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Yesterday, I came across a study from the Brookings Institution on the effects of the Affordable Care Act on income distribution.

As you can see, through the Medicaid expansion, the ACA offers a real, significant improvement to those in the bottom quintile.

However, things don't look as good when you step beyond that bottom quintile. The drop from the 2nd lowest decile (+5.3%) to the 3rd lowest decile (-0.9%) is just stunning. And those in the 4th lowest decile (30-40%) see the biggest hit of all. Paying out-of-pocket for health insurance is not cheap if you are in one of these middle deciles, even with subsidies but especially without them.

The middle 50%, here represented by 20% to 70% (although you could probably say 25% to 75% just the same), see the largest hit to their income. Those in the top decile see the least impact.

This just looks like the stereotype that so many have of the Democratic Party--willing to help the poorest of the poor, but not the middle or the struggling, and not willing to touch those at the top.

It reflects a pity-charity liberalism rather than one rooted in solidarity. And, as is often the case with pity-charity liberalism, it is more prone to attack. Universal benefits like Social Security and Medicare are popular because everybody benefits. Such programs are treated as economic/social rights that people want to protect (or expand). There is no "taint" associated with receiving such benefits (in the eyes of the public or the beneficiary him/herself) because the benefits are a right granted to all.

A single payer/Medicare for All system not only has economic value, but it has political value as well. Single payer champion Bernie Sanders is currently holding a hearing on the health care systems of other industrialized countries, ones that--unlike the US--have made health care into a right. He is, as far as I know, the only vocal supporter of single payer/Medicare for All in the Senate. We need more.

(Note: Credit goes to billmon for inspiring the title.)

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