The mindless canard stating as unexplained fact that it would be worse to expand the federal government by a third in order to accommodate single-payer healthcare insurance than it is to have private, for-profit health insurance companies playing this role instead
No one would ever accuse Bernie Sanders of thinking small. The senator from Vermont and Democratic presidential candidate wants to transform one of the world’s most boisterous free-market economies into an exemplar ofScandinavian-style “democratic socialism.” He wants to jail Wall Street executives and double the minimum wage. And he wants to spend taxpayer money, lots of it.
According to an estimate by The Wall Street Journal, Sanders’ spending plans would cost $18 trillion over 10 years, increasing the federal government’s size by roughly a third. He would create a single-payer health plan, make public universities free, expand Social Security, spend big on infrastructure, create universal child-care and pre-K programs, provide federal jobs for young people and bail out struggling pension plans, among other things.
To be sure, fully $15 trillion of the $18 trillion would come from Sanders’ health plan, which seems unlikely to cost that much. Bringing all Americans under the umbrella of a single-payer system would create enormous power to hold down prices.
Even so, there’s no doubt that Sanders, who’s running a surprisingly strong second to Hillary Clinton in the latest polls, is talking serious money.
— Bernie Sanders: ‘Now is the time for bold action’, USA Today editorial, yesterday
Yes, no one would ever accuse Bernie Sanders of thinking small. And no one should ever accuse the USA Today editorial page staff of explaining why increasing the federal government’s size by roughly a third is per se a bad idea. I mean other than just saying we can’t afford it.
I give the writer of this editorial credit for saying upfront and explicitly that $15 trillion of the $18 trillion would come from Sanders’ health plan. That’s more than Washington Post editorial writer Stephen Stromberg did the day after that WSJ report last month.* And it’s more than the WSJ reporter did in the article itself, if I remember right.
But why exactly is it per se bad to expand the federal government significantly? That is what Medicare and Social Security did, and the National Labor Relations Act and the Securities Exchange Act and the EPA, etc. If you think these pieces of legislation should not have been enacted, fine. But most people would disagree with you.
Sanders wants to replace private-industry healthcare insurance with federal, nonprofit, single-payer insurance. Like Denmark! And like Medicare. I would love to see Sanders have an economist like Uwe Reinhardt or Joseph Stiglitz compute what the cost to individuals receiving Medicare would be now if there were no Medicare. Especially since most of them are retired, so there would not be the possibility of employer-based private insurance.
What drives me crazy about this mindless but politically potent canard is that these folks don’t attempt to explain why it would be worse to expand the federal government by a third in this respect than it is to have private, for-profit health insurance companies playing this role instead. How much more income tax revenue would the federal government receive if the money that employers now pay in insurance premiums went instead to wages and salaries? And how much better would the economy be if that happened, and if individuals weren’t saddled with premiums and large out-of-pocket healthcare costs?
Josh Barro has an outstanding column in today’s New York Times, the theme of which is that Sanders unnecessarily complicates his candidacy and causes confusion—providing an opening to his opponents like the one Clinton took at the debate last week to imply that Sanders wants to nationalize businesses, large and small; he cited Clinton’s comment—by calling himself something he is not: a democratic socialist. He’s a social democrat, Barro and others he quotes, say, accurately.
But the key part of Barro’s lengthy column is this:
“When you look at the policies, there’s a way to see it as Bernie has cranked up Hillary’s agenda to 11,” [Roosevelt Institute economist Mike] Konczal said. To wit: Mrs. Clinton favors preserving Social Security with some enhancements for the poorest beneficiaries, while he wants to raise taxes on the rich to expand it in ways that could add $65 per month to the average benefit. This, like most political debates, is a disagreement about how far to turn the knobs when adjusting policy; it does not seem to call for a separate ideological label. That said, Mr. Konczal did offer one difference between Mr. Sanders’s and Mrs. Clinton’s worldviews that is of kind rather than degree. This is decommodification: the idea that some goods and services are so important that they ought to be removed from the market economy altogether. [Italics added.]
