Bernie Sanders’s health care plan is underfunded by almost $1.1 trillion a year, a new analysis by Emory University health care expert Kenneth Thorpe finds.
Thorpe isn’t some right-wing critic skeptical of all single-payer proposals. Indeed, in 2006 he laid out a single-payer proposal for Vermont after being hired by the legislature, and was retained by progressive Vermont lawmakers again in 2014 as the state seriously considered single-payer, authoring a memo laying out alternative ways to expand coverage…..
He also argues it would leave 71 percent of households with private insurance worse off once you take both tax increases and reduced health care expenditures into account.
Single payer is tough. As I argued in my post Medicare 200: Medicare E, there are a lot of questions that have be answered to create a feasible plan that could survive first contact with a friendly Congress much less first contact with a hostile Congress:
I understand the desire to use Medicare as the basic structure of a national single payer system as it is a pre-exisiting program whose skeleton is strong enough to build on. However that skeleton has some odd deformities to it, and a lot of trade-offs have been built into Medicare that would need to be re-examined if we were to massively expand Medicare’s scope….
- How should we treat people whose current insurance has an actuarial value (AV) in the high 80s or better (Medicaid, CHIP, Cost sharing Silver 1st and 2nd Tier, Platinum, good union deals etc)? Do we transition everyone to Medicare’s 81/82% acturial value and tell people with good, high AV insurance to suck it? Do we keep high AV plans? If we keep high AV plans, how do we prevent massive cost dumping of sick people from private pools into public pools.
- How do we treat Medicare Supplemental policies to increase AV?
- Medicare is a good insurance program but it is not a perfect insurance program. The biggest problem with Medicare from a beneficiary point of view is that it does not limit maximum annual exposure to costs nor does it do well with extreme outliers of care. As we’ve seen, Medicare Part B has a 20% co-insurance rate with no out of limit cap. Medicare Part D has a 5% co-insurance rate with no annual cap. Medicare Part A limits annual and lifetime hospital days covered….
I have a much harder time seeing how that end is achieved if Medicare-E advocates don’t start answering the hundreds of policy implementation and management questions that Medicare-E would entail. The biggest problem with Medicare-E is how to finance it from people who will be made significantly worse off. People with high incomes are highly likely to already have better than Medicare insurance through either work or the Exchange. Not pissing this group of people off is critical to building a winning political/legislature coalition. Not pissing this group of people off will either involve unicorns shitting bricks of gold out of their ass, or some seriously odd plumbing. A simple slogan does not address this critical blocking problem.
What is the solution?
Assuming Professor Thorpe is correct, most people would be worse off by the Sanders plan either through higher net taxes or lower actuarial value of coverage. Even more importantly, the people who will benefit the most are less likely to vote in general and less likely to be single issue voters on the matter of health insurance financing reform than people who will be screwed by the plan.
How does this work?
And back to Vox on the different assumptions being made:
Sanders assumes $324 billion more per year in prescription drug savings than Thorpe does. Thorpe argues that this is wildly implausible. “In 2014 private health plans paid a TOTAL of $132 billion on prescription drugs and nationally we spent $305 billion,” he writes in an email. “With their savings drug spending nationally would be negative.” (Emphasis mine.) The Sanders camp revised the number down to $241 billion when I pointed this out…..
Sanders assumes $160 billion per year in savings relative to Thorpe because, they argue, he includes elective procedures like plastic surgery, which single-payer wouldn’t cover. Thorpe disputes this: “Cosmetic surgery, really? That’s $12 billion a year and in the second decimal of rounding.” In other words: There’s no way excluding plastic surgery can give you $160 billion of savings.
These types of things are hard. It is a proposal to rejigger 17% of the US economy. It should not be easy. But if the proposal is to be credible, the people behind the proposal have to do their homework and avoid the WTF errors.
Projecting a prescription drug saving greater than total private sector prescription drug spend is a WTF error. It is a lazy error and does not advance the argument that Sanders wants to make.
FlipYrWhig
Clearly Kenneth Thorpe is part of the corrupt establishment. He probably has a credit card from Bank of America, which means he’s tainted and trying to bring down the true maker of revolutionary change.
Cacti
There you go with your facts and figures.
What about the analysis of revolution and bully pulpit?
Well?
Marcelo
@FlipYrWhig: Well the Sanders people did accuse him of being a shill for BCBS because he once consulted with them on the racial makeup of people who enroll in Medicare Advantage. So you’re not far off.
