Tag Archives: Democrats

Moderate Democrats Health Care Plans Fall Short

Listening to the Democratic debates since they began last year, I have been dumbfounded and angered that so many of the candidates running for President this year believe that some halfway measure to achieve universal coverage for health care is possible, if only voters would vote for them.

With the exception of Bernie Sanders and Elizabeth Warren, the rest of the candidates, those still running, and those who dropped out, advocate a public option or fixing the ACA. (see “Medicare for All and the Democratic Debates”) Their proposals fly in the face of study after study, article after article that firmly states that the only way to provide universal coverage at lower cost, and that will save money is Medicare for All.

They are trying to scare the American people with words like “Socialism” and suggesting that their taxes will go up, or that they will lose their employer-based or private health insurance.

As I have written in the past, there is a concerted effort on the part of the health care industry to defeat Medicare for All/Single Payer, and they have been targeting the Democrats to do so.

An article last Monday in The Hill by Diane Archer, senior adviser at Social Security Works states that twenty-two studies agree that Medicare for All saves money.

According to Ms. Archer, researchers at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine.

Every single study, they found, predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

In addition, all of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. As reported last year, even the Mercatus Center, a right-wing think tank belonging to the libertarian Koch Brothers, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage

The key takeaway from the studies is that Medicare for All is far less costly than our current system largely because it reduces administrative costs.

This is because Administrative savings from Medicare for All would be about $600 billion a year. Savings on prescription drugs would be between $200 billion and $300 billion a year, if we paid about the same price as other wealthy countries pay for their drugs. A Medicare for All system would save still more with implementation of global health care spending budgets.

None of the other Democratic candidates can make that assertion because their plans leave many uninsured and and keep in place the insurance companies and pharmaceutical companies to make huge profits from the health of the American people.

While I am no fan of Bernie Sanders as a candidate, and his recent dispute with the Nevada Culinary Union not withstanding, his goal is to cover every American with universal health care. Elizabeth Warren’s plan differs somewhat from Sanders’, but has a more reasonable time frame for implementation.

The inconvenient truth, folks is that Medicare for All will save money, will cover everyone, and will finally bring down the cost of health care so that no one has to go broke paying for it, or decide not to get medical care when needed because they can’t afford it.’

Those of you who are not physicians or in the insurance industry, or the pharmaceutical industry who pontificate on social media that Medicare for All is bad, are only delaying the inevitable. You consultants, analysts, researchers and other auxiliary industries to health care must see the truth staring you in the face. You are on the wrong side of the debate, and on the wrong side of history.

Multiple studies show Medicare for All would be cheaper than public option pushed by moderates | Salon.com

For all those skeptics and naysayers who say we can’t afford single payer, Salon.com has an article from Saturday (see below) that dispels the notion that Medicare for All is too expensive.

Yet, bear in mind, that we are spending billions on two wars, raising the military spending budget, wasting money on a stupid wall that is falling down, and a host of other useless and wasteful spending that is running up the deficit, at the same time health care companies and pharmaceutical companies are raking in huge profits and returning questionable outcomes.

But go ahead, believe the Republican lies, libertarian fantasies  and moderate Democrats wishful thinking about a public option. You only have your health to lose.

Here’s the article:

Yale and Harvard researchers found that Medicare for All reduces costs while public option makes health care more expensive.

Source: Multiple studies show Medicare for All would be cheaper than public option pushed by moderates | Salon.com

Wise Words on Medicare for All

POLITICO

November 25, 2019

Politco published yesterday an interview with William Hsiao, the architect of Taiwan’s single payer system. The article is re-posted in full:

POLITICO

November 25, 2019


“There’s a Fear Factor, a Fear of Change.”

William Hsiao knows more about single payer systems than pretty much any other American. What does he think about ‘Medicare for All’?


By Maura Reynolds

Plenty of Americans have opinions about single-payer health systems like “Medicare for All,” and some have even studied them closely. But vanishingly few individuals in the world have actually built one from scratch.

One who has is William Hsiao.

