Tuesday, July 31, 2018
Eugene Debs won 6% of the vote when he was the Socialist Party candidate for president in 1916, and he still won 1% when he ran again, from Federal prison, in 1920. For American socialists, it was downhill from there. Although FDR appropriated some major chunks of the Debs platform in his response to the Great Depression, and although Americans ignored the "socialist" label when LBJ introduced Medicare, it took Bernie Sanders to make socialism almost respectable again. Almost. When it comes to selling a policy, what you call it still counts for a lot.
"Medicare for all" has a nice ring to it. People like Medicare, so calling government sponsored health care "Medicare for all" makes it a lot more appealing than calling it "single payer" (too dry) or "national health care" (too European) or, heaven forbid, "socialized medicine." "Medicare for all" it is, then! Beyond that, it will be far easier to extend an existing system than to create a new one from scratch, so "Medicare for all" may have to be more than a politically palatable label.
The main obstacle to universal Medicare, though, is that most people don't need it. Most Americans have medical insurance through their employers, their benefits often are considerably better than those offered by Medicare, and they assume Medicare will be there for them when they retire. How, then, can today's socialists garner popular support for national health insurance?
The simplest answer is to sell Medicare coverage to employers, in direct competition with private insurers. Not required to turn a profit, Medicare can undercut private competitors; and as it grows, economies of scale would make it even more competitive. The risk pool of Medicare's users would become younger and healthier, and the new cash flow would alleviate the problems of finance that Congress fails to address. Mass enrollment also would create pressure to improve Medicare benefits, which currently are less than generous.
Contrary to popular opinion, socialists do not have to be oblivious to the power of markets; they do not have to be visionary idealists divorced from economic realities. They do have to be committed to democracy, though — because in any economic system, only the power of the many can constrain the corrupt avarice of the few.