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Neal's Hard Health Choices and the Medicare Pay-For Myth

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Article originally published in LaborPress

By Robert Weiner and Ben Lasky

Workers and unions have always understood that they will be the ones paying for healthcare for families if the government does not. Right now it's a mess where the USA pays twice the cost of other civilized countries. Health costs are the #1 reason for private bankruptcies.

Two approaches for improvement are that Congress can fix Obamacare by paying for the exchanges, or, as some have advocated, they can embrace Medicare for All.

The Trump administration announced a court challenge that would get rid of the Affordable Care Act (Obamacare), trying a legal route after failing in Congress more than 60 times. This action lays out a clear campaign battle line on the issue while offering no alternative for immediate replacement. The unions or workers' own pockets will have to pick up the mess for their members if health care coverage is drastically reduced.

Richard Neal (D-Springfield), the chairman of the powerful House Ways and Means Committee, is in the news for requesting that the IRS provide his committee with Trump's tax returns. But he also has a tough decision to make on healthcare. Half of the Democratic Caucus are pushing for Medicare for All, while those who oppose it as well as Republicans are asking where the government is going to get the money from. Some from both parties seek to repair Obamacare by funding the exchanges. Almost all are seeking cheaper drug prices.

Rep. Pramila Jayapal (D-Seattle), replaced Rep John Conyers (D-Detroit) as prime sponsor of the Medicare for All bill, providing free healthcare, matching most other countries. Conyers' bill was co-sponsored by a majority of House Democrats in the last Congress, and Jayapal this Congress has a near-majority of 107. Health care goes through Neal's committee.

"Medicare is not as good a health benefit as the Affordable Care Act. So, if you are to do Medicare-for-all you have to improve the package and when you improve the package, you have to have more money," said House Speaker Nancy Pelosi on April 4.

"Is this a bold and ambitious plan? It has to be," Jayapal, co-chair of Congressional Progressive Caucus, said when introducing the bill.

Critics of the bill all have the same question: "How will we pay for it?" There is a concrete answer. Jayapal suggested reversing the Trump tax breaks for the rich and continuing the Medicare formula of contributions from employers as ways to fund the bill.

However, rarely does anyone ask how we pay for government programs that are ingrained in American society. Do we ask how we're going to pay for police and the fire department? Or trash pickup? Public education? Libraries? Does anyone ask how to pay for the military? Those have no "pay for". That's what taxes are for.

As The Washington Post's Paul Waldman wrote, "The questions about the cost of Medicare-for-All seem to come from a bizarre alternate universe where we aren't spending anything now on health care, and we're going to have to come up with a shocking amount of new money to fund this crazy idea of giving everyone coverage."

The chair of the Ways and Means Social Security Subcommittee, John Larson (D-Hartford, CT), told us that he's "proud" to be a sponsor of Jayapal's bill and that in fact "it's revenue neutral:" Estimates have universal healthcare costing $14 trillion to $32 trillion per decade meaning 1-3 trillion a year. Under the current system, Americans are expected to spend $50 trillion on healthcare over the next decade. Even the lesser step of Obamacare the existing Affordable Care Act has already reduced the rates of increase, a fact not mentioned by critics

There are many other ways to pay for everyone in the U.S. to have healthcare. Since Trump wants to pull the U.S. military out of Afghanistan, the government can use the trillion for that war to pay for it

Neal supports "Medicare for All" but says the approach musty be "incremental". That could still satisfy the objective of coverage for all. Here's how:

Medicare for All" has to be an option, where if you like your insurance, you can keep your insurance. Larson agreed. Under the "option" plan, the country's "pay for" total drops drastically.

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