Tag Archives: Republicans

Medicare for All and Its Rivals | Annals of Internal Medicine | American College of Physicians

Richard’s Note: A shout-out to Don McCanne for posting this today from the Annals of Internal Medicine, which is providing the full article for free. The authors, Steffie Woolhandler and David Himmelstein, both MDs, should be familiar to readers as two of the authors I covered in my review of the Waitzkin, et al. book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health. In the spirit of the AIM, I am posting the entire article below with link to the original. It is that important.

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

The leading option for health reform in the United States would leave 36.2 million persons
uninsured in 2027 while costs would balloon to nearly $6 trillion (1). That option is called the
status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life
expectancy, the widening mortality gap between the rich and the poor, and rising deductibles
and drug prices. Even insured persons fear medical bills, commercial pressures permeate
examination rooms, and physicians are burning out.
In response to these health policy failures, many Democrats now advocate single-payer,
Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of
frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans
or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump
administration seeks to turbocharge market forces through deregulation and funneling more
government funds through private insurers. Here, we highlight the probable effects of these
proposals on how many persons would be covered, the comprehensiveness of coverage, and
national health expenditures (Table).

Table. Characteristics of Major Health Reform Proposals as of March 2019

Medicare for All

Medicare-for-All proposals are descendents of the 1948 Wagner–Murray–Dingell national health
insurance bill and Edward Kennedy and Martha Griffiths’ 1971 single-payer plan (2). They would
replace the current welter of public and private plans with a single, tax-funded insurer covering
all U.S. residents. The benefit package would be comprehensive, providing first-dollar coverage
for all medically necessary care and medications. The single-payer plan would use its
purchasing power to negotiate for lower drug prices and pay hospitals lump-sum global
operating budgets (similar to how fire departments are funded). Physicians would be paid
according to a simplified fee schedule or receive salaries from hospitals or group practices.
Similar payment strategies in Canada and other nations have made universal coverage
affordable even as physicians’ incomes have risen. These countries have realized savings in
national health expenditures by dramatically reducing insurers’ overhead and providers’ billing-
related documentation and transaction costs, which currently consume nearly one third of U.S.
health care spending (3). The payment schemes in the House of Representatives’ Medicare-for-
All bill closely resemble those in Canada. The companion Senate bill incorporates some of
Medicare’s current value-based payment mechanisms, which would attenuate administrative
savings. Most analysts, including some who are critical of Medicare for All, project that such a
reform would garner hundreds of billions of dollars in administrative and drug savings (4) that
would counterbalance the costs of utilization increases from expanded and upgraded coverage.
Reductions in premiums and out-of-pocket costs would fully offset the expense of new taxes
implemented to fund the reform.

 

