"The American people are pretty sharp!"

TUESDAY, OCTOBER 22, 2019

No distraction left behind: In this morning's column, Paul Krugman offers some basic words of caution about the politics of Medicare-for-all in an election year.

That said, we'll admit that we were provisionally puzzled, as we often are, by something in Krugman's second paragraph. The column started like this:

KRUGMAN (10/22/19): On Sunday, Elizabeth Warren said that she would soon release a plan explaining how she intends to pay for “Medicare for all.” Like many policy wonks, I’ll be waiting with bated breath; this could be a make or break moment for her campaign, and possibly for the 2020 election.

There are three things you need to know about Medicare for all, which in the current debate has come to mean a pure single-payer health insurance system, in which the government provides all coverage, with no role for private insurers.

As we've noted in the past, we've long been puzzled by the description of Medicare as a "single-payer" system. We've been puzzled because there are two major "payers" in the current Medicare system—the federal government on the one hand, and the individual health care recipient on the other.

Why call the system "singe-payer" when there are two major payers? Such matters are rarely allowed to intrude on our hapless American discourse.

That said, "Medicare for all," as formulated by Bernie Sanders, really would be "single-payer." Essentially, the federal government would pay the whole tab. Earlier this year, PolitiFact spelled it out:

GREENBERG (2/19/19): For individuals, there would be no costs—no deductibles, no copays or coinsurance. The two exceptions would be for some prescription drugs—though that would be limited to $200 a year—and possibly for long-term care.

[...]

Medicare for All is much more generous than the current Medicare program. Right now, the Medicare program is for Americans 65 and over; they receive care, but they’re also responsible for part of the costs. Unlike traditional Medicare, Sanders’ Medicare for All would cover medical bills completely, with no burden on the patient. There would be no Medigap insurance or Medicare Advantage.

Presumably, this explains why Krugman refers to "Medicare for all" as "pure single-payer." That said, how many voters understand such matters?

Not too many, we'll guess. As a nation, we spend all our time discussing whatever Donald J. Trump most recently said, preferably in the last fifteen minutes.

Today, the thing Trump said in the last fifteen minutes involved the fraught term "lynching." In response, everyone has swung into action, from Whoopi and Newt on down.

In theory, Medicare-for-all would be a dream in certain major respects. As with the financing of public schools, so too here—there would be no charge to the individual who received some medical treatment.

That doesn't mean that MFA isn't tricky as a political proposition. Krugman explains some of the problems—and eventually, he also says this:

KRUGMAN: An independent estimate from the Urban Institute (which is, for what it’s worth, left-leaning) suggests that a highly comprehensive Medicare-for-all plan, similar to what Sanders is proposing, would substantially increase overall health spending, although a more modest plan wouldn’t.

Why did we stumble over that? Here's why:

On the one hand, it makes perfect sense to read that Medicare-for-all would "increase overall health spending." If everyone is covered, and no one has to pay anything out of pocket, it stands to reason that many more people would receive many more medical services.

On the other hand, there's this:

At present, we already spend two to three times as much on health care, per person, as any comparable nation. In the abstract, it's hard to believe that a competent overhaul of the health care system might not be able to reduce overall spending.

That said, the question of America's massive health care spending is virtually non-existent within the American press. Donald J. Trump said "lynching" today! The children are struggling with that!

"The American people are pretty sharp!" Plainly, it's the oldest song in the nation's political song book.

Except we actually aren't pretty sharp, or so the anthropologists tell us, at least not when it comes to conceptual matters like this.

Our most brilliant elites are in charge of this game. As Donald J. Trump seems to know full well, few distractions will be left behind!