By John Marty
Response to the November 19, 2019 POLITICO article, “Does Gavin Newsom have the answer to Democrats’ health care fights?”
California Governor Gavin Newsom’s shifting position on single payer shows why voters become cynical. His switch shows why progressives are still waiting for universal healthcare almost ninety years after Frances Perkins first called for it.
The November 19 POLITICO article says that in two years, Newsom went from: “it’s about time” for single payer to: “these things take time” and now to: “[it] continues to be a guiding beacon for where we’re trying to go.” That might not sound like a big transformation, but it’s huge. Newsom’s vision of universal healthcare is now so far away that one cannot even see it – you need a beacon to help steer in the general direction. In other words, California is not going to get there in the foreseeable future.
I don’t know Governor Newsom and don’t know California politics, but it appears that he has become one of the “can’t do Democrats” he railed against in his primary campaign. As he said in the campaign, “If these can’t-do Democrats were in charge, we would have never had Medicare and Social Security.” He was right about that, and as Newsom morphs into a can’t do Democrat, California clearly won’t get universal healthcare.
Democrats opposing single payer claim there are “less disruptive” ways of achieving universal healthcare. Look at the Democratic presidential candidates’ positions. All of them, including those who don’t support single payer, say they support “universal” healthcare. That means everyone is covered.
All the Democratic candidates’ plans, like Newsom’s proposal, brag about covering more people. They hype the progress they are making. The POLITICO article says California reduced its uninsured rate down to about 7 percent, from much higher numbers before Obamacare. If they keep working, perhaps they’ll lower it to where Massachusetts is, only about 3 percent uninsured.
That would be a wonderful goal, except for two things:
- The three percent who don’t have any health coverage. That’s a lot of people, often very sick folks.
- The other 97 percent. Many of them cannot afford care despite their insurance. Check out the number of desperate families creating “Go Fund Me” pages to pay for care. Look at the bankruptcies caused by medical debt.
Does anyone think it would be acceptable if “only three percent” of young children were not able to go to elementary school because they couldn’t afford it? Would it be OK if some of the kids in school couldn’t afford the reading or math classes? No. We want every child to get an education. No exceptions.
But with healthcare, many candidate appeals to universal healthcare are cynical appeals to voters who believe everybody needs healthcare, just as every child needs an education.
I describe those political appeals as cynical, because many are. “Democratic and Republican strategists told POLITICO that the way single-payer played out in the Newsom-Villaraigosa contest is exactly how they see the fight” in the presidential race. “First, promise Medicare for All. Win the primary. Then move to the middle to pick up more middle-of-the-road voters and start explaining how you were misunderstood all along.” No wonder voters distrust politicians.
Returning to the claim of “less disruptive” ways to achieve universal healthcare, in California even Newsom’s staff recognizes that his alternative plan won’t get there: “The governor continues to insist that we move forward towards [emphasis added] a system that will cover everyone.” Effectively, we don’t really expect to get there, but don’t worry, we’ll push in that direction.
If there are alternatives to single payer that will deliver universal healthcare, why hasn’t anyone proposed an alternative that covers everyone? Democratic candidates who don’t support Medicare for All recognize the popularity of a universal system, so they offer similar-sounding plans like “Medicare for All Who Want It,” but those plans would not cover everyone and would not save money. They continue the bureaucratic insurance system, simply adding one more plan to the mix. It might save money for some of the people on it, but it doesn’t bring down costs or fix the fundamental problems.
While some countries deliver universal health care through private insurers, those insurers are selling the same plan, with the same coverage, with the same providers, and they are tightly regulated. In the U.S., it doesn’t work that way. Here, insurance companies effectively set the rules: The Senate author of the Affordable Care Act singled out a former insurance company VP as the designer of the ACA. Not surprisingly, insurance company profits have been sharply up since Obamacare’s passage.
Political consultants, pundits, and cynical politicians tell us that these incremental steps will lead to single payer. The article mentions health “experts” who suggest that Newsom’s numerous incremental steps and tinkering with the Affordable Care Act, “can put him on the doorstep” of universal healthcare. The best they can offer is that some year, far in the future, we’ll be on the doorstep, begging to be let in.
We ought to be ashamed at the mere tinkering our political system has done on healthcare. A single health plan that covers all Americans has been a goal of progressives since the 1930s, yet political consultants say we are moving too fast.
Minnesota has been trying other approaches to deliver universal healthcare for over thirty years. I’ve been involved in some of those efforts. We made some improvements, but they were marginal at best.
