The Middle Ground on Healthcare Reform

Hillary ClintonI’ve come to be pretty tired of the Clinton and Sanders camps sniping at each other — especially over healthcare reform. It’s hard for me to be objective, of course, because I am a Bernie Sanders supporter. But I do think more sniping comes from the Clinton camp. It isn’t a question of total sniping. But there is a whole lot more institutional sniping by Clinton supporters. And I understand it: she’s the establishment candidate for a reason: she’s the safe choice. And as a Sanders supporter, I have to admit: I don’t see much in the way of policy differences between the two once they are in office. We live in a democracy, not a autocracy. So I wish everyone would just cut it out.

But there are substantive differences between the candidates that are worth talking about. Healthcare reform is the big one: the “fix Obamacare” approach and the “replace Obamacare with single payer” approach. What I don’t understand is why these have to be different. As you all know, I’m very happy with Obamacare, Covered California: I Died and Woke Up in Canada. I certainly would prefer a universal, single-payer system. Obamacare is a complicated mess. And I don’t really see why I had to decide between the bronze and silver plans. Like I’m in any way qualified to know what is best for me! But that’s the way our neoliberal system works.

“Getting universal Medicare would require overcoming opposition not only from insurers and drug companies, but doctors and hospital administrators, both of whom are paid at levels two to three times higher than their counterparts in other wealthy countries.” —Dean Baker

Still, it seems to me that Obamacare is single-payer just waiting to happen. For this discussion, forget people who get their insurance through their employers. For one thing, it makes this all easier to think about. But more important, I think that now that we have Obamacare, employer provided health insurance will (Quite rightly!) become a thing of the past. It will probably take twenty years, but eventually, healthcare just won’t be provided in that way. It’s existence is a fluke of history anyway.

So we have a system now in three parts: Medicaid for the poor, Medicare for the old, and the Exchanges for everyone else. Currently, Medicaid provides free healthcare to those making up to 133% of the poverty level. (Because of John Roberts, this isn’t true in most red states, but that will change over time.) What I want to know is why we can’t change the Medicaid level. Why not increase it to 150%? Or 400% (the level where government subsidies end on the exchanges)? Or why can’t we lower the age for Medicare? How about 60 years old as a cutoff? For people like me who want “Medicare for all,” this seems obvious. Whenever the Democrats get control of the government, they can increase the number of people who qualify for Medicare and Medicare. And eventually, you end up with a universal, single-payer healthcare system.

Bernie SandersAs far as I can tell, there is only one objection to this healthcare reform plan: it isn’t realistic. But it is more realistic than simply jumping to a full out single-payer healthcare system. And it has the advantages of being a gradual process — one where the insurance companies can gradually move into other areas. But even more than that, our healthcare problems are a lot bigger than our fragmented private insurance market.

Dean Baker recently wrote, Paul Krugman, Bernie Sanders, and Medicare for All. He noted, “Getting universal Medicare would require overcoming opposition not only from insurers and drug companies, but doctors and hospital administrators, both of whom are paid at levels two to three times higher than their counterparts in other wealthy countries.” And that’s important. The country needs to get used to the fact that our idiosyncrasies have distorted our system such that healthcare reform is complicated. And it is going to take time on a lot of fronts to deal with this. There is no quick fix.

So in a sense, I agree more with Hillary Clinton about healthcare reform. But I know a little bit about negotiation. And if Clinton is talking about the very reasonable idea of making Obamacare work better and having it cover more people, the most likely result will be that nothing will change. But Sanders’ unreasonable push for single-payer healthcare right now is much more likely to result in good changes to Obamacare. Let’s not forget that Obama ran in 2008 on the unreasonable idea that we didn’t need an individual mandate. We didn’t get his more liberal plan, but we did get a plan that is providing me with healthcare and dental insurance at negligible costs.

None of this means that Clinton is bad. But similarly, none of this means that Sanders is unrealistic. I’ll proudly support either of them.

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About Frank Moraes

Frank Moraes is a freelance writer and editor online and in print. He is educated as a scientist with a PhD in Atmospheric Physics. He has worked in climate science, remote sensing, throughout the computer industry, and as a college physics instructor. Find out more at About Frank Moraes.

22 thoughts on “The Middle Ground on Healthcare Reform

  1. There is an advantage of starting negotiations from pie in the sky.

    Medicare For All would take decades to implement because of how screwed up our system is. It should be done but it requires a series of steps to prevent such a shock to the system that it wrecks everything else. Then again, I always wanted to know why we couldn’t have used the “Medicare For All-Good enough for Grandma, good enough for you.”

    I think the reason that the two camps are sniping more and more is because it is getting down to the wire and they have been doing this for months. Anyone gets tired and cranky when a huge effort is almost done and if it seems like after all of this time, you will fail? Anyone would get annoyed.

    • The interesting thing is that the government is paying for by far the most expensive demographic. And I hate hearing that $17 trillion number. That’s for a decade and even then it isn’t accurate.

      At the same time, we still could lose Obamacare if the Republicans take control of Washington next year. So I’m inclined to be cautious.

      • Trying to explain it to people means eye glazing though. Detailed analysis of government finances is not the sexiest thing to campaign on.

        • It’s a problem. These things have to be seen as the cost of citizenship. We’ve fallen into this petty individualism where the only thing you owe society is to make money.

          • This is true. I once read City of the Century about Chicago and even though most of the city fathers (-.-) were super libertarian about most things, they did start pushing civic pride to get the vastly wealthy individuals to change the way they did things. And today there is really not a lot of effort to instill pride in your own community as a city, county or what have you.

            People are just too fragmented in attention and worn out from working mentally exhausting jobs.

