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Wednesday, September 13, 2017

The argument AGAINST Medicare-for-all

Added note: Apparently, this is one of those posts designed to test reading comprehension skills. Some people glance at the headline, skim the first few paragraphs, and presume that my argument is something other than it actually is. It is written in the Book of Proverbs: "The wise man readeth a blog post before he replieth, lest he be accused of jumping the gun like a silly-billy."

Believe me, no household in America could benefit more than mine from a single-payer system. I haven't visited the doctor since my heart attack because I can't afford to do so. My ladyfriend, who has insurance, tends to "tough it out" rather than visiting a doctor because the deductibles are so terrifying.

Part of me hopes that a single-payer plan succeeds -- but I also recognize that there are potential problems, from a let's-win-the-election standpoint. Bill Scher in Politico gives a pretty balanced assessment:
Note that I didn’t say single-payer is electoral suicide. I would have said so a year ago, but today I can’t say that with certainty. As any single-payer devotee will eagerly tell you, a July Quinnipiac poll found 51 percent of voters support such a system. When characterized as Medicare for All, a June Kaiser Health Tracking poll registered support at 57 percent. In the current era of polarized politics, where centrist voters are increasingly elusive, single-player would certainly energize progressive voters and could help Democrats woo back some economic populist Trump voters.

But single-payer hardly comes with an Election Day guarantee. More than 90 percent of voters support requiring background checks for gun buyers. More than 60 percent oppose a border wall. Fifty-six percent say America should “discourage the use of coal.” And yet, we have a president on the opposite side of all those issues.

Moreover, the top-line numbers don’t ensure that support can withstand attack. Kaiser’s poll analysts concluded: “The public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments.”

For example, upon hearing the startling news that single-payer might “give the government too much control over health care,” support plummets to 40 percent. The revelation that the plan would “require many Americans to pay more in taxes” did the same. Maybe, just maybe, a Republican will give these talking points a try.
Precisely. The single-payer poll numbers are deceptive. The idea has polled over 50 percent in times past -- and then plummeted well below that point. Basically, Americans want health insurance without paying for it. Like it or not, there are many white Americans who feel like vomiting when they think about their tax dollars potentially helping to pay for a non-white person's health insurance. (People won't admit to feeling that way, but that's how they feel.)

My preferred solution: Not Medicare-for-all, but something like Obamacare with a public option.

Which, as you may recall, was the original Obamacare idea.

What I like best about this notion is that it puts to the test -- a brutally fair test -- two competing economic visions. Think of it as Milton Friedman vs. FDR. Are you a libertarian who really and truly believes in Friedman's vision? Then you should love to see this vision confirmed by experiment.

If you genuinely accept as an article of faith that Big Gummint never operates efficiently, then you should welcome the "battle" that I propose. You should feel secure in the expectation that private insurance would wallop the public option.

When O-care was a-borning, I said pretty much the same thing in various blog posts. A libertarian reader sneered that that the deck was stacked against the private insurer. I asked this reader: How? Just how was the deck stacked? At that time, everything was in flux; the details of the proposed law were not yet known. The libertarian simply assumed that the fight was unfair, that the rules were rigged against him. He couldn't cite any facts to support his presumption.

Let us have a truly even battlefield between the two counterpoised ideologies. If the apostles of Ayn are proven right -- if, in honest competition, the private plan always delivers better health care for less money -- then so be it! I will accept those results happily. I am much more committed to efficiency than I am to any ideology.

But when the public option was proposed before, Republicans insisted that the idea was unthinkable. They knew that was no way that private insurance could compete with a public option.

In essence, conservatives admitted that their most dearly-held beliefs were wrong. As I wrote back in 2011:
The health care debate had one virtue: It forced the Republicans to admit that libertarian theology is a sham. They came right out and admitted that private industry could not offer the citizenry a better deal than the (soon-discarded) public option. Why would they say such a thing? Why did they fear competition from the gummint, if the gummint always does everything wrong? Didn't Milton Friedman tell us that private industry is always more efficient?

Gosh -- could it be that the Friedmanites lied?

You think maybe that's why your credit card bills are sent to you via the post office, and not via Federal Express?
Libertarians do not want to have their ideology put to a fair test because they know in their hearts that all private insurance plans will be more expensive.

Thus, right now, I say no to Medicare-for-all.

