Politics, Moderate



Sanderscare is all cheap politics and magic math

Catherine Rampell on

Even as Republicans attempt to rip health insurance away from millions, single-payer has become astonishingly popular -- among the public generally and Democrats in particular. A June Pew Research Center survey found that a slim majority of Democrats say health insurance should be provided through a single national insurance system run by the government. Among Democrats under 30, the share was two-thirds.

And why not? Single-payer certainly sounds far simpler, fairer, less wasteful and cheaper than the patchwork of private and public insurers and providers we have today. Today's system was created more by historical accident than deliberate design. President Barack Obama said many times that if we were building a health-care system from scratch, we'd probably concoct something that falls under the broad category of "single-payer."

But we're not starting from scratch. We live in our patchwork world, which means if we want single-payer -- an ill-defined catchall, by the way -- we need to figure out how to get from here to there. This involves painful political choices, sharp tax hikes and some degree of buy-in from the many stakeholders who are going to get shafted in the transition.

What about the 178 million people who currently have employer-sponsored health insurance and overwhelmingly like it? What about the sticker shock awaiting individuals and employers over the tax increases necessary to pay for such a program? What happens if hospitals go bankrupt because Medicare reimburses at much lower rates than private insurance? Would the government step in and run them, as is the case in Britain?

And most important, how do you actually pay for this enormous, multi-trillion-dollar overhaul? (Is Mexico paying?) Given Americans' allergy to higher taxes, it's not enough to dismiss fiscal concerns by assuming Americans will gladly give Uncle Sam the money they currently earmark for a private health insurance system.

On this and other major questions, the Sanders plan punts. Anyone who asks such questions, or raises an eyebrow at the lowball estimates cooked up by the Sanders camp, gets branded a wet blanket, a heartless technocrat, a corporate shill or worse.

The goal should be universal health care, however we get there. And we're much likelier to get there if we start from a baseline of reality than if both parties hand-wave away inconvenient truths. There is no courage in saying everyone should have health care. The courage is in staking out a plan to pay for it.

One of the things about representative democracy is that you need the people's representatives to actually work out the details. On this aim, both parties are barreling toward failure. Democrats learned in 2016 that they needed a message and not just a slate of policies; now with unified government power, Republicans are learning in 2017 that they need a slate of fleshed-out policies and not just a catchy message.

Someday, maybe one of these parties will decide to invest in both.

(c) 2017, Washington Post Writers Group



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