Yves here. There is so much tearing of hair and rending of sackcloth over Trump’s Super Tuesday romp that I figured I’d give you something a little different.
By Beverly Mann. Originally published at Angry Bear
Paul Krugman has been incessantly complaining about some Sanders supporters who accuse him and other high-profile Sanders critics, especially academics, of conflict of interest. The Sanders supporters allege all manner of self-interested reasons for the Sanders animus, much of it (including Krugman’s) expressed with vitriol.
Thorpe, a Clinton administration healthcare official, gets his Sanders’-single-payer-critique cred because he worked on the failed Vermont single-payer plan. Just before it was about to begin being implemented last year, the governor, a supporter of the plan, agreed to kill it because it became clear that its costs would significantly exceed former projections.
Weirdly, the failure of the Vermont plan is used, by Thorpe and others, as evidence that single-payer could not be cost-effective nationally. As if the tiny state of Vermont has the same contractual bargaining power, regulatory power, medical training funding power, and any other relevant power as the federal government has.
Thorpe recently made big news with a report that deconstructed the Sanders plan as little more than witchcraft in its cost savings and costs overall and in its costs to this or that entity—the federal government, the states, etc. But in a January 29 article published at Huffington Post, two healthcare economists, David Himmelstein and Steffie Woolhandler, both with credentials at least as impressive as Thorpe’s, deconstructed the Thorpe deconstruction as, well, odd in light of certain facts. Including several that Thorpe earlier had used.
Not to worry. Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would. (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.) It is an issue that this week has become red hot now that it is likely that Trump will be the Republican nominee. And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump. According to the NYT, the Clinton campaign itself now shares our concern. Which the Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized thusly:
Sanders estimates a middle-class family of four would pay an annual premium of $466 under his plan, with no deductible or co-pays. Less affluent households would pay less than that, or nothing at all.
But for at least 72 percent of households enrolled in Medicaid — in which someone is working — the costs of Sanders’s plan would exceed the benefits, according to an analysis by Kenneth Thorpe, a public-health expert at Emory University.
That figure includes 5.7 million households, or 14.5 million people — among them, 4.2 million Hispanic recipients and 2.5 million black recipients. The requirements for eligibility for Medicaid vary widely by state, so that group includes some households living in poverty as well as some that are modestly better off.
How? Well:
“The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren’t going to receive really any financial benefits,” said Thorpe, a former Clinton administration health official.
Many lower-income people are already insured or eligible for insurance under Medicaid, at least in the states that expanded the program under President Obama’s healthcare reform. Many Medicaid beneficiaries also work, and those workers’ wages would likely decline due to the additional 6.2 percent payroll tax the proposal would levy on their employers.
The lengthy blog post is titled “Study: Bernie Sanders’s health plan is actually kind of a train wreck for the poor.”
That, presumably, is because of course Sanders could not, or at least would not, tweak the plan to remove the payroll tax for people qualify for Medicaid under current federal law. Because although the ACA is a very complex and very lengthy statute that took a year of drafting and amending to finalize, Sanders surely has thought of every possible issue and when that one came up he simply said, “Too bad.”
Sort of like Hillary Clinton, who regularly professes plans to build on Obamacare and move toward universal coverage for all—$10,000 deductibles? No prob.—but who never hints at what her building plans are, and, curiously, is never asked. Not by the likes of Thorpe or Krugman. And not by the likes of anyone else I know of.
But she’s definitely working on a plan for that move-toward-universal-coverage thing, and, as with the release of the transcripts of her highly-compensated speeches to large finance-industry and other big-corporate players, she’ll give us a hint about how she plans to do that the very minute after the Republican presidential candidates outline their plans to move toward universal healthcare coverage.
Or instead, she could refer us to Thorpe. Since he will again be a healthcare official in the Clinton administration.
____
UPDATE: Reader J.Goodwin and I just exchanged these comments in the Comments thread:
J.Goodwin
March 1, 2016 6:08 pm
Is there a reason we should anticipate that it would be significantly different than the Health Security Act?
I.e. larger federal subsidies and a stronger employer mandate than the ACA?
Me
March 1, 2016 6:54 pm
I think it wouldn’t be anything at all, J.Goodwin. I think it’s outrageous of her to keep saying generically that she wants to build on the ACA without saying what she wants to do, yet criticize Sanders for his plan.
And I think it’s outrageous of the Hillary shillary economists brigade–Thorpe, but Krugman too, and probably others–for not mentioning that she has said nothing at all about what she has in mind, yet keeps saying she has, well, something in mind.
Then again, I don’t know why Sanders hasn’t pointed out that she’s taking a page out of the Republican playbook: just keep saying you plan to do something about the uninsured; just don’t say what that is.
Added 3/1 at 6:59 p.m.
62 comments
Comments are closed.
from: http://www.nytimes.com/2016/03/02/us/politics/hillary-clinton-bernie-sanders.html
This is the “we can’t have nice things” syndrome. Undeserving, we should choose the lesser option, because of the mystical virtue of self-abnegation; then we will be rewarded (by the mystical Power).
In the syndrome, the precept substitutes for a more complex evaluation of the options and outcomes. Precepts are simple (or at least their conclusions are), but complexity is scary (aahh! make it stop!). People who doubt their ability to think (or doubt the value of thinking), readily accept a straight answer encapsulated in a rationalization. And such rationalizations aren’t always wrong or inappropriate; but one should check to see whether or not they are correct for the case. But that requires thinking! Noooo! I can’t have nice things :(.
This cycle has a lot of “Change” voters. Change voters reject the “we can’t have nice things” paradigm, sometimes quixotically. It’s not a new phenomenon in itself, but this time, instead of having the selection limited to a choice between Establishment candidates, they see two non-Establishment candidates, running on Change as their platform. Now they are keen.
