I don’t honestly know how Steve Rattner came to be thought of as a Democratic Party pundit. I know he’s a strong fundraiser and general party apparatchik. Other than that I see few if any qualifications for the role.
This morning in an op-ed in the New York Times it’s clear that Mr. Rattner has two complaints about the party’s adopting support for “Medicare for All” (M4A) as a litmus for the party going forward:
As a centrist Democrat, I’m scared to see my party pulled into positions that are both bad politics and dubious policy. And I’m disappointed that few of our party’s moderates are willing to resist the freight train coming at us from the left.
I think he makes a pretty fair case that it’s bad politics. The closest he comes to making a case that it’s bad policy is it costs too much:
Spellbound Democrats should also consider the fate of past single payer proposals. In Sanders’s home state of Vermont, a single payer plan was abandoned after an analysis found that it would require a near doubling of the state budget (and increasing taxes similarly).
In Colorado last November, a whopping 80 percent of voters rejected a universal plan, again over taxes and costs. And for similar reasons, California recently shelved a single-payer proposal.
Amid the many complications of Medicare for All, the question of what would happen to the 157 million Americans who get their insurance from their employers and the 19 million who are enrolled in Medicare Advantage loom large.
That Vermont and Colorado demurred from adopting state level single player plans is actually a political argument masquerading as a policy argument. The last paragraph is about as close as he comes and it’s pretty weak tea, amounting to an observation that there are lots of details that would need to be worked out. That didn’t stop the Affordable Care Act.
I’m skeptical of M4A as policy but I have some clear reasons for it, namely cost, time inconsistency, the impossibility of limiting coverage, and bleak prospects for cost savings through streamlined administration.
Cost is obviously a problem. Health care costs in the United States are an order of magnitude (at least) higher than they were when any OECD country adopted its present health care system, whether single payer, national health service, or related. When the U. S. adopted the Medicare system utilization went up and we should expect the same with M4A. Simply put health care in the U. S. is just too expensive for M4A to be affordable. At the very least even its supporters should find the cost issue daunting.
To believe that the U. S. will impose cost controls after adopting M4A is to believe that the federal government will behave differently this time than it has in the past. All of the political signals point in the direction of no cost controls and I see little prospect for a sudden change of heart now. If the Congress had had the stomach to control health care costs in Medicare, we wouldn’t have seen “doc fixes” enacted year after year until the Congress abandoned the charade.
The United States also faces an issue which no other OECD country has: it has a 1,500 mile land border with a country with a median income a quarter of its own and in which the national interest favors an open border. Unless we’re going to limit M4A to citizens, something that I think will be politically impossible, we will be inviting the entire world here for health care.
Finally, some have pointed to Medicare’s low administrative costs as a reason it should be a model for the entire U. S. I think that’s far-fetched. IMO it’s likely that Medicare’s true administrative costs are buried. The reality is that administrative costs in the U. S. are higher. Look at our educational system.
Come spend a day with my billers. See the difference between billing for Medicare and for the private insurers. Spend a day with one of my general surgeons. Watch them spending time to make sure they jump though all of the correct hoops with the private insurers. Come talk with the credentialing person I had to hire to keep up with the requirements by the private insurers (and the states).
Steve
Well great, steve says that even with all of the eyes of the world on the medical industry, there are no unfair costs.
I think that steve’s point is that administrative costs just have to be lower under M4A.
Steve’s point is that they are currently much higher for private insurance than they are for Medicare. I think your point is that if we go to M4A, that they administrative costs would just HAVE to go up (for some reason).
Steve
Medicare for All is an excellent solution for a country not falling apart. But the Republicans have made clear they will sabotage the program in any way they can with not one shred of concern for the human cost, while the Democrats will load the program with bloat to enrich their 10% base and corporate donors.
So I don’t see any path but the ruinous one we’re on.
No, it’s that we don’t know whether they’d go down, stay the same, or go up. They might go down because there are possible efficiencies. But they might also go up because the cost of administering Medicare could rise geometrically with scale. We just don’t know and drawing analogies between much smaller, more centralized countries and the U. S. is not likely to tell us much.
Could be, but again, I think you underestimate the extra costs and time (another kind of cost) taken up by dealing with several private insurers. Plus Tricare, disability and others when they show up. Both our COO and CFO, guys who wear MAGA hats, have said they would prefer we just go to single payer to do away with those costs and the rules promulgated by those insurers. They say this knowing our payments are 20%-30% higher from the privates.
I am not a politician but I have seen our political system degrade to the point that a large part of the younger generations have no faith in it. As far as M4A goes medical costs and expenses have always increased in my lifetime.
To adopt a plan that costs 52 trillion sounds like another plan that will cost the middle class dearly. It is time to realize that as a country we can not longer be all things to all people.