National Improved Medicare for All Making Progress

In The Road to Medicare for Everyone, Jacob Hacker is once again working to dissuade single-payer health care supporters from demanding National Improved Medicare for All, and he’s using our language to send us down a false path. Hacker comes up with a scheme to convince people to ask for less and calls those who disagree “purists.” Hacker calls his “Medicare Part E” “daring and doable.” I call it dumb and dumber. Here’s why.

Hacker makes the same assertions we witnessed in August of 2017 when other progressives tried to dissuade single-payer supporters.

He starts with “risk aversion,” although he doesn’t use the term in his article. Hacker asserts that those who have health insurance through their employers won’t want to give it up for the new system. Our responses to this are: There is already widespread dislike for the current health care system; people don’t like private insurance while there is widespread support across the political spectrum for Medicare and Medicaid; there is also widespread support for single payer; and those with health insurance can be reassured that they will be better off under a single-payer system. It is also important to note that employers don’t want to be in the middle of health insurance. Health care costs are the biggest complaint by small- and medium-sized businesses and keep businesses that operate internationally less competitive.

Next, Hacker brings up the costs of the new system and complains that it will create new federal spending. He points to the failures to pass “single payer” in Vermont and California. First, it must be recognized that the state bills were not true single-payer bills, and second, states face barriers that the federal government does not, they must balance their budgets. Hacker ignores the numerous studies at the national level, some by the General Accounting Office and the Congressional Budget Office that demonstrate single payer is the best way to save money. Of course, there would be an increase in federal spending, the system would be financed through taxes, but the taxes would replace premiums, co-pays and deductibles, which are rising as fast as health insurers can get away with. Hacker proposes a more complex system that will fail to provide the savings needed to cover everyone, the savings that can only exist under a true single-payer system.

Hacker also confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long-term care, and doesn’t require co-pays or deductibles. The system would negotiate reasonable pharmaceutical prices and set prices for services. It would also provide operating budgets for hospitals and other health facilities and use separate capital budgets to make sure that health resources are available where they are needed. And the new system would create a mechanism for negotiation of payment to providers.

Finally, Hacker tries to convince his readers that the opposition to NIMA will be too strong, so we should demand less. We know that the opposition to our lesser demands will also be strong. That was the case in 2009 when people advocated for the “public option” gimmick. If we are going to fight for something, if we are going to take on this opposition, we must fight for something worthwhile, something that will actually solve the health care crisis. That something is NIMA. We are well aware that the opposition will be strong, but we also know that when people organize and mobilize, they can win. Every fight for social transformation has been a difficult struggle. We know how to wage these struggles. We have decades of history of successful struggles to guide us.

One gaping hole in Hacker’s approach is that it prevents the social solidarity required to win the fight and to make the solution succeed. Hacker promotes a “Medicare Part E” that some people can buy into. Not only will this forego most of the savings of a single-payer system, but it also leaves the public divided. Some people will be in the system and others will be out. This creates vulnerabilities for the opposition to exploit and further divide us. Any difficulties of the new system will be blown out of proportion, and those in the system may worry that they are in the wrong place. When we are united in the same system, not only does that create a higher quality system (a lesson we’ve learned from other countries), but it also unites us in fighting to protect and improve that system.

Hacker succeeded in convincing people who support single payer to ask for something less in 2009, and we ended up with a law that is further enriching the health insurance, pharmaceutical and private health care institutions enormously while tens of millions of people go without care. Now, Hacker rises again to use the same scare tactics and accusations that he used then to undermine the struggle for NIMA. This is to be expected. The national cry for NIMA is growing, and the power holders in both major political parties and their allies in the media and think tanks are afraid of going against the donor class. Social movements have always been told that what they are asking for is impossible, until the tide shifts and it becomes inevitable.

Our task is to shift the tide. We must not be fooled by people like Jacob Hacker. We know that single-payer systems work. We have the money to pay for it. We have the framework for a national system and we have the institutions to provide care. Just as we did in 1965 when Medicare and Medicaid were created from scratch, and without the benefit of the Internet, we can create National Improved Medicare for All, a universal system, all at once. Everybody in and nobody out.

We know that we are close to winning when the opposition starts using our language to take us off track. “Medicare Part E” is not National Improved Medicare for All. It is a gimmick to protect the status quo and convince us that we are not powerful. We aren’t falling for it. This is the time to fight harder for NIMA. We will prevail.