Relevant and even prescient commentary on news, politics and the economy.

I’ve diagnosed the problem (with Clinton’s campaign; one of the problems, anyway): She keeps coming up with vapid soundbite lines that in the context of this primary contest are ridiculous. Like “It’s easy to diagnose the problem. You’ve got to be able to solve the problem.”

I’m getting really good at recognizing instantly the latest vapid or ridiculous soundbite that Clinton has settled on and will be repeating again and again.  So I detected her latest one the moment she introduced it at last Thursday’s debate:

It’s easy to diagnose the problem. You’ve got to be able to solve the problem.

Clinton was busy with private fundraisers on Friday and Saturday, I believe, but she confirmed the accuracy of my radar when on Sunday she told a block party in Washington Heights:

It’s easy to diagnose the problem. You’ve got to be able to solve the problem.

I’m not sure what problem she’s diagnosed that she has in mind.  It’s certainly not, for example, that many millions of Americans remain without healthcare insurance and that many, many millions more live in fear of actually needing major medical care because their deductibles are so high and that huge swaths of Americans find their standard of living significantly impaired because of the high and annually-increasing insurance premiums.

Unless, of course, she means that Bernie Sanders has diagnosed the problem.  And that he is proposing a way to solve the problem.

I mean … just sayin’.

Tags: , , Comments (21) | |

Millennials like socialism — until they get jobs. Or until a pollster tells them that it would mean tax increases but doesn’t tell them, for example, that the tax increases would replace healthcare insurance premiums and out-of-pocket medical expenses. And doesn’t tell them that “more government services” means something other than, say, trash collection twice a week instead of once a week.

Okay, so the title of a Washington Post op-ed piece today by research fellow and director of polling at the Cato Institute Emily Ekins is “Millennials like socialism — until they get jobs.”  She knows that this is do because a recent Reason-Rupe poll—that’s libertarian magazine Reason, and some polling organization they hired—found that:

When tax rates are not explicit, millennials say they’d prefer larger government offering more services (54 percent) to smaller government offering fewer services (43 percent). However when larger government offering more services is described as requiring high taxes, support flips and 57 percent of millennials opt for smaller government with fewer services and low taxes, while 41 percent prefer large government.

Ah, yes; the ole, reliable, generic smaller-government-with-fewer-services-vs.-larger-government-with-more-services polling gimmick. Because of course everyone absolutely definitely, completely understands what the generic “services” are.  Like, say, trash pickup twice a week rather than once a week?

The survey was, by this writer’s undoubtedly accurate account, prompted by a recent Gallup survey that, to quote Ekins, found that an astounding 69 percent of millennials say they’d be willing to vote for a ‘socialist’ candidate for president — among their parents’ generation, only a third would do so.”  Spilling the beans about the motive for the Reason survey, she continues, “Indeed, national polls and exit polls reveal about 70 to 80 percent of young Democrats are casting their ballots for presidential candidate Bernie Sanders, who calls himself a ‘democratic socialist’.”

Uh-oh.  And that was before Bloomberg released a poll yesterday showing Sanders’s support with a 1-point lead over Clinton nationally, with almost no undecideds: Sanders has 49% to Clinton’s 48%.

Ekins writes:

Millennials are the only age group in America in which a majority views socialism favorably. A national Reason-Rupe survey found that 53 percent of Americans under 30 have a favorable view of socialism compared with less than a third of those over 30. …

Yet millennials tend to reject the actual definition of socialism — government ownership of the means of production, or government running businesses. Only 32 percent of millennials favor “an economy managed by the government,” while, similar to older generations, 64 percent prefer a free-market economy. And as millennials age and begin to earn more, their socialistic ideals seem to slip away.

I dunno.  Ekins continues:

Tags: , , , , , , , , , Comments (37) | |

Harry and Louise Now Support Sanders’ Medicare-for-All Plan. With Good Reason.

In the Comments thread today to my post yesterday titled “Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs,” reader Urban Legend wrote, as part of a several-paragraph comment:

While a single payer plan is superior in theory — and has been proven in practice — thought should be given to the extreme political danger of offering a program at this time that can and will be painted by Republicans as one that will destroy half a million jobs in many different states. There was more than spite in Joe Lieberman’s objection to the public option. Think Hartford, Connecticut, insurance capital of the country. We would see “Harry and Louise” in spades. (Look it up if you’re too young to remember, and see what happened to Congress in the following election in 1994.)

