So....let's discuss my evolution on Medicare for All.
First, I was a conservative. I was opposed to any government healthcare, believing all the horror stories about how the government is gonna institute death panels and it's SO much worse than the free market.
Obviously, that was a bunch of nonsense. And Obama care was actually WAY too moderate of a proposal. It didn't fix the issues. it tried to expand coverage but the approach was so fragmented and flawed it never solved the problems. To this day, millions lack health insurance, healthcare is prohibitively expensive, trying to mandate all employees get healthcare just led to the proliferation of part time jobs to bypass those regulations, and many states refused to expand medicaid at all and now Mike Johnson is rolling back those protections. The ACA approach isn't working, and as I shifted away from the right to the left, and started looking at the problems with healthcare, I quickly supported medicare for all.
El Sayed, the Michigan guy I just discussed, is actually the strongest voices to make the case for it, literally writing a book on it. And I do wanna elevate his voice here. But to discuss my own views on it, the market is so fundamentally broken that a market based approach to healthcare is not gonna fix the problems. The profit motive and the structure of markets just dont allow for an affordable healthcare system that works for the people to flourish. When you commoditize healthcare, you're basically saying "your money or your life" and people will pay exorbitant sums of money to get care, leading to the issues we have today. Even more, our work based culture insists on tying employment to jobs, which has been a failure, since, as the ACA has shown, employers REALLY dont wanna pay for healthcare. And will hire people part time to avoid regulations. Wanna know why you cant work more than 25 hours a week at one job as a service worker? Because then they gotta give you healthcare, and they dont want that. So now you gotta take multiple jobs just to survive. A well meaning regulation that made our lives better actually made it worse.
It seems obvious, based on these problems, that a Medicare for All system is the ideal solution. It would solve the access and affordability problems. it would free people from being forced to take jobs to get health insurance. It should be the ideal solution. And from 2014ish on, I've been for M4A, putting it as my second highest priority, only outranked by a basic income.
But that's where my M4A support starts to falter. I've discussed this on the blog before, but around 2021, and you can go back to like April, May 2021 and see a lot of posts on this subject as I tried to work through the issues, my own policy platform has a significant problem of trying to afford both a UBI and Medicare for All. UBI would cost like $4.6 trillion, and M4A currently would cost $3 trillion on top of what we're already spending. That's the 2025 number, not the 2021 number, but even in 2020, 2021 as I worked through numbers, I kinda realized that we don't have unlimited money, and cant just fund everything. There is a ceiling of taxation, and UBI strains that, and M4A adds even more strain. Bernie style progressives can afford M4A mostly because they DONT embrace UBI. This gives them more economic flexibility to pursue other solutions like a massive green new deal jobs programs and M4A.
Even for Bernie though, a lot of his numbers were a bit iffy. In working on my M4A proposal for my book, I redid bernie's numbers, and found that given the healthcare inflation that's occurred since 2020, the costs of healthcare have ballooned. A universal healthcare system would now cost $5 trillion total. And as El Sayed would point out in his book, since I read it in preparation for working on my own proposal, the cost saving mechanisms of M4A are difficult to predict. Some say it would make healthcare more expensive, some say it would save money. We really don't know. It depends on the plan.
Bernie's plan in 2020 was intended to address a world where total healthcare costs were $3 trillion total, and we only needed around $1.75 trillion more than we were currently spending. Again, we're now up to $5 trillion, and needing $3 trillion. I just can't make the math work. I tried. Here's my best math to try to make it work:
Current healthcare spending- $1.9 trillion
7.5% payroll tax- $971 billion
4% household tax- $732 billion
Repealing existing tax breaks for health insurance- $140 billion
Increased corporate taxes- $300 billion
Wealth tax- $275 billion
Improving tax enforcement- $230 billion
Higher estate tax- $25 billion
+_______________________________________
Total: $4.573 trillion
We need around $4.9-5 trillion here. So I'm short. It's a good attempt, but I no longer feel confident I can fund it. And keep in mind, all of this is ON TOP OF UBI, which increases the tax rates across the board bt 20%. I've just decided to shelve the idea. To make the numbers work, I'd potentially have to scale back my UBI plan to around $10,000 a person to ensure the numbers work. That's 63% of the target amount, with potential deficits (keep in mind I'm several hundred billion short of the target) possible exacerbating that.
