[Photo by Piron Guillaume via Unsplash]

A Neoliberal Argument for Medicare for All

[NB: Note the byline, as always. /~Rayne]

The old white billionaire dudes lipping off about “un-American” expectations of fairness and equity in income distribution jogged something loose in me.

I’m so damned angry about their willingness to complain their ability to buy yet another fucking yacht may be diminished because the average working American has the chutzpah to demand health care for everyone on top of a living wage.

What really cheeses me off is the utter stupidity of these so-called business geniuses.

WHY ARE THEY IN THE HEALTH CARE BUSINESS AT ALL??

Let’s pick on Mr. Luxury Beverage’s business. His core competency is preparing beverages to meet Americans’ tastes in an appealing environment.

Why has he spent any of his corporation’s human resource dollars on health care programs? His corporation’s expertise is NOT health care or insurance; they’re only providing health care because competition for stable, healthy employees is tight and turnover costs a butt-load of money.

I know you’ll love that technical term ‘butt-load’ but seriously, turnover in low-wage jobs in which employers have invested considerable training eats away at profit margins. It can take a year or two for low-level employees to reach maximum productivity — like pouring the optimum level of crema on a double espresso and know the entire menu by heart while operating at full-speed during rush hour.

What does it cost the Luxury Beverage business if workers leave inside that first year because they can get health care elsewhere?

Ditto for Mr. Business News Provider. His core competency is gathering, reporting, distributing timely news preferred by businesses ahead of the rest of the competition; time matters greatly if stock trades on this corporation’s work product. Why is his corporation in the health care business at all?

And yet both disparate businesses — beverage purveyor and news distributor — expect a comparable level of health among their workforce. They aren’t factoring into SWOT analyses the possibility a competitor’s workforce might be more healthy and fit.

If we look at other industries like the automotive industry or construction, healthy workers who can handle physical demands becomes mission critical. Only so much work can be automated or eased with technology and equipment.

And yet the cost of negotiating and providing health care for their employees can be the difference between profitability and business failure.

The challenge is greater when competing with companies overseas as automakers do.  Health care costs for the Big Three here add a significant percentage to the cost of goods sold — far more than $2 billion a year — while their foreign competitors pay less because the costs is absorbed across all of society instead of their businesses’ experience. The costs are based on a population which has had uniform access to health care throughout their lives.

So why are industries which aren’t delivering health care in the business of providing health care at all?

It’s in the best interest of the country and its industries to use economies of scale to acquire good health care at lower cost, provide it to the entire country, so that the country’s businesses can focus solely on their core competencies as well as the features which differentiate them positively from competing overseas products.

This is exactly what the neoliberal “strong but impartial state” is for in concert with “free enterprise, the system of competition,” to provide what the people know is needed to establish economic justice, insure domestic peace, provide for the common defense against health and employment insecurity, promote the general welfare of all citizens and workers, while securing an optimum opportunity for businesses to compete.

The U.S. is going to spend $3.5 trillion on health care this year under this current system. This is nearly two times what comparable countries spend on average. It’s inflating the cost of everything we make and sell. Imagine the profits corporations could make and keep if they didn’t have to spend valuable time and resources on health care benefits management.

But, but socialism! — this is the immediate refrain offered as push back against institutionalizing health care as a federal program to be provided to all.

Do you see either Mr. Luxury Beverages or Mr. Business News Provider complaining about the federal government’s role in assuring baseline education across the country through its K-12 public school system? I would argue this is the most American federal program we have now or have ever had since its inception with the Pilgrims.

But socialized K-12 education!

Imagine having to argue as a presidential candidate that we can’t have education for all though this program has already directly benefited every business and our common defense in some way.

Imagine American corporations, each independently in isolation, spending billions each year on human resources to research and negotiate education programs as an offering for employees and their families. Ridiculous, right? It’d suffocate so many young businesses on the verge of scaling up.

But these old white male billionaires don’t see any problem with publicly-funded education for all which helped make them what they are today.

I can’t believe I’ve had to argue a neoliberal case for publicly-funded health care for all because a guy who grew up in public housing thinks such health care is “un-American.”

 

Treat this as an open thread.

image_print
145 replies
  1. Hops says:

    Grammar police: “Why is has …”

    Anyway, this is a big topic. In the end, most developed countries have now adopted single payer system, and not gone back. As Richard Feynman said of physics, “why think, why not just do the experiment?”

    • Rayne says:

      Thanks, I was kind of hopped up on my third cup of Aldi brand joe and hot under the collar. I’m sure there’s more boo-boos, let me know if you spot more.

  2. Mary McCurnin says:

    Imagine if we sucked half of the money hoarded by the top 1% or even the top .01% back into the general population. Miracles would happen.

  3. OldTulsaDude says:

    Rayne, I applaud your anger at our savage inequality.
    You might say I’m a dreamer, but I’m not the only one….

  4. P J Evans says:

    I don’t hear the 1% complaining nearly so loudly about government’s role in providing socialized services like paved roads and water/sewer/electricity services, and the USPS still is semi-public. Could it be that growing up with those makes them “invisible” government?

  5. RMD says:

    …an old bugaboo for me when aggrieved; writing quickly and misspelling, etc.
    Of late, I write and save, to revisit and revise after the thermometer and blood pressure gauge goes below 180.
    Always appreciate your writing.

    • Rayne says:

      Sometimes the schedule doesn’t allow a cool down before hitting publish. I hoped for the best and stuck my head out the door where the wind chill is now -20F. LOL

  6. David R. says:

    You may have thought you were making a contrarian argument, but I think it’s true. If the captains of industry had come up with universal health care as a scheme to cut their costs by tricking government into shouldering the burden, it would be a done deal by now. But this is power politics, now. It’s a left-wing idea, and they can’t afford to let anyone think the left wing can win.

    • Rayne says:

      It’s only a contrarian argument to a couple billionaires who haven’t fully embraced their inner universal fascist.

      As a B-school grad this slap-dash patchwork of health care at exorbitant prices never made any sense when it could have been shifted to the public. Businesses are all too willing to offload other externalities to the public, why not health care?

    • Raven Eye says:

      If universal health care came into being, what would the captains of industry use to lure employees into their enterprises?  And then keep them hooked?

      That’s more of a speculative question.  For the life of me, I don’t get how people can be so blase about U.S. industrial and service industries, as well as individuals, pissing away such a large hunk of the GDP on health care.  I worked with a guy who spent over a decade working in Germany (and married a German woman).  He used to rail against health care proposals for the U.S.  When asked how bad the health care was in Germany, he replied:  “Uh.  Well.  It was pretty good.”

  7. RMD says:

    I got an idea! How’s about we audit the Pentaprism™?

    Lots of looking-glass refractions, but little in the way of accountability.

    One report had multiple trillions, with a T, “missing” …. but I’m sure there’s a good explanation.

    Cuts must be made to ‘entitlements’, right?

  8. chicago_bunny says:

    Preach!  I have made this argument many times.  It usually prompts two counters.  First, “government will screw up my healthcare!”  Those same folks usually will admit that Medicare works pretty well, though.  And second, “employers want it that way because it makes it harder for employees to leave.”  I doubt that motivation outweighs the headache of providing benefits in the first place, but I suppose it’s possible.  Of course, employers who think that way always could offer more benefits to incentivize staying if public healthcare comes to pass.  And I also try to appeal to the “free market” instincts of these folks – shouldn’t we want to encourage the free movement of labor and let market demands sort it out, rather than constraining labor by tieing people to a particular employer in order to maintain healthcare?

    • Rayne says:

      Health care insurance is one factor creating labor monopsony. I’d prefer the best people who are most motivated to work for my business rather than people who feel obligated because they can’t port their health care insurance. Surely there’s a cost to the business either in productivity or brand value when the best people can’t work for them.

      The cost of recruiting, hiring, training employees for Starbucks must be greater than the cost to provide benefits. I don’t buy that Starbucks offers benefits because it’s their brand; this isn’t why people buy their coffee.

    • earlofhuntingdon says:

      Governments screw up by accident.  Health insurers, as large institutions, sometimes do that.  They also screw up – deny coverage, delay payments, and cause immense stress – as a business model.  If it makes money, they’re happy to ration anything, except the CEO’s bonus.

      Many American employers are happy to replace workers.  They seem to over-invest in machines or technology if it promises to cut employment.  It’s a matter of faith that doing so will produce a net gain.  Not to mention that firing employees with aplomb and a false straight-face is regarded as a right of passage to senior management ranks.