A health care economist now retired from Harvard University, Hsiao designed a national health care system for Taiwan in the 1990s, and helped manage that country’s transition from American-style employer-based insurance to a national single-payer system. He has also designed single-payer reform programs for Cyprus, Colombia and China. And not too long ago, after Vermont voted in 2011 to enact a statewide single-payer system, he worked on what would have been called Green Mountain Care, a project that eventually collapsed because of concerns over financing.

This all gives Hsiao a nearly unique vantage point on the current U.S. debate over Medicare for All. And while he’s a fan of single-payer health care, which he thinks leads both to better health and greater efficiency, he’s a pessimist about its chances to take root in the United States.

The reason? It’s not the economics. It’s the politics.

Given the public’s attachment to doctors and concerns about their own health, Hsiao says there’s a powerful “fear factor” associated with any major change — one easy for opponents to exploit, and hard to overcome. Fans of Medicare for All haven’t yet grappled with the heavy lift of educating the public enough to overcome people’s attachment to the status quo, and the powerful forces that can fan their anxieties.

Opponents of change “have done it before,” he says. “They were very effective in using keywords. The American Medical Association used the words ‘socialized medicine.’ People don’t know what that is. Most Americans do not like ‘socialized’ anything. But if you told most Americans that public schools are ‘socialized education,’ they would be really surprised. Fortunately, we had public schools set up before any powerful interest groups were formed.”

Hsiao was born in China, came to live in the United States when he was 12, and eventually became an insurance actuary. In the late 1960s and early 1970s, he worked for the Social Security Administration, eventually becoming the deputy chief actuary. In that position, Hsiao worked to implement not only the program’s retirement benefits but also the then-new Medicare and Medicaid health care programs for the elderly and disabled. Hsiao says that work convinced him of the value of social insurance and that government has a critical role in providing safety net programs for its citizens.


In recent years, Hsiao, now 83, has consulted with Sen. Bernie Sanders on his Medicare for All plan, and also supports Sen. Elizabeth Warren’s version. But his reality-check prediction is that it will take two more election cycles, at least, before the political groundwork for Medicare for All will be laid. With powerful lobbies like insurers, hospitals and drug companies dug in against such plans, he points to two other forces that will need to play key roles: big employers, which he sees as nearing an inflection point where they will insist on a better system; and doctors, who are increasingly being paid as salaried employees, which is changing their views of private insurance. “When the United States has a majority of its doctors being on salary, I predict American doctors will come out and support Medicare for All,” Hsiao said.


Hsiao spoke to Politico senior editor Maura Reynolds from his office in Cambridge, Mass., about what the challenges are, why he believes the change needs to happen, and how we might actually pay for it.

This transcript has been edited for length and clarity.

Reynolds: What’s the most important thing that you think proponents of Medicare for All don’t understand about single-payer systems?

Hsiao: The most important thing is that there’s a fear factor, a fear of change. There is a group of people who are opposing Medicare for All, and that includes the private insurance industry, pharmaceutical companies and, of course, some doctors and hospitals. They fear their income may be affected. So, for the common people, the fear is that they don’t understand how it would impact their health care, as well as their health insurance. And for the vested interest groups, they are in fear of their income and revenues.

Reynolds: Aren’t those fears justified?

Hsiao: I think they’re totally unjustified, but there’s a history to it. The last time the United States talked about universal health insurance was under President Truman. Subsequently, President Clinton also tried to propose a plan. And each time, the vested interest groups put on a very effective and powerful campaign to block it by offering common people a great deal of misinformation. In the late 1940s, the American Medical Association led the fight and called universal health insurance “socialized” medicine. And the Clinton plan, there were TV ads that said it would make medical care and claim filing much more complicated. Both of them, those kinds of public campaigns, of course, are untrue.

Reynolds: Is there a case that proponents of single payer should be making to the public that they aren’t making now?

Hsiao: I would actually show film clips from countries that have Medicare for All, like Canada, Taiwan, Germany and other countries. Taiwan educated people first that everyone would be covered by the same health insurance, a comprehensive plan, much better than what most of the people had then. That’s what I think persuaded people.

Reynolds: Many Americans say that they prefer market-based solutions as a lever for public policy, and those can be easier political lifts.