“Medicare-for-More” Public Options

Public-option proposals, which would allow some persons to buy in to a public insurance plan,
might be labeled “Medicare for More.” Republicans Senator Jacob Javits and Representative John
Lindsay first advanced similar proposals in the early 1960s as rivals to a proposed fully public
Medicare program for seniors. This approach resurfaced during the early 1970s as Javits’
universal coverage alternative to Kennedy’s single-payer plan and gained favor with some
Democrats during the 2009 ACA debate.
Policymakers are floating several public-option variants, most of which would offer a public plan
alongside private plans on the ACA’s insurance exchanges. Although a few of these variants
would allow persons to buy in to Medicaid, most envision a new plan that would pay Medicare
rates and use providers who participate in Medicare. Positive features of these reforms include
offering additional insurance choices and minimizing the need for new taxes because enrollees
would pay premiums to cover the new costs. However, these plans would cover only a fraction
of uninsured persons, few of whom could afford the premiums (5); do little to improve the
comprehensiveness of existing coverage; and modestly increase national health expenditures.
The Medicaid public-option variant, which many states might reject, would probably dilute
these effects.
Medicare for America, the strongest version of a public-option plan, would automatically enroll
anyone not covered by their employer (including current Medicare, Medicaid, and Children’s
Health Insurance Program enrollees) in a new Medicare Part E plan. It would upgrade
Medicare’s benefits, although copayments and deductibles (capped at $3500) would remain.
The program would subsidize premiums for those whose income is up to 600% of the poverty
level, and employers could enroll employees in the program by paying 8% of their annual
payroll. The new plan would use Medicare’s payment strategies and include private Medicare
Advantage (MA) plans (which inflate Medicare’s costs [6]) and accountable care organizations.
Medicare for America would greatly expand coverage and upgrade its comprehensiveness but
at considerable cost. As with other public-options reforms, it would retain multiple payers and
therefore sacrifice much of the administrative savings available under single-payer plans.
Physicians and hospitals would have to maintain the expensive bureaucracies needed to
attribute costs and charges to individual patients, bill insurers, and collect copayments. Savings
on insurers’ overhead would also be less than those under single-payer plans. Overhead is only
2% in traditional Medicare (and 1.6% in Canada’s single-payer program [7]) but averages 13.7%
in MA plans (8) and would continue to do so under public-option proposals. Furthermore, as in
the MA program, private insurers would inflate taxpayers’ costs by upcoding as well as cherry-
picking and enacting network restrictions that shunt unprofitable patients to the public-option
plan. This strategy would turn the latter plan into a de facto high-risk pool.

The Trump Administration White Paper and Budget Proposal

Unlike these proposals, reforms under the Trump administration have moved to shrink the
government’s role in health care by relaxing ACA insurance regulations; green-lighting states’
Medicaid cuts; redirecting U.S. Department of Veterans Affairs funds to private care; and
strengthening the hand of private MA plans by easing network-adequacy standards, increasing
Medicare’s payments to these plans, and marketing to seniors on behalf of MA plans. A recent
administration white paper (9) presents the administration’s plan going forward: Spur the
growth of high-deductible coverage, eliminate coverage mandates, open the border to foreign
medical graduates, and override states’ “any-willing-provider” regulations and certificate-of-
need laws that constrain hospital expansion. The president’s recently released budget proposal
calls for cuts of $1.5 trillion in Medicaid funding and $818 billion in Medicare provider payments
over the next 10 years.
Thus far, the effects of the president’s actions—withdrawing coverage from some Medicaid
enrollees and downgrading the comprehensiveness of some private insurance—have been
modest. His plans would probably swell the ranks of uninsured persons and hollow out
coverage for many who retain coverage, shifting costs from the government and employers to
individual patients. The effect on overall national health expenditures is unclear: Cuts to
Medicaid, Medicare, and the comprehensiveness of insurance might decrease expenditures;
however, deregulating providers and insurers would probably increase them.
In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and
persistent problems with access and quality triggered a roiling debate over single-payer plans.
As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative,
1 of several proposals promising broadened coverage on terms friendlier to private insurers.
Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet
the need” (10). President Nixon’s pro market HMO strategy—a close analogue of the modern-
day accountable care strategy—ultimately won out, although his proposals for coverage
mandates, insurance exchanges, and premium subsidies for low-income persons did not reach
fruition until passage of the ACA.
Five years into the ACA era, there is consensus that the health care status quo spawned by
Nixon’s vision is unsustainable. President Trump would veer further down the market path.
Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-
for-All proponents aspire to decouple care from commerce.

Another reason Single Payer is inevitable – Managed Care Matters

Once again, Joe Paduda has broken down why single payer is inevitable, and what will happen to millions if repeal of the ACA happens.

I won’t go over the reality of what the landscape would look like, because we have heard about it before, and does not bear repeating. However, what does need to be said is, repeal will lead to single payer, no matter what the medical-industrial complex says or does to stop it, and those who advocate an incremental approach, such as fixing ACA, or some other half Medicare measure, will eventually lose ground politically, especially those running for president.

