Medicare For All: Warren's figures

 As a "public service" I am providing three links to articles about Elizabeth Warren's proposal on "Medicare for All".  These are not the last words of course, but they show some of the initial reactions to her numbers from sources that neither endorse her numbers nor reject them out of hand. 

New York Times (just before Warren's plan was announced)

New York Times (just after Warren's plan was announced)

New American Prospect (just after Warren's plan was announced)  

Finally, here is Paul Krugman's take.

Oh, and one other thing: Medicare for Some -- what we have now -- does not even provide 100% coverage for its recipients. Nominally, the coverage is only 80% of costs. That is why so many older folks who are on Medicare also have supplemental plans to pay the remaining 20%.

What Warren should say about Medicare for All

This is from The New American Prospect:

October 22, 2019

Meyerson on TAP

How Elizabeth Warren Can Address the Medicare for All Question. Elizabeth Warren is now dotting the i’s and crossing the t’s on her own Medicare for All plan, which she has pledged to release shortly. As David Dayen astutely notes today, the plans put forth by Warren’s and Bernie Sanders’s primary opponents—chiefly, Joe Biden and Pete Buttigieg—will, if they’re any good, end up costing about as much as the Medicare for All proposals they’ve disparaged.

B&B’s emphasis on the taxes that will fund Medicare for All (and, not that they admit it, their own plans, too) misses the fact that the great majority of Americans pay far more for their private insurance than they would in higher taxes, though what they pay now is largely concealed from them because their employer routinely takes it out of their pay. (Of course, if we do go to Medicare for All, workers will have to fight to compel their bosses to transfer the savings to them, rather than divert it into dividends and buybacks.)

How can Elizabeth Warren address the major savings workers can win by shifting to Medicare for All? My friend Steve Tarzynski, who’s president of the California Physicians Alliance, suggests something like the following:

Right now, you and your family pay $18,000 a year in premiums for employer-sponsored insurance that doesn’t even cover everything and that you could lose at any time. Plus another $2,000 in deductibles before it even kicks in and another $1,000 in co-pays. That’s about $21,000 every year for a basically defective product. That’s the “private tax” you’re paying right now. And your choice of doctor is restricted and you can even lose access to your doctor at any time. All that would go away with Medicare for All—no more premiums, no more deductibles, and no more co-pays. And all the care you and your family need will be covered and can never be taken away. You can choose any doctor you want. Yes. You’ll pay $5,000 more in taxes for all of that. But it will put $16,000 back in your pocket. And it doesn’t even include the share of the premium that your employer pays now that you could get back in wages and salary. Would you settle for that?

And to my fellow Democrats on the stage here who oppose Medicare for All, who are you really working for? Because what you propose is exactly what the insurance industry wants.

That’s so good I got nothing to add. Would work not just for Warren but for Bernie, too. ~ HAROLD MEYERSON

The Cost of Medicare for All

Both Elizabeth Warren and Bernie Sanders have come out as favoring "Medicare for All" as the only healthcare plan for America they support. Neither has given a definite figure for the costs; Warren has been cagey and Sanders does not deny a figure in the $30 trillion dollar range. 

The claim (by both Sanders and Warren) that fails to be emphasized is the net cost to Americans: While their taxes will certainly go up (you can't get something for nothing), their total out-of-pocket expenses may very well go down, since they will pay no premiums and have no deductibles. The media, in its need to create controversy and "gotcha" moments, keep insisting that the candidates talk first about the increase in federal taxes. Maybe this is an attempt to bring up some sort of anti-government feeling in the electorate. It is unfortunate that this conservative attitude has been allowed to grow. The Democrats a long time ago should have pointed out that the government is our government -- we have a direct say in what it does and a constitution that codifies this say; this is opposed to our direct say in what private entities like corporations do, which is nil.  (Why don't our kids learn this in school? Answer: because right-wingers have eliminated or emasculated "civics" courses where we used to learn about our government, how we direct it, and how it protects us.)

Of course, the belief that current premiums and deductibles are greater (in dollars) than the (projected) increase in federal middle-class taxes under Medicare for All has itself has not been definitely established. Bernie points out that similar programs in other countries have produced medical care that is at least as good as what we have now, but at half the cost. This argument itself has been attacked (see below).

A lot of the cost estimates are discussed in a fairly long Politifact article which can be found HERE.

What has happened in other countries is not necessarily a foretaste of what will happen here. First of all, not all other countries that have universal healthcare (and that is pretty much all developed counties except the US) have a Medicare for All system -- some, like France, have a very good hybrid system with both public and private insurers. Secondly, drug expenses may be lower in other countries because of the simple fact that they are high in the US. Big Pharma still makes enough profit here so that they can charge less there. Also, the financial culture of doctors and hospitals in other countries is different from ours: Here doctors pay a lot for their education and consequently expect to get paid a lot after they become credentialed (they've been told this for decades by their peers and their guild, the AMA). Hospitals here have a different style of ordering and paying for tests and using doctors (and nurses) and charging for rooms; this "style" is the result of the influence of Big Pharma, the medical device industry, and doctors themselves who are often associated financially with these industries (e.g. many doctors have interests in medical scanning and testing businesses). These things will all have to change in order to bring down the costs of healthcare here, and it will not be easy. 