      Employees with seniority and leadership positions are relatively more expensive.  They are also more aware of the benefits of unions and the necessity of making demands on an employer which won’t provide anything it is not forced to give up.  Wal-Mart makes a fetish of keeping its employees as junior and inexperienced as possible.  It will leave a country if it enforces labor laws it does not like.  Many American companies are convinced they cannot employ more than a small number of Americans.

      The “market” is not the net effect of anonymous transactions by equally informed, comparably resourced actors.  It is the outcome of the demands of an industry’s strongest, most powerful players.  Government is usually the only well-resourced and informed actor that can compete with powerful private companies.  It’s one reason neoliberals have developed an elaborate mythology about why government intervention in “their” economy is both wrong and mathematically incapable of creating a net improvement.

  9. Fran of the North says:

    My day job is as an insurance technologist/prognosticator/speaker/writer. So I’ve got a couple of thoughts on this topic.

    Technology is going to radically change all sorts of risk financing, including funding for delivery of healthcare. But progress is hard to achieve for a number of reasons.

    The current system is dysfunctional. Different financing mechanisms, different reimbursements, differing laws by state, differing providers, different IT systems. It all combines to make progress difficult to achieve. Add in the inertia built into the current system, and there are lots of oxen to be gored.

    Items like:
    * The size of the US health insurance sector, the jobs and profits associated
    * The involvement of the DOI in each state
    * The health care provider lobbies
    * The compensation structure of the medical services providers
    * The profit margins of medical equipment manufacturers.
    * The whole process of pharma in the US (A whole different rant is warranted on this topic alone)

    Then there is the issue of the patient’s concept of self preservation. Nothing is too good or too expensive for me, but why are we wasting all of that money on those people over there? They should have known that when they did (insert whatever behavior you want)…

    Finally, nothing chaps my backside more than all of those businesses that work the employment system so that they don’t have to be responsible for the health care of their employees. Why should those businesses pay those expenses and reduce the cash into the pockets of stakeholders when you and I (and the rest of the suckers who actually pay taxes) will cover those costs?

    We pay them through higher costs for health services, higher insurance premiums and more stress in the body politic.

    I got better…

  10. earlofhuntingdon says:

    Mr. Luxury Beverage went to public schools in NY and a public university in Michigan.  One reason he could work and borrow enough to pay for college, apart from it being in the early 1970s, when that was still possible, is that he chose a public university.  (Even as an out-of-stater from NY, the cost would have been much less than, say, the private Kalamazoo College, also in Michigan.)

    One thing Mr. LB does not mention when he talks about hating higher taxes is what the public get in exchange for them. In Nordic countries, taxes are high, but the public services offered in exchange are exceptional, as is the quality of life.  Costs for it are shared equitably across all income groups.

    In the US, taxes pay for the world’s largest military budget.  Spending tax money on the military creates little economic leverage compared to spending it on infrastructure (however one defines it today compared to, say, 1950) or education or public services for low and middle-income people.

    Tax money that goes to the latter income groups is recycled almost immediately: people who live paycheck to paycheck spend an extra dollar immediately, not on the frivolous, as the right contends, but on everyday necessities.  Its multiplier effect is considerable.  Allocating tax dollars to the military or to high-income groups (say, through a tax cut) generates little to no multiplier effect.  The American economy gets little bang for the buck.

    Regarding health care, we could follow the Canadian model, in which private sector insurers and medical providers plays virtually no part.  Or we could follow the Dutch and French health care models, which do carve out space for private insurers.  There, however, they do not control the system.  They do not drive profits to themselves in the guise of limiting cost increases to insurance-paying employers or by denying or delaying coverage as a fundamental part of their business model.  They process payments and paperwork – quickly (speed is a metric, it’s lack is not a profit-center).  In exchange, they receive a low, fixed return.  In effect, they are a public utility, not aggregators of immense profits.

    Stopping the immense accumulation of economic rents by American health insurers is an essential step in managing health care costs.  The purpose, however, is to deliver medical care to as wide a swath of Americans as possible.  That is a public good that, like low-cost to the student public education, subsidizes many others.  We would all be better for it, even Mr. LB.

  11. Peterr says:

    I am forever flabbergasted at the folks — like Schultz just this morning on Morning Joe — who clutch their pearls and say “But people love their insurance! How dare you try to take it away?”

    People don’t want insurance – they want health care. These are not the same thing, despite what the MOTUs will say.

    And most people had next to no say in their insurance. Their company’s HR department decides who the insurer will be, and negotiates the detailed benefits, including copays, deductibles, preferred medication lists, and approved service providers. Then, after a year or two when the costs go up, and just as people figure out how to use their insurance system, HR will find another company and negotiate a whole new set of benefits (some better, one hopes, and others worse, more likely) and whole new set of costs.

    I have yet to find anyone who loves this system, other than insurers and corporate CEOs.

    People don’t want insurance. They want health care, and the current private medical insurance industry is NOT the only way in which top flight health care could be financed and supported.

    • Trip says:

      People want to keep the doctors they’ve established relationships with, who know their medical histories. It’s not that they love their insurance. They just don’t want a switch where physicians that they trust are suddenly not part of their network, and they can’t see them any longer. It’s a cynical talking point utilized that they “love their insurance’, as you say.

    • Rayne says:

      Yup. I love my doctor’s medical practice; they’ve saved my life. I do NOT love the insurance company which pays them; they’ve made me miserable.

  12. Trip says:

    Unfortunately, a lot of the neolibs do advocate for private education across the board. See the charter school cottage industry (and associated lobbyists). Something isn’t good, unless it’s profit driven for private corporations, in their scheme. We always hear how privatization lowers costs, but it never does. It does, however, remove regulation, oversight, unions, and usually distributes any savings or benefits toward the top.

    • Rayne says:

      The neoliberals who advocate for private education are those who see it as a business opportunity, treating children as profit centers. Private school will never lower cost for this reason — it can’t escape its primary function which is business.

      Parents want something beyond the public school? Fine, pay for it. But it is an essentially American value to provide public education for all. It may have started because of a bunch of Christians who dissented from the Church of England but this value helped create a thriving open society.

      • Trip says:

        No argument from me there. But people still get talked into how much it will save! However, the charter system is still built on tax dollars~only with less public say. What could possibly go wrong?

    • Peterr says:

      All too often, the charter school industry also pitches (quietly) the benefits to keeping *those* kids away from *our* kids.

      • Drew says:

        Oh yes, Peterr. And in NYC I saw it, Oh.So.Subtly. practiced among white liberals who would be shocked to hear me refer to them as Betsy DeVos Democrats. Private Schools have become a “necessity” for the “middle class” in NYC.

        • posaune says:

          Here’s what happens in DC:

          Any child can be enrolled at a public charter (pending waiting list, etc).  Many kids are enrolled in the public charters because their parents are desperate to get any possible better placement than the miserable DCPS schools.

          On October 6 each Fall (I think that’s the date), the charters submit their official census, that determines the basis for funding by DCPS, OSSE and the School Board.   Guess what happens next?   Why, amazingly, almost over night, hundreds of the charter kids are expelled for various “reasons,” and at that point in the school year, their sole option is the neighborhood public school (which in many neighborhoods is very, very poor).   The the public schools are obliged to accept the charter “expellees,” for admittance to classrooms that are already beyond full in schools that are failing.  The charter school gets to keep the money based on the inflated census. It’s a con game.

  13. HazumuOsaragi says:

    “The U.S. is going to spend $3.5 trillion on health care this year under this current system.”

    That’s a feature, not a bug. A mighty river/ocean of money where people with very long straws and/or vampire-squid-blood-funnels can siphon off a measly few million that will go unnoticed when there’s $3.5-million-million to be had. If you’re hungry for somebody-else’s-money milkshake, the feeding is easy *belch*…

    [FYI, your IP address suggests you have been here under another name. Stick to one identity or your LAN’s range will be banned. /~Rayne]

  14. jaango says:

    Thanks, Rayne!

    As a military veteran, I underwent a six day stay (two years ago) at the VA hospital for the cancer located in my back, and the results were excellent and the health care services were excellent. Thus, I awarded my Five Stars to the VA.

    Consequently, I favor a ‘new’ Medical Triangulation for “Goods and Services.”  As such, this triangulation would consist of Medicare, the VA and Indian Health Services.  Thus, each of us could assign our  ‘contract’ to any of  these three medical entities, And further, the medical industry of doctors and nurses would become eligible for such delivery contracts and as it exists today under Medicare.

    Need more be said?

