Medicare-For-All: Open Rebellion, Paid Politicians & Net Family Savings

Bernie Sanders in March 2016 explains "what we will ask for if we lose." Note the list near the end of the clip. His candidacy and policy proposals count as an act of "open rebellion" as defined below.

by Gaius Publius

The Medicare-for-All debate is heating up. Bernie Sanders has introduced a bill in the Senate that's gathering co-sponsorship — though noticeably not leadership support — and John Conyers has a similar, but not identical, bill in the House. Conyers bill has also drawn no leadership support; it has, in fact, drawn leadership opposition.

Still, these bills, riding the wave of great poplar support for the Medicare-for-All concept, represent both a great next step for progressive office holders and a gauntlet thrown down by Sanders and Conyers in an act of open rebellion against mainstream — pro-profit, neoliberal — Democratic leadership.

As a way of thinking about this phase of the war against "you can't have that" neoliberal economics, I want to offer three points:

1. This really is an act of open rebellion by office holders who support Sanders' economic policies. The response of Democratic leaders to that rebellion will have consequences.

2. Opposition by Democratic office holders to Medicare-for-All can be predicted by financial support taken from the insurance and pharmaceutical industries. Some of this support works like a bribe, and some works like Thank You money. Either way, there's a real financial benefit to opponents.

3. Most of the cost estimates headlined by the mainstream (i.e., pro-corporate) media exaggerate the cost side and completely ignore the savings to consumers.

If you keep these points in mind as the debate evolves, you'll be well-positioned to understand what ensues.

Closed Rebellion and Open Rebellion

For years, progressive Democratic office holders have opposed the "centrist," pro-corporate policies of Party leadership, but have done so primarily within the context of "not splitting the caucus."

For example, in the Senate session that began in 2013, with Democrats in charge of the Senate, filibuster reform was strongly considered. Among the proposals was "strong reform" supported by a large group of senators led by Jeff Merkley, and "weak reform" — or no reform at all — supported by a group of the most senior senators in the Party. Harry Reid, then Senate Majority Leader, appeared to have attempted to find a compromise proposal that satisfied both sides, but failed. The Merkley faction was adamant, and the opposition to the Merkley proposal was just as adamant.

The Senate ultimately adopted Reid's weak compromise, and the Merkley faction, which at one time appeared to number at least 46 Democratic senators — but less than the 51 needed to pass his reform bill — stood down. The Merkley proposal was withdrawn and the Democratic caucus, including Merkley-proposal supporters, voted unanimously for Reid's compromise.

What was the effect of withdrawing the Merkley proposal without first forcing a (losing) vote? To hide from public view the names of Democratic senators opposed what the Democratic base strongly supported. In fact, Merkley himself was upbraided earlier by Reid for revealing those names in a conference call to his supporters:

At Tuesday's closed-door caucus meeting, Merkley was upbraided by Reid for breaking unspoken Senate rules and naming specific senators in a conference call with Democratic activists last week, according to sources familiar with the exchange. "He's pissed off so many in the caucus," said one Democratic aide piqued at Merkley. "He has been having conference calls with progressive donors and activists trying to get them energized. He's named specific Dem Senators. Many are furious. He was called out on Tuesday in caucus and very well could be again today."

The names of those senators was eventually printed here, in a little-noticed piece by David Dayen at his seldom-used personal blog site. Those senators were "Carl Levin, Max Baucus, Dianne Feinstein, Patrick Leahy, Barbara Boxer, Mark Pryor, and perhaps Jack Reed and Joe Manchin." Merkley, by  withdrawing his proposal before a vote, protected these powerful, conservative senators from public anger. His act of "collegiality," in other words, served the interests of his opposition.

The filibuster debate and its resolution provides a perfect example of "closed rebellion" — an act of progressive opposition to conservative Senate leadership that nevertheless does not publicly embarrass his opponents. A kinder, gentler form of rebellion, if you will. 

Another example of "closed rebellion" that protects the Party from its base was the short-lived candidacy of strong progressive Barbara Lee for a House leadership position in 2012. Lee was running for the fifth-ranking leadership position in the caucus's only contested race. Her opponent was corrupt, former New Dem chair Joe Crowley. Rather than force a vote, which she would lose but which would force House members to declare themselves, she dropped out "in order to 'unify' lawmakers around Crowley."

Party-first progressive opposition to corporate Party leadership protects the enemies of progressive policy. It's one reason Party support among voters has dwindled in noticeable, electoral ways.

"Open Rebellion," in contrast, threatens to force wider the split between the corporatists and progressives. It forces pro-corporate members of the Party to decide, in public and in plain view, between loyalty to their donor base and support for policies preferred by their voter base. If closed rebellion is what Go players would call a "weak move," open rebellion is a "strong move."

