The Washington Post reported today that during a meeting with freshman House Democrats last night, former president Barack Obama “gently warned” attendees about “the costs associated with some liberal ideas popular in their ranks.” Though he wasn’t specific, “some people in the room took his words as a cautionary note about Medicare for All and the Green New Deal,” according to the paper:
People in the room, who spoke on the condition of anonymity to describe the evening, said Obama’s cost warnings weren’t deficit-scolding, per se. Rather he argued that voters care about the costs associated with policies and that Democrats should be ready to answer questions about how they will pay for an idea while making big promises to constituents.
Obama gave the example of taxes: Even a liberal, he argued, could be repelled from supporting a liberal policy if it’s accompanied by a major tax cut to their own bottom line.
Here, we have a meta-version of the centrists’ refrain: “It’s a nice idea, but how will you pay for it?” Obama didn’t say that—he merely asked how Democrats to think about how they will explain to voters how they’ll pay for it. See? He’s not a “deficit scold,” as some “people in the room” told the Post. He’s just asking questions.
But he’s asking the wrong question, at least when it comes to Medicare for All. On that proposal, the question for voters isn’t how the federal government will “pay for it,” but how their individual share of their health expenditures will change. And by that measure, Medicare for All is a slam dunk.
Questions of how the government will afford things are arbitrarily applied by moderates and conservatives to oppose programs they don’t want, and never seem to apply to defense spending. But federal government and deficit questions are far removed from the lives of individual Americans; what really matters, to most of them, is their bottom line. That doesn’t mean that zero voters care about deficits or government spending, but it does mean that voters at large will be more amenable to arguments focused on their own spending. And it’s inarguable that current household spending on healthcare is at crisis level, a crisis that would be solved by Medicare for All.
Currently, healthcare costs are extremely high and are not progressively distributed. It’s not even flatly distributed, as people of lower incomes actually spend a higher proportion of their money on health than rich people. There’s a confusing and difficult network of subsidies and programs for people of lower- and middle-incomes, but the subsidies for plans on the Affordable Care Act exchanges vary wildly by region, and many people who make slightly too much to qualify for them still struggle to afford their insurance. Almost a third of employer-sponsored health insurance policies have high deductibles that make it hard or impossible to actually get care. Pharmaceutical companies don’t charge you less for your drugs based on your income. Hospitals almost always don’t, either; though they might negotiate with you if you say you can’t pay, you’re out of luck if they don’t.
This is a long way of saying that people are paying too much for their healthcare, and they can’t afford it. So the answer to the question Obama is posing is quite simple. First, explain that the burden of any higher taxes paying for Medicare for All will fall on the very rich, taxes upon whom are strikingly popular. Second, explain that it will reduce their individual health spending significantly. Third, explain how in addition to that reduction, it will make healthcare (and health spending) much simpler.
It is true that, as our former colleague Clio Chang wrote in 2017, there is still a dearth of single-payer wonks in DC’s policy landscape, which is dominated by moderates who get something like a runners’ high whenever they hear the term “bipartisan solutions.” But Bernie Sanders did release a white paper on potential avenues to pay for Medicare for All a few years ago, incorporating ideas like a 1 percent wealth tax on the top 0.1 percent and raising taxes on high incomes, including a 55 percent tax on incomes above $10 million—not even as far as Alexandria Ocasio-Cortez’ proposed 70 percent tax on those households.
According to Sanders’ accounting of his plan, there would be a progressive tax paid by regular Americans too, but because of the drastically-reduced health costs, most people would end up paying far less for their care. According to Sanders, the increase in taxes paid by a family of four making $50,000 would be $844—in return for which that family would receive health insurance that covers all essential benefits plus abortion, vision, dental and drugs (personal spending on which would be limited to no more than $200 a year); pay no co-pays and no deductibles; and never have to fight with an insurance company again.
$844 is around $600 less than the average employee’s annual share of their health insurance coverage. So even just on premiums alone, it’s a substantial savings for the vast majority, let alone for those who currently pay for their insurance themselves, which can be as high as $800 a month. $844 a year is $32 a pay period, if you get paid twice a month, in return for everyone in America being covered and no one dying because they can’t afford insulin anymore.
I’m all for more serious, non-Koch-adjacent studies of how Medicare for All would be paid for. I’d love to see a version of Sanders’ white paper for the new bill introduced by Rep. Pramila Jayapal, for example, or one with a higher tax rate on the rich. But I reject Obama’s notion that the average American is so allergic to anything that might cost any money that Democrats must always be in a defensive crouch, covering their ears and hiding when the centrist ghouls wail, how will you paaaaay for ittttt.
It makes sense that Obama would think this, of course, because that crouch defined his presidency. Hampered as it was by real intransigent opposition from a plutocratic GOP, we never found out if the party might have fared better if Democrats had just made big, moral cases for the things they believed instead of pre-conceding policy, deporting more people and constantly attempting to slash deficits in a completely failed attempt to score points with Republicans.
The proposal from the new Democratic left-wing is to not fear proposing bold policies that would lift people out of poverty, crisis, and misery because of the imagined Panera Mom who wants to know how we’ll pay for Medicare for All. The proposal is to move beyond a politics defined by fear of what your opponents will say, and by ‘90s-era ideas about deficits and spending. And if Obama genuinely was just asking Democrats to be prepared to answer these questions, here’s some good news—we’ve got some pretty good answers already.