A Better Way to Convince Republicans to Support “Medicare For All”

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A few years ago, my Darling and I traveled overseas. My wife wanted for us to travel while we could because I had severe osteoarthritis in both knees and the distance I could walk was steadily decreasing. I already needed a walking cane to get around, and it was apparent that without knee replacement, I’d soon be using a walker. I was only 52, and working as a caregiver for my medically-fragile Foster children. Some readers will see ‘52’ as ‘already old’, but it’s not. It’s still young. Once you’re in your fifties, you’ll understand how young you still are.

Thanks to my benefits as retired Navy, I was able to get both my knees replaced at a total out-of-pocket cost of maybe $100. The taxpayers paid for the rest. After recovery and physical therapy (all taxpayer-funded), I can walk just as far as I could the day I retired from the Navy fifteen years before. Heck, I can even run now, and let me tell you, after spending a few years using a cane (and sometimes a walker) and thinking that your active life is over, you really appreciate being able to walk and run once more!

How does this anecdote apply to “Medicare For All” (M4A)? Easy. When I was looking at needing a cane and a walker (and eventually a wheelchair) to get around, I also knew that I would likely be a drain on society. Sure, the disabled can normally work and be paid well and even become successful (see Sen. Tammy Duckworth), but doing so is neither simple nor easy. But after getting my knees replaced, I’m not at all a drain on society. Instead, I’m working 65 hours per week and paying lots of taxes. In fact, the taxes I’ve since paid in far exceeds the amount paid for my surgeries by the nations taxpayers.

That, then, is the first key to presenting M4A to conservatives: it would enable a great many Americans to be able to work and pay taxes for years (and sometimes decades) longer than they otherwise could, thus offsetting the up-front cost of M4A. For those who might detect the “trickle-down” logic of this argument, one must bear in mind that while there is precious little hard evidence that “trickle-down” works when it comes to slashing taxes, there is a great honking mountain of hard evidence that people who receive health care do tend to be able to live and work (and thus pay taxes) for much longer than do those who don’t receive health care.

The second key to presenting M4A to conservatives is its benefit to businesses. Remember Burwell v. Hobby Lobby, wherein the Supreme Court decided that for-profit corporations can’t be required to pay for insurance coverage for contraception? Many conservatives strongly disagree with businesses being required to pay for employee health insurance at all, for doing so significantly detracts (in their eyes) from the profits of the businesses bearing such costs. From the New York Times:

It makes it difficult or sometimes even impossible for people to change jobs, not only damping economic efficiency but reducing the competition for labor and, therefore, reducing wages. Without alternative health coverage, there is ‘’strong evidence for job lock,’’ wrote two economists, Jonathan Gruber and Brigitte C. Madrian, in a National Bureau of Economic Research study released this year.

It suppresses the creation of new businesses because, for many potential entrepreneurs, quitting a job means forgoing health insurance, a risk too big to take.

It handicaps traditional industries like autos and steel, whose medical burden for retirees is staggering. The estimated lifetime expense for today’s steel retirees alone is $14 billion. In the auto industry, General Motors alone provides coverage to nearly one-half of 1 percent of the American people; One analyst, Gary Lapidus of Goldman Sachs, calls Detroit’s Big Three ‘’H.M.O.’s with wheels.’’

It unfairly excludes the unemployed, the self-employed and low-skilled workers. And it can shortchange single people, whose employers effectively pay higher wages to workers with families when providing dependent coverage.

On top of everything else, our employer-based system seriously obscures who is paying what, making cost controls difficult. Workers may think they are getting something for nothing, but employer-paid insurance premiums usually are provided in lieu of higher wages. And while companies dislike soaring premiums, at least they can deduct their cost from their income taxes, thus transferring a big hunk of the cost to the federal government.

The article was written in 2003, but the arguments apply today.

The third key is to maintain the drumbeat that lack of health insurance is a much bigger problem in red states than in blue states. From WalletHub (using data from the U.S. Census Bureau), here is a state-by-state comparison of percentage of population covered by health insurance:

Darker = more coverage, lighter = less coverage

The pattern is obvious. While there are exceptions, the general trend is that red states tend to have significantly lower percentages of population covered by health insurance than is the case with blue states…and as The Atlantic pointed out, health care is the one overriding kitchen-table issue that was driving the midterm election:

Health care has become the single most important policy topic in the midterm elections — everywhere and nowhere, a strange kind of omnipresent sleeper issue. It’s not grabbing many national headlines, compared with the migrant caravan or the Supreme Court fight or violence directed against minority groups or the trade war, but it’s motivating voters in race after race after race. New polling from the Public Religion Research Institute shows that Americans point to the cost of health care more than any other issue when asked what is most important to them this election cycle. “It’s official: The 2018 midterms are about health care,” Wesleyan argued.

It’s best to keep things simple in this age of ever-shortening sound bites. Advertising experts and focus groups would almost certainly be able to find ways to make the cases presented above more succinctly and effectively, so hopefully they can improve the below suggested bullet points that summarize the arguments for M4A:

  1. M4A enables Americans to be more productive and less of a burden on their employers, and the subsequent increase in tax revenue from those workers would offset the cost of implementing M4A.
  2. M4A removes the fiduciary burden of employee health insurance from all American businesses, thus making our business sector more competitive domestically and internationally.
  3. M4A is not Soviet-style socialism: it’s common sense, as evinced by the success of the red states that did embrace Medicaid expansion under the ACA.

The Republicans claim to be pro-business, and nos. 1 and 2 above show how M4A would be beneficial to every business in America. This not only refutes their claims that Democrats are “anti-business”, but may well result in many businesses making healthy campaign donations to Democratic candidates in the hopes that they will soon no longer be required to pay for health insurance for their employees.

The 2020 election is presenting the Democratic party with an historic opportunity. We are running against the most unpopular president in living memory, who is leading a party comprised almost solely of a continually-shrinking demographic. This will be America’s first real opportunity to gain what all the other first-world democracies already have (if in varying forms): universal health care for all.

Retired Navy. Inveterate contrarian. If I haven’t done it, I’ve usually done something close.

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