The entire Sanders candidacy was an act of open rebellion, and support for it was massive. By accepting a position within Senate Democratic leadership and continuing to advocate for his populist economic agenda, his open rebellion continues. He rarely criticizes other Democrats, but he never backs down from his original proposals, and he never fails to put other Democratic office holders on the spot as to their support for them. In my view, this is brilliant strategy, brilliant leveraging of his position as the most popular politician in America.

Your first takeaway — Sanders' Medicare-for-All bill is another act of open rebellion; it puts Democrats on the spot. You can read more about this bill and its reception in these pages. It's enough to say for now that mainstream Senators in the caucus (as opposed to actual or known progressives) are divide in their support for his bill based on whether they're flirting with a presidential run in 2020, or prefer to be bound instead by ties of loyalty and money to Democratic leaders, their power, and their leadership PACs' deep pockets.

Industry Money and Democratic Support

The second point to consider when looking at Democratic office holders' opposition to (or silence about) Medicare-for-All, is where their campaign financing comes from. There's a good discussion of that here. This graphic contains the primary message:

Note the names of such "progressives" as Ron Wyden, Debbie Stabenow, Patty Murray and Dick Durbin, all silent or opposed to Medicare-for-All.

Note also pieces like this, from David Sirota:

As Sanders Prepared Medicare Bill, Health Care Lobbyists Bankrolled Senate Democrats

As Bernie Sanders worked to finalize his Medicare-for-All Act of 2017, corporate lobbyists representing the traditional opponents of single-payer health care — including the nation’s major private insurers and drug companies — poured hundreds of thousands of dollars into Senate Democrats’ fundraising accounts. Now, many of those lawmakers have refused to sign on to the Medicare bill.

Sanders has faced questions about whether or not the bill would garner solid support among Senate Democrats. So far, 16 Senate Democrats have said they will sponsor the legislation — which the insurance industry slammed after he announced it. A new study from campaign finance watchdog group MapLight found that since 2010, Democratic senators who have refused to sponsor the bill have, during their careers, raised twice as much insurance industry cash as those who support the legislation.

As Sanders continues to press for public support among Democratic office holders and leaders, not only will pressure from public opposition to them grow, but the number of revelations like the above will increase.

Ignoring the Savings

The third point to notice is the most important and the hardest to find. Not only are the highest cost estimates being taken as the "headline number" for coverage in the mainstream (i.e., corporate) press — as well as those left-leaning sites that support neoliberal and Clintonist policies — but the obvious savings to consumers, which offset all costs, are ignored.

To take a made-up example, if the cost to a family of four in extra taxes is, say, $100 per month, but the savings in insurance premiums that no longer have to be paid is $150 per month, the net effect is a savings — $50 per month, or $600 per year — plus a much better health care system with its much-improved health outcomes.

Robert Cruickshank has done some back-of-the-envelope estimates on the net cost, including savings, of the California state single payer bill and notes, among other things, this (emphasis his):

Single-Payer Would Cost A Third of Current Health Care Costs Per Family

...But let’s say they’re right and the cost is closer to $400 billion overall, and that $100 billion in new revenues is needed (the high end of their $50b-$100b scale). That would pencil out to a monthly cost to each Californian of $208. ($100 billion / 40 million = $2500, which is the annual sum; divide that by 12 and you’re at $208.)

The average monthly premium for a Californian, as of 2016, was just under $600. For a household, it’s just above $1600.

In other words, even assuming the fiscally conservative analysis of the Senate Appropriations Committee and spreading the cost evenly across every Californian, single-payer would cost a third of what it currently costs Californians – just for health insurance alone. And unlike the present system, this would mean Californians don’t have to pay anything else beyond that $208/mo. No copays. No co-insurance. No out of pocket costs (at least within the Golden State). The ultimate savings would therefore be even greater. Californians could wind up paying just a quarter of what they pay now, if not less.

To make that clear, the highest cost estimate — far too high in many people's opinion — comes to about $208 per month per person for the new system.

But since that system would also eliminate insurance premiums, the average of which is $600 per month per person, not to mention copays, co-insurance, and the rest, the net savings is at least $400 for the new system.

Or, as Bernie Sanders puts it regarding his national bill:

Bernie Sanders explaining why his Medicare-For-All bill represents a net savings of close to $6000 yearly for the average American family, not a net cost as the media is dishonestly projecting

Opponents of the bill, in the media and among paid-to-oppose politicians, will never broadcast these numbers. But health care consumers, meaning the rest of us, should keep them in mind as we listen to the frightening "tax" numbers we're sure to hear in the weeks and months ahead.

I have a fourth point to be made as well — that the assumption that proposals like this "must be paid for" are nonsense, and in other contexts, war for example, everyone knows it. But I'll save that discussion for a separate piece.

GP