And those of you who advocate for more competition and a truly free market in health care should pay attention to what Joe say about that.

Finally, check out the infographic at the bottom of the text. It is funny.

Here is Joe’s post:

Earlier this week President Trump called for the GOP to become “the Party of Great Healthcare.” He wants three Senators to come up with a “terrific, beautiful” healthcare plan. What Trump is actually doing is accelerating the day when Single … Continue reading Another reason Single Payer is inevitable

Source: Another reason Single Payer is inevitable – Managed Care Matters

Why Are Republicans So Mean? – An Exploration

Revelations this week that the Orangutan Administration is going ahead with plans to repeal the ACA, as reported by myself and Joe Paduda, as well as the announcement by Education Secretary Betsy (I have ten yachts) DeVos, that her budget calls for cutting $18 million from Special Olympics, raises the question, “why are Republicans so mean?” and why do they hate the poor and those not like them?

This article will explore this question from an economic, ideological, political and sociological perspective, citing several previously published articles asking the same question as the title above. It is certainly not definitive, but does suggest some possible explanations.

To begin with, a little history. The Republican Party was formed due to the inability of the Whig Party to deal with the question of slavery and the disappointment many Northern Democrats had with their Southern brethren over this issue, one that occupied a central focus in the second quarter of the first half of the 19th century.

While that twenty-five year period ended in 1850, it is important to note that the GOP was founded in 1854, which is still in the range of the time frame.

After the Civil War, the Republican Party was made up of two wings: the Radical Republicans who favored Reconstruction and harsh treatment of former Southern Confederates (this will have a bearing on our discussion later) and the conservatives who were aligned with the Eastern bankers and industrialists.

In fact, it was the conservatives who, as pointed out in the Spielberg motion picture, “Lincoln”, that made it possible for the passage of the 13th Amendment when they were assured by the President that there were no Southern negotiators in Washington (They were on a riverboat in Virginia being guarded by African-American Union soldiers).

However, after the election of 1876, when Rutherford Hayes became President by promising the South to end Reconstruction, the Radical Republicans were slowly replaced by more conservative Northern Republicans loyal to the industrialists who would dominate the second quarter of the second half of the 19th century, and thus lead to future calls for reform and addressing of the effects industrialization had on the working class.

So as their wealth increased, so too did the misery and poverty of the working class, and this led to the rise within the GOP of a progressive movement, and a likewise movement among the rural population in the Midwest in the form of populism.

With the ascendancy of Theodore Roosevelt to the Presidency in 1901, progressivism took off, and many Republicans led the way for political, economic, and social reform. A brief return to the past in the 1920s under three successive Republican Presidents was followed by the election of FDR and the Democrats controlling Congress for decades to come, making more reform possible, and creating the largest middle class in history.

By the mid-20th century , the Republican Party had three wings: conservatives, moderates, and liberals. Barry Goldwater’s run in 1964, and Robert Taft’s in 1952 sort to change the dynamics in favor of the conservatives, but only meant they lost the battle, but won the war.

Then came Reagan, the first celebrity President. He brought victory to the conservatives and into government. Remember, he said that government was not the solution, government was the problem, and thus, that is how the GOP would operate when they took over.

Turning to the economic aspect of why Republicans are mean, let us look at something written a hundred years ago, Max Weber’s essay, The Protestant Ethic and the Spirit of Capitalism.

According to Wikipedia,

“capitalism in Northern Europe evolved when the Protestant (particularly Calvinist) ethic influenced large numbers of people to engage in work in the secular world, developing their own enterprises and engaging in trade and the accumulation of wealth for investment. In other words, the Protestant work ethic was an important force behind the unplanned and uncoordinated emergence of modern capitalism.

So in this context, Protestantism, or rather its Calvinist form, which influenced the Puritans of New England, formed the moral and ethical basis for the rise of modern capitalism, and while the descendants of the Puritans today in New England are decidedly more liberal than in the past, due to evangelical missionaries in the late 18th and throughout the 19th centuries, in what historians call the Great Awakenings, these values were transmitted to people in the South and Midwest, or were carried with them during western expansion.

