Thursday, August 23, 2018

Information Please

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As campaign season 2018 heats up, we can see the outlines of the party messaging forming. On the Democratic side, tying candidates to Trump, family separation policy and the tax cut that blew up the budget in order to increase corporate profits should be big. Plus, now, with the Mannafort and Cohen convictions, corruption will resonate with many. On the Republican side it's a little hard to know what they can run on. They'll still have immigration and government regulation, along with their old standbys racial animus and tribal fear and hatred, but it's hard to see how well that will play after two full years of Trump. It gets them into the 30% range, but it's not going to push them over the top like it did in 2018, when people could still think hopeful thoughts about a Trump White House with unfettered congressional power.

But in the real world - and assuming the economy doesn't collapse in the next 80 days, much of the discussion will center on health care. And after the implementation of the ACA and the angry tantrum on the right that resulted as they were forced to make it clear that they just didn't think poor people should be able to go to the doctor. This 'survival of the richest' Darwinian social experiment has played out, and people have now seen what even limited government intervention in the health care marketplace can do. The American electorate, to a large degree, is ready to have a conversation about shifting the health care system to a more modern, effective, subsidized system like all other industrialized economies have implemented.

But here we find ourselves at a crossroads. What will it be? Medicare for All, a Medicare buy-in option, a full-blown public option to compete with private insurers? What will public funds be used for, and how much public money will be necessary? We got a taste of where this is leading during the Bernie Sanders campaign. He dangled a concept - single payer - in front of people without being upfront about what that meant to him, how it might be passed, what it would cost and how those funds would be raised. Many of us accepted his good faith at his word and asked questions. These questions were immediately shouted down as the desperate cries of neoliberal shills out to protect the status quo. Huh?

Look. There's hundreds of ways to implement some kind of publicly funded universal coverage system. If I ask you questions, it's not because I'm trying to prevent your preferred program from becoming law, but rather because I'm going to work my ass off to prevent a BAD program from becoming law. If I have questions, it means we're engaging with each other to try to solve this problem once and for all. And if you can't tell me how much your program would cost, we can't even begin to have a conversation about it, because THAT'S the issue we have to address. The gigantic, bloated American military is the largest in the world by far, the most expensive in history, and it costs about 4% of GDP. Here we're talking about somewhere between 10 and 20% of GDP. The Republican tax bill cost $2 trillion over ten years. Here we're talking about more than $2 trillion dollars in year one alone!

So yeah, if I ask you how your health care program would be funded, you can't just shrug and say 'tax the rich'. If you can't say how much money you need, you don't know if that's a viable solution or not. Is your program means tested? Why - or why not? How does your program control costs? Since you're using public money you can't just pay whatever the doctor or hospital puts on the invoice. Are you using Medicare reimbursement rates? What will you do if not enough health care delivery organizations agree to take patients at those rates? What about employer-funded health care? How do you transfer those private costs to the public sector, and can you require employers relieved of those costs to raise wages or benefits?

See, there's really only one point here. If you say you want universal or single payer health care in the US, you should never react negatively to people who ask questions. You NEED to be able to answer the questions, because you can't actually get what you want until you take a nebulous concept and flesh it out with some real information. You also should realize that if you support a badly designed or stupid program, many of us will point this out. Not necessarily because we don't want a better universal health care system in the US, but because we don't want one that will fail. It seems fairly clear that we're beyond the point of arguing about human rights vs. Socialism, and we can begin to have a serious conversation about caring for all American citizens. So we need to get used to talking in some detail as opposed to shouting bumper stickers at each other.

This is a GOOD thing.
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