Thread by @asymmetricinfo

As we head into Medicare-for-All Season, I would just like to set the stage by reiterating my belief that the Overton Window, as commonly used in activist discourse, is a hot, steaming pile of garbage.

Is there an Overton Window? Yes, it is trivially true that some things strike voters as reasonable, and some things don't, and that the set of "reasonable" proposals changes over time.

Can this window move through activism? Again, yes: see "marriage equality", page 119.

Though also note that that one took at least fifteen years to move, required a lot of help from Hollywood, and didn't cost any money.

The garbage is when people argue that candidates should propose extreme and unpopular policies as a way of "Shifting the Overton Window", and then settle for something less than that, but better than they'd have gotten if they hadn't shifted the Overton Window.

Let us try this exercise with a policy that does not tickle Democratic fancies so much: private Social Security accounts. Turned out to be outside the Overton Window. Bush had to pull it back.

But what if Bush had had an Overton Ninja on his staff? Could he have gotten it through by, say, proposing that old people should be liquidated and turned into mulch for the diamond ranches of the wealthy, then settled for private accounts?

Okay, yes, this is hyperbole; diamonds do not get mulched, because they grow on vines.

So let's take a more realistic example: could he have proposed, say, just abolishing social security, and thereby gotten private accounts?

No! Obviously not! If he'd proposed abolishing Social Security, his approval ratings would have plummeted faster than my mood after learning Counterpart had been cancelled. He'd never have gotten elected; any legislators who had endorsed him would have lost their seats.

As for having outside activists do it for you--libertarians tried. For like, 50 years. Overton Window stayed pretty much put, because people like the social security safety net. The actual thing, not the words "Social" "security" "safety", and "net".

People are not some sort of protean cyber creature living in a word cloud, whose every opinion will change if you just make them use new words, or add more words they didn't know before. they pay some (far from perfect) attention to underlying reality.

Which brings me to Medicare for All, and the three big, stinking stumbling blocks to selling anything universal to the public:

1) Higher taxes
2) Losing the insurance you already have, which people are (mostly) satisfied with
3) Lower pay for health care workers.

These things are very ...

Very ....

Very ...

Very ...

Very ...

Very ...

Unpopular.

Telling people you want to do something very unpopular does not make them want to elect you to do something they maybe wouldn't hate so much. It makes them think you're a dangerous person who shouldn't be allowed near power, and all your other ideas are probably bad, too.

You ca't frame this problem away, because they are not confused. M4A will cost a bunch of money. It will involve taking away a health care plan they know and are comfortable with for one they know nothing about, and might not work as promised (see, Obamacare, page 423).

Nor are doctors and nurses and all the other health care workers, millions upon millions of them, somehow mistaken when they think that "paying Medicare rates" means "paying me much less money" and "me trying to explain to the bank why I'm late on the car loan again".

Like Social Security privatization, taking away employer sponsored insurance is probably just a lost cause that no amount of arguing is going to change minds on. Because this isn't about words. It's about the underlying reality.

You can probably pass something called "Medicare for All", but not a universal program that does away with ESI--and unless you do away with ESI, and its massive tax subsidy, you probably can't pay for anything else very big, because again, taxes.

Every universal program elsewhere was established when HC spending was under 10% of GDP, often under 5%. We're at nearly 2-4x that. That's reality. You too, are constrained by reality, not the bally Overton Window.

Thanks for listening. I'll see myself out.