The mindless canard stating as unexplained fact that it would be worse to expand the federal government by a third in order to accommodate single-payer healthcare insurance than it is to have private, for-profit health insurance companies playing this role instead
No one would ever accuse Bernie Sanders of thinking small. The senator from Vermont and Democratic presidential candidate wants to transform one of the world’s most boisterous free-market economies into an exemplar ofScandinavian-style “democratic socialism.” He wants to jail Wall Street executives and double the minimum wage. And he wants to spend taxpayer money, lots of it.
According to an estimate by The Wall Street Journal, Sanders’ spending plans would cost $18 trillion over 10 years, increasing the federal government’s size by roughly a third. He would create a single-payer health plan, make public universities free, expand Social Security, spend big on infrastructure, create universal child-care and pre-K programs, provide federal jobs for young people and bail out struggling pension plans, among other things.
To be sure, fully $15 trillion of the $18 trillion would come from Sanders’ health plan, which seems unlikely to cost that much. Bringing all Americans under the umbrella of a single-payer system would create enormous power to hold down prices.
Even so, there’s no doubt that Sanders, who’s running a surprisingly strong second to Hillary Clinton in the latest polls, is talking serious money.
— Bernie Sanders: ‘Now is the time for bold action’, USA Today editorial, yesterday
Yes, no one would ever accuse Bernie Sanders of thinking small. And no one should ever accuse the USA Today editorial page staff of explaining why increasing the federal government’s size by roughly a third is per se a bad idea. I mean other than just saying we can’t afford it.
I give the writer of this editorial credit for saying upfront and explicitly that $15 trillion of the $18 trillion would come from Sanders’ health plan. That’s more than Washington Post editorial writer Stephen Stromberg did the day after that WSJ report last month.* And it’s more than the WSJ reporter did in the article itself, if I remember right.
But why exactly is it per se bad to expand the federal government significantly? That is what Medicare and Social Security did, and the National Labor Relations Act and the Securities Exchange Act and the EPA, etc. If you think these pieces of legislation should not have been enacted, fine. But most people would disagree with you.
Sanders wants to replace private-industry healthcare insurance with federal, nonprofit, single-payer insurance. Like Denmark! And like Medicare. I would love to see Sanders have an economist like Uwe Reinhardt or Joseph Stiglitz compute what the cost to individuals receiving Medicare would be now if there were no Medicare. Especially since most of them are retired, so there would not be the possibility of employer-based private insurance.
What drives me crazy about this mindless but politically potent canard is that these folks don’t attempt to explain why it would be worse to expand the federal government by a third in this respect than it is to have private, for-profit health insurance companies playing this role instead. How much more income tax revenue would the federal government receive if the money that employers now pay in insurance premiums went instead to wages and salaries? And how much better would the economy be if that happened, and if individuals weren’t saddled with premiums and large out-of-pocket healthcare costs?
Josh Barro has an outstanding column in today’s New York Times, the theme of which is that Sanders unnecessarily complicates his candidacy and causes confusion—providing an opening to his opponents like the one Clinton took at the debate last week to imply that Sanders wants to nationalize businesses, large and small; he cited Clinton’s comment—by calling himself something he is not: a democratic socialist. He’s a social democrat, Barro and others he quotes, say, accurately.
But the key part of Barro’s lengthy column is this:
“When you look at the policies, there’s a way to see it as Bernie has cranked up Hillary’s agenda to 11,” [Roosevelt Institute economist Mike] Konczal said. To wit: Mrs. Clinton favors preserving Social Security with some enhancements for the poorest beneficiaries, while he wants to raise taxes on the rich to expand it in ways that could add $65 per month to the average benefit. This, like most political debates, is a disagreement about how far to turn the knobs when adjusting policy; it does not seem to call for a separate ideological label. That said, Mr. Konczal did offer one difference between Mr. Sanders’s and Mrs. Clinton’s worldviews that is of kind rather than degree. This is decommodification: the idea that some goods and services are so important that they ought to be removed from the market economy altogether. [Italics added.]
The idea behind the Affordable Care Act, and behind Mrs. Clinton’s approach to tinkering with Obamacare, is that quality health insurance should be affordable to everyone, and that people who can’t afford it should be given subsidies to buy it. For a democratic socialist, that’s not good enough; instead, health care should simply be provided to everyone without charge, removing the profit motive from health care. But even this is a matter of degrees. Mr. Sanders favors Medicare for all: a singlepayer health care system, with the federal government as the sole insurer. This would remove the profit motive from health insurance but not from health care, which could continue to be provided by private doctors and hospitals, often working on a forprofit basis. Mr. Sanders is not proposing to go further, like Britain, and have doctors work directly for the government. Nor does he appear inclined to decommodify broad swathes of the economy; in other countries, even conservatives often endorse special, less-marketized rules for health care than for other sectors.
This distinction is real, but it’s not clear to me that it merits Mr. Sanders his own ideological label.
That—the idea that some goods and services are so important that they ought to be removed from the market economy altogether—is why it is absolutely incumbent upon the USA editorial writer, Stephen Stromberg, Hillary Clinton, and anyone else who takes the position that a single-payer, Medicare-for-all healthcare insurance system is per se bad because it would be run by the federal government, to actually state why this is so.
*The editorial was, like all Post (and most newspaper) editorials, published without a byline, but Stromberg had a blog post there on the same day that was virtually identical to the editorial. [Elementary, Watson!]