Democrats Debate How to Give “Free” Stuff to More People

The first night of this month’s Democratic debates provided rapid-fire exchanges on health care, made more complicated by CNN debate moderators who rarely gave candidates time to explain their positions clearly. But the overall tenor of the debate seemed clear: Promising free stuff to voters.

Health care consumed a fair portion of the debate’s first hour. Following lengthy exchanges in the first segment, another extended discussion on electability in the second segment revolved around health care—specifically the provision in Sen. Bernie Sanders’ single-payer bill that would make private health coverage “unlawful.”

Sanders and his fellow Sen. Elizabeth Warren (D-MA) sparred with other, more moderate candidates—Sen. Amy Klobuchar (D-MN), Rep. Tim Ryan (D-OH), Rep. John Delaney (D-MD), and South Bend Mayor Pete Buttigieg—about the feasibility of banning the private coverage that most Americans currently have, and like. Warren won applause from the audience, and likely from the liberal base, with her (self-)righteous anger at these criticisms, decrying Democrats’ use of “Republican talking points” about “taking away health care,” and attacking Delaney for “talk[ing] about what we really can’t do and shouldn’t fight for.”

But partisan attacks aside, the debates showed more similarities than differences, on two key fronts. First, even candidates like Buttigieg and former congressman Robert Francis O’Rourke (D-TX) said they want to move everyone onto a government-run health plan—they just want to do it in a slower and more subtle fashion than Sanders.

When Buttigieg argued that a government-run “public option” would get to single payer eventually, he meant that he would sabotage private coverage to force people into the government system over time. After all, Democrats wouldn’t support the creation of such an “option” if they didn’t think it would lead to huge enrollment, which they believe can become a self-fulfilling prophecy through policy bias.

Yet while Sanders sponsored the legislation, he obviously has not read it, calling his proposal “Medicare for All” even though it would explicitly abolish the current Medicare program. Sanders also claimed yet again that his proposal would make health care a human right, even though it would do no such thing. People would have the “right” to have their care paid for if they can find a doctor who will treat them, but they have no explicit “right” to care under his bill.

In a similar manner, Warren refused to admit, despite repeated questioning from the CNN anchors, that taxes on the middle class would go up to pay for everyone’s “free” health care. She pledged that total costs would go down, an implicit acknowledgement of the obvious fact that wealthy individuals alone cannot fund a government-run health system costing trillions of dollars annually. But she, like her California Senate colleague Kamala Harris, somehow wants to keep up the fiction that middle-class families can consume all the health care they want without having to pay for any of it in taxes.

Ultimately, one key winner emerged from the debate: Donald Trump. Moderate candidates who have little shot at winning the nomination took multiple shots at the party’s leftward lurch that the Trump campaign can easily exploit next summer and fall.

The more Democrats keep pushing farther and farther to the left—with the debate on outlawing private health insurance a prime example—the better the president’s chances of winning re-election. Given the tenor of Tuesday’s discussion, the Trump campaign should offer to host, and pay for, another debate for Democratic candidates, as soon as possible.

This post was originally published at The Federalist.

Democrats Debate How Many Americans to Take Coverage Away From

The first segment of Wednesday evening’s Democratic presidential debate featured the ten candidates largely competing amongst themselves to see who could offer the most far-reaching proposals. In response to a question from the moderators, the candidates debated whether to allow individuals to keep the private insurance plans that most Americans have (and like) currently.

Of the candidates on stage, only New York Mayor Bill de Blasio and Massachusetts Sen. Elizabeth Warren said they wanted to do away with private insurance entirely. But as I explained on Wednesday, the other candidates’ plans for a so-called “public option” could result in two-thirds of those with employer-sponsored coverage losing their insurance. In reality, then, the debate centered not around whether to take away Americans’ current health coverage, but how many would lose their insurance—and how honest Democrats would be with the American people in doing so.

For better or for worse, by saying “I’m with [Sen.] Bernie [Sanders]” on eliminating private coverage, Warren admitted that she’s “got a plan” for taking away Americans’ current insurance. Having seen her fellow senator and presidential candidate Kamala Harris flip-flop on her earlier comments about banning private coverage, Warren went all-in on embracing single-payer insurance, perhaps to siphon away Sanders’ socialist base.

Warren used flimsy reasoning to justify her support for single payer, talking repeatedly about insurers’ profits. As she noted, those profits totaled just over $20 billion last year. But during the last fiscal year, Medicare and Medicaid incurred a combined $84.7 billion in improper payments—payments made in the wrong amount, or outright fraud. With improper payments in government programs totaling nearly four times the amount of insurers’ earnings, a move to single payer would likely end up substituting private-sector profits for increased waste, fraud, and abuse in the government plan.

In rebuttal, Maryland Rep. John Delaney pointed out that Sanders’ bill would pay doctors and hospitals at Medicare reimbursement rates. Because government programs pay medical providers less than the cost of care in many cases—72 percent of hospitals lost money on their Medicare patients in 2017—Delaney persuasively argued that extending those payment rates to all patients could cause many hospitals to close.

Indeed, a study in the Journal of the American Medical Association earlier this year concluded that single payer would reduce hospital payments by more than $150 billion annually. To cope with losses that massive, hospitals could lay off up to 1.5 million workers alone. If extended to doctors’ offices and other medical providers, single payer could put millions of Americans out of work—job losses that would obviously affect access to care.

Ironically, the health care debate soon pivoted to talk about “reproductive health.” Commentators noted that the candidates seemed much more eager to talk about abortion issues—on which they almost all agree—than on single payer. But of course, the two remain linked, as Democrats not only want to have taxpayers fund abortions, but to force doctors and hospitals to perform them.

It says something about the current state of the Democratic Party that forcing doctors to perform abortions, and taking away the coverage of “only” 100 million or so Americans, now represent moderate positions within the party. If Democrats want to win over persuadable swing voters next November, they sure have a funny way of showing it.

This post was originally published at The Federalist.

The Opportunity Cost of Fixing Obamacare

The Wall Street Journal reported Wednesday on five states considering whether to spend additional dollars to fix their health insurance exchanges or move to the federal exchange. Some lawmakers believe that “upgrading or sustaining the exchanges could deplete funding for roads, education or other vital programs.”

States trying to fix balky exchanges face technical and logistical problems—and two looming deadlines. The first is Nov. 15, the start of the open-enrollment period for 2015. The second, and perhaps more important, is Jan. 1—the date the U.S. Department of Health and Human Services loses authority to issue grants to states for their exchanges.

With the prospect of additional grants from Washington unavailable next year, some states are rethinking their fiscal priorities. Rep. John Delaney (D., Md.), who opposes efforts in Maryland to spend as much as $50 million more on its exchange, was quoted as saying: “You can’t just print money in the states. It could come from education or other important programs.”

Of course, the same arguments could be made regarding Obamacare’s Medicaid expansion. Despite a high federal match, expansion brings with it administrative costs—in the tens of billions, by a 2010 Heritage Foundation estimate—and state shares of spending would increase in future years.

The Fiscal Survey of States underscores the squeeze Medicaid has placed on states’ other spending priorities. In fiscal 2013, states collectively reduced higher education spending by more than $1 billion, even as Medicaid outlays grew by nearly $500 million.

It’s good that legislators, including supporters of the Affordable Care Act, are publicly recognizing the opportunity costs associated with greater state spending on health care. But it’s a debate that should have transpired years ago.

This post was originally published at the Wall Street Journal Think Tank blog.