Tag Archives: Medicare

Medicare Buy-In Option: The Next Span in the Bridge to Medicare-for-All

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Democratic presidential candidates are lining up in support of Medicare-for-All, and I’m glad they’re making that case to Americans.  Around the world, single payer systems like Medicare-for-All are delivering better and cheaper health care than Americans are getting, and we need to adopt such a system as soon as possible.  As William Hsiao, Ph.D., professor of economics at the Harvard School of Public Health puts it:

“You can have universal coverage and good quality health care, while still managing to control costs. But you have to have a single-payer system to do it.”

But for reasons I’ll explain below, I don’t believe Medicare-for-All can pass in 2020, even if Democrats control Congress and the White House.  So, we need to extend a meaningful bridge to Medicare-for-All.

So what could Democrats pass to make Medicare-for-All possible in the relatively near future?

The 74-Year Battle

Before we get to that, let’s back up to reflect on how we got here.   In 1945, Harry Truman wanted what we today would call Medicare-for-All.  For 20 years, it went nowhere.  What was dubbed “socialized medicine” by Ronald Reagan and other Republicans just didn’t prove to be politically feasible.

In 1965, Lyndon Johnson had a partial breakthrough. He passed Medicare for 65 and older, but it wasn’t as comprehensive as today’s Medicare. As support for Medicare grew, improvements were made.  In 1972, Republican Richard Nixon agreed to expand coverage. In the Reagan years, home health care, hospice services, and a limited prescription drug benefit were added.  In the George H.W. Bush era, the prescription drug benefit was expanded.

The historical lesson:  Health care reform in a nation dominated by powerful private health insurance companies has been supremely arduous, and therefore incremental.  This is true even though Medicare has proven popular and efficient.

Medicare-for-All Next?

Unfortunately, three-quarters of a century after Truman started advocating for Medicare for All, the debate still is treacherous. In 2019, the Medicare expansion debate boils down to essentially this:  Should progressives push for 1) publicly financed, mandated Medicare-for-All; 2) voluntary, consumer-financed Medicare buy-in option; or 3) a publicly financed, mandated “Medicare at 50.”

Many progressives, myself included, point to the polls showing strong support for Medicare-for-All, and say now is the time to push for it.

Indeed, progressives should continue to make the case for making Medicare-for-All the goal. At the same time, we have to recognize that in the current political environment, Medicare-for-All has much less popular support than a Medicare buy-in option.  A January 2019 Kaiser Family Foundation (KFF) poll finds that  56% of Americans support Medicare-for-All, while 77% support a Medicare buy-in option.  So when conservatives and insurance companies start attacking, the buy-in option would be much more politically bullet-proof than Medicare-for-All.

Moreover, as the debate heats up Medicare-for-All and Medicare-at-50 will be vulnerable to two of the most deadly attacks in all of American politics.  First, opponents will say they’re “massively expensive.” Second, they will say consumers would be “forced to give up your current coverage.”

We shouldn’t discount the political power of those two critiques.  When it comes to taxpayer expense and mandated change, American voters have historically been very easily spooked. Those two attacks, which would be greatly amplified via hundreds of millions of dollars worth of the most intensive political and special interest propaganda the nation has ever seen, will be very effective at eroding support.

Therefore, today’s poll numbers for Medicare-for-All and Medicare-at-50 will not hold up, and when they shrink, congressional votes will disappear.

Advantages Of A Medicare Buy-In Bridge 

A Medicare buy-in option, however, is much more politically durable, and not just because it has 21 points more support in the KFF survey than Medicare-for-All.

Not Expensive. First, a Medicare buy-in option wouldn’t have a big taxpayer price tag like Medicare-for-All or Medicare-at-50, because consumers under age 65 would be paying premiums, not taxpayers.

Not A Mandate.  Second, a buy-in option wouldn’t force any consumer to give up their current coverage, which they would need to do with either Medicare-for-All or Medicare-at-50.  Under the buy-in option, consumers who want to continue to pay more to keep their private coverage could still choose to do so.

The fact that a Medicare buy-in option is voluntary and self-financing would largely disarm the most potent political attacks that have been working since 1945.