    • Thomasa says:

      I am also a military veteran. I get my medical care at the VA by choice. The care is excellent. But (turning on the sarcasm here) the VA medical system must be destroyed. It serves as a good example of what can be done with single payer/single deliverer. It giges lie to the conservative arguments about how such a system will result in death panels, interminable waits for service and a long list of other Republican horribles. Privatize it on the sly before it’s too late and the Democrats takr the senate.

  15. Nathan says:

    This point gets lost a lot, but Australia’s population is about the same age as America’s, about the same % immigrant, spread out over about the same land mass (excluding Alaska), but the amount they pay per capita for universal health care plus about half their population having some form of fancier private insurance is about the same as Americans currently pay per capita in federal, state, and local taxes that goes towards funding health care.

    We already pay enough taxes for Universal Health Care. We simply don’t actually get it. And closing that gap is purely a matter of politics, not any sort of actual physical impossibility.

  16. Jockobadger says:

    Wonderful argument Rayne. I also like that we are actually discriminating bt healthcare and health insurance – it’s easy to view it as monolithic when it should not be.

    Since this is an open thread, I wanted to note (Mr.Trip) that Wikistrat/Psy met with Jr. after the nomination to discuss stuxnetting the coming election. Something I did not know is that the SC has interviewed Joel Zamel. Psy/Zamel pitched the plan to Rick Gates in April, 2016. It seems that Psy had run simulations of influencing via FB, etc., and they were quite persuasive. I hope to Dog that Mueller can prove that DT and his goons hired Psy to assist in the hijacking.

  17. BobCon says:

    The history of this in a nutshell is that right after WWII, Walter Reuther, head of the UAW, made this argument. He saw that health care costs were going to kill the US auto makers in the long run, and pushed GM, Ford and Chrysler to join him in lobbying for a national taxpayer funded health plan.

    The big 3 (I think especially GM) got sucked up in ideological arguments pushed by the AMA and right wingers and threw their weight against Reuther.Tax policy then became fossilized to promote employer based plans and there was no hope for a national plan. In the late 40s, though, there was a real shot at the US joining the other major economies in nationalizing health care.

  18. Trip says:

    @Jockobadger
    January 30, 2019 at 3:24 pm

    Yes, they were paid around $2 million dollars, but for what service we do not know. As soon as the PSY group was interviewed by the Mueller camp, the company was immediately dissolved. Something stinks. FWIW, Cambridge Analytica (SCL/parent) used “alumni of Israeli intelligence hackers” to infiltrate Nigerian opposition in 2015. The article I read didn’t name them, but it makes you wonder.

    Mueller also interviewed Aleksandr Kogan (Professor of psychology at Cambridge University), who collected questionnaires and data from Facebook, “thisisyourdigitallife” for Cambridge Analytica. He traveled to Russia and somehow that data was accessed by Russians, in a case of serendipity, I s’pose /s. We haven’t gotten anywhere near the real drivers of the 2016 election, IMHO.

    • Jockobadger says:

      Many thanks, Trip.  I’ve read about the disappearance of Psy, but not the business re: Nigeria. Nice

      Serendipity indeed.  Must’ve accidentally left a thumb drive in his motel room or something.  You’re so right that something stinks to high heaven.  Here’s hoping that Witch Hunter Bob (and Da Nang Dick!) can get to the bottom of the meddling.  In all seriousness, I hope I don’t kick the bucket before these people are finally cornered and thrown in the hoosegow.  Thanks EW.

  19. P J Evans says:

    I am grateful for socialized medicine (AKA Medicare). It’s been paying most of the cost of the cancer treatment I’ve been getting for the last…close to 18 months. As a result, I’ll be round for a lot longer than I would have been otherwise. If Schultz wants to argue that it’s a frill that we don’t need, I’ll send him scans of the Medicare statements with numbers that will make him pale at least a little – and of the statements that show how much I put in as premium, even now.

    • Trip says:

      It’s bizarre, really, because he recounts a terrible time in his life when his father lost his job due to injury, had no paycheck and no medical insurance, where the family pretended they weren’t home, when bill collectors called. Other than loving to make others suffer, why wouldn’t he want more people to have health coverage or social safety nets and to not experience the same harsh indignities he went through as a child? Creating jobs, or being a “Job Creator” as he calls himself, wouldn’t have done jackshit for his father who couldn’t work because of an injury. I can’t seem to find whether his father was covered by any workman’s comp or SS.

      • bmaz says:

        Some people are just narcissistic dicks, and Schultz is one of them. He is last thing this country needs to clean up Trump’s mess. Schultz does not understand policy, politics or law. Is he as evil and ignorant as Trump? Maybe not, but he is not much better.

  20. Rapier says:

    Big questions are not well served by short answers but anyway. Health care is a racket. If your a very rich person you know many people in the racket.  Pharma execs to big time surgeons.  It’s part of your portfolio. Rule one is, don’t fuck with anyone else’s racket. In the neoliberal sense there is no other possible organizing principal than profit.

    When reliable cash flow in health care was created by Medicare the ways to harness it were born. A ‘market’ was created, that served the owners. Medicare for all would make the market so big it would crowd out lots of other stuff. Best leave it where it is.

    Ross Perot got mega rich, data processing for Medicare.

    • Rayne says:

      There are a lot more of us than them to fuck with their so-called racket. We’re done with a minority of monied people fucking with us.

      The Constitution guarantees no one a profit, either.

  21. Jonf says:

    You really nailed that piece down. I loved your anger. We will need that going forward. People keep telling me we can’t afford single payer. How are you going to pay for it? WTF we already pay for it, every freaking nickel. If we need to pay for it with taxes, so what? We might save at least a trillion a year, maybe more if we start looking into drug costs.  And that will come back in improved GDP. Get corporations the hell out of the insurance business and get the health insurers the hell out too.

    I would even let our corporations pay a portion of compensation to Medicare to include some from the employees, like social security. But after that stay the hell away. Either way. Put it in the progressive tax rates or take it out of compensation. But stop with the socialist crap. ( I sort of favor letting corps take it out of pay to start. No other changes to progressive income tax rates.  But you can convince me.)

  22. Savage Librarian says:

    Great topic and insights, all. I was ranting & raving about this with a friend at lunch a couple of weeks ago.

    Doctors like to think of me as an interesting patient (not to be confused with interesting person.)

    That’s because I was told the rare autoimmune disease I had was found in only 1 of 500,000 patients.

    That one is under control and monitored. But it seems that it is not unusual to get another autoimmune disorder if you have had one before.

    Thus, I have been poked, prodded and probed lately by docs who see me as a rare case, not a sentient being. Grrrr… It brings out the Savage in me.

    Fortunately, it also motivated & inspired me to think of a tool that would provide economies of scale and reduce opportunity costs in the health care field.

    When I said to my friend at lunch, “I can’t understand why nobody has done this?”
    She said, “Maybe they just didn’t think of it”

    Hmpf! Of course, it was easier for me to think of it because I was so frustrated. The thing is, it is such a simple thing that could be ubiquitous and implemented on a national scale.

    But much more than that, it would reduce suffering, both physically and emotionally, as well as reducing time. A tool that absolutely promotes cost effectiveness.

    So, I am “patient”ly waiting for an energetic, open minded new POTUS who might even find an avenue to solicit ideas from the people.

    Wouldn’t that be a novelty?!

  23. Gerondoc says:

    I have worked directly in Healthcare as a practicing physician for decades and have watched it erode.

    What is the core problem? Our healthcare system seems to be immune to our American system of checks and balances. Much of our political establishment and many deep-pocket special interests have huge stakes in maintaining the status quo. Pharmaceutical lobbying and private sector bureaucracy is a major factor.

    Fears that universal coverage or a national single payer system is “socialized medicine” and political rhetoric that calls it “big government”. Does universal coverage mean “socialized medicine”? Discussions of health care are couched in ideological terms rather than on what is economically viable so change is summarily dismissed as “socialized medicine,” which limits the discussion and distracts from the real issues. Our current health care system could be labeled “privatized socialism” because private entities (as opposed to the federal government) dictate which doctors we can see, how much they can charge, and the kinds of medicines they can prescribe. Most of our global competitors give more control for private-sector care providers than we do and they rank higher in health quality. How long will we tolerate this empty rhetoric to protect the status quo?