As for the South, as mentioned earlier, the debate over slavery has some bearing on why many of today’s Republican leaders in Congress are Southerners, and what that means for the country’s direction these past thirty years or so.

Sara Robinson’s article in Salon.com, attempts to answer why this is so, and sheds light on the difference between North and South. To begin with, despite the rise of Capitalism from Calvinist Protestantism, seen originally among the Puritan settlers, Robinson states that,

For most of our history, American economics, culture and politics have been dominated by a New England-based Yankee aristocracy that was rooted in Puritan communitarian values, educated at the Ivies and marinated in an ethic of noblesse oblige (the conviction that those who possess wealth and power are morally bound to use it for the betterment of society).”

On the other hand, Robinson relates that the New England-based aristocracy is opposed by,

…the plantation aristocracy of the lowland South, which has been notable throughout its 400-year history for its utter lack of civic interest, its hostility to the very ideas of democracy and human rights, its love of hierarchy, its fear of technology and progress, its reliance on brutality and violence to maintain “order,” and its outright celebration of inequality as an order divinely ordained by God.

Robinson cites David Hackett Fisher who,

described just how deeply undemocratic the Southern aristocracy was, and still is. He documents how these elites have always feared and opposed universal literacy, public schools and libraries, and a free press.

In addition, Robinson cites Colin Woodward, who wrote that,

…From the outset, Deep Southern culture was based on radical disparities in wealth and power, with a tiny elite commanding total obedience and enforcing it with state-sponsored terror. Its expansionist ambitions would put it on a collision course with its Yankee rivals, triggering military, social, and political conflicts that continue to plague the United States to this day.

However, Robinson writes that the most destructive aspect of the Southern’s worldview,

is the extremely anti-democratic way it defined the very idea of liberty. In Yankee Puritan culture, both liberty and authority resided mostly with the community, and not so much with individuals. Communities had both the freedom and the duty to govern themselves as they wished (through town meetings and so on), to invest in their collective good, and to favor or punish individuals whose behavior enhanced or threatened the whole (historically, through community rewards such as elevation to positions of public authority and trust; or community punishments like shaming, shunning or banishing).”

Robinson continues,

Individuals were expected to balance their personal needs and desires against the greater good of the collective — and, occasionally, to make sacrifices for the betterment of everyone. (This is why the Puritan wealthy tended to dutifully pay their taxes, tithe in their churches and donate generously to create hospitals, parks and universities.) In return, the community had a solemn and inescapable moral duty to care for its sick, educate its young and provide for its needy — the kind of support that maximizes each person’s liberty to live in dignity and achieve his or her potential. A Yankee community that failed to provide such support brought shame upon itself. To this day, our progressive politics are deeply informed by this Puritan view of ordered liberty.”

Conversely, Robinson states,

In the old South, on the other hand, the degree of liberty you enjoyed was a direct function of your God-given place in the social hierarchy. The higher your status, the more authority you had, and the more “liberty” you could exercise — which meant, in practical terms, that you had the right to take more “liberties” with the lives, rights and property of other people.”

Anytime a Southern conservative talks about “losing his liberty”, Robinson follows with, the loss of this absolute domination over the people and property under his control — and, worse, the loss of status and the resulting risk of being held accountable for laws that he was once exempt from — is what he’s really talking about. In this view, freedom is a zero-sum game. Anything that gives more freedom and rights to lower-status people can’t help but put serious limits on the freedom of the upper classes to use those people as they please. It cannot be any other way. So they find Yankee-style rights expansions absolutely intolerable, to the point where they’re willing to fight and die to preserve their divine right to rule.”

