At the end of last week, the Wall Street Journal published an editorial designed to terrify anyone who is afraid that a “single-payer” health care system would signal the end of democracy in America. The country is about to be taken over by the “left-wing,” the editorial warned, the same wild-eyed radicals who brought us the 1960s. And what lies at the center of their master-plan? Medicare-for-all.
Since the piece relies so heavily on half-truths and innuendo—particularly with regard to healthcare—I feel obliged to comment.
The editorial, which is titled “A Liberal Supermajority,” begins by declaring that the election is a done deal: “if current polls hold, Barack Obama will win the White House on November 4 and Democrats will consolidate their Congressional majorities, probably with a filibuster-proof Senate or very close to it. Without the ability to filibuster, the Senate would become like the House, able to pass whatever the majority wants.”
“If current polls hold . . .” And, “if current polls” are accurate…
I have lived through enough presidential elections to know that the American electorate cannot be second-guessed. Particularly in an election like this one, when highly charged issues such as loyalty to the nation, religion and race become part of the mix, one cannot assume that what a voter is willing to tell a stranger is necessarily the truth about how she will cast her ballot.
I wonder: does the editorialist hope that some liberal voters might stay at home if an editorial in the august Wall Street Journal announces that the race already is won?
What is certain is that the writer wants to warn conservatives that the
apocalypse draws near: “Though we doubt most Americans realize it,
this would be one of the most profound political and ideological shifts in U.S. history.
Liberals would dominate the entire government in a way they haven’t
since 1965, or 1933. In other words, the election would mark the
restoration of the activist government that fell out of public favor in
the 1970s. If the U.S. really is entering a period of unchecked left-wing ascendancy, Americans at least ought to understand what they will be getting, especially with the media cheering it all on.”
Let’s pause for a minute. Liberals would “dominate the entire
government”? Last time I looked, conservatives seemed to have a firm
hold on the Supreme Court. Isn’t this what they call “checks and
balances?” In fact, wouldn’t the government the writers envisions be
much more balanced than the government we have had for the last eight
years, when conservatives controlled the White House, Congress and the
Court? (You may recall, on one occasion, a conservative Court actually
cast the final vote, electing a conservative president.)
Moreover, the liberals who might well enjoy a majority in 2009 are
quite different from the liberals the editorialist alludes to, who
dominated politics in 1965 or 1933.
The liberals of the mid-Sixties and Thirties were, indeed, “activists.” In both eras, many called themselves “radicals.”
By contrast, the progressives in Congress today are, by and large, “New
Democrats” who have built their base not by appealing to the working
class, unions, and those who live in inner cities, but by shifting
their focus to the suburban middle and upper-middle class. Unlike
their counterparts in the 1960s, these New Democrats are not, by and
large, anti-war. Most thought the Gulf War a good idea. The majority
even went along with the invasion of Iraq. And they are not
enthusiastic about redistributing income.
Nevertheless, the author of “A Liberal Supermajority” predicts that if
this largely centrist coalition is elected to Congress, life as we know
it will forever change:
“Medicare for all. When HillaryCare cratered in 1994, the
Democrats concluded they had overreached, so they carved up the old
agenda into smaller incremental steps, such as Schip for children. A
strongly Democratic Congress is now likely to lay the final flagstones
on the path to government-run health insurance from cradle to grave.
“Mr. Obama wants to build a public insurance program, modeled after
Medicare and open to everyone of any income. According to the Lewin
Group, the gold standard of health policy analysis, the Obama plan
would shift between 32 million and 52 million from private coverage to
the huge new entitlement. Like Medicare or the Canadian system, this would never be repealed.
“The commitments would start slow, so as not to cause immediate alarm. But as U.S. health-care spending flowed into the default government options, taxes would have to rise or services would be rationed, or both. Single payer is the inevitable next step, as Mr. Obama has already said is his ultimate ideal.”
The language reminds me so much of the warnings I heard as a child
about how the Communists were invading America: “slowly, so as not to
cause immediate alarm,” their cells were quietly infiltrating our
neighborhoods. If we weren’t vigilant, before long, they would control
our lives “from cradle to grave.” (Somehow, that phrase makes life
sound brutish and short.) And we would be doomed for eternity:
“Like Medicare or the Canadian system, this would never be repealed.”
Maybe I missed something—but does anyone want Medicare to be repealed?
Do you want to wake up tomorrow and be told, “Sorry, your parents are
now on their own. You better start making plans for their care”?
Moreover, Senator Obama has never said that single-payer is his
ultimate ideal. What he has said that if we were starting all over,
with a blank slate (say in 1776, or maybe even 1933), he never would
have designed anything as insanely complicated as the fragmented,
multi-layered system that we have today. Accidents of history built our
system. Single-payer would be much simpler.