I responded:

Guys, I’ve pretty much given up on trying to convince Dem baby boomers and silent generationers that it’s no longer the ’80s and ’90s and that the Bernie-is-a-SOCIALIST thing would mean a George McGovern-like trouncing and a Repub sweep in congressional elections. Finally, that argument is no longer being made by the punditry; instead it’s now the reverse: Can Clinton beat Trump, given the public’s now-obvious anti-Koch-brothers-Republican-platform mood.

But I do want to respond to Amateur Socialist’s concerns about Harry and Louise, whom I remember quite well.

The reason for the success of the insurance industry’s anti-Hillarycare ad featuring the young couple Harry and Louise was that the essence of Hillarycare was that it would all-but-force people who had choose-any-doctors-and-hospitals-you-want insurance into HMOs or PPOs that limit the choice of doctors and hospitals to those in a network, sometimes a small network, especially back then, and that sometimes required a referral by a primary care doctor for access to a specialist.

Most people back then had employer-provided insurance that did not have those limitations.  Their insurance was like Medicare—usually like Medicare with a supplemental plan is now.  The problem back then was that there still were tens of millions of people who had no access to insurance, many of them because of preexisting medical conditions, and also that premiums had been skyrocketing. And suddenly many employers were no longer paying the entire premiums.

But of course now, very few employers provide insurance that does not involve healthcare networks.  And very few now pay the full premiums.  And most policies have much larger copayments and much larger deductibles.

These are the really big problems with the ACA’s marketplace plans, too.

And these are the problems that Sanders’ Medicare-for-all proposal would eliminate.  No provider networks, no large copayments, no large deductibles, and affordable premiums.

In other words, Harry and Louise would support the Sanders plan now.

Enough said on that, I would think.

The two paragraphs in Urban Legend’s comment that precede the one I quoted read:

I agree that the Thorpe alleged take-down of Sanders’ single payer proposal is ridiculous. As you say, you can’t expect a candidate to dot every i and cross every t in a broad campaign proposal. The experience of other countries indicates almost certainty that in the long run, everyone would come out ahead with a “Medicare for All” system.

And:

I disagree completely that Clinton has no proposals for healthcare. She has quite specific proposals, including tax credits up to $5000 to reduce co-pays and deductibles (which she says are excessive), efforts to reach 16 million people who are eligible for Medicaid (a single payer plan) but haven’t signed up, and revival of the public option, the primary purpose of which was to make a genuine non-profit, efficient insurance offering available and force insurance costs further downward through direct competition. Whether they are adequate or not is a matter of opinion, but it should not be said that she has no proposals. They are there for everyone with a finger and two seconds to see.

The first of those paragraphs refers to the main point of my post: the sheer silliness of Emory University healthcare economist Kenneth Thorpe’s most recent attempt at a takedown of the Sanders proposal. The second of the paragraphs—well, it’s meaning needs no background.

But it does raise this question: Why has there been no study by mainstream progressive economists about the costs of these proposals of Clintons’, and an explanation of why this would be better than a plan that would, among other things, significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles?

Paul Krugman, maybe?  Nah.

Tags: , , , , , , , , Comments (31) | |

Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs. [Typo in sentence referencing Max Ehrenfreund’s Wonkblog post corrected 3/2 at 2:28 p.m.]

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.

I’m not among the Sanders supporters who subscribe to the academics-who-want-a-position-in-the-Clinton-White-House general 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.*

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 response 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 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:**

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 health-care 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 who 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.

*This entire paragraph was inadvertently deleted before the post was published. So now it’s back.  And the post makes sense!

____

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.

_____

**Sentence edited and separated from preceding paragraph, to make sense. 3/2 at 2:19 p.m.

Gotta tell ya, Microsoft updated its Office 365 last week, and since then I’ve had nothing but big problems trying to write anything using Word.  With this post, two main parts were just missing from the post by the time I pasted it into AB’s new-post function. There was the mysteriously deleted paragraph that I reinserted last night, and there was a sentence between this now-edited one and the preceding paragraph, and they were two separate paragraphs, as they are now.

This post is not the only thing that the Word update has made very hard for me to write.  I am not happy about this, and do not look forward to calling Microsoft and having them FIX THE SETTINGS SO THAT I CAN USE WORD AGAIN.

Okay. Rant done.  Now back to trashing pols and economists.

I’m very grateful to Yves Smith for reposting this post at Naked Capitalism this morning, and I’ve now posted the following comment to the repost there:

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.

Tags: , , , , , , , , , , Comments (27) | |

Sighhhh. [Addendum added.]

Sarah Kliff has a very helpful account of Vermont’s attempt to create a state-level single-payer health care system, and why it failed. It’s a bit like the old joke about the farmer, asked for directions, who says “Well, I wouldn’t start from here.”

