Monday, October 21, 2019

Fair Is Fair


In a superb article about the politics of taxation, Huffington Post's Arthur Delaney notes "the tax question" posed about health care at the Democratic presidential debates :ignores the underlying math" and is a terrible question because it

is a trap, premised on the idea that raising taxes is always bad politics. The moderator already knows the candidate’s position. Both the moderator and the candidate believe that answering with a simple “yes” would launch a thousand Republican attack ads. Not answering doesn’t work either. After the September debate, TV analysts and the Republican National Committee bashed Warren for not disavowing taxes and not embracing them.





Bernie Sanders was a little more forthcoming in Westerville (Ohio), acknowledging that "taxes" will "go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less -- substantially less than what they were paying for premiums and out-of-pocket expansions."

One can already anticipate the response of presidential nominee Sanders to a GOP ad attacking him for pushing higher taxes for the middle class. But "they won't go up as much as for the wealthy" won't cut it for an income tax-phobic public.

Nonetheless, "how would you pay for it" is a legitimate question- or rather would be, were it asked of all candidates about their health care plan. Someone who knows a lot more about business economics and health care than almost any of us

Of course, it wouldn't put as much of a strain on national health expenditures as would Sanders' "Medicare for All," which is (albeit not known as) single-payer health care. If it were truly paid for by the public, it's unlikely that- notwithstanding what critics claim- people would prefer to stay with their insurance company.

Buttigieg/Klobuchar/Biden (in descending order of clarity) favor any an expansion of Obama care with any combination of public option/Medicare for those who want. We don't know exactly what they're advocating because they, with media allies and the health insurance industry, have put Medicare for All advocates- primarily Sanders and Warren- on the defensive.

But in stating (or implying) that all Americans should be insured, the center-left candidates are advocating reform of the Affordable Care Act (Barack Obama's great legacy, if we are to believe them) by expanding public subsidization of health care. Therefore, there inevitably is- as Dayen notes- significant cost to taxpayers.

In the rush to undermine single-payer by denigrating even the thought of eliminating health insurance companies, journalists and other pundits appear to have chosen not to ask the culturally liberal, economically conservative Democrats how much their plans would cost.

If it gets us to universal health insurance- as they'd have us believe- the overall costs to an average American would exceed whatever they would be for Medicare for All because of the continued existence of insurance companies and the wealth of paperwork.  Somehow, however, I have my doubts that this presumed goal would be met.  Two weeks ago, the New Republic's Libby Watson criticized President Trump's recently-signed executive order which

directs HHS to study raising the prices paid by Medicare “to more closely reflect the prices paid for services in [Medicare Advantage] and the commercial insurance market,” which reimburses providers at a far higher rate than Medicare does. The goal is, according to the order, to “encourage more robust price competition, and otherwise to inject market pricing” into Medicare fees....

This particular proposal would be great for hospitals and other health care providers, who would stand to reap greater profits. It would be terrible for everyone else. Medicare premiums would have to rise to cover these costs. There is no sense to raising provider rates to reflect what private insurance pays, because those rates are stupidly inflated and, for that matter, deeply opaque: The public does not know what private insurance pays.

This still could be Medicare for All, as Buttigieg proposes, or be branded a "public option," as Klobuchar and Biden advocate.  Thus, as a matter of simple fairness, the major candidates should be asked whether they agree with Trump's executive order and their reasoning.

Bernie Sanders and Elizabeth Warren already have made clear their alternative.  And if the Massachusetts senator is being called upon to pinky swear that she won't raise taxes on the middle class, the trio of insurance company apologists (and the other candidates) must be asked about the costs of their own  ideas. 



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