Medicare For All Is Coming, No Matter What They Say

From Our Future

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The idea of Medicare for All, or single-payer health care, has grown in popularity so quickly that it was recently an answer on the quiz show Jeopardy.

More than half of all Americans, 53 percent, now want a single-payer plan, up from 40 percent in 1998-2000.

But at the same time, Medicare for All suffers from the rise of a new growth industry: telling Americans what can't be done to make their lives better. It seems like the nation that used to pride itself on its "can-do" spirit is constantly being told, "No, we can't." Why do critics oppose this idea, which could improve the lives of so many?

Bernie Sanders' presidential candidacy injected the single-payer idea into the political discourse. That created an opening for Democrats to embrace the idea as they seek to oppose Republican efforts to dismantle Obamacare. These include, significantly, Sen. Elizabeth Warren of Massachusetts.

"President Obama tried to move us forward with health care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts," Warren recently said. "Now it's time for the next step. And the next step is single-payer."

Yet, even as the idea grows in popularity, opposition to it has become more vocal. Much of that opposition adopts the world-weary pose of the seasoned professional who has abandoned the idealism of his youth and is regrettably forced pass his disillusionment on to those who are more naà ¯ve.

One example of this world-weary opposition is a 2016 column by economist Paul Krugman column entitled "Health Reform Realities." Krugman argues that Obamacare is the left's "biggest political success in almost half a century," that "incumbent players" like insurance companies are "too powerful," that there would be disruption in a switch to single-payer (more about that shortly), and that it would be "difficult to make that case to the broad public" that they will save more money from out-of-pocket health costs than they will spend in new taxes.

Krugman reiterates this argument in a recent op-ed, writing: "Most of the health economists I know would love to see single-payer -- Medicare for all. Realistically, however, that's too heavy a lift for the time being."

Elsewhere, Krugman approvingly quoted Ezra Klein, another healthcare "realist," for dismissing a major overhaul of the health system as "puppies and rainbows." Condescending phrases like that are a key element of the "world-weary" style.

Krugman argues that Medicare For All is politically unachievable, despite its growing popularity. But when he's confronted with a real political problem -- Republican governors' unwillingness to work with Obamacare's Medicaid provisions -- he waves the problem away, saying only that "Republicans show no interest in making that happen."

A health plan whose ultimate success relies on cooperation from Republican politicians and for-profit insurance companies? Now that's "puppies and rainbows."

But then, Krugman has been misjudging the politics of healthcare for at least a decade now. In the 2007 primaries, a mandate-driven plan much like "Obamacare" was proposed by John Edwards and quickly embraced by Hillary Clinton. Krugman insisted on characterizing it as "universal health coverage." We chided him for it at the time, since it was always clear (or should have been) that many people would remain uninsured under such a program.

Krugman also misinterpreted a 2009 poll somewhat. The poll, conducted by the Boston Globe and the Harvard School for Public Health, found that 79 percent of Massachusetts residents wanted to keep the law. A closer reading indicated the political dangers facing Obamacare. Support for the law had begun to slip, even without the Republican onslaught that everyone should have seen coming at the national level. Residents were "evenly split" on whether the law could continue without changes. A majority wanted to see the law changed, with cost reductions being the primary concern.

Health care costs, even after the Affordable Care Act, are at crisis levels. The actuarial firm Milliman calculates that the average family of four with "good" employer-based PPO coverage will pay more than $11,000 in out-of-pocket expenses this year. So when Krugman writes that "most Americans under 65 are covered by their employers and are reasonably happy with that coverage," and that "they would understandably be nervous about any proposal to replace that coverage with something else" -- well, I wouldn't be so sure about that.

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