The point is not that single-payer is a bad idea. It is that given where the U.S. is now, achieving the kind of low costs we see in other countries would involve imposing large losses on many stakeholders, including people with generous policies, health care providers, and more — which is the point I’ve been making. The gains would almost surely be bigger than the losses, but that’s not going to make the very hard politics go away.

— Paul Krugman, Lessons From Vermont, today

I don’t have time right now to read Kliff’s piece, so I don’t know whether she, like Krugman, says that Sanders’ single-payer plan precludes the purchase by employers for their employees, or by individuals, of separate, private-insurer, supplemental policies?

Medicare-for-all means Medicare for all.  Or something close enough to it to allow separate, private-insurer, supplemental policies.  Just like real Medicare does!

As an aside, I do wish Krugman would address the candidate he champions’ campaign tactics, especially regarding healthcare insurance but also about … well … things.

Gotta run.

—-

ADDENDUM: By Noni Mausa in the Comments thread:

Noni Mausa / January 20, 2016 6:59 pm

Canada here. I had a good professional job for 20 years, which included a generous supplemental health policy. Having been retired for 15 years (!) that means that for at least 35 years public and private coverage have rolled along smoothly side by side here.

Still haven’t read the Kliff piece.  But, for the life of me, I don’t understand the basis of this claim that Sanders’ single-payer proposal precludes the availability of supplemental healthcare policies. Or precludes employers from providing them as benefits.  Or whatever these folks are saying.

It sounds like a classic canard, to me.

 

Tags: , , , , , Comments (49) | |

The little problem with Clinton’s message that Krugman doesn’t mention in his critique of Clinton and Sanders today: Her incessant claim that only taxes bears negatively against “incomes”. [Edited and typo-corrected. 1/20 at 11:34 a.m. Addendum added 1/20 at 11:50 a.m.]

[T]there are serious questions about how we’re going to pay for what we want to see our country do. And, I’m the only candidate standing here tonight who has said I will not raise taxes on the middle class. I want to raise incomes, not taxes, and I’m going to do everything I can to make sure that the wealthy pay for debt free tuition, for child care, for paid family leave. To help us bring down student debt we’re going to refinance that student debt, saving kids thousands of dollars.

Yeah, and that will also come out of the — some of the pockets of people in the financial services industry…

— Hillary Clinton, during Sunday night’s debate

Yep.  She wants to raise incomes, not taxes.  Because all that matters to the financial bottom line of ordinary folk is taxes.  Or so ordinary folk think, cuz they can’t do simple math computations and don’t own calculators that do that.

Or so wealthy Democrats like Clinton, her army of campaign consultants, and Paul Krugman think.

In a blog post this morning critiquing Clinton politically strategically and Sanders substantively, Paul Krugman diagnoses Clinton’s main political problem as against Sanders this way:

[Clinton’s] biggest vice, from my point of view, is listening too much to consultants who want to make cheap shots, like the claim that the Sanders plan would kill Medicaid, when her real strength comes when she lets her inner wonk and fundamental toughness shine through.

Krugman hits Sanders as dishonest for making claims of massive savings in healthcare expenditures in his single-payer plan.  Fair enough—and I dearly wish Sanders would read this post of mine from this morning on healthcare expenditure issues.  (Yes.  My post on this subject.  It’s a good post.  Really.  It mentions Uwe Reinhart!  Who now will post something somewhere on the Supreme Court, in retaliation.*)

But does he think Clinton will actually be able to pay for what she proposes by taxing only the wealthy?  Just wonderin’.

Far more important, though, does he actually think it’s a terrific idea for Clinton to use as a campaign mantra that raising incomes for the non-wealthy and raising taxes on the non-wealthy are mutually exclusive, thus defining “incomes” in a remarkably crimped way?

Why does he think Clinton should claim that, say, healthcare premiums and out-of-pocket healthcare expenditures don’t effect “income” in any but the narrowest sense if those payments are made not to the federal government (horrors!) but instead to UnitedHealthcare, Anthem Blue Cross, hospitals, medical labs, and physicians?

Depends on what the meaning of “incomes” is.  Y’know?

Krugman is exactly right that Clinton is listening too much to consultants who want to make cheap shots, like the claim that the Sanders plan would kill Medicaid.  Actually, though, she should stop listening to political consultants at all.  It doesn’t instill confidence in her abilities as a candidate or officeholder that she mouths imbecilic and easily-verifiably false soundbites proposed by these political consultants.

Or did she actually expect that voters would assume she was correct that Denmark is not a capitalist country and that it has low levels of innovation and a low standard of living?  And that Bernie Sanders wants to remove healthcare coverage from huge swaths of people—or from anyone, for that matter, because universal healthcare coverage means universal for almost no one.

