An Expanding Medicare

Terry H. Schwadron

Feb. 19, 2019

There has been a lot of fuss about “Medicare for All” as the singular vehicle to emerge as a central issue for the next presidential campaign.

• For Republicans, this concept of government-funded health insurance is being attacked as “socialist,” and as taking away individual choice of doctors, treatment, hospitals, and, of course, insurance companies. You can hear the sarcasm dripping from Donald Trump’s remarks before they actually emerge.
• Among Democrats, there has been a rush to put out position papers that wholly endorse or seek to avoid Medicare for All — Bernie Sanders’ signature issue, for example. So, Kamala Harris, Cory Booker and Julian Castro are fully endorsing the concept, Amy Klobuchar and Sherrod Brown, not so much.

Before we get too far down this road, my thought is that Medicare for All as a singular road creates a overly narrow roadway for choices. But it is an awfully enticing aspiration, and ought to be the subject of real examination — starting now.

I’m proposing that Democrats do something both practical and radical for partisan politics: Start holding public hearings, either under the aegis of government committees or, better, not. Start with a big splash that explains exactly what’s at issue and why it matters, start inviting people from the various points of view, open it up to Republicans, insurers, medical people, employers to start collecting real and valuable information.

By doing so, Democrats could start showing what they say they care about — governing with a great dollop of empathy.

They would also immediately transform the next 20 months of endless campaign bs into a usable and reliable citizen examination of one of the top issues in the land. Such an effort would also give the Democratic Party apparatus some formal reason to exist and the substance for campaigning. In other words, we might agree that a political party that has nice words about health care actually might put some skin in the game.

The radical part here is to set the debate among too many Democratic candidates to even remember names, never mind positions on access to health care, and to aim to distill a feasible plan for immediate legislative remedies and long-term aspirations — outside of the stalled and stilted constraints of Congress.

Even at its best, Medicare for All does not necessarily guarantee lower pharmaceutical costs, particularly for long-term drugs or emerging, expensive drug treatments for cancer, say. Some are talking more practically, for example, about an evolution in allowing a certain number of individuals to buy into the Medicare program at age 55, then 50, and so forth. The governing officials of Medicare need the power to negotiate drug prices, as another example.

What we have now are a few white papers that speculate that overall health costs in a healthier nation would make paying for public insurance a much better bet. We need to get beyond the aspirational numbers into some more practical steps.

Rather than having endless numbers of Democratic candidates opine endlessly with little fact matter other than citizen’s “right” to good health care, they should all throw in to an effort to solve the current problems.

News media would participate, of course, amplifying the various findings of business people and unions, government officials and private voices. The various candidates would each have a chance to participate while not having to own the results. The outcome could well be a set of agreed-upon facts and figures that could work to make it easier to start legislating as soon as the new president takes office.

I believe that most of our widespread social movements were driven by citizens outside of government — from civil rights to same sex unions to the turn away from hard liquors to smoking. Then government follows, often taking credit for passing bills that encompass the “progress” that already has won widespread public support.

Take legalized marijuana either for medical purposes or for recreation. The wide use of marijuana has run before any of the increasing number of state laws to decriminalize or to legalize the use of household amounts of marijuana. This has not depended on the government to devise legal solutions. Why should we wait for the stars to align in our deeply divided political nation to come up with plans for access to health care.

In a way, this is similar to the current conversation about a Green New Deal, which will be dismissed because it is seen as socialist American government for all, while punishing corporations, but who knows because the language is so general as to be nearly useless. But what I love about the Green New Deal is that is prompts real conversation about what our public policy should be toward the environment.

The Congress can’t seem to do this. Let’s do it ourselves.

##