Will Covid-19 change the politics of our health care reform debate? Yes? No? Maybe? I’m mildly optimistic. If this scourge cannot change our thinking about our neglected public health system and the limitations of an employment-based health insurance scheme, then what good is it!
A year ago, when candidates began entering the Democratic primary and staking out their positions on health care reform, they quickly divided into two camps: some version of Medicare for All or some version of Fix Obamacare. Although I have campaigned for single-payer reform in the past, in recent years, I held back and planted myself in the Fix Obamacare camp.
Bear with me while I explain. I think linking our health insurance to our current employment is absurd. Once upon a time, when people worked for the same employer for decades, then retired into Medicare, this scheme worked even if it didn’t make a lot of sense. The only people this works for today are union workers who might switch employers but stay with the same union health plan for decades. Everyone else is either changing employers every few years, or working for a small business that can’t offer generous benefits, or self-employed with no benefits at all. And today, of course, we have millions newly unemployed who are in their own stew.
My other reason for supporting Obamacare was my observation of how successful Republicans have been at discrediting the whole concept of government, something that I view as essential in modern society. When people trust private health insurance companies, whose incentives are skewed toward profit, more than their government? Well, something has gone awry, but we cannot ignore that fact. It’s true that many polls report widespread support for Medicare for All, and I find that encouraging. Still, I worry about a plan in which the government, rather than private insurers, becomes the only gatekeeper, and therefore responsible for every bad outcome resulting from delays or denial of coverage.
The cost of Bernie’s Medicare for All plan used to be a concern, but one thing I’ve learned from our novel coronavirus is that deficit spending is not the problem I thought it was. Maybe we have to pay for things eventually, or maybe not. In any event, running a deficit to cover the change over to M4A isn’t the impediment I thought it might be.
Should I now be optimistic? Surely, the absurdity of employment based health insurance will now be obvious to all. If Democrats cannot make the case for de-linking health care and employment after this economic meltdown… Well, they will. Our friend, the virus, could also remind people that government is actually essential, even if imperfect.
It also ought to be possible to make the case now that our current expectations regarding health insurance have moved way beyond the basic concept of insurance, i.e. something we buy to protect against rare, catastrophic losses. People have learned painful lessons about health plans with high deductibles. These plans actually resemble old-fashioned insurance. They expect people to pay for lesser expenses themselves, but kick in for major expenses that exceed the deductible.
The problem is that people don’t go to the doctor if the visit is not covered. They don’t budget for these expenses, they don’t see these lesser expenses as their responsibility; they just get angry at the deductible. It’s the high deductible that makes the plan “affordable,” but avoiding doctors for minor problems can sometimes result in much bigger problems.
I think these lessons learned during our years with Obamacare, plus the obvious flaws of employment-based insurance could dramatically alter the debate about how best to provide health insurance to all. Yes, fix Obamacare, then tackle the details of Medicare for All. If we can thank the virus for anything, surely it’s the realization that we must cover everyone, for our own sake.