This would appear to not only apply to the justification for the South’s secession from the Union in the 19th century, but for the way Southern politicians, both Democrats (remember, many were Southerners who were promised committee chairmanships by FDR to get the New Deal passed) and Republicans after passage of the Civil Rights Act in 1964 led to Southerners fleeing the Democratic Party for what LBJ said would be for a generation, have acted towards any legislation that would cause them to lose their liberty. Today, we call that White Privilege.

For an ideological perspective, Marc-William Palen, in Foreign Policy in Focus, provides us with a clear understanding that the Republican Party is not merely a party of classical liberalism, but something different from what it was when it was founded.

According to Palen,

From its mid-nineteenth-century founding, the Republican Party was the party of big government, high tariffs, and government-subsidized internal improvements. The exceptions to this rule were the Gilded Age Liberal Republicans. In their vocal calls for laissez faire principles, these Liberal Republicans quickly became the independent thorns in the side of the Republican elephant throughout the first decades following the Civil War. When the big-government Republican majority continued to prove intractable, these Liberal Republicans became known as the “Mugwumps” when they ultimately switched their support to the Democrats in 1884.

Palen writes that classical liberalism was founded on moral sentiments, and that these moral sentiments, “are almost non-existent within the Republican rank and file, especially since the ultra-nationalist party draped itself in the red, white, and blue following 9-11, and led the jingoistic charge into Afghanistan and Iraq.

Nor is morality to be found amid the incessant Republican demands to cut social spending,” he says, pointing out what Grover Norquist, the driving force behind the GOP’s anti-tax, small government ideology when he said in 2001,  he wanted to

shrink government to the point where he “could drag it into the bathroom and drown it in the bathtub.

Palen suggests that if the Republicans current ideology is not found in classical liberalism, then where does it come from? Palen says, Ayn Rand’s pronounced atheism and intellectual elitism certainly does not align with the ideological outlook of most Republicans. And, he says, there is perhaps an element of a Social Darwinian “survival of the fittest” ethos—although no Republican politician is likely to admit to subscribing to anything associated with the theory of evolution.

So where does it come from?

…a large part of Republican ideological inspiration stems from fear. In particular, it is a reactionary ideological response to the turbulent upheavals inherent in an increasingly globalizing world. Such fears—let’s call it “globaphobia”—are frequently expressed on issues such as immigration, global terrorism, global warming, and American participation in international institutions like the United Nations. The massive federal intervention in the so-called free market following the global financial meltdown invariably exacerbated Republican fears that government intrusion in the market— and Keynesian economics more generally—would eventually undermine American individualism, citing Douglas LaBier.

However, Palen says it is not entirely satisfactory. According to Palen,

their fear-driven ideological inspiration dovetails with the philosophy of Thomas Hobbes, who predated Adam Smith by a century and who expounded on an amoral philosophy of self-interested individualism, counterbalanced by acquiescence to authoritarianism. Hobbes believed that a strong state prevented “war of every man against every man,” a chaotic type of warfare that Republicans believe is contained within al-Qaeda’s radical philosophy.

As we have seen, there is no one answer to why Republicans are mean. It seems to be a combination of factors all valid and relevant to today’s political climate in Washington and in the nation at large.

But nothing ever is just as simple as being mean. since we are dealing with human beings and not machines.

For our purposes, health care is just one more “liberty” conservatives are afraid of losing, so therefore, they will deny it to others, so that they can have more of it. Any discussion of universal coverage in a single payer health care system is a threat to their liberty, and therefore must be opposed. Add to that, the economic loss of profit and gain by those in the medical-industrial complex, and you get a clearer picture of the problem.

But to answer the question raised at the beginning, why are the Republicans so mean? It’s because it is in their DNA passed on from one generation of conservatives to another like our genes are passed down from our parents, grandparents, and so on.

Now the question is, what to do about it?

 

Single Payer A Bargain

Another shout out to Don McCanne for the following.

On Friday, the Nation published an article by Steffie Woolhandler, David Himmelstein, and Adam Gaffney.

