Why are liberals making such bad arguments for Medicare for All?
For some time now, the standard pro-Medicare for All refrain, when anyone asks about how it would be paid for, is “how come you don’t ask conservatives how war will be paid for?”
Just yesterdat, liberals seemed jubilant that celebrity Congresswoman Alexandria Ocasio Cortez is giving voice to just that line of argument. She asked on CNN how the US can pay for “unlimited war” but even question how a massive health care overall will be paid for.
At first glance, that appears to be a kill-two-birds-with-one-stone argument. It exposes the hypocrisy of conservatives who claim to be fiscally responsible but have no qualms about piling on debt when it comes to their priorities: tax cuts and war. Second, and I suspect more to the point, this line of argument is an attempt to focus the debate on the benefits of Medicare for All rather than what is likely to be a eye-popping price tag.
It is fine to draw attention to Republican hypocrisy. It’s also fine to focus on the benefits of a proposed system. But doing so as exclusively a way to avoid talking about the cost of such a system is a very bad idea for two reasons: first, it makes progressives into the thing we claim to despise: irresponsible borrow-and-spend hacks who don’t care about the fact that the interest on the national debt alone is already greater than any non-defense discretionary spending.
And secondly, the point about comparing health spending to war spending is one of the worst, least thought out, no good, very bad, terrible, horrible argument to make for anyone who actually wants to make a case for single payer health care. It is a dishonest argument.
Let’s take the second point first. Below are the figures of how much the US spends on each of these categories: war and Medicare.
In September 2018, Congress approved the latest defense budget, and it was a staggering, mindblowing $717 billion. Of this amount, $686 billion is allocated to the Department of Defense. And yes, for those of you about to bust outrage, this includes funding for the overseas wars (known formally in the budget as OCOs, or Overseas Contingency Operations).
Do you want to know what total Medicare outlays are presently? It is almost a dollar-for-dollar match with the total defense spending above. In 2018, total Medicare outlays were budgeted at $718 billion, and although of this $600 billion was actually incurred by the federal government - the rest was offset by premiums and copays paid by beneficiaries - under a plan that would eliminate individual premiums and copays, the figure for comparison would be the $718 billion.
This is just Medicare spending, by the way. It does not include state and federal spending on Medicaid, children’s health insurance program (SCHIP), subsidies on the Affordable Care Act exchanges, or the veterans administration. Those spending amounts are as follows:
Medicaid (state and federal, 2017): $557 billion
ACA Subsidies (FY 2019 projection): $58 billion
SCHIP (FY 2019 projection): $18 billion
VA health care (FY 2019 budget): $76.5 billion
That is a total health care spending of $1.43 trillion ($1.3 trillion if you exclude Medicare cost sharing). And that’s just government programs and subsidies, not including private health insurance, which Medicare for All also seeks to replace.
Yes, Medicare has a dedicated funding stream (namely a payroll tax), and so it doesn’t add to the deficit. But that doesn’t mean money isn’t spent.
By constantly drawing attention to defense spending and war, progressives are opening the door for Republicans and conservatives to tie health care spending to defense spending in order to embarrass us. It would be too easy for right wing conservatives to force a vote on limiting spending for Medicare for All to be no more than defense spending in any given year. It would be too easy because progressives themselves are stupidly making the argument that it should get the same funding priority and mechanism as war and defense.
It would be too easy to expose the invocation of defense spending and war spending as a fraudulent, dishonest argument in favor of health care spending because, let’s face it, that is exactly what it is: a dishonest, fraudulent argument.
We need to spend money no health care. However we reform and improve the system, we need to spend money. We need to control costs, but we need to talk about spending money. Liberals need to stop chickening out of the conversation about the cost of our proposals. We need to be excited about the benefits and be honest about the costs. As President Obama would remind us, the American people can be convinced of the need to invest if they can be assured that we are good stewards of their money.
Which brings us full circle to the first point: progressives should not be the “other side of the coin” to conservatives. The Left in this country should not be a mere counterpart to the Tea Party, equal but opposite in decibels, equally afraid to honestly discuss the costs of its vision. Progressives should not steal from future generations just because Republicans do, and progressives should not avoid tough conversations about costs just because it’s difficult.
If progressives do not set ourselves apart from the Republicans in both substance and strategy, the progressive movement will have only itself to blame for the American people losing their trust in government.
And that would be to the benefit of conservatives.
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