Depends on what the meaning of “universal” is, I guess.  According to Clinton, her daughter, and her campaign, anyway.

It also depends on the meaning of weird. This falls comfortably within that definition.** But a campaign consultant said this was a terrific way to counteract Sanders.  Because …. um …. who knows? Reason enough for Clinton to run with it.

Same with the Republican-governors-could-kill-single-payer-so-I’m-supporting-Obamacare-whose-marketplaces-provision-works-vis-à-vis-the-states-exactly-like-the-2013-Sanders-bill-would.  Nothing—no issue, no matter—is too important for Clinton to profoundly mislead about it. She isn’t paying all those consultants those huge fees for nothin’, you know. She’s gonna get her money’s worth.

Live by the sleight-of-hand, die by the sleight-of-hand.  Or at least because of the sleight-of-hand: you’re own.  At least if your opponent is now, finally, getting real media attention and has a zillion followers.  Who use social media!

But Krugman makes another big mistake that Clinton and her campaign also make: He conflates Clinton’s toughness in defending herself against Republican attacks with toughness in deconstructing, for the public, Republican memes and specific legislative proposals.

Clinton, Professor Krugman, is not Elizabeth Warren.  Warren never conflates herself as an individual with her skill as a policymaker and as a communicator on policy, hers and theirs.  Clinton incessantly does.

Click Krugman’s link, above, to “fundamental toughness”, and up pops a picture of Clinton at … surprise! … the Benghazi hearing last October!  Seriously.

Seriously?

Sorry, Professor Krugman, but I-want-to-raise-incomes-not-taxes is the very antithesis of toughness against Republicans. It’s unnerving that Clinton doesn’t recognize that.

This matters. A lot.

What Krugman gets right in his post today is his reiteration—he’s said this before—that Sanders really, really needs to make clear that he recognizes the abiding importance of regulating the shadow finance industry.  He needs to retain a real expert in this to formulate a specific, detailed proposal to address this.

Please, Sen. Sanders.  Please do this.

But Clinton needs at least as much to ditch the I-want-to-raise-incomes-not-taxes slogan, and to recognize, belatedly, that the price of some cutesy soundbites can be high.

As an alternative, she can switch parties.  Or could if it weren’t too late.

—-

ADDENDUM: Here in sum is the point: Clinton says that the only thing that matters to people’s bottom line is the amount of taxes they pay.

Which apparently is largely true for the wealthy, but is hardly true for the middle class and so-called working class–whose financial bottom line, financial security and standard of living is impacted tremendously by such things as healthcare insurance premiums, whether paid to the government or instead to a private company, and out-of-pocket payments to hospitals, medical labs and physicians.

That’s was so enrages me. Clinton claims by that soundbite of hers that all that matters is “income,” not income minus such things as private-healthcare-insurance premiums and out-of-pocket payments for health care. Added 1/20 at 11:50 a.m.

—-

*For those who don’t read Angry Bear regularly, the Supreme Court is my area of expertise; healthcare economics is definitely not.  So that sentence was intended as a joke.

** Sentence rewritten to make sense. Paragraph corrected also to change “know” to “knows.” Post (obviously) written hurriedly yesterday (I had only a few minutes to write it) and posted in anger.  Rather than deleting it, since there are comments posted to it, I edited it somewhat.  The post’s sentiment remains intact. 1/20 at 11:34 a.m.

Tags: , , , , Comments (6) | |

FOLLOW-UP TO: The critical point that Paul Waldman highlights, perhaps unwittingly, about the healthcare debate between Clinton and Sanders

FOLLOW-UP TO: The critical point that Paul Waldman highlights, perhaps unwittingly, about the healthcare debate between Clinton and Sanders

I exchanged the following comments with reader Lyle in the Comments thread to my post titled “The critical point that Paul Waldman highlights, perhaps unwittingly, about the healthcare debate between Clinton and Sanders”:

Lyle /January 18, 2016 6:31 pm

The question I would put to Sanders: Hospitals say that they lose money on medicare patients and make it up by charging those with insurance under 65 more. If they are being truthful how many hospitals would your plan drive out of business, or force major modifications to. How many physicians would retire if they could only get medicare reimbursement rates?

Now perhaps then you move to a model like the Japanese system, where once a year the providers and the government negotiate fees,

 

Beverly Mann / January 19, 2016 10:57 am

Lyle, quite a number of rural hospitals went under, with tragic results—they were the only hospitals within a range of, say, more than 100 miles—after the ACA kicked in, in states that refused to agree to the Medicaid expansion, because the Medicaid program as structured before the ACA had included substantial subsidies to hospital apart from the Medicaid benefit to individual recipients that paid ER bills and such.  The ACA switched that part, and only that part as I understand it, to the Medicaid expansion provision in the ACA, presumably as encouragement to states to adopt the Medicaid expansion.