The idea behind the Affordable Care Act, and behind Mrs. Clinton’s approach to tinkering with Obamacare, is that quality health insurance should be affordable to everyone, and that people who can’t afford it should be given subsidies to buy it. For a democratic socialist, that’s not good enough; instead, health care should simply be provided to everyone without charge, removing the profit motive from health care. But even this is a matter of degrees. Mr. Sanders favors Medicare for all: a singlepayer health care system, with the federal government as the sole insurer. This would remove the profit motive from health insurance but not from health care, which could continue to be provided by private doctors and hospitals, often working on a forprofit basis. Mr. Sanders is not proposing to go further, like Britain, and have doctors work directly for the government. Nor does he appear inclined to decommodify broad swathes of the economy; in other countries, even conservatives often endorse special, less-marketized rules for health care than for other sectors.
This distinction is real, but it’s not clear to me that it merits Mr. Sanders his own ideological label.
That—the idea that some goods and services are so important that they ought to be removed from the market economy altogether—is why it is absolutely incumbent upon the USA editorial writer, Stephen Stromberg, Hillary Clinton, and anyone else who takes the position that a single-payer, Medicare-for-all healthcare insurance system is per se bad because it would be run by the federal government, to actually state why this is so.
*The editorial was, like all Post (and most newspaper) editorials, published without a byline, but Stromberg had a blog post there on the same day that was virtually identical to the editorial. [Elementary, Watson!]
My concern is with medical advancement under a single-payer system.
Why put money into research if the government will not let you profit from the results?
Also, rationing will happen. Not everyone can get all the medical care they want. If all doctor’s visits will be free, what will stop people from going to the doctor for a headache? After all, it might be a tumor.
The question is, will rationing be rational? Will people make their own decisions about whether it is worth the money to go to a doctor, or will it simply be first-come-first served, with no triage — no rhyme or reason?
As it stands now, more doctors are refusing to take new Medicare patients. It’s not worth their time.
The same is happening with Obamacare patients.
The UK is having to hire more and more foreign doctors — it’s just not worth the time and expense of becoming a doctor there.
Our own government is causing doctor shortages here by other means;
Some goods and services are too important to be government controlled.
Greed is good, bureaucrats bad!
The entrepreneurial ruse!
It is like taking $60 a seat from a poor southerner to listen to hillbilly music …….
A few comments:
1) The government can just be the insurer, and goods cans still be purchased through private providers at the government rates, there may still be room for private gap insurance for some income ranges, and the appearance of “freedom”. Hopefully, that keeps people happy.
2) Good opportunity add some “free” secondary education here – anyone attending school to get health degrees pays no tuition – but with stipulations attached. For example, you can force med students to serve as Internal Medicine MDs for a certain number of years. There would need to be some limits so you do not get an oversupply of health professionals.
3) Regarding #2 above – providing medical care has little to do with dollars, it has everything to do with ample supply of labor to meet the needs of people without to much hassle (e.g. waiting times for care, geographic coverage). Money/accounting is just paper and digits. Money/accounting is simply how you allocate each person a portion of that health labor/supplies. We have plenty of paper to allocate/manage the supply. If there were one health care professional left in the world, Medicare would be bankrupt, regardless of how much “money it has”. I am pretty confident we have the labor and materials to treat everyone in the United States.
4) I wish the democrats would learn some marketing. Triangulate on the republicans and present a plan that can win enough over. Make it a universal single payer plan with a progressive deductible and health savings accounts. Use tax credits to fund low income accounts, and Bill Gates would fund his own deductible. I know this gets some people so bent over, “Ugh HSAs, the horror”. Who cares if it accomplishes the goal of universal care. Who cares if it gets congressional votes. The packaging is super important, and needs to create the appearance that it is not just run by the government, and provides freedom blah blah blah.
In the end the private insurers would be pissed, but the Fed government could buy them all and turn them into insurance processing groups – nobody loses their jobs except some highly paid execs.
Maybe expanding the Federal Government in that way would go swimmingly in some other universe. In this universe, a public monopoly over all health care (whether a national health service, or just a cabal of rent-seeking contractors as with the F-35) would eliminate whatever little benchmarking and quality control remains, likely creating a novel version of road construction or city-bus “service”.
You all know the drill. Some crews show up, barricade the road, create an endlessly lengthy time-wasting detour, and conspicuously accumulate construction equipment. They aimlessly dig holes for a day or three, pushing the dirt from here to there. Then they disappear altogether for five weeks. Then they return for a few days to push some dirt from there back to here. Rinse and repeat for half the spring, the entire summer, most of the fall, and maybe beyond. The word “done” never quite entered their vocabulary. The next season, they come back and rip it all up again because the materials proved substandard, or some other excuse. Rinse and repeat all over again. Finally, just when it seems like the ordeal is over, it rains and the whole works floods out again, just the same as it did before the so-called “work” started.