Hsiao: Markets have a serious failure in health care. That’s been proven empirically in the United States and throughout the world. I’ll describe the fundamental failure. You and I, common people, we have a symptom, a headache, a fever. We have pain. We go to a physician for diagnosis and treatment. That’s not like buying a pair of shoes or buying a shirt where the buyer and seller pretty much have an equal position. We go to physicians seeking their expertise. Even if you watch TV ads for drugs, the drug advertisers say, “Talk to your doctor.” That’s because even in their advertisement, they know you would not understand all of the possible effects of that drug.

So the physician holds a superior position in the marketplace. That’s proven. As a result, physicians can charge you any price, particularly if you are in surgery. If you operate on people’s vital organs, like brain, heart, eyes, and even orthopedics — people are willing to go bankrupt to go see a doctor if they need, let’s say, heart surgery. In medicine, actually, there is an opposite effect [from the way the market usually works]: People believe that doctors who charge higher fees must be better. That’s because they don’t understand medicine. So they figure if you can charge higher fees, you must be a better doctor. Those are market failures.

I’ll give you another example. A few decades ago, American doctors who were trying to do the right thing for their patients, for exactly the same service, would charge the poor nothing. If you were rich, they would charge you, let’s say, $8,000 for an operation. If the doctor thinks you are an average earner, he might charge you only $4,000. At the time, this was praised as doctors performing a social service. But that also tells you what kind of market power doctors have over patients. Can you imagine you go to a car dealer; you want to buy a Chevrolet. The Chevrolet dealer sees you as an average citizen and tells you, “That’s $25,000.” For rich people, “That’s $50,000.” You would say, “Wow. There’s something wrong with this market.”

Reynolds: How do you explain the health care industry’s resistance to current measures to increase transparency in pricing?

Hsiao: That’s very unique to the United States. United States has many insurance companies. The insurance companies negotiate with, let’s say, hospitals for the price, for a discount from their list price. By the way, their list price is not based on any facts of the cost; It’s a price that hospitals would like to charge. There’s no cost study to support that price. So if you are an insurance company, you say, “I can bring 50,000 patients to your hospital.” The hospital may give you an 80 percent discount from the list price. If you are representing a company that employs 200 employees and their families, they say, I’ll give you only a 25 percent discount. If you are an insurance company representing only two employees, I may not give you any discount. That’s why the hospitals don’t want to publish their price, because they may have five to 10 different prices, depending on which insurance company negotiates with them and how many insured people they can bring to their hospital.

Reynolds: What’s a better way of setting prices for that hospital?

Hsiao: I would set the price based on the actual cost of the hospital and give them a small margin of profit, so they can have some flexibility to improve and to expand. That’s how Medicare sets its prices.

Reynolds: Right, but many players in health care say Medicare pays far too little — and that if a Medicare for All system were to force doctors and hospitals to accept Medicare prices for everything they do, they’d go out of business. Do you think that’s a fair argument?

Hsiao: No, that’s misinformation. In the United States, in the same community, hospitals have different costs partly because they’re managed differently. Some hospitals are managed well and some hospitals are not managed that well. This was studied three decades ago: In Boston, for example, for a normal baby delivery, the cost and charges could vary three times between hospitals. That’s one other piece of evidence that the market doesn’t work: that in the same community, the price could be varying that much. So those opponents who claim they’re going to lose money, they may be high-cost hospitals. They may be poorly managed or they may be too small to operate. They should have gone out of existence a long time ago.

Reynolds: But hospital closures aren’t a minor problem. There’s real concern about rural hospitals being the first to close, right?

Hsiao: Yes, you should see them differently. Rural hospitals serve a social purpose. But that’s a special category.

Reynolds: One issue any reform faces is that health costs in the U.S. are just far higher than other countries. Why is that?

Hsiao: Efficiency, duplication, very high salaries for some people. Our surgeons, particularly surgeons dealing with vital organs, are making half a million dollars or more every year. Meanwhile, your family doctors and pediatricians are only making $200,000 each year.

Reynolds: And in other countries, is there less disparity between the different levels of—?

Hsiao: Specialties. Yes, there may be a 50 percent differential. Here, we have a differential of 2.5 or 3 times. That’s how the market works. When you’re dealing with people’s vital organs, with people in fear of their lives, you can charge them much higher.