You may recall these folks from my book review, “Health Care Under the Knife,” and it’s conclusion, “Some Final Thoughts on ‘Health Care Under the Knife.'”

Rather than regurgitate it for you, I am letting you read it in its entirety. But before I do, let me bring to your attention, an issue that is flying under the radar and has serious consequences for the country, our rights, and for the future of health care and other social programs.

Those lovable brothers from the Midwest, Charles and David Koch, are funding a group called ALEC, the American Legislative Exchange Council. One of the goals of ALEC is to call an Article V (of the Constitution, for those of you not familiar with the document) that allows for the creation of a convention in the event the government gets too much power.

I recommend you read up on it because it will radically alter our system of government for the benefit of the corporations and wealthy. Say goodbye to Social Security, Medicare, Medicaid, and direct election of Senators, to name a few goals.

That brings me to a quote I must let you read from a man who has no clue what he is talking about, and is emblematic of the dysfunction of his party. That man is former Oklahoma Sen. Tom Coburn, himself a physician who said the following regarding a convention and why he and others feel it is necessary.

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.”

In case you missed that, let me repeat it:

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.” Violent, ain’t he?

Pray tell, what country in western Europe is Marxist? Last I heard, none. Folks, these guys not only want to take away health care, they are still fighting the Cold War and godless, Marxist Communism.  No, what they are really about is defending a system, both economic and health care-wise, that cannot be sustained.

Here is the article in full:

Last week, Charles Blahous at the Koch-funded Mercatus Center at George Mason University published a study suggesting that Bernie Sanders’s single-payer health-care plan would break the bank. But almost immediately, various observers—including Sanders himself—noted that according to Blahous’s own estimates, single payer would actually save Americans more than $2 trillion over a decade. Blahous doubled down on his argument in The Wall Street Journal, and on Tuesday, The Washington Post’s fact-checker accused Democrats of seizing “on one cherry-picked fact” in Blahous’s report to make it seem like a bargain.
The Post is wrong to call this a “cherry-picked fact”—it’s a central finding of the analysis—but it is probably right that single-payer supporters shouldn’t make too much of Blahous’s findings. After all, his analysis is riddled with errors that actually inflate the cost of single payer for taxpayers.
First, Blahous grossly underestimates the main source of savings from single payer: administrative efficiency. Health economist Austin Frakt aptly demonstrated the “bewildering complexity of health care financing in the United States” in The New York Times last month, citing evidence that billing costs primary-care doctors $100,000 apiece and consumes 25 percent of emergency-room revenues; that billing and administration accounts for one-quarter of US hospital expenditures, twice the level in single-payer nations; and that nearly one-third of all US health spending is eaten up by bureaucracy.
Overall, as two of us documented recently in the Annals of Internal Medicine, a single-payer system could cut administration by $500 billion annually, and redirect that money to care. Blahous, in contrast, credits single payer with a measly fraction of that—or $70 billion—in administrative savings.
Our profit-driven multi-payer system is the source for this outlandish administrative sprawl. Doctors and hospitals have to negotiate contracts and fight over bills with hundreds of insurance plans with differing payment rates, rules, and requirements. Simplifying the payment system would free up far more money than Blahous estimates to expand and improve coverage.
Next, Blahous lowballs the potential for savings on prescription drugs. He assumes that a single-payer system couldn’t use its negotiating clout to push down drug prices, ignoring the fact that European nations and the US Veterans Affairs system achieve roughly 50 percent discounts relative to the US private sector. (Single payer’s only drug savings, he argues, will come from shifting 15 percent of brand-name prescriptions to generics.) Hence Blahous foresees only $61 billion in drug savings in 2022, even though tough price negotiations would likely achieve threefold higher savings.
Third, Blahous underestimates how much the government is already spending on health care. For instance, he omits the $724 billion that federal agencies are expected to pay for employees’ health benefits over the 10 years covered by his analysis, which would simply be redirected to Medicare for All. He also leaves out the massive savings to state and local governments, which would save nearly $3.6 trillion on employee benefits and another $5.3 trillion on Medicaid and other health programs. Hence, much of the “new money” needed to fund Sanders’s reform is already being collected as taxes.
Yes, there will need to be some new taxes—albeit much less than Blahous estimates. But those new taxes would just replace—not add to—current spending on premiums, co-pays, and deductibles. Additionally, at least some of the new taxes would be virtually invisible. For instance, the $10 trillion that employers would otherwise pay for premiums could instead be collected as payroll taxes. Similarly, Medicare for All would relieve households of the $7.7 trillion they’d pay for premiums and $6.3 trillion in out-of-pocket costs under the current system.
It’s easy to get lost in the weeds here. But at the end of the day, even according to Blahous’s errant projections, Medicare for All would save the average American about $6,000 over a decade. Single payer, in other words, shifts how we pay for health care, but it doesn’t actually increase overall costs—even while providing first-dollar comprehensive coverage to everyone in the nation. The Post’s fact-checker is wrong: Single-payer supporters can and should trumpet this important fact.
Of course, the most important benefits of single payer are altogether invisible in economic analyses like the one performed by Blahous. No matter what injury or illness we faced, we would be forever freed from one great worry: the cost of our care. It’s hard to put a price tag on that kind of freedom. Yet, paradoxically, even the slanted analysis of a libertarian economist provides evidence that it would be fiscally responsible.