    Healthcare is too precious to be considered a business or a marketplace commodity. Whatever system we choose must commit itself to the needs of the population and the global community, not simply our own personal needs. It must be based on needs not based simply on service expansion (with aggressive marketing to create demand – “Ask your doctor about …”).
    The patient’s suffering and distress (the illness) is the focal point. Service delivery should be comprehensive, humane, non-judgmental, and ideally, free at the point of service. Patients should be able to choose among providers and preventive care should be emphasized and interdisciplinary teamwork should be encouraged and facilitated. Advanced communications technology should be used when appropriate to transcend barriers of access, distance, isolation, and neglect. Our dollars need to be focused in a fair and morally responsible way to reduce suffering and distress. If not, the global inequities will threaten global security and destabilize global programs. Given our current political climate, it seems unlikely that the future healthcare system will be less reliant on government dollars.

    We need a program of universal health coverage that eliminates the middlemen. Funding will be the greatest challenge but numerous opportunities exist and a creative management system can be devised. Excessive management overhead and CEO compensation should be slashed. Physicians could be generously salaried based on skill, schedule, and experience. Real progress will depend on stronger primary care health systems that integrate preventive care with treatment for acute and chronic illness. This primary healthcare system has to include the entire population because HIV, polio, SARS, and mad cow disease do not respect political or socioeconomic boundaries. And we could learn from other countries (Great Britain, Germany, Sweden, and Japan for example) that view healthcare as a basic human right.

    How much more productive will we be as a nation, if we have healthier people who do not live in fear of losing their health-care benefits or of facing bankruptcy because of illness? How many domestic jobs will stay in America and how much will wages be able to increase if healthcare costs are contained? How much “outsourcing” of jobs overseas will be eliminated if businesses do not have 15 to 30 percent of their payroll going for health insurance? Our products will be more competitive and our economy will be more secure. As mankind evolves, with the goals of peace, security, economic opportunity, freedom of speech, and freedom of religion, freedom from illness will be seen as the cornerstone of global harmony. It is time for us to develop an ethical system of healthcare for all. We cannot prosper and have it any other way.

    [FYI, blank lines inserted to improve readability. /~Rayne]

    • Jockobadger says:

      Gerondoc – Thanks for the great comment.  That’s the kind of stuff that brings me here every day.

      My Dad is a retired clinical path/nuclear medicine doc.  He started practice in the AF and then started in private practice in the PNW.  He and his buddies (partners) have done very, very well out of the existing system and for years when I was growing up, going to college, etc., he talked about “socialized medicine” as though it was the worst thing that could possibly happen.

      He changed his tune about 20 years ago when my niece, his granddaughter, was diagnosed with cystic fibrosis.  She had a terrible time growing up that would take way too much space to even begin to describe, but without Obamacare, and it protections for pre-existing conditions, etc., she might well be dead.  He knows this and is now a vigorous proponent of single-payer health care for all.  He has also become much more “progressive” in his thinking.  I’m very proud of him for that and for a lot of other reasons.

      People can change.  Even hard-headed old-school AMA guys.  Thanks again.

      • Eureka says:

        That is a Dad & story to be proud of, Jockobadger- though I am so sorry for your niece and family’s suffering that got him there.  With many of these politicized human rights issues, it is so true that some have to be converted by direct experiences, or ones that hit close to home.

        I’m glad your niece lives and wish her and all their thriving best!

        • Jockobadger says:

          Thanks very much, Eureka.

          She started a clinical trial for a new med about 10 months ago.  Her life has become nearly normal.  We didn’t believe it possible.  about 95% of her cohort has had similar outcome, so they stopped the trial and put everyone on this stuff.  I’ll ask my Dad what it is.  Anyway, she’s going to Europe for the first time soon – she could never have done that.

          Your comments are always on-point.  Wish mine were.  JB

          • Eureka says:

            That is the best of all possible outcomes- I am glad you shared those additional bits.

            I always enjoy your comments, Jockobadger, and find them memorable.  I think it’s the case where we all think our own comments are off and others’ are on, lol.

      • bmaz says:

        Agreed. This is a fantastic thread starting with Gerondoc on down.

        And Gerondoc, if this was not said before, thank you for reading us since FDL (so it has been a good long while now) and now participating. Please do so more often, it is a good thing!

  24. Drew says:

    Good piece. The logic is impeccable. I think the actual reason that the capitalists (neoliberal or otherwise) in this country never got there (yet) is the historical context: the Ray-gun Revolution used as its main point of attack that big government was inefficient & failing and taxes were dragging the country down. It was a rhetorical saturation & an analysis of the economy that was cherry picked, at best, a cynical fraud at worst. But that was the story, and if you weren’t going to stick to it, you weren’t going to lower the taxes, bust the unions, and build exorbitant profits & fortunes.

    It was not an environment where the people wanting to build big profits for their companies could easily pivot to a large government argument. (Billary tried in 1993, but making the argument in all directions at once was too complex & the effort flopped).

    I’m thinking that after MFA is implemented & succeeds, there will be a lot of revisionist memories among neoliberal tycoons, and they will all claim credit for the great business move–but not now.

    BTW working inside Mr. Business News Provider’s company (actually the real revenue comes from the trading platform & database stuff, not the news), working there is the ultimate Nanny State experience–being beholden to the company is an article of faith, and those that remain cleave to that faith tenaciously–those who feel patronized & controlled leave.

  25. Badger Robert says:

    These arguments illustrate that socialism is a bad thing, in some minds. That prevails until Wall Street risk takers have created the basis for a financial collapse. When that happens we have a round of business socialism, and then we go back to capitalism. Back and forth. Perhaps.

    Thanks for providing this venue.

    • Rayne says:

      What we have now that we didn’t have in the past is large quantities of data and the computing power to analyze it.

      What we also have now that we didn’t have in the past are newer forms of antitrust — Big Coffee, you might say — which can afford to corrupt the process by which we can make more informed decisions.

      You’re right that this is a cycle and we’re in the rebound toward a more socialized economy. But I don’t think in the U.S. it’s a case of “go back” to an opposing extreme since we’ve never really had an extreme until now. This is a reset toward a better mixed economy, one which might be better prepared for the loss of jobs to an increasingly automated society.

      • Badger Robert says:

        Usually upgrading the status of people who live on wages and salaries has led to a massive increase in productivity. Abolition of slavery, and the agitation for the 8 hr day may be examples.

        Health care is one of those things in which the seller has a huge information advantage on the buyer. Insurance systems of any type can even that out.

        Facts could demonstrate whether universal care for ages 0-19 would lead to significant cost savings. The facts are usually not discussed.

        Health care is one of those things that affects every day people.

        Its nice to read postings that don’t insult my intelligence. Thanks.

  26. Michael says:

    My last employer was not in the healthcare business but they provided (paid for) employee healthcare because ….. well, the very same reasons as other companies, and chief among them was that nobody else did and nobody else had the required $$$,$$$,$$$.

  27. To be continued says:

    I think for many universal healthcare societies there is the underlying belief in Maslows hierarchy of needs, that no matter what someone’s background (rich or poor) they should receive public education, healthcare, housing and adequate nutrition as essential needs. It sometimes requires turning a blind eye to those who appear to be abusing the system, but they would rather see too many people receive unnecessary benefits than see someone, especially a child, overlooked. Why do countries against universal healthcare appear to relish in punishing those who fell on hard times or don’t know any better than the life they were born into? Why is socialism so against everyone’s religion…

    • bmaz says:

      It is NOT particularly “socialism”. That kind of framing and discussion needs to stop. It is about fundamental fairness and basic human rights. Our parents had and have Medicare, nobody screams “socialism” about that. Universal healthcare, or Medicare For All, is perfectly compatible with our Constitution and way of life. Which I think is what you are saying….

    • earlofhuntingdon says:

      The right has spent more than a century demonizing “socialism” and its association with the popular left.  It was once a respected and popular movement.  There were major “Red Scares” after WWI and WWII, both involving J. Edgard Hoover, as part of that demonizing process.

      Eugene Debs, a socialist, was a serious contender for the presidency that Wilson won in 1912.  Might be one reason, along with war fever, the government’s commitment to propaganda, and the right’s predilection for never letting a serious crisis go to waste, that he was demonized and sent to prison.  (He was pardoned a few years later, when he was too old and sick to be a threat.)  Other socialists included the immensely popular Jack London and Upton Sinclair.

      Democratic socialism is making something of a comeback, with people like Bernie Sanders openly associating with it.  As bmaz says, labels aside, it is largely an economic and social justice movement.

  28. LeeNLP says:

    Rayne, I am absolutely in love with your passion, eloquence and rationality.  It’s become so obvious that the right wing economic talking points aren’t valid argument, but PR materials produced by richly paid spin companies and think tanks for the express purpose of making money for the very rich.  They’re not arguments at all, but products.  It is confusing until you realize the person you are listening to isn’t a person at all.

