Thrilled to see the excitement over the Medicare-For-All bill introduced yesterday. I support universal healthcare and am happy to see Bernie Sanders continue the fine work of people like Ted Kennedy, Hillary Clinton and especially John Conyers, who has been proposing single-payer, Medicare-for-All type legislation since 2003. The Trump administration has not advanced any meaningful policy, just worked to roll back protections we put in place for the climate, for women, for immigrants, for campus rape victims, for senior citizens, for student debt holders, for minority voters, and for children, so it’s fun to have some actual policy to write about for a change instead of just having to scream about how it’s not really cool to hurt people for corporate profit, or even worse, no reason at all except fear and loathing.  

This bill offers some of the most comprehensive coverage of any government-sponsored health care system in the world, covering all doctor visits, specialty or primary, all hospital stays, basically everything including dental and vision, and all free at the point of service. These are lofty and admirable goals that would certainly make life easier for people who use the healthcare system if implemented well.

I do understand, and expect the senator does as well, that this current bill is not meant to become law (there is currently no activist push to get Republicans on board, just Dems), and is more means of moving the conversation forward, and also a litmus test for Democrats, a way to determine whether or not they are “on board” with single-payer. This sort of political theater is normal and expected, but not of much interest to me, especially since my senators already back the legislation. This is not to say I disapprove, I’m sure this kind of thing is both necessary and effective. It’s just not all that interesting to me.

What does interest me is policy and health care. I would very much like to see Senator Sanders succeed where others have failed and see the US adopt a system where equal, affordable, comprehensive coverage is available for everyone regardless of their standing. Here are the issues I see that need to be addressed to properly implement a system like this. I hope the senator and his policy folks can find a way to address these needs and put together a serious proposal.

First and hardest is the upheaval to the health insurance industry itself. It’s easy to think of the insurance industry as faceless corporations and evil CEOs, but there are over half a million people (500,000) in the health insurance industry, most of them just regular workers banging out a wage. What happens to those people if their industry goes away needs to be addressed, and there’s too little talk about how to do that. The main criticisms of coal regulations (one example) have to do with the jobs lost that were never replaced. One would think it would be easy to find better jobs for people than slogging away in a coal mine, but it’s something we failed at, and that failure dominates much of the conversation. This is also a big failure when it comes to some of our free-trade agreements, where low-wage jobs lost weren’t adequately addressed. I made the mistake of pish-poshing this point when discussing coal regulations and free-trade years ago, dismissing it as the price of progress. We should not make the same mistake now. It’s not just a political trap. There are real human beings involved here too.

Second, and almost just as hard as the first, is addressing the shortage of resources. We’ve been facing a shortage of health care professionals that drives up costs and waiting times. We just can’t make doctors and nurses appear out of thin air. I don’t have many ideas here, but it’s an important issue that has gotten even less attention than insurance industry job losses.

Third is the issue of getting rising health care costs under control. Some of this would be alleviated by the stronger bargaining leverage over providers afforded by a single-payer system, but given the stratospheric rise of costs recently, it’s almost a certainty that more should be done, and we need innovative solutions.

Last, and by far easiest, is paying for it. I have read the white paper, and the numbers don’t really add up. Which is fine for a bill that is not meant to pass. I understand why there is no payment system committed to here. At least some of the provisions used to fund the bill will be unpopular with at least some people, and there’s no need to commit to unpopular policies and give critics of the bill’s supporters attack ammo. But without some kind of structure in place or any numbers to point at, opponents will just be able to scream about massive tax increases they make up out of thin air and proponents will not have much ammo to fight them with, and there is no practical way to advance the bill politically when it gets to the stage of debating the nitty-gritty.

Look, we all know the money is there. There is no shortage of money. But we still have to show our work on that.

It’s like this:
Waitress: Here’s the check.
You: This is no problem, I have plenty of money.
Waitress: So, cash then? 
You: I’m sure the people here don’t mind kicking in.
Waitress: So you’ll be splitting the bill?
You: There are a number of different options.

See, eventually you have to put something in the little black folder.

Thanks for reading.