Gallup Poll Says Americans Equally Divided on Single-Payer

Don McCanne, former President of the Physicians for a National Health Plan posted a New York Times article that said that Americans are equally divided over support for single-payer versus private insurance.

The article also said that support for single-payer edged up 10-points from last year, and closed  a 27-point gap since 2010.

This year’s survey, conducted Nov. 2-8, indicated that 48% preferred the private health insurance system and 47% preferred the government-run system.

Here is the breakdown by party:

Favor government-run system
22%  Republicans/Leaners
67%  Democrats/Leaners

Favor system based on private insurance
76%  Republicans/Leaners
29%  Democrats/Leaners

When asked if they had an opinion on “Medicare for All”, the majority said they did not have enough information.
17%  Favor
21%  Oppose
61%  Don’t know enough to say

While private insurance is still favored, if only by a percentage point, time will tell as the GOP’s tax plan takes effect and wipes out the middle class, whether that poll changes in the direction of single-payer.

GOP Tax Reform: Say Goodbye to the Middle Class

As a student of American Social history, I am acutely aware that for much of the 241 years of the Republic, the majority of the American people were not what we today would call “Middle Class.”

In fact, they were cash poor, dirt farmers, tradesmen, owning very little except what they could carry on a horse, mule, or in a wagon as they migrated west in search of better opportunities.

Until the New Deal, the Middle Class as we know it did not exist in such great numbers. True, there was a middle class in the cities and towns of the East Coast and Midwest, but most of them were descendants of immigrants from the 17th and 18th centuries, and rose steadily into the middle class as the nation’s economy shifted from a mercantile to an industrial economy in the first half of the 19th century.

Consider the following quotes from three US presidents regarding the power of money and corporations. You will notice that none of them are wild-eyed radicals in the least.

“I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial by strength, and bid defiance to the laws of our country.”

Thomas Jefferson

“Mischief springs from the power which the moneyed interest derives from a paper currency which they are able to control, from the multitude of corporations with exclusive privileges… which are employed altogether for their benefit.”

Andrew Jackson

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. Corporations have been enthroned, an era of corruption in high places will follow, and the money-power of the country will endeavor to prolong it’s reign by working upon the prejudices of the people until the wealth is aggregated in a few hands and the Republic is destroyed.”

Abraham Lincoln

So it is no surprise that the Republican Party is ramming down the throats of the American middle class, a tax reform bill that will effectively wipe out the remaining members of the middle class, and redistribute the wealth to those making over $75,000 and those at the very top, the oft-mentioned 1%.