But Clinton is not a Change candidate, like Trump, or Sanders. Sanders can pull Change votes from Trump that Clinton cannot. In fact, Clinton’s appeal outside of the Dem base is low, thanks in no small part to decades of FOX News demonizing. As odious as Trump may be, Clinton will not seem like a sweet rose. Clinton may be able to tamp down the Change fervor in the Dem base and “leaning”, but not outside of that (insufficient) range.
Bernie, even as a “socialist”, is relatively unknown, a quality often found in Change candidates. The ability to attract Change voters away from Trump is why Bernie does better than Clinton in national match-ups against Trump (or any Rep).
Why can’t we have nice things on health care?
My answer is, the real reason is absolutely horrible. Its not what they tell us at all, instead, thats almost all lies and the real reason is just horrible.
Read the following paper, its open access and its free on CiteSeer – Don’t be put off by the long and somewhat boring sounding title. Please share this with your friends. Dont say, I’ll do it later, download it now so you wont forget
—–
The potential impact of the World Trade Organization’s general agreement on trade in services on health system reform and regulation in the United States
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.405.5725&rep=rep1&type=pdf
— Fool me once, shame on you, fool me twice..
Read it!
Guarantee that Clinton’s whatever does absolutely nothing to solve any problems differently, except trigger WTO jurisdiction by involving foreign providers or insurers, also the various complicit officials and politician have scienter, knowledge that they are committing a crime as shown by their pretending to offer solutions that are known not to work and concealing that trade deals are what….without informed consent in a situation of extreme inequality in knowledge and power – The use of makes it a crime. That makes it medical experimentation on humans without informed consent (because giving health care away is cheaper that the scheme they are trapping us into- and more than 100,000 Americans are dying each year who would not die in the civilized countries health systems Multiplied by 20 thats two million excess deaths amenable to real not fake affordable health care. – )
See State Health Reform Flatlines IJHS – 2008
also see
CTPC Maine Health Care Subcommittee–GATS Draft
Also, this 2009 paper is essential to understanding this horrible trade deal lock in problem well
They are misleading the country- please think before voting-
That is false. Clinton has proposed specific changes to ACA, including tax credits up to $5000 to bring down co-pays and deductibles that she acknowledges are too high, efforts to reach 16 million people who are eligible for Medicaid (single payer, by the way) but have not applied for it, and a public option. You can argue these are insufficient, but to say she has proposed no improvements is just plain wrong.
Medicaid has claw backs which are very much a negative against enrollment.
Thank you SD.
No more Stockholm Syndrome America.
>Medicaid has claw backs which are very much a negative against enrollment.
They cannot expand medicaid because of standstill and ratchet, so they can’t and wont, they will never tell us thats why, though
There may be something about standstill in here:
https://www.citizen.org/documents/FinanceReregulationFactSheetFINAL.pdf
the new way to phrase it is “capture the autonomous level of liberalisation”
See the actual TiSA standstill in here:
http://data.consilium.europa.eu/doc/document/ST-6891-2013-ADD-1-DCL-1/en/pdf
You may have to right click and save with .pdf extension if you see gibberish
very eye opening doc on TiSA!
How is she proposing these “credits” be given? The reality is for the really poor, a credit the following year is not going to resolve a medical problem that occurs during the year. They’re going to continue to forgo care and they are going to continue to cost the system when the problem becomes worse because they went without care back when a problem was smaller and more manageable.
And no Medicaid is NOT single payer. You’ve got 50 different states for cripes sakes. How is that SINGLE payer? It’s like 30 different payers.
Personally, she needs to spend some trying to navigate a health care system with less than opaque pricing. She needs to address things like “in network” and “out of network” that impact the prices for “customers.” The idea that if my doctor wants me to get an MRI that I should be spending valuable time “shopping around” is absurd. Why can’t the system say an MRI is going to cost X dollars ANYWHERE? Why is a sick individual told to do the footwork and shop around instead of the system being regulated to ensure that pricing is fair no matter where a consumer goes. No one chooses to get sick. Why should they be gouged when a hospital brings in an “out of network” doctor to their ERs or their ORs? I literally got a $3000 bill for an ER visit to an in network hospital because the doctor was NOT within network. What am I supposed to do when my kid has a 103.8 fever? Shop around? Really? And the really abysmal thing is when you talk to the insurance they blame the hospitals(you should ask them why they have out of network doctors?) and when you talk to the hospital they blame the insurance(they need to actually have doctors and not all of them agree to the compensation system an insurance company sets.) Meanwhile the sick person is stuck in the middle and expected to navigate it at absolutely the worst time to ask someone to navigate something complicated- when they are sick and vulnerable.
I’m going to be honest. I’ve stopped going to the doctor. Why? I’m not going to have my household bled $250 every time I have blood in my urine because they are trying to figure out if the blood and pain is coming from my kidneys or my uterus. I’m going to gamble. And if and when I throw snake eyes(I have an enlarged kidney on my right side and in addition to being hospitalized for pyelonephritis I had a stent put in one time because I had a stone so large that it blocked off my kidney) I’m going to cost the system more. However, it won’t entirely be my fault. I’m not the one who set up a convoluted system that says putting a catheter in is outpatient surgery(even though it isn’t performed by a surgeon.) That will be the fault of hospitals and insurance companies. Should I be getting regular care for both of my conditions? Probably. However, with the current system being what it is, I’m not shelling out the hundreds of dollars for ultrasounds, CT scans, and the sundry other tests on top of what we pay in premiums, co pays and the thousands my husband’s company pays to insurance companies already. For cripes sake, I’m now being charged for a doctor to read the test he ordered(because they can charge more for testing.) How ridiculous is that? Who orders a test they AREN’T going to look at?
Sadly, I have GOOD insurance. I can’t even imagine what it must feel like to be asked to come up with $2000 because you have a high deductible plan.
I haven’t heard Hillary say it (yet) but I heard Obama say we had to have copays and deductibles so we’d have “skin in the game”
Why hasn’t he and everyone else who uses that phrase been called out?
What you describe IS skin. Plenty of skin.
Do they think being sick is a trip to Disneyland? That chronic illness is nothing but fun? We must be charged. Both with money and outrageous responsibilities like finding in network assistant surgeons?
