In this issue of Civil Squared, we’re sharing a question from one of our readers, and we’ve asked an expert for tips to help discuss a very important issue—healthcare coverage—with a family member.


Healthcare for all

Two months ago, much of the nation’s attention was focused on the Democratic debates and the upcoming presidential election. Proposals for “Medicare-for-all” dominated headlines, and a reader wrote to us and asked:

I have a family member who works in the medical field who is ‘all in’ on the proposal of Medicare-for-all. I want to have a civil conversation with her and express my concerns about how this policy will have a negative impact on our economy. I also think it will affect her financially. How can I have a productive conversation about this topic when we both feel so strongly about it?

Scarcity means we’ve got to make some trade-offs

In our most recent episode of the Ideas at Work podcast, we put this question to Dr. Bobbi Herzberg. Dr. Herzberg has served on several state policy committees on health, and she has experienced many discussions among people who have strong feelings on this subject.

Dr. Herzberg identified the three main concerns we need to weigh when considering healthcare coverage: access (who can get it?), cost (how much does it cost and who pays for it?), and quality (how effective is it?). In a world without scarcity, everyone would have access all the time, the cost would be low, and quality would be high.

We do live in a world where scarcity is present, so we must make trade-offs between access, cost, and quality. Our country is large and diverse, and our individual needs and preferences vary greatly. Thus, according to Dr. Herzberg, there are “no right answers” in healthcare coverage. Instead, there will always be different points of view on how we balance considerations and who will bear the cost of these trade-offs. When we discuss specific policy proposals with one another, she suggests we focus on two questions:

  • How would you balance access, cost, and quality?
  • How should we pay for this proposal?

A topic that is even more urgent now

Would “Medicare-for-all” have mitigated the impact of the current COVID-19 crisis? Joe Biden and Bernie Sanders debated exactly that point on March 15th (which seems like a long time ago now), and at least one recent poll shows that nearly half of Americans said they “favor the transition towards a single-payer system where every American receives health insurance from the government.”

The question may be even more relevant today than it was in mid-March. As we face heartbreaking decisions about trade-offs in care, it seems we actually can’t provide healthcare for all.

With alarming predictions of unemployment rates rising to 30%, the expansion of government-run healthcare coverage may become even more popular than it was just a few months ago. I am as strong an advocate for limited government intervention as you are likely to find, but if I lose my job (and I am one of millions of Americans whose health insurance is tied to employment), those principles are going to be small comfort if my children become ill.

The COVID-19 crisis sharpens the challenges of providing medical care when we are at our most vulnerable, but discussion of this issue will last long beyond the current situation. It isn’t surprising that our reader and her family member have strong feelings about the subject. As Dr. Herzberg reminded us, “trade-offs matter in everything,” and thinking about those trade-offs and our willingness to make them (or not) with respect to access, cost, and quality can lay the foundation for a productive discussion.

Our show notes for this episode provide lots of material you and your family members can discuss together. Email and let us know how those conversations go!


 5 more links worth your time

  1. [Podcast] Ideas at Work: Dr. Bobbi Herzberg on Healthcare – An expert on healthcare policy responds to our reader’s question about how to productively discuss various proposals when we disagree.
  2. [Online Event] Civil Squared Live: Ask an Economist – COVID-19 and Economic Trade-Offs – Join us online on Thursday, April 9th at 7:30 pm (EDT) for a live discussion with economist Dr. Lynne Kiesling, Co-Director of the Institute for Regulatory Law & Economics at Carnegie Mellon University. We’ll consider how to weigh the trade-offs we make between public health and economic health. Bring your questions!
  3. [Online Event] Civil Squared Live: A Pop-Up Conversation on “How Will a Divided Country Emerge from COVID-19?”  – Join us online on Wednesday, April 15th at 7:30 pm (EDT )for a facilitated conversation about the current crisis and political polarization. We’ll discuss two short articles from The Atlantic and Real Clear Policy.
  4. Why Medicare-for-all isn’t enough, The Washington Post – What if the healthcare crisis isn’t just an access problem, but a “health inequality” problem? Here, a historian offers a look at the shift in attitudes to individual care in the 20th century and how current approaches often leave out considerations of what “good health” requires in the first place.
  5. Crowdfunding for medical bills, NORC at the University of Chicago – 20% of Americans report having donated to a crowdfunding campaign to help with the cost of another individual’s healthcare, yet surveys show that the majority of Americans think the government should pay more of our healthcare costs. Is this civil society solution a band-aid or does it offer a creative solution?


p.s. If you’ve got a political, ideological, or philosophical issue you’ve been considering, email me at and I’ll work with my team to put together a list of articles, issues, and interesting points of view to share with you and others.

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