Reynolds: One of the big arguments in the presidential campaign right now is about how the country would actually pay for a universal system. There’s a lot of discussion over whether taxes would increase, particularly for the middle class. There’s less discussion about whether we should retain an employer-based system, and whether employers should contribute. You’ve recently written that the growth of the gig economy, of less formal forms of employment, is also creating problems for the employer-based model. What’s your recommendation for a better financing system for the United States?

Hsiao: I would base the financing of health care on income because, in an advanced economy, some people’s incomes are from lots of things — rent, dividends, interest and capital gains — not just wages. So the first principle is to tax people based on their income. But I support what Senator Warren has proposed, a tax on financial transactions. You add on only a little bit on each financial transaction, [but] you can generate tremendous amounts of income.

Under Senator Sanders’ proposal, and I worked on the cost of it, you can save close to $800 billion a year — $800 billion a year — from inefficiency, from fraud and abuse of claims, and from duplication of services and also, from using your buying power to bargain with pharmaceutical companies for a reasonable price. That $800 billion has to be used partly to pay for the uninsured people and the underinsured people. Even then, every American, on average, could save $1,000 every year. Those are the numbers.

Now, if you tax rich people more, or like Senator Warren proposes, then, of course, rich people would not save [money]. But 90 percent or more of Americans will find they actually can save money from Medicare for All. That point has not been made strongly at all by the proponents of Medicare for All.

Reynolds: You’ve been around these issues for a long time. Do you think that we’re actually at a moment now in the United States where the American public is ready for this kind of sweeping health care change? Or do you think that we’re not there yet?

Hsiao: My honest answer, even though I know that this is recorded, is that I don’t think we are there yet.

Reynolds: Why is that?

Hsiao: We’re not there yet because the common, average American is not educated yet and there is a lot of misinformation being directed at them. And you haven’t even seen the insurance industry and pharmaceutical industry come out yet with really well-organized campaigns against it. The private insurance industry’s annual revenue is $1.3 trillion. The pharmaceutical industry’s annual income is $400 billion.

They only have to use one-thousandth of 1 percent of their revenue to fight [this]. They can elect the key decision-makers in Congress, [the Senate and the House of Representatives], because they can mobilize literally a billion dollars. And those powerful, wealthy, well-organized, vested interest groups have not come out openly yet. That’s the reality of American money, politics.

Reynolds: And you think when those monied interest groups do start fighting, that they will swamp this new interest in Medicare for All?

Hsiao: Yes. Look at what happened with Clinton’s plan. [It was] only the insurance companies who came out in an organized way for the Clinton plan, and the Clinton plan couldn’t even get a hearing before the U.S. Congress. No committee in the U.S. Congress held a hearing about what Clinton proposed. Of course, Hillary Clinton overplanned the Clinton plan. She planned out every detail; she left no decision for congressmen and senators. But still, not even one hearing. However, I do think two elections from now, the United States may see Medicare for All.

Reynolds: Why two elections?

Hsiao: To make a big change like this, you need to educate the public. You need to sharpen the issues and sharpen the key points. Right now, there’s a lot of confusion in the public’s mind and even among the political candidates.

Reynolds: But it sounds like you feel that economically, there really isn’t any question that either single-payer or a public option is the right answer for the United States. The question in your mind is the politics.

Hsiao: I think that most people who specialize in this field, the majority at least, think that single payer is the right solution because it’s much more efficient. You create a unified electronic record that can improve the quality of care and also give patients much better information about their history and their treatments.

I see changes in America. American employers find health insurance, the costs are rising faster than they can afford. As a result, because of the costs of health insurance for their employees, they can’t give them raises. Meanwhile, their employees demand higher cash wages, as well as to keep their health insurance. That can’t last that long.

Reynolds: So do you think that the employers hold the key to solving this problem?

Hsiao: They do. They are silent right now. But if you look at three powerful, big companies — Amazon, JPMorgan, Berkshire Hathaway — they have united together trying to form a health company, trying to innovate to do something. That tells you these corporations find this burden something they cannot continue to afford. That’s one change.