And the whole idea of affordability!!!! That the gazillionairs sit around and talk about how much of this Skin we can or should afford is pure BS.
Private health insurance is extortion. And the whole system has to be cleansed of it. Abolish Medigap and Medicare Part D.
I am so sorry you aren’t going to the doctor. And I hate Hillary for vowing that it will Never, Ever be better for you and us.
I made that argument back when we were discussing reform.
I’ve always thought the argument that people go to the MD office for giggles as one of the most absurd ones ever.
Even when my co pay was $25, there was always something I would have rather done with that $25( I could buy a good book($20) and get a starbucks coffee($5). I could take the kids to the pool($17)and then get the kids half price happy hour slushies($8). I could rent a movie from redbox($2) and buy pizza and a 2 liter for a movie night($23.) I could go out on a date night to a restaurant or tapa bar($25) . There are a million things I’d rather do than not feel good and sit in an office with people who are also sick ,so we can all share germs. I’m just not that stupid and I resent the industry for selling it that most of us are overutilizing care(because it cuts into their profit line.)
Anyway thank you for your kind words. It makes me feel a little less alone.
I think Hillary and her ilk wants us to feel alone. They are enraged at Bernie for bringing us together.
Well, they might stop him from being President but he’ll be going back to the Senate and I don’t think Medicare for Everyone will disappear quite so easily this time.
Thank you. Indeed yes.
The neoliberal vocabulary is grotesque. Skin in the game and bending the cost curve.
Any politician who mouths these absurd terms is as out of touch with the working class as Marie Antoinette, and deserves a similar just end.
We recently moved back to the US after spending 11 years abroad. My wife, who is Thai, still cannot understand why even basic medical care is so absurdly expensive here. Me too.
DWS and the DNC are working on that part of the plan. The poorer citizens will be able to take out a pay day loan until tax time. They will also have the benefit of a very high interest rate and flexible refinance payback opportunities as well. At least its better than the Republican plan of just die. Is financial slavery better than dying??
Oh gawd, tax credits. I’ve got to make the deductible now, because I’m sick, and Clinton proposes to help me with tax credits I might get — assuming my personal economy hasn’t already gone into a tailspin because of illness and the deductibles — at some point in the future.
Tax credits suck. That’s why Republicans like them. That’s why Clinton likes them.
Ted Cruz does NOT like tax credits. He will abolish the IRS (A Day One Production) and institute a flat tax you can fill out on a post card, or an email or better yet, a Tweet! Now, that would be efficient! So, either Ted Cruz is not a real republican or Hillary loves complex tax codes with epicycles going off into infinity to help bring about change we need TurboTax to believe in!
My very large problem with Ted Cruz is he is a fundamentalist. Don’t get me wrong the Bible is a decent book with a lot of good information and stories, however I am not 100% convinced that what God said to Paul thousands of years ago applies to what he wants now from the people who are alive today. Additionally, I have real problems with people who want to thwart’s God’s decision to give mankind free will, even if it is done with the intentions of “saving their souls.” It’s wrong.
Okay, now on to flat taxes, I really like the idea of a less complex system but I would want details. Why? Trump is calling his plan a “flat tax.” It isn’t a flat tax though. It gives a yuge advantage to the investment class by essentially tripling their savings($25,000 income exemption PLUS $50,000 investment exemption.) In other words, if I labor for $75,000 I’m penalized for the income I earn from actual LABOR while the guy who dabbles on the stock market gets to keep $50,000 of his gambling money tax free.
Don’t get me wrong I’d be fine with making people have a standard and doing away with deductions and credits for 401ks, HSAs, mortgage interest, “gifts” that are actually more income than a full time minimum wage earner, 529s, credits for making improvements to you home, credits for being able to afford that energy efficient vehicle, Hummers etc, etc although I suspect that you’d have middle income people coming at you with pitchforks(and I suspect what is more likely to happen is that the only real revision made would be to EITC which surprise, surprise is a credit that the poor are able to use to get money from Uncle Sam rather than a credit or deduction, tax haven(whatever you want to call all these little loopholes that allow you to keep from paying Uncle Sam more) the middle class and rich can use to get their liability to ZERO. But hey, let’s play pretend that it’s only the poor who are takers for using the exact same system the rich and middle class use to get their tax liability down.
That’s my largest problem with the right. They’re completely disingenuous and oozing with contempt for those who weren’t with a silver spoon in their mouths.
Tax credits? Whoopee. You still have to front out the money.
And, last I checked, money isn’t exactly growing on trees.
Medicaid is privatized – a wealth transfer program for insurance companies. After all these years it’s beyond time for ACA/Obama/Clinton defenders to acknowledge this.
” More than one-half of Medicaid beneficiaries are now in privatized plans…”
LINK
Just a head’s up, the original post has been edited to include this paragraph between the first and second paragraphs of the post:
“I’m not among the Sanders supporters who subscribe to the academics-who-want-a-position-in-the-Clinton-White-House theory. And making that charge against Krugman is ridiculous. But there is one virulently anti-Sanders healthcare economist who I’m betting is motivated exactly by personal ambition: Emory University’s Kenneth Thorpe.”
Watch out!!! Health care retailization is coming!
What?
The Affordable Care Act (ACA) is empowering patients via social networks and smartphone apps.
What?
Catering to the needs of these empowered patients is the name of the game – i.e., health care retailization.
What?
At the recent annual meeting of the Federation of American Hospitals, the Acting Centers for Medicare & Medicaid Services Administrator asked the for-profit hospitals to join CMS’s ongoing push for the retailization of health care. “Providers should imagine negotiating with cash paying consumers.”
Retailization?
Because health care consumers are taking on more responsibility for payment for their healthcare, they will naturally act like retail consumers in their selection and payment. The retailization of healthcare will drive the trend of providing services at the lowest-cost.
“Placing the patient-consumer in charge of health care spending?” asks Don McCann at PNHP.