(In response to questions from both the media and other Democratic presidential candidates, Elizabeth Warren has  announced that she will publish her plan for Medicare for All, including proposed finances. She obviously has to be careful since everyone will be ready to pounce on her inevitable use of increased taxes.)

 

Who's helping whom?

As usual, Paul Krugman says it best. Here's his column explaining how Blue states are bailing out Red states, and being slapped in the face for it:

The Moochers of Middle America

Waiting for the Dems

It is getting very frustrating waiting for Democrats to actually act. They threaten they might hold Barr in contempt ... in a few days. They threaten subpoenas of information  (say from IRS staff) ... in a few days. They might institute perjury charges ... in a few days. They may issue subpoenas for Barr and Mueller to appear ... in a few days.

How many days will that be?

Why isn't Mueller subpoenaed right now? Now. Yes, he is supposedly still an employee of the Justice Dept. (such as it is under Barr) -- so? Subpoena him now and he has time to quit or even appear without quitting. Will he be prosecuted by Trump or Barr for appearing while technically still an employee? Will he be fired and lose his salary? Who cares? Let's have Mueller on the stand next Monday.

While Trump and his allies seize the moment, the Democrats will do something... in a few days. If Pelosi and Nadler and Schiff think Barr is a liar (which, of course, he surely is) what are they waiting for? In a few days, lies travel around the world many times.

Could we please have some action from the Hamlet-like Dems?

Center for American Progress Cannibalizes Sanders

Think Progress, the commentary arm of the Democratic Center for American Progress, has levelled an ad hominem attack on Bernie Sanders.

Harold Myerson, of The American Prospect, muses that this is exactly how the right-wing attacked FDR. You can read Myerson's remarks HERE.

Just what we need: the Hillary Clinton arm of the Democratic establishment attacking the frontrunner for the Democratic presidential nomination -- not on the basis of his policies, but because he has made money on his very popular writing. 

Enlightened Monarch or Democracy

Supposedly, many "millennials" who work in "Hi-Tech" have decided, on the basis of their work experience with successful startups, that having an all-powerful genius leader is the way to produce fast and effective results. They then extend this "principle" to national affairs and push for "strong executives" -- i.e. national autocrats -- who will lead the country to greatness.  Here is an article from Salon magazine discussing (somewhat lightly) these ideas:

https://www.salon.com/2019/04/13/why-some-in-silicon-valley-are-advocating-for-monarchy/

Here's my take.

People who work or have worked in successful startups (no one talks about unsuccessful ones -- see below) have observed that a hierarchical structure seems to be the way to go. The Originator of the idea or prodect knows best -- at least at first -- what it's all about. Decisions must be made quickly and, of course, correctly. There is no time for voting and even if there were, it's the Originator who most likely knows best. Democracy is probably not the best way to procede at the "startup" stage.

Already one begins to see that the argument here has a bit of a hole. No one talks about the unsuccessful startups -- maybe they are not even remembered. In these, the Originator may not be, in fact, that smart and imaginative -- maybe just lucky. Since the structure is autocratic, there is no way to correct the Originator who errs, and so the enterprise fails. And no one remembers why.

Once we turn to endeavors other than startups we see that the autocratic structure is far more likely to fail. The important example is the nation-state. Here there is not just a single process or invention, as in a startup, but a complicated mesh of economics, power, and special and general interests. It almost never happens that there is a One Person who understands every strand in this mesh and can consistently make correct decisions. One needs a lot of ideas and a way of choosing among them that has the highest odds of being correct. I think that history has shown that democracy and division of powers is the best (though not infallible) way to come up with these ideas and to choose among them. The more power a single autocrat has in a nation, the more chance there is that he/she will make a terrible decision. Look at the list: kings, czars, tyrants; Napoleon, Hitler, Stalin, Idi Amin. Even in a near democracy, when (presidential) power is too concentrated or unchallenged or secretive, disasters occur: Lyndon Baines Johnson (Vietnam), George Bush (Iraq, Afghanistan), Trump (everything). It is exacly when there are no checks and no openness that disaster is likely to occur, and when it does, is most likely to be most costly.

In complex life, Democracy is a far better way of solving problems than autocracy. Think of the lines from Shelley:

"And on the pedestal, these words appear:

My name is Ozymandias, King of Kings;

Look on my works ye Mighty and despair!

Nothing beside remains. Round the decay

Of that colossal wreck, boundless and bare

The lone and level sands stretch far away"

See what I mean?

(Here's the rest of the poem.)

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