This week, Bryce beamed into CNN to keep up the momentum — and ran straight into a question about whether he, like a growing number of Democrats, supports European-style universal health care.“You want to raise $32 trillion in taxes?” asked CNN’s John Berman.“There’s a lot of people not paying their fair share in taxes,” Bryce said. “There’s corporations getting away with a lot.”“That would be quite a tax hike,” said CNN’s Poppy Harlow. “That’s an astonishing number, $32 trillion over a decade.”
Ugh. We saw a similar discussion in 2016 around Bernie Sanders’ single payer plan, and while I had numerous criticisms of that plan, this is the single dumbest response to single payer that you could possibly come up with. We shouldn’t be surprised to hear it from Republicans — if there’s an enormous number they can toss around while screaming “Democrats are gonna raise your taxes by a zillion percent!” they’ll do it. But no self-respecting journalist should fall into the trap of repeating something so inane.
There is simply no critique you can make of single payer health care that is more wrong than “It’ll be too expensive.” That is 180 degrees backwards. Single payer is many things, but above all it is cheap. And what we have now is the most expensive system in the world, by a mile.
If we were to institute some kind of single payer system, what we’d be doing when it comes to money is changing how we pay for health care. But when you say, “Hoo boy, it would mean trillions in new taxes!”, you’re acting as though we’d be paying all those taxes on top of what we’re already paying. But of course we wouldn’t.
Let’s look at what we’re paying now. In 2016, we spent $3.4 trillion on health care. That spending is projected to rise an average of 5.6 percent per year over the next decade. If you do the math, that means that between 2018 and 2027 we’ll spend $49 trillion on health care in America. That’s the current system.
That $32 trillion number the CNN folks are tossing around comes from an analysis of the Conyers bill, which is basically a placeholder — it’s only 30 pages long, which for bill texts is like an executive summary of an executive summary. If we get to single payer, the Conyers bill won’t be it. Nevertheless, Republicans have seized on the $32 trillion number to scare people into thinking that Democrats want to raise their taxes some insane amount (“When you look at the majority of House Democrats, they support a single-payer, $32 trillion bill backed by Bernie Sanders,” says Sean Spicer). But if we’re going to spend $49 trillion under the current system, and single payer would cost $32 trillion, doesn’t that mean we’d be saving $17 trillion? Congrats on all the money you’d be getting back!
It wouldn’t work out that way precisely, of course. But the point is, if we were to shift to a single payer system we’d be changing how we pay for health care, not just paying more. Right now if you’re like most working-age Americans, you pay thousands of dollars every year to insurance companies. If we switch to a primarily government-funded plan, you’d pay for it with taxes, but you’d be relieved of what you now pay to insurers.
But Republicans would like you to believe that any cost of single payer would be on top of what you already pay, which is completely false. Now here’s the truth: Republicans don’t object to single payer because it’s expensive, because compared to what we have now, it isn’t. Their objection is philosophical: they don’t think it’s government’s role or obligation to provide health insurance.
We should have a robust debate about whether it is or not. But Republicans don’t really want to have that debate, because the last few months have proven something that chills them to the marrow of their bones: Americans like government health coverage. Medicare is spectacularly popular, and it turns out Medicaid is popular, too. Most people have no problem going on a government health plan, if it provides good benefits. They don’t think that being kicked off Medicaid makes people “free.” They aren’t hoping for some glorious Randian future where the noble rich get health coverage and the weak and sick are left to their own devices. That may be Paul Ryan’s fantasy, but for most people, it’s a nightmare.
There are two more points I’d like to make about single payer as a policy and political matter. The first is that “single payer” is not well defined, and people use it to refer to a range of very different health systems. In a pure form, it would mean that the government pays for all health care and there are no private insurers; Great Britain’s system is the one that comes closest. But there are very successful systems that achieve universal coverage and have a role for private insurers, whether they’re hybrid systems built on a basic government plan that covers everyone but that also include private supplemental insurance (as in France), or systems built on private but tightly regulated plans from which everyone chooses (as in Germany).
As Democrats start advocating more strongly for single payer, they need to think seriously about which of these systems they favor and how to get from where we are now to there. I’d prefer a hybrid system built on an expanded Medicaid, but there are arguments to be made for each of them. Any Democrat who says “I’m for single payer” should be prepared to answer the follow-up question, “What kind?”
Second, Republicans are going to try very hard to scare Democrats into retreating into a milquetoasty vagueness on this issue, particularly in 2018. Right now Democrats are debating among themselves about whether it’s more important to just be anti-Trump or to have a clear and identifiable agenda voters can understand. The answer is: Yes! Being anti-Trump is incredibly important, particularly to 2018, since success in midterm elections comes from turning out your base. But those base voters also need to know that Democrats know what they want to do the next time they have the power to enact their own policies, and voters in the middle need a sense of what their agenda is.
The nice thing about single payer is that unlike previous Democratic health care reforms, it’s not that hard to explain. But if they’re going to get the chance, they’ll have to bat away some bogus attacks from Republicans — and, sadly, from the news media too.