You need to get this out in front of Democrats ASAP. And then they need to spend some serious $$ to tell the truth and debunk the upcoming lies from the gop.
It won't matter. The Democrats are constitutionally incapable of effective, impactful messaging. That's why the republicans have controlled the political narrative in the U.S. since the days of Reagan. republicans suck at governing, but they know how to create short, simple messages that resonate with the voters. (Just ask MAGA.) If the Dems ever learn how to message effectively, they'll never lose another election. They need to stop listening to overpaid campaign consultants and start listening to the American people.
The Democratic Party is a loose confederation of interests that will never coalesce around a unifying message. Better to attack Republicans with the same savagery they display.
First (and FWIW), I agree with Paul. Second, if I proposed this on some left-leaning social media site, “progressives” and M4A advocates would excoriate me as one or all of a centrist, an incrementalist, an appeaser (really), a corporate Democrat…you name the progressive epithet and it would be trotted out.
Less hospital use saves $. Medicaid for ALL kids regardless of income will save $ cuz if kids are sick (VS adults) & don't have a MD, parents take 'm to ER. If all kids had Medicaid, schools could post team costs (PT,OT,SP) to it saving local $ & serve elders in school clinics.
Feds can add to Medicare or Gov's can use Medicaid waivers to give homecare to all in place of NH's. W 1,290,000 Americans in NHs it would save $160,000/ person/ yr over NH costs + $ for less meds & less hosp for infections & drug-ind illness or potentially $206 billion per yr.
An observation and a question. Observation: I don’t think Lieberman was only motivated by spite; CT is I believe the location of the headquarters of several major insurance companies? Question: I wondered about this with Krugman’s column also. Why are you advocating a public option for Medicare rather than Medicaid? My understanding is Medicaid is generally more efficient, mainly because it’s not polluted by Medicare Advantage (ie private insurance rip-offs). Medicaid makes more sense to me, but maybe I’m missing something. Otherwise completely agree with you.
A Medicare buy-in has to tackle one glaring defect of Medicare that has so many people buying in to Medicare Advantage plans that just allow insurers to suck money out of the system. Regular Medicare has no out-of-pocket maximum. So if you get a major health issue you can be on the hook for countless thousands of dollars, whereas with Medicare Advantage I have a max out-of-pocket limit of $3,400/year. So I never have to pay more than that. If regular Medicare would institute a reasonable maximum out-of-pocket limit, it would go a long way toward cutting Medicare Advantage insurance companies off at the knees. I strongly suspect that their lobbying may well be the reason why Medicare never instituted a max OOP limit.
well, "not polluted by Medicare Advantage" sounds like a good place to start. Medicare is a better plan because it is (was) paid for by the workers themselves: insurance for predictable basic needs. Medicaid is welfare and a bureaucratic nightmare. Lieberman was a politician and a "moderate" aka fifth columnist.
Medicaid is even more privatized at this point than Medicare. Three quarters of Medicaid recipients are covered by managed care organizations operated mostly by private insurance corporations. These MCOs get our taxpayer money as a fixed amount per enrollee. The incentive to deny and delay care is obvious. This is similar to Medicare Advantage, which has only managed to capture about 54% of Medicare recipients. Medicaid’s payments to providers is also substantially less than Medicare’s.
Paul, great analysis and recommendation as always. I would tweak your idea just slightly. Lower the age of Medicare qualification to 62 to align with Social Security and automatically enroll every child at birth through 18. Everyone else can buy in at the ages in between. This would be SUPER popular and easy to understand and implement.
I'm struck not so much by the substance of the idea (though it is excellent and politically feasible), but by the semantics. Democratic politicians wouldn't have to utter those damning words, "Medicare for all," when talking about it (looking at you, Jeffries).
Paul, there's a central fact here that nobody's talking about, but which is the core of the whole argument. It is this:
Over (perhaps WELL over) two-thirds of ALL US healthcare spending is made with taxpayer dollars. Our money. WE are the ones paying all these "private" bills.