In other words, it was the federal government that was keeping many hospitals afloat, and still is in states that accepted the Medicaid expansion.

Look, in every other modern-economy, Western-style democracy in the world, the government funds the country’s hospitals as part of the country’s healthcare system. The hospitals do just fine in countries—which is all of them, I believe—that have that system.

As for doctors, I have no idea how many would leave the profession if their incomes were cut.  But, without question, this country needs more medical schools and more residency positions; that’s been the real bottleneck in the medical field.  There are large numbers of people graduating from college with premed credentials who aren’t accepted to medical school because of the small number of medical schools and small class sizes.  And there are many more who would get the premed credentials if they thought they had a decent chance to get into med school—and would have a way to fund it.

Which brings me to this: Medical school should be tuition-free.  At public and private universities alike. This would be a really inexpensive way to eliminate one big reason that justifies the sometimes-exorbitant fees doctors charge.  The government should pay off young doctors’ current medical school loans, and, in my opinion, during the financial transition period should offer physicians stipends to compensate somewhat for lost income.

Many doctors, especially so-called primary physicians—internists, family practitioners, pediatricians—while they have comfortable incomes, don’t make huge amounts of money.  Specialists, especially surgical specialists, do, mostly, I believe.  I have the greatest respect for them and for all competent and dedicated physicians.  But maintaining the huge fees many of them charge just cannot justify the huge costs of healthcare in this country.

What strikes me as absolutely necessary—the Clinton administration’s failure to do so in 1993, and the Obama administration’s failure to do in 2009, were respectively fatal and deeply harmful to the effort—is to place one of the most accomplished healthcare economists at the helm of structuring the plan: Princeton’s Uwe Reinhardt.  There are a few, but only a very few, others who could play the role well.  That Bill Clinton put his wife, who had no background whatsoever in this, as head of his administration’s effort, and that Obama mostly just delegated the entire project to Congress, were foreseeably awful decisions.

There is no question, in my opinion, that physicians’ groups must be major players in this process.  But the issues you raise are not insurmountable obstacles, or should not be—any more than they were in any of the other many countries that have excellent universal healthcare whose costs are far lower than the costs of this country’s current system.

These are, obviously, critically important issues.

Tags: , , , , Comments (1) | |

The critical point that Paul Waldman highlights, perhaps unwittingly, about the healthcare debate between Clinton and Sanders

Back when I was in college, a professor in one of the science courses I took in order to fulfill the Liberal Arts Science requirement made the point—maybe specifically in refutation of Creationists, although I don’t remember—that it is scientists, not those who contest and try to interfere with scientific discoveries, who will ultimately prove or disprove scientific theory.

A blog post this morning by Paul Waldman in the Washington Post about the healthcare insurance debate between Clinton and Sanders, which I just read, reminded me of that professor’s observation.  Waldman says:

Clinton’s theory of change is practical, realistic and born of hard experience. But it’s also not particularly inspiring. It takes opposition from Republicans as a given and seeks to avoid direct confrontation with certain powerful interests. It’s essentially the same theory Obama operated on in 2009, when his administration set about to co-opt the insurance and pharmaceutical industries instead of fighting them. And it worked — after half a century of Democratic failure on health care, they passed sweeping reform.

Sanders’s theory of change starts from the unspoken presumption that the ACA was in its own way a failure, because it didn’t change the system enough — there are still people left out, and though costs have been reined in, we still spend far more than countries with single-payer systems, and always will as long as we have a system based in private insurance. The problem with Sanders’s theory, however, is that it’s vague on getting from where we are to where he wants to go. He talks about the need to “stand up” to special interests and create a “revolution,” but standing up isn’t a plan.

Lest any of my friends supporting Sanders call me a squish, I’d note that I’ve been touting the benefits of single payer for years. In various forms it has been tried and worked far better than our system in every other advanced country in the world. In places like France or Germany or Japan, everyone is covered, the quality of care is as good or better than what Americans get, and it costs dramatically less than our bloated, inefficient system. But — and it’s a big “but” — moving from our current system to a single-payer system would be an extremely complicated endeavor, both practically and politically. If you tried to do it all at once, the opposition from both Republicans and the affected industries would make the fights over Bill Clinton’s and Barack Obama’s health-care plans look like nap time at the preschool.

But that doesn’t mean Sanders’s ideas about health care should just be dismissed. It’s no accident that he’s getting the support of millions of idealistic Democrats. He’s a radical, in the traditional sense of the word as one who gets to the root of things.

