LATIMES.COM/OPINION FRIDAY, OCTOBER 4, 2019A
OP-ED
S
en. Bernie Sanders’
once-quixotic campaign to
abolish private health in-
surance in the U.S. — most
of it employer-sponsored
— in the name of “Medicare for all”
has now become the leading prog-
ressive litmus test for anyone seek-
ing the Democratic Party’s presi-
dential nomination. Twelve of the
remaining candidates subscribe to
it, in various versions.
Unfortunately, the progres-
sives’ eagerness to upend the en-
tire $3.5-trillion U.S. healthcare
system while canceling the current
health insurance of 217 million
Americans is based on some seri-
ous misconceptions.
It disregards what other coun-
tries actually do to achieve near-
universal access to healthcare; it
underestimates the financial con-
sequences for Americans of such
radical restructuring; and it fails to
recognize how much easier it
would be to achieve the same — or
better — healthcare outcomes by
building on, rather than disman-
tling, the Affordable Care Act.
While Sanders is correct that
most advanced countries guaran-
tee healthcare access to nearly all
their residents, they do not neces-
sarily do this through a single-pay-
er national program like Medicare.
Most notably, some of the rich-
est European countries like the
Netherlands, Switzerland and
Germany have what might be
called “HealthCare.gov for all,” the
central feature of the Affordable
Care Act. They deliver access to
healthcare by mandating that all
households purchase private or
nonprofit (not governmental) in-
surance policies, and subsidize the
cost based on income — an ap-
proach identical to what the ACA
does through the online insurance
exchanges.
Canada has what might be
called Medicaid for all, provincial
programs that vary in benefits of-
fered. Provinces are reimbursed by
the national government based on
levels of provincial need and re-
sources, much like our states are
with respect to Medicaid. This ap-
proach is embodied in the Afford-
able Care Act’s Medicaid expan-
sion program that — in the 36
states that implemented it — made
millions of Americans newly eligi-
ble for Medicaid by allowing people
with higher incomes to qualify.
England has the equivalent of
the U.S. Veterans Affairs health-
care program “for all,” with hospi-
tals and healthcare providers di-
rectly supported by the national
government.
Further, every country so ad-
mired by the Democratic progres-
sives guaranteeing universal ac-
cess to healthcare also has a large
role for private insurance. In Cana-
da, two-thirds of all households
buy complementary private insur-
ance to cover additional benefits
and better care (much of it deliv-
ered across the border in the U.S.),
as do almost 50% of Australians
and 40% of Danish households, ac-
cording to a May 2017 report by the
Commonwealth Fund. In Ger-many, more than 10% of house-
holds opt out of the government
program altogether and purchase
unsubsidized private insurance.
(In fact, most Americans on Medi-
care have supplemental coverage
to fill Medicare gaps.)
The financial underpinnings of
Medicare for all rest on the as-
sumption that great savings will be
achieved by abolishing the profits
and administrative costs of the pri-
vate insurance industry and that
its total cost will be less (or at least
not more) than current combined
public and private expenditures.
Some advocates claim that any in-
creased taxes required will be off-
set by savings in out-of-pocket
healthcare expenditures and
health insurance premiums.
Each assumption is unfounded.
In 2017, according to the Centers
for Medicare and Medicaid Serv-
ices, the cost of administration and
profit per privately insured indi-
vidual ($618) was actually less than
what government insurance pro-
grams (Medicare, Medicaid, VA
and the Children’s Health Insur-
ance Program) spent on adminis-
tration alone ($921).
Even Sanders acknowledges
that the cost of Medicare for all will
be staggering. The Urban Insti-
tute, a policy research organiza-
tion, estimates that the approach
would add $2.54 trillion annually to
the federal budget. Even if that
were entirely offset by eliminating
expenditures on private insurance
(currently $1.68 trillion), that
leaves $860 billion per year to be
shouldered by federal taxpayers.Completely eliminating associated
out-of-pocket costs (currently
about $170 billion) would still re-
quire taxpayers to pay $690 billion.
What is most surprising about
the Democrats’ advocacy of Medi-
care for all is their rejection of the
Affordable Care Act as a far more
realistic foundation for assuring
universal access to healthcare.