We don't have a "private" healthcare system. We have a system that funnels vast amounts of tax money into private corporate pockets, while incentivizing them to deny us care every way possible. The gap between what Americans are paying for through their taxes and what we (don't) get in return explains almost the entire vast difference between our costs and those of virtually every other developed nation.
The math's not complicated. Add up Medicare, Medicaid, SCHIP, active-duty military care, the VA, Tricare, and the assorted smaller systems that treat groups like prisoners and Native Americans. Add in all the millions of federal, state, county, and municipal employees whose care we cover. (Most of them are on private plans, but we're still picking up the tab.) Then add in the tax deductions that corporations take for the money they spend on employee plans -- another way we're subsidizing health care.
If "socialized" is another word for "something the government pays for," then we passed the state line into socialized medicine a long way back there. And we are not getting anything close to our money's worth.
One way out of this is to simply be a lot more explicit about this -- and to claim the prerogatives that should accrue to the person who's writing the checks. "If you are getting healthcare paid for by the taxpayers, then we the taxpayers are going to insist that you get it from a system that we are in control of. We are no longer giving our money to privateers." It's one easy rationale for putting all of the folks I listed above on Medicare, making that the first step toward Medicare for All.
Mr. Waldman, you wrote that "everyone knows what Medicare is, and almost everyone loves it. Which is why it would be extraordinarily difficult for Republicans to argue against." I would beg to differ. republican politicians HATE Medicare and are planning to destroy it, starting next year, if they somehow manage to cling to power in Washington after the mid-terms. Mike Johnson has already told us that they're coming after Social Security, Medicare, and Medicaid. They aren't even hiding it. It's why our first order of business is not to roll out a new healthcare option: it is to elect Democrats up and down the board in the mid-terms. That's the only way to protect what's left of Medicare. And frankly, it's the only way to protect what's left of American democracy. Trump and his republican flying monkeys are rapidly destroying everything good about this country. If we don't stop them in November, we can forget about healthcare plans or anything else. We won't have a constitutional republic left if we allow republicans to remain in control .
About 10 years ago when Du Pont sold out (split into 3 companies) they also changed my fully covered insurance (full retirement) to a yearly payment towards premiums. When it first started the money ran out in October, the next year it ran out in September, then July and now I think it runs out about May. When the prescription drug plan was first offered I did not sign up because I was not taking any prescription drugs. Several years later when I found out there was a penalty for not signing up, I did sign up. I now pay $40.00 per month for not signing up at the beginning. I am 88, I have been paying this penalty for many years and I was told that penalty never ends; I will pay that penalty for the rest of my life. When I retired in 1991 with a small pension I thought that would work — in 2026 it no longer works.
This is a good idea. Employers offering health insurance might well be inclined to pay less for a Medicare plan that is not prone to double digit premium increases like their current private plans (and, in competitive industries, perhaps be willing to pay for the supplemental to attract employees). That would get us over the hump for the biggest drag on the Medicare for All debate: people like their employer-provided plans.
I’m not sure people do understand what Medicare is. For example I know people who believe that means no more private insurance but most people on Medicare buy Medigap policies or enroll in Medicare Advantage plans which are managed by insurance companies. Just yesterday I watched an interview on MS Now with a woman who wants to be able to enroll in Medicare to get dental coverage. Some Medicare Advantage plans may cover basic dental care but many don’t.
It drove me crazy during the 2016 primaries to hear several journalists declare that all other rich countries have Medicare for All type insurance coverage. They have no clue that several countries — Germany, Switzerland, Belgium, the Netherlands and Japan — have universal, affordable health care coverage which relies primarily on private plans bought by individuals or employers.
Joe Biden? Yes, he tossed his healthcare plan into oblivion. His priority was supporting transgender rights, including in sports, which was in one of his Executive Orders that he signed in the Capitol right after he took the oath of office. He had a transgender staffer who was the child of a influential big D player in Delaware politics. If you know anything about Biden, this makes perfect sense.
He could have done a Day 1 Executive Order on a healthcare issue. But no, it was too difficult. Doing a favor for D politician in Delaware? Yes, easy!
I totally agree with your general point about simplification, but suggest going even simpler. Because “Medicare buy-in” can and likely will lead to the exact same wonky (and mostly bad faith) questions and arguments we need to avoid: is Medicare really that great? How much to buy in? What about private insurance (the general concept of which remains bewilderingly popular)?
