The American Medicare for All Conundrum

The New York Times is now calling Medicare for All what it always was, a divisive, undoable, and ultimately unpopular proposal that might very well cost the Democrats the election in 2020. Study after study has documented that the versions of Medicare For All proposed by various Democratic candidates are very unpopular with a majority of the voters, and are especially unpopular among swing voters, and particular swing voters in the battleground states. (This is exactly the same analysis I published three months ago, for which I was rounded excoriated.)

Unfortunately, the damage has already been done. The association between Medicare for All and the Democratic party is now firmly embedded in the national consciousness, and Democratic candidates will have to choose between angering their progressive-liberal-left wing supporters by walking back their Medicare for All proposals or making themselves unpalatable to a majority of the mainstream voters.

Elizabeth Warren’s campaign has already experienced the backlash against her Medicare for All proposals, with the negative reactions being quite obvious in her poll numbers and her fundraising totals. Her Democratic opponents (and Bernie Sanders) correctly criticized her proposals for greatly underestimating the costs while her plan to tax the assets of the rich rankled strict constructionists who can find no such power granted in the Constitution.

In the Medicare for All imbroglio, the Democrats — and especially Bernie Sanders — have conflated two issues into one hot potato: the whys and wherefores that result in the absurdly high cost of health care in America and the belief that a majority of Americans support the idea of providing the same quality of medical care for everyone free of charge for everyone.

Americans are not that generous. Want proof?

Be honest now: Would you be willing to pay a ten percent surcharge on YOUR federal taxes to cover the costs of Medicare for All? What about your next-door neighbors? Would they be willing to do that?

If you are not willing to do that, then you aren’t really committed to Medicare for All if it is actually going to cost you money. You are committed to Medicare for All, only as long as someone else pays the bills.

Now ask yourself another question: Would your company be willing to pay a ten percent surcharge on its federal tax bill.

Even if you answered, “Yes,” to that question, it doesn’t matter because current laws require corporations to maximize the return on investment for their investors, which means doing everything possible (and presumably legal) to increase dividends to their shareholders. Paying a voluntary ten percent surcharge doesn’t fall into that category, and any CEO who tried to do that would be out of a job by the end of business that day, along with any board of directors that voted to do such a thing.

The entire premise behind Bernie’s version of Medicare for All was to basically outlaw private insurance and the capture the payments that private insurers were receiving. That’s the only reason that Medicare for All was invented.

However, the structure of all of the Medicare for All proposals have one fatal flaw: they lump together the people who CAN afford private health insurance and can pay out of pocket for procedures that insurance doesn’t cover. These people do not need Medicare for All, and they don’t want it either, but including them in the various Medicare for All proposals actually makes those proposals unaffordable rather than helping to cover the costs.

There is no reason that we should even be thinking about providing Medicare for All. Let those who can afford health insurance keep their health insurance. Let those who can’t buy into Medicare by removing the age restriction and charging a monthly fee equal to or less than most affordable private insurance plans available, and provide free care for those who cannot afford to buy in.

This would still take billions of dollars to implement, but not nearly as much as any of the current proposals would cost, nor would it upset the existing systems with which many people are quite happy.

Of course, there are many people who are quite unhappy with the present system. I’m one of them, but please don’t serve me air pudding with wind sauce and call it a great dessert. The costs are too high, the pre-existing condition clause is too onerous, and overcharging (and double charging) by service providers is rampant, and Medicare doesn’t have the ability to adequately police its own system. Proof of this is sitting in the United States Senate right now (instead of jail which is where he should be sitting) in the person of Rick Scott, who was the CEO of a company that perpetrated the single biggest fraud in Medicare history. As Governor of Florida, he hamstrung medical financing for poor people. As a Senator, he is a bought and paid for vote against Medicare for All.

Conflating the unconscionably high cost of American health care systems with the desire to cover everyone who isn’t currently covered creates a morass of confusion for voters. Medicare for All will not fix that without taking over the entire medical care system, including the pharmaceutical industry…which is never going to happen because the Democrats don’t have the votes to make it happen.

