We are now in the absurd season of Democratic primaries, a season that, I fear, may last until the very moment that the candidate is nominated. There are many honorable exceptions, but a lot of the information seems of third order: it does not deal with the candidates, let alone with their political proposals, but with expert opinions on the opinion of the voters about the candidates' eligibility. . It's a debate in which basically nobody has any idea what he's talking about.
However, there is also ongoing the occasional real political debate. They do not revolve primarily around the objectives: choose who you choose, the Democratic candidate will profess allegiance to a progressive program aimed at reducing inequality, to strengthen the social buffer and take action against climate change. But there are big differences with respect to the way to reach those objectives.
And the issue that most divides is health care. Almost certainly, the final program will defend Medicare for X. What is not known is what word will be chosen at the end to replace the X parameter and, what is more important, what that means in terms of effective policy will be crucial for both the general election and what happens next if the Democrats win.
On the one hand, there is the "Medicare for all", which has come to be identified with the position of Bernie Sanders: replace the entire US health insurance system with a health program similar to that applied to Medicare in which the State pays directly almost all medical expenses.
On the other hand, there is "Medicare for America," originally a proposal from the Center for American Progress, now converted into a legislative proposal. Although none of the Democratic candidate candidates has yet endorsed this proposal, it is easy to assume that the majority will propose something similar.
The big difference with Sanders' plan is that citizens would be allowed to keep their private insurance if they preferred, but they and their businesses would also have the option to sign up for an improved version of Medicare, with substantial subsidies for income families. low and medium. The most important thing you need to know about these rival plans is that both would serve.
Many people are aware, I think, that we are the only advanced country that does not guarantee essential health care to its legal residents. But I guess there are fewer people who know that countries achieve that goal in different ways, and that all of them work.
Every two years, the Commonwealth Fund publishes a valuable survey on the health system of the major countries. The United States always occupies the last place; In the most recent edition, the three leaders are Great Britain, Australia and Holland.
The incredible thing about these three countries is that their systems are radically different. Britain has a truly socialized medicine: the State directly provides health care. Australia has a unique payer system: basically the Bernie system applied to the southern hemisphere. But the Dutch depend on a system of heavily regulated private insurance companies, with many subsidies, but one that looks more like an Obamacare version with more funds than a Medicare for all. And Holland is in fact the first place in the Commonwealth Fund rankings.
So, what system should the Democrats defend? The answer, I would say, is the system that we have the best chance of creating, the one that is best placed in the general elections, and then more likely to be approved by Congress in case the Democrats win.
And there is a great truth on the ground that any realistic health strategy has to take into account: 156 million Americans - almost half of the population - now have insurance provided by their companies. And most of these people are satisfied with their coverage. A Medicare plan for everyone would actually tell these people: "We're going to take away your current plan, but trust us, the substitute will be better. And we are going to implement a lot of new taxes to pay for all this, but trust us, it will be less than what you and your employer now pay in premiums. "
The thing is that these two statements could very well be true. A single payer system would probably have less total costs than a hybrid system that retains some forms of private coverage. But even if the optimistic claims about Medicare are true, will citizens believe them? And although the majority believe them, the fact that a significant minority of voters do not trust the promises of those who defend the single payer system could condemn the democrats in the general elections or at least make the approval of their plan impossible in Congress. .
To me, therefore, Medicare for America - which allows citizens to keep their company health policies - seems much better to me to actually achieve universal coverage than Medicare for all. But I could be wrong. And it's good to spend the next few months debating the issue.
What would be wrong would be for the activists to turn a position contrary to private insurance into a litmus test, and to declare that anyone who advocates a more gradual approach is not a true progressive, or is perhaps a corrupt accomplice of the medical complex. industrial. As you can imagine, my worries do not come from nothing; they are things that I am already hearing.
So Democrats should try to turn this into a real debate about the best strategy to achieve a common goal. Will they succeed? I guess we'll find out.
Paul Krugman He is Nobel Laureate in Economics. © The New York Times, 2019. Translation of News Clips.