Elizabeth Warren didn’t spend long leading the Democratic presidential race before being forced to pull in for a policy pit stop. The serious problem that needs attention: Her adopted health care plan. That is, the single-payer scheme that Democratic socialist Bernie Sanders has offered up.
For Warren, the policy issue right now is, how do you pay for a plan credibly estimated to cost $34 trillion over 10 years? As Sanders himself has acknowledged, that’s exceedingly difficult to do without hitting some members of the middle class with higher taxes.
Warren has tried to steer around that blazing hazard by saying that she won’t sign into law a government-run health care plan that doesn’t lower overall costs for middle class families. That’s another way of saying, yes, your federal taxes may go up, but because you will no longer pay insurance premiums or out-of-pocket health-care expenses, your total costs will be lower.
But on something this significant, vague assurances aren’t enough. So why doesn’t the woman with the plenitude of plans already have a financing framework? Because it’s hard to develop one that doesn’t put an “I’ll-tax-the-middle-class” bullseye on her back.
That’s hardly the only problem with single-payer, or “Medicare for All,” by its folksier name. Another: Voters’ natural preference to choose for themselves rather than be forced off their private insurance and into a government-dictated plan. Running on the latter approach is akin to dressing up as a piñata — and handing the GOP a general election club.
“The Republicans will run ads warning the voters that the Democrats are going to take away their health insurance,” says Phil Johnston, former New England regional administrator of Health and Human Services and a fervent Warren supporter. “We have seen that movie before.”
Johnston is talking about the insurance-industry-funded attack on the health care plan Hillary Clinton designed back during husband Bill’s first term; the Clintons’ effort eventually foundered. We also saw the damage Democrats suffered with President Obama’s assurance that “if you like your health care plan, you can keep it,” which didn’t prove to be true for those whose plans failed to meet the Affordable Care Act’s minimum standards.
Political optimists expect voters to sort through the health care financing debate and conclude single-payer will be a better deal overall. Hmm. Remember the poll from 2017 showing that, almost seven years after it became law, 35 percent of Americans didn’t realize Obamacare and the Affordable Care Act were the same thing?
Which is to say, health care policy and politics are complex, and many voters don’t do complexity well. If they did, Donald Trump obviously wouldn’t be president.
Now consider some Kaiser Family Foundation polling. Adding a Medicare-like public option for the Affordable Care Act is supported by three-quarters of Americans. Medicare for All earns a bare majority of 51 percent — and when people learn it would mean eliminating private insurance, 58 percent then say they would oppose such a plan.
There’s another poorly understood policy matter lurking here. In arguing that single-payer would allow the United States to reduce its health care spending to a European-like percentage of gross domestic product, its advocates are assuming the government would compel doctors and hospitals to accept payments significantly lower than they would otherwise get.
Problem: The prices private insurers pay in effect cross-subsidize Medicare (and Medicaid), whose rates are at least 10 percent lower than provider costs. Using Medicare rates would push some marginal hospitals into financial jeopardy.
And put a squeeze on physicians’ income. No one will weep for highly paid specialists, but primary care physicians aren’t making a killing. Expect single-payer to incur fierce opposition from those who went into serious debt to earn a medical degree.
“Nobody is more lefty than I am, but I think a public option should be the Democrats’ position,” says Johnston. Another highly credentialed lefty, New York Times columnist and Nobel laureate Paul Krugman, is essentially arguing the same thing.
Will Warren listen?
Let’s hope. This election is too crucial to mess up with an easily avoidable mistake.