How about just “universal affordable healthcare”? Period? It’s what the very popular ACA promised (but ultimately failed to deliver, mostly thanks to Republican sabotage). It’s easy to grasp and doesn’t immediately raise detailed questions in voters’ minds or open up debates over cost. It’s not so much a policy prescription as a value statement, and one that can be made from a clear moral high ground.
Paul. this may be the most important post you ever made. I will underline two problems that we will encounter: Democrats don't deliver and the people know that. You have to find a way to convince them this time it's different. Second problem is that the best Medicare For All solution is a very hard sell, and may have to wait until after the election to be explained at length over time: it needs to be paid for by the workers themselves, just like Social Security... and "the young" need to be convinced that paying a small premium now, that is larger than private insurance while they are young and healthy, will come back to them many times over when they are old and not so healthy and probably have less, or no, money to pay for the then much higher private insurance premiums. I think that ultimately the Government will have to pay for public "medical centers" where people go for evaluation and simpler treatments, staffed by doctors with set salary and no incentive to over-treat. those doctors may be easier to find than is generally thought. Meanwhile "medicare buy in" may be the easiest sell. But provide details to the people. don't treat them as stupid and content with vague promises (lies) and demands for "the rich to pay for it." The rich won'r pay for it, but they will pay a lot to see that it never sees the light of day.
I see your idea as morphing into government doctors in the public health centers as the gatekeepers to specialized care. Private health insurance employees or government doctors working to limit expensive referrals - the No is the same whoever utters that word.
Another great post, Paul. I completely agree with your conclusion. Democrats must approach healthcare one step at a time. People are wary of big changes.
You need to get this out in front of Democrats ASAP. And then they need to spend some serious $$ to tell the truth and debunk the upcoming lies from the gop.
It won't matter. The Democrats are constitutionally incapable of effective, impactful messaging. That's why the republicans have controlled the political narrative in the U.S. since the days of Reagan. republicans suck at governing, but they know how to create short, simple messages that resonate with the voters. (Just ask MAGA.) If the Dems ever learn how to message effectively, they'll never lose another election. They need to stop listening to overpaid campaign consultants and start listening to the American people.
The Democratic Party is a loose confederation of interests that will never coalesce around a unifying message. Better to attack Republicans with the same savagery they display.
I didn''t want to say that, huge sigh. But we can hope, right?
First (and FWIW), I agree with Paul. Second, if I proposed this on some left-leaning social media site, “progressives” and M4A advocates would excoriate me as one or all of a centrist, an incrementalist, an appeaser (really), a corporate Democrat…you name the progressive epithet and it would be trotted out.
Less hospital use saves $. Medicaid for ALL kids regardless of income will save $ cuz if kids are sick (VS adults) & don't have a MD, parents take 'm to ER. If all kids had Medicaid, schools could post team costs (PT,OT,SP) to it saving local $ & serve elders in school clinics.
Feds can add to Medicare or Gov's can use Medicaid waivers to give homecare to all in place of NH's. W 1,290,000 Americans in NHs it would save $160,000/ person/ yr over NH costs + $ for less meds & less hosp for infections & drug-ind illness or potentially $206 billion per yr.
https://thomastashjian.substack.com/p/healthcare-costs-are-treatment-induced?utm_source=share&utm_medium=android&r=6yutzs
An observation and a question. Observation: I don’t think Lieberman was only motivated by spite; CT is I believe the location of the headquarters of several major insurance companies? Question: I wondered about this with Krugman’s column also. Why are you advocating a public option for Medicare rather than Medicaid? My understanding is Medicaid is generally more efficient, mainly because it’s not polluted by Medicare Advantage (ie private insurance rip-offs). Medicaid makes more sense to me, but maybe I’m missing something. Otherwise completely agree with you.
