In 2017, I wrote a column suggesting that Trump might score politically by supporting such an agenda. Conservatives in Taiwan in the 1990s reversed their hostility to single-payer and took advantage of it politically, stealing a major problem from the liberal platform. The same could have happened here.
Republican politicians had long opposed single-payer insurance. But they have repudiated their previous support for free trade and opposition to tariffs under Trump’s leadership.
Medicare For All’s case is strong, but it is complicated. It would take real leadership to convince voters that this is a good idea. Whatever one might think of Trump, he was a marketing genius who could have sold the idea to the country.
Trump had promised to replace Obamacare with a much better system that would cover everyone. Medicare For All would do just that, but establishment Democrats had pulled themselves into a corner promising not to raise taxes for most Americans, which Medicare For All would demand. Most Republicans had painted themselves into a similar dead end by taking the “Norquist Pledge” of never raising taxes.
But most people are only interested in the bottom line. Almost everyone’s higher taxes would be more than offset by their increased wages once employers no longer provide their insurance. Trump could have insisted that Congress demand that every dollar no longer subtracted to pay for a worker’s insurance be added to their salary.
Trump, who excelled in garnering national attention, could have pointed out how vested interests exploit two important facts to confuse voters about their interests:
Fact 1: Workers insured through their jobs think it’s paid for by employers. But the money employers pay for insurance is just a portion of their labor costs, subtracted from the pool from which cash wages are paid.
Workers therefore indirectly pay for this insurance themselves. But this large sum of money is invisible to them because the dollars they pay never pass through their hands.
Fact 2: The tax increase required by Medicare For All would be fully visible to workers, even if it would be less than what they were paying before due to Medicare’s administrative efficiency.
For workers who don’t know how much they are currently paying, albeit indirectly, Medicare For All therefore looks like a terrible deal.
Medicare For All would serve three important conservative values:
Efficiency and saving money: It now costs each doctor between $80,000 and $100,000 a year to bill multiple insurance companies with complicated policies, an administrative expense that is reimbursed by insurance and drives up his cost. But under Medicare, providers’ administrative costs are much lower because they only have to bill one insurer.
Simplicity: Obamacare is terribly complex, and people with fluctuating incomes often “rotate” between different insurance programs. Any medical policy without a single payer adds governmental complexity and imposes impossible choices on individuals because it forces them to decide which insurance policy to buy without having the necessary information to make an intelligent decision.
Competition: Single-payer insurance would not create a government monopoly on the provision of medical services. There would always be competition between suppliers, especially if they were forced to stop keeping their prices secret. (How can comparison shopping work if people can’t know what something will cost?).
The first step to getting Medicare For All must be to convince people that it would save them money and protect them against losing their insurance if they become unable to work. As president, Donald Trump would have been in an excellent position to make this sale.
Note to job-insured readers: To find your salary increase under Medicare For All, see line 12 (code DD) of your annual W-2 form.
— Paul F. deLespinasse is Emeritus Professor of Political Science and Computer Science at Adrian College. He can be reached at [email protected].
Paul F. de Lespinasse