Can privatizing Medicare, converting Medicare to a voucher market of private plans, be far behind?
“This is coming from an administration headed by a Democrat – a neoliberal administration that has been mislabeled as progressive – and supported by a presidential candidate who rejects Medicare for All and wants to build on Obamacare with its high deductible private health plans that place the patient-consumer in charge.”
http://pnhp.org/blog/2016/03/01/cmss-slavitt-calls-for-retailization-of-health-care/
Sophisticated consumers are shopping around for health care, so let’s put them in charge of health care.
Is this realistic? In health care, is the best treatment a choice? Do patients want to make the choice? Do patients really make choices? How do older patients make choices? To what extent are they prepared to be involved in health care decision making, given the diseases associated with ageing and the increased prevalence of long term and chronic conditions?
Patient-consumers at a distinct disadvantage when it comes to making informed decisions. Abilities to make such choices are relatively sophisticated. Choosing between health care providers and treatments is unlike any other consumer service or product. There is a key need to consult expertise. It is not enough to know which health care provider is less expensive; consumers must have the confidence that they are getting quality professional services. Patients require awareness when treatment is poor. And it is of little use being able to tell if treatment is poor, if one is unaware of the quality of alternative providers.
Health care is not easily understood by many people, who have a hard time using health information. Many struggle to understand and are just not sophisticated enough. Informed decision-making would be, in reality, just guessing influenced by slick advertising. Flawed consumers unable to make informed choices leads to poor quality care.
Only in America.
I guess they’re going to have to add a lot of cramped little cubicles adjacent to hospital emergency rooms and admittance desks.
Hospital salesperson: “So you’ve got the MRI listed here, we’ve managed to get you the special aftercare package and if you sign tonight we can get this financed at the special 1.9% rate for 48 months”
Sick suffering patient: “…”
HS: “Well, I don’t know we never go lower than this but… it’s almost the end of the month let me take it to my manager maybe we can make a special deal for you…”
They will ship poor sick people overseas. Or use staffing firms from countries in South Asia or Africa to staff hospitals under trade in services agreements.
BTW, Single payer cannot charge money – One tier means everybody in, nobody out.
So, there cant be any punishment tiers for evenybody who doesnt pay the most.
So it violates neoliberal “competition policy” which says that more money has to buy more, less money has to buy less. That’s a cornerstone of US trade policy.
It can only be completely non-commercial and be in a country where the entire market sector is non-commercial. Just like education. See GATS Article I:3 (b) and (c) (two part test)
Also, it has to be started and established before 1995. Do you think that’s possible?
Given that the cost of medical services varies so widely depending on where one lives, whether one has insurance, whether it’s an individual plan or a group plan with negotiated costs, if one doesn’t have insurance and can’t afford the care, or doesn’t have it and can pay cash, I would venture to guess that it’s impossible to determine what the actual cost of any medical service is.
It’s hard enough sometimes trying to decide if the treatment options are being driven by what one actually needs to get well, or what one’s insurance will cover, that anything other than routine checkups and screenings can turn into a nightmare.
One advantage of paying cash is honesty, doctors can discuss tests and treatments with a self-pay that they are forbidden from even talking about by insurers, as part of their contract.
Delisting happens and they don’t even need to tell a doctor why they were delisted.
Retailing health care is useless to people like me who don’t have the money for expensive tests and drugs.
You should go overseas for short periods for your tests and subsequent medical care- While you still can!
I say that because chances are, very soon those overseas systems will be co-opted and joined at the hip with the same ultra-tiered entities here who have screwed everything up so the opportunity to access modern, honest medicine somewhere, will gradually close.
Instead, people will get shipped where its cheap and get the same crappy care they used to get here, with more profit.
i can’t say that i’m too plussed about this blaming of voters, especially as it’s purely racial and ageist, as if southern young, white democrats don’t deserve any blame for the clinton wins.
No new president is going to change health care quickly. ACA is an imperfect compromise plan which will stay there for a while, because it’s too difficult to replace it. I’m more interested in what the president can do immediately. Bernie could put in an attorney general and SEC that will JAIL corporate criminals rather than just letting them pay trivial fines. He could move away from perpetual war in the Middle East. Torpedo the TPP. Try to bring back Glass-Steagall. HRC will do none of these things. Trump is a wild card—nobody knows what he’ll do.
Original Medicare was implemented in one year. It may or may not have been difficult, but it definitely wasn’t “too difficult.”
I’m genuinely perplexed about what you mean by difficult to replace? PPACA itself was a modification of existing laws, not some kind of brand new thingamajig. It was complex because it was designed to screw people over, not because amending the Social Security Act is inherently complicated.
At any rate, are you aware that another healthcare overhaul was enacted just a few years earlier, in 2003(!)?
Not good enough. By a country mile. We need immediate change.
Fantastic!!! We’ll get it if we will it hard enough. No plan necessary for getting it passed when it would not even have won a majority with Democratic control of Congress in 2010, apparently, or so you say.
Absolutely none of the candidates can do anything good, its been rendered impossible by GATS and soon TiSA, TPP, TTIP.
Can people see my posts?
This isn’t spam by virtue of its truth. If it was untrue, and didnt explain these problems, then it would be spam, but if its the answer to a posed question, perhaps not a pleasant one, but the answer nonetheless, its not spam.
Might as well go crawl in a cave, then. And why bother putting comments on a blog? Who cares?
No, you are misunderstanding what i am saying. If trade deals systematically prevent every way which would save money, for example, they prohibit “new monopolies” they contain “Disciplines on domestic regulation” which require that countries eliminate any barrier to foreign corporations, such as limits on profitmaking of any kind, they have open market access obligations, which means that you cannot have a single payer because they will have a right to set up insurance networks – perhaps ones that partner with hospitals or providers elsewhere, You may think, oh thats great, we need cheaper health care, but whats going to happen is balkanization which has proven again and again to INCREASE the cost of healtcare substantially, also it will essentially eliminate the minimum wage because as it stands right now, I am pretty sure that no wage parity or even minimum wage requirements exist in the L1 visa space, so people may be working for almost nothing, just to get the experience in the US. The person they likely would have replaced might have made 80k-100k – and deserves it because they work extremely long hours and require an advanced degree. Same thing with IT, and with teaching and even law. they are all targeted for “liberalisation” Really, and I can prove it.
