Socialists Finally Adopt Healthcare Incrementalism, But Their Justification Is A Hilarious Lie

Bernie Sanders

If there is one thing that defines and unifies leftists of different stripes, it’s their derision for compromise and incrementalism.

When Susan Sarandon endorsed Donald Trump for president after the loss of her preferred candidate, Bernie Sanders, in the 2016 Democratic primary, she demonstrated this virulent hatred. Sarandon famously proclaimed that Trump, evil as he is, would be such a shock to the system that the much vaunted ‘revolution’ a little birdie on Bernie’s podium foretold would be accelerated, whereas a vote for Hillary Clinton would be a concession to incrementalism.

Repulsive and laced with white privilege as it was, Sarandon’s message resonated with a lot of ideological leftists raw from the bruising defeat of Sanders because they, like Sarandon, believed that anything, including the the placement of a neofascist at the top of American government, is better than the pragmatic road to progress Hillary Clinton had laid out and Barack Obama and Joe Biden had walked for eight years.

Populists abhor the idea that both the diversity of needs in a pluralistic society and political reality dictate that progress is better delivered and more durable as concrete steps over time rather than as a 10,000-volt electrical shock. Further, they believe that any policy that fails to brutally punish the villains in their narrative - whether or not it helps the protagonist - is corruption.

Imagine my surprise, then, when I saw the following words in the pages of Jacobin, one of the most prominent publications of record among the socialist left: “Medicare for All isn’t yet winnable. Expansion is.”

The line is attached to an article that urges the left to adopt Bernie Sanders’s approach to expand Medicare by lowering the eligibility age and adding to traditional Medicare vision, hearing, and dental benefits. But what is being credited to Sanders is a shameless plagiarization of the platform Hillary Clinton - who was absolutely ransacked by the left for positions just like it - ran on in 2016.

Be that as it may, the real schadenfreude comes from watching socialists twist themselves into a pretzel to justify this sudden shift after brandishing for years their single-payer-or-bust dogma out, loud, and proud.

To make their audience swallow this bitter pill of compromise, Michael Lighty, the author of Jacobin’s foray into the dark side and a prominent DSA evangelist, sets up a false choice: it’s either Sanders’s plagiarized Medicare expansion or the evil Obamacare subsidies for individuals to buy health insurance.
Should we make the expanded subsidies for purchasing commercial insurance permanent, as Democratic leaders like Nancy Pelosi prefer, or should we lower the eligibility age for Medicare, while covering dental, hearing, and vision and capping all out-of-pocket spending at $2,000 per year, as Bernie Sanders proposes?
One has to wonder why we must choose. What would be the policy reason for why we should, in effect, increase the healthcare costs of everyone else (which is what ending the extra subsidies would do) in order to expand Medicare coverage?

The answer, from the socialist perspective, is obvious. Ultimately for socialists, helping people isn’t the objective, hurting the villains of their stories is. In their view, helping people buy health insurance is bad, because they happen to buy it from private insurance companies, who are the villains. Enhancing Medicare, on the other hand, is clean and doesn’t involve having to help insurance companies.

Oh, but it does.

Lowering the Medicare eligibility age and making enhancements to Medicare plans will also automatically put more taxpayer dollars into the pockets of the health insurance companies socialists so appear to dread.

Wait, what? Really? Really.

Lowering the Medicare eligibility age to 55 or 60 will also make the option to choose a private health care plan under Medicare - known as Medicare Advantage - available to those newly eligible. 40% of Medicare beneficiaries are already enrolled in Medicare Advantage plans, and that share is only growing. Lowering the Medicare eligibility age may be a good idea, but it too will increase subsidies to the private health insurance industry, since the arrangement under Advantage plans requires the government to pay to a beneficiary’s chosen insurer a set sum of money.

Since you cannot simply strike Medicare Part C - the part of Medicare that Medicare Advantage falls under - with 50 votes in reconciliation (which cannot be used to change broad non-budgetary policy), expanding Medicare and enhancing benefits will also mean more money paid to private insurers to cover a beneficiary at least as well as traditional Medicare could.

What about lowering the out-of-pocket maximum to $2,000 though? That will hurt private insurance, right, since they’ll have a much harder time competing with that low a cap? That would really stick it to insurance companies, right?


Medicare Advantage is set up so private companies cannot take advantage of the government, but also so that they can provide fair competition on a level-playing-field against fee-for-service Medicare.

By law, Medicare’s payment to Advantage plans to cover beneficiaries who choose those plans are based on how much it would cost Medicare to cover those individuals under traditional, or original, Medicare. If traditional Medicare lowers the out-of-pocket maximum for beneficiaries, that would mean that the government’s per-beneficiary cost would increase, which would also increase Medicare Advantage payments the government makes on behalf of the beneficiary to private insurance companies that provide Advantage plans.


Even when they inch closer to political realism and embrace policy incrementalism, socialists feel a need to justify a policy and good policy not because of how it will help people who need help but how it will hurt people they don’t like. And even then, they’re just devastatingly, ridiculously, hilariously wrong.

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