Fresh off a victory against Trumpcare, health care activists are now looking hopefully towards the future. Already there has been significant progress: within the Democratic Party “Medicare for All” has now achieved a level of support and enthusiasm unprecedented in recent memory.
Yet even as a broad spectrum of progressives coalesces around the cause, others are warning that we should be pressing on the brakes, not the throttle. Joshua Holland penned a piece in the Nation making this case just last week, and Paul Krugman made many similar points in his New York Times column on Monday.
Both argue that single payer should not be a “litmus test” for progressive candidates. They’re sorely mistaken.
Let’s begin with Holland’s arguments as to why Medicare for All may not be the best solution to our health care woes. Holland opens by asserting that while advocates want to use Medicare as the model for single payer universal health care, “Medicare isn’t a single-payer system in the sense that people usually think of it.” After all, he correctly notes, Medicare is partially privatized (via Medicare Advantage plans run by private insurers, as well as in the privatized design of its drug benefit). In addition, because Medicare imposes out-of-pocket expenses on enrollees (for example, co-payments and deductibles) and fails to cover some services, many enrollees purchase supplementary coverage (“Medigap” plans).
“The array of options,” Holland writes, “can be bewildering — it’s a far cry from the simplicity that single-payer systems promise.”
Indeed it is! Which is precisely why prominent single-payer proposals discard these flawed elements. Medicare Advantage primarily functions as a siphon from the public purse to insurance company coffers, and Medicare’s out-of-pocket payments squeeze many seniors. Both are unnecessary. Both should be nixed.
There seems to be some confusion here between what we might call “Currently Existing…