More- 1. Subjection of public entities
to GATS rules
2. “Standstill” of existing
exceptions to liberalization
3. Requirement to allow any
new financial service (loans, not help)
4. Requirement to “endeavor
to remove or limit any
significant adverse effects” of
domestic regulation (visas, license, 50 state differences- )
All that PLUS “negative list” in TiSA which means everything, every sector and all “modes of supply” are included by default.
In short- the impact on the middle class will be astronomical once it starts rolling.. Ive heard figures of 30 million jobs – thats what they are thinking..quietly..
Now do you see?
Major change that NOBODY realizes will happen. A few NGOs have written a tiny bit about it, All way too conservative- not really getting the economics- Huge amounts of money will be pocketed – from much lower wages-
The analysis on Wikileaks- are not good- most are not as good as they should be, either.
Read Jane Kelsey “Serving Whose Interests” – Google for it.
When Vermont first announced its effort to do single payer, I was horrified. As an ex-health insurance guru and long time advocate for single payer, it was easily clear to me that Vermont was exactly the wrong place to try this (both size and geography were against it), and that if Vermont did it and then failed (as I believe it would have), it would set back the effort by 20 years. No one was happier when Vermont stopped its effort than I was, and I would note, for the exact same reasons I had panned it initially.
There are very few states that could do single payer alone. Hawaii and Alaska, because of their geographic isolation, perhaps some states that are otherwise isolated like Montana and the like. Any state with a large job pool and a population in flux would be the worst. Vermont falls a bit into the latter group, but also has the crushing negative of a small population in a region of otherwise high population states. All of this goes to controlling the pool; those who are eligible for coverage, and Vermont was incredibly vulnerable on this regard. Anti-selection would quickly have overwhelmed the state’s program, and it would have been irretrievably bankrupted.
I don’t think any state could run a single payer program without massive federal help. The states piggyback on federal tax collection. Consumption taxes are self reported. The states couldn’t raise money tomorrow, and the existing bureaucracy doesn’t even exist at a bare bones level from which to grow. Team Blue hit the GOP for not setting up exchanges for ACA, but the states don’t have the money. It’s why Massachusetts dumped their Romney Era exchange and good, blue states such as Oregon quietly rejected their state run exchange.
States do roads and schools, and Reagan and Clinton used unfunded mandates to push policy without without paying which squeezed the abilities of states to pursue their own constructive policies.
Trade deals basically forbid anything which can save money, systematically, everybody in this thread is barking up the wrong tree, of course Clinton cannot fight FOR us, she has the largest imaginable conflict of interest in that her husband frigging signed the US into the mother of all bad deals for Americans, the WTO services agreement (GATS) which is literally trying to END public health care and education for various US mega corporations all around the world.
Agreed. And there’s another problem at the state level, which is the local power of universities (medical schools) and hospital chains.
They are often among the largest employers in the region and have directors/trustees/whatever from the other big employers in the region. The incestuous nature of those relationships renders it effectively impossible to drive down the major cost in US healthcare compared to the rest of our industrialized peers: too many overpaid specialists and administrators. Indeed, our very own First Lady was once an overpaid hospital administrator.
Plus, federal policy itself is a big part of the problem. No individual state can overturn federal IP law or customs inspections or the financing and technological incentives Medicare and other programs create to centralize power in large hospital chains rather than independently practicing doctor offices that focus on prevention and family practice over treatment and specialization.
Not Timothy, read the document from the state of Maine I posted earlier, here is the URL again..
http://www.maine.gov/legis/opla/ctpchlthcaresub.pdf Also the Skala paper. keep in mind that you cannot just pick and choose onething and cal something single payer, all of the elements need to be there.. Only one payer, (for both bargaining power AND simplicity AND people going to the doctor whe they get sick and not when they are dying- ) Also, non-duplication of services and allocation of resources by need, so people who NEED imaging or surgery get it right away.. its essential that everybody get the same level of care- thats what keeps the system honest- Also, GATS rules – has to be totally free or GATS will destroy it by design, Google this sentence for lots of info-
“For the purposes of this Agreement…
(b) ‘services’ includes any service in any sector except services supplied in the exercise of governmental authority;
(c) ‘a service supplied in the exercise of governmental authority’ means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.”
No states can do single payer since the US signed GATS in 1994-95. Whatever is being proposed it cannot violate a huge long list of provisions that systematiclly bar all the key elements of single payer. #1 single payer means no insurance companies at all operate there. #2, Single payer is the single source of payment for medical doctors and hospitals and other service providers. So they dont have to deal with 1500 payers and 5000 different plans all different. 3.) For single payer to work, there cannot be bills designed to discourage people from seeing doctors. Payment of a bill is not what turns your health care on and off. Taxes are separate from healthcare. If you dont pay your taxes thats a tax problem but your healthcare does not stop or change in ay way. Richer people dont get better health care. Everybody gets the best healthcare possible and practical Also, as I said earlier, specific provisions in the GATS restrict countries from creating new nonconforming state monopolies after signing which in our case was 1995 or 1998. See nicholas skala’s 2009 IJHS paper on the WTO and US health care reform that I cited above.
Vermont wasn’t a single payer plan to begin with. It was a proposal to start a plan that would still allow for private insurers to compete and ultimately lay the foundation for single payerr. Implementing a genuine single payer plan in US states is nearly impossible when the single biggest pool of people and single largest pot of money — Medicare — is untouchable without federal dispensation.
It’s important to recognize that kinda sorta single payer won’t work because the fiscal key to universal coverage is the reduction of the massive administrative and profit costs in our health care economy. The source of those costs is the existence of multiple private sector entities making money off of insuring people. Private insurance has to be eliminated or radically regulated to find the real costs savings needed to achieve universal coverage.