A real primary debate needs the elements that both Sanders and Clinton provide: on one hand, a fundamental examination of what drives the system and a vision that speaks to the party’s essential values, and on the other hand, a realistic assessment of what the next president can accomplish. That’s why even though they have a profound disagreement on health care, both of them are right.

Sanders, though, isn’t really vague that major restructuring of how political campaigns are financed in this country is a prerequisite to enactment of a single-payer, Medicare-for-all system, and that a prerequisite to that in turn is massive involvement in our electoral system by people who want these.

But Waldman’s post illustrates exquisitely that the point my long-ago professor made about scientists is true also about Bernie Sanders’s candidacy.

I’m not a scientist, man. But I applaud and support them.  As I do, now, Bernie Sanders.  For similar reasons.

Tags: , , , , Comments (17) | |

Why Do So Many Wealthy Democrats Think The Only Money That Matters To The Hoi Polloi Is The Money They Must Pay To The Government? [with update]

Second, single-payer would require a lot of additional tax revenue — and we would be talking about taxes on the middle class, not just the wealthy. It’s true that higher taxes would be offset by a sharp reduction or even elimination of private insurance premiums, but it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves.

Finally, and I suspect most important, switching to single-payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers. You might say that they would end up just as well off, and it might well be true for most people — although not those with especially good policies. But getting voters to believe that would be a very steep climb.

Health Reform Realities, Paul Krugman arguing today in his New York Times column against attempts to enact single-payer, Medicare-for-all healthcare insurance

Good grace.  Where to begin.

Maybe by quoting myself with this excerpt from my post from yesterday, posted before the debate began:

Having no healthcare insurance is not the same as having healthcare insurance.  Unless of course the medical care you need is not covered by the insurance you have, because the deductibles and co-pays under your employer-provided insurance or under the policy you bought through a state marketplace under Obamacare for a premium low enough that your employer or you could afford it, means (unlike more comprehensive plans that others have but you do not) that you must pay those medical bills yourself.

Apparently, Chelsea Clinton doesn’t get out much these days.*

But then, neither, it appears, does her mother, who has claimed repeatedly, including in comments in defense of her daughter’s odd statements about Sanders’ single-payer concept, that the only expenses—the only money people pay—that actually matters to them is money paid to the government.

No other expenses count as money—as loss of income or as other expenditure that actually effects your and your family’s financial bottom line and therefore standard of living.  Money paid to UnitedHealthcare or Anthem Blue Cross in premiums, and to hospitals, physicians and medical labs in co-pays and deductibles, don’t count.  That’s not money paid to the government, see.  So it’s wayyy better to pay more for less-comprehensive coverage to private insurance companies, and still be financially insecure about medical expenses, than to pay less money in healthcare costs to the government and be financially secure about medical expenses.  Because, y’know … the government.

Which—I wish Sanders would point out—is exactly what Clinton says.  Again and again. Just like the Republicans do.

Hillary Clinton should get out more, too.

Sanders did almost exactly that in the debate last night.  But I hope, especially in light of Krugman’s column today, that he points out that the Democratic politicians and commentators who say the public thinks that the only money that matters to their financial bottom line, the only expenses that effect their standard of living, is taxes. Or that the math involved to understand that that is not so is too complicated for most folks to perform.

Calculators are cheap these days.  Even the hoi polloi can afford one.

Sanders got it right last night.  This is the Republican mantra.  And it’s no longer selling so well.

But Sanders also should question why it is that the Clintons and now Krugman, and surely other wealthy Democrats, think (or claim to think) that large and annually increasing healthcare premiums and co-pays and deductibles don’t matter to middle class and so-called working class folk because they’re paid to private insurance companies and private hospitals, physicians and medical labs. Sanders’ next ad should feature one of those folk saying that his or her family’s healthcare insurance premiums and the four-figure medical bills they are paying for a short hospital stay are actual money.  Honestly and truly.

Another ad should show a small-business owner discussing the amount the business pays in premiums for private insurance for its employees and that paying less to the government in additional taxes than the amount it is paying for private insurance could be paid instead in increased salaries and wages.

And there should be a third ad, maybe featuring that very same small-business owner, explaining that the business has a few employees who are seniors and receive, um, Medicare—and that the business pays for their excellent Medicare supplement insurance.  Not complicated.  And not very costly, given that Medicare is—yes, really—itself good insurance. So … voila! Hard feelings by those employees because they aren’t part of the awesome UnitedHealthcare plan that the younger-than-65 employees have and love.

