When South Bend, Ind., Mayor Pete Buttigieg released a list of the clients he worked for while at powerhouse consultant McKinsey a decade ago, one immediately leaped out to observers: Blue Cross Blue Shield of Michigan. After bringing the firm on, the nonprofit insurer downsized employees. When asked about it by MSNBC’s Rachel Maddow Tuesday night, Buttigieg denied having anything to do with those decisions, pointing out the downsizing came after he ceased working on that project. He then answered a question he wished had been asked. “What I do know is there are some voices in the Democratic primary right now who are calling for a policy that would eliminate the job of every single American working at every single insurance company in the country.”

There’s nothing like slamming rivals — in this case, Sens. Bernie Sanders and Elizabeth Warren — with a medical industrial complex talking point. (Buttigieg is not even the first to go there — Joe Biden’s spokeswoman Kate Bedingfield has also made the point in the past.) In parroting this argument, Buttigieg isn’t just cherry-picking facts to make the industry’s case. He’s pitting the needs of those who, in many cases, benefit from making the health-care system more difficult to navigate against the moral imperative of making it better for everyone.

Here are the facts: A study released last year found that it’s quite possible the health-care sector would lose between 1.8 million and 2 million jobs if Medicare-for-all became the law of the land. Many — though not all — of those positions would come from such patient service areas as claims processing and such hospital administrative services as medical bill coding.

These are not, in many cases, jobs that help keep people healthy. They are, instead, holders of positions responsible for deciding on the validity of your insurance claim, or ensuring the medical provider gets the maximum amount of money for it. They are, in other words, the foot soldiers in a system that is causing active harm to millions of other Americans — financially, emotionally and to their health. Despite the claim that we’ve got the best health-care system in the world, the typical American life span is falling. Polling shows 1 in 4 people with a chronic health condition reports a health insurer denied their claim and that people would, among other things, rather walk over hot coals, lose their luggage or suffer a flat tire than enroll in or review a health insurance plan.

Furthermore, Medicare-for-all doesn’t leave the people holding these endangered positions hanging. It’s all but certain, for starters, that some number of these people would transition into the new system to continue filling administrative needs. As for others, the Medicare-for-all legislation does offer downsized workers retraining, and that doesn’t even include Sanders’s initiative that would guarantee anyone who wanted it a job with the federal government paying at least $15 an hour. Moreover, there are jobs in the health-care industry that need filling now or in the future. Demand for home health-care aides to work with the elderly is surging, while other research points to a future increased demand for everything from doctors to nurse practitioners to lab technicians. Still other people would almost certainly pursue other positions — we live in a dynamic and ever-changing economy.

In other words, if your defense against Medicare-for-all is that you prefer our current system of a privatized, costly and highly inefficient jobs program that delivers inferior health-care outcomes, you should be up front about all that.

None of this is to say there will not be losses. There are some people who will have a harder time finding their footing again than others. But if you are going to draw the line and say that job cutbacks in the medical industry are unacceptable, you need to also address the issue of, say, taxi drivers who lost huge chunks of their income after Uber entered the market, small retail business owners whose lives were upended by online shopping and so on. While you are at it, you might want to also ponder other victims of economic and political change over the past several decades. Defense cutbacks after the Cold War ended led to major job losses in the defense industry, and many of those people ended up suffering long-term unemployment or underemployment. As Rep. Pramila Jayapal (D-Wash.) noted last month in Politico, “This happens every time there’s innovation,” adding, “It happens with movie cameras instead of still photographs. This is part of what happens as you make things better.”

But this stuff almost always goes unmentioned. The reason is obvious. Candidates such as Buttigieg, when they promote this line, are prioritizing our expensive, dysfunctional and less-than-humane health-care bureaucracy over the overall welfare of Americans. They need to be asked about that.

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