Another change is American doctors are supporting Medicare for All in larger numbers. American doctors today, 47 percent of them are salaried now. They are not in private practice. The doctors who oppose Medicare for All, the older doctors who are in private practice, they like the autonomy of their own office and they also do not want any interference from any semi-government agency. But the salaried doctors today find that the paperwork imposed on them by insurance companies is so horrendous that they cannot really devote enough time to the patients. They are in support of Medicare for All. When the United States has a majority of its doctors being on salary, I predict American doctors will come out and support Medicare for All. The American Medical Association, the American Hospital Association will not be able to say, “We are against it,” like they did before.

Reynolds: Doctors hold the blame for scuttling a national health care system after World War II, but you think that they hold the key to solving that problem when the next generation of physicians is in the majority?

Hsiao: Yes, and that majority is going to emerge in the next five years. Look at the figures. Already 47 percent of American practicing doctors are salaried. And every year that number increases by 1 or 2 percentage points.

https://www.politico.com/news/agenda/2019/11/25/health-care-economics-072145

It would seem that Dr. Hsiao believes that if either Sanders or Warren would be elected next November, neither one would be able to get Medicare for All passed through the Senate. He states that it would take two election cycles to educate the public, get doctors on board, have employers demand change, and the state of the US health care system get worse before single payer would be feasible,

So, it is incumbent upon any Democrat interested in running for President in 2024 or 2028 to be able to convince voters that the time is right for single payer. What Dr. Hsiao is also saying, although not in so many words, is we will have to continue with the ACA for some time to come, especially if former Vice President Biden is elected, or someone else is who advocates keeping the ACA and improving it. Otherwise, the Orangutan and his Russian-asset House and Senate members will repeal it if the Democrats

Don’t Listen to the Noise Coming From Naysayers

Quote of the Day re-posted this article from Common Dreams on why those in the Democratic Party are wrong to dismiss Medicare for All. You hear them during the debates, and as any well-informed advocate of MFA knows, their arguments are red herrings and even outright lies and misinformation.

Here is the article:

Published on Wednesday, November 20, 2019 by CNN

Democratic Naysayers Are Wrong on Medicare for All

“Americans know that their current private health care payments, whether insurance premiums or out-of-pocket, are nothing other than ‘taxes’ they pay to stay alive.”

Supporters rally for universal health care in Chicago. (Photo: Shutterstock)

The American political debate over health care is absurd. Americans pay twice as much as any other nation for health care, and then are told daily that they “can’t afford” to switch to a lower-cost system very similar to those of Canada and Europe. If President Donald Trump and the plutocratic Republican party were the only ones carrying this ridiculous message, it would be understandable. Yet this message is also coming from media pundits aligned with the Democratic Party and the most conservative wing of the party.

Let’s be clear on the central point. Medicare for All, as first proposed by Bernie Sanders and endorsed by Elizabeth Warren, is affordable precisely because it is cheaper, much cheaper, than the current system.

America’s health care system relies on local monopolies (such as a health care provider centered at the sole major hospital in a city) and national monopolies, notably pharmaceutical companies holding exclusive patents.

In other countries, the government sets delivery prices and typically pays the health bills through the budget. In the US, the monopolists set the prices.

The sky-high revenues end up as huge corporate profits, wasteful administrative costs, useless and even harmful advertising and lavish salaries. Health care CEOs are making gargantuan salaries, many exceeding $10 million per year.

Who loses? Almost all Americans, whose insurance costs and out-of-pocket outlays inevitably lead to lower income because of unaffordable health care costs, untreated chronic illnesses, premature mortality and personal bankruptcies. Single-payer systems such as in Canada and Europe are cheaper, fairer and have better outcomes.

A recent international comparison of the performance of 11 national health systems on five main dimensions (care process, access, efficiency, equity and health care outcomes) ranked the US health system dead last.

Despite all of this, the US pundits profess to be alarmed about the prospect of Medicare for All. There has been a wave of op-eds and columns published (for example, here and here and here) declaring that Medicare for All would lead to massive tax increases, and that Sanders’ and Warren’s support for Medicare for All threatens to reelect Trump. It’s ridiculous.

Both Sanders and Warren poll well against Trump, ahead in the overall popular vote (though like all Democrats, facing headwinds of the Electoral College).

And at this stage of a national campaign, the goal should be to explain to voters the vast benefits of a single-payer system rather than to prejudge the politics based on self-fulfilling fear-mongering.

