Strong points, unanswered questions: In yesterday's New York Times, Bernie Sanders wrote an op-ed column introducing his Medicare for all proposal.
We thought he made some excellent points. We were struck by some unanswered questions.
Sanders started as shown below. And yes, he named some actual names in the highlighted passage about the massive looting which defines our health care system:
SANDERS (9/13/17): This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?Sanders named four miscreants, double the normal number. For future discussion, this recent post by Kevin Drum throws in several more.
We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about.
Before too long, Sanders mentioned a widely-disappeared group, The USA 9400. We'll make a few points about this:
SANDERS: Even though 28 million Americans remain uninsured and even more are underinsured, we spend far more per capita on health care than any other industrialized nation. In 2015, the United States spent almost $10,000 per person for health care; the Canadians, Germans, French and British spent less than half of that, while guaranteeing health care to everyone. Further, these countries have higher life expectancy rates and lower infant mortality rates than we do.In that passage, Sanders engages in some basic blocking and tackling. For the record, these are the more precise OECD figures to which his passage refers:
Per capita spending, health care, 2015You'll note that Germany didn't spend less than half as much as we did. Acknowledging that minor apparent blip, we'll offer these award-winning questions:
United States: $9451
United Kingdom: $4003
Why have you never seen those numbers on the front page of the New York Times? Why have you never seen those numbers discussed by the major stars on MSNBC, our "corporate liberal" channel?
Sanders is starting a real discussion about a hugely important topic. That real discussion has never occurred because players like the Post, the Times and our corporate TV stars have always seemed to agree that it mustn't occur.
Last point—can you spot the possible semi-contradiction in this passage?
SANDERS: The reason that our health care system is so outrageously expensive is that it is not designed to provide quality care to all in a cost-effective way, but to provide huge profits to the medical-industrial complex. Layers of bureaucracy associated with the administration of hundreds of individual and complicated insurance plans is stunningly wasteful, costing us hundreds of billions of dollars a year. As the only major country not to negotiate drug prices with the pharmaceutical industry, we spend tens of billions more than we should.Sanders praises the cost-effectiveness of Medicare. One paragraph earlier, he cites our failure to negotiate drug prices with the pharmaceutical cabal.
The solution to this crisis is not hard to understand. A half-century ago, the United States established Medicare. Guaranteeing comprehensive health benefits to Americans over 65 has proved to be enormously successful, cost-effective and popular. Now is the time to expand and improve Medicare to cover all Americans.
As everyone knows, Medicare is one principal place where we have failed to do that! Now for a question:
Have you ever seen data for American health care spending on people over 65, versus comparable spending in a nation like France? We've never seen that either!
We would assume that our Medicare program vastly overspends too, as compared to everyone else. Why has the pandering corporate clown Rachel Maddow never discussed such a topic?
Our health care system is defined by systematic looting. The Post, the Times, MSNBC all seem to like it that way.
That leads us to our final questions:
How much do players like Maddow get paid? Why do you think you aren't told?
I like the tone of this post, although don't know why the snark at the end about Rachel Maddow and how much she makes. After all, I heard Sanders saying this on MSNBC! Good on them, right?ReplyDelete
I know this is just the beginning of the discussion, but not every doctor accepts Medicare patients currently. That's a potential problem. And what will happen to the billions of dollars that the insurance companies invest in the market?
Anyway, I would rather see columns about this than about Mika Brzezinski's books.
Bob does this kind of column routinely, and I, for one, found the Mika columns very interesting, too. Especially since I have no plans to ever read them, I found Bob's synopses of these books both comical and alarming, especially as part of his larger point about the relative paucity of simple fairness and predictable sanity that seems to go far to define the outlook and behavior of so many of our "star" liberal pundits.Delete
I found the Mika columns yet another example of bitterness from Bob Somerby's recognition he has failed at every career he has adopted.Delete
For the curious, Medicare isn't much of an improvement than the $9400 figure per capita.ReplyDelete
Sad to say that if you cut costs to international levels you also cut $1.5 trillion and more from the economy. Fact is the USA is POOR and getting worse. Shipping all those jobs overseas does have an effect, you're seeing it in the average american being priced out of healthcare, education and housing.