Many alternatives to single payer have tried to cut costs and make sure nobody gets unnecessary treatment. The most common result from those reforms is an increasingly complex and bureaucratic system – listen to doctors and nurses who burn out from paperwork. And, with this convoluted system, where you need to “qualify” for care, there will always be people with mental health or other physical or intellectual challenges that prevent them from successfully enrolling and re-enrolling every year.
Unfortunately, our current, insurance-based model is unable to deliver universal healthcare. And we cannot afford additional decades of tinkering.
Democrats who oppose single payer claim it isn’t feasible.
Neither was Social Security. The concept of providing “social security” to the elderly and people with disabilities, was a nice dream, but in the 1930’s, in the middle of a depression, that just wasn’t realistic – there is no chance it could pass. But it did.
Ten years ago, gay marriage wasn’t going to happen in our lifetimes. But then it did.
I share the concerns of Newsom and others about the strength of the political opposition, but that does not justify inaction when lives are at stake.
And lives are at stake. Occasionally these tragedies catch the public eye. But week-in and week-out, people die from a lack of access to care with virtually no public awareness. Preventing those senseless tragedies and making sure everyone has access to health care should be our first concern.
Dismissing universal healthcare, or any other proposal, as “politically unrealistic” is a self-fulfilling prophecy. If even people who (pretend to) support the policy say it’s unrealistic, then it must be unrealistic, so why fight for it?
Democratic opponents say we can’t afford single payer
But the reality is quite different. Not only is our current insurance-based model unable to deliver universal health care, but we will never control spending without a universal single-payer system. Why? Only a Medicare for All single-payer approach allows for real price negotiations and only it eliminates the bureaucratic and extraordinarily wasteful financing system.
POLITICO quotes a Democratic strategist dismissing single payer saying, “the deeper you go, the harder it is to explain how you’re going to pay for it.” Perhaps it would be difficult to explain if we weren’t already paying for it.
We currently spend over one sixth of all the dollars in our economy on healthcare – twice what most industrialized nations spend, yet we have worse health outcomes. That astronomical spending is driven by our complicated insurance and billing system and the lack of rational price negotiations. When some hospitals charge 16 times as much as other hospitals for the same procedure, the need for fair price negotiations is obvious. The same is true when comparing prescription drugs. Other countries negotiate drug prices, but we don’t have a real system for doing so. Only in the United States do we allow price gouging by Big Pharma.
There are also enormous savings to be gained with a logical, efficient financing system that gets rid of sad reality where most hospitals have more billing clerks than hospital beds.
With these efficiencies, the universal system would be less expensive than the current system, despite covering everyone. Since we already pay more than enough for universal healthcare; we simply need to change how we collect the money and where it goes.
A good start would be changing from premiums based on age, to premiums based on ability to pay. Everybody pays, but it’s affordable to all.
Businesses would be freed from the time consuming, expensive, and challenging responsibility of shopping for health insurance, replaced by reasonable healthcare taxes.
The biggest source of funds for healthcare, by far, would continue to be the federal and state governments. Well over half of all healthcare dollars are already paid for by government.
These are significant, but manageable changes in the financing of care. More of the dollars would be collected by government, not insurance companies. Instead of paying premiums to Aetna or United Healthcare, we would pay them to Medicare (or whatever state plan is created.)
Just as the dollars we pay into Social Security are not co-mingled with other public funds, we can ensure that these dollars go directly to Medicare where they are used for healthcare and cannot be diverted for other purposes.
To paraphrase that Democratic strategist quoted earlier, “the deeper you go, the harder it is to explain how you’re going to pay for the current dysfunctional health care financing model have while covering more people.”
Make no mistake. It’s important to work for incremental improvements, but it’s not an excuse to avoid bolder change. In the Minnesota Senate, I advocate for universal healthcare and simultaneously work on smaller changes. Advocating for a solution to access and affordability problems does not excuse one from ignoring incremental changes to make the system better in the interim. I’ve been fighting for an end to pharmaceutical price gouging, less insurance company interference in treatment, and have passed numerous bills to improve the system. I supported the passage of our MinnesotaCare plan many years ago and pushed for implementation of the Affordable Care Act and expansion of Medicaid more recently.
But when we as a nation fail to treat people with serious mental illness, housing them in jails instead, when young adults die because they cannot afford insulin, when workers with “good” health insurance plans face bankruptcy from medical bills, incremental changes are not enough.
John Marty is a senior member of the Minnesota Senate and author of a proposed single payer universal healthcare plan.