The fact that those pictures are so often unrealistic is why they’re so easily punctured by raising the possibility that there might be trade-offs in making change. Wait, you mean if we want universal child care, we’d have to pay for it? Like with taxes? Ugh, forget it.
But here’s the truth: Not only does complicated policy change always come with trade-offs, so does the status quo.
Let’s take health care. Here’s an argument that candidates who oppose Medicare-for-all make to union audiences:
Of course, 160 million people didn’t walk picket lines; Biden conflated the overall number of people with private insurance with the much smaller number of union members who have negotiated for strong health-care benefits.
But he’s right about one thing: Many unions have indeed negotiated for excellent coverage, and union members are wary of giving it up.
The response of Medicare-for-all advocates is usually that if employers didn’t have to cover those costs, they would return the savings to employees in the form of salary or other benefits. Which they might, but there are no guarantees, and if you’re lucky enough to enjoy one of those gold-plated plans, it’s possible that you could wind up with insurance that’s not quite as generous as what you have now.
We should be able to acknowledge that in achieving universal coverage, there may be some number of people who lose out in some way — not in a catastrophic way, but perhaps by getting a plan they’re somewhat less happy with than what they have now.
To say if that’s true, then the whole thing isn’t worth doing, you’d have to pretend the status quo doesn’t come with trade-offs. But it does. And those trade-offs are absolutely massive.
You have the “freedom” to get insurance from a number of private companies (though in practice, your boss probably chose your insurer for you and chose what plan you’d get). But in exchange, there are tens of millions of people without coverage, people face premiums and deductibles that keep going up, and fully a third of Americans say in the past year, they or someone in their family has put off a medical treatment because of the cost.
Those are just some of the features of America’s current system that people in other countries find mind-boggling. There’s also the idea of “medical debt,” the fact that hospitals routinely sue patients, the joy of “surprise billing” and the fact that if you get a cancer diagnosis, there’s a good chance that you’ll wind up declaring bankruptcy.
Perhaps we don’t think of them as trade-offs because there was never a moment when we decided that we’d accept all that if it meant we could have the good things about our health system, such as ubiquitous imaging centers and the warm feeling you get from knowing that your orthopedic surgeon must be really good if he makes $600,000 a year.
Let’s consider one more trade-off that’s often mentioned by those working against reform. There are lots of people who work in the insurance industry and who wouldn’t have much to do if we went to a single-payer system with a much more streamlined bureaucracy. According to one study, a single-payer system would eliminate the jobs of 800,000 people in the insurance industry and an additional 1 million in the rest of the health-care industry.
This has come up recently with Pete Buttigieg, who has been criticized for his work at the McKinsey management consulting firm, where he may have helped Blue Cross eliminate workers. His answer: “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.”
As Helaine Olen points out, Buttigieg is “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.”
It’s an argument that parallels the one Biden and others make about union health plans: These folks over here have it good, so we can’t threaten what they have even if it might be better for the rest of us. The trade-off of too much change is unacceptable.
Now to be fair, Biden and Buttigieg would argue that their preferred reform, an expansive public option, would involve fewer and more preferable trade-offs (though a public option would cost plenty of industry jobs by drawing millions of Americans away from private insurance and toward the government plan).
What we shouldn’t forget, however, is that whichever idea you prefer, the absolute worst set of trade-offs comes with the status quo. That’s the one that’s ruining people’s lives by the million.