Joseph Fishkin –
We seem to be approaching an apotheosis of liberal health care angst, as the irresistible force of the appeal of truly universal health care meets the immovable object of Democrats’ desire to make double-triple-sure not to lose the 2020 election. Replacing our current shambles of a health care system with something much simpler and more efficient and equitable makes all kinds of moral, economic, practical, and fiscal sense. However, as Elizabeth Warren is discovering, when you actually spell out a plan for Medicare for All, you start taking heavy fire fast. (And we’re still in the friendly-fire phase—the cynical and deliberately false attacks in the general election will be worse.)
The argument that Medicare for All will be a political albatross has two parts. First, critics argue, moving to a single-payer system will require substituting visible, salient, and unpopular taxes for the submerged and obscure premium costs middle-class people may not realize they’re paying now. That will be unpopular. Second, critics argue, many of the majority of Americans who now have employer-based coverage fear losing it. That fear, in my view, has two distinct components: (A) a fear of disruption of whatever is going well with your current insurance coverage, and (B) what we might call fear of equality: the fear that however flawed your current insurance may be, it must be a lot better than whatever would be offered in a universal program open to the poor.
This month Elizabeth Warren came out swinging with an answer to the first part. She now has a plan for how to pay for Medicare for All that—unlike Bernie Sanders’ plan—does not involve any tax increases on the middle class. By cleverly insisting that both states and employers keep paying much of what they are already paying (except that the payments will now go to the federal government), she avoids asking the same of the middle class. What she hasn’t done is address the second part—many Americans’ fear of losing their employer-based coverage. And that is actually the bigger problem.