I hate to have to start this way today after the Thanksgiving holiday.
But if you're watching on YouTube at least wait, please don't hit [inaudible]
the dislike button just yet.
Consider watching this video first.
Before you do that.
I am here to talk about the unfortunate reality that a national Medicare for all is not happening
anytime soon.
And I'll explain why and I'm not here as an opponent of Medicare for all.
I'm not someone who wants it to fail.
I'm an advocate of Medicare for all, but I'm also an advocate of being realistic with you
if we want to make things happen.
And the reality is that without me attacking Medicare for all, without me attacking the
concept of Medicare for all, I recognize that national Medicare for all isn't happening
anytime soon.
I'm not here to say we should advocate for centrist policies that are more realistic,
that we should advocate for the policies we think are the right ones.
And the right progressive policy is Medicare for all.
But I'm not here to tell you unrealistic things.
Like if Bernie gets elected, we'll have Medicare for all in four years.
We won't.
And I'll explain why in a second.
Our politicians do enough of the unrealistic stuff.
I'm here to discuss the realities and I'm here to tell you today that because national
Medicare for all simply isn't happening anytime soon, even if the next president supports
it.
We need to be smart, so let's go through this piece by piece and once we're done, rather
than, you know, calling me a shill or whatever, tell me where you think I'm wrong on the reasoning
because that's really what this is about.
It's about talking about the facts and reality.
Number one, I've already talked about some of the areas of concern around Medicare for
all plans, but that's not really what this segment is about.
Yes.
I've talked before about how most of the plans for how to pay for Medicare for all are unrealistically
optimistic about how much healthcare spending per person will go down.
If we switch to Medicare for all.
In reality, it could take 10 or even 20 years to see those costs reductions.
I've talked about that before.
That's not what I'm talking about today.
There are political considerations.
Even if Democrats take the Senate in 2020 which would be by the slimmest of margins
as I've outlined for you before, it's not going to be enough to pass Medicare for all
because number one, even if Democrats do take the Senate by a few seats in 2020 you need
60 votes in order to pass something like Medicare for all which Democrats are not going to have
after this upcoming election, and not all Democrats even support Medicare for all in
the Senate.
You can then look at 2022 but then if you're only starting the conversation again, you
still need 60 votes in the Senate to pass this.
It's a question Mark whether Democrats could even get a 60 vote majority in 2022 and of
course the alternative would be get rid of that 60 vote requirement.
You can do that with a one seat majority, but even Bernie Sanders has hesitated to say
we should get rid of that a 60 vote requirement because it could massively backfire if Republicans
take control again when Republicans take control again.
So that's a serious political obstacle.
It doesn't matter whether Bernie's president or Warren's president or whoever, it's just
a real obstacle and then imagine that you solve that problem.
You have some bigger issues to deal with.
We have a conservative Supreme court.
We are going to have a conservative Supreme court for some time.
Why does that matter?
When we talk about Medicare for all two different reasons, number one, if you don't make private
insurance illegal as some want to do, it significantly hurts the financial viability of Medicare
for all.
Making private insurance illegal would be almost impossible under the current Supreme
court or any Supreme court that's like it.
It will be fought endlessly by moneyed interests up to the Supreme court.
This is not a Supreme court that will say private insurance is now illegal.
It's just not going to happen and that is something that will hurt the financial viability
of Medicare for all and realistically will make it not happen politically.
Issue number two, you aren't going to be able to force doctors to accept Medicare for all.
Many doctors will choose to accept private insurance because again, it's not going to
be illegal and you will see more of a move to what's called self pay.
We already see self pay more and more in the mental health field.
We see it in dentistry because dental insurance is terrible in the United States.
We could spend much longer on this Supreme Supreme court issue, but again there is no
way that a Supreme court that is even remotely like the one we have right now would rule.
Doctors have to accept Medicare for all.
That will be a major problem for the financial viability of Medicare for all, but it won't
even get to that because it is not going to be something that you will get 60 votes in
the Senate for under these parameters.
So what I want to talk about is not that I think Medicare for all is bad.
I think it's good.
I like it.
I do see it as a drastic and maybe the best improvement over the system that we have.
I don't want to suggest to you that it doesn't matter if a candidate supports Medicare for
all it does.
We should.
We should support candidates who see Medicare for all as the gold standard and who see it
as the goal, but you and I have to be realistic that it's not happening anytime soon.
So before we even talk about candidates, let's talk about what could happen.
Number one, it's important to get some wins that demonstrate that conceptually Medicare
for all or something.
It would work.
These include, and this, this is so lame.
I'm almost like going to throw up in my mouth a little, a little bit saying it.
We need to support some version of a public option as an eventual point that we get to.
I said during Obamacare, Barack Obama should've started the negotiation for Medicare for all
so that at minimum we end up with a strong public option.
We didn't.
He started with the public option and we ended up with just a massive handout of tens of
millions of new customers to for-profit insurance companies.
I know it's so lame and milk toast to talk about a public option.
And as I said before, all the public option will do is estimate, say it'll reduce the
cost of private insurance by seven to 9% because of its impact on the market.
But if we end up with the best possible version of a public option, ideally it will work well
because it will be properly set up and funded.
We can then point to it and say, look, that was an improvement.
Let's keep going to the next step.
That's number one.
But that's not all.
Number two, it might be possible to make a change to the Medicare eligibility age, which
won't totally rock the boat.
Like for example, lowering the age to 60 or maybe to 58.
This is actually step one in some people's plans for Medicare, for all Elizabeth Warren
for example, it talks about let's lower the age eligibility, the eligibility age, better
said in steps and uh, that might actually be a viable first step.
There would probably have to be some kind of trade though because again, even many Democrats
in the Senate don't support Medicare for all.
That's not going to change in 2020 and it's unlikely to change in 2022 third and this
is to me the most exciting.
What about state single-payer?
Vermont wanted to do this, but it ended up failing for a variety of reasons that we could
explore in a different segment.
If Medicare for all succeeds at the state level, a serious conversation about national
Medicare for all would hopefully be able to start Obamacare mirrored years later.
In many ways, the Romney care system that started here in Massachusetts, it falls way
short of being what we want, but the point is state level success can actually push nationally
implementing some of these policies.
So please don't kill the messenger.
This is not me attacking Medicare for all.
I like Medicare for all.
I want Medicare for all this is the reality.
So that doesn't mean that we now say, Hey, you know what?
If either way, the best we can get as a public option or low lowering the eligibility age
for Medicare a few years, you might as well vote for Joe Biden.
No, that's not what I'm saying at all.
What I am saying is that there are a lot of people out there and they're emailing me regularly
who seem to be making arguments and decisions based on the idea that if Bernie wins, we
get Medicare for all in four years.
That if Warren wins for the people that believe she's for Medicare for all, and she does seem
to be, um, uh, then we get it within four years.
We just don't, and I'm not being defeatist.
Let's strategize around what we can do.
Let's make it happen.
And if you disagree with me, tell me where I'm wrong on the facts.
Not that I'm a shill or whatever.
I want Medicare
for all, but
I need to be realistic about how we get there.