A Bridge To Medicare-for-All. But make no mistake, passing a Medicare buy-in option would constitute dramatic progress that would make Medicare for All much more likely in the future.  Let me count the ways:

  • More Affordable for Millions.  Because Medicare has much lower overhead than private health insurance, it would give millions of Americans more affordable coverage than they have today. By the way, if private insurance somehow turns out to be cheaper and/or better than the Medicare option, as conservatives have long claimed, consumers obviously will choose it.  If that happens, Republicans will be proven correct. So let patients decide, not politicians. Conservatives should have nothing to fear from giving this option to consumers.
  • Aid Cost Control.  A Medicare buy-in option would give Medicare a bigger pool of consumers, which would give Medicare officials much more leverage to negotiate cost control with hospitals, doctors, device makers and pharmaceutical companies. “Medicare-for-more” would not be as effective at leveraging lower costs as “Medicare-for-All” will be, but it will bring important progress.
  • Deepen Medicare Support. As more Americans voluntarily switch from private insurance to the cheaper Medicare buy-in option without experiencing worse service and coverage, it will show Americans that this “government-run health care” is not the horrific bogeyman Republicans have made it out to be.
  • Broaden Generational Support. Finally, while Medicare currently mostly only has senior citizen champions, newly converted believers in Medicare would be in their 20s, 30s, 40s, 50s, and early 60s. This would dramatically strengthen the Medicare-for-All base of support.

So, a Medicare buy-in option would be much more politically feasible than Medicare-for-All or Medicare-at-50, and it is the next logical span of the bridge to Medicare-for-All to add. Progressives shouldn’t be hesitant to build it.

Progressives and Moderates Intrigued By Gary Johnson Should Look Deeper

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Cursor_and_gary_johnson_funny_-_Google_SearchWhen I started seeing ads and social media chatter about former Republican Governor Gary Johnson running for President, I went to OnTheIssues.org to learn more.

I liked some of what I saw on foreign policy and law enforcement reform, but one line jumped out at me as particularly disturbing. It said Governor Johnson wants to:

“cut the federal budget by 43%.”

Just to be clear, a 43% cut in federal spending would constitute a major conservative revolution.  That would bring a much deeper reduction in government services than has been proposed in the past by ultra-conservative firebrands such as Barry Goldwater, Ronald Reagan, Pat Buchanan, Newt Gingrich, John Boehner, Mitch McConnell, Ted Cruz, or Michele Bachmann.

Still, I realize that a 43% cut has surface appeal.  After all, nobody feels a deep affinity for the abstract notion of “the federal government budget.” But budgets are collections of individual programs that deliver individual sets of services and benefits to Americans,  so we need to evaluate Johnson’s radical austerity plan on a program-by-program basis.

So, my fellow Americans, which federal services are you willing to cut by 43%, as Gary Johnson proposes.

Cut Infrastructure by 43%?  For instance, are the American people willing to cut infrastructure investments by 43%?  Do we want to slash investment in roads, bridges, transit, trains, airports, water and sewage systems, and the like?  A GBA Strategies survey finds that an overwhelming 71% of Americans want to spend $400 million more on infrastructure, not less.  Only 13% oppose such a massive federal government spending increase.

Cut Medicare by 43%?  Do the American people want to cut Medicare by 43%? After all, Medicare is a huge and growing part of the federal budget.  Americans not only don’t want to cut Medicare, more than three-fourths (77%) of Americans want to fund a new, massively expensive Medicare-for-All option.  Only 17% oppose such an expansion of government services and spending.

Cut Social Security by 43%?  Maybe Americans want to cut Social Security benefits by 43%?  While Social Security represents an enormous slice of the federal pie, the vast majority of Americans not only don’t want to cut Social Security benefits, a whopping 70% want to strengthen them.  Only 15% oppose expanding Social Security benefits.

Cut National Defense by 43%?  What about a 43% cut in national defense spending? Gallup finds that only 32% of Americans support national defense budget cuts.

Cut Other Programs by 43%?  Similarly, the GBA survey finds that an overwhelming majority of Americans want major government spending increases for green energy technology (70% support, 20% oppose), debt-free public higher education (71% support, 19% oppose), and subsidies for high quality child care  (53% support, 33% oppose) . There is no public appetite to cut any of those federal programs by 43%, as Governor Johnson proposes.

