Bernie Sanders takes part in a rally.
Vermont Senator Bernie Sanders’s Medicare-for-All plan was already bold. It just got even bolder.
Sanders, an early front-runner for the 2020 Democratic presidential nomination, had initially called for phasing out America’s employer-based insurance system in favor of universal government coverage that’s free for patients (that is, outside of the higher taxes they’d pay to finance it).
On Wednesday, he released a more ambitious version that includes coverage for long-term care. It addresses a significant gap in the current system and source of financial hardship for many – but also adds to an already high price tag.
Four of his competitors in the Democratic primary – Cory Booker, Elizabeth Warren, Kirsten Gillibrand and Kamala Harris – are co-sponsors, which might suggest that a once fringe position is becoming mainstream. It’s more complicated than that. All four of those candidates support contradictory plans or have made statements that suggest that they may favor less ambitious approaches. As Sanders’s bill gets more generous, there are powerful forces pulling his competitors and the Democratic party in the other direction.
There’s a potent policy case for radical thinking. The current system is a mess; Americans spend more on health care than any other nation, often with worse results.
And the system is badly fragmented: Health status and outcomes vary wildly based on race, geography, and income. Millions still lack coverage and medical expenses spur many bankruptcies, even with more robust protections created by the Affordable Care Act.
A single government payer has the potential to be more equitable and effective at negotiating costs than any alternative arrangement. That all adds up to a strong argument for starting from scratch.
On the other hand, there’s a compelling political case for taking things slow. Support for a Sanders-type plan fades when difficult details and potential trade-offs are revealed.
About 156 million Americans have employer insurance that is substantially subsidized by the tax code. They are often heavily insulated from the cost of their often generous coverage, especially if they’re healthy.
A plan that eliminates that coverage will be controversial, especially when coupled with big tax increases and cost-containment efforts that could reduce choice.
Tax hikes may be offset for many by the elimination of premiums and individual health-care spending, and employers may raise wages if they aren’t paying for care. But that’s a more abstract argument than the one Republicans will roll out: that Democrats are socialists who want to ration health care and take your income.
Thus the appeal among some of Sanders’s rivals of alternative arrangements that would expand government-sponsored coverage while leaving the employer market alone. Such plans universally offer less generous benefits and would result in higher patient costs than what Sanders proposes. However, they represent a cheaper and less disruptive path and are more likely to make it through Congress.
Going all-in on a Sanders-type plan may drown out a message that helped Democrats back the House in 2018 – namely, that President Donald Trump and Republicans want to kill the ACA’s popular protections for people with pre-existing conditions and gouge Medicaid.
Trump handed Democrats a gift in March with his decision to fully back a legal effort to eliminate the ACA without an alternative plan in sight. Plenty of Democrats, most notably House Speaker Nancy Pelosi, prefer to seize on that opportunity and focus on safer efforts to shore up the law up.
It’s all friendship and solidarity now. But don’t be surprised if some of today’s co-sponsors turn into tomorrow’s critics as the primary heats up.
It was only a month ago that many Democrats were hoping Robert Mueller’s investigation into Russia’s interference in the 2016 presidential election would lead to indictments — perhaps even of President Donald Trump’s family and inner circle — for conspiring with the Russians. That did not come to pass, nor will it, so the focus has turned to “the narrative.” The term itself is a sign that this story is now entirely about politics.
Donald Trump inadvertently may have hit on a solution for paying for the $2 trillion tax cut he and his fellow Republicans pushed through Congress to benefit rich people and all those corporations that now pay no tax at all.
Senator Elizabeth Warren has written a new op-ed for Essence magazine, a publication that caters to professional African American women. In the piece published Friday, the Democratic presidential hopeful announced “a new commitment to Black women.”
The announcement that former special counsel Robert S. Mueller III will testify before two House committees next month is significant only if Mueller goes back on his word. You›ll remember that, in a public statement in May, the former FBI director who investigated possible ties between Russia and Donald Trump›s campaign made clear that he had no desire to testify before Congress. If he were to appear, he added, “I would not provide information beyond that which is already public.”
Theresa May never seemed to appreciate the importance of tempo in politics. She was not good at surprising, disrupting and confusing her opponents. Boris Johnson has learned from her mistakes.
What happens to a democracy when people stop talking to one another about what matters to them and the country? When people are afraid to speak their minds because they fear the personal blowback likely to come their way? Or worse,
The other day I saw a report of an airstrike hitting a medical facility in Idlib, killing a paramedic and an ambulance driver. Not a legitimate military target, but a medical facility. Then, shortly after, an airstrike hit again.