The Bias Against Change and Medicare for All
BOB GARFIELD: This is On The Media, I'm Bob Garfield. There are some things people just say–the weatherman is always wrong, the commercials are better than the shows, cats are arrogant. It's conventional wisdom never challenged. And yet, and yet, altogether untrue–except for the cat one. But there's another piece of conventional wisdom central to a debate that may be central to the 2020 election. It concerns universal health coverage now commonly known as Medicare for All.
MALE CORRESPONDENT: Medicare for All is unaffordable. It's not plausible. [END CLIP]
BOB GARFIELD: It's not surprising that this is a key Fox News talking point, as we shall learn. Socialized medicine has been a conservative bugaboo for a century. But according to Washington Post columnist Paul Waldman, the allegation of basic unaffordability has seeped, mainly unchallenged, into media coverage. And as the Democratic Party has lurched to the left, the electorate is being misled. Paul, welcome back to the show.
PAUL WALDMAN: Thank you.
BOB GARFIELD: Help us with terms here please. Bernie Sanders, Kamala Harris, Kirsten Gillibrand, Elizabeth Warren, Beto O'Rourke and others have said they support Medicare for All. Now sometimes we hear the term single-payer coverage or universal coverage, are they all talking about the same thing?
PAUL WALDMAN: No, they are not. And over the course of the past year or so, some people started talking about single-payer but it turned out that wasn't really appropriate because it didn't really describe what many people were actually supporting. You do hear a lot of people say the words universal coverage, but Medicare for All has really been the thing that everyone has kind of hit upon. Even if it doesn't necessarily accurately describe what they all stand for–but it has a real benefit. This really comes out of the experience of the Affordable Care Act, which was so difficult to explain and, in many ways, was a real kind of traumatic experience for Democrats. They spent so much time trying to tell people what it really meant and what it involved, all the while they were dealing with misinformation about death panels.
MALE CORRESPONDENT: There is a provision in there that anyone over the age of 74 has to go before, what is effectively, a death panel.
MALE CORRESPONDENT: Yes they do.
CROWD: BOO! [END CLIP]
PAUL WALDMAN: And the really nice thing about Medicare for All is that it's simple, just three words, and you don't have to explain it. Everybody knows what Medicare is. You just give Medicare to everyone, even if that's not exactly what you're doing.
BOB GARFIELD: You've declared that the press are botching the debate. How?
PAUL WALDMAN: Well, whenever there's a new plan that some Democrat puts out, one of the first questions they get is--.
FEMALE CORRESPONDENT: You haven't proposed in your plan how this would be to paid for it, so how would you pay for it?
FEMALE CORRESPONDENT: Yeah. Thanks for the questions. [END CLIP]
PAUL WALDMAN: This I should say makes Democrats kind of perturbed because nobody ever asks how we're gonna pay for the next year's military budget of $700 billion or whatever it is. Republicans very easily dismiss questions about how their tax cuts are going to be paid for. But since Democrats are the party that is supposed to be serious about policy, they always get asked, 'how are you going to pay for this?' The trouble is that we miss kind of the most important part of the context of that affordability discussion, and that is what we're paying right now. In 2017, when the United States spent $3.5 trillion dollars on health care, it was about 18 percent of GDP. According to the most recent projections, we're probably going to spend about $50 trillion over the course of the next 10 years. That's what we're already spending. So if somebody comes up with a new plan and you say, 'well this is going to cost $30 trillion--
MALE CORRESPONDENT: Thirty trillion dollar increase would be coming from Medicare for All. It is just not something that America can support. [END CLIP]
PAUL WALDMAN: How can we possibly afford that? You have to start from the place that if we do nothing, we're gonna spend $50 trillion. When we look around the world, you know, the average highly developed country like ours, spends about half of what we do and they manage to afford it. So the idea that it's just sort of prima facie unaffordable just doesn't accord with the experience of the rest of the world.
BOB GARFIELD: And there's the parallel issue of the difference between expenditure and investment. The interstate highway system was expensive too, but it obviously was a huge boon to the economy. Is there any kind of corresponding economic benefit from a single-payer program or any kind of universal coverage that would pay large, or even modest dividends, down the road?
PAUL WALDMAN: Well, it's an extremely complicated question, and you know you'd need a team of healthcare economists to sort it all out. But sure, if you give everyone health coverage then there are going to be new benefits. You know, say people who are going to be healthier and will be more productive. There also, we have to acknowledge if we're going to make a massive new reform that puts a lot of people out of private insurance and gives them insurance through the government, there are actually going to be ways in which that entails some costs. Like for instance there are a couple of million people who work in the insurance industry. If insurers have a much smaller part to play in our healthcare system then those people are going to have to find new jobs. It's an extremely complex system when you're talking about something that is almost a fifth of the United States' economy. If you're going to overhaul it, there are going to be all kinds of ways that we get economic benefits and their economic costs entailed. And I think that there are ways in which people both on the right and the left, sometimes, underestimate just what kind of a big deal it's going to be.
BOB GARFIELD: You mentioned potential lost insurance industry jobs. Now Republicans and the right wing media call everything that they don't like a job killer–every bit of regulation.
FEMALE CORRESPONDENT: The new rules on greenhouse gases could come at a very high cost–nearly a million lost jobs.
MALE CORRESPONDENT: We need to end bailouts. We need to end too big to fail. We need to protect consumers. We need to bring derivatives out into the open.