In other words,  only a thin slice of the most deeply ultra-conservative voters support Johnson’s fiscal austerity ideas.  Therefore, more moderate voters who are concerned about the nation’s poor, middle class, national security and global competitiveness need to learn about the implications of Johnson’s fiscal proposals before they jump on the Johnson bandwagon.

Sanders Drawing Wrong Parallels To Explain Democratic Socialism

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Cursor_and_Denmark_flag_-_Google_SearchWhen presidential candidate Bernie Sanders explains why Americans shouldn’t fear his “democratic socialism,” he usually points to Scandinavia.

“I think we should look to countries like Denmark, like Sweden and Norway, and learn what they have accomplished for their working people. In Denmark, there is a very different understanding of what “freedom” means… they have gone a long way to ending the enormous anxieties that comes with economic insecurity. Instead of promoting a system which allows a few to have enormous wealth, they have developed a system which guarantees a strong minimal standard of living to all — including the children, the elderly and the disabled.”

His opponent, Senator Hillary Clinton, who clearly understands American exceptionalism biases, quickly shuts down Sanders’ arguments with a smug shrug: “We are not Denmark.”

By continually citing countries other than America to explain democratic socialism to Americans, Senator Sanders is hurting his case. Instead of pointing to Norway, he should more consistently cite the New Deal.

First, let’s consider the definition of “democratic socialism” offered by Democratic Socialist’s of America:

“Democratic socialists believe that both the economy and society should be run democratically—to meet public needs, not to make profits for a few. To achieve a more just society, many structures of our government and economy must be radically transformed through greater economic and social democracy so that ordinary Americans can participate in the many decisions that affect our lives.”

Truth be told, the United States of America is no stranger to this kind of democratic socialism. It was brought to us during some of the most successful and popular presidencies of the past century. Teddy Roosevelt, Franklin Roosevelt, Harry Truman, and Dwight Eisenhower enacted a whole series of popular measures that fit under this definition of democratic socialism.  At the time their ideas were proposed, they were criticized as infeasible, un-American and socialistic, just as Sanders’ ideas are today.

Therefore, Senator Sanders should be explaining his democratic socialism with American examples that a large majority of Americans already know and love. Sanders might say something like this:

You want to know what democratic socialism is? When the great Republican Teddy Roosevelt dissolved 44 corporations to protect the middle class, and when he protected ordinary Americans from the railroad companies and other big corporations, his critics said “you can’t pass that, because it’s socialism.”  But he passed them anyway, because the American people demanded it.

When the enormously popular Franklin Roosevelt used government funding to put Americans to work building community infrastructure, they said “you can’t pass that, because it’s socialism.” When FDR proposed a Social Security system of government-run pensions that lifted millions of American seniors out of poverty, conservatives said “you can’t pass that, because it’s socialism.”  But he passed those things anyway, because the people demanded it.

When Harry Truman enacted Medicare, people like Ronald Reagan called that socialism too.

And you know what? When Republican Dwight Eisenhower invested in an enormously expensive interstate highway system and had 90% income tax rates on the ultra-wealthy, they said it again: “You can’t pass that, because that’s socialism.”  But he passed those things anyway, because the American people demanded it.

And despite the dire predictions from critics, America’s economy prospered under these policies that were all predicted to be catastrophic for the economy.

So in 2016, when the defeatist “no you can’t” crowd tells Americans “you can’t pass bills to provide higher education and health care to all, because that’s socialism,” I get my inspiration and courage from Teddy, FDR, Give ‘em hell Harry and Ike.  Because of them, I know America can overcome the cynics’ name-calling and naysaying to do great things for the middle class now, just as we did then.”

Democratic socialism is already in America, and it is enormously popular. Surveys consistently show that Americans are vehemently opposed to cutting or eliminating democratic socialist programs such as Medicare, Social Security, and the minimum wage.

Americans not only have embraced democratic socialism in the past, they strongly support it for the future. A recent GBA Strategies poll shows that likely 2016 voters overwhelmingly support a whole range of Sanders’ ideas being dismissed as socialist ideas lacking sufficient political support:  Allowing governments to negotiate drug prices has 79% support. Medicare buy-in for all has 71% support. A $400 million infrastructure jobs program has 71% support. Debt-free college at all public universities has 71% support. Expanding Social Security benefits has 70% support. Taxing the rich at a 50% rate — the rate under conservative icon Ronald Reagan — has 59% support, and only 25% in opposition. Breaking up the big banks has 55% support, and only 23% in opposition.