Yes, one way or another, taxes would rise with Medicare for All, but private health outlays would go down by much more. Total health costs would fall.

That idea is not so hard to understand.

One influential pundit, economist Paul Krugman, has come around. In the 2016 election cycle, Krugman railed against Medicare for All. Yet after Warren laid out her proposal, Krugman supported Medicare for All. In truth, he was simply returning to the economically sound observations that he had long made before 2016.

The pundits seem to believe that Americans will rebel at “higher taxes.” Actually, Americans are much smarter than that. They know that their current private health care payments, whether insurance premiums or out-of-pocket, are nothing other than “taxes” they pay to stay alive. They’ll agree to pay higher taxes to the government if those new taxes eliminate larger private health care bills — again, there are “taxes” by any other name — that they now pay.

Some mainstream pundits are simply repeating what they hear from Democratic Party conservatives and centrists, the wing that has been dominant since Clinton’s election in 1992. They are following the lead of Nancy Pelosi, Pete Buttigieg and others who are trashing Medicare for All.

What in the world are these leading Democratic Party politicians doing in opposing the transition to a fairer, more efficient and lower cost health care system? I would suggest it’s not a lack of understanding. It’s the power of campaign financing. These Democrats are funded by the status quo. The health sector contributed $265 million to federal campaigns in 2018, of which 56% went to Democrats. The sector spends nearly $500 million per year on lobbying. Money talks. Meanwhile, Americans go bankrupt or die early.

There remains the issue of the best way to raise budget revenues for Medicare for All. The basic answer is to use progressive taxation to fund the program. In this way, the nation as a whole will pay much less for health care and the vast majority of households will as well. The highest income households will end up paying a bit more because their funds will not only finance their own health care but will help to pay the health care costs of the poorest households as well.

Sanders rightly proposed a menu of options to pay for Medicare for All, including payroll and income taxation. Warren has proposed one specific approach: progressive taxes on the super-rich and the corporate sector but also a surprisingly regressive “head tax” on companies. She took great pride in not charging a penny of new income or payroll taxes on middle class households. But the proposed head tax on companies would hit wages indirectly and regressively.

Still, both Sanders’ and Warrens’ approaches would result in a more equitable and less expensive system. For most households, overall health care costs will decline.

The most worrisome thing about Warren’s statement as she introduced her Medicare for All plan, is her emphasis on “not one penny” of new middle-class taxes. Here we go again. The Democrats have, for far too long, copied the Republican mantra about “no new taxes,” even as our public debt soars, our infrastructure and public services collapse and inequality reaches stratospheric dimensions.

To honor the silly stricture of “no new taxes” directly paid by middle-class households, Warren ended up endorsing a regressive head tax paid by the employer, which would end up hitting lower-wage workers even though its paid by their employers.

Let’s hope this blunder is a one-time stumble for Warren. Most importantly, both Sanders and Warren are pointing the correct way to reform America’s costly, unfair and inefficient health care system. And this is a goal that most Americans support.

Jeffrey D. Sachs

Jeffrey D. Sachs is the Director of The Earth Institute, Professor of Sustainable Development, and Professor of Health Policy and Management at Columbia University. He is Special Advisor to United Nations Secretary-General Ban Ki-moon on the Millennium Development Goals, having held the same position under former UN Secretary-General Kofi Annan. He is Director of the UN Sustainable Development Solutions Network. He is co-founder and Chief Strategist of Millennium Promise Alliance, and is director of the Millennium Villages Project. A recent survey by The Economist Magazine ranked Professor Sachs as among the world’s three most influential living economists of the past decade. Sachs is the author, most recently, of The Age of Sustainable Development,” 2015 with Ban Ki-moon.

Seven Years Good Luck

Despite LinkedIn’s algorithm to the contrary, today is the seventh anniversary of this blog. It was seven years ago that I began to write about Medical Travel and Workers’ Comp.

And although it has morphed into a blog about health care issues, and more recently, about Medicare for All, it is an accomplishment that it has lasted this long.

As I am sure happens to many a blogger or writer, one runs out of things to say, so they fall back on re-posting what others have written to keep themselves in the game. Such has been my experience of late.