Okay, look.  Only people who are, like the Clintons and Krugman, financially way-more-than-comfortable would actually think that people who aren’t don’t care how much they pay in healthcare premiums and out-of-pocket medical expenses because the checks are made out not to the federal government but instead to private entities and parties.  And that only the most sophisticated among the rest of us will understand that Medicare combined with platinum plated supplemental policies paid by their employer will give them the same awesome benefits that they receive now.  Maybe even better.  Even though it will cost the employer less money.  (Less real money.  Really!)

The Clinton claims and Krugman arguments are profoundly elitist.  They’re spades that should be called, by Sanders, what they are: spades.

Krugman, too, should get out more.

*Chelsea Clinton said last week that she doesn’t “want to live in a country that has an unequal health care system again.”  As I said in my post yesterday, she apparently wants to move to France.  Or Canada.  Or Scandinavia, or Germany, or Thailand.  Or one of the many other Western-style democracies that has an equal health care system.

—-

UPDATE: Reader Lee Russ has posted this comment to the Comments thread:

Krugman’s assessment leaves out one extremely important reality and understates a second.

He left out the reality that his approach is a surrender to the power of the health insurance industry that, as he says, “played a major part in killing health reform in the early 1990s.” As he also says, Obamacare was specifically designed to rely on private insurance to keep those insurers from killing it. Now Krugman recommends walking away from a national healthcare system that even he acknowledges is both better and less expensive than Obamacare, again in deference to the insurance industry’s desires. Allowing the insurance industry to control our lives and our health is not practicality, it is an abandonment of our
rights in a democracy and it is a very big mistake.

Krugman also understates the problems that Obamacare is causing out here in “reality.” Expanding Medicaid has helped the poorest of us get some care, but that program’s low reimbursement rates mean that many doctors decline to treat Medicaid patients. The doctors who do take Medicaid are swamped by the newly Medicaid eligible, and may lose money treating them.

For many people who buy insurance policies through the exchange, massive deductibles must be paid before the insurer pays anything. Doctors across the country have noted the increase in the number of “insured” patients who are having serious problems figuring out how to both eat and pay their deductibles. Krugman wrongly says that “access to health insurance for all Americans” has been the goal. It’s access to health care—not to insurance—that matters. Obamacare too often fails to achieve it.

Exactly.

Tags: , , , , , Comments (14) | |

Pre-Debate Contest: Guess which one of Sanders’ past or present policy positions or legislation he supported that Clinton will misrepresent most outlandishly tonight [Updated!]

UPDATE: To see the winning Clinton claim, read my my comment to Robert Waldmann’s post above. 

—-

Last week when Chelsea Clinton made he now-infamous statements about Sanders’ single-payer healthcare insurance plan—specifically, the one he proposed as a bill in 2013, but presumably a blueprint for the one he plans to propose—I wondered how Sanders had managed to enlist her in the service of his own campaign.  Most memorable was the part about the horror that would be life without private healthcare insurance and the stripping of healthcare insurance frommillions and millions and millions of people by providing universal, comprehensive, and nearly identical insurance to all American citizens and legal residents.

To refresh your memory, she said (among other things):

Sen. Sanders wants to dismantle Obamacare, dismantle the [Children’s Health Insurance Program], dismantle Medicare, and dismantle private insurance.  I worry if we give Republicans Democratic permission to do that, we’ll go back to an era — before we had the Affordable Care Act — that would strip millions and millions and millions of people off their health insurance.

But in my opinion, that wasn’t even the oddest part of her trip down the rabbit hole.  This was:

Sen. Sanders wants to devolve the authority to set up state health insurance programs to individual state governors. Now maybe if I lived in a place like New Hampshire, with your governor, I would feel okay about that. But if I lived in a state that had a Republican governor, particularly a Republican governor who already turned down Medicaid expansion matching funds, I don’t think I would be comfortable, right? Because I don’t want to live in a country that has an unequal health care system again.

Sooo, I said when I read that, Chelsea Clinton wants to move to France.  Or Canada.  Or Scandinavia, or Germany, or Thailand.  Or one of the many other Western-style democracies that has an equal health care system.  Which is what she will have to do under this country’s current system if she feels that strongly about not wanting to live in a country that has an unequal health care system.

Sanders’ 2013 proposal no more gives the states the option to join or decline to join the program than does Obamacare—the program Chelsea and her mother champion and want to preserve rather than move to a single-payer-healthcare-for-all system—give states the option of participating in the state-based marketplaces that have minimum coverage requirements and mandate acceptance of patients irrespective of preexisting medical conditions.  The Medicaid-expansion option that states have under the ACA has no analogy in Sanders’ 2013 single-payer proposal.  Chelsea was parroting her mother on this bald misstatement.

