The Difference Between a ‘Public Option’ and ‘Medicare for All’? Let’s Define Our Terms

Various proposals are floating around, each of which would change the health care system in distinct ways. Some, like one from Senator Bernie Sanders, would do away with all private health insurance. Some would make small expansions in existing public programs. Some would try to cover all Americans through a mix of different insurance types.

It can be mystifying when people call all of these ideas “Medicare for all,” as some in the debate have been doing.

.. Private plans handle Medicare drug coverage, and you can choose among options. You pay premiums each year, and you pay deductibles and co-payments when you use medical services.

Because the program’s out-of-pocket spending has no limits, most Medicare beneficiaries also buy private supplemental insurance to limit those costs. That insurance doesn’t cover medical services outside the Medicare system, but it helps pay the patient’s share of the bill when a person goes to the doctor or hospital.

.. Mr. Sanders, who prominently featured such a plan in his 2016 presidential platform and just announced he has joined the 2020 race, uses this term a lot. His plan would both expand traditional Medicare to cover all Americans, and change the structure of the program, to cover more services and eliminate most deductibles and co-payments. So the Medicare everyone would be getting would differ in crucial ways from the Medicare older people get now.

Bernie Sanders and the Myth of the 1 Percent

The very rich are richer than people imagine.

A peculiar chapter in the 2020 presidential race ended Monday, when Bernie Sanders, after months of foot-dragging, finally released his tax returns. The odd thing was that the returns appear to be perfectly innocuous. So what was all that about?

The answer seems to be that Sanders got a lot of book royalties after the 2016 campaign, and was afraid that revealing this fact would produce headlines mocking him for now being part of the 1 Percent. Indeed, some journalists did try to make his income an issue.

This line of attack is, however, deeply stupid. Politicians who support policies that would raise their own taxes and strengthen a social safety net they’re unlikely to need aren’t being hypocrites; if anything, they’re demonstrating their civic virtue.

But failure to understand what hypocrisy means isn’t the only way our discourse about politics and inequality goes off the rails. The catchphrase “the 1 Percent” has also become a problem, obscuring the nature of class in 21st-century America.

Focusing on the top percentile of the income distribution was originally intended as a corrective to the comforting but false notion that growing inequality was mainly about a rising payoff to education. The reality is that over the past few decades the typical college graduate has seen only modest gains, with the big money going to a small group at the top. Talking about “the 1 Percent” was shorthand for acknowledging this reality, and tying that reality to readily available data.

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But putting Bernie Sanders and the Koch brothers in the same class is obviously getting things wrong in a different way.

True, there’s a huge difference between being affluent enough that you don’t have to worry much about money and living with the financial insecurity that afflicts many Americans who consider themselves middle class. According to the Federal Reserve, 40 percent of U.S. adults don’t have enough cash to meet a $400 emergency expense; a much larger number of Americans would be severely strained by the kinds of costs that routinely arise when, say, illness strikes, even for those who have health insurance.

So if you have an income high enough that you can

  • easily afford health care and good housing,
  • have plenty of liquid assets and
  • find it hard to imagine ever needing food stamps,

you’re part of a privileged minority.

But there’s also a big difference between being affluent, even very affluent, and having the kind of wealth that puts you in a completely separate social universe. It’s a difference summed up three decades ago in the movie “Wall Street,” when Gordon Gekko mocks the limited ambitions of someone who just wants to be “a $400,000-a-year working Wall Street stiff flying first class and being comfortable.”

Even now, most Americans don’t seem to realize just how rich today’s rich are. At a recent event, my CUNY colleague Janet Gornick was greeted with disbelief when she mentioned in passing that the top 25 hedge fund managers make an average of $850 million a year. But her number was correct.

One survey found that Americans, on average, think that corporate C.E.O.s are paid about 30 times as much as ordinary workers, which hasn’t been true since the 1970s. These days the ratio is more like 300 to 1.

Why should we care about the very rich? It’s not about envy, it’s about oligarchy.

With great wealth comes both great power and a separation from the concerns of ordinary citizens. What the very rich want, they often get; but what they want is often harmful to the rest of the nation. There are some public-spirited billionaires, some very wealthy liberals. But they aren’t typical of their class.

The very rich

  • don’t need Medicare or
  • Social Security; they don’t use
  • public education or
  • public transit; they
  • may not even be that reliant on public roads (there are helicopters, after all).

Meanwhile, they don’t want to pay taxes.

Sure enough, and contrary to popular belief, billionaires mostly (although often stealthily) wield their political power on behalf of tax cuts at the top, a weaker safety net and deregulation. And financial support from the very rich is the most important force sustaining the extremist right-wing politics that now dominates the Republican Party.

That’s why it’s important to understand who we mean when we talk about the very rich. It’s not doctors, lawyers or, yes, authors, some of whom make it into “the 1 Percent.” It’s a much more rarefied social stratum.

Hypocrisy in Interests, not Wealth (Paul Krugman)

There are only two sure things in life: death, and Donald Trump refusing to release his taxes. At this point hiding his taxes isn’t even supposed to be an option: the law says that the House of Representatives has the right to see his returns, and IRS officials are breaking that law if they fail to comply. But this isn’t the America we used to know. It will be a big surprise if the Trump administration complies with the law, and most Republicans will surely support Trump in his defiance.
What will we see, if those returns ever become public?

  • Maybe that Trump isn’t as rich as he claims;
  • probably evidence of corrupt practices, before and after taking office; and
  • we will definitely see clear, unconstitutional conflicts of interest in his dual role as president and business tycoon.

.. Hypocrisy is pretending to care about the public interest when you’re actually serving your own interests. Opposing things that would be to your personal benefit, and supporting things that would make you a bit poorer, isn’t hypocritical at all — if anything, it deserves a little extra respect, because you’re making at least some sacrifice in support of your beliefs.
Democrats of all people should realize that being rich — which, by the way, none of the candidates are, as the truly rich assess such things — doesn’t prevent a politician from helping ordinary working families. Ever heard of a guy named Franklin Delano Roosevelt?
I have to admit that Sanders’s reluctance to release those returns, and his vague, almost Trumpian promises to release them “soon” were starting to worry me. Was there something actually bad in them? But right now it seems that he was just being foolish.
Trump, by contrast, almost surely has some very strong reasons he doesn’t want us to see his taxes — reasons strong enough to push him into defying the law. And that’s exactly why the public interest demands that those returns get released.