A Medicare buy-in has to tackle one glaring defect of Medicare that has so many people buying in to Medicare Advantage plans that just allow insurers to suck money out of the system. Regular Medicare has no out-of-pocket maximum. So if you get a major health issue you can be on the hook for countless thousands of dollars, whereas with Medicare Advantage I have a max out-of-pocket limit of $3,400/year. So I never have to pay more than that. If regular Medicare would institute a reasonable maximum out-of-pocket limit, it would go a long way toward cutting Medicare Advantage insurance companies off at the knees. I strongly suspect that their lobbying may well be the reason why Medicare never instituted a max OOP limit.
You'll have a good point. Worth full consideration. And I hear you regarding Medicare "Advantage" too.
well, "not polluted by Medicare Advantage" sounds like a good place to start. Medicare is a better plan because it is (was) paid for by the workers themselves: insurance for predictable basic needs. Medicaid is welfare and a bureaucratic nightmare. Lieberman was a politician and a "moderate" aka fifth columnist.
Medicaid is even more privatized at this point than Medicare. Three quarters of Medicaid recipients are covered by managed care organizations operated mostly by private insurance corporations. These MCOs get our taxpayer money as a fixed amount per enrollee. The incentive to deny and delay care is obvious. This is similar to Medicare Advantage, which has only managed to capture about 54% of Medicare recipients. Medicaid’s payments to providers is also substantially less than Medicare’s.
Paul, great analysis and recommendation as always. I would tweak your idea just slightly. Lower the age of Medicare qualification to 62 to align with Social Security and automatically enroll every child at birth through 18. Everyone else can buy in at the ages in between. This would be SUPER popular and easy to understand and implement.
I'm struck not so much by the substance of the idea (though it is excellent and politically feasible), but by the semantics. Democratic politicians wouldn't have to utter those damning words, "Medicare for all," when talking about it (looking at you, Jeffries).
Paul, there's a central fact here that nobody's talking about, but which is the core of the whole argument. It is this:
Over (perhaps WELL over) two-thirds of ALL US healthcare spending is made with taxpayer dollars. Our money. WE are the ones paying all these "private" bills.
We don't have a "private" healthcare system. We have a system that funnels vast amounts of tax money into private corporate pockets, while incentivizing them to deny us care every way possible. The gap between what Americans are paying for through their taxes and what we (don't) get in return explains almost the entire vast difference between our costs and those of virtually every other developed nation.
The math's not complicated. Add up Medicare, Medicaid, SCHIP, active-duty military care, the VA, Tricare, and the assorted smaller systems that treat groups like prisoners and Native Americans. Add in all the millions of federal, state, county, and municipal employees whose care we cover. (Most of them are on private plans, but we're still picking up the tab.) Then add in the tax deductions that corporations take for the money they spend on employee plans -- another way we're subsidizing health care.
If "socialized" is another word for "something the government pays for," then we passed the state line into socialized medicine a long way back there. And we are not getting anything close to our money's worth.
One way out of this is to simply be a lot more explicit about this -- and to claim the prerogatives that should accrue to the person who's writing the checks. "If you are getting healthcare paid for by the taxpayers, then we the taxpayers are going to insist that you get it from a system that we are in control of. We are no longer giving our money to privateers." It's one easy rationale for putting all of the folks I listed above on Medicare, making that the first step toward Medicare for All.
Brilliant!
Mr. Waldman, you wrote that "everyone knows what Medicare is, and almost everyone loves it. Which is why it would be extraordinarily difficult for Republicans to argue against." I would beg to differ. republican politicians HATE Medicare and are planning to destroy it, starting next year, if they somehow manage to cling to power in Washington after the mid-terms. Mike Johnson has already told us that they're coming after Social Security, Medicare, and Medicaid. They aren't even hiding it. It's why our first order of business is not to roll out a new healthcare option: it is to elect Democrats up and down the board in the mid-terms. That's the only way to protect what's left of Medicare. And frankly, it's the only way to protect what's left of American democracy. Trump and his republican flying monkeys are rapidly destroying everything good about this country. If we don't stop them in November, we can forget about healthcare plans or anything else. We won't have a constitutional republic left if we allow republicans to remain in control .
Republican voters like Medicare, though.
