The beauty of ‘Medi­care for all’

The Mercury News - - Other Views - Eu­gene Robin­son Colum­nist Eu­gene Robin­son is a Wash­ing­ton Post colum­nist.

The smartest, savvi­est peo­ple in Wash­ing­ton will tell you Bernie San­ders' “Medi­care for all” idea is dead on ar­rival, a waste of time and en­ergy. But since those same smart, savvy peo­ple told you Don­ald Trump didn't have a prayer of be­com­ing pres­i­dent, I'd ad­vise keep­ing an open mind.

What the Ver­mont sen­a­tor's bill has go­ing for it is sim­ple: It's the right thing to do.

The is­sue is not whether we should have so­cial­ized medicine in this coun­try. We al­ready do — Medi­care for ev­ery­one over 65; Med­i­caid for the in­di­gent, the work­ing poor and the dis­abled; the Chil­dren's Health In­sur­ance Pro­gram for mi­nors in mod­est in­come fam­i­lies. That's a to­tal of around 133 mil­lion Amer­i­cans who al­ready en­joy most of the ben­e­fits of a sin­gle-payer health sys­tem sim­i­lar to those in other wealthy coun­tries.

The philo­soph­i­cal de­bate about whether gov­ern­ment should play a ma­jor role in med­i­cal care is over, as ev­i­denced by the GOP's “re­peal and replace” fi­asco. In try­ing vainly to get rid of the Af­ford­able Care Act, Repub­li­cans ar­gued about how to sub­si­dize health in­sur­ance, not whether to do so. The most con­ser­va­tive ap­proach — work­ing through the ex­ist­ing free-mar­ket, fee-for-ser­vice health care sys­tem me­di­ated by pri­vate in­sur­ance com­pa­nies — had al­ready been tried. It is called Oba­macare.

In the end, Repub­li­cans couldn't pull the trig­ger. The ques­tion now is whether Democrats will con­tinue to set­tle for half-mea­sures or fi­nally de­mand what the party has claimed to want for decades: fully uni­ver­sal health care as a right, not as a priv­i­lege.

Six­teen Demo­cratic sen­a­tors have an­nounced sup­port for San­ders' bill, in­tro­duced Wed­nes­day, “to es­tab­lish a Medi­care-for-all na­tional health in­sur­ance pro­gram.” It is no ac­ci­dent that among them are such po­ten­tial 2020 pres­i­den­tial hopefuls as Ka­mala Har­ris of Cal­i­for­nia, El­iz­a­beth War­ren of Mas­sachusetts, Kirsten Gil­li­brand of New York, Cory Booker of New Jersey and Al Franken of Min­nesota. They prob­a­bly be­lieve, as I do, that the party's ac­tivist base is ready to go big on health care, even if the con­gres­sional leadership re­mains guarded and skep­ti­cal. Both Se­nate Mi­nor­ity Leader Chuck Schumer and House Mi­nor­ity Leader Nancy Pelosi are stud­iedly non­com­mit­tal.

There is, of course, the not-in­signif­i­cant fact that Repub­li­cans con­trol both the Se­nate and the House. Even though Trump has to be con­sid­ered a wild card — he has, over time, taken ev­ery con­ceiv­able position on health care — it is hard to imag­ine this Congress jump­ing on the uni­ver­sal-care band­wagon.

But what San­ders did with his in­sur­gent cam­paign for the Demo­cratic pres­i­den­tial nom­i­na­tion was to bring “Medi­care for all” in from the fringe and make it an ac­cept­able topic for pub­lic de­bate. Medi­care is enor­mously pop­u­lar among se­niors be­cause it works. Why wouldn't it work for the rest of us?

Crit­ics re­ply that it would be ru­inously ex­pen­sive. They point to a 2016 Ur­ban In­sti­tute study pro­ject­ing that “Medi­care for all” would cost a stag­ger­ing $32 tril­lion over the next decade. How­ever, this as­sumes the fed­eral gov­ern­ment would take over all cur­rent health care spend­ing by state and lo­cal gov­ern­ments, em­ploy­ers and in­di­vid­u­als, which would add up to $26 tril­lion over that same pe­riod. Even if this money were paid to the gov­ern­ment rather than to health providers and in­sur­ance com­pa­nies, ac­cord­ing to this anal­y­sis, there would still be a siz­able gap to some­how fill.

Dur­ing last year's pres­i­den­tial cam­paign, San­ders es­ti­mated that of­fer­ing Medi­care to all would cost $14 tril­lion over a decade and be off­set by tax in­creases. He has not yet placed a price tag on the bill in­tro­duced this week.

There is an­other way to look at costs, how­ever. Ac­cord­ing to the Or­ga­ni­za­tion for Eco­nomic Co­op­er­a­tion and Devel­op­ment, in 2015 the United States spent $9,507 per capita on health care. That's more than twice the amount spent per capita in Bri­tain ($4,125), France ($4,530) or Canada ($4,533), all of which have uni­ver­sal health care. In rank­ings based on fac­tors such as life ex­pectancy and in­fant mor­tal­ity, the United States lags be­hind coun­tries that spend much less on health.

As Trump and the Repub­li­cans in Congress dis­cov­ered, health care is dif­fi­cult. The de­tails are dev­il­ish, but the big pic­ture is clear: Our sys­tem is too byzan­tine, too ex­pen­sive, too un­fair. Other ad­vanced na­tions pro­duce bet­ter out­comes with sin­gle-payer sys­tems that their pop­u­la­tions would never trade for ours.

The ACA was a gi­ant step on the road that leads log­i­cally to some­thing very much like what San­ders is propos­ing. Pro­gres­sives should take the next step by loudly and proudly pro­claim­ing the des­ti­na­tion.


Sen. Ka­mala Har­ris, D-Calif., is one of 16Demo­cratic sen­a­tors that sup­port Bernie San­ders’ bill, in­tro­duced Wed­nes­day, “to es­tab­lish a ‘Medi­care-for-all’ na­tional health in­sur­ance pro­gram.”

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