My fellow blogger, and unsuccessful Democratic candidate for County Legislator in upstate New York, Joe Paduda, wrote a very potent analysis of the GOP tax scam legislation. Yes, I did call it a scam, but that is not my word. Others have used it in the past few days in an effort to derail and stop it from passing.

Besides destroying the middle class, it will as Joe points out, bankrupt the health care system. Then we will have to go all the way to a single-payer system just to get the whole thing working again.

Here is Joe’s piece in its entirety:

The tax bill’s impact on healthcare or; If you like your cancer care, you can’t keep it.

        

The GOP “tax reform” bill will directly and significantly affect healthcare. Here’s how.

It removes the individual mandate, but still requires insurers to cover anyone who applies for insurance. So, millions will drop coverage knowing they can sign up if they get sick.

How does that make any sense?

Here’s the high-level impact of the “tax bill that is really a healthcare bill”:

The net – healthcare providers are going to get hammered, and they’re going to look to insured patients to cover their costs.

The real net – The folks most hurt by this are those in deep-red areas where there is little choice in healthcare plans, lots of struggling rural hospitals, and no other safety net.  Alaskans, Nebraskans, Iowans, Wyoming residents are among those who are going to lose access to healthcare – and lose health care providers.

Here are the details.

According to the Commonwealth Fund, “repeal would save the federal government $338 billion between 2018 and 2027, resulting from lower federal costs for premium tax credits and Medicaid. By 2027, 13 million fewer people will have health insurance, either because they decide against buying coverage or can no longer afford it.”

Most of those who drop coverage will be healthier than average, forcing insurers in the individual market to raise prices to cover care for a sicker population. This is how “death spirals” start, an event we’ve seen dozens of times in state markets, and one that is inevitable without a mandate and subsidies.

For example, older Americans would see higher increases than younger folks. Here’s how much your premiums would increase if you are in the individual marketplace.

So, what’s the impact on you?

Those 13 million who drop insurance, which include older, poorer, sicker people, will need coverage – and they’ll get it from at most expensive and least effective place – your local ER. Which you will pay for in part due to cost-shifting.

ACA provided a huge increase in funding for emergency care services – folks who didn’t have coverage before were able to get insurance from Medicaid or private insurers, insurance that paid for their emergency care.

From The Hill:

[after ACA passage] there were 41 percent fewer uninsured drug overdoses, 25 percent fewer uninsured heart attacks, and over 32 percent fewer uninsured appendectomies in 2015 compared to 2013. The total percent reduction in inpatient uninsured hospitalizations across all conditions was 28 percent lower in 2015 than in 2013. Between 2013 and 2015, Arizona saw a 25 percent reduction in state uninsured hospitalizations, Nevada a 75 percent reduction, Tennessee a 17 percent drop, and West Virginia an 86 percent decline.

If the GOP “tax bill” passes, hospital and health system charges to insureds (yes, you work comp payer) are going to increase – and/or those hospitals and health systems will go bankrupt.

What does this mean?

It means we of the middle class had a very good run, but the ruling class has spoken, and they want us to disappear, or at least shrink to the point that we become unimportant to their pursuit of greater wealth. Why else would the donor class of the Republican Party, the Koch Brothers, the Mercer family, Sheldon Adelson, and the rest of their donors threaten members of Congress with no more funds for their re-election if they fail to pass this bill?

There is a word for that, it’s called Extortion. And we are the sacrificial lambs.

The Economist Explains it All: What the U.S, Needs to Do With Health Care

Thursday’s The Economist had the following article.

It explains what the U.S. needs to do to fix health care.

Our leaders in Congress, both Democrats, and especially Republicans should listen to what it has to say.

Medicare for All is not socialism, socialized medicine, or communism. But the status quo is health care capitalism, and has been a disaster.