Monday, January 18, 2016

Sad but True: Hillary Is Right about Healthcare, and Bernie is Wrong

It's the misinformation, stupid.

Bernie's right, but Hillary's righter.
(update below, read this first)

I've always understood that Medicare for all would require something most people would understand as a tax, even if it were a smaller figure than what the vast majority of Americans pay for health insurance. If you pay $12,000 a year for your family's healthcare, and the cost of Medicare for your family would be $9,000 a year, you've got a net savings of $3,000.

Gone, too, would be the separate administrative costs of Medicaid, VA healthcare, CHIP, and all the associated medical services that could be captured under the umbrella of Medicare for all. The government could use all its best tools in one program -- negotiating drug costs, a national prosthesis program, prenatal services, and so on -- and trim additional costs. Redundancies of all kinds could be eliminated, so I would imagine lower costs would be discovered as we look at how to merge existing services into one set.

Fine. So when Bernie Sanders proposed Medicare for all, I was disposed to agree with him and extremely indisposed toward Hillary Clinton's disingenuous attacks on Bernie's proposal as an attack on Obama's ACA. It was maddening.

Then Paul Krugman presented his reasons for why Hillary was right and Bernie was wrong, and they have nothing to do with what's best for America. Bernie's proposal is what's best for America. But so what?
Second, single-payer would require a lot of additional tax revenue — and we would be talking about taxes on the middle class, not just the wealthy. It’s true that higher taxes would be offset by a sharp reduction or even elimination of private insurance premiums, but it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves.
Finally, and I suspect most important, switching to single-payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers. You might say that they would end up just as well off, and it might well be true for most people — although not those with especially good policies. But getting voters to believe that would be a very steep climb.
In the end, it's not what's true that matters, it's what you are likely to get people to believe. And the chances that amid the droning, harping, and carping likely to erupt in the Republican Party and conservative media, so well practiced in disinformation campaigns, it would be possible to sustain the momentum required to get what's best for America to be accepted, well, the chances to say the least would not be good. Hell, skeptical low-information Democrats would be yet another segment of the resistance.

Sad but true. So progressives would do better to back Hillary on this one and hope we could work toward incremental changes to Obamacare. Public option, anyone?

Update. Paul Krugman offers an addendum to his column via his blog:
Now, it’s true that single-payer systems in other advanced countries are much cheaper than our health care system. And some of that could be replicated via lower administrative costs and the generally lower prices Medicare pays. But to get costs down to, say, Canadian levels, we’d need to do what they do: say no to patients, telling them that they can’t always have the treatment they want.
Saying no has two cost-saving effects: it saves money directly, and it also greatly enhances the government’s bargaining power, because it can say, for example, to drug producers that if they charge too much they won’t be in the formulary.
But it’s not something most Americans want to hear about; foreign single-payer systems are actually more like Medicaid than they are like Medicare.
I don't totally buy Krugman's take here. I've lived under and/or experienced three different healthcare programs -- the French, the Dutch, and the Japanese -- and I get that they're not as "generous" as our expensive American system. But what shouldn't be shoved aside in this discussion is that all of the above and many other countries' outcomes surpass ours. You can say all you want about what's politically possible or expedient, but to contend that this is the best we can get because American cry-babies want their shitty healthcare and are willing to pay almost twice as much because they don't want to stand in line for eventual better and cheaper care, well, call it what it is: low-information, misinformed Americans getting what they deserve.

I get the political part. But I won't stand for the it's-impossible-to-do-better-anyway part. I ain't buying it.

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