Yes to Medicare for All

I was really tempted to just write "Medicare for all" over and over again for this issue, but I did have something more I wanted to say. Ultimately I will fall in line on whatever Medicare for all proposal the progressive caucus decides to support in 2027; we won't see eye to eye on some other economic policy areas but on this one they are just 100% in the right.

Costs are out of control

The morning my mom died, I woke up hearing her wheezing but trying to hide it to not wake up my father beside her. The night before, she had refused to eat, she said because of an upset stomach from chemotherapy. I was in college on practically a full-ride, but living at home because it seemed like my Mom may not make it. I just cannot shake the feeling she might have wanted to die to take the financial pressure off my family. It was barely a few days later when it was clear that financial pressure had totally lifted. My Dad made an off-handed remark about how strange it was that life insurance and social security money was flooding in when it would have been so much more helpful had it come just a week before.

I am still painfully aware that medical bankruptcy is the most common form of bankruptcy in America. We pay on average $13,432 per person for healthcare while comparable countries average $7,393. The next closest country to us is still only $9,688. Global Pharmaceutical companies get 75% of their profits from just our country; triple the rest of the world combined. We overpay on overpaying for medicine.

What other countries have figured out that we haven't is that this is fundamental to our private healthcare system. In a typical industry, demand is more elastic than supply; meaning its more sensitive to prices and goes up and down more quickly. That's not true in healthcare, most demand only goes down because people literally can't afford to pay the high prices. The market dynamic is supposed to discourage unneeded healthcare like optional screenings, not to cut off poor people from access to medicine. But functionally unlimited demand means prices will be as high as we allow these companies to extract.

What healthcare system should we adopt?

At this point I will take any model from any of the other developed countries on par with our wealth. If it were up to me, I would probably pick the German system with statutory health insurance that everyone is automatically enrolled in but you can opt out if you buy high class private insurance instead. It's a little on the expensive side but still 33% less than ours, and they actually have lower wait times! Technically, this is not a single payer socialized system, which I think Americans would find easier to accept, but 90% of Germany uses the government offered insurance because private can't offer a better deal. Just like medicare and medicaid have far lower admin costs than private healthcare, government plans in other countries are also just cheaper and yet get better results than we do.

So just offer government insurance already! I'm not even coming from an ideological capitalism/socialism stance on this issue: the global evidence is just abundantly clear that our way of doing medicine is outdated and wildly inefficient by comparison. Any government sponsored system is better than this system, and yet even the most limited public option couldn't pass when I was young in 2010. We're using more caution in creating price limits on insulin and other drugs than creating AI or restarting nuclear bomb testing. It is by far the most incompetent thing our country still does is tinker around the edges of this system instead of just building a one based on well-proven modern practices from the rest of the world. It's like we're riding in horse-drawn carts and yelling at other countries with cars that internal combustion leads to tyranny.

The key battle that we need to anticipate

I think its very likely that we will be able to pass modernized healthcare should democrats ever regain control of the congress and presidency. The Overton window on healthcare has shifted so much since 2010 that I believe a public option will pass through a Democratic congress today. I want to focus on a key under-discussed point: what your company spends on your healthcare now is considered part of your compensation package. If the US passes medicare for all, that spending should not go back into the company's pocket: it belongs to you the workers. They report how much they spend on your healthcare already; the government should make sure that money goes into workers' pockets if medicine is socialized.

Corporations are going to viciously fight against that. It is such a huge amount of money in a one time raise that there will be massive investor pressure to take as big a slice of that pie as possible. Because of the lack of labor power in this country, it will be up to the government to pre-empt that move. We have to aggressively write enforcement into the law that stops what would otherwise be an historic level of wage theft. That would be the piece of the healthcare law I would aggressively fight for when it becomes possible to pass it.