Notes on the debate

Kudos to the ABC/Univision moderators of Thursday's debate, whose questioning of the Democratic candidates was immeasurably more professional than that of the moderators from MSNBC and, especially, CNN.  As I watched, I wondered if their professionalism reflected the older, more traditional ethos of broadcast news, rather than cable's appetite for drama.  The next debate is back on CNN, in cooperation with the New York Times.  One hopes that the Times will serve as a moderating influence – or that CNN will have learned from its mistakes.

Joe Biden was better rehearsed in his talking points this time around; but by hour two, he seemed to be tossing out talking points at random, shifting subjects midstream.  Why anybody thinks he could hold his own against Tr*mp is a mystery to me.  Contrary to popular (and pundit) opinion, I sincerely believe he is the weakest contender the Democrats possibly could nominate.  It's not his age, necessarily.  Biden's entire political history is replete with gaffes, missteps, and confusion.  Frankly, I think he's just not smart enough to win.

Elizabeth Warren and Bernie Sanders did better this time at explaining how universal health care can be funded, but they still haven't nailed it.  Sanders correctly observed that US health care is twice as expensive per capita as Canadian health care, and Warren emphasized total cost to families and the profits taken out of the system by private insurers; but neither produced the kinds of sound bites favored by TV – so the message won't go out as it should.

Socialism Redux?

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.

Medicare for All?

It's obvious that Bernie's "Medicare for All" bill is not about to become law, but that doesn't make it an exercise in futility.  It is a means for ambitious Democrats to define themselves as progressive, not slaves to the party establishment.

The single greatest obstacle to national health insurance is not Republican or industry opposition – it is employer provided health coverage.  As long as most Americans have that, they will not be especially concerned for those who do not; so public pressure for national health insurance never will be sufficient to bring about change.

There must be a means to transition from employer provided insurance to public insurance – and the most direct route begins with allowing employers to purchase Medicare for their workers.  This "free-market" approach would put a government-run program in direct competition with private insurance.  Profit-free, Medicare should have a competitive advantage; and by introducing younger, healthier participants into its insurance pool, Medicare should become more economically viable.  The new money in the system also would make the prospect of future cuts in benefits or increased premiums less likely.

The impact on the private insurance industry would be gradual, as employers switched over.  Since Medicare is far from a "Cadillac" plan, many employers also would shop private markets for supplementary, further softening the impact on the industry.  Over time, there would be plenty of public pressure to improve the coverage that Medicare offers, and to offer Medicare as an option in the ACA insurance markets.

Once a majority of Americans already are covered by Medicare, it would be far easier to find support for universal coverage, paid for by a combination of individual and business taxes.  Here in the USofA, "creeping" socialism is the only kind that ever wins the race.