Upthread someone extols the singlepayerness of Medicaid. Medicaid is the worst public insurance program in the industrialized world. It is chronically underfunded, segregates the poor from others seeking access to medical care, has too few providers in most states and is wildly inefficient. Medicaid administrative costs are at least two and a half times those of Medicare, largely because of the need for constant eligibliity testing.
Medicaid is a desperately needed lifeline for tens of millions of Americans. But let’s not pretend it’s a model for anything. Means tested health insurance programs are not particularly sustainable.
The attacks about ‘single payer’ against Sanders really are despicable, as they are outright lies.
Strange is it not that here in Hong Kong we have a health service structured on that of the UK’s NHS – Hong Kong having a population in excess of 7 million, and more importantly from a neoliberals perspective is allegedly a business friendly state that ranks highly in numerous comparative studies by numerous rightwing institutions. Given this fact, and the fact HK has a flat income tax system with large personal tax allowances, I wonder how they manage to do it, well apart from the fact it does not waste most of its GDP on defence spending.
The fact remains that for the bulk of the population in HK they are reliant on its public health system, which does note consume 17% plus of GDP per year – wonder if team Hilary have heard of Hong Kong, or understand that despite its business-friendly credentials that it boasts a world class health service with 100% coverage of the entire population. And if you want to waste your money on private health insurance, of course you can, but as in the UK, if its brain surgery or something very complicated, its done on the state or at a state hospital – but allegedly it won’t work in the USA for some unknown reason, despite HK being now part of China, which itself has a different health system.
They will never walk away from this.. They will do everything imaginable to preserve the lie.
Look at the huge cover up of single payer facts.. muddying the facts on single payer.. Even Harry Reid joined in. OMG, there is really good proof of it. ‘stepping stone to singe payer” BUSTED. Also, te PHRMA deal with Billy Tauzin.. and all the stuff that happened in 2009 was all fake, cover up. 90% lies.
The standstill for GATS financial services was in 1998, so the US would have to (no chance of this ever happening) have to pull out of the WTO, (!!) and then, compensate all occupants of that market segment, (GATS Article XXI) to be able to violate that and I have no idea if TiSA has in terms of penalties – its likely ISDS which in the case of health insurance would mean a trillion dollar plus payout to insurance companies for their “loest expected profits”
Suddenly, poof, free property..
also they would be throwing TISA and all that super cheap captive labor away, as those Mode Four jobs are the payiff to the developing countries – Also then they would not get National Treatment and Most Favored Nation status, there, no branch offices, owned wholly by the corporatio, no National Treatment obligations..
So, just like single payer, they have a whole web of things which they want, another thing is then wages in the developed countries cant be ushed down to global average levels or even lower (because of all the indebted people desperate to save their homes) the whole deal depends on privatizing big chunks of the public sector and then putting them into the WTO GPA e-portal..
So that they can be bid out..
For kind of an idea of what may happen, read between the lines of this article
..
Like single payer, you cant just ick one part and get the payoff – They have gotten wise to the two timing game-
The job crunch is very real for the developing countries, which have a lot of corruptio, and their leadership is desperate to export their restless educated and have them snd back remittances instead of cleaning up government. Here too!
They see it as the reward they are owned by the US for 20 years of playing the globalization game.
They dont realize that Obama dn Clinton and Bush basically created these shortages artificially.. they think they are real and they are gearing up to helpus solve them.
The framing to the media, Congress is fragile and healthcare and IT in particular success is dependent on creating multiple crises which have to be “solved” by TiSA for the scheme to not be seen for what it really is, a 20 year in the making SCAM thats almost ready to fly.
The more they lie, the harder and EXPONENTIALLY more expensive to the society it gets maintaining the reality distortion field.
That’s what the old saying “Oh what a tangled web we weave when we practice to deceive”
means. It couldn’t be more true.
Hong Kong’s healthcare system is quite good – and so is the UK’s even now despite the attacks on it by the neoliberals in the Cameron government. (Allyson Pollock has written quite abit about the effect of trade deals on the NHS)
The minute money becomes involved, however, in a market segment, for example, the minute a private insurance scheme is allowed to be involved then a ‘ratchet” process begins that is designed to bring about full liberalisation. (privatization) Then competition policy requires that the public service not crowd out commercial firms by being too attractive and eliminating trade distorting subsidies that block maximization of their profit potential.
Here’s the thing I am either constantly mumbling when reading about Clinton’s “plan” or yelling at the TV when watching her talk about it: insurance does not equal care. By the time you add up the premiums, the co-pays, the deductibles, and the co-insurance percentage, insurance often functions as a barrier to care.
The real problem, of course, is one that was routinely ignored during the construction of the ACA: as long as “new” systems are built on the rotten and unstable – but so American! – foundation of private insurance, we are going to continue to cycle into crisis mode. And the time in between crises is going to get shorter and shorter.
Clinton’s so-called solutions to “the problems” don’t actually solve them; they just create a short-term illusion that they are fixed. Or if not fixed, better.
Here’s a little anecdote for you that I think is emblematic of what a lot of people are facing. Both my daughter and her husband work for small businesses that do not offer group health insurance. They had had coverage under a BC/BS plan they obtained in the private market. That plan, however, was pre-ACA, so if they renewed the old plan, it would not come with all the “benefits” of the new mandates under the ACA. So, they found a new, ACA-approved, plan that was comparable, and that worked well for a year. It wasn’t cheap – around $600/month – and they make too much money to qualify for any subsidies.
In October, they got a letter from BC informing them that if they wished to renew the policy, the new premium was going to be almost $900/month. And, because they were having a baby at the end of the year (they already had one child), adding the new baby would take the premium to over $1,000/month. Plus the deductible, and so on. $12,000 for insurance for a year. No.
