The Progressive Case For Private Insurance

It finally happened.  The rarest of occurrences is when events unfold in real time that force our hottest political and policy debates out of the realm of imagination into the realm of reality.  The outbreak of the COVID-19 pandemic is the ultimate stress test for the American healthcare system.  You know the one that Republicans are always insisting is “the best in the world“?  Now we get to find out in the boldest and coldest live action any of us could have imagined.

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Of course we would all be better off under a universal healthcare system that provided testing for all Americans and charged nothing for treatments.

But that is not the system we have and even in Bernie Sanders’ wildest Medicare-For-All fever dreams it would take three or four years to have it implemented.  The private health insurerers and healthcare providers will be under the microscope like never before so there will be nowhere to hide their profit-protection policies.  Soon and very soon, reports will emerge on who profited from this crisis, how they profited from this crisis, and how much they profited from this crisis.  It will not be pretty.  And people will wonder how many lives could have been saved if those profits had been put into patient care and spread prevention instead of into the coffers of Kaiser, United Health Group and Anthem.  Then we will find out if Americans really love their health insurance as much as GOP talking points insist they do.

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But since the coronavirus rang the ringside bell I say let those big boys fight for their survival and defend their profits and performance.  Let the self-styled free-market gladiators and corporate masters of the universe fight for what they believe so firmly is theirs.  Of course, there is a catch:  I say let the big health insurance carriers who believe that being the middle man between patients and healthcare providers is a good business step up and compete against the best.  And for all its woes, the best fascilitator of health care is the federal government.  I say if the private health insurance companies really can deliver better, broader, and more secure healthcare to all Americans they deserve to thrive and profit.  In order to meet these objectives and beat Medicare-For-All in an argument over actually providing healthcare to the people, they are going to have to prove it right now.

I was always less impressed with Pete Buteigege than the rest of the country seemed to be during  his Democratic primary bid, but he hit the right note repeatedly on one major issue.  Giving everyone the option to buy into Medicare was a winner everywhere last fall and winter and it is a winner everywhere now.  Espeically after the havoc COVID-19 has wreaked, there really is no viable argument against it.   But at the same time, any recomendation of killing off private insurance is a loser.  And as a practical matter it would be a disaster.  It feels like a hundred years ago since Barack Obama pled his case to his progressive bretheren that “if we were starting from scratch Medicare for all would be far and away the best structure for our healthcare system- but we’re not starting from scratch.”

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Buteigege got that and he pressed the point well.  I gave him a rough time for many other reasons but credit must be given where credit is due.

The reality is Medicare for all is an extremely hard sell and an unbearably heavy lift politically.  Our progressive thought leaders don’t like that but that is why they are our thought leaders- they are smarter on policy than the rest of us.  Good for them.  That’s why I love them.  But when it comes to politics, being right is beside the point.  You have to win elections or else you’ll be sitting on your ass at home being right about a bunch of policies you never get a chance to enact.  And what good is that?

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So while I appreciate the fact that Bernie and Elizabeth scare the dog sh*t out of the insurance industry and the GOP, by the end of spring we all better be ready to make this pivot or be ready for an election so close we will all be on blood pressure medication before its finally called for Joe.

Here is the deal:  private health insurance has an important place in our economy and our culture.  Far too important for us to just kill it off legislatively.  On the economic side, millions of people are gainfully employed by health insurance companies as they battle each other for market share and profits.  We all know that the profit motive is the original sin of our current healthcare system but this is exactly what President Obama was acknowledging in his “if we were starting from scratch” explanation.  Where will all of those people go if private health insurance is “banned” and their jobs disappear?  And I am providing first hand testimony here that some of those jobs pay very well.  Those newly unemployed professionals are not going to make $90K a year driving an Uber when there is no Kaiser Permanentae or Anthem to sell or service clients for.  That is a real problem that “Medicare for all” has no real solution for.

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What is wrong with allowing the private health insurers to compete with the newly enacted public option for marketshare?  There will be plenty of customers out there that will still want that name-brand private health insurance for any number of reasons.  And being forced to compete with a public option would force them all to improve what they offer to the public or fade to black for good.  If you don’t trust anything else you can always trust big business to find a way to survive any way that it can.  And if any of them can’t make it, then so be it.  That survival of the fittest b.s. they are always selling will be carved on their company tombstones.  In all likelihood many of the insurance carriers would eventually fold.  But it would take a while and the economy would begin to naturally evolve around the attrition.  And those companies that can figure it out and find a niche in the new market will be bigger and better service providers than they ever were before.  Their days as public predators will almost certainly be over.

On the cultural side, there is no denying that Americans LOVE to have choice- even if it is little more than the illusion of choice.  And it has pretty much always been an illusion for those of us who get our insurance through our employer because we aren’t choosing a damned thing- some executive at the company we work for is choosing for us.  And we have all heard the kicking and screaming that follows whenever a company changes the healthcare plan options at renewal- knowing employees can’t do a damned thing about it.  Translation: even if it will be better health policy, it will be bad for the psyche of many Americans to have their “choice” taken away in a switch to an expanded Medicare system.  And contrary to conventional wisdom, voters vote with their psyche- not based on logic, or love or even on their bank accounts.  The Trump Experiment has proven that beyond any dispute.

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Our union brothers and sisters are still laboring under the misimpression that having to negotiate with management for health insurance is somehow a benefit to them and something to be proud of.  Until it dawns on them that there is far more to be gained in labor negotiations with healthcare off the table, they are as likely to rail against Medicare-For-All as Tea-Party Trumpists are.

If the ultimate goal of progressives is for America to join the rest of the first world and provide healthcare for all of its citizens- to treat healthcare as a right for all and not a commodity for the privileged- the answer is not kicking private insurance out of the boxing ring.  The answer is forcing it to square off against an opponent that will most assuredly give it the ass-kicking it richly deserves.  But if it fights back and finds ways to make the changes to meaningfully compete for customers over the long-haul we have lost absolutely nothing and won everything we wanted.

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