This is no accident. Having been diagnosed with ESRD, and attending to the protocols involved with receiving treatment and dealing with it on a daily basis, I have had to slow down the pace of writing, concentrated on other issues, or just took a break from it by not working on it period.

However, with the Democratic primary campaign heading towards its next phase, I thought it would be a good idea to review the positions of each of the major candidates now debating regarding health care for Americans.

This review is a follow-up to previous posts on this blog about the Democratic debates and Medicare for All, namely Medicare for All and the Democratic Debates and The Debate Continues.

Since then, I have concentrated on posts that single out aspects of some of the candidates positions on providing health care to more people, but each and every article posted has shown that those positions will not lead to the outcome that will provide universal health care to all Americans.

So, here are the plans for health care of each of the candidates currently still debating:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source: https://www.npr.org/2019/09/10/758172208/health-care-see-where-the-2020-democratic-candidates-stand

Since August, five of the last eight posts I wrote addressed some aspect of why those advocating a public option or keeping private insurance are wrong, and why we have not had universal health care.

The New York Times, as part of a series of articles published in their Sunday magazine about the year 1619, included an article as to why universal health care has been rejected in the US.

The article, Why doesn’t the United States have universal health care? The answer has everything to do with Race, traces the opposition to universal health care to after the Civil War, when the South was devastated, and the Freedmen’s Bureau addressed the smallpox virus that was spreading across the South. It was argued then by white legislators that it would breed dependence.

But, other articles posted since August, have criticized calls for a public option, such as the article, Public Option A Bad Policy, which was re-posted from The Nation earlier this month.

A second article, Private Insurance Failure to Lead to Medicare for All, re-printed from The New York Times two weeks ago, was written by a former CEO of a health insurance company, and currently professor of health care finance at the Weatherhead School of Management at Case Western Reserve University.

His observations about where private insurance is leading us should be read by those who are supporting candidates who advocate keeping private insurance.

Physicians for a National Health Program (PNHP) president Adam Gaffney, in Boston Review, put it simply: “It’s the financing, stupid.

Emmanuel Saez and Gabriel Zucman, writing in The Guardian four days ago, stated that Medicare for All would cut taxes for most Americans, and that not only would universal healthcare reduce taxes for most people, it would also lead to the biggest take-home pay raise in a generation for most workers.

This is something that Elizabeth Warren has not been able to address in the debates, instead talking about how it will lower costs for people. She has not been wrong in doing so, because if the average family pays $5,000 in taxes and has medical costs twice that, moving to a single payer system will save them money, even if their taxes were to increase by a small percentage. Their medical bills would fall far below the $10,000 level. However, Warren will be releasing a plan to pay for it.

Saez and Zucman, in a chapter in their book, The Triumph of Injustice: How the Rich Dodge Taxes and How to Make Them Pay, called private insurance a poll tax.

According to Saez and Zucman,

“…private insurance premiums are akin to a huge private tax. Although most workers get insurance through their employers – and thus employers nominally foot the bill – the premiums are a labor cost as much as payroll taxes are. Just like payroll taxes, premiums are ultimately borne by employees. The only difference is they are even more regressive than payroll taxes, because the premiums are unrelated to earnings. They are equal to a fixed amount per employee (and only depend on age and family coverage), just like a poll tax. The secretary literally pays the same dollar amount as an executive.”

Listening to the candidates other than Sanders and Warren, they would rather keep the status quo so that stakeholders can profit from the dysfunction in the system than address the problem of health care head-on.

It is as if we said we wanted to go to the Moon, but opted to go part of the way, saying we will get there someday, but not now, as it is too expensive, people like looking at the Moon without knowing there are men up there and spacecraft parts, and that we shouldn’t mess with it until we clean up down here.

It is better to advocate going all the way, then not at all. If you fail, then you know you must do it again until you get what you want. Thus, was the case with passing the ACA. It did not happen overnight.

This video, from a president who knew how to speak in complete and intelligible sentences, illustrated what it took to get Medicare and Medicaid passed.

Just like President Kennedy’s call to go to the Moon in the 1960s, so too did he call for universal health care as far back as 1962 when he made this speech in New York’s Madison Square Garden.

We cannot afford to do anything less, because the stakes are that important. Medicare for All must be the one and only goal. Anything else is a half-measure destined to fail.

