On April 18, Senator Jeff Merkley (D-OR) and Senator Chris Murphy (D-CT) introduced the Choose Medicare Act into the U.S. Senate. The bill closely tracks the recommendations made in a January Article by Jacob Hacker and a February proposal by the Center for American Progress (CAP). Both Hacker and the CAP were leading advocates of the public option during the debates that led to the passage of the Affordable Care Act in 2010.
Choose Medicare would improve Medicare with benefits comparable to a current gold plan under the ACA. It would allow people the option of purchasing a Medicare plan on a healthcare exchange and allow employers the option of purchasing a Medicare plan for their employees in lieu of private insurance. It would give Medicare the authority to negotiate prescription prices.
So what’s not to like?
Like Medicare and Social Security, the proposals in the House (HR 676) and Senate (S 1804) for Expanded and Improved Medicare for All are social insurance programs. All Americans would receive comprehensive cradle to grave coverage. Healthcare would be equitably financed through taxes with no significant financial barriers to care.
Choose Medicare, on the other hand, would create a “Medicare Part E” plan that would effectively be a private insurance product purchased in the marketplace. Access would be limited to those who choose to buy it (and can afford to do so) or whose employer deigns to offer it as a benefit. Except for those currently eligible for Medicaid under the ACA, its costs would be fully paid for by premiums--with, as in the ACA, some income-based subsidies-- not public financing. Coverage would be available only so long as you, or your employer, paid for it and beneficiaries would still be responsible for approximately 20% of their total healthcare costs.
There are intrinsic problems when public goods, like healthcare, are treated like commodities. A system designed to accommodate profit seeking and multiple payers can never achieve the efficiencies and cost savings of a social insurance model. Competing health plans with different costs, co-pays and deductibles reinforce inequality and disparity and make a single standard of care unachievable.
Commodified health insurance products generate all kinds of unanticipated consequences including the dreaded “adverse selection” in which decent coverage is undermined by shoddy insurance plans. Continued linkage of health insurance to employment deprives working class Americans of the healthcare security that they want and deserve
Déjà vu All Over Again
There are many good things about the Choose Medicare proposal. If this were the only possible option to improve on our current dysfunctional healthcare system, it might be worth consideration. However this proposal comes at a time when support for Medicare for All has never been stronger. Some states are coming close to enacting Medicare-for-All-style legislation and a powerful grassroots movement is gaining momentum. More and more politicians are jumping on the bandwagon. A pathway to victory is emerging.
Groups close to the Democratic establishment are promoting the Choose Medicare plan. As Bernie Sanders remarked, it “shows that the Democratic Party is moving our way.” However, we’ve gone this way before.
In 2007, as the country faced a massive economic crisis and the American people were demanding a solution to the healthcare crisis, Jacob Hacker released his "Public Option Plan". Declaring that a Medicare for All plan was politically unfeasible, he called for a robust public option using a Medicare-like plan that would effectively compete with private insurance and enroll over 100 million Americans. Political candidates latched on to the concept as an alternative to calling for Medicare for All. Barack Obama incorporated it into his campaign platform and, once elected, repeatedly stated that he would not sign a bill that did not include a public option.
The House ended up passing a version of the Affordable Care Act that included a deeply compromised version of a public option that would have, at best, covered no more than 10 million Americans. Even this modest provision was stripped out of the bill in the Senate and we were left with an Affordable Care Act that gave Americans the right to buy health insurance but fell far short of establishing a right to healthcare.
Nonetheless, nearly all of the original advocates of the public option —even those who argued that it could be a circuitous route to Medicare for All—went along with each compromise and concession until, as Grover Norquist famously declared about other government programs, “…it is so reduced in size that I can drag it into the bathroom and drown it in the bathtub.”
Fight for What You Want. Not What You Think You Can Get.
Nearly all supporters of Choose Medicare (and of the public option before it) would agree that a single payer Medicare for All system would cost less, cover more and deliver better healthcare. But they maintain that Medicare for All is not politically feasible. Their mantra is, “Don’t let the perfect be the enemy of the good.” In effect, they are saying that the power of the Medical Industrial Complex is so great that it can forever stifle the clearly articulated political will of the majority of the American people.
The problem with this, as any shop steward who ever sat across the table from a boss knows, is that when you start negotiating by conceding your opponent’s points, you have nowhere to go but downhill. Frederick Douglass had it right: “Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you will find out the exact measure of injustice and wrong which will be imposed upon them.”
Proponents of this approach believe that clever policy proposals will somehow get us to healthcare for all without the necessity of an all out fight. They are like Douglass’ sunshine soldiers who “want the ocean without the awful roar of its many waters.” But, as economist Gerald Friedman has pointed out, “There is little reason to believe that insurance and pharmaceutical lobbies won’t fight just as hard against the [Medicare Choice] plan, which would undeniably be a disaster for their bottom lines.”
The Pathway to Victory
Medicare for All has won the battle of ideas. Now we have to win the battle against entrenched economic and political power. This fight won’t be made any easier by harboring illusions that we can somehow compromise our way to victory. Every country in the world that recognizes healthcare as a right for all of its citizens did so in response to a powerful working class movement backed by unions and grassroots organizations. The time has come to construct such a movement in the U.S.
“A defensive posture and incremental demands have not worked. Let’s play offense instead,” says Michael Lighty of the National Nurses United. “We don’t need insurance, we need healthcare. This is the strategy that can turn the tide: building a broad movement of workers to demand economic and health justice.”
This June 22-24 at the National Single Payer Strategy Conference in Minneapolis, we will be part of the launch of a new national campaign to win Medicare for All. We won’t be talking about clever policy proposals. We’ll be planning how to build the kind of power necessary to transform American politics and win healthcare for all.
Be part of this historic event. Register today!