This is hardly a portrait of a nation that opposes democratic socialism.  Overwhelming support for democratic socialism is already there, ready to fuel a 2016 presidential candidate.  But for two reasons, Senator Sanders needs to cite American parallels to explain his approach, not European.

First, citing examples of American policies will help build confidence that bold measures can be enacted over fierce opposition now, just as they were in the days of Teddy, FDR, Truman and Ike.  Second, citing American examples will paint Sanders’ democratic socialism label and his policy ideas red, white and blue, rather than just red.  It will show that such ideas have been embraced in the past by idolized Republicans and Democrats.  It subsequently will normalize democratic socialism.

Americans are in a very nationalistic, ethnocentric and nostalgic mood. So, rather than continually pointing to the Rikstag, Storting, and Folketing to explain democratic socialsm, Sanders needs to point to the faces on Mt. Rushmore.

Note:  This post was chosen for re-publication in MinnPost’s Blog Cabin feature.

Americans Support An Actual “Government Takeover of Health Care,” And I Don’t Mean Obamacare

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Government_takeover_of_health_careOn the heels of the closing of the second year of open enrollment for Obamacare coverage, expect to hear a lot of “government takeover of health care” ranting from conservatives.

That phrase is heavily used by anti-Obamacare zealots, and that is no accident.  In 2009, Republican political consultant and celebrated wordsmith Frank Luntz advised his conservative clients to portray the proposed Affordable Care Act, also known as Obamacare, as “a government takeover of health care.”

Conservatives did as they were told. If you Google those words, you’ll see that the usage of that phrase, and close variations, has been widespread among conservatives ever since.

In a 28-page strategy memo, Luntz explained why stressing a Washington “takeover” was so important:

“Takeovers are like coups.  They both lead to dictators and a loss of freedom.”

In other words, the Affordable Care Act shouldn’t be talked about as it were a legislative proposal in a representative democracy.  Instead, it should be talked about as if it were a Stalin-esque freedom grab.

There are two problems with conservatives parroting the Luntz-recommended phrase “government takeover of health care” to make Americans fearful about health care reform: First, It’s demonstrably false.  Second, It doesn’t scare most Americans.

False.  I’m not going to go into detail about why it is false, because it’s pretty self-evident.  But suffice it to say that ‘government takeover of health care” as a descriptor for the Affordable Care Act was named by the non-partisan editors of Politifact as their 2010 “Lie of the Year.”   In a lie-intensive election year, “government takeover of healthcare” was named by both editors and readers as the Pants on Fire of all Pants’s on Fire.  Politifact notes the obvious:

“It is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

It’s true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.”

Not Scary.  But beyond being false, the more surprising thing to me is that “government takeover of health care” is not all that scary to a  majority of Americans.

While Obamacare is not remotely close to a government takeover of health care, putting Americans into the government-run Medicare program would be exactly that.  And you know what? Most Americans are just fine with even that level of government takeover of health care.

Medicare_for_All

A January 2015 GBA Strategies survey asked Americans if they support enactment of “a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare.” By a 15-point margin, a majority of Americans (51% support, 36% oppose) supported that kind of government takeover of health care.

The same survey then asked Americans about giving people the option of having government take over their health care.   Specifically, the survey asked if respondents would support giving “all Americans the choice of buying health insurance through Medicare or private insurers, which would provide competition for insurance companies and more options for consumers.” An amazing 71% of Americans support having the option of a government takeover their health care, including 63% of Republican respondents.

So it turns out that, after six years of intensive Luntz-led vilification of “government takeover of health care,” backed by hundreds of millions of dollars of political advertising and public relations efforts, there are very few issues in America today with as much public support as there is for the federal government taking over American health care.

– Loveland

Note:  This post was republished on MinnPost.

Romney is Correct About Americans Being Government-Dependent

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I hate to admit when Governor Mitt Romney is correct.  But when he said 47% of Americans are dependent on government, I have to face the facts.   Romney had it right.

He just understated the claim by 53%.

After all, 100% of us are dependent on government, and it’s been that way for the entire history of the nation.  One hundred percent of us are dependent on publicly funded national defense, roads, highways, bridges,  police, fire, water, sewage, environment and health protections and education.   We can’t compete and succeed without those things.  We are dependent. Continue reading →