Candidates, pundits, and debate moderators have identified the continuing existence of private insurance as the core issue dividing fundis from realos on Medicare-for-all. The real question is much broader than that–it is risk aversion, as shown in the following questions:
- I SAW WHAT HAPPENED WITH THE ROLLOUT OF OBAMACARE. I’M OLD AND SICK, AND I CAN’T AFFORD ANY INTERRUPTION OF SERVICE. WHAT HAPPENS IF THE SAME THING OCCURS ON A FAR GRANDER SCALE WITH THE NEW SYSTEM? I would love to reassure you on that point, but, hey, to err is human. In the long run, the inevitable administrative problems will be resolved, but in the long run, we’re all dead.
- I’VE BEEN PAYING INTO MEDICARE MY WHOLE LIFE. HOW DO I KNOW THAT MY TAX MONEY WON’T JUST BE SHIFTED TO PAY FOR MILLENNIALS WHO NEVER PAID A DIME INTO THE SYSTEM? That isn’t Bernie’s plan, but once the process starts, you can never really know for sure where it will end.
- I DON’T TRUST THE GOP. HOW DO I KNOW THEY WON’T CUT THE QUALITY OF CARE TO FINANCE SOME NEW TAX CUT? That would be risky and unpopular, but let’s not pretend it couldn’t happen. The NHS gets cut occasionally, and the GOP historically gets away with hurting its constituents for the benefit of the donor class by ratcheting up the culture war.
- I HAVE EMPLOYER-BASED INSURANCE. HOW DO I KNOW THAT MY EMPLOYER WILL ACTUALLY USE HIS SAVINGS TO INCREASE MY WAGES? That’s the theory, but it actually depends on how much bargaining power you have. If we’re in a recession, or your job can be shipped overseas, there are no guarantees you will see any of that money, and you could wind up worse off financially, after taxes, than you are today.
- IS A SYSTEM WITH FEW OR NO CO-PAYS TRULY REALISTIC? The Sanders proposal is much more generous on co-pays than other existing single-payer programs. Based on that, you can probably count on them to be increased significantly over time.
The bottom line is that the public has plenty of good reasons to be concerned about the government’s ability to deliver on Bernie’s promises. That’s the hurdle he has to overcome; it isn’t that everyone is in love with private insurance.