Medicare for All

Top Pelosi Aide Tells Insurance Industry Medicare for All Would Be Costly, Politically Perilous, and Difficult To Implement

He's right.



In December, a senior policy aide to House Speaker Nancy Pelosi gave a presentation to insurance industry representatives telling them not to worry about Medicare for All.

The presentation, reported by The Intercept, outlined a number of problems for single-payer health care, including "cost," "implementation challenges," the existence of other spending priorities, the creation of winners and losers, and stakeholder—which is to say, health care industry—opposition. It's a telling sign of how divided Democrats remain on the issue, and a preview of the looming intra-party war over single payer.

Looked at one way, Democrats are moving quickly to embrace single-payer health care. Much of the party's 2020 field has embraced the idea, and Sen. Kamala Harris (D-Calif.), whose campaign rollout last month probably received more attention than any of her competitors, has gone so far as to defend the idea that today's private insurance market should be eliminated, which is essentially what the Medicare for All plan put forth by Sen. Bernie Sanders (I-Vt.) calls for.

But although many of the party's rising stars are rushing towards the idea, the old guard is hanging back, and acknowledging some of the difficulties of the project. After Harris' remarks on Medicare for All last week, for example, Sen. Dick Durbin (D-Ill.), who ranks second in Senate Democrats' leadership, offered a more skeptical assessment, saying, "It would take a mighty transition to move from where we are to that." Other Democrats, including Harris' fellow Democratic senator from California, Dianne Feinstein, responded similarly.

Although the Pelosi aide's insurance industry presentation predated Harris' remarks, it's really just a more detailed version of the same set of objections, which is that Medicare for All, as envisioned by Sanders, would be expensive, difficult, and disruptive. The presentation urged a focus on other issues—defending Obamacare, lowering drug costs, slowing the growth of health care spending, and pushing towards universal coverage via the system that is already in place. It was a brief for liberal incrementalism of the kind that supporters of Sanders-style Medicare for All reject.

Blue Cross Blue Shield, the insurer reportedly present at the meeting, would neither confirm nor deny that the presentation happened, but there's little reason to doubt the story. Not only did The Intercept publish a reproduction of the slide show that accompanied the presentation, it's essentially what Pelosi herself has been saying in public for years. In 2017, as the story notes, Pelosi warned that the public didn't like the idea of single-payer, and that it is difficult to implement if you're not starting from scratch. "This is an idea that if we had a tabula rasa, if we were just starting clean, would be the most cost-effective way to go forward. We don't have that," Pelosi said in an interview with Joy Reid. "Over 120 or 150 million people in our country have employer-based access to their health coverage and insurance."

Which is another way of saying that Pelosi saw, and probably still sees, value in defending the false but politically necessary proposition that President Obama relied on to sell the Affordable Care Act: If you like your plan, you can keep your plan. Harris, Sanders, and other proponents of Medicare for All in its strongest form do not.

This is the conflict that will define not only America's health care debates in the coming years, but much of Democratic Party politics, which has been pulled further and further to the left, and which has elevated health care to the top of the priority list. And while the party's radicals will no doubt continue to sing the praises of disruptive single-payer plans (an aide to Rep. Alexandria Ocasio-Cortez (D-N.Y.) tweeted last week that the elimination of private insurance was a "feature, not a bug"), I expect that the party's more seasoned political strategists will be more hesitant, if not directly opposed.

In the end, that will probably mean embracing the label of Medicare for All, but applying it to something less than full-on single-payer—a Medicare buy-in proposal, or a public option (an insurance plan run by the federal government), which is, notably, what Durbin suggested last week when responding to Harris. Indeed, the specific policy meaning of Medicare for All has already become somewhat ambiguous, with some, like Sanders, using it to denote single-payer, and others repurposing it to describe lesser forms of government-driven coverage expansions. So while Medicare for All will probably win out in the Democratic party as a slogan, I suspect it will not be as the strict single-payer system that Bernie Sanders and his fellow socialists imagine.

Progressives no doubt bristle at finding Democratic leadership making essentially the same criticisms of single-payer that critics on the right have made for years—that the legislative price tag would be too high, that it's too disruptive and too politically risky. But the problem for Medicare for All boosters is that for all their enthusiasm, virtually all of the evidence suggests these criticisms are right.

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  1. Children can afford anything when their parents are paying the bills.

  2. Honestly I'm so glad Democrats are back in control of the House that I don't really care what they do with respect to health insurance or Medicare for All or whatever. As long as they #Impeach when Mueller submits his final report.

  3. You know things have gotten weird when Nancy Pelosi is the voice of reason

    1. Blind squirrel finds a nut once in a while.
      Speaking of nuts...

    2. More accurately, she is the voice of corruption. The notion that insurance is playing a central role in anything is laughable (they don't actually pay and they don't get operated on and they don't do the operating) - except that insurance is a major donor group in that industry.

