The Price of BernieCare

Democrats object that Republicans are telling voters the truth about single payer.

Mr. Trump noted in his op-ed that the plan would cost the federal government $32.6 trillion over 10 years.

That figure is from an analysis by the Mercatus Center’s Charles Blahous, a respected researcher and a former Social Security and Medicare trustee who sometimes writes for us. His findings are in the ballpark of every serious analysis.

.. That spending figure amounts to 10.7% of GDP in 2022

.. National defense—routinely derided as too expensive and wasteful—is a mere 3% of GDP today.

.. As in every socialist system, the real “savings” would come from price controls and wait lists for many health-care services. Have a cold? Come on in. A hip replacement or breast reconstruction? Get in line.

.. Maybe Democrats should have looked at the results in Vermont when Bernie’s home state tried to set up single payer. A Democratic Governor abandoned the idea in 2014 once he was looking at an 11.5% payroll tax, plus a 9.5% income tax, and more increases to come.

.. Progressives couldn’t even get single payer up and running for about 625,000 people in a state with a decent health profile. In 2016 nearly 80% of voters rejected a referendum to set up single payer in Colorado.

.. The GOP ideas that would cover pre-existing conditions include high-risk pools that subsidize tough-to-insure patients directly.

Medicare for All comes with a price tag — and hard choices

Under certain assumptions, the report found, Medicare for All would reduce total U.S. health expenditures by about $2 trillion over a 10-year period.

.. Blahous shows with his study how hard the choices are, even when making generous allowances for the M4A plan. Leftists can mock him all they want for trying to meet them on their own turf, but if Democrats at some point actually try to pass Medicare for All, the Congressional Budget Office would perform much the same calculations, with much the same results. And laughter won’t make the hard numbers, or the hard choices, go away.

.. Having stacked the deck in favor of “M4A,” as Sanders calls his proposal, Blahous then comes up with a price tag: By 2031, the federal government would be spending an additional $4.2 trillion a year.

.. Medicare for All advocates will protest: Think of all the money that people wouldn’t need to spend on premiums! But the advocates already face an uphill battle persuading people to give up their current insurance — which 70 percent of Americans say they’re quite happy with, according to Gallup — for a massive Medicare expansion that might not suit them as well. The climb would be stiff indeed after people found out that their taxes were being doubled to pay for it.

.. And that’s if you make generous assumptions about costs — assumptions that are not very realistic, as Blahous notes. Particularly the assumption that health-care providers can be forced to accept Medicare reimbursement rates that are, according to the author, an average of 40 percent below the rates paid by private insurers.

What Is the Democratic Story?

Choosing between a focus on race or class is the wrong choice to begin with.

.. There’s a lot of discussion about how far left the Democratic Party should go these days. Is it destroying its electoral chances when its members call for a single-payer health plan or abolishing ICE?

That’s an important question, but the most important question is what story is the Democratic Party telling?

.. As Alasdair MacIntyre argued many years ago, you can’t know what to do unless you know what story you are a part of. Story is more important than policies.

.. The story Donald Trump tells is that we good-hearted, decent people of Middle America have been betrayed by stupid elites who screw us and been threatened by foreigners who are out to get us.

.. Back in the 1980s, the Democrats told two different stories. One was the compassion story associated with Mario Cuomo and Ted Kennedy: Too many Americans are poor, marginalized and left behind. We must care for our brothers and sisters because we are all one family.

.. The other was the brainpower/meritocracy story associated with Gary Hart and later the New Democrats: Americans are masters at innovation. We must use our best minds to come up with innovative plans to solve our problems and head into a new technological century.

I don’t hear those two stories much anymore. The Democrats are emphasizing fighting grit these days, not compassion or technocratic expertise.

Today’s Democrats tell two other stories.

  1. The first is the traditional socialist story associated with Bernie Sanders: America is rived by the class conflict. The bankers and the oligarchs are exploiting the middles. We need a fighter who will go out and battle concentrated economic power.
  2. The second is the multicultural story: American history has been marked by systems of oppression. Those who have been oppressed — women, African-Americans, Latinos — need to stand together and fight for justice.

.. Racial justice socialism seems to be the story of the contemporary left. This story effectively paints Trump as the villain on all fronts, and Democrats do face the distinct problem of how to run against a bully like Trump. But is it good politics for the entire Democratic Party to embrace it?

.. no national Democrat has ever fully embraced this story successfully. In fact, Democrats like Bill Clinton and Barack Obama went to great lengths to assure people they were not embracing this story.

  • .. They did because Americans trust business more than the state, so socialism has never played well.
  • They did it because if you throw race into your economic arguments you end up turning off potential allies in swing states like Wisconsin, Iowa and Pennsylvania.
  • They did it because if you throw economics into your race arguments you end up dividing your coalitions on those issues.

In brief, Democrats have stayed away from this narrative because the long hoped-for alliance between oppressed racial minorities and the oppressed white working class has never materialized, and it looks very far from materializing now.

.. for 100 years, Democrats have tended to win with youthful optimism and not anger and indignation.

.. The Democrats who have won nationally almost all ran on generational change — on tired old America versus the possibilities of new America:

  • F.D.R.’s New Deal,
  • J.F.K.’s New Frontier,
  • Bill Clinton’s bridge to the 21st century and
  • Obama’s hope and change.

If I had to advise on a Democratic narrative I’d start with three premises:

  1. First, by 2020 everybody will be exhausted by the climate of negativism and hostility.
  2. Second, the core long-term fear is American decline; are we losing our mojo?
  3. Third, communities and nations don’t come together when they talk about their problems; they come together when they do something on behalf of their children.

Maybe the right narrative could be rebuilding social mobility for the young: America is failing its future. We need to rally around each other to build the families, communities, schools, training systems and other structures to make sure the next generation surpasses this one. People are doing this at the local level, and we need a series of unifying projects to make national progress.

.. This story pushes people toward reconciliation. It is future-oriented.