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7/29/19

Medicare for All's opponents are playing language games because they are losing

The public loves Medicare because it is a reliable government program, in contrast to private insurance, which is unreliable. But Neera Tanden argues that "Medicare for All" is misleading, since one can supplement Medicare's government coverage with private coverage.

The public loves "universal health care" because this phrase, for decades, was associated with a reliable government program - in contrast to private insurance, which is unreliable. But The Center for American Progress insists that since wonks use "universal" to describe any system that aspires to cover everyone - including private health insurance systems - that by the rules of logic, the public must have had this meaning in mind too.

A recent Marist poll asks respondents a question that contrasts "a national health insurance program or their own private health insurance program" - as if beneficiaries "own" their private health insurance in a way that they do not "own" their public health insurance. This framing, of course, suggests that beneficiaries have some degree of control over private insurance, and lose it in a public insurance program.


The opponents of Medicare for All are losing. They cannot defend a private insurance system on the merits, and certainly cannot defend it as superior to single payer. And you can tell that they are losing because their position has increasingly come to rely on empty language games like the three above. Remember this when M4A's opponents call for an "honest conversation," a "good faith debate," and so on. For them, an "honest conversation" means aggressively promoting these tactical redefinitions with quite deliberate messaging campaigns - and then berating as dishonest anyone who doesn't want to accept their terms of debate.


UPDATE: Quite independently from me, Matt Bruenig posted today about another language game at work in our health insurance discourse - the semantics of the term "churn".

This is not a "policy debate" in the rationalistic sense we typically have in mind when we talk about such things. There is no real disagreement on basic facts like "employer-provided coverage means that you lose your current coverage constantly" and "a transition to Medicare for All means that you would lose your current coverage exactly once". Nor is there any substantive disagreement about which system would be preferable, when we put it that way.

So instead, as Bruenig explains, opponents of Medicare for All have created a line of argument against it that depends on using "churn" inconsistently. This move pulls the debate away from a substantive conversation about the policy; to demystify it, partisans of Medicare for All have to engage in this exercise of pure reason that deconstructs the language game at hand and reveals how it is being played.

Presumably, opponents of Medicare for All will keep using words like "churn" and "universal" and framing gimmicks like "their own private insurance" or "Medicare means private insurance too" in order to keep the debate in the realm of the semantic and as far away from a substantive conversation as possible.