Sunday, November 17, 2019

Elizabeth Warren and Dr. Christine Mann: Trying to Have it Both Ways

     The biggest surprise about Elizabeth Warren's so-called "Medicare For All" transition plan is that I have seen it before. Nor did she get this policy tidbit from Bernie Sanders or Jay Inslee. Instead this policy gem was sitting cheerfully on the website of a candidate for Congress in the Texas 31st Congressional District, Dr. Christine Eady Mann. The differences are that Dr. Mann's plan lowers the Medicare age to 55 rather than 50, enrolls "all infants" immediately when the law goes into effect and doesn't require a second vote. It includes Medicaid expansions and increased subsidies to insurance companies through the ACA not included in the Warren "Medicare For All" transition.

     Most important, both Senator Warren and Dr. Mann's plans are based on the idea of selling a public option for the first three years before everyone is covered. This is the poison pill that ruins any idea of either being truly Medicare For All. Dr. Mann's has the added problem of actually strengthening the insurance companies and their ability to ultimately cause the public option to fail. If the public option fails, single payer will not be introduced. The failure of the public option will then be cited as proof of why single payer should not go into effect.

     Why will the public option fail? The glib, sarcastic answer is that it will fail because the insurance companies want it to fail. If Dr. Mann's idea of incorporating increased subsidies for purchasing private health insurance into the transition to single payer goes into effect then we are literally paying the insurance companies to keep fighting single payer. We will be prolonging their existence instead of phasing them out.

     Even if we don't essentially expand the ACA framework in opposition to the future single payer plan, selling a public option puts the government in the business of selling health insurance. What will the premiums and deductibles of the plan be? Dr. Mann doesn't say while Senator Warren call is it "true Medicare For All." If the public option is "true Medicare For All" then how does the buy in occur, what changes when the system becomes fully single payer and how does one pay for "true Medicare For All" until that happens?

     Dr. Mann names the public option as such. This is the Obamacare public option, a health insurance plan sold by the government. It is easy to see the public option becoming a high risk pool paid for by the government while younger, healthier, more profitable people are covered by the private insurance industry. The result would by that private insurance would be more profitable, and harder to get rid of, than ever while government insurance would be seen much as providers see Medicaid now. The public option would be labelled an expensive failure and single payer would never happen.

     The only good faith reason I can imagine for this kind of plan is to convince the insurance companies that they will remain profitable until their doors close. A golden parachute for the insurance companies will produce a bill more moderates will vote for. This may be why Pramila Jayapal have been willing to lend their support to the terrible Warren "Medicare For All" plan. If they see it as more broadly popular with other Dems and equally practical in the real world they will lend it support for pragmatic reasons.

     This is precisely why these plans are dangerous. We know the insurance industry and Big Pharma act in shockingly bad faith. We understand that health insurance companies make a profit by accepting payments and denying care. So why do you any good faith progressives think they are worth appeasing?

Sunday, November 3, 2019

Once More, No, You Aren't Middle Class

     There is no middle class in managerial feudalism. There are tenants/workers, bosses and landlords. The middle class is a right wing trick that has been unfortunately perpetuated by many who represent themselves as being on the left of American political thought. While I don't think that Elizabeth Warren really thinks mega-millionaires are "middle class" I do believe she thinks there is a middle class, and that she is including people better described as bosses or landlords within it.

     The idea of the middle class is a legacy of the Cold War attempt to create some quasi-left wing ideology that would support social and economic progress without undermining the basic ideas of capitalism. The most privileged members of the working class were convinced that their interests were separate than those of blue collar factory workers. That's precisely why the addition of "tenant" is so important. The tenant/worker class is defined by work for wages and paying rent. As I explained in my last essay, mortgage loans are de facto rents to a de facto landlord. Therefore I am including home owners still paying on their mortgage in the category of "tenants."

    Even such bastions of capitalist thought as the Brookings Institution still can't clearly define the middle class. There's a reason for this and it's because the concept is just wrong. If you admit this it becomes much easier to admit that you have interests in common with nebulously defined people like "the poor," "criminals," and "immigrants." They're all working people trying to pay their rent, just like you. The poor are having trouble paying their rent consistently. The criminals are only able to do so by breaking the law. Immigrants have been fooled by middle class snake oil the same as you and I, regardless of whether they are documented or not. We're all trying to pay the rent.

    Our power is in numbers. There's a reason we write or tweet about the 99% all the time. In the end, there are a lot more of us than there are of them. It's our only protection against the landlord and the boss. So we have to stick together. Solidarity is the only weapon we have.

     Middle class identity is a false identity used to alienate us from our own best interests. We think of ourselves as few steps down the ladder from wealth when we are really in danger of falling into poverty at any moment. Not recognizing this cedes an immense about of power to the right and center. We can't afford to do that. The left has to be class conscious.