“For the curious, Medicare isn't much of an improvement than the $9400 figure per capita.”Delete
I appreciate the link, but I think Bob directly addressed just that point: Medicare covers people over 65, and it can be assumed that spending for the elderly is almost by definition more expensive than spending for younger people. Wouldn’t Medicare for all serve to spread costs (statistically) to lower that per capita figure?
I’m not how you reasoned that cutting costs to the levels that other nations with universal healthcare pay would result in a 1.5 trillion loss to the economy, but it seems to me that figure would necessarily include the waste and profit motive that defines our current system.
Just like the fossil fuel model we currently subscribe to for our energy needs, healthcare needs a serious overhaul. It ain’t gonna be easy, and it won’t happen overnight, but the necessity for it is obvious.
But perhaps neither scenario will happen at all, as long as our government is in thrall to the oligarchs. It’s going to require a mass movement to get these things done. Bernie seems to be on the front in addressing the healthcare issue.
" .... but I think Bob ...."Delete
What is the point of this cryptic slam?Delete
"What is the point ....?"Delete
"I’m not how you reasoned that cutting costs to the levels that other nations with universal healthcare pay would result in a 1.5 trillion loss to the economy, but it seems to me that figure would necessarily include the waste and profit motive that defines our current system."Delete
Healthcare spending is about 19% of our economy, or $3-3.5 trillion per year. If other nations spend half of what we do per capita and we manage to "reduce our costs" to their level there would be a reduction of healthcare spending around $1.5-1.75 trillion. Consider that healthcare workers, according to the Bureau of Labor Statistics, earn around $781 billion in wages. According to them there are roughly 12 million people who work for the industry. I don't know if that includes peripheral industries or insurance workers. 12 million by itself is 8% of the work force. Reducing our costs would not only direct affect those 12 million but also those who rely on the industry. Also consider that if you reduce these companies revenues by half many if not most of them would go bankrupt. Perhaps thats a good thing but if 19% of the economy goes bankrupt, it will have nasty repercussions on the other 81%. It will affect banks, the stock market and have all sorts of unintended consequences.
If you want to reduce healthcare spending you have to tell 8% of the labor force that they've been massively overpaid for a generation. You have to tell prospective healthcare employees that they won't earn as much as they used to. The schools which teach and certify these employees can't charge as much. It would be deflationary as hell.
Anon 11:39 - Using your reasoning, it would seem that we can vastly improve our economy if we would just overpay everyone for the work they do. You also seem to assume that all the money we would no longer spend on health care would suddenly evaporate from the economy. I would guess that if we no longer had to pay twice as much for health care we might suddenly be able to afford education for all and finally fix our infrastructure problems. All those health insurance jobs would go the way of the buggy whip manufacturers, but there would be plenty of jobs in other areas of the economy where the spending would increase.Delete
Looks like I missed the word “sure” in my response to your post. Oops!Delete
My mother, an RN with an MBA, worked for years for a private company (one of the peripheral industries you allude to), and her sole job was to approve Medicare and Medicaid payments. She was good at it, and would routinely deny payments when she deemed them inappropriate.
If we do get Medicare for all, I think we would see a transition from insurance companies making life-or-death decisions to one where actuaries work for the new system. For jobs in which my mother worked, there would likely be no net loss. It takes an expert to do this kind of work, so insurance company employees in the field would likely find that work.
So I think it seems a bit of a stretch to say that the 19% of our economy of which healthcare is comprised would go bankrupt. As I mentioned, it will be a difficult transition. But once the profit motive is excised, with all of its attendant overhead, I would think (as no expert on economics) that it could be done.
"Using your reasoning, it would seem that we can vastly improve our economy if we would just overpay everyone for the work they do."Delete
How do you and others here feel about raising the minimum wage. Please consider how it relates to this sentence.
"You also seem to assume that all the money we would no longer spend on health care would suddenly evaporate from the economy. I would guess that if we no longer had to pay twice as much for health care we might suddenly be able to afford education for all and finally fix our infrastructure problems."
Consider the financial crisis a decade ago. All that money (value) did essentially evaporate.
"If we no longer had to pay twice as much for housing..."
Interesting you picked the two examples, education and infrastructure, that are also known for excessive costs in the United States.
"All those health insurance jobs would go the way of the buggy whip manufacturers, but there would be plenty of jobs in other areas of the economy where the spending would increase."