Not only does the ACA incorpo-
rate elements of other countries’
approaches to universal health-
care coverage, it has provided
health insurance to 20 million more
Americans, cutting the uninsured
rate by over 40%, according to a re-
cent study by the Kaiser Family
Foundation.
The ACA has also protected
millions with preexisting health
conditions from losing coverage,
enabled young adults to be covered
by their parents’ insurance, and
made the scope of benefits more
comprehensive and consistent for
most Americans. And — in a fea-
ture that even the Trump adminis-
tration supports — it has enabled
states to test ways to use their
Medicaid grant allocations to de-
liver more effective healthcare.
Unless it is overturned by a
pending court challenge, the ACA
is still the law, and can be strength-
ened to close the coverage gap both
by executive order (undoing recent
actions to weaken it) and a few rea-
sonable amendments.
First, restore enforcement of
the requirement that all Ameri-
cans have health insurance and re-
instate the subsidies that enabled
uninsured middle-income individ-uals to afford private insurance of-
fered on federal and state online in-
surance exchanges. More than 14
million more Americans can gain
coverage this way and it would
have the additional benefit of
broadening the insurance risk
pool, lowering the cost of insurance
premiums for everyone.
Second, improve incentives to
get the 14 states that declined to
join the Medicaid expansion pro-
gram to opt in. This would immedi-
ately insure an additional 2.5 mil-
lion Americans. Finally, to get to
universal coverage, make a low-
cost public health insurance op-
tion (as advocated by former Vice
President Joe Biden) available for
the 10 million Americans who can’t
afford even subsidized private poli-
cies, but have incomes too high to
qualify for Medicaid.
These fixes together would cost
an estimated $200 billion annually,
much of it in foregone taxes.
All Americans deserve access to
healthcare equal or superior to
that of other advanced nations.
However, this does not require
massively disrupting an industry
that accounts for one-fifth of the
U.S. economy, or legislation that
has no realistic chance of passage,
or a wildly extravagant increase in
the federal budget. The ACA has
already moved the U.S. a long way
toward universal access. Building
on it with some eminently feasible
reforms can finish the job.Peter D. Salinsis a professor of
political science at Stony Brook
University in New York.Don’t be taken in by a ‘Medicare for all’ fantasy
By Peter D. Salins
I
magine anaffirmative action
200-meter dash. If you’re Afri-
can American, you get a five-
second head start. If you’re
white, you take off when you
hear the starter pistol. If you’re an
Asian American high school stu-
dent, as I am, you have to wait five
seconds after the starter pistol be-
fore you can go.
This might sound ridiculous, but
that’s how it sometimes feels, espe-
cially in light of the ruling handed
down this week in a 2014 case
brought against Harvard University
by Students for Fair Admissions.
The suit alleged that Harvard’s ad-
missions policies used race as a pre-
dominant factor in evaluating appli-
cants and in so doing set a higher
bar for Asian students. Judge Alli-
son D. Burroughs rejected those ar-
guments and said the school’s af-
firmative action policies were fair.
Harvard has said its affirmative
action program increases diversity
and gives disadvantaged students a
better chance of getting in. But every
system that gives one group an ad-
vantage ends up putting another at
a disadvantage.
The problem isn’t that Asian
Americans aren’t well represented
at elite universities. At Harvard, for
example, the most recent class ad-
mitted is about 25% Asian Ameri-
can. The problem is that the admit-
tance rate for Asians — the rate at
which they are accepted compared
to the rate at which they applied — is
lower than for any other race or eth-
nicity. According to the Harvard
Crimson, about 5.6% of the Asian
Americans who applied in 2017 were
admitted, compared to 7% of white
applicants, 6.8% of African Ameri-
can applicants and 6.1% of Latinos.
A 2013 analysis by Harvard, later
cited in the lawsuit, examined ad-
missions data to see what would
happen if admissions officers
judged students only by academic
achievements and test scores.
Under such a standard, the analysis
found, Asian Americans would
make up 43.4% of the admitted class,
compared to their actual 18.7%
share. Even when all an applicants’
attributes were considered — extra-
curricular activities, personal rat-
ings, etc. — Asians were still found to
be sorely underadmitted.
Many Asian American students
are immigrants themselves, or the
children or grandchildren of immi-
grants. Our families generally came
to the U.S. seeking greater opportu-
nities, and they almost all faced high
barriers to socioeconomic mobility.
