Richard Painter on single payer Medicare for all

By David M. Perry
Pacific Standard, May 17, 2018

Excerpts

A few weeks ago, Richard Painter shocked the Minnesota political establishment by declaring that he would run for the United States Senate as a Democrat. Painter was the White House ethics lawyer under President George W. Bush and has become widely known as a centrist Republican commentator, in his own writing and on media outlets such as MSNBC. He’s now a professor of corporate law at the University of Minnesota. It was no surprise when he announced an exploratory committee to compete for the Senate seat vacated by Al Franken earlier this year, but no one seems to have guessed that he’d switch parties.

Right now, in addition to his long-running criticisms of President Donald Trump, Painter is challenging Minnesota Senator Tina Smith from the left on health care, the environment, and corporate partnerships, especially over the new NFL stadium in Minneapolis. Smith was lieutenant governor of Minnesota before Governor Mark Dayton appointed her to replace Al Franken after the latter’s resignation last December.

I recently sat down with Painter in a suburban coffee shop in Eagan, Minnesota.

David Perry: I’d like to start by asking you to tell me the story of how you decided to run as a Democrat.

Richard Painter: I have a paper trail that goes back to at least 1994. I’ve been writing, and that’s what professors do. I challenge people to find an issue that I’ve really made a substantial change on. I recognize new evidence, for example, of even worse behavior in the banking sector than what I talked about in 1994. But because I worked for President Bush as the ethics lawyer, people assume that somehow everything else that was going on [then] was things that I would agree with.

DP: So you haven’t always been in lockstep with everything in the Republican Party platform?

RP: There are quite a lot of differences. I have tended to speak out on the issues that are in the purview of my professional expertise—business ethics, corporate ethics, and government ethics. Until recently, I didn’t get into what I think is the best health-care system, weighing in on abortion or something. In the past year or two, I started to weigh in on a lot of issues. People assume that, because the Republican president that I worked for had a different position on those issues, that back then I had a different position. That’s just not the case. The whole paper trail is there.

DP: I’d love to hear more about your recent decision to run as a Democrat for the Senate, especially when everyone else was assuming you’d run as a Never-Trump Republican. Can you take me into that decision?

RP: When I actually go to take public positions on issues, and you go down the issues, the Republican Party has moved dramatically from where they were in earlier times. On environmental issues, on women’s reproductive health, on a military spending, we can go through issue after issue after issue where the Republican Party—and it’s a trend that started in 1980 with [President Ronald] Reagan, but it’s accelerated even it it weren’t for Trump—I’m running on a platform that’s very different.

DP: Let’s talk a little about those issues. You’ve come out for single-payer health care, and even used the issue as a way to attack Senator Smith from her left. What does single payer mean to you? If you had the power to create a health-care system, what would you do?

RP: I think it’s in the interest of the consumer and also the small business owner to ask the question: How do we get the highest-quality health care for the best price? And also [how to] not have health-care issues interfere with the ability to start businesses? Right now, when you connect the employment relationship with health care, that means the big business has an enormous advantage over the small business. It makes no sense to connect those two. Why should health care be linked to your job?

DP: So what’s the better solution?

RP: The advantage of having a single-payer system is that there’s negotiating power vis-à-vis providers, drug companies, medical device companies. So I’m looking at it from an efficiency vantage point. I want best quality for best price.

DP: Debates around the best kind of single-payer usually identify one of three models. There’s Medicare for All. There’s the public option model. And there’s the Obamacare exchanges plus subsidies model.

RP: I like Medicare for All. The advantage of Medicare for All, and we might not be able to do it right away, [but in] the ideal system, your employer would have nothing to do with your health care, just like your employer has nothing to do with your kids’ education. Your employer doesn’t send your kids to school. Your kids’ health care shouldn’t depend on your employer. So we separate that relationship.

And of course that may relieve the employer of a lot of expense, so we may have to raise taxes to do it, OK! You gotta find the money somewhere, but employers then would not have to pay this extra amount of money [on health care]. We would separate out the employment relationship from health care and use tax revenue, but does it matter whether I pay higher taxes or I have to pay an insurance company?

That’s issue No. 1. Two is negotiating power to cut costs. You remove all those insurance company execs who are making a lot of money. Granted, this single-payer [system] is gonna have to pay people, but I don’t think you’d pay them as much as the big insurance companies.

DP: It’s not a stock option-based system.

RP: You don’t have the stock and the stock options and the advertising and the legal costs and everything. A lot of the costs that are in the current system are the insurance companies competing against the other. The time it takes for consumers to compare all these different options—you say competition is good, but it’s time comparing insurance options. What you should be doing is comparing doctors.

Now let’s talk about the drug companies and medical device companies.

DP: You’ve been critical of Senator Smith on her support for repealing the Obamacare medical device tax and her support from the chief executive officer of the medical device company Medtronic.

RP: We’ve made enormous advances, but at a certain point, Americans are paying for most of it. The rest of the world gets the medical devices and the drugs for maybe a third of the prices we do. A lot of the money is going to stock options and the investors and the executives, not going to research and development.

DP: So what’s the solution?

RP: I think the single payer negotiates with the drug companies. It’s negotiating power, it’s the ability to get those prices down. To say, for this medical device, this is the price that’s being paid; for this drug, this is the price we’re gonna pay. Which is exactly what Canada is doing and every other country is doing, all the industrialized countries. In the United States, we’re paying two or three times as much.

DP: Let’s talk about connections between health care and other issues of workers and work. What are your thoughts around these more fundamental issues of labor, economic well-being, the Supplemental Nutrition Assistance Program, and food security? Where do you fall on these positions?

RP: First of all you take health care out of the equation [by instituting single payer], so people don’t have to worry about that. That’s going to help a lot. Then we talk about what’s left. Certainly childhood nutrition, that’s the kind of thing the government ought to be spending on. I am very much focused on government doing what government should do and do it well. So: Nutrition for children [is] absolutely critical. We ought to be doing a lot more than we currently do with SNAP, like school lunches and breakfasts and other meals for children. That’s a useful role for government.

DP: So philosophically, it sounds like you’re pretty aggressive in terms of using the power of government to set tax policy, to set minimum wages, to create subsidies, and otherwise to intervene pretty strongly to bring everyone up to a basic level.

RP: I would tend to have more spending on education and health care and food assistance—critical functions of government. I’m going to be exercising a lot of scrutiny over both defense spending and large-scale infrastructure projects. I wanna see roads repaired. I wanna see bridges repaired. I wanna see more mass transportation, particularly electric busses. I’m gonna be looking very carefully at very large-scale rail projects.

DP: Last question: You’re running now as a Democrat. You’re running to get a nomination of a party that you haven’t been a part of. You’re running against a lieutenant governor who by all accounts has done a good job helping Governor Dayton shepherd Minnesota to a much better place than where it was eight years ago. What happens if you lose, or if you don’t get the nomination? Are you going to continue to be a Democrat? To vote for Democrats and support Democrats?

RP: I don’t see Republicans on the ballot for federal office, this year, in any state, who should get support. They have all fallen in line behind President Trump. I think it’s critical to our democracy. This isn’t about being a Democrat; I’m an American before party. I’ve been a pain in the rear for the Republican Party, and if I were to continue to be involved in the Democratic Party, I will continue to be a pain in the rear on campaign finance, health care, the environment. I’m not interested in party loyalty issues. I’m interested in policy, in issues, and the right thing to do.

https://psmag.com…

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Comment:

By Don McCanne, M.D.

Richard Painter’s lesson for us? It’s not about party. It’s about policy and ethics. It’s about the right thing to do.

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