this list, should be reminded there's another election in less than 2 years).

Nate McMurray hasn't announced yet, but I'm pretty certain he's going to run in NY-27 again. Early this morning he told us that "People want single payer. I campaigned in one of the supposed 'red' districts in America, and we lost by only 0.38%. Everyday I said I will demand single payer, and everyday the crowds grew and cheered. If members of Congress who pledged to fight for single payer do not have the courage to lead, why will Americans trust them to lead again!"

My own congressman, Adam Schiff, was a cosponsor of HR 676 so I was curious about why his name wasn't on the list for the new bill. I thought he might be so busy impeaching Trump that he hadn't gotten to it yet. I contacted his office and a longtime spokesperson confirmed that he "plans signing on as an original co-sponsor of Rep. Jayapal’s Medicare for All bill." I'm glad I reminded them. Please do the same with your own member. Meanwhile, sincere, full-throated support for Medicare-for-All should be a MUST for all congressional candidates. It is for Blue America.

Mike Siegel is running for the Austin to Houston corridor seat held by Michael McCaul, a Republican who would rather repeal Medicare than expand it. But Siegel running hard on Medicare for all. "The people want Medicare for All, and we cannot squander this rare opportunity. Countless lives depend on Democrats seizing the moment and standing for a bold solution to our national healthcare crisis. Here in Texas 10, and I am running on Medicare for All, and will enthusiastically vote for it in 2021 if we haven't passed it yet. Despite what many might think about Texas, folks here identify with the simple concept of extending Medicare to every person. And when the inevitable question comes up-- how will we pay for it?-- we need to be able to respond that only by having a true universal healthcare program can we realize the necessary savings in terms of administrative costs, prescription drugs, and so forth. Of course, the incumbent Michael McCaul, not only opposes MFA, but he opposes the ACA and just about any government healthcare program. He couldn't care less about whether regular Texans live or die. My campaign offers a real alternative on this life-or-death issue, and I'm confident that the voters will respond."

In Omaha, Kara Eastman is also taking on an anti-healthcare Republican incumbent, Don Bacon. "The reality for residents of the Nebraska 2nd is that far too many people do not have access to healthcare," she told us-- our Governor is dragging his feet on the Medicaid expansion bill that passed on the ballot in November-- or are paying far too much in out of pocket expenses including deductibles, premiums and non-covered expenses. My 17-year -old daughter’s recent knee surgery cost us $5000 out of pocket and this is with 'excellent' insurance through my husband’s employer. A Medicare-for-All system is the best option we have for being fiscally responsible and providing medical care to Americans. Rep. Don Bacon is putting special interests before the needs of his constituents. He is bought and sold by the insurance, pharmaceutical, and healthcare companies and healthcare companies that profit off of people being sick. This is sickening."

In Chicago and in Flagstaff, Arizona, Blue America is backing primary candidates Marie Newman and Eva Putzova who are also running against incumbents who is putting special interests before the needs of his constituents-- except their opponents ultra-conservative Blue Dogs who vote with the GOP-- Dan Lipinski and Tom O'Halleran. "Healthcare is a right, not a privilege," Eva told us. "It's time that our political ambitions move beyond expanding Medicare to just cover hearing aids for elderly and focus on expanding Medicare to cover all Americans. Medicare For All is the kind of system that will do just that.

Marie is coming from the same values. "While this $32 trillion number over 10 years is bandied about without framework in order to create hysteria, It i clear that it is much more affordable than the $50 trillion it will cost us keeping the current system in place. Let’s all accept that the ACA was a good step and enabled 20 million more folks to have insurance, but, unfortunately, it did not solve ever-rising costs. My hope is that we can all stop with the hysteria and have a real conversation and debate. Their are no less than 8 M4All bills out there right now. Congresswoman Jayapal’s bills looks strong, lets start there and get this solved."


UPDATE: Audrey Denney

"One of the most prevalent misconceptions I hear when I’m advocating for universal healthcare is that we cannot afford it. In actuality, we can’t afford to not guarantee quality healthcare to all Americans. Paying for Medicare for All wouldn’t require additional spending-- just a reallocation of private and public money we’re already spending. Our broken healthcare system tops the list of issues facing many voters in my district. When elected, I’ll continue to advocate for Medicare for All and work to make sure we get the system change we need. No American should go bankrupt because they can’t afford life-saving care."


UPDATE II: More Members Sign On As Co-Sponsors

These are all members who have been enthusiastic supporters of Medicare-For-All who just didn't make the first batch on signers for one reason or another. They are all officially on board as of this morning.

• Katherine Clark (D-MA)
• Jahana Hayes (D-CT)
• Brain Higgins (D-NY)
• Lucille Roybal-Allard (D-CA)
• Jackie Speier (D-CA)
• Bennie Thompson (D-MS)
• Bonnie Watson Coleman (D-NJ)