Matthew Yglesias notes that Sanders, unlike Warren, is able to dodge the ‘how will you pay for it’ question regarding Medicare for All, but I don’t think Yglesias gets how Sanders do so. Yglesias (boldface mine):
Sanders’ most obvious vulnerability by far is that over the course of his two campaigns he’s centered a Medicare-for-all agenda that, while popular as an abstract slogan, tends to become politically dicey when people kick the tires and examine the details.
This has come up time and again at previous debates, but typically with Elizabeth Warren as the subject of scrutiny. Friday night it was Bernie’s time in the barrel as Joe Biden argued that Medicare for All “will cost more than the entire federal budget we spend now” so “the idea middle-class taxes aren’t going to go up is just crazy.”
It’s a tough charge and a fair one, but Sanders simply ducks it.
We are spending twice as much per capita on health care as do the people of any other country. Maybe it has something to do with the fact that the health care industry last year made $100 billion in profit. Maybe it has something to do with the fact that we are wasting $500 billion a year trying to administer thousands and thousands of different plans.
What Medicare for all will do is save the average American substantial sums of money. Substantial. It would be much less expensive than your plan. And we will expand Medicare to include dental care, eyeglasses, hearing aids, and home health care, as well.
What makes this answer work is that while it’s evasive on the taxes point, it also stands up to fact-checking scrutiny.
If you look at American health care spending in international terms, you’ll think you’re going insane. It’s not just that the Canadian and British governments finance health care that’s free at point of service for all citizens, they do it while spending less than our government does even if you completely ignore America’s enormous private sector health spending…
Warren, who had a brand as the woman with a thousand plans, was expected to draw up a specific plan to make her health care vision work. What’s more, her whole campaign is vulnerable to attacks from the left from Sanders fans so she always had to worry about looking less-than-fully committed. Sanders is free of a wonk reputation or a need to worry about his left flank, so he doesn’t try to offer a specific health care financing vision — which, if he did it, would inevitably end up featuring some unpleasant tradeoffs.
Instead, he just makes the basic compelling point captured by that chart — America’s health care system is bizarrely terrible, providing less coverage at greater cost than what we see in comparable countries. This is not an adequate basis for actually enacting Medicare-for-all, but it’s a good political answer that explains his big picture view of health care without falling into nasty political traps.
The phrase “Sanders is free of a wonk reputation” is doing a lot of work here. What Sanders, to his credit, has is an uncompromising moral and ethical vision of how healthcare should be. He phrases our problem as an existential crisis–which it is for millions of Americans (boldface added):
M4A supporters have spent too much time arguing about how we pay for it, and not enough time emphasizing the carnage (Sanders, to his credit, is trying to do this, but very few are following his lead). Our healthcare insurance system kills the equivalent of a 9/11 massacre every 3-5 weeks. If terrorists were murdering people on that scale, would we be worrying about whether we ran deficits? Of course not. We would spend what we need to spend to stop the carnage. If asked how do you pay for it, I usually respond with something like, “The same way Republicans have paid for their stupid wars and tax cuts for the rich”, followed with “First, we need to stop the dying“:
What infuriates me is that, for the past quarter century or so, balancing budgets has taken priority over providing things we need (never mind providing nice things we want).
We’ve now reached the point where tens of thousands of people die needlessly every year due to inadequate healthcare. Many more suffer and are immiserated. People die because they can’t afford insulin. To use a prominent local politician’s phrase, our healthcare system, despite its overall expense, is inflicting massive American Carnage. This is a full scale emergency.
We need to staunch the bleeding.
We need to stop the dying.
First order of business must be providing healthcare to all. If we stipulate that everything must be paid for up front, it will be nearly impossible to stop the dying. Inflation might rise if we don’t have a payment mechanism, but we have ways to deal with that through both fiscal and monetary means. Yet we know, with near certainty, that if nothing changes, this year, and the next, and the year after that, people will die needlessly.
That is the crisis. The potential hit to after-inflation returns on unearned income pales by comparison.
If we reach the point of ‘how do we pay for it?’, to a considerable extent, we’ve already won–the Republican (and New Democrat) opposition to the proposal will occur on much more fundamental levels.
And, once healthcare is phrased as an existential crisis, the answer is pretty easy:
We will pay for it the same way we pay for things we have needed to do (along with those we haven’t): tax increases (both user fees and general funds) and deficit spending. If the policy makes people’s lives better, it will tend to work out–it’s not like the post-WWII economy was particularly bad.
It’s 2020, and still, most Democrats haven’t learned how to talk about policy in moral and ethic terms. It’s not genius, just stating the obvious.