Why Defend Private Insurance?

Weingarten begins her piece by pointing out the obvious, in Sanders-esque language, even: “In other developed countries, health care is a basic human right, but in the United States, it’s a commodity — a highly profitable one for the health insurance industry.” It’s likely, she adds, “that only the government can provide something on that scale.” That checks out, as countries where health care is provided by the government, like Canada and the United Kingdom, achieve better health outcomes at a fraction of the cost we pay in the United States.

But then Weingarten pulls her bait and switch; different versions of Medicare for All, including plans “that preserve a role for commercial insurance,” are actually all the same, she argues, and are just different paths to universal coverage:

Pitting these ideas against each other is a false choice. It’s a fear tactic sowed by defenders of corporate greed meant to divide us and make us think that high-quality universal coverage — be it public, private or some combination thereof — is out of reach, even in the wealthiest nation on the planet.

Weingarten’s main assertion here, and the thesis of her entire column, is that defenders of corporate greed are using the tactic of pitting Medicare for All against a system that preserves private insurance in order to make us think that universal coverage is out of reach. This is just not true.

Defenders of corporate greed — millionaire doctor and University of Pennsylvania vice provost Ezekiel Emanuel; the New York Times–selected panel of experts; and establishment candidates Joe Biden, Kamala Harris, and, yes, Elizabeth Warren have spent the past three years muddying the waters on Medicare for All, introducing similarly named plans like “Medicare for America” and “Medicare for Choice,” and arguing at every possible opportunity that there are “a lot of different pathways” to universal coverage and that private insurance is, for some never-stated reason, worth preserving.

This is wrong. A true Medicare for All program — a single, comprehensive, universal program, free at the point of service — is the only viable option for fixing America’s health-care system. When the Democratic Socialists of America canvass for Medicare for All, we ask people about their (overwhelmingly bad) experiences with private insurance and then explain how Medicare for All could help them. Some of the most heart-wrenching moments of Bernie’s 2020 campaign have involved regular people just describing their experiences with private insurance to him (watch this video if you haven’t yet). Private insurance companies make people miserable, and so long as they exist, they will keep trying to undercut Medicare for All; why let them?

The most charitable reading of Weingarten’s prose would have her trying to win support for some kind of “politically feasible” Affordable Care Act expansion. In the aforementioned ThinkProgress interview, she said, “Any plan that provides more people with the care they need and gets us one step closer to affordable coverage is a step in the right direction.”

But a close reading makes it clear that Weingarten is arguing against single-payer advocates in her own union and making the case for private insurance.

Take this passage, for example:

The goal for all of us must be universal coverage. A broader public plan and employer-sponsored private insurance can coexist while still making universal coverage mandatory if we expand our sense of what’s possible.

If who expands our sense of what’s possible? Between the Sanders campaign’s decently strong position going into 2020 and the idea’s popularity with the public, a true Medicare for All program that eliminates private insurance entirely has never been more popular. (While I’d fully support expanding our sense of what’s possible to include a fully nationalized health service and state production of drugs, I doubt that’s what Weingarten has in mind.) No, Weingarten is clearly arguing that single-payer advocates should take a softer stance on allowing employer-based plans to exist. She’s repeating, with qualifications, establishment talking points about people liking their employer-based plans and markets being necessary for innovation — even writing, “union members have made concessions on wages and other benefits in order to get better health care” without mentioning that Sanders’s labor platform calls for all company savings resulting from Medicare for All to come back to workers in the form of increased wages or benefits.

Weingarten’s defense of private insurance when interviewed by Krystal Ball on Rising is even more perplexing, especially because Ball’s question referenced GM’s morally indefensible decision to pull health care from striking workers:

It’s a really obscene, awful thing that GM did. Having said that, the proposal I made in this column was, in some ways, what we have from Medicare right now, which is: have Medicare as the base, not a ceiling. Many of us have actually negotiated Medicare supplemental plans! Like, teachers have Medicare supplemental plans or other types of things to actually ensure that the kinds of things that you want to make sure people have, they have. And so that’s what I proposed.

Again: when single-payer advocates talk about Medicare for All, we are not talking about something that can be relevantly supplemented by private insurance. Medicare for All is universal, comprehensive coverage with no copays or deductibles. The Sanders bill explicitly bans private insurers from offering duplicate coverage. You wouldn’t need supplemental coverage under a Sanders administration, and it would be impossible for employers like GM to use health care as leverage in negotiations to force a bad settlement.

Ball is understandably confused by this line, asking a follow-up: “Aren’t those all reasons, that you just laid out . . . Aren’t those all reasons to fight to eliminate [insurance companies’] influence in our system altogether?

Weingarten responds:

I think that we have to, look, I’m all for fighting to eliminate the influence of big pharma, of big insurance companies, and, frankly, of hospitals that gouge people! But at the end of the day, what’s gonna happen is, just like the other conversation we just had, we have to make sure that workers have more power, and that workers have more choice . . . The one thing I am afraid of is that in many of the different plans, that if you have too short a horizon in terms of when insurance goes, you’re taking things from people that people rely on right now.

The “other conversation” Weingarten seems to refer to is the conversation about GM workers having health care stripped from them during the strike. If that’s truly the implication, then we’re talking Joe Biden levels of misinformation.

No proponent of Medicare for All is arguing that we should take away workers’ health care or replace workers’ health care with a worse plan, and no one who’s read the Sanders bill or H.R. 1384 could possibly come away with that interpretation. The whole point of Medicare for All is to give everyone the free, high-quality health care they need, not take anyone’s health care away. This is a “fear tactic,” sowed by defenders of corporate greed, meant to divide us and make us think that true universal coverage — through Medicare for All — is out of reach.

The Only Viable Option

My union, the Temple Association of University Professionals (TAUP, AFT Local 4531), is currently negotiating a new contract, as our current agreement ends October 15. As for so many union workers, health-care costs are a sticking point. The administration wants to increase our annual deductibles and is demanding those with families pay more in monthly premiums to keep their spouses and children on their insurance plans.

The plan currently offered to part-time faculty is bare-bones as hell: no vision or dental, as I learned when I had to replace my glasses last spring, and no prescription coverage, leaving me to put off filling prescriptions and ration meds to cut costs during the summer. Just to maintain the status quo, we’ll likely be forced, as unions regularly are, to give up gains elsewhere in the contract.

Medicare for All would be huge for me and for my union. It would relieve an enormous burden for union members in all industries. All this raises the question: if AFT members voted to support Medicare for All — a policy that would benefit not only union members but also guarantee free, comprehensive health care for every American — why on earth is our union president crusading against it?