But we’re not looking at a blank slate. Eighty-five percent of
Americans have employer-sponsored insurance, and most think they want
to keep it. This is why Obama’s plan offers them a choice between
sticking with a private sector plan (probably the one they have now),
or choosing a public sector plan that is much like Medicare.
Obama very definitely has not proposed “shifting” 32 million to 52
million American out of private sector plans—which implies that they
will be “shoved” into the public sector. Anyone who moves from a
private sector plan to the government plan will do so voluntarily.
I realize that some readers who favor a single-payer plan will now
assume that I am arguing against it. I am not. As I have stated
repeatedly, I believe that if given a choice, over time the vast
majority of Americans might well choose a government plan over private
insurance, just as people have in Germany, and many other countries.
Ultimately, the government should be able to offer better coverage at a
lower price because it doesn’t have to spend money on advertising,
marketing, lobbying, underwriting, multi-million-dollar executive
salaries, and profits for shareholders.
But if we tell Americans that they must switch to a single-payer plan
today, giving up the insurance they know (or think they know) for an
unknown, I don’t believe that the legislation will ever pass.
Nor does the person who penned this editorial. He or she wrote it
not to give hope to single-payer advocates, but to terrify voters who
now have employer-based insurance. His goal is to persuade them that if
they don’t vote for the conservatives, “the government” will take over
their lives.
Briefly, here are some of the other radical changes that the writer envisions, come the revolution in 2009:
- Union Supremacy ( U.S. workplaces will become union shops.)
- Felons Will Get the Right to Vote
- A major goal of the supermajority left would be to Shut Down Talk Radio.
Does any of this sound likely? Just how would the Left shut down talk
radio? Would this be after they repealed the First Amendment? Don’t you
think the Supreme Court might have something to say? So now we know
that our editorialist is—well, let me put it politely—given to
hyperbolic fantasy.
With that in mind, let’s return to what he has to say about taxes, and payroll taxes to fund Medicare:
“Taxes will rise substantially, the only question being how high. Mr.
Obama would raise the top income, dividend and capital-gains rates for
‘the rich,’ substantially increasing the cost of new investment in the
U.S. More radically, he wants to lift or eliminate the cap on income
subject to payroll taxes that fund Medicare and Social Security.”
Quotation marks around “the rich” imply that Obama will fund the
revolution by hiking taxes on folks who really aren’t that well off.
Here are the facts: Obama’s tax increases would apply only to couples
earning over $250,000 and single individuals earning over $200,000.
Those earning less would not see a tax increase of any kind.
Chartjunk
offers a very helpful chart, drawn to scale, which shows how many
people would be affected. As you can see, Obama’s plan would tax only a
tiny elite at the very, very top of the income ladder. Everyone else
would enjoy a tax cut.
As for raising Medicare taxes, there the Wall Street Journal’s
editorialist is simply wrong. Obama would not “lift or eliminate the
cap on income subject to payroll taxes that fund Medicare” because there is no cap on income subject to Medicare taxes. You pay Medicare taxes on every dollar earned.
There is, however, a cap on the amount of income that is taxed to fund
Social Security. Today, only the first $102,000 of a worker’s income is
subject to the tax. Obama would change that, the Tax Foundation explains—but again only for couples earning over $250,000.
Here is how it would work: everyone would continue paying 12.4 percent
on the first $102,000 of wages (as they do today); then they would pay
0 percent on earnings between $102,000 and $250,000, and 4 percent on
earned income over $250,000.
Finally, the Tax Foundation notes that Obama would eliminate all income taxes for seniors earning less than $50,000 a year.
Does that sound like socialism to you?
I continue to remain confused about the motivations of such writers. Are they totally craven and will say anything just for money? Or are they so ideologically invested in their worldview that they are blind to reality?
It is one thing to be against a policy for philosophical reasons, but if one has to lie about the facts then one’s motives need to be questioned. McCain is still going around saying Obama will raise people’s taxes.
On the positive side there are several strands coming together which may lead to a moderation of runaway health costs. Just to mention two, there are new restrictions on payments to doctors by drug firms.
Psychiatrist Daniel Carlat has some discussions on his blog:
http://carlatpsychiatry.blogspot.com/
Then there was the latest in a series of articles about treatments being judged for effectiveness. This in today’s NY Times:
http://www.nytimes.com/2008/10/27/health/policy/27device.html
This about a breast cancer radiation treatment which has no long-term studies to back its use up.
So, even without major reform, there may be a change in climate that will relieve some of the cost pressures on health care.
Robert–
Good to hear from you.
Having covered Wall Street and worked for Barron’s (which, like the WSJ is owned by Dow Jones) for many years,I have to say that most people who write editorials like this are not craven and are not doing it for the money,
They are just so ideologically invested in the point of view that they are blinded to the facts. Also, Ccnservatives tend to base their writing on ideas, or philosophy, rather than rigorous research into the numbers.