            • Yes. I think we should have a society in which only one person in a couple is able to work outside the home. There’s too much to do. We’ve become a country that only values things that result in paychecks. And that doesn’t include voting or child rearing or much of anything that a society is actually built on. Our civilization is doomed. But you already knew that.

              • Maybe I will just pull a Phillip J. Fry and come back in a thousand years to a culture that peculiarly still speaks late 20th century American English.

                Go to bed. You are tired and need your sleep to write oodles on the morrow.

                • Shows like Futurama show a frightening level of optimism about humans. Although I do think the suicide booths are coming soon.

                  • Speaking of which, Bender tricking the suicide booth in that first episode is one of the funniest ideas ever. It makes absolutely no sense. It doesn’t get better than that. Maybe I’ll call it a night and binge watch the first season.

                    • That sounds good. It is either that or watching all of the balloon puppets I find on Youtube.

                      Now if you will excuse me, I need to visit a suicide booth. :-P

                    • I watched that last night. The great thing about Bender is the pure joy he gets from stealing. It really isn’t about getting the money. He just feels very clever — like a five-year-old does. He’s the “puppet” character of the show. He is (like Crow T Robot or Bugs Bunny), ultimately, chaotic good.

  2. I don’t know much about negotiation either, but I do know that the rule of thumb is that you ask for more and settle for less. You should not ask for less – ask for single-payer.

    Yes, it’s hard. In Canada, doctors went on strike in protest when the first single-payer plan came in. But the people held! In less than one year the new normal was reached. I’m sure it would take longer in the USA, but it doesn’t have to be decades.

    • Especially with a popular policy. If you went too far on something unpopular — say, stating you planned to cut the military budget by 90% — I’d love it, but most voters would be appalled. From the other side, this is exactly what happened to Bush when he went too far saying he was going to use “political capital” to privatize Social Security. (A smarter, just as dastardly move would have been something like cutting benefits to anyone who’d been convicted of a drug crime in their life.)

      Since polls show voters are willing to listen to single-payer, yer damn right the best move is shoot for the moon and settle for changing the negotiating territory.

    • The probably is inequality. The doctors and hospital owners and insurance executives all have so much political power. I don’t really care what we do, just so long as we continue to work.

      • Then the newly minted negotiator-president can appeal to the public, saying that vested interests are trying to frustrate the express will of the people. Worked for FDR.

        I don’t expect it to be easy, and I don’t expect that all the goodies will come on the first pass. But the goodies will be greater if the goodies asked for are greater.

        • Yeah. I don’t buy the idea that Sanders is just some ideologue who won’t be able to govern practically. He’s shown his ability to compromise. Maybe Clinton is the right person for the job, but these over-broad attacks on Sanders are wrong.

    • The reason I said decades is because there is more than just a few hundred thousand providers who have a lot of political muscle-there are millions employed by the health insurance industry. There has to be some effort to manage the sudden glut of people who are not working because we switched to a single payer system-which gives us savings up to 25% nationally but doesn’t necessarily translate into 25% of 2.9 trillion of ready cash to pay all of these people that would be out of work.

      It makes sense to do ten year life increments (55-65 or 1-10) every five years to give the various entities and humans to plan their lives accordingly and to absorb the change. It gives schools enough to time to churn out the people needed to work in the field as well (and prepare those who do go into the field the knowledge they are not going to be making $350,000 a year as a cardiologist.) Granted I think we could end the purposeful bottlenecking done by the medical schools but that is a different fight.

      • But a lot of those workers in insurance could easily be absorbed into working for the government. Your idea about ten year increments is a good one. There’s no shortage of good ideas on how to do progressive reform . . . just, so far, a shortage of progressive reform campaigns!

        $350K for being a cardiologist (or proctologist, or . . .) Anybody who works with doctors on a regular basis will tell you that while most are jerks, specialists are the serious jerks. Occasionally someone goes into medicine because they care about helping people. Almost every specialist is strictly in it for the money.

        (If you’re ever in a hospital and in serious pain, don’t ask the doctor for help! Always, always, ask a nurse.)

        • The workforce would not expand that much-Medicare runs a very tight shop and so they don’t need the same number of people since all of those different codes are dropped into one system and so on.

          Pretty much view doctors and lawyers as the same when it comes to ego.

          • Actually the insurance work force would rapidly decline if single-payer were brought it – that part is a slight downside actually. With only one insurer and one compensation schedule, there’s a lot less busywork.

            I ain’t no tone troll, but I don’t see that there is much point in putting down lawyers and doctors. Do they really have a greater ago than others in the same income bracket? Not clear. I’m disinclined to trust generalizations about any reasonably large group of people.

            As a left-wing Canadian I’ll tell you that I love the USA, despite everything I have to criticize. I look forward to the day when my American friends can enjoy the benefit Canadians and British have enjoyed for a long time (for less money!).

            • You’re right, of course, generalizations are bad, and most wealthy people are egoists. What’s frustrating to me as someone who deals with doctors professionally is their job description involves helping vulnerable people, and many act as though it’s almost beneath them. I’m guessing that’s Elizabeth’s beef with lawyers as well. I don’t expect an engineer or hedge-fund manager to be compassionate towards the vulnerable, that’s not their job.

              As to the job loss thing, you are both right. I’d counter that since everyone would be enrolled, and people wouldn’t be terrified of going to the doctor when they’re sick (the way we are now with co-pays and deductibles), the job loss wouldn’t be as extreme as some would think. But it would be a serious problem. One a serious electorate could easily deal with, though!

            • I know a vast number of lawyers here around town and well, I have a reason for my view of them.

              Most of the time though a few years at my level knocks out the most annoying ones.

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