    FWIW, one of the best introductions to the PR industry’s lies is the old classic Toxic Sludge is Good For You.

  29. Savage Librarian says:

    OT – Does EW accept paper checks by snail mail? I’m thinking I asked a couple of weeks ago, but it fell through the cracks.

    If so, who should it be made out to? Where should it be sent?

    Thanks

  30. Savage Librarian says:

    bmaz,

    Thanks. Found it. I’m on a cell. Had to go to “Contact” at the bottom of the page. Last time I looked it didn’t say who to address it to. I don’t think it said Snail Mail either.

    But I’m so glad you accept paper. Happy to contribute!

    • earlofhuntingdon says:

      Currently, click “Support,” then “Donate by Check.”  It takes you to a contact screen with a snail mail address.

      Paper, I believe, is as readily accepted as plastic or digital contributions.

  31. Jonathan says:

    The Big 3 automakers don’t care about how much health care costs in the US, because they aren’t really US companies anymore. They are just as happy to produce cars in China or Mexico. China in fact produces far more autos than any other country, in no small part because US companies make so many cars in China. https://en.wikipedia.org/wiki/List_of_countries_by_motor_vehicle_production

    For example GM now makes more cars in China than in the United States. https://www.bloomberg.com/news/articles/2018-05-24/gm-is-building-cheap-cars-for-china-s-masses

    American auto execs (like much of our elite who are happy to export US jobs and  technology to China) are in fact traitors to America. They think that when China rules the world, the world will still be a fun place to live for them. Spoiler: it won’t. But they are happy to bank their bonuses now and disregard the future.

    While I hate to admit it, Trump is right about the threat China poses to the United States. Too bad that his trade negotiating style is so inept and oafish.

    Another point: China has leverage over the US industries which have invested huge amounts in Chinese plant & equipment, and in China based joint ventures. This is leverage the Russians never had during the Cold War, when the US wisely followed George Kennan’s containment policy and kept Western technology away from China, Russia, and the rest of the East Bloc. The policy of “engagement with China to change China” has been an absolute shambles for the United States, and any observer with the merest knowledge of Chinese history could have predicted this.

    Which is all to say, once upon a time there was some truth to the saying, “what’s good for GM is good for America.” Now GM and the other carmakers could care less about the US, health care policy included.

    • Rayne says:

      If you said this,

      The Big 3 automakers don’t care about how much health care costs in the US, because they aren’t really US companies anymore.

      to someone in China they would laugh. GM and Ford are still American companies and Fiat-Chrysler definitely isn’t Chinese.

      China makes a butt-load of cars because it’s one of the two largest markets in the world, bigger than the US by at least 3X and still rather under-served while the US has a car glut — multiple cars per adult. You really ought to take a stroll with a Chinese search engine and look for Chinese-made cars, electric in particular. You will find that GM and other US makes don’t even crack the top search results.

      You linked a Bloomberg article which explains the reason why GM produces so many cars in China: gm-is-building-cheap-cars-for-china-s-masses, right there in the URL. That may be but they are getting their butts kicked. Meanwhile they’re still building cars for the American market with American labor.

      The Big Three do still worry about health care costs because the US is still home to major production facilities — I linked to an article in which the number of UAW workers was cited in addition to how much the big three paid for their health care programs at the time they last negotiated a contract. That did not include the white collar workers or contract personnel which are as numerous as direct employees (I live in Michigan, have worked for a Big Three company and one of its contractors; I have family who still work for Tier 3 companies including one who sells manufacturing equipment to China).

      Trump really has no grasp on the relationship the US has with China. His dealmaking is as thin as his understanding. With our demand for sophisticated products we have provided a means for China to propel its workforce out of the damage Mao did with his leveling culture. We provided a focus for something other than building a military-focused agrarian society. And in turn we were supposed to work on more challenging products leaving the less-demanding production to China.

      Unfortunately this was shot to hell during the Bush years — they didn’t really understand that China was prodding us to invest in ourselves. Instead we blew our nascent surplus on forever war and overextended ourselves around the globe because gods forbid we use tax dollars on government programs to elevate anybody but the already privileged.

      And we sent far too much of our electronics technology production to Asia including China instead of keeping it here.

      The US isn’t fucked because of the Big Three. They are still investing here in the US and would have spent even more this past year if that jackhole in the White House hadn’t pulled unnecessary steel and aluminum tariffs out of his ass and concentrated on what China was doing to cut the U.S. out of trade with EU and middle east with its Belt and Road initiative.

      And if foreign automotive producers fuck us again the way Volkswagen did with their emissions cheats, we’d be far better off with our own domestic production.

      Our problem now is the same as it was when GWB complained about cheap gas: we should have just as much variety in electric and alternative fuel vehicles as the Chinese but thanks to the Kochs and the petro-states we aren’t making progress toward a green future or a globally-competitive automotive industry.

  32. Eureka says:

    I am thrilled that Stacey Abrams is giving the SOTU response. The dems are hitting it out of the park on this one. It makes me proud to be an American. We really are moving on with trying to heal our country— and damn the MFers and their perpetually-inflicted flesh wounds.

  33. Lydian says:

    I’ve used health care in both Canada and the USA and if I could, I would choose the Canadian system in a heartbeat. My experience has been that both systems have been about equal, in terms of quality of care and meeting my needs. The huge difference is, of course, in costs.

    I currently buy insurance on the Exchange at around $1000/m. If I was living in Canada, let’s say British Columbia, that amount would be $37.50/m. Health care in Canada provides you with the basics – does not include things like acupuncture, chiropractic care, mental health care, dental, to name a few. Those extras would be provided (usually) by your employer via additional health care you can buy on the market (secondary health insurance). Even if you didn’t buy secondary insurance, it’s highly unlikely that your costs for the ‘extras’ I named above would not bring you up to $1000/m.

    It sickens me to pay so much for health insurance. It feels like a mortgage payment. I find myself rationing my meds even tho I don’t need to, just because my out of pocket costs are so high (I bought a Bronze plan). I’m in that unlucky group who is older, needs more health care and is too young for Medicare.

    I don’t have children to support, or an ailing parent/spouse to care for, so I am fortunate. However, paying so much for something I need (as opposed to being discretionary) feels like I’m carrying an extra weight. I’m counting down the years until I hit 65 and can have an extra $20,000/year. I can only imagine how hard it is for low income families.

    My apologies if this sounds akin to a rant. It took me some time to compose something that didn’t sound too angry.

    BTW – this is by far the best discussion I’ve read yet on our health care system. Thank you all for that!

    • Rayne says:

      I think you’ve described my problem. Based on age and health history, a silver plan will cost between $20-25K for two of us and I’m 10 years away from Medicare. I’m going to have to go back to work to pay for my own insurance once my spouse retires. After putting two kids through college I don’t dare take more money out of retirement savings to pay for insurance now.

      If Canada can do it there’s no reason we can’t just the other side of the border. We only lack the political will power to take that $3.5 trillion we’re going to spend and do it right for everyone.

      Nice to see you in comments here at emptywheel, thanks for sharing about your health insurance experience.

      • SAO says:

        I’m in grad school in my 50s and no one believes me when I say tuition, fees, books and student health insurance is cheaper than I was paying for a Bronze plzn with the highest possible deductibles.

        The thing that frustrates me is all the people who say single payer will cost trillions, without taking into account the costs saved from the existing. It’s like selling a house and buying a new one, but never looking at the $coming in from the sale of the old house, just at the cost of the new one.

        • Rayne says:

          Cheaper, really? I may have to go back to school instead of work, then, if it’s cheaper! Perhaps I can go for my MFA.

          Yes, agreed — I think most folks don’t realize the $3.5T we are going to pay now anyhow could pay for EVERYBODY. I’d also expect some drop in total cost after the first 10 years because people who wait until their health is in crisis will be able to seek much less expensive early intervention.

  34. Eureka says:

    @ Rayne 924p:
    1- that was a forward-looking statement based on the quality of your title
    1.5 joking to self, I was about to add ~ It would only get more jazz if you had added ‘white paper’ or ‘think tank’ to the title
    2- I will have you know that my system crashed shortly after typing that
    3- look at who is the number one result already on ddg for neoliberal medicare for all:
    https://duckduckgo.com/?q=neoliberal+medicare+for+all
    3.5 and that is ddg- I bet the goo is even better

      • Eureka says:

        Right, lol- I was coming back to write “sub *Centrist” since that’s the only word I know of that people self-generate, and non-pejoratively, that’s close enough ish.  (But then you’d have to change “Argument for” to “Position on” to keep things comfortable and plausible for the click.)

