On the Difference Between Political and Technical Concerns

One of the frustrating things about the centrist response to single payer proposals is that they cannot seem to determine in their own minds whether a particular objection is political or technical. Indeed, often objections will start off as technical and then, when pushed back against, quickly morph into a political argument.

It’s fine of course to make political arguments. It’s also fine to make both technical and political arguments. But what is not fine is to conflate the two.

Catherine Rampell’s latest post is a masterpiece of this kind of conflation. This is especially true because she borrows from the argumentative themes of technical impossibility (“facts, evidence, and experts”) in order to make arguments that are almost entirely about her own personal opinions about how voters will behave.

Consider her money paragraph:

[1] What about the 178 million people who currently have employer-sponsored health insurance and overwhelmingly like it? [2] What about the sticker shock awaiting individuals and employers over the tax increases necessary to pay for such a program? [3] What happens if hospitals go bankrupt because Medicare reimburses at much lower rates than private insurance? Would the government step in and run them, as is the case in Britain?

Neither one nor two are technical problems. We know how to move people from employer insurance to Medicare as we already do this for people when they turn 65. It is technically feasible to do this even if they “overwhelmingly like” their employer insurance. We know this because many 64-year-olds like their employer insurance and yet get pushed onto Medicare. We also of course know how to levy taxes even if people are “sticker shocked” by them.

Three is a technical problem but its solution is trivial: increase provider payments to the level necessary to prevent sector exits.

Rampell continues her takedown:

And most important, how do you actually pay for this enormous, multi-trillion-dollar overhaul? (Is Mexico paying?) Given Americans’ allergy to higher taxes, it’s not enough to dismiss fiscal concerns by assuming Americans will gladly give Uncle Sam the money they currently earmark for a private health insurance system.

How do you pay for it? You raise taxes. Rampell seems to know this is how you pay for it, but then shifts into an argument not about the technical possibility of raising taxes in one of the most lightly taxed countries in the developed world, but instead about her hunches concerning the persuadability of people on it.

Like I said at the top, it’s totally fine if pundits want to write takes that say that, in their opinion, voters won’t like it and can’t be persuaded. I wouldn’t say pundits have a whole lot of credibility on the topic of how voters behave, but hey everyone is entitled to an opinion.

What is really obnoxious though is this tendency exemplified by Rampell where she conflates technical and political challenges in order to borrow from the scientific patina of the former to mask the random conjecture that typifies the latter.

  • mlo12

    “We know how to move people from employer insurance to Medicare as we already do this for people when they turn 65. It is technically feasible to do this even if they “overwhelmingly like” their employer insurance. We know this because many 64-year-olds like their employer insurance and yet get pushed onto Medicare.”

    Most 65-year-olds who are employed remain on their employer insurance and Medicare is merely supplemental.

  • Lewis

    This is usually framed from the doctor’s point of view as a burden, but I have Medicare, and if everyone had Medicare I suddenly have more choices. I can go back to doctors or therapists I had to drop because they didn’t take my insurance.

    The major reason I want to see Medicare for everyone is I have friends who are cooks and photo editors and grocery checkout guys, and their healthcare is terrible. It’s asprin, cough syrup and caffeine. They have to avoid seeing the doctor all the time, and on top of that, just to make rent, food etc. they work themselves half to death. That puts a strain on them and our friendship. The whole way we interact with each other different because we have to squeeze in a little bit of friendship into an hour or two here and there. That sticker shock line is such a joke unless you’re a major party donor.

  • Meegs

    And how do you raise taxes?

  • DavidT

    Apologies for the late entry here…. You don’t really address her second question: What about the sticker shock awaiting individuals and employers over the tax increases necessary to pay for such a program? That question assumes that single-payer is added on to what currently exists; it doesn’t seem to have occurred to Rampell that a single-payer program means that neither employers nor employees will be paying for the health insurance that they currently buy. If I suddenly save $1000 a month in health insurance premiums — and get a $1000 a month raise from my employer, who no longer has to pay that much as his contribution — a tax increase of $1500 a month to pay for medicare for all actually ends up being profitable for me. Other have pointed out that (1) health care isn’t going to be more expensive under single payer (probably the opposite), so why assume that the premiums being paid now won’t cover it if those premiums are converted to tax payments, and (2) the premiums we now pay include a profit margin of about 25% for health insurance companies, so that represents an immediate savings over current prices.

  • zero

    I pay around $400 per month for high-deductible insurance through my employer. They pay an additional $800 or more on my behalf. Call it $1,200 per month. Single payer would cost between $500 and $900 per month depending on the details, let’s call it $800.

    The old system costs $1200 for the insurance premium and does not begin to pay out until I’ve racked up $3000 in expenses. The new system would cost $800 in total. My premiums would double, but I will definitely save on total healthcare expenses in an average year. My employer will save enough to offer me a $5/hr raise at no net cost to them, which is more than enough to offset my increased costs. (They could also just pocket the $800/mo per employee, of course.) Don’t forget that this is all-inclusive, which means there would be no separate medicare tax on my income.

    Single payer will mean retraining over a million insurance industry workers and cutting off a huge supply of ‘float’ for investors. These are positive results that will lead to a more productive economy so long as we adequately provide for those whose jobs will be eliminated.