While, in and of itself, none of this is fatal to M4A support. if I was really hell bent on doing it, I would make it work, again, if it comes at the expense of my UBI plan, that's the one thing that can make me back off. So it's not that I've become a centrist sell out or whatever. It's that I have a hierarchy of priorities, and I gotta compromise on healthcare to ensure my UBI plan has the proper amount of leeway to work.
On the other hand, Medicare Extra for All, the backup public option plan I considered back in 2021 the last time I faced this problem, is only $300-600 billion. Now, it does this by offloading costs onto the customer instead, but still, the plan is structured not all that differently than a progressive tax would be on income. People with less money get free healthcare. Those who make more money pay more as they're able. The difference between a premium and a tax isn't that significant in practice, so it's just a different way of handling it, and would allow me to keep the accounting on the government side more free for UBI to function.
In my healthcare draft, I also debated which would be net better for people at the end of the day: Medicare extra or medicare for all. If my UBI were cut in, say, half, each individual would lost $8,000, and your typical 2 adult 1 child household would lost $18,750. On the other hand, such a household would pay around $4,800 a year in healthcare premiums and face a maximum of $5,000 deductible. So...they'd pay at most $9,800 for healthcare per year.
So...if we adopted Medicare for all, the typical family would lose around $18,750 in order to save around $9,800. That's a net loss of $8,950. With that said, I'd rather pursue a public option. I mean, the more I research the costs, and how I can STILL accomplish my healthcare goals via a public option like medicare extra for all, ensuring universal access and higher affordability, and ensuring that anyone who wants a government plan can have it, and it will align with their income situation whatever that may be, honestly...I've just decided to shelve Medicare for All for now.
I'm not IDEOLOGICALLY opposed to it. I believe it's the most elegant healthcare policy we could have. But given fiscal constraints other policy priorities impose on my platform, I think it's in my best interests if I distance myself from it and pursue a public option instead. I understand this might disappoint some. It is a move similar to what yang did in his 2020 campaign. And he didnt do it explicitly because of UBI, he just believed he couldnt make the logistics of a transition work. Ironically Medicare extra for all would allow us to possibly expand into a M4A system down the road if we can swing the cost. I mean, when Harris ran on a "medicare for all" system in 2020, her plan was actually a medicare extra for all style public option that would start out as a public option, transitioning to M4A over time.
In a way, el sayed actually discussed a lot of these possible transition options in his book. He talked about lowering the age, expanding a public option into a universal option over time. I mean, M4A is itself a flexible concept.So...idk. I mean, healthcare policy is a spectrum, really. The difference between a public option and M4A kinda blends together. I guess the big difference is whether you'd ban private health insurance. And I'm leaning toward not doing it. Someone else could do it in the future if they find it fiscally sustainable on top of my other priorities, but I'm just not gonna actively pursue that. I just wanna make sure people are covered and actually have options.
So yeah, that's why I'm no longer actively for medicare for all. I wouldn't say I've changed ideologically, I just made a fiscal compromise to make my own ideal platform more sustainable. To any progressive who wants to use this to blast me or purity test me, I'll do it back to you. What do you think about UBI? Do you support UBI? Care about UBI? I notice a lot of M4A purists arent UBI supporters and I know from 2020 when Yang ran a lot are hostile on the idea. And if that's the case, well, we just have different policy priorities and preferences. Just know this, I haven't changed or "sold out" as much as you think. I just evolved. My own priorities have always been UBI first and M4A second. I'm just acting that out as I try to translate my policy preferences into actual policy that can be implemented in the real world. You don't like what I have? You try to do a better job and then I'll purity test YOU. Like really, I have no chill toward jobist leftists who act all high and mighty on this subject when they don't even share MY priorities. I just wanted to put THAT out there before I deal with annoying purity testers.
No comments:
Post a Comment