Debates show need for clear terms on health reform
In the recent Democratic debates, moderator Lester Holt’s poorly worded questions on health reform handed candidates a golden opportunity to clarify terms. But they blew it.
Holt mirrored far-right rhetoric that uses red-scare tactics to shut down discussion on health reform. He created a false dichotomy by asking whether candidates would “abolish” or “scrap” private insurance for “a government-run plan.” Such a rigid dichotomy does not exist even in countries with single-payer tax-financed systems, which have private markets for supplemental insurance. Moreover, the pretense of mutual exclusivity decreases public understanding of our nation’s current hybrid system, which simultaneously includes commercial, nonprofit and government insurers.
Holt’s verb “abolish” misleadingly suggests transformation toward a single-payer system could occur only through a revolutionary pivotal moment. His term “government-run plan” easily could be misinterpreted to connote socialized medical systems in which the government owns the clinics and employs the doctors. But no candidate in either major party has proposed such a plan for the United States.
Why didn’t any of the candidates challenge Holt’s presuppositions? The fact that many continue scrambling to clarify their response proves what an important question that is.
No candidate responded in either of the two possible, appropriate ways: 1) Emphasize what the Democratic candidates have in common: a moral commitment to achieve stable health coverage for all Americans; 2) Refuse to answer as worded and suggest a preferable wording. Such a callout could have segued to a robust discussion of candidates’ diverse health-financing proposals.
As a result of that failure, not even the candidates seemed to understand for what they raised or withheld their hands. Sen. Kamala Harris raised her hand (to scrapping private insurance for a government-run plan). But then after the debate she claimed to take it down, insisting she had not clearly understood the question. It’s a shame she didn’t realize in real time that millions of Americans hadn’t clearly understood the question, either.
Sen. Elizabeth Warren raised her hand, seeming to come clean in response to previous criticism of her equivocation on health care. But it remains unclear whether her “standing with Bernie (Sanders)” position is on a shared end goal of a single-payer system, or also on the means and timetable. Several candidates who favor either long-term movement toward a single-payer system, or increased options for citizens to buy into existing government plans, neither raised hands nor spoke.
Holt likely intended to invite cross-candidate comment on single-payer insurance proposals, often tagged “Medicare for All.” Constructive responses to that invitation must both articulate the underlying ethical goal — coverage for all — and specify policy proposals.
Currently the slogan Medicare for All is used as a catchphrase for several very different proposals. At one end of the range are modest options either to let some insurance-poor but non-elderly Americans buy into the Medicare program, or to move toward a single-payer system incrementally over time. At the other end are visions for short-term overhaul that will result quickly in one tax-financed insurance pool covering all Americans. Not all Democratic candidates who endorse policies within this broad range embrace the term Medicare for All. Yet some crassly alternate, depending on audience, between emphasizing their rejection of the term or emphasizing their approval of certain policies others use the term to describe.
Tradeoffs among equity, efficiency and political factors embedded in this span of proposals deserve discussion that cannot occur when all sides of the political spectrum cower behind ambiguous phrases.
The first step to meeting America’s health care challenge is clear language. If the public insists on precise terms, hopefully journalists and candidates will follow.