That said, many of the conservatives you see on television (Fox, and many other places) really are doing it for the money. Television pays jouranlists far more money and tends to attract people who are good on camera, whether or not they know, or care, about what they are talking about.
The good news: the climate is changing. Especially in this economic climate, people are more willing to listen to evidence about over-treatment and ineffective care.
Also, “governmetn regulation” and “government helping us” are now, for the first time in a long time, becoming popular ideas.
Maggie,
I think it is very easy for Washington politicians to become intoxicated by power. Whenever one side wins a substantial victory, especially in a presidential election year, there is a strong tendency to overreach. Whether it’s labor unions clamoring for card check legislation to make it much easier to unionize workplaces or trial lawyers seeking broader grounds to bring lawsuits in an already overly litigious society, it is understandable that business groups have some concerns.
Just in my own little corner of the world, I can see how the Sarbanes-Oxley legislation that came out of the Enron and Worldcom scandals has drastically increased both our administrative burden and the claims on our senior managers’ time. Sometimes I think that we’re not in the money management business anymore. Instead, we’re in the business of trying to satisfy auditors despite a more than five decade history of operating with absolute honesty and integrity on behalf of our retirees and current employees.
In recent decades, substantive reform at the federal level usually needs to be bipartisan to pass. One of the best aspects of the Wyden-Bennett healthcare proposal, for example, which has an equal number of Democrat and Republican co-sponsors, is that it gives both sides the core of what they want. Democrats get universal coverage and Republicans get personal responsibility. In 1974, we failed to pass national health insurance because organized labor overreached. It expected a big Democratic win in November of 1974 (which occurred) and it expected to be able to push a single payer system through over President Nixon’s veto. Nixon resigned in August, 1974, a severe recession set in and there was suddenly no money for new entitlement programs. In the end, we wound up with nothing, and 34 years later we still have nothing (or at least very little). Let’s hope the new generation of leaders has learned from the mistakes of the past.
Barry–
You write: “In recent decades, substantive reform at the federal level usually needs to be bipartisan to pass.”
Actually, in the past 8 years, the Republicans in
Congress stood firm, refusing to engage in bipartisan politics.
In response, liberals caved. So liberals supported the ill-advised war in Iraq, the unaffordable tax cuts for the very wealthy, and any number of other consevative bills that, in a truly bi-partisan Congress, would never have pssed. (On global warming,
etc.)
In 2009, if liberals do, indeed, become a majority, they may be equally unwilling to compromise–and for good reason.
We appear to be entering a
recessinon/depression that is going to cause great pain. The people I follow on Wall Street (who write very intelligent investment newsleters) are predciting that the stock marekt won’d bottom until 2011.
Even then, we may see a false bottom, as we did in 1930-31. Then the real pain came-in the second step down.
It’s likely that we’re looking at 10-year period of pain for the economy.
If that happens, I don’t think we’re going to need bipartisan legislation. We’re going to need a new “New Deal” (which was hardly bipartisan.)
I’m late to the party, but appreciate the catch you breath and reality behind the rhetoric approach, Maggie. I ran across the most extraordinary factoid in the Jewish Woen’s Archives website – it was a nurse, Lillian Wald, who as part of her public health advocacy, approached New York Life and established the first health insurance policy. I blogged about her (link at my name) career and activism because she makes the 100 year mark new again. Her agenda and the current health agenda aren’t too dissimilar.
Great post. It’s great to see bloggers covering health care as we approach next week’s election. It is, without a doubt, an important and complex issue. Here at Public Agenda we’ve put together an informative non-partisan guide that focuses on the facts and on the plethora of perspectives surrounding the health care debate in America. Be sure to check it out at http://publicagenda.org/citizen/electionguides/healthcare and feel free to contact us with any questions.
The worst thing that could happen to Obama would be a veto proof Senate.
In that case Congress could swing way, way left and Obama could do little but watch.
Single payer is not out of the question at that point.
From the operations viewpoint, none of the reformers, left or right, have any idea what their plans would do to providers short run or long run.
Great opportunity to enhance my consulting income.
The worst thing that could happen to Obama would be a veto proof Senate.
In that case Congress could swing way, way left and Obama could do little but watch.
Single payer is not out of the question at that point.
From the operations viewpoint, none of the reformers, left or right, have any idea what their plans would do to providers short run or long run.
Great opportunity to enhance my consulting income.
Rustbelt, Annie, and Billy,
Thanks for your comments.
Rustbelt–
I don’t think that even a left-leaning Congress would vote for single-payer. Lefties in Congress might well favor it (all 7 of them), but they know that the people who vote for them do not want to be told that they have to give up the employer-sponsored insurance they have.
And if we have single-payer, but don’t herd everyone into it, it will wind up being primarily people who are now uninsured or very, very underinsured–i.e. the poor, and the sick.
