Medicare for All Divides Democrats but Might Unite the Nation
Monday, April 15, 2019
MARC STEINER Welcome to The Real News Network. I’m Marc Steiner. It’s great to have you all with us. Democrats are in an internal battle royale over healthcare. Bernie Sanders introduced Medicare for All into Congress. The liberal establishment is pushing something they call Medicare Extra for All that keeps alive private insurance. And of course, Republicans are describing Medicare for All as a creeping socialist disaster. And when you poll people, if you ask them about Medicare for All, 64 percent say “yes.” You ask them about single-payer, it goes down to 48 percent. And if you use the word “socialized medicine,” it takes it down to 44 percent even though in principle, they’re all the same thing. So where does this leave us? Where is the internal Democratic Party struggle taking us and them? And how may this play out in one of the biggest issues at play for the 2020 presidential election? Joining us is Michael Lighty, once again, Founding Fellow of the Sanders Institute, and currently serves on the Lancet Commission on Public Policy and Health in the Trump era, and who has advocated, organized and developed policy around healthcare reform in California and nationally for the last 30 years. Welcome. Good to have you with us.
MICHAEL LIGHTY Thank you, Marc. Thank you. Great to be here.
MARC STEINER So let’s just start where we began, where I began, with this poll and your sense of this poll. When I read this poll, one thing that was glaring to me was, it all has to do with presentation and language because really, when you’re talking about “healthcare for all,” “Medicare for All,” it’s all the same thing. So talk a bit about what this poll says to you and what you think we walk away with from this.
MICHAEL LIGHTY I think you’re right. I think how Medicare for All is described, or how universal healthcare is described, has everything to do with people’s perceptions of what it is. What I was struck by that poll, actually, was how well the phrase “single-payer” did. If we’re approaching now majority support on that, we’re doing well. But I do think that there is some confusion and folks who want to muddy the issue or come up with alternatives, like to obscure the difference between a Medicare for All program that really does guarantee healthcare with no barriers to care, versus other approaches which want to kind of obscure the difference between what universal coverage is versus guaranteed healthcare. And this can get like quicksand very quickly, so I think we need to be very clear and concise: guaranteed healthcare with no barriers to care. That’s the principle. That’s the description. And I think when you talk about it in those terms, reflected in that Kaiser poll, it does turn out to be very popular.
MARC STEINER So let’s take a look at that for a moment what this might mean. Right now, the Democratic Party is having this gigantic internal debate and people from the Center for American Progress have come up with Medicare Extra for All, as opposed to Medicare for All, and it goes along with The Center for American Progress debate with Bernie Sanders. I think it’s all part of this giant battle over what happens to the D.C.C.C. battling Progressives who challenge incumbents and the rest. But having said that, I’m curious what you think is going to happen inside that internal war inside the Democrats themselves, over this issue of Medicare Extra for All being, leaving private insurance in place but giving people a public option, and more.
MICHAEL LIGHTY Right. Well I do think it is going to depend on who wins the nomination. I think if Senator Sanders wins, as I expect him to, then this policy will be set as his. And if another challenger gets the nomination, I believe it’s going to be very squishy and we will see things that keep the private insurance companies in charge. And that’s really what’s obscured by this discussion, Marc, is that there’s always a role for private insurance entities in these national health systems. That role can be small or big, depending on the system. But the notion that somehow this whole debate turns on whether people like their private insurance is just silly. We’re desperate to keep our private insurance, but we certainly want guaranteed healthcare.
MARC STEINER Sorry to interrupt but describe what you are talking about because I have not heard this argument very much. Very few people talk about this idea. What do you mean that if we have Medicare for All, which covers everybody, and as for what Bernie Sanders was saying, dental care and eye care, which often is not included in many things, and long-term care? So what do you mean it will still include the private industry? Now you sound like Medicare Extra for All.
MICHAEL LIGHTY No, no. What I’m saying is that there’s a difference between overlap and supplemental. There’s a role for supplemental coverage in Medicare for All. Even in a comprehensive Medicare for All, there’s a role for supplemental coverage. Insurance company workers right now process claims for Medicare. Aetna and other companies contract with Medicare to simply reimburse providers according to the rules of Medicare. They don’t do an insurance function. So there are roles for these entities that are not like their current role, which is to deny care, to base their decisions on revenue and profit. That’s what we eliminate. So I just think we ought to be clear about that.
MARC STEINER So let’s talk about this for a minute. I want to talk about the private industry for a moment. It is a slight digression, but I think it’s important because I think people don’t ever address this very much. You have around one million people, or more— it depends on what study you’re looking at— that work either directly for the healthcare industry or another large body of people that work for hospitals and doctors, processing all the private insurance forms. It could be up to 1.5 million people. What happens to them in this process of moving from Medicare for All when employed by a private insurance? They can’t all be sucked up into Medicare administration in Washington. So what happens to them?
