Progressives Beware: The United States of Care Is Not What It Seems
There is a pronounced liberal eagerness to embrace noble-sounding rhetoric upon first hearing. It arises from fine qualities, including idealism and a fundamental belief in human goodness. This impulse is beautiful. It is tender. And it can sometimes lead people astray.
Consider the United States of Care, a new organization that has been warmly received by some progressives. USC is led by former Obama health official Andy Slavitt. Slavitt is a former Goldman Sachs investment banker and McKinsey consultant. The most prominent Republican face in the organization is former senator Bill Frist, a physician who became wealthy as an HMO executive. The group also includes health insurance executives and former health officials from both parties.
Slavitt has reportedly created an investment fund (more here) that hopes to make money from “low-income, high need populations” – that is, people who depend on the government for their health care. That’s a pretty fundamental conflict of interest.
The group still might be worthy of support, if it's well designed and has the public's best interests at heart. And the United States of Care agenda certainly sounds good, which is why some liberal luminaries in Hollywood and in politics promptly gave it their social-media seal of approval. What's not to like about a program that, in the words of a Slavitt op-ed, is "founded on the premise that no American should have to go without the care they need"?
Unfortunately, many unanswered questions remain, and what we have seen so far is worrisome.
A Matter of Principles
The group insists that it is steering clear of specific policy proposals so that it can build bipartisan consensus based on three core principles. A careful parsing of those principles raises some serious concerns.
Those principles are:
"All Americans should have access to a regular source of care for themselves and their families."
Why a "regular" source of care? Why not say that everyone should have access to "quality care, regardless of financial circumstances"? Or why not use the centrist rhetoric of previous years and promise “universal coverage”?
"No one should face financial devastation due to illness or injury."
This even avoids that standard-issue centrist word, "affordable." The word "devastation" suggests a very low level of financial protection, at a time when increasing numbers of Americans report putting off needed medical care because of the cost.
So-called catastrophic insurance plans would arguably fit this criterion, and they are disastrous for working families. Even Donald Trump's health insurance proposal, flimsy as it was, could conceivably fit the bill.
"We need to achieve these goals through policies that are fiscally responsible and have the political support to last."
In Washington circles, "fiscally responsible" is coded language that means, worrying about federal deficits where the general public's welfare is concerned, even when it's not warranted.
Can We Transcend Politics?
In his op-ed, Slavitt write that, "when the next debate begins, we should start with fresh thinking that can unite us in a common goal of putting the health of our nation over politics."
That’s what the Affordable Care Act tried to do. The Democratic proposal incorporated conservative principles, some of which were first articulated at the Heritage Foundation as a countermeasure to the Clintons' 1994 health reform proposal. They included the individual mandate to purchase private-sector health insurance, along with the broader idea that "market-driven" healthcare would turn citizens into "smart shoppers" as competition drove down health care costs.
These ideas were fundamentally flawed. As we wrote in 2007, the individual mandate was doomed to be politically unpopular, while the complexities of medical care overwhelmed free-market competition in a maelstrom of technical issues, contradictory incentives, and the self-interest of medical providers and intermediaries.
Given the obstacles, why does Slavitt believe his organization can "unite us in a common goal," where so many others have failed? Despite its use of conservative ideas, and even though it was modeled on a state program implemented by 2012 GOP nominee Mitt Romney, the ACA failed to get a single Republican vote in the Senate.
Can we really transcend politics, on healthcare or any other critical issue? For that matter, should we? Abstract, dispassionate, technocratic solutions to fundamental issues don’t exist. Any group that claims it can rise above politics is trying to exempt its own opinions from open debate.
An Anti-Medicare For All initiative?
Is it possible, as some commenters have suggested, that the group has another goal in mind? A generally favorable USA Today article, for example, says this: "The organization is trying to prepare for an eventual opening for bipartisan policy, while heading off increasingly volatile swings in health policy when political fortunes shift in Washington."
The first "volatile swing" it cites (in fact, the only one it cites) is, "Senator Bernie Sanders’ ‘Medicare for All’ bill, which has more than a dozen co-sponsors in the Senate."
Slavitt approvingly posted a rather snarky Twitter thread on that subject this week, written by a fellow Obama alum, which began with this comment: "I'm for Medicare for All. There's an American health and financial crisis, and Medicare for All could be part of the solution." (This statement doesn't exactly compute; by definition, Medicare For All covers everyone, so it can’t be “part” of a mixed solution.)