They worked hard and broke barri-
ers, only to find their descendants
punished by Harvard and other elite
schools because of their success.
Both my parents grew up in Tai-
wan before coming to America to
pursue their master’s degrees. My
dad often tells me how poor he was
after he graduated from university
and got a job. His wages were so low
he slept in his office at night on a
Murphy bed that he nailed together
with scraps from Home Depot and
lived on instant noodles.
He struggled to save money for a
down payment on a house, knowing
he would have to rent out rooms to
make the mortgage payments. But
he was determined to achieve his
piece of the American Dream.
My parents encouraged me to
succeed too, never suspecting that
I’d be punished in the college admis-
sions process for meeting their ex-
pectations. Even though I spend a
majority of my free time focusing on
academics and activities that put
me at the top of my class, I may very
well never make it to an Ivy League
university because of my skin color.
It’s not that I can’t understand
the other side. Universities want to
build classes that reflect the diver-
sity of the United States. And I know
that America is still working to over-
come the legacy of slavery, which has
condemned many black students to
poverty and inferior schools. I also
understand that many Latino stu-
dents have faced similar kinds of de-
privation and discrimination.
But in higher education today,
Asian Americans also experience
textbook discrimination: Some of us
are denied admission because of our
skin color. We are not admitted to
top universities in the numbers our
achievements would justify.
The most galling thing of all is
that, even as Asian Americans are
punished for their achievements,
less accomplished children of
wealthy alumni and big donors get
favored treatment in admissions.
How can this possibly be justified?
Another huge problem with ad-
missions policies toward Asian
Americans is that they tend to lump
us all into a single category of “model
minority,” when we are in fact a div-
erse group. Yes, some of us have
grown up privileged, but many oth-
ers have not. They have grown up
poor, sometimes facing the insecuri-
ty of uncertain immigration status
for their parents or themselves, or
struggling to learn English.
Like many stereotypes, the mod-
el minority trope does have some ba-
sis in fact. I am Taiwanese Ameri-
can, a group with some of the high-
est household incomes and one of
the lowest crime commission rates
of any ethnicity. We even have a
Wikipedia page highlighting our
successes.
But the stereotypes have nega-
tive implications too. As a group,
we’re not considered creative. We’re
thought to be followers rather than
leaders. These things are absurd, of
course, as we’re individuals with a
range of talents. But I worry that it is
easier for admissions officers thou-
sands of miles away to assume such
stereotypes are accurate.
The fact that we aren’t rewarded
in proportion to our achievements
only serves to worsen competition
among my Asian peers, undermin-
ing our mental health and straining
parent-child relationships. Many of
us set unrealistic standards, and we
tell ourselves that because of our
skin color, we must have the highest
GPAs and test scores. I witnessed
the downside of that kind of striving
first-hand when Palo Alto experi-
enced a suicide cluster in 2008. Six
teenagers took their own lives and
devastated our community.
I know of cases in which Asian
American students have tried to cir-
cumvent affirmative action. They
change their last names or lie about
their race on college applications.
No one should have to deny his or
her heritage to get a fair break.Ethan Hwangis a junior at Palo
Alto High School, where he is a staff
writer for his school’s journalism
publication, the Paly Voice.The Asian American
admissions handicap
By Ethan Hwang
L
ONDON — Brexit is
roiling Britain. Prince
Andrew has been ac-
cused by a woman of
abusing her as a teen-
ager in Jeffrey Epstein’s child
sex-exploitation network. Yet
the British tabloids are obsessed
by another royal: Meghan
Markle, the most high-profile
woman of color in Britain.
Why Markle, the Duchess of
Sussex, has become the reigning
royal chew toy isn’t obvious. She
is a self-made professional who
has eagerly become a royal
champion of charities benefiting
girls and women. She quickly ac-
complished the traditional job of
female royals: providing a male
heir. Among British millennials,
she is more popular than Prince
Charles, and she shares his 46%
positive rating among Britons
overall, according to a recent
poll. And she’s married to the
most popular male royal, Prince
Harry.
Markle’s ascendance was an
inspiration to many black girls
and women. Yet the duchess has
acquired a virulent mob of media
detractors, who provide a mega-
phone for attacks from es-
tranged relatives, snipe at such
non-offenses as Markle cradling
her baby bump, and single her
out for the luxurious lifestyle she
married into — though she
hardly invented British royalty
and its costly trappings.
