(Photo: Sipa USA via AP)
The coming years will require progressives to play extremely tough defense if we hope to preserve gains we've made. That means highlighting the disconnect between the promises that Donald Trump and Republican lawmakers have made and their actual proposals, and hammering home who their plans are designed to help: people who are already very wealthy. It also means mobilizing in our communities to exert pressure on politicians, as progressives did with considerable success during the recent health-care debate.
But it's obvious that defense isn't enough. To win over and mobilize the public, social justice advocates must articulate what we're for, not just what we're against. The American people deserve better than what's currently on offer from team Trump, but for many, the status quo also falls short. If progressives are to fulfill one of our core principles-the use of public policy to improve the lives of those left out or underserved by the market economy-we need a simple, plausible plan that excites people. Two key components of that plan are Medicare for All and a guaranteed jobs program.
A Medicare for All health-care system
Republican complaints about Obamacare never passed the laugh test. Some, like the claim that it was killing jobs, were completely unfounded. Others, like the GOP's frequent reminders that millions of Americans remain uninsured, were hypocritical to the extreme. Their own bill proposed knocking 24 million people off of coverage. And it's because of Republican opposition that 19 states and millions of Americans still don't benefit from the Medicaid expansion.
The public's rejection of the House GOP's draconian Obamacare replacement bill was notable. "Trumpcare's failure proved, in the most emphatic way possible, that you can't go further right than the Affordable Care Act without starting to drop people en masse from health insurance coverage," The New Republic's Sarah Jones pointed out. "[I]f you want to improve health care in this country, there is nowhere else to go but left."
We agree. The Affordable Care Act led to historic gains in coverage and slowed down the growth in health-care costs. But one can applaud and work to build on those gains while also noting that our system continues to leave millions of people uninsured and many more with high deductibles, co-pays, and premiums (even after accounting for government subsidies).
We can improve the current system by getting the Medicaid expansion into the 19 states that haven't yet adopted it (for which there now appears to be budding support), introducing a public option into the insurance exchanges (as former President Obama himself suggested last year), improving outreach and assistance efforts, and raising marketplace subsidies to lower out-of-pocket costs.
But we should also aim higher, building off the compelling fact that other countries already provide universal or near-universal coverage to their citizens while spending about half of what we do as a share of GDP. Their approaches vary, but a common thread unites them: an increased role for the public sector, either as regulator, price-setter, insurer, provider, or some combination thereof. In fact, there are sound economic reasons that health insurance belongs in the public sphere. For one thing, consumers lack sufficient information to make welfare-maximizing choices in private markets. For another, the unpredictable nature of health care needs and the lack of incentives to cover sick people make a large risk pool optimal. It should come as no surprise that our own government-run health programs, Medicare and Medicaid, are both far more popular and more cost-efficient than private insurance in this country.
How to get from where we are to Medicare for All is a huge challenge. Paul Starr recently suggested a smart, incremental step in the Prospect: "Midlife Medicare," which extends the system to 50- to 64-year-olds without employer coverage. Demos strategist Vijay Das recommends expanding Medicare first to kids. In a political climate where some conservatives want to cut social insurance, these ideas provide examples of turning from defense-"hands off Medicare!"-to offense: expand Medicare's eligibility.
A federal job guarantee
One of the many bad ideas in the failed Republican health-care bill was a Medicaid work requirement. As we explained in a recent op-ed, most people who can work already do, and those who don't are often faced with a lack of available jobs, transportation options, child-care services, or other work supports.
Lawmakers serious about providing work opportunities for people, rather than unnecessary and unrealistic requirements, should instead back a federal job guarantee. This proposal, outlined recently by Mark Paul, Sandy Darity, and Darrick Hamilton in Jacobin and by Jeff Spross in Democracy, is straightforward: the federal government would provide a job, with salary and benefits, to anyone who wanted one and didn't have one. A job guarantee could simultaneously lower un- and underemployment while providing critically needed labor in fields ranging from infrastructure to education to child and elder care.
A federal job guarantee would also be a useful program during recessions; when private-sector employment took a hit, public-sector employment could grow to offset the lost demand. It would help stabilize the economy while significantly reducing poverty and replacing the opportunities swallowed up by recession.
Making The Case
The arguments against these ideas would tend to fall into two familiar categories: "They require too much government" and "They're too expensive."
On the first objection, the government is already present, if not always accounted for. The idea of health care as a right is embodied in the fact that hospitals must treat the ill, regardless of their ability to pay. Half of our spending on health is already in the public sector. We already recognize health care's non-market attributes.
That's less the case with jobs, but think of it this way: When credit markets fail to provide enough capital to keep commerce humming along, it is widely agreed that the Federal Reserve must step in as the lender of last resort. Having conceded government's responsibility for boosting commerce, why not for labor? When the job market fails to provide adequate employment opportunities, as is the case even today when the national unemployment rate is quite low, there is a role for government to make up the difference.
As to cost-the second objection-funding these policies would indeed require significant tax hikes. The sharp rise in inequality in both pre-tax income and wealth suggests that progressive tax increases-ones that ask the most from those with the greatest ability to pay-are the right place to start. We should not kid ourselves into thinking, however, that we can pay for Medicare for All and a jobs guarantee solely by taxing the rich.
Yet we must consider not just the tax side-there's the benefit side of the equation, too! Part of our job must be to help people understand the benefits they'd receive from Medicare For All and a job guarantee. Analyses of Medicare for All-type programs conducted over the years, for instance, typically predict that low- and moderate-income Americans would see net savings. And we should not underestimate the consumer benefits of simplifying our complex, hybrid health-care system by significantly limiting the role of private insurers.
Many Americans, especially those left behind by structural economic changes that have undermined their economic opportunity, might also be deeply relieved and thus willing to help pay for an employment system that essentially took job insecurity off the table.
We recognize that the devil is often in the details and that we're talking about these two policies at a fairly abstract level. There's a great deal of analytic work to be done before we can fully enumerate their costs and benefits. Moreover, given our current president and Congress, we're a long way away from getting even incremental improvements to our laws on the books, let alone big overhauls like Medicare for All or a job guarantee.
But our fight against the bad ideas Republican lawmakers propose will be decidedly stronger if we simultaneously lay the groundwork for the good ideas the American people deserve.
