OP-ED: Battle over MFA may end up hurting Democrats
In the Democratic primary debates the candidates agree on a lot of things; the most obvious being that they believe that anyone on the stage would be a better president than President Trump. The problem is debates where everyone agrees don’t make news (or good television), so the moderators try to ask questions in a way that is intended to get the candidates to go after each other. Health care is a topic that demonstrates this. While most Democrats agree that that health care is a right and everyone should be able to get treatment, the moderators have focused on whether or not the candidates support Medicare for All (MFA) as the best way to provide it.
Health care is an important issue, and because Republican efforts have consisted of a failed effort to repeal Obamacare while offering nothing to replace it, polls show that voters trust Democrats more than Republicans on the issue. So theoretically, it should benefit Democrats to focus on it, but there are valid concerns that a battle over MFA may end up hurting the Democrats. One criticism of President Obama was that he spent all his political capital passing Obamacare, which the Republicans claimed it would be the end of civilization as we know it (death panels!), and led to huge Democratic losses in the House in 2010. While the policy worked, and as more people used Obamacare it became more popular, the initial politics really hurt the Democrats. Some Democrats are rightfully afraid MFA will be a repeat of that experience.
In the most recent debate, the moderators (as well as many of the other candidates) targeted Elizabeth Warren, trying to get her to admit that Medicare for All will require raising taxes on the middle class. Warren, who objects to the question as an oversimplification designed to yield a “gotcha” moment that the Republicans would use to scare voters into thinking that Warren was going to cost them all thousands of dollars in taxes, refused to answer with a simple yes or no. The reason Warren refused to answer is that while taxes might go up, health care costs paid by most middle-class families would go down by a greater amount, so overall they would be better off, which is why a question only about how it might raise taxes is misleading. Refusing to answer this loaded question is a strategic political calculation on her part, but political pressure may force her to reconsider that calculation.
The basic problem faced by the Democrats is that while MFA (or some other universal healthcare system paid for by the government) is the most efficient way to provide health care, it has some serious political drawbacks. The most serious political problem is that many people who currently have their health insurance through their employers are happy with it, and forcing them to switch to a government plan will be somewhat disruptive, even if the government plan is better (this is loss aversion, a natural fear of change because one might end up worse off). Now they may be happy with their insurance because they’ve never used it, so they’ve not experienced co-pays and deductibles that MFA will remove, but politically, that doesn’t matter.
The other problem is that right now, if a family is getting their health insurance through their employer, unless the new law requires employers who provided health insurance to increase employee pay by the amount that formerly went to the insurance companies, the employees will see higher taxes and their employers will realize the savings. Additionally, taxes going up are more visible than deductibles not paid, so even if people are financially better off, it may not be as visible.
Another political problem is that currently one of the hidden tax subsidies is that people do not pay income taxes on health care provided by their employer, so even if their employer increases their pay by the amount of their health insurance (around $13,000 for a family of four), that pay would be taxed (whereas the health insurance costs were not). Policy-wise, eliminating this hidden subsidy would make MFA more affordable by correcting a historical anomaly that currently benefits people whose jobs provide them with health insurance, but politically, people who benefited from the hidden subsidy may be unhappy when they lose it.
As with any large changes to how the government operates, there will be winners and losers. Medicare For All would provide universal coverage to everyone, and be significantly less expensive than our current system because it would reduce a lot of administrative costs, and make obtaining health care much simpler. Because it is simpler and universal, it would reduce the time patients spent filling out paperwork and reduce the stress that goes with co-pays and wondering if unexpected health care costs will force you into bankruptcy. The government could also use its bargaining power to reduce costs. Of course, if the government replaces the insurance companies and reduces payments to providers, there will be a loss of employment and income in those sectors, so investors and employees in those sectors may suffer economically.
A single-payer system (such as MFA) would be the most effective way to provide health care to the nation, but the critics are right; implementing it would be disruptive, and unless the Democrats win both houses of Congress and the presidency, it won’t pass anyway, so why fight so hard over the details? On the other hand, sometimes you have to go big on a proposal in order to provide room for compromise, and this may be the approach Warren is taking. The debates are artificially exacerbating the differences between the candidates to boost ratings, and those differences are small enough that they should not define the Democrats in the 2020 election. The Democrats should agree that single payer is the goal, but there are many acceptable ways to get there, and move on to other topics, instead of hurting each other by arguing about the specifics of one plan.
Kent James is an East Washington resident and has degrees in history and policy management from Carnegie Mellon University. He is an adjunct professor of history at Washington & Jefferson College.