        Otherwise, the best I got for gloss bait here is “Romney ”  ~~shivers~~

        Adding:  OR, getting really crazy (meaning let’s be honest here):  just translate relevant titles to  ~ “What do Centrists Think of (AOC’s +/- Elizabeth Warren’s) _(name of policy/plan)__:  The Never Trumper’s Guide to Progressive Policy You Didn’t Know You Agreed With”

  35. Jonathan says:

    @Rayne, as a former Wall Street mutual fund manager (now an independent stock trader) with 30 odd years in the financial markets, I have some background here too. And yes, I understand Fiat Chrysler is Italian owned. But in this you are only strengthening my point– these companies, like others that are nominally domiciled in the US, are not nearly as “American” as they used to be.

    Granting that GM isn’t nearly the biggest carmaker in China, it still makes more cars there than here. So my point still stands that by investing heavily in China, GM has handed China leverage over its fate — and presumably its DC lobbyists know all about that. Which is also my point.

    Re health care. Maybe I missed something — and being based in Michigan you may have seen this — but I have yet to hear about carmakers pushing seriously for universal health care. And yes, I followed the 2009-10 debate on the ACA fairly closely, as you all did at FDL. So while the Big 3 have certainly complained in Wall Street financial presentations about health care costs, they seemingly haven’t cared enough to do the obvious.

    You are of course correct that Silicon Valley has been less careful than the carmakers about handing over their advanced technology to China. In my view, the technology transfer party actually got started in the 1990s, when McDonnell Douglas set up an ill fated joint venture to make airliners in China. That allowed China, whose domestically produced airframes were then made of steel (!) to make advanced airliners and glom up other, more military oriented technology. https://seekingalpha.com/article/247991-china-where-foreign-owned-companies-go-to-die

    Re the Kochs and petro states. Of course oil interests should carry their share of blame for America’s weak position in green tech. But they are only one example of laser focus on short term profit in one’s own narrow interest, as is so common in the US. OTOH, China has a clear conception of its national interest and structures its industries accordingly. Which is why they are kicking our butts across the board.

    • Rayne says:

      but I have yet to hear about carmakers pushing seriously for universal health care

      That’s not the function of a carmaker. They have to work with the employment contracts they have. It’s up to the public to make this an issue.

      They’re also up to their ears dealing with a rapidly changing marketplace — like the demand for electric cars. Do the Big Three spend their resources on fighting what’s ultimately a public decision? Nope.

      And that’s why I write.

  36. HStuff says:

    You lost me at “old white billionaire dudes.” The Billionaire part is fine. The old, white, and dudes components suggest ageism, racism, and sexism, respectively.

    I’m an old white dude, and I resent being lumped into the set of jackasses you’re talking about. There is no good reason to characterize them this way, as if nobody of any other gender, age, or race would hold these same elitist views. Before you generalize about any broad class of people, remember the golden rule.

    • Rayne says:

      Oh you poor thing, won’t someone thing about the old white dudes? Don’t make me laugh, buddy.

      You’re never going to worry whether someone will wait on you when you step up to a counter in a Starbucks or when you walk in the door of an automobile dealership to buy a car. You’re not going to worry if anybody at the pharmacy will balk at filling your erectile dysfunction meds because of religious objections to your control over your body. You’re not going to get pulled over, frisked and cuffed, roughed up, dragged to jail for overnight observation because you were driving while white. You’re not going to get stopped in the street and told “You need to smile more, come on, don’t be that way, bitch, smile.” You’re never going to be asked whether you have the authority to make a decision without your partner’s approval. You’re never going to be asked where is your boss.

      You can find the exit on your own. See ya.

    • Eureka says:

      Anand Giridharadas: “We’re led by a billionaire crook because, for decades, billionaires ran America like a club for their own benefit; and now billionaires promise us they are the solution. I wrote @WinnersTakeAll for all who ask why we’re here and how we set ourselves free.”

      Anand Giridharadas: “#NotAllBillionaires is the new #NotAllMen and #NotAllWhitePeople!”

      Compare:
      Not All White People: The King’s Edition

      “Why am I telling this … writer to change their message specifically to center and protect me?”

  37. e.a.f. says:

    I’ve always understood why 1%ers didn’t want health care for all. they might have to kick a few more bucks in for taxes. What never has come to me, is why the average working American isn’t pushing for it. Americans have over the decades have kept voting for politicians who were opposed to health care for all. Is it something in the water?

    • P J Evans says:

      (a) many people had company-paid health insurance that was relatively affordable until the last 20 or so years

      (b) propaganda about socialism as horrible stuff (complete with lots of lies about how it works in other non-socialist countries – like Canada)

      • Rayne says:

        And mostly the latter — like 25-35 years of carefully-crafted propaganda from the right-wing denigrating anything “liberal” so that it’s now construed to be a pejorative referring to the left instead of a political philosophy based on liberty and equality. They did the same to the term “socialism” in spite of the fact the most popular and successful social programs in the U.S. are Social Security and Medicare and they are both socialist and work.

        Some of the decades of propaganda also sowed FUD — fear, uncertainty, and doubt about any new approach to deliver health care to all.

  38. Thomas says:

    SWISH!

    Awesomely concise argument.

    I’ve made this argument myself. Socialized medicine is actually a benefit to an otherwise capitalist economic system. I would argue that socialized college education provides a similar benefit.

    You give K-12 public education as an example, and you’re right, but that system was what the country needed for a 20th century economy, and the 21st century requires socialized college education.

    If I can add a neoliberal argument for the Green New Deal:

    The industrial model of energy production and distribution is a big plant producing massive energy to supply mass population over a step down grid.

    The Green Model must be different to maximize alternative energy resources. It’s the “internet model”:

    Decentralized networks of local energy-producing nodes that supply close to source and share surplus over medium voltage lines.

    In essence, everyone is a capitalist producer and each producer profits from personal/local conservation, selling their surplus where it is needed in the network.

    Imagine the cost savings to both individual consumers and businesses. Imagine the benefit to capitalism, generally. We eliminate monopolies and distribute the wealth broadly, at least in the energy industry, stimulating broad based spending in other sectors.

    And yes, I’m not the only one who has envisioned this both conceptually and in terms of specific integrated technologies in green energy production, storage and distribution.

    • Rayne says:

      Interesting. I will have to think on this, needs some framing.

      Michiganders received an emergency alert tonight if they are a customer of Consumers Energy, the natural gas and electricity provider for about 2/3rds of this state. Customers were asked to turn their thermostats down to 64F until Friday because the state is at risk for a natural gas shortage due to demand in our current polar vortex conditions (it’s currently -13F outside). How do we handle this situation in a distributed production environment relying on multiple forms of alternative energy?

      • P J Evans says:

        It’s like being asked to turn your thermostat up in hot summer weather. (I let mine go up to about 85 in summer, or down to about 63 in winter, before I turn it on – it eats power, especially AC. Not fun when it’s like 110F outside.)

  39. Fran of the North says:

    Sincere apologies, I forgot my own industry when calling out the inertial forces above. My post headed to mods (??) and so I never got my opportunity to take a review in the 5 minute edit window. No subterfuge intended

    * The health insurance industry has many reasons to drag their feet
    *They have very large businesses that can be profitable
    *They expend significant lobbying efforts to maintain status quo
    *They are a backwards looking industry (using history to predict the future)

    Thus they have little incentive to change operations .

    • Rayne says:

      So kind of like the +2000 billionaires until somebody realistically threatens their billionaire status. Then they might get off their duff and do something, oh, like run for office to preserve their status quo.

      I guess we can expect the insurance industry to do the comparable thing, expressed as a corporation does — probably with donations to Howard Schultz’s campaign, hmm?

      • Fran of the North says:

        Absolutely. But they’ll work harder than that.

        Take representatives and senators to lunch and dinner and explain how many of their constituents are employed in the industry.

        Create position papers on how the insurance industry is vital to the process of risk financing.

        Send their agents to the Hill to lobby their representatives personally.

        I’ve seen it all, and they are very good at what they do.

        • Rayne says:

          And a huge chunk of the people now working for the industry will likely be needed in a single payer system.

          But there’s no way around the fact the entire health care insurance industry will need to reset its business models. Like so many businesses in the 1990s-early 2000s they will have to re-engineer.