  4. Even if you were willing to entertain the idea of Medicare for All, the final product would probably look a lot different than the proponents imagine.

    Most of the proponents compare the US system to foreign systems that are vastly different-- usually with doctor's on a public payroll making much less than they do in the US.

    The US system probably couldn't take the shock of reordering such a huge segment of the economy to make Medicare for All work.

    But for the record, even as a libertarian I'm willing to discuss Medicare for All, but it's going to come with Doctors, nurses and other practitioners becoming federal employees on a standard GS scale.

    Also, like the NHS, people should be allowed to seek private care outside the system, and that can even be a perk of employment.

    1. Doctors from the Canadian province of Quebec have shocked the world by turning down a pay rise.

      And when I lived there from 2011-2014, there was a doctor shortage. Unrelated, I'm sure.

      1. I'm not even saying Medicare for All would work or even work well, or not end up with the obvious and time-tested results of all top-down controlled markets with price controls. Shortages will abound as they always do. But we can't have the smorgasbord, all-you-can-eat, see-a-doctor-instantly system we have now coupled with Medicare for All.

        If you want a healthcare system like Canada's or the UK, it's going to LOOK like Canada's or the UK's. And by the way, I travel to Canada a lot on business and the locals bitch non-stop about their healthcare system.

        1. My interactions with it were somewhat limited - I had to go to the clinic a few times for non-emergencies. I showed up early to get a place in line, still waited for an hour or more, saw an unhappy doctor for a few minutes, got what I needed, and went on my way. I have a much, much better experience with my doctor here in the States. It's night and day.

          But, Canada was free at the point of service (and my tax contribution was small). I have a high deductible plan now (but still with pretty high premiums), so I end up paying more in the States. That's the trade-off. Given the option I'd go off the board and choose C.

    2. The US system probably couldn't take the shock of reordering such a huge segment of the economy to make Medicare for All work.

      Any drop in healthcare spending back to, say, 1980s levels would immediately result in a recession. No politician wants to be in office when that happens.

      Kamala Harris basically gave the game away when she admitted that the only way to make it "work" is to outlaw private health insurance entirely. Even the most ardent existing socialist healthcare plans in other countries don't go that far.

      1. Welllll, Canada's system barred people from seeking private care, hence the controversy about ten years ago when the Supreme Court found the Canadian government in violation for not providing adequate care. This was after it was discovered the public officials were quietly slipping across the US border to get healthcare.

    3. Also, like the NHS, people should be allowed to seek private care outside the system, and that can even be a perk of employment.

      Charlie Gard, a rebuttal?

      Charlie? You there? Hello?

    4. Agree. It will come via some sort of govt HMO-type provider network. Not sure it would actually be federal. Every state has municipal hospitals, university hospitals, and non-profits that would join that provider network at the local level and those are the vast majority of hospitals in every state x FL, NV, TN, TX (those four are 40-50% for-profit now). Locals and feds would split operational roles (presumably in the stupidest most corrupt way possible)

      One thing is for sure though - Over 120 or 150 million people in our country have employer-based access to their health coverage and insurance. This particular barrier to change will disappear in the next recession and most employers would freaking love to get rid of this shit now. Course employers don't vote - employees do. And employers aren't going to help govt actually sell any change.

  5. Honest question - are people currently on Medicare actually satisfied with it?

    At any rate, a government run option seems like a guarantee if the Democrats take control in 2020.

    1. No. Far from it.

      I'm of the belief that "Medicare for all" means "free health care of your choice" to its supporters.
      But Medicare is expensive (there's a monthly premium), it has high deductibles, it pretty much requires secondary coverage (whether for prescriptions or hospitalization), it limits services, and it *forbids* service providers from negotiating anything at all. So, once you're on Medicare, you can't take advantage of programs such as those offered by Kroger, Walgreens, CVS, et. al. *Everybody* on Medicare pays the Medicare price. It is a one-size-fits-none program that sucks.
      Only those at a distance from it, those entertaining fantasies of 'free unlimited care', could find attractive.

      1. I think my parents are averaging two doctor visits a week each, so it can't be all bad.

  6. More confirmation to me that the Dems have given up on 2020, that the stalwarts know the current crop of contenders are all completely unpredictable in the primaries, non-starters in the general election, and that they intend to let the children run rampant and let off steam for 2020 while the parents regroup for 2024.

    But 2024 makes me wonder what the Dem leaders actually think they will have to do. Become populists? Embrace free trade and troop withdrawals? They must have noticed by now that simply trying to out-war the chicken hawks is pointless and that Trump gets kudos for withdrawing troops and winding down wars. Similarly, tariffs are not popular among the riff-raff.

    Gonna be lots of popcorn sales over the next few years.