Same drill for bus “service”. Shiftless drivers get paid $90K/year to show up if and when they happen to feel like it, with the schedule barely even a suggestion. Mainly it’s a charity pretending to employ the otherwise otiose and unemployable.
Now, while hardly anyone dies because some feckless bus driver couldn’t be bothered to show up on time, medical services are sometimes life-critical. They may be vitally needed in a competent and fashion, and right now, not when somebody feels like it. That requires consistently and discipline, two things utterly lacking with government monopolies ranging from bus “services” to our often-incompetent and trigger-happy police. Even when you find an agency that sometimes does something well, you simply can’t count on it.
So: if you ever find some secret sauce that brings consistency and discipline to that great geyser of incompetence, sloth, and corruption that is too often government in these US of A, let us know so we can go for it. But I expect that even our toddlers lack enough life expectancy. In the meantime, a public-monopoly health sector would be a very frightening prospect indeed. Just because what we have is in many ways bad, doesn’t mean we can’t make it even worse.
“Mainly it’s a charity pretending to employ the otherwise OTIOSE and unemployable.”
I have never heard that word before! Thank you!
I think it is false to claim that Clinton thinks a single-payer system is bad per se. But one implicit negative is that, temporarily at least, it could throw tens of thousands of people who work in the insurance industry out of jobs — or at least a plausible and politically potent argument can be made that it would, and the notion that some portion of those people (in a more efficient system) would get re-employed is cold comfort. It is not politically feasible.
Clinton, like Obama did deceptively, advocated a public option. Medicare-for-All as an option that can be purchased on the exchanges — fully-funded through premiums rather than general tax revenues, with — is a politically feasible step in the right direction. It could be a compelling political position if focused in the next year on making it an option for anyone over 50 — where the age differentiation in premiums makes exchange-based insurance quite expensive for those with modest incomes who nevertheless make too much to qualify for tax credit assistance — who cannot be insured through employer-sponsored insurance. I would love to see Republicans oppose that — and lose as a result in race after race.
U.L., a simple question…
Where does the Constitution give the U.S. government the power to enact such a program?
I think that the future and definition of war is changing fast. We can no longer afford to fight a traditional style war like a Vietnam or Iraq with ground troops for 10 years. These are huge societal cost draining trillions of dollars wars where the gains are questionable…Now if you put $1 or $2T back into our economy rather than fighting unwinnable wars we could afford to do many other things…When I looked at Trumps tax plan last week it showed that it would cost $10T for 10 years. This plan to me looks like better spent-investment money that motivates work, achievement and innovation rather than a democrat-socialist plan that has planned give a ways -freebies that will cause runaway deficits. We must keep the incentive to work and earn and to pay our way while at the same time keeping the balance of predatory capitalism and the oligarchs and China in check. I still believe that as bad as Trump may be he is still our best future hope for peace and prosperity. He seems to me at this time to be the only candidate who has the capability to do this. IMHO.
Bev points out mindless canards stating unexplained “facts” only to have PaulS drag out…. Mindless canards posing as facts! Priceless, and thanks for the unexpected example.
Meanwhile in the health care system the rest of us inhabit quite a serious concern wrt the complete inability of the vaunted “freedom markets” to address critical shortage of investments in new antibiotics to treat multi drug resistant bacterial infections of all kinds but particularly worrisome is the lack of new cost effective tools to treat TB (as highlighted in this recent article in the Nation, sorry if it’s paywalled). http://www.thenation.com/article/drug-resistant-tuberculosis-is-a-global-crisis-why-are-we-doing-so-little-to-fight-it/
It’s well documented that antibiotics are simply lousy investments for drug companies – they lose effectiveness the more they are used (it’s overuse of these drugs that probably triggered the evolution of bacterial agents that resist them). Much safer and more profitable to focus research and development efforts on chronic lifetime conditions especially those suffered by high income patients in the US where prices are essentially unregulated. How else to maintain a reliable source of innovation EXCEPT a non-profit or humanitarian entity (probably an international one at that).
An expanded federal bureaucracy that properly regulated profit margins on drugs (to name but one example) would limit excesses like the recent Pharma Bro ugliness. And probably be a significant boost to public health to boot.
