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We Americans Like Our Choices: Why Can’t We Have Medicare-For-All?

Medicare-for-all

Medicare-for-all would be a uniquely American way to embrace the kind of universal health-care seen in most industrialized countries.

If you listen to the politicians and talk radio, you’d think Medicare-for-all was an idea only supported by the fringe left.  After all, only a handful of hard left Democrats in Congress support it.  Even Nancy Pelosi agreed to not include it in the Dem. Party Platform.

Several polls indicate that a majority, usually just under 60% of the US population would support some version of single-payer.  It usually gains the most support when the question is phrased as “Medicare-for-all”, or vaguely refers to the government ensuring that everyone has access to affordable health care.  

The Kaiser Foundation, for example, shows 53% public support for “single-payer”, but 57% support for “Medicare-for-all”.  Support is also not as strictly down party lines as one might think.  It comes as no surprise that support is stronger among Democrats than Republicans, but it may come as a surprise that most of these polls show that at least 40% of identified Republican respondents support “Medicare-for-all”.  

The only elected Republican in the Federal Government right now who has ever shown support for single-payer is…none other than Donald Trump.

While indeed single payer was not in his campaign platform, but in the past, in his book “The America We Deserve”, Trump has expressed support specifically for Canada’s single-payer healthcare system and suggested that America should consider something similar.

“The Canadian plan also helps Canadians live longer and healthier than America. … We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

While no Republican in Congress has expressed support for any form of single-payer health-care, other than protecting the Medicare and Medicaid we already have, many conservative thinkers and columnists are coming around to the idea.  

Matthew Walther made his conservative case for single-payer for “The Week”. Chase Madar made his for “The American Conservative”.  F.H. Buckley with the New York Post wrote a piece urging President Trump to embrace some form of single payer, as more conventional, Paul Ryan’s drafted attempts at health-care reform have failed.  

But the general tone among conservatives for single-payer is essentially that Obamacare is unaffordable, and is a form of crony capitalism, but single-payer would be far more fiscally responsible and significantly reduce overall healthcare costs in the country by having one large “risk pool” and reducing the administrative costs associated with multiple for-profit health insurance companies competing for government coerced customers.  Under current law there is a tax penalty for not buying health insurance.

So why can’t we have Medicare-for-All, then?

Nearly all industrialized countries in the world have some form of single-payer.  It is true that America is “exceptional” in so many ways, for better or worse.  One of these exceptional characteristics is that Americans prefer freedom to security, choices to centralized efficiency.  

However, there are powerful forces that do not want Medicare-for-all, just as they didn’t want a “public option” as part of the Affordable Care Act.  As politico reported in 2009, “the health industry spent $133 million in the second quarter alone, more than a million bucks a day.”  

The public option ended up being killed in the Senate, with Senators Ben Nelson and Joe Lieberman dealing the deathblow.  As the Democrats were unwilling to force a bill in the Senate to a vote over a Senate filibuster, they forced themselves to need no less than 60 of the 100 Senators to pass anything.  They had 58, but Nelson and Lieberman were the two who refused to end the filibuster unless the public option were removed from the Affordable Care Act bill.  Nelson and Lieberman received $1.6 million and $1.1 million, respectively, in campaign contributions from the insurance lobby that year.

If the insurance lobby is willing to go to such lengths to stop a mere public option from competing with them in a health insurance market with an artificially increased demand (via the individual mandate coercing tax-payers to buy insurance), how much further will they go to stop any form of Medicare-for-all?

A majority of the American public supports Medicare-for-all.  A majority of self-identified “independents” support Medicare-for-all.  A sizeable minority of Republicans, over 40%, support Medicare-for-all.  Yet we’re led to believe that only a fringe of the progressive left supports Medicare-for-all.  

Gaining momentum

The truth is that Medicare-for-all is fiscally sound, morally just, and has the support of the majority of the American population.  An American take on single-payer would probably need to be more flexible than what is seen in most of the world.  We Americans like our choices.

Medicare-for-all can accommodate this.  The aforementioned polls did show more support for “Medicare-for-all” than “single-payer”.  Some might think that’s simply a matter of terminology.  However, it’s likely that the 5% who say yes to “Medicare-for-all” and no to “single-payer” have a very legitimate reason for this seeming discrepancy.  

Medicare-for-all could mean that Americans of all ages would have the option of being covered by Medicare, but could opt out in favor of a private insurer, or self-coverage if they prefer.  Pure single-payer, which most industrialized countries actually don’t have, would eliminate all private options in favor of a truly single payer system.  It really would be single.

Few in America, including the average Bernie supporter, would embrace such a plan.  But public support for the option of government backed coverage is gaining momentum.  Congress continues to debate complex healthcare reforms that are widely unpopular, while average Americans struggle to afford the healthcare they need.  The contrast between bipartisan support for Medicare-for-all among the people, and only fringe left support in Congress can only be ignored for so long. It’s not just Berniebros anymore.

 

 

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