          What we really need are center-to-left nonprofit entities designed to begin communications across commercial and social media to change expectations.

          It worked on swing voters to get us that ferret-headed freak in the White House after all.

  40. JD12 says:

    We really shouldn’t have to debate this anymore. It’s not like single-payer is some kind of experiment—there are plenty of examples of systems that currently work better than ours. The American public has favored a Canada-style healthcare system in polls going back at least to the late 1980s.

    Those astroturfed Tea Party protests against ACA set us back a few years, but they made it look like they had more support than they really did. More recently the GOP’s attempts to repeal the ACA last year actually caused support for M4A to go up.

    It could be a winning issue for someone to run on in 2020 or 2024. It’s not like the GOP has or will have any alternatives to offer, they’ve had years to come up with one but they haven’t. Their typical free-market arguments are pretty easy to swat down—there is no free market when you’re dealing with lives. When you’re house is on fire you can’t shop around for quotes for firefighters to put it out. And if you’re having a heart attack you go to the nearest hospital, not one with “competitive” prices.

    • Rayne says:

      The 2020 race has already begun. People are already taking positions. And it is a winning issue, one on which Howard Schultz has taken the wrong side.

  41. Jonathan says:

    @Rayne, re the carmakers and case for universal healthcare. They certainly lobby on things that affect their costs like safety and fuel economy. If they had wanted to weigh in when the debate was hot, they could have made a difference. It’s not a matter of stepping outside core competence, adding another line of business, etc. It’s a matter of ordering their DC office to do the kinds of things they already do.

    • Rayne says:

      And they’re not going to fuck up their contract with UAW in the process. They have better leverage to do something if the public leads.

      • Jonathan says:

        Of course the UAW would not lightly give up the health benefits they have fought and bled for. OTOH, Walter Reuther was a fierce advocate for national healthcare and when the business community said nix to that, he was able to get health benefits into the UAW contract for the first time as you know, in 1950. So, advocacy for universal healthcare is baked into UAW’s DNA and if the Big 3 approached them with respect, I suspect such an alliance on the issue could have done big things.

      • Rayne says:

        It takes some experimentation, I know. I am still learning which sites use unique identifiers for individual pages and stories versus tracking identifiers. I can only snag the link, remove what I think is tracking instruction in a URL, then try the link in my browser. If it doesn’t break and goes where I expect, good. If it breaks I try breaking the URL until I’ve proven I can’t remove anything else.

        • Jenny says:

          Good to know.  Somethings there is a / at the end so I know where the break is.  This time no /.  This can get very complicated.  Yep, I could go off the grid any time. Ha.

          Thanks for being the link patrol keeper.

  42. earlofhuntingdon says:

    When he let’s his 24/7 salesmanship down, there’s nothing light about Howard’s neoliberal Republicanism. Sounds more than a tad sexist. In Seattle, that’s not gonna go far. And something about how many incidents there were at his former company involving people of color – either for just being in the store or for not buying something quickly and hanging out for hours like those needing free wi-fi – smacked of a lack of messaging from the top. Now I’m wondering why he left his company.

  43. gadfly says:

    Rayne:

    You are blaming employers for concepts developed by medical providers and insurance companies to assure that they get paid. Not only are insurers dictating pricing, they are dictating drugs and permissible treatments.

    Concepts here: Take employers out of the business of providing healthcare; Never put the government in charge of anything; Return to the days of yesteryore when patients and doctors made one-on-one agreements on care provided and applicable charges.

    The big five insurance companies in health care must compete for your business and providers will suddenly have to provide price lists. If you don’t want or cannot afford health insurance it is nobody’s business but yours –  but upon returning to free enterprise, more affordable policies will be offered.

    As for those unfortunates with preexisting conditions, we are outside the concept of insurance and into welfare programs – which is where government might want to put its efforts –  but even here, Americans are generous contributors to charity.

    • Rayne says:

      So basically you advocate going back to an era when children died for lack of vaccinations and adults dropped dead of diabetes otherwise manageable — for starters.

      Got it.

      This bit is particularly fucked up: As for those unfortunates with preexisting conditions

      EVERY WOMAN WHO GETS PREGNANT HAS A PREEXISTING CONDITION.
      EVERY WOMAN WHO HAS PAINFUL PERIODS HAS A PREEXISTING CONDITION.

      We’re talking at least half the goddamn population has a preexisting condition according to insurers because they are female humans.

      And you think we should just suck it up? We’re just charity cases?

      You are not worth the energy I have just spent on this comment. You’re now two for two after your December comment throwing around the term RICO.

      p.s. If you show up here again under a different user name — you have two now — your comment will go into the void.

      • gadfly says:

        Sorry about the two names – I use both – one for Blogger and the other for Discus – so when I am on any other site, I don’t have a rule that I remember. I certainly will remember now!

        As for my concepts, I believe that Obamacare failed because the insurance concept was violated and people were forced to take coverage that they did not want and everyone has to pay for coverage they do not need. So the cost for everyday coverage was astronomical as was easily predictable.

        Medicare for all will not work  – simply because the government only pays about 10% of billed services now and insurance companies and providers survive by upcharging everyone else. When we are down to single source payer, the efficiency of the organization that pays is important to controlling costs  – and government doesn’t understand the concept.

        We will have far less providers, thus more limited service, under a changed Medicare. The Brits and Canadians have never backed out of the their single payer system because, once you start, change is impossible to manage in the bureaucrats mindset.

        And us old folks do not believe that doctors failed us in the old days – but we do know that waiting times were short, medical offices were modest and staff did not outnumber patients.

        And If I may, I apologize for my ridgid accountant’s mind which tears the emotion out of this important subject. Nobody buys a  Cadillac if affordability is an issue – but the government never considers options.

    • Fran of the North says:

      Gad: Your lack of understanding of this topic is breathtaking in scope. Perhaps you were the consultant that whispered in Individual-1’s ear that we could provide health coverage for all citizens for the low low cost of only $ 5 per month.

      The delivery of healthcare to the people of the US is incredibly complicated. There are many moving parts. There are vast numbers of people and organizations with conflicting goals and agendas.

      It’s less than helpful to regurgitate simplistic solutions and talking points that aren’t logical nor offer solutions. There are solutions. They’ll take hard work and compromise.

    • earlofhuntingdon says:

      Say, “Hi,” to John Galt when you meet him in the void.  You’ll have lots to talk about.

      A tad less snarky, yes, insurance companies grossly manipulate their business practices in order to maximize their revenue.  American executives become senior executives only when they have drunk that Kool-Aid.  They believe that is the only possible business model to have.  America’s insurers are not alone in having run touchdown after touchdown with it.

      In the provision of health care, however, such practices should be prohibited.  Government is the only social institution with the power to prohibit such practices and require new ones.

      Health care is a moral and civic right, one of many that constitute public goods.  It should be available at cost, without the need to allocate, say, $58 million just to the CEO of Aetna – a middleman between patient and provider – for one year’s labor. His compensation is a handy gauge to the rent extraction his industry accomplishes. It is a major driver in why America has the highest cost health care in the world, with only mediocre outcomes.  Anti-monopoly, anti-price gouging, and other measures need to be enforced.  Without health care, society as a whole suffers, as do people, and every private business.

  44. pizza says:

    Some group of billionaires should start a healthcare company of their own with the express mission of growing a big as possible to swallow up all the others and thus become the single-payer system this nation needs.  It’s not entirely inconceivable.  I am a wishful thinker though.

  45. pizza says:

    gadfly says:
    January 31, 2019 at 10:43 am

    – I don’t want to get into the middle of anything but gadfly you really should put down that cup of Kool-aid.  I was like you and kept eating the bullshit the 1% spews constantly to hide the truth.  I used to think socialism was a bad word but I’m a full on socialist now.  Fuck it!  I’m not listening to their garbage anymore.  I know what life is like and I know what we have now is unfair and unsustainable.

    The “free market” won’t fix any of this just fatten the bank accounts of those who don’t need it.  Don’t listen to those lies anymore. They lie to divide us so they can keep us down.

  46. Willis Warren says:

    Karl Rove has an article, which I haven’t read, about how Medicare for All will make you lose your health care plan, or some shit.  I’m amazed at how bad (faith) the arguments against M4A are in general, but Karl probably doesn’t understand Medicare and how it works currently, let alone has he ever had to worry about a health care plan.  It’s a stupid fucking argument and it doesn’t require you to know a whole lot about the industry to see that it’s full of shit.

    What no one is arguing, and what is certainly true, is that M4A would drive down costs for medicare and probably the entire industry.

