Randomize

Earlier today, a PAC called “Friends of Bernie Sanders” sent out a survey about “Medicare for All.”

Since I’m quite sure this is just a ploy for campaign contributions and not a word of the answers will reach the ears of any policy makers, I decided to answer the questions publicly instead. If my thoughts are going to be a tree falling in the forest, I’ll at least fell that tree in my own forest.

HOW DO WE COUNTER THE LIES AND DISTORTIONS AGAINST MEDICARE FOR ALL THAT IS SURE TO COME?

Drill three things into the public’s mind:

(1) Private insurance IS privatized socialism already. All insurance is. That is the very nature of insurance.

(2) Private insurance is NOT a free market, because most Americans don’t choose their provider, their employer does. Even those who buy individually have more choices in cell phone provider than health insurer. The risky nature of insurance necessitates that only large insurers can survive.

(3) Private insurance is also NOT a free market because you don’t know what you’ll get until possibly years after you pay for it. Free market capitalism works when you buy a crummy hamburger–you just go somewhere different next time. It doesn’t work when you’ve paid premiums for years, only to find that your provider refuses to cover you when you need it.

Also, make DAMNED sure the program pays for itself, because even though I’m a very liberal guy, I won’t support a program that requires us to borrow more money to pay for public healthcare.

HOW DO WE MAKE CERTAIN THAT ALL OF US - MEN AND WOMEN, GAY AND STRAIGHT, BLACK, WHITE, LATINO, ASIAN-AMERICAN, NATIVE AMERICAN - ARE IN THIS STRUGGLE TOGETHER?

One key point specifically for men is to rebrand “women’s health” as “family health.”

I am just as responsible for my wife’s pregnancies as she was, and both I and our children rely on her continued health as much as we rely on our own. Since every man is born of a woman, we men are just as dependent on care for female health issues as women are.

HOW DO WE BRING YOUNG AND HEALTHY PEOPLE TO STAND ALONGSIDE THE ELDERLY, THE SICK AND THE POOR?

(1) Share the MANY stories of young healthy people dealing with sudden accidents, illnesses, and other unexpected, unmerited medical costs.

(2) Appeal to their patriotism and civil duty.

(3) Give them extra incentives to be covered early.

(4) Work with private companies (such as gyms) to create special discounts for people who demonstrate they have coverage.

(5) Actively combat the selfish survivor-bias mentality of Social Darwinism and radical libertarianism.

PLEASE GIVE US YOUR VISION OF WHAT A HUMANE AND RATIONAL HEALTH CARE SYSTEM LOOKS LIKE.

(1) Create a Public Option to save the Exchanges from collapsing due to lack of providers – run by Medicare, but funded solely through premiums offset by existing market subsidies. To even have a hope of passing, it MUST be net-zero, adjusted each year. Argument to Republicans: if you think the free market is more capable of providing an affordable plan, let those private insurers do so. If they can beat a “big government” program’s cost, great!

(2) Create a National Catastrophic Medical Insurance program. This would, again, be run by Medicare at cost, paid for by increasing FICA. This would cover ALL citizens’ healthcare for a limited number of issues that are high cost but low probability – the items that discourage private insurers from providing affordable individual coverage absent a mandate, and that without coverage, tend to bankrupt the patient. For example, cancer, emergency trauma, and rare but debilitating diseases. Show the public how a having a pool of 300m people for these items can significantly lower their private premiums. (We already have a model for this–the National Flood Insurance Program, which was designed because of a similar risk that private insurers couldn’t handle.)

(3) Speed up the approval of generics. If possible and safe, provide priority FDA review of drugs if the owner agrees to an early end to their patent and a negotiated price for government-paid prescriptions (whether they are through Medicare, Medicaid, government employee healthcare, or VA). Companies tend to focus on short-term profit, government can give them a faster path to market in trade for longer-term savings.

(4) Get rid of HSAs/HMAs and simply make all eligible healthcare expenses itemized tax deductions even when taking the standard deduction. Asking people to predict their expenses adversely benefits people who can afford to lose that bet, and creates a perverse incentive to spend money on unnecessary care or schedule care based on when they have money set aside rather than when they need it.

(5) Enhance the unemployment insurance program to include short-term Medicare, so people between jobs aren’t hit with the double-whammy of COBRA or ACA premiums when they can least afford insurance.

(6) Require that EACH paystub include both the employer-paid and employee-paid costs of health insurance. Until the 80% of people with private insurance understand the true cost, they won’t understand how to compare that cost with single-payer options.

(7) Think inside out. Rather than replacing insurance providers, create a program where the Federal government creates a single virtual risk pool that private insurers put their customers in and pay the government the per-patient cost of payments. The insurance provider then basically manages the program without taking the financial risk of each patient. This is not unlike how many large employers already self-fund their insurance programs. This would create more competition, and would focus the insurance providers on being efficient and customer-focused. (This works well with #1.) This idea is somewhat analogous to FDIC or the Federal Reserve.

(8) Eventually, move to a single-payer system for most healthcare costs, with incentives for personal responsibility in managing one’s health (e.g., losing weight and kicking substance abuse habits when the doctor asks you to do so). The political reality is that this is not possible right now, but we can use steps like 1-7 above to prove to people that government can solve real problems for everyone without spiraling the deficit.

PLEASE SHARE YOUR THOUGHTS AND HELP US MAP OUT AN EFFECTIVE POLITICAL STRATEGY.

Find small solutions that unite libertarians, conservatives, and liberals.

Medicare for All is simply not doable in the current climate, so we need to change the climate, address real issues, and demonstrate that moving toward a single-payer system will improve the health (and wallet) of every American, not just the poor.

Case in point, the ACA’s provisions for young people on parents’ plans and guarantees for preexisting conditions are perfect examples of changes that had real impacts for at-risk populations that virtually all Americans support, and these small ideas are probably more likely to have saved the ACA from GOP repeal than the exchanges, subsidies, and Medicare expansions that made up the bulk of the bill.

So, find more icing for the cake – common sense reforms that don’t cost taxpayers and that help a large number of people.