And having no healthcare insurance is not the same as having healthcare insurance.  Unless of course the medical care you need is not covered by the insurance you have, because the deductibles and co-pays under your employer-provided insurance or under the policy you bought through a state marketplace under Obamacare for a premium low enough that your employer or you could afford it, means (unlike more comprehensive plans that others have but you do not) that you must pay those medical bills yourself.

Apparently, Chelsea Clinton doesn’t get out much these days.

But then, neither, it appears, does her mother, who has claimed repeatedly, including in comments in defense of her daughter’s odd statements about Sanders’ single-payer concept, that the only expenses—the only money people pay—that actually matters to them is money paid to the government.

No other expenses count as money—as loss of income or as other expenditure that actually effects your and your family’s financial bottom line and therefore standard of living.  Money paid to UnitedHealthcare or Anthem Blue Cross in premiums, and to hospitals, physicians and medical labs in co-pays and deductibles, don’t count.  That’s not money paid to the government, see.  So it’s wayyy better to pay more for less-comprehensive coverage to private insurance companies, and still be financially insecure about medical expenses, than to pay less money in healthcare costs to the government and be financially secure about medical expenses.  Because, y’know … the government.

Which—I wish Sanders would point out—is exactly what Clinton saysAgain and again. Just like the Republicans do.

Hillary Clinton should get out more, too.

Okay, Clinton of course doesn’t want you to realize that that’s what she’s saying.  She wants you to think she’s saying that the large price tag for Sanders’ plan is in addition to private insurance premiums and deductables and co-pays.  But her own daughter says that Sanders wants to end private insurance.  Clinton should check with her daughter. Best to get the story straight.

What Chelsea Clinton did, in other words, is highlight the two reasons that her mother’s campaign is flailing: that the candidate sees even issues as important to people’s lives as the costs and breadth of healthcare coverage as something to mislead about as a campaign tactic, and that at bottom she, like Republicans, believe that the only thing that matters as personal or family expenditures is the amount paid to the government.  And according to a New York Times report today, Bill and Hillary Clinton both believe that the mistake Clinton and her campaign made is that they didn’t begin these tactics months before they did.  (Shucks!  The public loves to be played like toys about really important things. Why didn’t our consultants figure that out earlier?  What are we paying them for?!)

So, buckle your seatbelts, folks.  What will the biggest sleight of hand, the most outlandish assertion or inference about Sanders’ policy proposals, be?

We’ve already had the Denmark-isn’t-a-capitalist-country-and-it-would-be-a-grave-mistake-and-unAmerican-to-emulate-them thing in the first debate, which sort of backfired when in the days following that debate the news media was filled with articles about Denmark’s vibrant capitalist economy, large number of small businesses, and high level of innovation.

We’ve had the no-industry-except-the-gun-industry-has-immunity-from-strict-liability-for-criminal-use-by-a-customer misrepresentation about the gun-manufacturer and gun-retailer legal immunity statute that Sanders voted for in 2005.  Actually, no other industry is strictly liable, in any state under state law, under such circumstances, a fact that got little media attention but enough, apparently, to cause Clinton to stop making the claim.

And there was, of course, the he-told-ME-to-stop-shouting-even-though-I-wasn’t-shouting-because-I’m-a-woman dust-up.  She didn’t accuse him of supporting legislation that would arrest women for disturbing the peace when they speak, but she came close to it.

In addition, of course, to the Sanders-is-coming-for-your-healthcare-insurance-and-is-out-to-lower-your-standard-of-living stuff.  Denmark! Somalia-level healthcare coverage!  Bankrupting the country because the $10 trillion (or whatever) currently spent annually on healthcare in this country WILL EVAPORATE upon enactment of Sanders’ single-payer plan, and so won’t be available to pay instead for the single-payer plan.

How about Denmark-level healthcare coverage?  For less than what is spent annually in this country for our current Swiss-cheese sandwich.  Which is what Sanders is proposing.

My bet is that one of tonight’s treasures will again be on the gun-industry immunity law, along the lines of a message to the media last week by Clinton Campaign chief John Podesta.  Podesta conflated manufacturing with sales.  Specifically, the level of control that the fast-food industry has over the content of the food it serves, and the level of control that gun retailers have over their customers’ later use of the purchased gun.

But there’s still time for you to enter this contest.  Okay, not much time; I should have posted this earlier.  But for all you very quick thinkers, that should not be problem.

The prize is an interview with the Clinton Campaign for a job as a campaign consultant.  The job will pay well, I’m sure.

Tags: , , , , , , , Comments (6) | |