In Order To Keep Private Insurance Companies, Medicare For All Would Have To Kinda Suck
I almost felt a little bad for the gang at CNN last night. They spent the debates looking for a hero, a "moderate" Democrat who would be able to successfully convince voters that the progressives were "going TOO FAR." Someone who could be their new Joe Biden, but with less awkward baggage and more ability to carry themselves in a debate. Someone who could be the Elizabeth Warren of convincing people that not actually doing or changing anything but generally having a more pleasant demeanor than Donald Trump is the way to go. They tried so damn hard, and they ended up with this bloody mess.
The funny thing about this liberal media of ours is that you never see any of these interviewers breathlessly asking Republicans if they are afraid that their extreme views and policies will "scare" voters. Republicans don't have to care. As Pete Buttigieg pointed out last night, Republicans are allowed to be as ambitious as they like with their shit, which is actually terrifying and which will actually hurt people, but Democrats are supposed to walk on eggshells with things that will actually help people. Democratic candidates are supposed to act as if they know that liberal policies are a thing no one actually wants, like they are vegetables that have to be disguised as vegetti in order to get anyone to swallow them. This is a terrible marketing strategy. Part of the reason why I love Elizabeth Warren is because she does not play that game.
It seems other people like that, too, because as hard as the CNN gang tried to do the whole "OOH! These kinds of policies just won't go over in the heartland!" with Warren and Sanders all evening, when they turned to their panel of Iowa voters, all of them except one said that Warren won. Whoops! Guess those of us who happen to live in the middle of the country are not quite as backwards as these anchors seem to think we are.
One of the angles that the panel spent a lot of time in particular swooning over was Tim Ryan's bit about how we need to keep private insurance companies because unions negotiated for private health insurance plans and it's unfair to take those away from them. Finally! A way of attacking Medicare for All from the "left!" You guys like unions, right? You don't want to do anything that would hurt the unions, do you?
Now look. I get it. In order to get these health insurance plans, unions have often had to give something else up in terms of compensation. We need to make sure that all companies are required to adjust their worker's compensation accordingly. That is important. What this person said:
But if we have a single-payer system where everything is covered, for everyone, what is it that will be left for private insurance companies to cover? What is it that they will be doing? What? We're going to have everything covered for everyone and people are just gonna pay private insurance companies a huge amount of money, or a chunk of their compensation, each month, simply for the delightful privilege of doing so?
Medicare For All isn't designed to work like a traditional "insurance plan." The way it is supposed to work is that if you go to the doctor or you go into the hospital, your treatment is taken care of and then the government is billed and then you never have to think of it again. Just like in Canada! There's no endless paperwork and negotiating back and forth about what they will cover and what they won't cover (which, by the way, is a thing that will reduce a lot of hospital costs and is a big reason why M4A will be far less expensive than private insurance. If they still have that paperwork to do, someone has to pay for it and that someone is you, the consumer). A public option type system will work like a traditional insurance plan, but just through the government. It will cost about as much money as Medicare For All, but we will get less in exchange.
The fact is, the only way for this system to actually work and be the best it can be is if everyone has to use it. If everyone has to use it, then doctors can't say "Oh, sorry, we only take private insurance." If everyone has to use it, including rich people, those rich people will use their power to make sure that the system is good and that it works.
Now, it's true — while a majority of Americans support Medicare For All, that support drops off when they hear that there won't be any more private insurance companies. People who oppose single payer love that line. They love getting to say, "Oh! But my goodness! These people are so madly in love with their insurance companies and you're just going to take that away from them?"
But guess what? When you tell them that they'll still be able to keep their preferred providers, it goes right back up. They're not in love with their insurance companies, they like their providers. That is what they are afraid of losing. No one is dying to pay more than they need to for healthcare so that someone else can make a profit off of them. No one is dying to worry about whether or not what they need done will be covered. They are worried that they will not continue to get the same level of care they are getting now. The problem is that if you do not eliminate the private insurance companies, they won't.
"But Obama told me that if I liked my plan I could keep my plan and that turned out not to be true, so..." Yeah, and do you know why that is? INSURANCE COMPANIES. The problem with Obamacare is that the insurance companies were at the table when it was being written. The job of insurance companies is to turn a profit. The way they make that profit is by telling you "no."
You know how we all roll our eyes at Republicans saying that they can keep the requirement that insurance companies cover people with pre-existing conditions without a mandate? Because we, the fabulous intellectuals, understand that if there is not a mandate, people will just sign up for insurance when they have a serious problem rather than paying into it all along, and that this will tank the entire system? Yeah. This is the same deal with trying to have Medicare For All and also private insurance. The whole point of Medicare For All is that it is less expensive than private insurance and the very existence of private insurance is what makes things more expensive than they have to be, across the board.
Keeping private insurance means that we don't have the same leverage to negotiate prices with pharmaceutical companies, doctors and hospitals that we would have if the country were on one big insurance plan. It means that we all still have to pay for the overhead costs of paperwork for different insurance companies, plus whatever public option type thing there will be. It means that doctors and hospitals can't be required to take it. It means that powerful insurance companies will lobby to make sure that Medicare For All can't cover everything, can't negotiate drug prices at a lower cost than they are able to. In order to have both, in order for there to be room for these private insurance companies, Medicare for All would have to kind of suck. It would have to be exactly the kind of "government program" that these people are dreading it will be.
If we are all going to have our tax money going to a program like this, it needs to be a program that will actually work, that will actually cover everything, where you can just go to the doctor for whatever you need and then never think about it again. Otherwise we are just wasting a bunch of money for almost no reason.
It's not that those of us who support Medicare For All want to eliminate private insurance companies because we are crazy socialists who want to take private insurance away from people who love private insurance and just want to ruin their day. We want to do that because we understand that this is actually the only way it can work, and the only way it can be less expensive than our current system. We are being pragmatic, frankly. The wide-eyed idealists here are the ones who think you can have both.
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Robyn Pennacchia is a brilliant, fabulously talented and visually stunning angel of a human being, who shrugged off what she is pretty sure would have been a Tony Award-winning career in musical theater in order to write about stuff on the internet. In addition to her work at Wonkette, she also has a biweekly column at Dame. Follow her on Twitter at @RobynElyse