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The Political and the Technical

Rebutting the latest anti–Medicare for All nonsense.

Quentin Verwaerde / Flickr

One of the frustrating things about the centrist response to single-payer proposals is that they cannot seem to determine in their own minds whether a particular objection is political or technical. Indeed, often objections will start off as technical and then, when pushed back against, quickly morph into a political argument.

It’s fine, of course, to make political arguments. It’s also fine to make both technical and political arguments. But what is not fine is to conflate the two.

Catherine Rampell’s latest post is a masterpiece of this kind of conflation. This is especially true because she borrows from the argumentative themes of technical impossibility (“facts, evidence, and experts”) in order to make arguments that are almost entirely about her own personal opinions about how voters will behave.

Consider her money paragraph:

[1] What about the 178 million people who currently have employer-sponsored health insurance and overwhelmingly like it? [2] What about the sticker shock awaiting individuals and employers over the tax increases necessary to pay for such a program? [3] What happens if hospitals go bankrupt because Medicare reimburses at much lower rates than private insurance? Would the government step in and run them, as is the case in Britain?

Neither one nor two are technical problems. We know how to move people from employer insurance to Medicare, as we already do this for people when they turn sixty-five. It is technically feasible to do this even if they “overwhelmingly like” their employer insurance. We know this because many sixty-four-year-olds like their employer insurance and yet get pushed onto Medicare. We also, of course, know how to levy taxes even if people are “sticker shocked” by them.

Three is a technical problem, but its solution is trivial: increase provider payments to the level necessary to prevent sector exits.

Rampell continues her takedown:

And most important, how do you actually pay for this enormous, multi-trillion-dollar overhaul? (Is Mexico paying?) Given Americans’ allergy to higher taxes, it’s not enough to dismiss fiscal concerns by assuming Americans will gladly give Uncle Sam the money they currently earmark for a private health insurance system.

How do you pay for it? You raise taxes. Rampell seems to know this is how you pay for it, but then shifts into an argument not about the technical possibility of raising taxes in one of the most lightly taxed countries in the developed world, but instead about her hunches concerning the persuadability of people on it.

Like I said at the top, it’s totally fine if pundits want to write takes that say that, in their opinion, voters won’t like it and can’t be persuaded. I wouldn’t say pundits have a whole lot of credibility on the topic of how voters behave, but hey, everyone is entitled to an opinion.

What is really obnoxious, though, is this tendency exemplified by Rampell where she conflates technical and political challenges in order to borrow from the scientific patina of the former to mask the random conjecture that typifies the latter.