After the midterms, remember when I spoke of “incremental change?” Here’s what it could look like.


In the euphoric days following the Democratic steamroller in the US House, the conversation quickly turned, since as Democrats we’re actually concerned with governing, The Democratic challengers had made quite a few rather concrete promises, and the question was how to actually get anything done in a split congress.

One possible solution was to pass promises made through the House, and then let Yertl the Turtle scuttle them in the Senate, enabling the Democrats to put more pressure on flipping the Senate to get those measures passed.That’s a perfectly valid strategy, since it shows that we’re doing our part, and it’s McConnell and the Senate that are stifling popular measures.

My personal suggestion was that we consider using incremental steps on big issue legislation. Medicare-for-all was a perfect example. It’s popularity in polling is now well over 50%. and a lot of candidates touted it in their campaigns, but it’s not something that could be passed in this congress , Or even in a Democratic Senate that lacked 60 votes to break a filibuster. So don’t even try.

Remember, a walk scores the same run as a homer if you can get all the way around the bases. My suggestion was to break Medicare-for-all into smaller, incremental pieces, each one of which itself is popular, and yet sets the table for future incremental steps. The example I chose was prescription drug prices. Medicare and Medicaid combined are the largest purchasers of prescription drugs in the United States. And yet they are at the mercy of the big pharma companies, forced to pay the “going freight.” Pass a bill that allows Medicare and Medicaid to negotiate directly with the drug companies for lower, bulk prices. And if they refuse, then threaten to negotiate directly with Canadian drug companies for FDA approved alternates. Since the GOP base is largely made up of older, lower income, white Americans that are currently on either Medicare of Medicaid, good luck killing that bill in the Senate, and see what it gets you.The next increment would be to allow Medicare and Medicaid to negotiate directly with insurance company medical “groups” of hospitals and physicians for lower rates. See how it goes?

Well, one of the candidates currently running for President on the Democratic side is proposing to do exactly that, but writ large, and on a much sneakier (which I of course love) level. In her televised town hall in Michigan on MSNBC Monday night, Senator Kirsten Gillibrand floated her own vision of Medicare-for-all, on an incremental level.

One possibility that has been floated was for anybody over the age of 50 or 55 to be able to voluntarily “buy in” to Medicare. This is a totally sensible plan, since it allows those most likely to be uncovered by private or company provided insurance access to healthcare, and it also minimized the “high risk” pool for insurance companies. Gillibrand’s plan is subtly different, but that subtle difference make all the difference in the world. Her plan would allow anybody not covered by private insurance to “guy into” Medicare, regardless of their age. It would leave people already covered by private or company provided medical insurance the option to keep their coverage if they wished.

In my humble opinion, if this bill passed, it would lead to Medicare-for-all in 5 years or less. Here’s why. If you get health insurance through your employer, you are quite likely paying some kind of a “split” every two weeks. Whether it’s 50-50, or 40-60, your employer is picking up at least half of the cost of your coverage, and you are paying the balance. With that insurance coverage comes the dubious distinction of having to hassle and wrangle with the insurance company over every goddamned thing, from tests to doctors and hospitals “in the group.”

We’ll use Teri and I for my example. Teri gets her insurance through her work, and she gets paid weekly. Every paycheck, she has $42 deducted from her pay for her “split” on the insurance. I don’t have coverage, because adding me to her policy would bring her “split” up to almost 50% of her paycheck, which is insane. But last December, when I contacted the Social Security Administration regarding my disability claim for my glaucoma induced blindness, the automated recording announced that the 2019 Medicare premiums would be $126 a month.

Think about that for a minute. My beloved wife is paying $168 a month for tolerable insurance coverage through her work. Why should she stay with her company insurance if she can “buy into” Medicare, with less hassle over her healthcare choices, and save almost $50 a month in the process? Now, look at it form the employers point of view. Every year, either the employer, or their HR department, has to negotiate the rates for their healthcare for the next year with the insurance company or companies wanting to bid. They have to evaluate cost, plan benefits, and all of the peripheral features and benefits. I’m guessing that the majority of companies in America, regardless of the split, are paying well in excess of $126 a month to cover their employees. It would make perfect economic sense for the company to either eliminate their health insurance coverage as a benefit entirely, advising the employees that they actually save money by converting to getting their insurance from Medicare, or if they want to tout medical coverage as a benefit, give the employee a commensurate raise that would cover the $126 a month that the employee would have to pay, knowing that they’re saving money in the transaction.

Gillibrand’s healthcare plan is a textbook example of the kind of incremental that I’m talking about. On the face of it, it doesn’t change a single thing about the current healthcare system, it simply provides people without coverage access to an affordable plan through the government. But that single incremental step will make it cheaper for both employees and employers to get healthcare through the government. And the most deliciously ironic part of this plan is that congress wouldn’t even have to pass a law mandating Medicare-for-all. They’d just have to sit back, and let the GOP’s oh, so precious “economic rules of unfettered capitalism” work their magic. Talk about hoisting somebody on their own petard.

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6 Comments on "After the midterms, remember when I spoke of “incremental change?” Here’s what it could look like."

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It’s things like this that make Gillibrand my #1 pick. You know what, people? Al Franken can afford health insurance. Let’s talk about the rest of us. I think Gillibrand has the same progressive goals as all our candidates, but also thoughtful, creative ideas about working toward them. And I deplore people who have decided that there is only ONE way of getting to affordable access to health are for everyone, and have made that a litmus test for whether you are “pure” enough for their taste. I’d prefer that we agree on the end goal and then have an… Read more »
Denis Elliott
I think you’ve nailed it. It’s a variation on the “Public Option” that was originally going to be part of the ACA. Alas, it was deleted in what I firmly believe then was a useless attempt to pull at least some GOP votes for the final bill. I also believe President Obama pulled it much too soon in the process. Private insurance and “concierge” medical care will always be there, but with people having the option to buy into Medicare it will be radically transformed as it simply can’t compete – especially if someone isn’t offered coverage by their employer.… Read more »

Actually, the person mostly responsible for sinking the public option, which everyone assured us would be there, is my second least favorite politician of the 00s, after Dick Cheney: Joe Lie-berman.