So, off they went in search of a new plan, which they thought they had found. She made sure to check with all of their doctors to make sure they were participating providers – she even checked with the hospital where she would give birth, in case the baby was late and didn’t arrive until 2016 (he arrived Christmas afternoon!). The policy was more than their old plan, but less than the new cost of that old plan. They enrolled, paid the first premium, and she thought all was well.
The first problem? Their claims for January doctor’s visits were rejected because the doctor wasn’t in the plan. Say, what? Big snafu, but maybe that one is the doctor’s fault for telling them he was in the plan. They didn’t want to change doctors, so she went looking for another plan, which she eventually found; she had paid the January and February premiums for United and the new plan would be effective March 1. Next problem? United Health canceled their plan. Why? Oh, they got the premium payment my daughter sent in December, but they never applied it, so they canceled the plan and refunded her premiums. Meanwhile, the cost of her 6-week post-baby checkup was now not covered, none of the well-child and well-baby and vaccinations, etc. were covered – even if that doctor had been in the plan, United’s canceling the policy over their own failures would have rendered the charges not eligible. She held her breath and hoped they would not need anything other than routine care in the gap before March 1. They made it! And it looks like the refunded premium will be more than enough to pay the cost of charges during that uninsured period.
Dollars to doughnuts, tax credits under Clinton’s plan aren’t going to be available to people like my daughter and her husband. If lowering the cost of premiums means raising deductibles and such, that’s not helping them – they still end up being out-of-pocket an enormous amount of cash.
And through this several-month debacle, we kept saying, “this is why we need a single-payer system.” It’s so obvious when you’re caught in this kind of dystopian shitshow – and if Hillary Clinton was really invested in “fighting for” us, instead of making sure her own corporate-funded cash flow continues unimpeded, i’d have more confidence – currently, I have none – that she really wants a system that works.
The fact that her goal is for coverage and not care really tells you everything you need to know. Insurance, as it is currently constructed, does not provide access to actual care, nor does it make the care one does get more affordable.
Sorry for the rant (I am a longtime reader, but haven’t commented much – used to be a regular at Talk Left, but…well, spend a few minutes there and you’ll understand why I left).
Thanks for your story. NC seems to be the only place that collects them; it’s like there’s a news blackout, or something, on systemic problems with ObamaCare.
Just the sort of stress you need, with a new baby, too. Think of it as Darwinian; those who can adapt to a system where money is as important as oxygen will adapt and survive.
Anne, I did pop into TalkLeft a couple of times a few weeks ago. But it was pretty clear that any comment I might make would be disapproved.
I’m sorry you had lo leave (or take a break) there…. I’ve always appreciated your comments…. And look forward to seeing you here.
A really, really important story of just the sort that is not being focused on for reasons that are beyond me.
Have you ever had a close family member who was a habitual liar on matters of great importance?
The heart of the reason they wont talk about it is best illustrated by the results you will have returned when you google this: ‘a service supplied in the exercise of governmental authority’ means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.
let me know what you think, please google that and give me some feedback as to whether that explains the situation – without understanding that you’ll not understand how the privatization trade for jobs works. All the services sectors and all modes of supply.
I can’t believe that people cannot find this info on their own.
If you read up on the Doha Development Agenda you’ll get a feel for what the developing countries want but the US news coverage you will notice leaves out the jobs part consistently.
Just be happy your daughters pregancy was not ecotopic with preeclampsia and spread over two plan years and was a consumer driven plan (cafeteria style, high deductible) Cost in 2009.. get ready $280,000 With insurance. According to KFF, “maternity care in consumer driven health care)
If you get a chance, watch Obama’s first SOTU address, do you see the coded message in there to the wealthy not to worry, Obamacare wont be a serious contender.. Hint- “self sustaining” Schumer.
So to summarize, employees at universities with medical schools don’t like the idea of constraining the cost of medical care to merely the level of cost in every other industrialized nation on the planet.
Got it.
officially, only around a third of every dollar spent on healthcare is attributed to insurance but that leaves out some of the major drivers of increased cost which the insurance system creates which are absent in the non-fake single payer.
Huge cost reductions by eliminating all co pays and user fees because people utilize health care when they need it which saves a lot of money in the long run. Even the World Bank says that. The second RAND study says that, dozens of studies have made it clear that doctors do not overutilize resources, so the only conclusion we can come up with is that the denial of care is done to make health care MORE, not less expensive, in a way which targets poor people.
Another big savings is negotiating drug prices down- thats another thing the US and its neoliberal ideology is fighting globally, The effect of trade policy on drugs, Americans take fewer and older drugs and the price of even generics has triped since neoliberal Obama came in. US policy couldnt be clearer there..its clearly intended to make them more expensive globally.
Also, we are fighting public higher education.. and science (Google site:.in GATS education WTO for lots more on that!
The EUA.be web site of EU colleges has a statement about TTIP and TISA decrying their attack on the existence of public education.
Americans actually have low rates of healthcare utilization, much lower than other developed countries. Another myth shattered. Also, medical malpractice is up, but malpractice cases and awards are at record lows. So all the things they try to blame the high cost of health care on are all made up stories except for the insurance system, oh, and endocrine sisrupting chemicals are a huge and growing driver of costs, more than 100 billion euros a year in the EU. And they want to make regulating them really hard with TTIP. Also, they want to export natural gas in TTIP which will impact housing. We’ll lose a lot of housing.
Taiwan even is not fully single payer at all. Systems which are part private are in a process of privatization called ratchet, basically gradual privatization like the UK. The only way to avoid that is to have beeen totally free in 1995 or 1998 and then have stayed completely that way after GATS was signed.
here is another discussion
The only way health care will ever be profitable will be in its effectiveness. If it makes people well. Because cost effectiveness and the value of a healthy society. So far this goal is in contradiction with profit making – because no more patients if they are all healthy so how does a former extreme-capitalist country resolve this little glitch? Especially when the former extreme-capitalist economy is flat on its back and unemployment (ergo no tax revenue) is at 23% but that reality is denied by the apparachix and their statistical magicians? So there is no solution to this problem. And if we all agree that health care is a right and not a privilege then the first step is to stop with the rotten old idea of making a profit on illness. Kill private health insurance companies – just put them out of their misery because they are so done for. Beat the crap out of big pharma, as in bloody pulp, and give them no painkillers. And then start from scratch. No profiteering allowed.