It wouldn't be just health insurance jobs. Health insurance doesn't make a whole lot of money in the big scheme of things. Consider that the top five insurance companies. According to https://www.axios.com/profits-are-booming-at-health-insurance-companies-2418194773.html they made $4.5 billion profit in the first quarter of this year. Annualized that is $18 billion out of $3.4 trillion (https://www.advisory.com/daily-briefing/2017/02/16/spending-growth), or 0.1%, spent in healthcare. Also consider that $60 billion was lost due to "fraud and waste" at medicare every year according to the GAO. (http://mds.marshall.edu/cgi/viewcontent.cgi?article=1178&context=mgmt_faculty) Apparently we've been making progress on this front, perhaps it is only $40 billion now. Still dwarfing health insurance profits.
So if we reduced healthcare spending by half it would be hundreds of thousands of people affected, perhaps millions, including doctors, nurses, therapists, etc. People with mortgages and student loan payments whose entire life just got flipped upside down. Then they're told they could be teachers or construction workers instead? I'll go ahead and add "coders" in there too. It would be a greater disruption than the financial crisis of 10 years ago.
"So I think it seems a bit of a stretch to say that the 19% of our economy of which healthcare is comprised would go bankrupt. As I mentioned, it will be a difficult transition. But once the profit motive is excised, with all of its attendant overhead, I would think (as no expert on economics) that it could be done."
It would probably be larger than 19%. It would affect the companies directly involved, the schools whose graduates are now unemployed, the banks who own their houses, and so on. One man's cost is another man's wages.
“…made $4.5 billion profit in the first quarter of this year. Annualized that is $18 billion out of $3.4 trillion...”Delete
Billions next to trillions sounds like a small thing. But I ask you, why should there be profit considered in the context of healthcare? It’s obscene. It’s depraved.
When this issue is discussed in economic terms regarding loss of jobs (a speculative assertion), it misses the entire point of the idea of universal healthcare. At this point in time, it’s a privilege, not a right. That paradigm is corrupt to its core.
The jobs that currently exist in our for-profit system will be affected, no doubt. But we need a better system. How we make the transition is the discussion we must have.
Your reasoning has served the Military Industrial Complex extremely well, though with different outcomes.
Bob asks why no one has addressed the seeming contradiction. I suspect it is because you don't want to be criticizing Medicare when you are trying to expand it to cover more citizens. It is flawed, as Somerby notes, but pointing out those flaws while launching a major campaign to promote more Medicare for all, just seems counterproductive.ReplyDelete
This isn't rocket science. Why isn't that obvious to Somerby? Does he really think Maddow should be attacking the system Sanders is trying to expand? (Yes, it will be perceived as an attack, even though it is an improvement to it.)
The NYTimes did a good job comparing Tig Notaro and Louis CK today.ReplyDelete
Actually, Medicare for all would increase everyone's taxes. And if Republicans think Obamacare is socialized medicine, imagine what they would think about this idea.ReplyDelete
Does Bob actually advocate Medicare for all? It's never quite clear from his columns.
Good day everybody,ReplyDelete
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1. The institutional goal of both parties to obstruct grassroots efforts keeps it off the agenda. Overcoming willful representatives is key, and yet, they will rarely swear off the juicy campaign donations from pharma. We can't have poor people demanding "a Chavez" as top Democrat donor once said, or as the leading representative of the liberal class put it in a book explaining what happened in 2016, "a pony." A combination of brute tribalism and paychecks, or in other words...
2. Very smart lobbying. The insurance / pharma lobby spends money to control the dialogue around healthcare through fear. Recall the scare of "death panels" in 2007, launched by Newt Gingrich, correlated with a several year drop in support for government healthcare. It parallels the creation of Medicare, which was decried at the time as Soviet infiltration. Even the mild reforms of CHIP and managed care were attacked by astroturf campaigns funded by the industry lobby. Combine this with both parties refusing to rally people to the cause, and their own susceptibility to compliments to their strategic intellect, and the astroturf works. The leadership are convinced the population really does oppose providing themselves with healthcare. A big media trope is to point and laugh at people in red states who are at risk of losing Obamacare. Oddly, the privatization and nutritional undernourishment of the national Wendy's/Dunkin Donuts diet doesn't seem to factor into improving the intellects of the heathens. They are simply to be punished.
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