Elizabeth Warren’s Medicare for all proposal is right in principle. It’s flawed politically and economically. It is neither realistic nor fair. It’s also irresponsible in a larger sense: it ensures that Warren’s candidacy will not succeed at a time when a door knob should have the capabilities of defeating Donald Trump.
Warren is unnecessarily inviting criticism for herself and likely defeat for Democrats, assuming she makes it through the primaries, by proposing what, at best, a popular first-term president with a record of getting things done could submit ahead of her second term. It’s not the sort of radical proposal an untested, polarizing candidate makes in divisive times that beg for compromise to attain more urgent goals.
Health care is certainly an issue. But so is immigration. So is climate change. So is a budget deficit out of control. So is mass incarceration, mass inequality and a tax code channeling Calvin Coolidge’s love affair with Andrew Mellon. So is the collapse of America’s alliances, its deranged international relations and the disappearance of governance. This isn’t the time to remake the country’s economy, however justified the goal, let alone seize on one issue at the expense of all others. It’s a time for repairs.
Medicare for all of itself is not that radical. The pilot project has been in effect for 55 years.
It works, it works fairly, and it works far less expensively than the private insurance system, which is a form of indentured servitude for most of those who depend on it and deal with costly illnesses. So Warren’s goal is ultimately the right one. Opposing it on principle is not defensible. There are 60 million people on Medicare. Among them you’ll find the largely conservative bloc that opposes the extension of the program that benefits them. Their hypocrisy and selfishness is making a lot of people ill, or bankrupting them.
They love to claim that they’re not getting anything for free, that they’ve been paying for their medicare all their life. But of course they’re getting it much of it for free. As the Urban Institute calculated, the average male who retired at age 65 in 2010–the year the tea party’s anti-universal health care brigades came into their own–was getting $100,000 more in benefit than he paid in taxes. Younger people and yes, undocumented immigrants, are subsidizing you, old men (and women). But that’s how the system works: the working generation always subsidizes the retired. Nothing wrong with that. Just don’t pretend to be paying your own way while keeping younger people from getting the same health security you have. So it is immoral for anyone on Medicare to oppose its extension.
It’s also pointless to howl at the projected costs of the Warren plan of $20 trillion or likely much more over the next 10 years as somehow prohibitive. Those figures are irrelevant, because the existing Medicare system, Social Security and the private insurance system can all be made to seem monstrous and prohibitive over the next 10 years–and they are: the government’s Center for Medicare and Medicaid Services projects annual health care spending of $6 trillion by 2027, a fifth of the national economy. (Military spending is just as monstrous and “unfunded,” but no one goes around claiming the Pentagon will be bankrupt in 10 years.)
For most of us private insurance is the most burdensome and regressive tax we pay, though it’s called premiums, deductibles, copays and out of pocket expenses. We’re the only western nation with such contradictions of insurance coverage as out-of-pocket expenses and deductibles, which make a mockery of insurance and essentially do little more than pad insurers’ stock dividends. In most of those other nations copays are nominal fees. By any measure, Medicare for all would cost less, I don’t mean us individually, though that’s certainly true, but it would less as a share of the economy, even if it would enlarge the size of government. Better a larger government than a gouging private sector.
But Warren is dishonest and wrong to claim the middle class will not pay a cent in her Medicare for all scheme. Dishonest, because sooner or later, directly or indirectly, no universal insurance system spares anyone. Wrong, because just as with existing Medicare, we must all pay if the system is to be fair and soundly paid for. Warren’s assault on the rich is not entirely misplaced. But it’s discriminatory. Of course the rich must pay more. But the rich must not be the only ones who pay. Barack Obama’s tax increases in 2009 were wrong for the same reason: they spared anyone making less than $200,000 a year. The rich have made out obscenely since the Reagan years, even more so in the Bush and Trump years. But we’re not a Robin Hood economy. Make the rich pay. But don’t punish them, and don’t sanctify the middle class as somehow exempt from its own social responsibilities. Progressive taxation works. Soaking the rich doesn’t.
Finally, Warren’s proposal of eliminating all private insurance, however appealing, is bonkers. It’s not necessary. Medicare for all should start with a public option that offers a better plan than any private insurance can, which wouldn’t be difficult, but without eliminating private insurance. Maybe over time that sort of Medicare for all will make private insurance obsolete. But forcing the issue is not the way. And the insurance cartel would never let it happen.
Warren’s plan is certainly more commendable than Republicans’ continuing catatonia on health care. But Warren’s starting point might as well be her epitaph on a Democratic gravestone. The country needs a politically realistic lifeline. Warren’s is not it.