Don't Make Health Care a Purity Test.
'There are multiple ways to achieve universal coverage.
We’re now in the silly season of the Democratic primary — a season that, I worry, may last all the way to the nomination. There are many honorable exceptions, but an awful lot of reporting seems to be third order — not about the candidates, let alone their policy proposals, but about pundits’ views about voters’ views of candidates’ electability. It’s a discussion in which essentially nobody has any idea what he or she is talking about.
Meanwhile, however, there are some real continuing policy debates. They’re not mainly about goals: Whoever the Democrats nominate will profess allegiance to a progressive agenda aimed at reducing inequality, strengthening the social safety net and taking action on climate change. But there are some big differences about how to achieve those goals. . .
The most important thing you need to know about these rival plans is that both of them would do the job. . .
What won’t be fine will be if activists make a no-private-insurance position a litmus test, declaring that anyone advocating a more incrementalist approach is no true progressive, or maybe a corrupt shill for the medical/industrial complex. As you might guess, my concerns aren’t drawn out of thin air; they’re things I’m already hearing.
So Democrats should try to make this a real debate, one about the best strategy for achieving a shared goal. Can they manage that? I guess we’ll find out.'
https://www.nytimes.com/2019/03/21/opinion/medicare-for-all-democrats.html?
= new reply since forum marked as read
I don't know purity test from litmus test. I do know health care is the issue I care the most about and therefore will be the deciding factor when I vote in the primary. I am doing my best to not demonize, or infer malevolent motives, on the candidates who do not support Medicare for All with no private-insurance participation because I think Krugman is correct in his assessment that getting to this will be a heavy lift. I trust the candidates want to "do the job" of getting universal healthcare at the lowest possible price, I do not agree with their thinking that seeking an accommodation with private insurers will make them more electable.
As Krugman said in the first paragraph, the discussion about candidate's electability is "a discussion in which essentially nobody has any idea what he or she is talking about."
As far as I'm concerned, the decision about who is electable is decided on primary day. I am voting for who matches me on healthcare, everyone else can make their calls, and then I vote with the Democratic herd in November. Perhaps this is me echoing Krugman, but I'm not capable of playing 11 dimension chess and trying to anticipate how others will view any given candidate when it is decision time.
I do disagree with Krugman that the rival plans all "do the job" if doing that job includes saving a butt-load of money and avoiding more than a few headaches. I don't think he is doing anything underhanded but his equating the Dutch system with enhanced Obamacare doesn't address his aforementioned "fact on the ground" that 156 million Americans have employer-based health insurance. Correct me if I am wrong, but the implication is we would have a problem going to a single-payer Medicare for All because so many of these employed American are satisfied/happy with their current coverage.
So, first, I HAVE to point out that Krugman throws in that the Dutch system is a "better-funded" version of our Obamacare. I suspect this might have something to do, at least partially, with the extra layer of administration stemming from accommodating "private insurers." (I use parentheses because Krugman also mentions they are "heavily regulated" and I think we can well imagine that European regulation is a tad more stringent than our norms.)
Despite this, Dutch healthcare costs are approx. 60% of ours, with overall better outcomes.
Second point, Dutch health insurance is NOT employer-based. It, like Obamacare, is a system wherein citizens are required to have health insurance, and subsidized if they need assistance paying for it.
So please don't be confused by his including various examples of how other nations have achieved universal healthcare coverage. Yes, there are so many ways to achieve the goal.
Now, ask, listen and challenge the candidates to explain how they want to achieve our share goal. Universal coverage, save numerous lives, cut healthcare costs, and avoid a lot of headaches. Actually the House Medicare for All bill, proposed by Pramila Jayapal, is the most effective option.
Medicare for some, or a Medicare public option, seems to me, to be a perfect set-up for those who want to continue believing government is a failure. Lowering the age — to 55 years old for instance — does bring in a big chunk of healthier (than the average 65 year or older) people but, on average, because they are older there will be a larger cohort of people needing medical care than those in younger age groups. In addition, those who are healthy enough to work in their later years also are more likely to have employer-based coverage, so we have another unfavorable selection process going on.
I don’t know who supports this idea, but I’ve also heard of Medicare for some covering young people. OK, on the face of it, sounds good, and you can even make the argument that it’s a great stepping stone to our ultimate goal: Medicare for All. Call me cynical, but I would be wary of this because… well, besides older folks who else spends a lot of time visiting doctors? Kids! Parents are constantly taking their children to see the doctor. It’s part of growing up, getting adjusted to life on the planet I suppose.
So let’s say we create a Medicare for Some “stepping stone” plan towards Medicare for ALL wherein people age 55 and older, and people age birth to 20 are covered. If I am a private health insurance provider, yeah I might be miffed my overall pool of clients just got smaller but WOW, you just delivered the creamy filling in my Twinkie! 
People age 20 – 50? Yeah, I’ll sell them health insurance all day long…cha-ching 
Meanwhile the government, stupid/corrupt/inefficient government gets to pay the healthcare costs for those most likely to need it.
Again, I understand concerns about hanging this issue around the neck of any given candidate and hoping she or he can convince 51% of America (or 270 electors, or 5 Supreme Court justices) to vote for them. Part of my response to that concern might be a tad optimistic: I tend to have faith that people understand that the policy stances that attract them to a candidate are not done deals. I want Bernie in the White House, but I know he will have to work with Congress, with the Supreme Court and with all of us to deliver on ANY of his promises. This is true of every candidate, and I think we all get that. The best we can expect from our officials is they work like heck to represent our priorities.
So I imagine a Democratic voter, or an independent one, might not want to go with Medicare for All, but they might still vote for a candidate who wants to go there because of other factors and...well... 45
One last note, sorry for the LONG read. In the 2018 primary for Governor in Michigan, it will come as no surprise that I supported Abdul El-Sayed because he had a beautiful plan to take a stab at single-payer called MICHICARE. He did not win that primary, partly, I suspect, because a lot of Democratic voters were nervous about their candidate being called a "socialist."
Imagine my (pleasant) surprise when his opponent - Gretchen Whitmer - was accused of wanting a "a radical government takeover of your healthcare" during the general election.
We're going to have a debate about healthcare within the Democratic Party, our candidate will take SOME position in favor of expanding coverage, and she or he will be called a godless, spendthrift Socialist who once dragged our flag through a manure field. That is going to happen regardless.
Enjoy this debate, argue for your candidate, and work your hiney off for our godless, spendthrift....