Bud­get sav­ings should make head­lines


The Prince George Citizen - - FRONT PAGE - JAMES DOWNIE

hrough­out Repub­li­cans’ doomed push to re­place Oba­macare, two words struck fear into their hearts: CBO score. No mat­ter how much mo­men­tum the GOP built up for an up­dated bill, the Con­gres­sional Bud­get Of­fice would project tens of mil­lions of newly unin­sured peo­ple and sky­rock­et­ing health-care costs, and Repub­li­cans would be on the de­fen­sive again. Democrats would ex­press anger at the num­bers; even cen­trists would chas­tise the GOP for be­ing so cruel to so many. And what wasn’t in those head­lines? The bud­get sav­ings. Few Repub­li­cans dared to ar­gue that leav­ing mil­lions unin­sured was just fine be­cause the govern­ment would save money, be­cause so many rightly saw that rea­son­ing as morally in­de­fen­si­ble.

In short, dur­ing the first eight months of 2017, the start­ing point for any as­sess­ment of a health-care plan was a moral frame: “How many peo­ple would be left unin­sured, and how many peo­ple will be stuck with un­af­ford­able bills?” Af­ter Sen. Bernie San­ders’s in­tro­duc­tion of his Medi­care for All Act, the me­dia and po­lit­i­cal es­tab­lish­ments re­gret­tably have changed the de­bate’s start­ing point to “How much does it cost?” That shift is a great shame.

Moral fram­ings should not be some­thing one can pick and choose when to in­voke. While Oba­macare has had its suc­cesses, 28.5 mil­lion peo­ple re­main unin­sured. Is their lack of in­sur­ance any less an out­rage be­cause they are al­ready with­out in­sur­ance? Sim­i­larly, that the GOP’s ideas would have in­creased out-of­pocket pre­mi­ums by thou­sands of dol­lars was rightly seen as ter­ri­bly cal­lous. By the same logic, is it not an af­front that Amer­i­cans spend bil­lions more on health care than peo­ple in other de­vel­oped coun­tries with­out bet­ter health out­comes?

Is it now fine to deny reme­dies to peo­ple suf­fer­ing un­der the coun­try’s bro­ken health-care sys­tem be­cause it might save the coun­try some money? Those who in­voke moral­ity only as a rea­son not to go back­ward, never to go for­ward, lose cred­i­bil­ity on both counts.

Nor should a moral cal­cu­lus be ditched on grounds of “pol­i­tics.” His­tory is lit­tered with moral ad­vances that party es­tab­lish­ments slow-walked be­cause they were cowed by poll num­bers and vote counts, from the push for child labour laws and a pro­gres­sive in­come tax in the early 1900s through the civil rights fights that con­tinue to­day.

This is not to say there won’t be com­pro­mises along the way. That’s how pol­i­tics works. But lib­er­als will get more ef­fec­tive deals when ul­ti­mate moral goals stay cen­tral to the dis­cus­sion.

As Jared Bern­stein wrote on Thurs­day, “for far too long, Democrats have way over-ne­go­ti­ated with them­selves, start­ing de­bates where they wanted to end up.” San­ders and his al­lies rec­og­nize this – as re­flected in their no- holds-barred de­fense of Oba­macare this year – and are try­ing to change the party’s mind-set.

“But the terms of a pol­icy de­bate in­evitably de­pend on the sta­tus quo,” comes the re­ply. No, they are en­tirely ar­bi­trary. Take, for ex­am­ple, the nar­rower ques­tion of whether uni­ver­sal cov­er­age would be cheaper than the United States’ sta­tus quo. Uni­ver­sal-cov­er­age sup­port­ers can point to ev­i­dence from around the world, yet de­trac­tors can only of­fer hy­pothe­ses why that wouldn’t work here.

And yet, ac­cord­ing to party es­tab­lish­ments and many me­dia outlets, the side with­out ev­i­dence gets taken at face value.

If more lib­er­als and (es­pe­cially) cen­trists wanted to re­turn to the moral cal­cu­lus used ear­lier this year, they could do so to­mor­row and they should.

Dis­agree­ing with the de­tails of San­ders’s pro­posal is fine – there are other ways to reach the same goal within the decade.

But those who ar­gue for in­cre­men­tal­ism, who want to make the goal more mod­est, should be asked: “How much longer do mil­lions stay with­out in­sur­ance?

How much longer do fam­i­lies have to deal with the in­se­cu­rity of sky-high health costs?

How much longer can any­one’s sav­ings be wiped out be­cause of one ac­ci­dent?”

For any­one who hon­estly be­lieves that lack of in­sur­ance or sky­rock­et­ing health costs is an out­rage, the first ques­tion is not “How will you change the sta­tus quo?” or “Who will pay for it?” It is “How will you achieve af­ford­able care for all?”

Any other frame is a moral be­trayal.

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