    1. It occurs to me that all the backlash over paying for Medicare-for-all and single payer whatsit might also inspire a new financial saneness (relatively speaking!) among the Dem leadership, primarily to make room for all the politically correct spending they see coming down the line, but also to recast themselves as fiscally responsible, to differentiate themselves from Trump and Republicans, who will have had 8 years of increasing deficits by 2024.

      Of course, Trump could use a second term to cut back spending and derail that Dem plan. He's too unpredictable to rule that out.

    2. More confirmation to me that the Dems have given up on 2020

      What? After the #BlueTsunami the Democrats look stronger than ever. And with the exception of the awful Tulsi Gabbard, their Presidential contenders are especially appealing. Harris, Warren, Gillibrand, Beto, Sanders ? any of them will easily beat any Republican in 2020.

      1. Trump ain't a Republican any more than Bernie Sanders is a Democrat.

        1. I think you know what I mean. Whoever gets the Democratic Presidential nomination in 2020 is guaranteed to beat whoever gets the Republican nomination.

          1. I know you meant to use "whomever" vice "whoever", but I doubt that was part of your parody.

          2. OpenBordersSocialist: "I think"

            I have seen no evidence that you even CAN think. But, if you want to give it a try I will be happy to watch and hope for the best.

  7. Medicare for All Would Be Costly, Politically Perilous, and Difficult To Implement?
    That can't be right.
    Alexandria Ocasio-Cortez and Comrade Bernie Saunders never told us about the cost of medicare for all, and I'm sure they would've brought that up at some point.
    I'm sure both Saunders and AOC would inform us quite correctly that medicare for all would be free.
    After all, I'm sure all the doctors, nurses, and other medical staff would work for free for this most noble cause just like college professors would work for free at the local re-education camps, restaurant workers would work for free to feed the masses, welders would work for free, bus drivers would work for free, etc.
    Everything would be free according to socialists like AOC and Comrade Bernie, and when have they ever been wrong?

    1. Trump is going to hang his whole re-election on that "socialist" word. Anyone who doesn't vote for him will be labelled a "socialist". If you don't vote for him, we're going to turn into Venezuela in less than 4 years, right?

      1. Anyone who doesn't vote for him will be labelled a "socialist"

        If he does, he will be correct about 80% of the time.

  8. How come nobody ever brings up that people on Medicare require supplemental insurance? Seems like an appropriate end on any argument for it. "Hey, it will double your taxes and the deficit, and you will still need to speed just as much on insurance. But at least you get to meet lots of nice people while waiting days on end to see your doctor. Your welcome, -big government."

    1. ""How come nobody ever brings up that people on Medicare require supplemental insurance?"'

      It's brought up frequently. Don't expect the proponents to bring it up though. They are not interested in the reality of it.

  9. Long before Haight-Ashbury turned on, bummers were Union soldiers who fanned out of Sherman's March to Altanta and raided Confederate farms for everything edible as forage for the troops. Bummer Care is another such locust-swarm parasitism at gunpoint, and the best reason invented for living outside of these Sovereign States and Dominions since alcohol became a crime in June of 1919. Some 20,000 Americans lived around Paris until the Republican Crash and Depression made even that unaffordable.

    1. "Some 20,000 Americans lived around Paris until the Republican Crash and Depression made even that unaffordable."

      Since i was interested in this, I studied it. The crash and the banking crisis were primarily driven by the failure of international loans .. the majority of which were to Germany because they were willing to borrow at high rates. The default on those loans ... mostly by large NY banks based on money loaned to them from smaller banks all across the country triggered the crisis. Most banks lost most of their reserved since they were allowed to loan them to other banks and still consider them reserves.

  10. Medicare for all is basically just like Obama care, a lazy attempt to fix the health care problem that actually just makes it worse.

    They need to completely destroy and rebuild the health care industry to something like Canada or the UK, but that's not going to happen.

  11. So, you're telling me that "Medicare for All" is unaffordable?


  12. Medicare for all? All I ever wanted from Medicare and SS for that matter was the freedom to say no thank you I'll take care of myself. Stole my freedom and got garbage in return. Those native Americans did much better getting some beads for Manhattan

  13. As dumb as the whole thing is, if we were to make a deal with the devil, it could work.

    The deal should be MASSIVE deregulation of the free market healthcare system in the USA. I mean like removing almost ALL regulations of any type. Then offer some BS government buy in crap for poor people to make the commies happy.

    Once the free market was freed it would kick so much ass, basically nobody would ever use the government shit program, and it would prove that the market is far better. Such a deal would probably end up saving people a ton of money on net. One MIGHT be able to do this by offering up the shit government plan to cover everybody, and lord knows we'll never see serious deregulation unless we can "guarantee" all the poor people won't get screwed. But with that system we might be able to swing it.

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