Weiner’s Case for Universal Medicare

John Nichols quotes Representative Anthony Weiner, who’s emerged as a leading advocate of a Universal Medicare approach to health care:

And the New Yorker suggests that, “The real reason we haven’t seen the Democratic Party embrace the obvious and simpler idea is that it boils down to pure beltway politics. We’ve been reluctant to tackle the real inefficiency in the current system, namely, the very presence of the private insurance companies. Too many in Washington would rather stay friends with the insurance and drug companies when real reform probably can’t be achieved in a way that makes these powerful institutions happy.”

Noting that insurance companies skim 30 percent profits from the current system in order to satisfy shareholders, Weiner says: “Let’s leave it to the Republicans to defend those actions. I, and most Democrats, should not join the chorus that sounds like we care more about insurance companies than taxpayers.”

Given my softness on the Baucus Plan, readers may be surprised to learn that I largely agree with what Weiner is saying here. Certainly if I could crank up a time machine to 1995, what I would say is that rather than spending 14 years trying to build support for a wide lens but incremental transformation of the American health care system, progressives should just focus on incremental expansion of public programs. More and better Medicare and Medicaid, in other words, aiming to create a single-payer system. Heck, that’s what I was arguing back in January 2007 when the Democratic primary was first starting to evolve in the direction of a mandate/regulate/subsidize consensus.


That said, that was then and this was now. Anyone advocating that progressives take a completely different approach to health care at this point is in effect arguing that we should delay action on health care for a good long time. The current strategy isn’t one I liked when it was first being outlined, but it’s the strategy that won the day, and it’s the strategy that’s brought universal health care very close to being enacted. You can’t at this point just switch. Instead, you can lose and start all over again. But starting from scratch would leave you taking a good long time to get anywhere.

The other thing to say about this is simply that it’s naive to think that insurance companies are the only special interest that would fight vigorously against a Universal Medicare plan. Universal Medicare could save us a lot of money. But not merely, or even primarily, by squeezing out insurance company profits. It would also squeeze the profits of hospitals and doctors and medical device makers. That’s a lot of interest group opposition. And while politicians taking on “big insurance” will almost certainly win, taking on doctors and hospitals is a good deal harder.