It’s Medicare for All or Nothing

Despite the number of Democrats who have co-sponsored Medicare for All bills in the past few years, the idea is falling out of favor with prominent Democratic leaders, including those running for president. Instead, we are hearing more and more about voters who want to keep their employer-based insurance, as tenuous as the evidence for those voters is.

The focus on the minority of Americans who have employer-based insurance that they like—at most 34 percent of Americans, assuming a very generous interpretation of polling asking people if they’re “satisfied” with their employer-based coverage—is hardly surprising, since those people are richer and therefore much more important. The national Democratic leadership has great reverence for and fear of those suburban Panera Bread moms who powered their midterm victories, and who the party believes will run straight into the arms of the Republican Party if they hear that Medicare for All will mean they can’t have their employer-based insurance anymore.

That’s why Democratic candidates including Joe Biden and Beto O’Rourke are going in on their alternatives to Medicare for All. Biden, for example, proposes a public option with unspecified premiums, and lowering the percentage of your income that your Marketplace plan premium could cost from 9.86 percent to 8.5 percent. Sorry, are you still awake?

O’Rourke, meanwhile, had a little tiff with Bill de Blasio last week over his preferred plan, Medicare for America:

That plan he’s talking about is Medicare for All, which would force people off their private insurance—and straight onto a government plan with no co-pays, premiums, or deductibles, and no restrictive provider networks. They never manage to mention that part.

If the apparent virtue of Medicare for America is that Americans would be able to keep their current insurance, it matters a lot whether that is actually true. And it is not true. Under Medicare for America, your employer would choose whether they would continue paying for employer-provided insurance, or instead pay an eight percent payroll tax and have employees use the public option instead. But small employers, those with fewer than 100 employees or less than $2 million in annual payroll, would “not be subject to a mandatory employer contribution,” according to the bill’s text.

That means it’s a very good deal for small employers to just load their workers onto the public option instead, saving them thousands of dollars per employee. 47.5 percent of the workforce, or 58.9 million people, worked at small businesses in 2015. What percentage of their employers would be daft enough to keep offering expensive private insurance when there’s a free government option out there? However you slice it, if the public option is attractive enough, employers are going to want to use that instead, meaning…their employees will lose their employer-provided insurance. Government takeover! Red Beto!

The entire point of any of these public option plans is the fiction that those who like their employer-based insurance could keep it. As Matt Bruenig has pointed out repeatedly, this is utterly ludicrous, regardless of the specifics of the plan. No plan that preserves employer-based insurance will ensure that anyone who likes their employer-based insurance can keep it, because a defining feature of employer-based insurance is that you lose it when your employment changes and that it’s up to your employer to keep your plan the same, which they frequently decline to do.

Your boss might switch insurers entirely, or pass on more of the premium to you, or switch to offering shitty, high-deductible plans. In five years of full-time employment in the United States, I’ve had two different insurance companies and at least four different plans, plus a spell on COBRA, each with different networks, coverage levels, co-pays, deductibles, and drug coverage. My insurer might decide they don’t want to cover the migraine drug Aimovig anymore, which would roughly double the number of migraines I experience, or I might get a new job and find that the new insurance company doesn’t cover it. Or I could lose my job completely, and have no coverage at all.

And this is the reality I’m supposed to want to keep; by the Democrats’ logic, a comfortably salaried, white-collar worker like me with generous insurance is supposed to be terrified of losing her precious employer-based insurance. Yeah, I fuckin’ am—and that’s exactly why I want Medicare for All instead.

You might say that perhaps a majority of Americans wouldn’t make this connection because they don’t know what Medicare for All really is or how it would end this. In that case, I guess I’d ask why prominent Democrats like Beto O’Rourke and Joe Biden are putting so much energy into lying to the American people about what their plans would do (where have I heard that one before), instead of putting marginally more effort into actually informing them of the realities of the policy landscape we’re debating. Ideally, you would hope that our leaders, particularly those in the At Least We’re Not Gunfucking White Nationalists Party, would strive to educate and inform the public about the policy nuances that regular people don’t have time to pay attention to. You would not hope that they would sign up to spread the exact lies that the insurance industry wants to spread. (It’s surely a coincidence that a top Joe Biden adviser was previously a lobbyist for the hospital industry.)

It’s understandable if a voter’s initial reaction to hearing that a policy would get rid of “their” insurance is fear, meaning that they don’t think hard about how many times they’ve lost their plans in the past few years, especially if they don’t also know how generous Medicare for All would be. Tell a middle or upper-middle class voter that Scary Bernie wants to get rid of that lovely employer-based insurance, without also mentioning that he would replace it with a plan that covers far more for no premiums, co-pays, or deductibles, and the result is that they might oppose Medicare for All. (A shockingly high number of independents already support a Medicare for all plan, even when the question spells out that it would replace private insurance, even with very little public education about what the plan would be or context from the media about how it would essentially eradicate their personal healthcare costs.)

If you’re a voter and your primary concern is that you’re worried about losing your insurance, you must really hate the employer-based insurance system. The only way to ensure you never have to worry about losing healthcare coverage again, even if you lose your job, your income, or your home, is Medicare for All.