Don’t Listen to the Pundits: Progressive Policies — Like Medicare for All — Are Pragmatic, Affordable, and Moral

Incrementalism, moderation, and compromise between two ruinous positions is neither reasonable nor virtuous.

Let’s take Medicare for All, for example. We are asked how we can afford it. We are told it — like other progressive policies — is extreme, radical, and that only those on the “far left” want it.

So let’s examine this.

WHAT IS MEDICARE FOR ALL?

The proposed universal healthcare plan embraced by progressives is a single-payer health insurance plan, combined with various measures to bring exorbitant healthcare costs under control.

WHAT DO WE HAVE NOW?

Our current system is actually a patchwork of different systems that is very difficult to navigate. (Medical practitioners need to hire teams to understand the tangled mess of insurances and their complex, constantly changing requirements and restrictions. It’s a burdensome expense for providers.) There are many components to the system — employer-sponsored health insurance and individually purchased health insurance (with dozens of health insurance companies and each with multiple plans), Medicare (with Parts A, B, C, and D), Medicaid, CHIP, the VA, Tricare, IHS, and others.

In 2019 the US spent 17.8% of its GDP on healthcare — about $3.6 trillion. (We are projected to hit 18% for 2020.) This percentage of GDP for healthcare is the highest among all developed nations. Each year healthcare spending in the US rises, usually between 4% and 6%, with most years coming in around 5.5%. (Of course, it is expected to be higher this year.) Conservatively, then (using the 4% rate), the US will be spending at least $50.5 trillion on healthcare over the next ten years if we maintain our current system.

How are we going to pay for this? What will we sacrifice so we can continue to pay for this?

But our healthcare system costs us more than just dollars. Prior to the pandemic (which caused many people to lose their jobs and, thus, their insurance) there were about 30 million uninsured people in the US, with millions more underinsured — which means that many risks are not covered or people cannot afford the copays and deductibles they would need to pay in order to access their coverage. Some sources estimate that nearly half of all American adults are either uninsured or underinsured.

About 1 in 4 Americans delay treatment for needed medical care due to cost. It is estimated that anywhere from 45,000 to 70,000 people die each year in the US from treatable illnesses because they could not afford medical care. (That’s the equivalent of fifteen to twenty-three 9/11 terrorist attacks.) It is also estimated that about two-thirds of all bankruptcies in the US are primarily due to medical debt. We don’t see these kinds of costs occurring in any other developed nation in the world.

How do we justify these costs? Well, we don’t. Because we ignore them. We treat these people like they don’t matter. But they do matter.

WHAT WOULD MEDICARE FOR ALL COST?

This is a difficult question to answer because included in Medicare for All is a plan to bring down costs across the system, and many of these will involve negotiations (e.g., negotiating drug prices, as is done in every other developed nation), so it is impossible to say exactly what the costs will ultimately be.

However, there have been numerous studies estimating the cost of Medicare for All, and ALL of them found that it would cost LESS than what we are currently projected to spend, some in the tune of tens of trillions over the first decade of its full implementation.

BUT WHAT IS MEDICARE FOR ALL?

Contrary to some people’s claim, Medicare for All is NOT a nationalized health system, akin to the UK’s NHS. And regardless that many progressives point to Canada as an apt comparison, in actuality the country with the healthcare system closest to what Medicare for All proposes is Taiwan, which, since 1994, has a single-payer health insurance system with medical practitioners that remain in private practice.

In 2018 Taiwan’s healthcare spending came to 6.3% of its GDP, and its annual healthcare cost growth rate averages around 3%. They have achieved universal coverage. Average wait times to get a doctor’s appointment — even a specialist — are hours; most people can get in to see a doctor within a day of calling for an appointment. Taiwan reports some of the highest public satisfaction rates with their healthcare system in the world.

WHY AM I TELLING YOU THIS?

Because people like to characterize progressive policy proposals as “extreme” and “radical” and “expensive.” People like to hold up “incrementalism” as reasonable and being “middle of the road” as somehow virtuous. People like to claim that progressive policies are not “pragmatic.”

But the data tell us that Medicare for All (along with other progressive policies) would NOT be extreme, as universal healthcare plans of some configuration are in place in dozens of countries around the world. And the data tell us that instituting a single-payer healthcare plan would SAVE us money compared to what we are currently spending and projected to spend.

Any incrementalism and halfway measures would mean that millions of people would still be left without healthcare coverage, and that means that tens of thousands of people will continue to die preventable deaths every year and millions of people will continue to suffer financial devastation as they try to pay for exorbitant healthcare costs just so they or someone they love can live. To me, incrementalism and half-measures continue the gross immoralities of our present system; they are neither reasonable nor virtuous.

And I don’t consider any response to a problem to be “pragmatic” if it doesn’t actually solve the problem at hand. Many people like to hold up the ACA as “pragmatic.” But the problems with the US healthcare system remain and, in some areas, are worse (e.g., drug prices have skyrocketed under the ACA). Just because something got passed through our obscenely dysfunctional Congress does not mean it is “pragmatic.”

Next time you hear pundits or political figures painting progressives and progressive policies as “radical” and “extreme,” keep all of this in mind. Question what and how they are trying to get you to think.