Thanks, Barry Ritholtz
Says who? The Koch Brothers…
A new report – from an unlikely source – now underscores the obvious truths about medical care for all, one of the most troubling underlying issues of the day and certainly for November’s mid-term elections. The libertarian-leaning Mercatus Center report lays out the overall costs of medical care for the country over the next decade or so and tries to deal intelligently with getting that overall cost under better control.
In the report, the author attempts to roughly score Sen. Bernie Sanders’ most recent Medicare for All bill and reached the somewhat surprising (for Mercatus) conclusion that if the bill were enacted the new costs would be more than offset by the new savings it generates through administrative efficiencies and reductions in unit prices…Along the way, 30 million additional Americans would be covered while saving billions of dollars.
RTFA. No doubt conservatives and libertarians are embarrassed by math and facts getting in the way of ideology. That hasn’t stopped from otherwise doing their damndest to interfere with working folks trying to reorder the politics of our society to better provide for a healthy and equitable life.
❝ The U.S. white working class is in big trouble. The data is piling up. Economists Anne Case and Angus Deaton have a new paper out, exploring mortality trends in the U.S. The results confirm the finding of their famous 2015 study — white Americans without college degrees are dying in increasing numbers, even as other groups within and outside of the country live longer. And the negative trends continued over the past year.
The problem appears to be specific to white Americans…
❝ Why is this happening? Case and Deaton don’t really know. Obesity would seem like a possible culprit, but it’s also up among black Americans and British people, whose mortality rates from heart disease have fallen. Deaths from suicide, alcoholism and drug overdoses — what the authors collectively call “deaths of despair” — have been climbing rapidly. But they only account for a minority of the increase. And no one knows the definitive reason for white despair.
❝ Case and Deaton instead suggest economic causes — lack of opportunity, economic insecurity and inequality. But this is hard to square with falling mortality for black Americans, who also suffered mightily in the Great Recession and have been on the losing end of increasing inequality…
❝ …But whatever the cause, I know of one policy that would go a long way toward fighting the baleful trend — national health care.
A national health service — which also goes by the names of single-payer health care and socialized medicine — would drive down the price of basic health care. Because an NHS would be such a huge customer, it would be able to use its market power to get better deals from providers. This is probably why the same health-care treatments and services cost so much less in Europe than in the U.S. — those other countries have their governments do the bargaining. In fact, this already works in the U.S. — Medicare, the single-payer system that ensures the elderly, has seen much lower cost growth than private health insurance, even though Medicare isn’t yet allowed by law to negotiate for cheaper drugs…
Though the Pentagon is allowed to do for our military.
❝ Finally, an NHS could prevent overuse of opioids. Prescription of painkillers has been a major factor in the opiate epidemic, which has hit the white working class hard. Drug manufacturers, however, have lobbied to preserve widespread access to opioids. These companies have also given doctors incentives and perks — essentially, bribes — to keep prescribing these dangerous drugs. An NHS would be able to resist lobbying pressure and make sure doctors didn’t have an incentive to hand out too many opioid pills.
❝ A NHS wouldn’t require the creation of a new bureaucracy — it would just require expanding Medicare to cover the whole nation. There’s already a campaign to do this, led by none other than Senator Bernie Sanders. An NHS also wouldn’t prevent rich people from buying expensive or rapid treatment in private markets.
I agree with Noah. “If…Trump wanted to prevent the people who elected him from continuing to die in rising numbers, he would join Sanders in the campaign to extend Medicare to cover all Americans”…But, then, we already know Trump is a pathological liar. I wouldn’t trust him to carry through even on a promise to Bernie – much less the rest of us.
No, I like the idea of supporting the election of for-real independents regardless of whatever political label they want to slap on their foreheads. Fight for single-payer expansion of Medicare to all and I’m there, Bubba.
BTW, Noah Smith is one of the jillions of folks on Twitter actually worth following.
❝ National health insurance has become a defining issue in the contest for the Democratic nomination. Bernie has put “Medicare for all” squarely back on the table. Hillary calls that pie-in-the-sky: instead, she would build on the Affordable Care Act…As she says, market-based private insurance was originally her idea.
❝ We can all agree that the ACA has benefited many, particularly the poor and the sick.
But Medicare for all has picked up some interesting supporters: for example, Fareed Zakaria, a high-profile TV commentator whose beat is foreign affairs, and Donald Berwick, MD, who, as administrator of the Centers for Medicare and Medicaid Services, supervised the roll-out of the ACA.
Moreover, the Kaiser Family Foundation December 2015 Tracking Poll demonstrates majority support among ordinary Americans – 58%; a 2014 survey of physicians and medical students in Maine showed that many doctors also (in Maine at least) would prefer single-payer, especially those practicing primary care.
So it is disappointing that liberal economists whom I respect, such as New York Times columnist and Nobel laureate Paul Krugman, conclude that single-payer would be too expensive and too disruptive — that we should improve the ACA instead.
❝ Krugman, of course, is trained to crunch numbers — I can’t. But from the exam room where I sit, his conclusion doesn’t make sense. The principal advantage of single-payer, after all, is that it is less expensive than our market-based system.
That is not just idle speculation: every other developed nation has either some form of single-payer or highly regulated private insurance with price controls — and they all achieve better health outcomes, with genuinely universal coverage, for at least 30% less (as a fraction of the Gross Domestic Product) than we do, even though we still cover something less than the entire population.
❝ Perhaps the economists simply substituted Treasury payments for employers’ contributions to their employees’ health insurance (something the ACA was specifically designed to preserve), and left everything else in place: that would indeed be a huge hit to the federal budget, particularly since employers, representing a large group of mostly healthy employee families, can negotiate better deals with insurers than individuals can.
But that is not how Medicare for all would work. Instead, it would be like Medicare today, improved to make it even less expensive for the Treasury and individual beneficiaries. Since everyone would receive the same, comprehensive benefits, administrative costs would be much lower. The huge transaction costs engendered by the ACA — hundreds of thousands of annual negotiations between insurers, doctors, hospitals, pharmaceutical benefit managers, and manufacturers — would decline significantly…
❝ Finally — and most controversially — Medicare, which currently sets prices for doctors and hospitals, would extend price controls to other health services, such as prescription drugs and devices, through open procedures with due process and opportunity for comment as mandated by the Constitution. Or Medicare could negotiate prices, as the Department of Veterans Affairs currently does.
I didn’t include the whole article. The core is here. RTFA for details – which further illustrate the benefits of Dr. Poplin’s proposal. I’m pleased she included mention of the negotiations already standard procedure for the Department of Veterans Affairs. Nothing new. Part of normal operations for years resulting in significant cost savings.
Speaking of costs, you should take notice of the history of what’s accepted as standard in the medical-industrial complex vs federal government management of Medicare or, say, Social Security. Administrative costs to civil service managers run in general less than 3% to run those programs. Insurers bag taxpayers 15-25% for the same kind of work.
A cost I look forward to seeing brought down to the level of existing entitlements.