KFF Health Tracking Poll – September 2019: Health Care Policy In Congress And On The Campaign Trail | The Henry J. Kaiser Family Foundation

This month’s poll probes Democrats’ views about the general approaches to expanding health coverage and lowering costs put forward by the candidates; the public’s health care prio…

Source: KFF Health Tracking Poll – September 2019: Health Care Policy In Congress And On The Campaign Trail | The Henry J. Kaiser Family Foundation

 

Comment by Don McCanne
According to this new poll, Democrats support Medicare-for-all (“a national health plan”), Independents are split, and Republicans are opposed. Also, Democrats and Independents both support a public option (“a government-administered health plan”), and Republicans are split. However, the public is confused as to whether Medicare-for-all and a public option are similar or different, and half have not heard much about Medicare-for-all and even more have not heard much about a public option.
It seems as if individuals do have an opinion on Medicare-for-all and on a public option even though many are confused as to what they are. The fact that the pollsters referred to one as “a national health plan” and the other as “a government-administered health plan” likely leaves many of those polled with little understanding of the refinements distinguishing the two models.
Features that people might be interested in include the following:
Everyone is automatically covered for life
Affordability is assured through equitable taxes based on ability to pay
Financial barriers such as high deductibles are eliminated
Choices of physicians and hospitals are assured through elimination of insurer networks
Hundreds of billions of dollars in administrative waste is recovered
Of course, these are features of the single payer model of Medicare for all and none would apply by merely adding a public option to our fragmented financing system of a multitude of public and private insurance programs.
When will the pollsters finally ask the following questions?
Should everyone be covered or just some of us?
Should insurance be automatic forever or should it depend on life circumstances?
Should payments into the system be made affordable based on income, or should many be left out because they can’t afford the premiums?
Should high deductibles and surprise medical bills be used to deprive individuals of health care that they should have?
Should patients have choices of their physicians and hospitals or shall we continue to allow private insurers to restrict choices to their networks?
Should we continue to tolerate wasting about half a trillion dollars in administrative excesses, or should we redirect those funds that so that we can pay for care for those currently uninsured or underinsured?
In other words, do we want a health care system that we can afford that takes care of all of us, or do we want to merely add a public option and a couple of tweaks to ACA that leaves our overpriced, highly dysfunctional system in place? People really need to understand the differences between Medicare-for-all (single payer version) and a public option. Let’s see that they do.

Majority of Americans Would Switch From Employer-based Health Care

Common Dreams and Business Insider both reported last week on polling that counters the right-wing narrative, and what some Democratic primary candidates are defending, that says that Americans like their employer-provided health care.

The survey, they wrote, showed that 59 percent of respondents who have employer-provided insurance “said they would support switching their employer-based health insurance to a government plan under Medicare for All” as long as quality of coverage would remain the same or improve.

The poll also found that Americans on government-run healthcare plans such as Medicare and Medicaid are more satisfied with their coverage than those on employer-sponsored plans, which have soared in cost over the past two decades.

According to BI, this is how the polling was broken down:

  • 44% of people said they were on an employer-based plan. Of them, 41% love their plan, 20% don’t like their plan, and 39% would be fine if it changed as long as they kept coverage.
  • 28% were on Medicare, Medicaid or military coverage. Of them, 57% love their plan, 14% don’t like their plan, and 29% would be fine if it changed as long as they kept coverage.
  • 12% directly purchased health insurance. 39% love their plan, 22% don’t like their plan, and 39% would be fine if it changed as long as they kept coverage.
  • 7% said they did not have health insurance.
  • 9% didn’t know or had some other type of coverage.

As reported in BI, the results highlight the fact that although a majority of Americans are fairly satisfied with their employer-based health coverage — which supports other polling on the subject — mainly people just like being covered in general, bearing little loyalty to a specific insurer.

Therefore, If the system provides equal or more comprehensive benefits, then broad swaths of Americans are likely to support it.

Medicare for All is not likely to pass anytime soon, but as more people come to see the benefits of such a program, compared to the rising cost of employer-based health insurance, that majority will only grow larger.

Those who advocate for Medicare for All need to keep pounding away at educating the public, and to make sure that coverage under Medicare for All is better than employer-based health care.