Perhaps a Department of
Meghan Studies will someday
ponder why Markle is endlessly
jeered for things that win other
royals applause, like wearing
one-shoulder gowns and jewels,
and expensive parties and vaca-
tions. Or explain how, after tab-
loid reports that Markle has
brought discord into the royal
family, the British monarchy re-
mains strangely intact.
Those wondering what
Meghan and Harry have been
thinking about this onslaught
got their answer this week, whenMarkle filed a lawsuit against the
Mail on Sunday newspaper for
publishing a private letter she
sent to her father.
“I have been a silent witness
to her private suffering for too
long,” Prince Harry wrote in a
statement, decrying “relentless
propaganda” by a “press pack
that has vilified her almost daily
for the past nine months.” He
further elaborated, “I lost my
mother and now I watch my wife
falling victim to the same power-
ful forces,” referring to his
mother, Princess Diana, who
died in a car crash in Paris while
being chased by paparazzi on
motorcycles.
To some, the takedown of
Markle is all about race. “Dear
England and English press, just
say you hate her because she’s
black, and him for marrying a
black woman and be done with
it,” tweeted British actress
Jameela Jamil. “Your bullying is
so embarrassing and obvious.
You’ve all lost your marbles.”
Markle’s biracial heritage has
been mocked since the day the
Daily Mail’s headline announced
“Harry’s girl is (almost) straight
outta Compton.” Prime Minister
Boris Johnson’s sister Rachel de-
scribed Harry’s then-girlfriend
as the daughter of a “dread-
locked African American wom-
an” who would bring “rich and
exotic DNA” to the royal family.
“The problem is that Meghan
Markle is a mixed-race woman,
occupying a space which was
presumed for a white woman, in
a notoriously white institution,”
journalist Ilayda McIntosh wrote
on the online Common Sense
Network.
As the razzing grew, the actor
George Clooney scolded the
British press. “She’s a woman
who is seven months pregnant
and she has been pursued and
vilified and chased in the same
way as Diana was,” Clooney said.
When the royal baby, Archie, was
born, BBC presenter Danny
Baker tweeted a photo of a posh
man and woman with a chim-panzee, captioned “royal baby
leaves hospital.” Baker was fired.
A BBC summer satire show por-
trayed a cartoon Markle with
darker skin threatening to knife
Kate Middleton in a caricatured
urban accent.
Markle was even criticized for
her guest-editing of a fall issue of
British Vogue, though Kate
Middleton had guest-edited the
Huffington Post. “Was the criti-
cism racist? Some of it, yeah,”
Edward Enninful, the editor of
British Vogue, told the Guard-
ian.
British tabloids thrive finan-
cially by turning their monarchy
into a soap opera. Royal women
bear the brunt of media criti-
cism, which is sometimes crassly
sexist, like the suggestion Markle
suffers from “American wife syn-
drome.”
After the Sussexes were criti-
cized for preaching environmen-
talism while flying in private jets
— Harry said he was concerned
for his family’s safety — a Guard-
ian columnist joked that maybe
the royal couple should just stay
home, where the “[b]uzzwords
for Meghan’s mood board might
be: silent, stoic, dutiful.”
Instead, Markle and Harry
flew British Airways to South Af-
rica, where Markle told a cheer-
ing crowd that, “while I am here
with my husband as a member of
the royal family, I want you to
know that for me, I am here as a
mother, as a wife, as a woman, as
a woman of color, and as your sis-
ter.”
The trip was a reminder that
the Meghan-and-Harry love
story has put a modern face on
British royalty and Britain’s long
history of race-based colonial ex-
ploitation. In dismantling this
image, Britain has far more to
lose than the Duchess of Sussex.Anne-Marie O’Connoris
a London-based journalist and
the author of “The Lady in
Gold: The Extraordinary Tale
of Gustav Klimt’s Masterpiece,
Portrait of Adele Bloch-Bauer.”PRINCE HARRY, condemning the attacks against his wife, the Duchess of Sussex, said this
week: “I lost my mother and now I watch my wife falling victim to the same powerful forces.”Michele SpatariAFP/Getty ImagesMeghan Markle
vs. the tabloid mob
By Anne-Marie O’Connor