MALE CORRESPONDENT: We're going to bring in John Boehner our next hour. He's already calling this idea jobs killer. [END CLIP]
BOB GARFIELD: Every bit of legislation--
MALE CORRESPONDENT: When he proposed a 30 percent minimum tax, that would be about as big a job killing proposal as any president has ever made.
MALE CORRESPONDENT: In Seattle, the minimum wage hike went to 11 dollars an hour in April. And that city loses a thousand fast food jobs in May. Doesn't that destroy the whole rationale for this living wage? [END CLIP]
BOB GARFIELD: And sure enough, they're saying that now.
MALE CORRESPONDENT: You'll get rid of the employer based health care system, which is a job incentive–so it's a job killer. It's giving an entitlement to people who maybe wanted to take a job because it gave them health insurance. [END CLIP]
BOB GARFIELD: So is Medicare for All inevitably a job killer?
PAUL WALDMAN: Oh I don't think so at all. And especially if you think about how much employers now spend on health care for their employees, you know, in many cases tens of thousands of dollars a year. If we move to a universal system they're going to be able to take that money, they'll pay some more of it in taxes, but then there will probably be some surplus that they'll be able to either give back to their employees or invest. It's a really complicated question of exactly what the effects are going to be. And even if you have some very specific job losses that happened, saying the insurance industry, that's probably going to be dwarfed by all the jobs that get created. But one of the things about the media discussion about these things is that you can have a small number of people who lose out in some kind of a transition and they can take on an outsized importance. We saw that with the Affordable Care Act. You might remember, you know, Barack Obama said--
BARACK OBAMA: If you liked the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor too. [END CLIP]
PAUL WALDMAN: And it turned out that once the new regulations on minimum benefits were imposed, there were a group of people who had kind of bare bones policies who got letters from their insurance companies saying this policy doesn't exist anymore and now we're going to give you something new. That number was pretty small but it was a huge controversy. It blanketed the media for weeks.
MALE CORRESPONDENT: Kevin McCarthy of Thousand Oaks California grew angry last spring when he learned that his family doctor of 14 years did not accept the Blue Shield insurance he'd purchased under Obamacare.
KEVIN MCCARTHY: And we were like outraged we were like--.
MALE CORRESPONDENT: Outrage because when McCarthy shopped for his policy Blue Shield confirmed that his doctor was covered.
KEVIN MCCARTHY: Oh yeah. I mean were duped. [END CLIP]
PAUL WALDMAN: And just the fact that there were sort of identifiable people who lost out, whose stories you could tell, made it a big media issue. And that's the thing I think that that we have to understand. Any time we're going to do something big and have some kind of bigger forum, there are going to be some people who lose out even if the vast majority of people end up better off. Those people who lose are likely to to really be featured in the media discussion, especially since Republicans are going to have an incentive to you know lift them up and point to them and try to get the press to pay attention to them.
BOB GARFIELD: So when Democrats say the private coverage may be kept as an option that it isn't necessarily going to be single-payer where the government is the only insurer. Should we take them at their word? And I don't ask that for no reason. Because last month Senator and presidential candidate Kamala Harris was talking about gutting any vestiges of the current system.
MALE CORRESPONDENT: So for people out there who like their insurance, they don't get to keep it?
SEN. KAMALA HARRIS: Well listen, the idea is that everyone gets access to medical care. And you don't have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require. Who of us have has not had that situation where you've got to wait for approval and the doctor says, 'Well I don't know your insurance company is going to cover this.' Let's eliminate all of that. Let's move on. [END CLIP]
PAUL WALDMAN: Her staff, the next day I think, walked that back and said, 'well, that's just one of the options.' Right now, Sanders is the only one of the presidential candidates who has put out a specific plan. In his plan, there is no role, ultimately, for private insurance. If we look around the world, even the most socialized system in Great Britain has a small role for private insurance. They have private insurers in Canada which is the single-payer system. There are hybrid systems like in France where there's kind of a basic Medicaid like plan that covers everyone and then people buy supplemental private insurance. I think we're going to see a lot of the presidential candidates ultimately find their way to something that expands Medicare and or Medicaid, and gives people the option to join a government plan if they want to but still has private insurance for people who don't want to–at least in some sort of long transition period. And the reason is, I think they're very, very aware that people are afraid of change, and that it's easy to frighten people by saying that what you have now is going to be taken away even if what you have now may be kind of mediocre.
BOB GARFIELD: All right, so you've explained the world as it exists, now if you would just spend the remaining moments of this interview telling us what's going to happen.
PAUL WALDMAN: I wish I knew what's going to happen. Well right now, there is a real hunger in the Democratic Party for ambitious change–especially on the issue of health care. You know the experience of the Affordable Care Act I think was really traumatic for Democrats in a particular way. The bill finally got passed by the skin of its teeth and then it had to withstand all these kind of legal challenges, and ultimately an effort by the Republican Congress to repeal it. And after all that, the feeling in the Democratic Party is, 'we don't want to go through that again.' I think Democrats believe that if they get their preferred universal system, it will quickly become beloved by all Americans, and then Republicans won't be able to undo it even if they want to. The only trouble with that is that there is going to be a painful transition to whatever the system is. Whether it's total single-payer or some kind of modified public private system, the transition will not be easy, and there may even be some short term pain. And that's going to give Republicans a window to say, 'we should just get rid of this and go back to the way things used to be.'
BOB GARFIELD: Well, Paul thank you.
PAUL WALDMAN: My pleasure.
BOB GARFIELD: Paul Waldman is an opinion writer for The Washington Post's Plum Line blog.