That would make single-payer unaffordable.
Also, I don’t know who you think will be elected that will create a critical mass of lefties on the Hill. Seriously, give me names. Right now I
can count them on my fingers–without using my toes . . Dennis K. . . many in the the Black Caucus . . . and ???
Annie- thanks for the kind words.
Your piece on Wald is very interesting. I urge everyone to click on “Annie” to read it.
Billy– thank you. Your site seems to do a good job of clarifying the opposing points of view . . .
“According to the Lewin Group, the gold standard of health policy analysis, the Obama plan would shift between 32 million and 52 million from private coverage to the huge new entitlement.”
The Lewin Group was recently purchased by Ingenix, which is a subsidiary of United Health Group, our nation’s (and therefore the world’s) largest profit-driven health insurer.
More later.
B.Spoon–
Thanks very, very much for the head’s up on the Lewin Group.
For the past year, I’ve been questioning the Lewin Group’s numbers–and wondering what was going on.
But others kept saying it ws an unbiased, gold-standard for analysis.
Maybe he Lwsin Group was jsut that at one time- but obviously not now. Probably the internal change happened over a peiod of time–which explains the dubious numbers I have been seeing over the psst year.
The sky may not be falling, but certainly the value of the US dollar has.
And what of skyrocketing health care costs and projected insolvency of Medicare by 2019? Then what would become of ‘Medicare for All’?
And what about lowering health care costs by integrating wellness and prevention into mainstream medicine?
My greatest concern about single payer is the potential complete elimination of Health Freedom for millions of Americans who depend on natural health products and services either alone or in conjunction with mainstream medicine. That includes millions of hardworking taxpayers of all ages. And if we lose Health Freedom, the sky may as well be falling.
Dr. Mary–
Thanks for your comment.
See my recent post on
what drives sky-rocketing health care spending– cutting edge cutting edge technologies.
We need to measure the effectivness of these technologies before assimilating them and using them on broad technologies
I see no reason that alternative treatments cannot be included in a nattional health insurance program. I would just say that they, like any other treatments, need to be able to show that they are effecstive for some, if not all patients.
For instance, is acupuncture still considered an
“alternative treatment”?
Certainly, there is enough evidence at this point to show that it works.
I would think this also would be try of other natural treatments.
The main thing is that we have to take these decisions away from parties that have a financial interset in outcomes, and make them based on unbiased research done by people with no financial or ideological stake.
Single-payer is inevitable
Maggie Mahar, responding to a recent WSJ editorial, tries to soften the blow and calm fears of a government takeover of health care.
The best solution will be the result of compromise. It will also involve a commission created to address the drivers of our high costs. That commission will need to be made up of physicians, healthcare administrators, patients, insurance company administrators, employers, and public policy experts. Without a diverse team like that, we will be left with an incomplete solution.
Your post is fairly biased as well, although in the opposite direction. Of course a big Obama win would give much more power to the Democratic party than the Republicans had — the Republicans never got 60 senate seats.
If Obama has a filibuster proof majority then his agenda will pass in a way Bush never came close to and failing to recognize that is just being disingenuous. As is the “aw, shucks” routine about how making Medicare available for all just.. might.. cause tens of millions of Americans to switch to it. Must be because Medicare is such a great government program that we’ll all want it once we have a chance to try it!
It’s surely not because Medicare is unsustainable and is currently promising a completely unrealistic set of benefits for what it costs. It’s like Congress passing a law specifying Magic Government Insurance that costs $1 and covers everything — look, everyone switched to it. Guess they hated BC/BS after all! Oh wait, now the government is on the hook for a few trillion. Guess we’ll just have to raise taxes… on the less than 50% of Americans who will actually pay taxes under Obama.
Alex–
Before stating that Medicare is unsustainable, I suggest you do some reserach.
Read the Medicare Payment Advisory Commissoins March 2008 and June 2008 reports which discuss, in detail, the many ways that Medicare can be sustainable.
That’s roughly 700 pages or reading–so you’ll learn a lot. (I’ve read both reports a couple of times).
As for whether the Bush administration pushed its agenda through Congress:
Even though Republicans didn’t have sixty votes, we are in Iraq. (In that case, of course, they used a Big Lie
to win.)
Without 60 votes they passed the Medicare Modernization Act in the middle of the night. (The Senate Ethics committee later confirmed that one legilslator was bribed to vote the administratoin’s way at a crucial moment.)
Everyone knew the bill was simply corporate welfare for insurers and drugmakers (that’s why John McCain voted against it.)
The Bush administration also managed to push through tax cuts for the wealthy that we cannot afford.
Progressives didn’t win a single major vote–until last summer, when they voted against Medicare Advantage.
So, even without major reform, there may be a change in climate that will relieve some of the cost pressures on health care.