I said it when the ACA was passed, and I’ll say it again;
I doubt the left will be allowed to touch healthcare for a generation.
I stand by this, now more than when the ACA actually had support and I was openly jeered for saying anything negative about it.
Let’s be real about this guys, for healthcare to be meaningfully shifted left would require: a sizable majority in both houses of Congress (again,) a Democrat president who probably isn’t a Clinton that’s been campaigning against single payer since before it was much of a conversation (looks like that’s not even open now,) but most importantly a population that isn’t pretty sure the Democrats are just insurance company tools (yeah, that’s gone.)
So, who is going to submit this bill? Who will vote on it? Who will sign it? None of these questions are meaningfully answered, as they can’t be. Even the dumb “tax credit” talk can’t be done. (Now is a good time to point out that there isn’t even the political will to fully implement the ACA, as to this day it has features that are “coming soon.”)
So I seriously view all this as an “angels on the head of a pin” type conversation; enlightening and fun, but of absolutely no bearing on current issues.
(BTW, I recognize that leaves the Republicans, and they WILL do something. No, this does not make me happy. I would like to take this opportunity to thank all sitting Democrats for putting us in a position where we are forced to look for salvation from Republicans.)
That’s one of my favorite parts about the whole saga. The legislation is so terrible that we’re almost at the end of the Obama Administration and yet that hasn’t been enough time to get everything figured out.
All of the things in Obamacare had already been tried a half dozen or more times in states. Nobody expected it to last any more than a few years. They have always collapsed after a few years. The point of the Obama/Clinton/GOP style plans is to create the impression we’re doing something. Its a way to delete discussion, until WTO becomes the final say and they invariably will roll back regulations which were changed after 1998 that the health insurance industry does not want. Was it created after 1998, and is not liberalisation. If Yes – it has to be rolled back. Period.
POST SHOULD READ:
“… Not to worry. Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would. (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.) It is an issue that this week has become red hot now that Trump is the probable Republican nominee. And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump. According to the NYT, the Clinton campaign itself now shares our concern.
“The Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized Thorpe’s headline grabber thusly:”
I just corrected the original post at Angry Bear and added a note at the bottom raging about Microsoft’s update to Office 365 that has caused big, big problems for me in drafting anything in Word. In this case it mysteriously deleted an entire paragraph, which I reinserted last night, and also a sentence that had prefaced the one mentioning Ehrenfreund’s blog post and making clear that his post was about Thorpe’s latest attempt to take down Sanders’ healthcare plan, not about the Clinton campaign’s concerns about the strength of Trump’s candidacy and problems with her own.
washunate, what I mean by difficult to replace is I don’t think there is the political will to change the health care system which was just plopped down there a couple years ago. The only way something would happen is if Bernie was elected with big coat-tails and the Dems got both houses. That looks unlikely, so you will have the usual gridlock. Minor tweaks to ACA.
First, I would empirically deny your assertion. It has been just as long since PPACA as it was between MMA and PPACA. If passage of time is a barrier, that has been overcome.
Second, if by political will you mean the people in power, well, then it will happen the moment we get people who support universal healthcare in power. The difficulty is not replacing PPACA; there’s nothing unique about healthcare legislation. The difficulty is electing people who advocate for the public good. PPACA wasn’t progress; it was a tool to prevent progress.
Third, I don’t really know what you mean by the usual gridlock? See point 2. The difficulty is electing actual leaders. But in addition to that, Washington does actually work pretty smoothly. It’s just that our leaders have different priorities. The House, Senate, White House, and Supreme Court agree to trillions of dollars of spending. Every year. The appearance of gridlock is of course carefully crafted to make it look like nothing is going on, but that’s quite different than actual gridlock.
I guess my point is the only hope for medicare for all is Bernie, and he apparently is losing. I think EVENTUALLY medicare for all will win out, just as universal marijuana legalization will win out, because these things are humane, practical, and logical. But right now big insurance, big pharma, and some of the other “bigs” have too much control, including control of HRC. Gridlock will continue, IMHO, because the GOP will maintain control of both houses (due to gerrymandering) and HRC will probably be elected prez. If a Republican is elected prez, I don’t know exactly what they will do regarding health care, but I guarantee you it won’t be medicare for all. What is it you want, exactly, regarding health care? Because the only thing that makes sense to me is medicare for all, because as long as you have insurance companies involved, the whole thing is screwed. And I’m saying this as a guy that has free insurance, because I’m retired military, and the whole thing is still complicated and totally screwed, annoying, and stupid.
I would add that I agree there is nothing unique about health care legislation, in theory. But they go out of their way to make it complicated because they have to take care of the insurance companies, who give them money. The simplest and best thing would be to simply extend medicare to everybody. We have to sooner or later be like the rest of the first world countries.
Trade deals remove the ability to change things but that means that they must make even more noise to hide the paucity of substance-
Also, sock puppetry must be employed, large teams of fake bloggers who use special persona management tools..
The pols will happily pretend to argue, rearrange the deck chairs, change the names of things, this is what they do now.
Thats all!
God forbid that we would ever figure it out! Actually most people I know in the real world have, its striking how people on many more popular blogs seem to have forgotten the recent past and how they were scammed in 1994 and 2008-9 and are falling for all the same BS again- this is actually maybe the third of fourth time, and it really is the same steaming poop. Its guaranteed to fail in 4 or 5 years.. See the States Flatline paper on PNHP!
No surprises, because as I said, they deliberately are giving the ability away so that the precariat doesnt vote REAL single payer (which means no insurers, no suppkntary insurance and NO TIERS) also or a New Deal stimulus in there, not realizing that the might as well be secret for how little people know about it GATS prevents care.