Former President Barack Obama was wrong. And he was right. And what he said may have been a turning point for the U.S. health care system.
In a recent speech that was noteworthy primarily for its unvarnished criticism of President Donald Trump, Obama made a passing reference to issues that could be winners for Democratic candidates.
"Democrats aren't just running on good old ideas like a higher minimum wage, they're running on good new ideas like Medicare for all, giving workers seats on corporate boards, reversing the most egregious corporate tax cuts to make sure college students graduate debt-free," he said.
OK, first, Medicare for all is not a good new idea. It's been around for decades under many guises, including "single-payer health insurance" and "a public option."
However, Obama was correct in saying this was a strong political issue for Democrats as Republicans persist in their efforts to dismantle the Affordable Care Act and cruelly leave millions of Americans uninsured.
More importantly, his highlighting Medicare for all represents the highest-profile political endorsement to date of a reform that finally would allow Americans to enjoy the benefits of an insurance system that provides universal, affordable coverage in almost all other developed countries.
"President Obama's endorsement is significant because it acknowledges that we still have important steps to take to guarantee universal health care in the U.S.," said Gerald Kominski, a professor of health policy and management at UCLA. "Adults in America are still very vulnerable to being uninsured, or subject to disruptions in insurance they get through their employer."
"As more baby boomers become eligible for Medicare, they understand that, for the first time in their lives, they have insurance that can't be taken away from them. And they like having that security."
Until now, Medicare for all has been largely a pet project for the progressive wing of the Democratic Party. Sen. Bernie Sanders (I-Vt.) championed the idea when he ran for president in 2016. He's currently sponsoring legislation that would open Medicare to everyone, not just people age 65 and older.
By taking up the cause so publicly, Obama has shifted the conversation to the mainstream and pitched it to the party establishment not as a gonzo lefty crusade but as a solid pocketbook issue that will resonate with all American voters.
The facts are undeniable. Citizens of developed countries with variations of single-payer systems--Britain, Germany, France--pay roughly half what Americans pay for health coverage and have better results to show for it (longer life spans, lower infant mortality).
They accomplish this not through some exotic foreign magic but by exploiting the economic benefits of large insurance pools that represent the entire population. This allows comprehensive coverage to be offered at affordable rates because everyone shares in the risks and rewards of the system.
Let's be real clear: This isn't socialism. This isn't communism. It's simple risk management--the same economic principle that underlies all forms of insurance.
Yet conservatives for years have persisted in the bizarre belief that using taxpayer funds for health coverage is tantamount to taking our first steps down the Ho Chi Minh trail.
Never mind that they support using tax money to fund public education, and police forces, and fire departments, and infrastructure projects, and any number of other endeavors that protect and promote the public good.
Never mind that they will defend taxpayer-funded Medicare and veterans assistance as sacrosanct.
The idea of a government-run health insurance program for non-veterans younger than 65 is just too radical a notion for them to embrace.
Conservatives have been so successful in their irrational demonization of single-payer that Democrats are now afraid to even say the words.
The Democratic Congressional Campaign Committee warned candidates last year not to utter the phrase "single-payer" lest they be pilloried by Republicans for being running-dog fellow travelers. Instead, Dems should always say "Medicare for all."
Obama stuck to that script. But he could have pushed the envelope more.
Polls show that most Republicans support the safeguards in the Affordable Care Act for people with pre-existing conditions. They agree with Democrats that people with cancer or diabetes or heart disease shouldn't be denied coverage by insurers and shouldn't have to pay more than healthy people.
"It's a reflection of what's happening overall with health care," said Charles Idelson, a spokesman for the California Nurses Association. "People see family members who can't pay for chemotherapy or insulin."
Yet Republicans, as much out of knee-jerk party loyalty as out of shameless economic ignorance, see it as a crushing blow to personal freedom for the government to require that people join a risk pool, although that's precisely the economic give-and-take that makes Social Security and Medicare possible.
When it comes to health care, conservatives want the apple pie but won't eat their broccoli.
"The result is that the health-care crisis that the Affordable Care Act was intended to solve has continued to spiral out of control for tens of millions of people," Idelson said.
UCLA's Kominski said that if conservatives could get past their ideological hatred of Medicare for all, they could play a constructive role in strengthening the U.S. health-care system in a way that builds on the successes of other countries while also learning from their shortcomings, such as limited choices or rationed care.
"Medicare for all can be structured so that people still have choices," he said. "Under traditional Medicare, people have virtually unlimited choice of doctors and hospitals."
Kominski added that even if the United States didn't fully adopt a single-payer system, it could still achieve universal coverage via a program that relies primarily on the government to finance health care but "allows a smaller role for private insurance that is heavily regulated."
Almost all other developed countries, he observed, "regulate prices for doctors, hospitals and pharmaceuticals, rather than relying on mythical competition to keep prices under control."
Obama was wrong to say this was a good new idea for Democrats. But he was right to spotlight Medicare for all as a meat-and-potatoes idea whose time has come.
If Republicans were smart, they'd recognize the same and try to make the issue their own, reflecting conservative economic values, such as an emphasis on fiscal responsibility. Rather than being single-mindedly determined to make things worse.
Editorial on 09/16/2018