We Deserve a Better Debate Over Medicare For All

Photo: Jim Watson/AFP/Getty Images

In each debate, the healthcare questions are mostly the same, and so, too, are the candidates’ answers. Medicare for All is just so expensive: How would [insert left-wing candidate here] pay for it? Ah but look here, have you considered the fact that some unions oppose it? That a lot of people say they like their private insurance? The questions are no longer urgent. They are almost identical to each other, debate after debate, and no longer uncover any new information. The candidates who say they support Medicare for All have explained repeatedly why they believe it makes fiscal sense, why voters might be open to a future without insurance companies, have pointed out, even, that many unions do support the legislation. Either voters accept their answers about the popularity and technical feasibility of their proposal or they don’t: there is nothing more to be revealed by this line of questioning.

Pundit fixation on these aspects of Medicare for All is predictable. They follow a pattern set years ago, when elected Democrats and columnists alike worried that the Affordable Care Act, a far less radical policy, would bankrupt the nation and knock Obama’s party from power. Years later, everyone still remembers their cues, with a new healthcare proposal as the focus of the performance. The show goes on, and will assault the sanity of all sensible observers until it makes itself irrelevant. The performers may believe they are objective, pontificating from on high like a class of priests. But they help drive public opinion, and will continue to do so until the election finally happens. Voters will either elect someone who supports M4A in spite of its skeptics, or the skeptics will win, and so will a less ambitious vision of progress.

Healthcare reform deserves a more serious public conversation, and it’s possible to start one without ignoring M4A at the debates. Nor should the press abandon its responsibility to question such a radically transformative policy proposal. All that’s needed is a simple redirection, a new line of questioning that accurately grasps the real case for M4A.

The nearly exclusive focus on government spending and on public opinion misses the real rationale for the policy. M4A is a moral argument disguised as a policy proposal. It takes stock of the American healthcare system as it currently exists, and identifies it as a logically and ethically bankrupt structure that exposes people to unnecessary, life-shortening risks. In short, healthcare is a right – a right the status quo violates, and which would be better protected by an entirely different kind of system. So M4A proponents propose a new system, which would cover every person to precisely the same degree, and would in theory rescue them from medical bankruptcy and missing bill payments and crowdfunding campaigns for their insulin pumps. And it assigns to the U.S. government the responsibility of safeguarding the right to healthcare from harm. The policy’s supporters have explained as much, many times. They don’t have much choice: There isn’t a way to explain the proposal, including its financial details, without making certain claims about its moral superiority to both the status quo, and to the alternatives others propose.

A public option would require less government spending. According to most polls, it is somewhat more popular; it would even be a dramatic improvement on the system in place right now. But the public option doesn’t fully address the serious moral crisis that M4A is designed to solve. Individuals would still have to navigate a complicated, frequently counter-intuitive system, in order to exercise the right the public option theoretically expands. M4A, by contrast, argues that there should be no obstacle between a person and the coverage they need. It shifts the cost of healthcare from individuals and employers, where it currently sits, to the government not only because this will save consumers money, but because the policy’s advocates believe this is the most ethical course of action available.

To return briefly to the primary: Ask any candidate in the field if they think Americans have a right to healthcare, and they’d almost certainly agree. But journalists should know better than to take politicians at their word. Instead of rehashing the same three or four criticisms of M4A until we all go numb from the repetition, ponder instead the implications of framing healthcare as an absolute right. If Joe Biden and Pete Buttigieg really believe that right exists, why do both their healthcare plans leave some Americans without coverage? Why is the public option, which doesn’t automatically enroll people in coverage, morally preferable to a universal alternative like M4A? If the only arguments against M4A are that it’s popular, but not as popular as it could be, and that implementing it would take a lot of work, is the problem really the policy itself, or is it a lack of political will? Why should voters settle for moderate versions of healthcare reform that don’t scale to the crisis at hand? And how does it really benefit the public to leave private insurance companies intact?

To engage only with the practical considerations of the policy, and ignore the moral claims that shape it, is to present a lopsided view of its merits to the public. Nobody needs to see journalists re-enact Philosophy 101 on stage with a horde of aspiring presidents; the prospect is more unappealing than Tom Steyer’s tartan ties. But the press can at least stop pretending that policy is an abstract puzzle. All policy preferences have some moral weight attached to them. As American lifespans drop, the media’s decision to ignore the full case for M4A has a moral dimension too.

We Deserve a Better Debate Over Medicare For All