Anticipating the other side
I've always been a fan of "Medicare for all" and I think that if the Court strikes down Obamacare tomorrow, liberals should organize around the idea. But I'm with Ed Kilgore on this point and it's very important that everyone understands what that means:
[T]he idea of making Medicare universal—even if it initially gains a positive response in public opinion—is going to run into some serious heavy weather once specifics are discussed and criticism begins.Now I don't see this as reason not to do it. If Obamacare is found to be unconstitutional, I suspect it will require that the employer sponsored health care system break down to such an extent that most Americans are affected before we take another wack at it. It's likely to take a while and during that time liberals have a huge job ahead of them to make people understand the moral imperative of universal health care. They really need to make sure that the libertarian/conservative cant that led to people shouting "yes" and applauding the idea of letting people die at the Republican presidential debates, is shown to be the inevitable result of our unwillingness to embrace universal health care.
As I’ve argued for a good while as others wondered why Republicans have been able to pit Medicare beneficiaries against those benefitting from ACA, many and perhaps most seniors receiving Medicare do not perceive the program as a social good that government gives them, but as an earned benefit—earned through lifelong payroll taxes, premium payments (once retirement age is reached), and more abstractly, through a lifetime of work that is performed before eligibility is reached. Extending “Medicare” to “all” would change that assumption rather dramatically, particularly with respect to younger beneficiaries (including children) who haven’t “earned” much of anything, from the point of view of seniors. The GOP talking points write themselves: Liberals want to give YOUR Medicare to THOSE PEOPLE! If “Medicare For All” is vastly easier to understand than ObamaCare, then so, too, are the racial and generational arguments against making it available to darker and younger people as opposed to just “cutting” Medicare (or setting up “death panels”) to give something new to THOSE PEOPLE. I’m afraid anyone who thinks a universal Medicare would be as popular as the current Medicare is missing this important if unfortunate point.
I do think that most people are either morally repelled by that "yeah!" or are smart enough to realize it could one day be themselves in that position to eventually understand this. But they haven't made the connection between that and the necessity for a commitment to universality. A campaign for "medicare for all" could be a great vehicle to make that case, but it shouldn't be done with eyes closed to what the reaction from the right would be.
In fact, this campaign should be done regardless of whether the Supreme Court knocks down the ACA tomorrow. The moral arguments must still be made to ensure that the reforms are strengthened rather than weakened. It's the right thing to do no matter what. But it won't be easy.
Exhibit A: libertarian economist Tyler Cowan:
A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.
There you have it. Poor people dying is part of what makes our system so great. Why mess with success?
Do most Americans agree with that? I'd like to know.