    Currently people 65 and over pay 135$ per month in premium for medical insurance through medicare.  That’s it.  Sure, you have to add a drug plan (33$ on average), but the premiums are still less than 170 per month.  That’s 85$ every two weeks, which is less than what most people are paying for insurance through their employer.  If you want, you can add a Medicare advantage plan with drug coverage for 0$ (most of them) in which medicare outsources your healthcare to UHC or Humana or whoever.

    That’s 135$ a month for a plan that is every fucking bit as good as people under 65 are paying through their employer.

    Remember, the over 65 risk pool is the riskiest risk pool.  Now, even in the medicare field, there are agents making 300k a year, probably an average around 75k a year per agent.  That’s a lot of money being sucked out of the system by the healthcare providers.

    Add in people under 65 to this system, and the risks go down.  Yes, that’s the way the system works, fuckers.  Stop lying about this.

    I’m a pretty firm believer that deficits drive down the cost of healthcare, so running deficits will force hospitals to stop charging bullshit prices and double billing.  I have detailed files on this if anyone wants a more complete writeup.

    • Trip says:

      I noticed that the right wing talking points always start with, “They’re going to take away your….” (fill in the blank). That always sounds like a scary proposition that you will lose something and by force.  “Do you want someone to take away your coverage?” sounds terrifying. Of course the answer is “No, I want coverage”. They intentionally phrase questions so that the respondent will react with a defense of keeping something, rather than asking if they’d like to pay less or be guaranteed coverage. It’s a nice slight of hand parlor trick.

      • Rayne says:

        Exactly. The right-wing knows the only real barrier to a single payer system is the threat of losing their current health care provider.

  47. Fran of the North says:

    Reply to AitchD @ 12:07.

    None other than Warren Buffet has called employer sponsored health care a threat to US companies competitiveness. While corporate taxes are 2% of annual GDP, US health care costs are 17% of GDP.

    He makes his point clear with this quote: “Medical costs are the tapeworm of American economic competitiveness.”

    The partnership btw Amazon, Berkshire and JP Morgan is initially designed to create a solution for the employees of the 3 companies. No one should make the mistake that that is their only goal. Once proven, they’ll take their solution to market.

    Jeff Bezos (CEO Amazon) is quoted as having said “Your margin is my opportunity”.

    And Warren Buffet bought a little insurance company that was started to insure government employees. You may have heard of it. Government Employees Insurance COmpany. Their mascot is a green lizard that you see on Tee Vee all the time.

    That solution doesn’t obviate what this thread is discussing however. No matter how noble the intent of helping American business’ competitiveness, that partnership will be still be designed on a for-profit basis. The profits may be a bit smaller, and who ultimately pockets them may change, but there will still be excess cost (those profits) in their solution.

  48. cfost says:

    Hillary Clinton was vilified when she pushed for healthcare reform in the early 90s. Ronald Reagan began the “government is the problem, not the solution” mantra on the day of his inauguration. Yet any objective observer would say that the government is handling Medicare very well. If people knew more of the details about all the shenanigans by hospital systems, Pharma corporations, doctors, and insurers, there would be even more outrage. Medicine in general, in this country, is a corrupt mess.
    What we’ve seen done by big tobacco, big oil and big auto, we’re seeing here with medical care. Attack, confuse, distract; and if you can’t win (as with ObamaCare), then make sure the final product has big problems, so you can spend the next ten years attacking it. These propaganda methods really aren’t so different from Russian methods.

  49. P J Evans says:

    @Willis Warren January 31, 2019 at 12:04 pm
    Assuming you can afford any of them, which isn’t guaranteed once you’re retired – and Medicare is not as good in some ways as ACA coverage. (It’s about $135 a month for part B coverage, regardless of your actual income. Things that need fixing.)

  50. Michael Keenan says:

    If you feed the horse enough coffee beans, some will pass through to the road for the homeless
    .

    • Rayne says:

      Or the coffee bean purveyor will hit upon a new, even pricier coffee product made from “pre-processed” beans.

      Road apple coffee.

      Swear to gods this is how somebody hit on that stupid kopi luwak — civet cat coffee.

      And another batch of low-wage jobs will be conjured to sweep up behind the coffee bean consuming horses.

  51. Willis Warren says:

    @PJ

    if you can find me an ACA plan for 135 a month (you won’t) then we can talk. ACA is a huge pile of shit because they shit on it until it’s nothing but shit.

    Even the subsidized plans have deductibles that are far higher than medicare (which has a 185 part b and 1350 hospital). if you can’t afford the monthly premium for part b, you qualify for medicaid.

    Like I said, I’m prepared to lay waste to anyone on this issue. I have detailed files

  52. Willis Warren says:

    And don’t think I’m not gonna take a free shot at the stupid fucking libertarians.  They’re always talkign about the broken window fallacy… well, healthcare is the BEST FUCKING EXAMPLE OF THAT and they conveniently ignore it

  53. Eureka says:

    @ Savage Librarian 704am: Yes- to see the woman who should be *Gov Abrams* address the nation in counter to the very corrupt cabal who designed her defeat will be historic and legendary. In thinking about it, I can’t recall a prior SOTU response as meaningful.

  54. Rayne says:

    The author’s mission with this post was
    — to point out so-called business geniuses aren’t;
    — to note even a currently unpopular economic theory finds flaws in claims that health care should remain as it is in the U.S.;
    — under no obligation to develop a strategy for funding health care for all since this is a democracy and a public program should be debated in public (as it is with this post);
    — to provide dissent against a system which has been created by, bought by, implemented and enforced by old rich white dudes in spite of the fact they are a minority in the population (hello plutocracy, the true wedge creator).

    The author further finds it odd a commenter with an IP address in the heartland of the US insists on using a Russian email account.

    Lastly, the author would definitely fail if they didn’t tell you to kindly fuck all the way off.

    EDIT — 2:11 PM ET — Dorian, that last sentence? That’s for you. Don’t waste your time or ours.

  55. Thomas Paine says:

    The reason Schultz and all friends like company paid healthcare is because those companies are subsidized by Uncle Sam to provide it. I would bet, most of them make money from the subsidies. Medicare-for-All could probaly be rasily paid for by ending these subsidies and rationalizing the market. By rationalizing I mean removing the middlemen from both the paying and providing ends of the business who suck up 30% of every healthcare $$. Medicare’s overhead is only about 4% by comparison. The economy would get a huge boost by eliminating the 26% of wasted $$ on all the healthcare market middlemen, but you’d have to kill havr the bastards on K Street to
    let it happen.

  56. Eureka says:

    I happened upon this piece from the Atlantic which tastes great with coffee man- and lots of others. Fits with many elements of this discussion:

    Power Causes Brain Damage
    https://www.theatlantic.com/magazine/archive/2017/07/power-causes-brain-damage/528711/

    Quoting excerpts with internal links removed:

    If power were a prescription drug, it would come with a long list of known side effects. It can intoxicate. It can corrupt. It can even make Henry Kissinger believe that he’s sexually magnetic. But can it cause brain damage?

    The historian Henry Adams was being metaphorical, not medical, when he described power as “a sort of tumor that ends by killing the victim’s sympathies.” But that’s not far from where Dacher Keltner, a psychology professor at UC Berkeley, ended up after years of lab and field experiments. Subjects under the influence of power, he found in studies spanning two decades, acted as if they had suffered a traumatic brain injury—becoming more impulsive, less risk-aware, and, crucially, less adept at seeing things from other people’s point of view.

    Sukhvinder Obhi, a neuroscientist at McMaster University, in Ontario, recently described something similar. Unlike Keltner, who studies behaviors, Obhi studies brains. And when he put the heads of the powerful and the not-so-powerful under a transcranial-magnetic-stimulation machine, he found that power, in fact, impairs a specific neural process, “mirroring,” that may be a cornerstone of empathy. Which gives a neurological basis to what Keltner has termed the “power paradox”: Once we have power, we lose some of the capacities we needed to gain it in the first place.


    End quote.

    • earlofhuntingdon says:

      Perhaps as likely, those with a “power” brain inherently lack capacity for “mirroring,” empathy, and thus have fewer constraints in using power to accumulate more of it, to the obvious – but to them, irrelevant – detriment to others, including the whole planet.

      • Eureka says:

        And either path would lead to what might be called ~ a neurodevelopmental scion problem.

        If it’s not there to mirror, it’s not there.  Consider (Fred>) Don Sr and Jr, Princess, among many others.

Comments are closed.