Medicare for all. Why not?


Roosevelt signing the Social Security law in 1935. See any Republicans?

Not surprisingly…the Supreme Court argument over the so-called “individual mandate” requiring everyone to buy health insurance revolved around epistemological niceties such as the meaning of a “tax,” and the question of whether the issue is ripe for review.

Behind this judicial foreplay is the brute political fact that if the Court decides the individual mandate is an unconstitutional extension of federal authority, the entire law starts unraveling. But with a bit of political jujitsu, the President could turn any such defeat into a victory for a single-payer healthcare system – Medicare for all.

Here’s how. The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs including marketing and advertising…On average more than 1000% of the cost of government’s managing of Social Security.

The President and the Democrats could have avoided this dilemma in the first place if they’d insisted on Medicare for all, or at least a public option.

After all, Social Security and Medicare require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. But because Social Security and Medicare are government programs financed by payroll taxes they don’t feel like mandatory purchases…

Moreover, compared to private insurance, Medicare is a great deal. Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

Should those of us who care more about health care for Americans than the profits of insurance companies be of good cheer? Of course not. One of the biggest hurdles to overcome will be the Democrat Party.

Not the rank-and-file. Maybe even a fair share of mid-level activists in that party. Then, we get to elected officials and at the national level – in Congress – what is the parliamentary party. Most nations recognize the self-interest of national elected officials as separate and distinct from grassroots members. For Democrats, that means Congressional Democrats with little backbone and even less commitment to the issues living strong in the hearts of their constitiuency. For Republicans, that means trying to keep your gig while sounding almost loony enough to satisfy the bigots, Birchers, religious nutballs and Tea Party activists chartered by the most reactionary elements in corporate America.

Above all else, both groups don’t want to offend the power brokers and money launderers they work for sub rosa in Congress – and hope to represent more officially after they’re out of office. Lobbying giants ranging from the Chamber of Commerce and Big Oil to individual manufacturing and trade associations like the RIAA.

Americans sincerely interested in committing their time and money to real reform – like a single payer system for healthcare – will have to rely on the broad range of political pressure available from organizations outside of Congress, outside the Democrats in Congress. That doesn’t mean you don’t work for the rare pol with guts. Just don’t count on her or him to muster the troops on the taxpayers’ payroll. Dedicate your personal efforts to organizations with real courage and a history of commitment.

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