Having attempted to position herself as a supporter, thread author Aisling McDonough then attacks Medicare for All and its backers at length, using the dismissive and condescending tone that has become all too familiar to single-payer advocates. Like other opponents before her, McDonough caricatures their arguments (who says Medicare For All will be "simple and painless”?) and observes with palpable condescension that “health care is complicated."
The Ghost of Healthcare Future
Slavitt and Frist are also part of the Future of Health Initiative, an industry-backed group whose first state principle includes the phrase, "Policies that promote stable private insurance markets."
The group also says it advocates, "Approaches to affordability that do not over-subsidize higher-income Americans or under-subsidize lower-income Americans."
This rhetorical gambit, which favors a "means testing" approach to public goods, has been used for years to undercut programs like Social Security and Medicare. It is a deeply ideological position, and should be debated as such. It also stands in direct opposition to Medicare For All, which, like public insurance programs in other developed nations, would be available to everyone.
Last year, Slavitt and Frist wrote a joint op-ed for the Washington Post. It begins:
"At a meeting in California this spring, we sat down with a number of insurance company chief executives who are major participants in the Affordable Care Act exchanges. They asked us to carry back a message to Washington: Put partisanship aside and end federal uncertainty about support for the ACA; otherwise, they will end up setting premiums higher than necessary or withdrawing from markets across the country."
They remind readers that the ACA health exchanges are about to be "open for business" again before outlining five recommendations. They included a call to bring down premiums; not by reducing health care costs or profit-taking, but by shifting part of private-sector premium costs (including profit margins) from individual enrollees to the government, and therefore to the public as a whole.
Slavitt and Frist also called on Congress to "help middle-income consumers manage the size of their deductibles," not by reducing them, but by increasing the amount of pre-tax earnings that can be set aside for health spending accounts. This benefit is heavily skewed toward high earners, since most Americans are struggling with stagnant wages.
The idea is particularly ill-timed, given the fact that nearly half of Americans polled say they could not come up with $400 to cover an emergency expense.
Smart Shoppers Ask Questions
While the venture met with considerable liberal approval, the United States of Care was also greeted with warranted skepticism in some circles. Slavitt responded on Twitter, saying he and his team are posing responses to questions that have been raised—“some very strongly worded"—and that they will be posted soon.
"The answers aren't going to make everybody happy necessarily,” Slavitt writes, “but there should be a lot more clarity."
Clarity is certainly needed. Here are some questions Slavitt and his team should be prepared to answer in full.
What are the "points of agreement" you say form the basis of your consensus-driven policy?
How can this group take an unbiased approach to health policy, since so many of its members seem to have financial conflicts of interest?
There is significant overlap in membership between this group and the Bipartisan Policy Center. One of that group's stated goals is, "Policies that promote stable private insurance markets." Is that USC’s position as well?
You have denied published reports that your group wants to block single-payer. Most Americans support it, according to at least one poll. Seventeen members of the United States Senate cosponsored a Medicare For All bill. Why doesn't your group include a single-payer advocate? How can a consensus be reached without including this point of view?
Why haven't you published your donor list? Will you do so?
How will your means-testing process work? Why are you opposed to a public program along the lines of Social Security and Medicare?
Why aren't more key participants in healthcare, such as nurses, represented in the group?
We’ve Been Here Before
Without good answers to these questions, it will be hard to avoid the conclusion that this group exists primarily to blunt calls for a more progressive approach to health care. USC’s rhetoric echoes previous "bipartisan" initiatives, like "No Labels" and "The Can Kicks Back." It presents itself as above "partisan politics," but that is often coded language for promoting "bipartisan" deals that are worked in back rooms by insiders.
We've been down this road before, especially on Social Security, where a long list of billionaire-funded groups, using some of the same players, has used similar rhetoric to undercut a popular and successful program.
Too often, calls for "fresh thinking" become calls to create complex, Rube Goldberg-ish devices to forestall or undercut public solution. Experience tells us that these don't work, either as politics or as policy.
Every other developed nation on earth has done a much better job providing medical care and controlling costs than this country’s private sector. So has Medicare. We don't need magical fresh thinking. We need to take policies that have worked elsewhere and apply them to our entire health system.
Liberals should withhold their trust from anybody who promises political miracles without answering tough questions. It’s tempting to believe in a world of solutions that transcend politics. It doesn’t exist. Anyone who says otherwise is playing a political game.