The high cost of health care in America is due to a number of factors, including the sheer size of the country and the size of our population. It costs more to feed 330 million people than it does to feed 5.5 million, and it costs more to provide them with medical care because the institutions that provide that care are massive and therefore massively expensive to maintain.

Distance plays a factor. We need more hospitals than other countries because our population is so spread out and because the distances between urban centers are so big.

Demand also plays a factor in the cost equation: More people require duplications of services to prevent the loss of salvageable patients due to a shortage of resources.

No one ever seems to want to come to grips with these facts.

Agreed, there are extreme abuses in the pricing systems and blatant, widespread corruption throughout the medical profession, but that’s a result of the debased state of American ethics, not government policy per se, although the government isn’t trying to fix that either.

The major players in the Democratic primaries are old…and this campaign is undoubtedly their last hurrahs…which is why they are attempting to address all of America’s social problems in one fell swoop with major, interlocking proposals that link different — and sometimes mutually irrelevant — issues into the same solutions.

The Green New Deal is a case in point. We need to address the climate issue which, now, has boiled down to the CO2 issue, but we don’t need to do that within the context of a proposal that also attempts to guarantee high paying jobs for everyone, eliminating poverty, ending all forms of racial, religious, and gender discrimination, and guaranteeing everyone a basic minimum monthly stipend.

As a cause célèbre, the Green New Deal is laudable. As a piece of legislation, it is a failure waiting to happen.

No society has ever succeeded at eradicating poverty, because poverty is a concept, not a function of income or assets.

If you want to define poverty accurately, it comes down to not having adequate food, housing, clothing, and medical care to sustain life, not how much you make per year, but we’ve been tricked into thinking about poverty that way, as an absence of money.

So, let’s play that game for a minute.

If you took the world’s net worth (estimated at $241 trillion) and divided it evenly among all 7.8 billion people, you get a per capita distribution of $30,897 per person, ONCE and only once, because, by dividing the world’s net wealth you have liquidated all of the corporations that generate that wealth.

Income distribution in the United States alone (because we can’t even control Canada, let alone the rest of the world) is just as problematic. The total domestic product of the United States was around $21 trillion in 2019. Divide that among 330 million people, and you get a per capita income of $63,363…but you would only get that distribution once because dividing all the profits made by all the companies in America would drive them all into instant bankruptcy since virtually every corporation of America is sitting on a mountain of debt that must be serviced. No income means no debt service and no debt service means you are de facto bankrupt and soon to be broken up by the courts.

Distributing the world’s gross domestic product ( or just America’s domestic product) in this manner would kill the geese the lay the golden eggs because it would drive every corporation out of business immediately.

No society (larger than the tribe or a collection of clans) has ever existed without multiple strata separating the rulers, the rich, the wealthy, and the poor; any attempt at income equalization will result in either the collapse of the experiment or the collapse of the society that attempts it.

If you are at the bottom of this pyramid, life sucks. There’s no doubt about that. There is also no doubt that we can make life at the very bottom more livable by ensuring the basics of food, shelter, clothing, and medical care, but that effort comes with a price tag of much higher taxes than we are now paying, and that means higher taxes for everyone because the only way to bear this burden is to share it.

It is undoubtedly true that the very rich can and should pay a higher percentage of their income to support the poor…but most of them don’t think they owe that debt. (The very richest people on the planet know they owe that debt, but — with very, very few exceptions — they never pay that debt fully. )

Putting all of the Democratic parties eggs into one or two baskets, and then calling the baskets Medicare for All and the Green New Deal, was like waving a red cape in front of an angry bull. Had the same goals been expressed quietly, in separate pieces of legislation, parts of that program would have passed, but the Democratic party has an obsession with being seen as the party of the disenfranchised, no matter how loudly the disenfranchised chant that they don’t trust the Democrats anymore.

The problem with that obsession is that, if you pander to it too much, that’s exactly what you end up, an electorate of the disenfranchised, which is much smaller electorate than the one the other side has recruited to its cause, a cause that might be defined as, “I’ve got mine, and to hell with you.”