About 10 years ago when Du Pont sold out (split into 3 companies) they also changed my fully covered insurance (full retirement) to a yearly payment towards premiums. When it first started the money ran out in October, the next year it ran out in September, then July and now I think it runs out about May. When the prescription drug plan was first offered I did not sign up because I was not taking any prescription drugs. Several years later when I found out there was a penalty for not signing up, I did sign up. I now pay $40.00 per month for not signing up at the beginning. I am 88, I have been paying this penalty for many years and I was told that penalty never ends; I will pay that penalty for the rest of my life. When I retired in 1991 with a small pension I thought that would work — in 2026 it no longer works.
we're already bogged down in paperwork... for everything. Yes, things to come will be much worse. I like the idea of a medicare buy-in.
This is a good idea. Employers offering health insurance might well be inclined to pay less for a Medicare plan that is not prone to double digit premium increases like their current private plans (and, in competitive industries, perhaps be willing to pay for the supplemental to attract employees). That would get us over the hump for the biggest drag on the Medicare for All debate: people like their employer-provided plans.
Can you somehow get a job consulting democrats-because they will somehow screw it up as usual-
how about citizens committees to yell at the Democrats until they can't pretend not to hear it?
I’m not sure people do understand what Medicare is. For example I know people who believe that means no more private insurance but most people on Medicare buy Medigap policies or enroll in Medicare Advantage plans which are managed by insurance companies. Just yesterday I watched an interview on MS Now with a woman who wants to be able to enroll in Medicare to get dental coverage. Some Medicare Advantage plans may cover basic dental care but many don’t.
It drove me crazy during the 2016 primaries to hear several journalists declare that all other rich countries have Medicare for All type insurance coverage. They have no clue that several countries — Germany, Switzerland, Belgium, the Netherlands and Japan — have universal, affordable health care coverage which relies primarily on private plans bought by individuals or employers.
Joe Biden? Yes, he tossed his healthcare plan into oblivion. His priority was supporting transgender rights, including in sports, which was in one of his Executive Orders that he signed in the Capitol right after he took the oath of office. He had a transgender staffer who was the child of a influential big D player in Delaware politics. If you know anything about Biden, this makes perfect sense.
He could have done a Day 1 Executive Order on a healthcare issue. But no, it was too difficult. Doing a favor for D politician in Delaware? Yes, easy!
I totally agree with your general point about simplification, but suggest going even simpler. Because “Medicare buy-in” can and likely will lead to the exact same wonky (and mostly bad faith) questions and arguments we need to avoid: is Medicare really that great? How much to buy in? What about private insurance (the general concept of which remains bewilderingly popular)?
How about just “universal affordable healthcare”? Period? It’s what the very popular ACA promised (but ultimately failed to deliver, mostly thanks to Republican sabotage). It’s easy to grasp and doesn’t immediately raise detailed questions in voters’ minds or open up debates over cost. It’s not so much a policy prescription as a value statement, and one that can be made from a clear moral high ground.
Paul. this may be the most important post you ever made. I will underline two problems that we will encounter: Democrats don't deliver and the people know that. You have to find a way to convince them this time it's different. Second problem is that the best Medicare For All solution is a very hard sell, and may have to wait until after the election to be explained at length over time: it needs to be paid for by the workers themselves, just like Social Security... and "the young" need to be convinced that paying a small premium now, that is larger than private insurance while they are young and healthy, will come back to them many times over when they are old and not so healthy and probably have less, or no, money to pay for the then much higher private insurance premiums. I think that ultimately the Government will have to pay for public "medical centers" where people go for evaluation and simpler treatments, staffed by doctors with set salary and no incentive to over-treat. those doctors may be easier to find than is generally thought. Meanwhile "medicare buy in" may be the easiest sell. But provide details to the people. don't treat them as stupid and content with vague promises (lies) and demands for "the rich to pay for it." The rich won'r pay for it, but they will pay a lot to see that it never sees the light of day.
I see your idea as morphing into government doctors in the public health centers as the gatekeepers to specialized care. Private health insurance employees or government doctors working to limit expensive referrals - the No is the same whoever utters that word.
Another great post, Paul. I completely agree with your conclusion. Democrats must approach healthcare one step at a time. People are wary of big changes.