If we are given a single-payer system, the Apostles of Ayn will shriek "WE TOLD YOU SO!" every single time the system has a hiccup. No, it is better to have a public option competing with the various private options. Let the best weltanschauung win! If the public option succeeds, then the Randroids will have no basis for complaint; they will simply go to their corner and sulk, unable to pretend that theirs was a noble, untried ideal.
Med-Care for all from birth to death that pays 100% of all cost. Then for those that will whine about how about end the endless wars. People and this Nation first to hell with the merchants of death and their friends.
You missed my point, Jo. If Med for All becomes law, then every single time a problem occurs...and even you must admit that problems are inevitable...the Libertarians will insist that capitalism is always better, that capitalism remains an untried idea.

So do what Robert Reich pushed for: Have private plans go head to head against a public option.

If the public option wins in a fair fight, the Libertarians won't have a leg to stand on.
Am I mistaken in my belief that Medicare is a national insurance program, the government contracts with dozens of private insurance companies for the administration of insurance coverage, and neither Medicare nor the government is a health-care provider?

Lucky you, you get to ride the wave of willful idiocy that will now be raining down on everyone.

Medicare, per se, is not a Cyclops. It's an option for those who are eligible. Many subscribers also buy supplemental insurance from private insurance companies for claims or services not covered or paid sufficiently for by Medicare insurance. Medicare also includes a prescription drug option with private insurance companies.

That excerpt from Politico proves that day-writers who earn their living by reporting have to write something even if it's anything. Let's start the poll-numbers game with this question: Which one issue matters more to you: your own health care, coverage, and costs; background checks on other people for gun ownership; building a border wall; or coal burning plants? Take your time before answering.

Don't forget about the NASA-Teflon-Tang spinoff benefits. As the aging population comprises increasingly large numbers of people, there were not and never would be enough ophthalmologists to provide care and treatment. Not all that long ago, many diagnostic and examination procedures that were only performed by ophthalmologists are now performed by optometrists. First-tier care, second-tier costs. Similarly, most pharmacies have certified and licensed practitioners who can provide vaccinations, paid by one's insurance including Medicare.

Unlike the 1930's or the 1990's, at this hour many, many more people know about the benefits of health insurance in general and Medicare in particular. The economy (i.e., what used to be known as the society) happens to be ripe for a windfall to families and individuals of at least $10K per year. If meager wages can't go up, ungodly expenses can be eliminated.
Amelie, it's true that there are about 50 or so private companies involved in the Medicare system. But the fact that it is administered by the Gummint makes it indistinguishable from Marxism, at least in the eyes of yer average Ayn Randroid.
These discussions/debates are going on all over the blogs today since Sanders delivered up his symbolic bill. Symbolic because it doesn't stand a chance in hell in our current political climate. Sanders knows this himself. I have no problem in strategizing how we get to universal care but pretending that Sanders' stab is remotely realistic makes me want to scream. Because it's more a vanity project than anything else. Also a litmus test for sitting Democratic members to prove themselves worthy.

You're so right about the polling numbers, Joe. Pew did a poll/analyses in June and the total support for single-payer clocked in at 33% with another 25% supporting a private/public hybrid. Liberals, however, poll at 65% approval. The fly in the ointment, of course, is how we pay for it and Bernie's 'suggestions' including astronomical taxes on the rich will never get off the ground.

I like the idea of offering a public option against private plans. Let people choose and see where the fur lands. Or expanding Medicare (which is not free, btw) to the 50-55 year old demographic and see how that works out. None of this is going to be easy or fast and nothing, zip, zero will happen unless the Democrats win in 2018 & 2020.

The present healthcare debate always reminds me of a semi-educated redneck I knew back during the time I was a community college student.

While stereotypes are generally bad "Bob" was every bit the hard right-wing, vaguely racist, Bible thumper who hated government and felt ANYONE on welfare were lazy bums ripping off folks who worked. That is until the loaded shotgun Bob had stored underneath the seat of his truck went off after hitting a bump in the road. The blast shredded his left leg leaving it barely attached. Unable to work his low skilled construction job Bob had to use Medicaid to get healthcare and feed his family with welfare money. He spent weeks in the hospital and months after in rehab.

Yes, Bob's experiences changed his perspective on government assistance. He was still a full-fledged dick but it did at least let him understand the government isn't the antichrist. Long story short, while some polls say a majority of Americans are pen to single payer, it will probably take a multitude of loaded shotguns to really convince them.
The average person on Medicare pays about 300_400 dollars/ month for supplement insurance s how is that free. If a person has any kind of income, he wouldn't qualify for Medicaid assistance with the premiums. I believe go with Hillary plan of tweaking Ocare
The private insurance vs single payer is what Hillary proposed and tried to get passed as First Lady 1993-4. Guess who voted against it- Bernie.

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