MICHAEL LIGHTY Right. This is a vitally important question, Marc, and I think we really need to get into dialogue with those administrative workers who are affected by this change. But the study that was done by Robert Poland and the other researchers at UMass-Amherst, was very specific on this point and that is, we understand exactly what the demographic and financial profile is for insurance industry workers and for those administrative workers that you mentioned on the hospital or provider side. This House Bill H.R. 1384, devotes one percent of total system funding to income maintenance, job training, pension protection, and other transition funding for those affected workers. We are for the first time, I think on this issue, taking seriously what it actually costs and requires to transition these workers into the new system. And frankly, there are going to be new opportunities under a Medicare for All. They’re going to be clinical jobs that open up because people are going to be going to the doctor more. We anticipate that and we also think that there will be a shift overall, of course, from administration to clinical and that will open up new jobs. So this is a vitally important question. I’m really encouraging us to dialogue with those insurance industry workers to reassure them that we are going to take care of them, just as we’re going to take care of everybody with healthcare.
MARC STEINER In America that makes a lot of people nervous because whenever there’s a shift, workers are never taken care of in this country. They are always left to kind of swing in the wind and the reason I asked that question. The other is, that one of the arguments that I think will happen in any campaign, whether it’s within the internal Democratic campaign or the campaign of the general election, is that not just the cost of this, but how are you going to get covered? Who is going to be covered? And by that I mean, they are going to look at Canada. They’re going to look at Britain. They’re going to look at other places, saying that they’re not allowed to have certain procedures. They cut back on what people could do. You can’t choose your own doctor. These are things that people are really worried about. So how do the Medicare for All people respond to that?
MICHAEL LIGHTY Well I thought your description was pretty accurate of the present system.
MARC STEINER No, I agree. Absolutely, absolutely. [laughter]
MICHAEL LIGHTY That’s the reality. If you look at these comparative studies that the Commonwealth Fund does every other year, we actually have some of the worst wait times in the world. The truth is that we have something no other country has and that is severe barriers to care: 44 million Americans have insurance but they can’t use it because the deductible is too high. 29 percent of Americans with insurance, don’t go to the doctor. They forgo a prescription. So when we talk about Medicare for All, we’re talking about a uniquely American solution that guarantees healthcare, eliminates all premiums, copays and deductibles, and actually achieves something that every other country in the world with comparable economies has achieved, which has real cost-control on healthcare. So if you take out the revenue and profit model— the insurers control the prescription drug prices— you are able to cover everybody for less. And so, we think that basic explanation, a uniquely American approach to guaranteeing healthcare for all that eliminates the high out-of-pocket costs that are creating such anxiety, that overcomes the concern that people may have.
MARC STEINER So a couple of quick questions here as we wind down, Michael. One of them is about the internal battle going on inside the Democrats around this issue and Medicare Extra for All. And what do you think the politics, how would you analyze the politics of this debate and what’s taking place?
MICHAEL LIGHTY The debate I think has been the same essentially since 1993-94 when it was perceived that the insurance industry in particular beat back Hillary Care. And ever since then, centrists, or what we would call neo-liberal Democrats, have said we have to accommodate the healthcare industry in order to reach universal coverage. But so far, that hasn’t worked and it’s not going to work primarily because we have a disagreement within the Democratic Party whether you can actually create a program through government that provides a sense of security for people. In this case, healthcare. The neo-liberal agenda says no, we cannot do that; the private interests are too powerful. They are too politically potent for us to defeat and so, we must accommodate them. But the problem isn’t healthcare. If you accommodate the industry, they’re in charge. People are denied care and we don’t solve the problem.
MARC STEINER So finally, the last question you’ll hear on this issue for today anyway, Michael, is if Medicare for all becomes one of the key platforms of the Democrats in the coming election. In the general election, if that actually happens, then you’re going to set up a battle royale again in this general election and the Republicans will, all the insurance care money, industry money, will be focused on defeating this candidate and this idea. So it becomes a question of perception and how you sell it and that to me will be key whatever happens in this election— beyond all the politics, ideology, and analysis.
MICHAEL LIGHTY That’s right. I think you’re exactly right, Marc. Here’s the problem. We have to make sure that any politician wanting to promote Medicare Extra, or Medicare for America, or some other scheme, that uses our tax dollars to subsidize private insurance, therefore must defend the practices of that industry: the denials of care; the $66 million that the United Health CEO earns annually; the $35 billion in profit the private insurers earned last year. You have, if you’re going to say I want to keep private insurance, then defend it. And those practices frankly, are indefensible from my point of view, but that’s what’s kind of defined the politics of this debate. Which side are you on— the profit and model of the private insurers, or guaranteeing healthcare for all people in this country? That to me is a debate we can win.
MARC STEINER Michael Lighty joins us. Always good to talk to you. Michael, thank you so much. Looking forward to more down the campaign trail.
MICHAEL LIGHTY All right thank you, Marc.
MARC STEINER Take care. Good to have you with us. And I’m Marc Steiner here for The Real News Network. Thank you for joining us. Take care.