Finally a recent personal real life example of the role of government in health care: A couple weeks ago I left for a weeks vacation in Toronto. Unfortunately a hasty departure for the airport left my fiance’s anti-anxiety medication on the counter. This is a daily regimen that while not immediately life threatening would have seriously impacted our planned holiday of sightseeing etc. Girding ourselves for the worst of bureaucratic runarounds we headed for a pharmacy recommended by the hotel’s concierge. The pharmacist told us right away not to bother getting a Rx sent up from the US she simply would not be able to fill any prescription unless it was written by a Canadian doctor.
But she helpfully recommended a health clinic just a few blocks away and suggested we see a physician there. I left him at the clinic expecting the usualy multi-hour wait for a non-life threatening health care situation in the US. I went across the street to a large shopping mall to look for shoes while he waited to see the doctor. I hadn’t even picked out the first pair to try on when he texted me barely 15 minutes later – he’d already been seen by a doctor and has his Canadian Rx – he was at the pharmacy next door waiting to get it filled. Which cost us less than half what the same drug cost in the US. After a co-pay of $60CAD which is about what his Obamacare requires in the US.
Wow. A government run health care system that is easy to use, and cost effective to boot. No wonder they got rid of the obnoxious xenophobe Harper.
Hmm. Was just gonna respond to PaulS, but then read your comment, Amateur Socialist.
No need for me to respond now. You did it for me. Thanks, AS.
A.S., you can go to a multitude of clinics and urgent care centers in the U.S. just as you did there in Canada.
Nice Red Herring you’ve got there, Warren. I’ll try to type this out slowly…
The point of my personal anecdote wasn’t that clinics/urgent care facilities aren’t available in the US, the point is that according to the prevailing right wing trope here in the US, those services are slow, difficult to use and subject to cumbersome bureaucracy, especially for novices/foreigners. None of which was even slightly consistent with our, you know, Actual Real Life Experience.
Sorry the above comment meant to read “…trope here in the US, those services *in Canada*…” above.
Ah — I did indeed miss your point. Nonetheless, anecdotal evidence is just that. More general studies of the situation are not so rosy:
There’s probably no reason at all to suppose that your cited study might actually reflect a concerted effort by the recently fired Harper government to you know, cheapen and degrade Canadian health care. As part of his overall Austerity/Privatization policies… Nothing to see here…
Well, we’ll see how the new government does, won’t we?
Sure, sure. And while we’re waiting maybe we can review some other studies that look at costs vs. outcomes for Canadian vs. US patients wrt a range of typical medical conditions. You’d think something would have been published by now after over a half century of Government Controlled Medicine up there. If there were only some technique that might easily allow one to find and review the relevant data….
Way off topic but I can’t help wondering if Trudeau’s campaign promise of running significant fiscal deficits will provoke some kind of politically motivated debt downgrade. I imagine the Canadian taxpayer who looks at what the S&P downgrade did to long term borrowing rates here in the US would welcome such a decision by the financial mandarins up there.
Hey can I get a downgrade over here? I’m a lousy credit risk ask anybody!
And just to veer back on topic, just in case anybody is (still) paying attention:
I wonder if Warren would like to expand a bit on his first comment in this thread, viz.: “My concern is with medical advancement under a single-payer system.”
How do you propose medical advancement might take place under the “Freedom because Markets!” system wrt critically needed medical advancements in say antibiotic research? Wherein all the major players in pharma have essentially abandoned or dramatically scaled back significant investment? For what are perfectly fine business reasons that also have genuinely horrific potential public health impacts?
This isn’t an academic what if – thousands of people are dying right now of bacterial infections that simply can’t be treated either because no drugs are available or the ones we have aren’t survivable by sick patients. Many of which were originally contracted during routine procedures in otherwise considered safe hospitals, including some very expensive and prestigious ones. (A recent Frontline highlighted this problem very well, including the tendency of most institutions to try to keep these infections very very quiet. Watch it here: http://www.pbs.org/wgbh/pages/frontline/hunting-the-nightmare-bacteria/ )
The next person to die might be you or me or somebody we love. How do you expect this critically needed “advancement” to be handled by that invisible hand you keep raving about?
That is the False Dichotomy Fallacy, A.S.
You are proposing a single-payer health care system. There are multiple possible alternatives to that, not just a ‘“Freedom because Markets!” system’.