Gin & Tonic
This is a very disappointing post, as it probably scuppers any chance of the Hillary Rettig post downstairs reaching a TBogg unit.
Davis X. Machina
I’m just spitballing here, but I figure that one of the prerequisites for a social democracy in the US is a shitload more social democrats…
Bobby Thomson
I bet your kid lives in Trump Tower.
Paula
Question:
Bernie’s willingness to re-fight health care after a mere 8 hears after a bruising policy fight is probably a bad idea, but I also see an argument floating around that Obama “sent [the OFA/his supporters] home” or “shut them down” during that fight and that is why he ceded so much ground to Republicans. Implying that Bernie will do a better job of mustering the vote of his ardent voting block towards policy goals after becoming president.
Is this … true/desirable? I had to unsubscribe from OFA a few months after the election because I was getting too MUCH damn e-mail from them. so I have no idea. Barack Obama was not only no longer campaigning, but I also thought it part of the natural order that the organizing arm would act independently to enact policy rather than waiting around for marching orders — presumably because after running a national campaign, they would have the skills to pay forward.
(Which doesn’t get into the more relevant point that anyone interested in leftist policy probably shouldn’t be beholden to organizing tied to a mainstream party.)
Cacti
St. Greenwald has taken to attacking Paul Krugman now, for being insufficiently obsequious to The Bern.
Shut up Krugman! Do you think you have a Nobel Prize in economics or something?
Lord Baldrick
Clintonoids would do well to avoid Charles Pierce today.
ellennelle
richard, always enjoy your level analyses.
first, in thorpes’s calculations, is the government’s role in keeping costs down even considered, at either the basic or pharm levels? i mean, it seems to me we’re not necessarily talking about the same beast if there is no longer profit to be made at the insurance level. won’t costs necessarily drop when medicare is the only game in town?
second, these analyses that only look at the cost at the government’s level seem also too constricted. i mean, should not the cost to the consumer also be considered? this point gets glossed over so much it is baffling; is not healthcare as it is delivered to the consumer the point? so, if i have to pay as much as 5% more in taxes each year, but do NOT have to pay the $12k in premiums, plus deductibles and co-pays, i will necessarily be saving a good chunk of change.
plus, one would assume these cost adjustments in favor of the consumer will only improve over time, likely also in favor of the treasury. i mean, after all, if gazillions are not wasted (and let’s face it fans, waaaay too much of our healthcare dollars are wasted; i’d say along with sanders that ALL health insurance dollars are wasted, so get rid of that middleman, please), and citizens have minimal worries wrt healthcare, and they have more in their pockets to spend on other things, then there is that much more to spend in the economy, increasing tax revenues, etc.
this is of course the long view, which i have noticed not many naysayers appear too capable of considering. or, to put it in a more respectful way, those who count the beans rarely even know there is someone hungry within a few feet of them.
chopper
that certainly looks bush league.
Richard Mayhew
@ellennelle: Yep, Thorpe does assume a blended average payment rate of roughly 105% of current Medicare FFS the minimum break even point which would be a significant reduction in total medical spend.
He did an analysis of increased taxes versus lack of premium payments that is where he partially gets his 70% of people are worse off figure.
As to your third point, that is too hard a of a point to model over a generation or more, so a static analysis of what the first few years would look like is what Thorpe did… and what the CBO would do….
msdc
I just want to say how much I appreciate a primary elections post that has nothing to do with polls, supporters, likeability, “narrative,” or any of the other bullshit that consumes 99% of our political discourse. A nice reminder that the winner will ultimately have to deal with reality, and that elections have consequences.
Tractarian
Maybe Hillary can cover the shortfall with her speaking fees?
Jake Nelson
@Richard Mayhew: Q for Richard, possibly open-ended, but thought I’ve had lately: how workable/what would the issues be for requiring all providers that accept Medicare to charge no more than 150% of Medicare rates for non-Medicare patients? IE, the uninsured, people with crappy employer insurance, etc.
Seems more doable to me than all-payer rate setting, and a starting point for a future ratchet…
Brachiator
@Cacti:
This is too funny. Greenwald has always been full of himself, but it takes some nerve to attack an economist on his home turf if you are not bringing an equivalent level of genius. And Greenwald ain’t no genius.
ellennelle
@Richard Mayhew:
wow; thx richard. appreciate the speed of response.
of course, the aphorism about bean counting and hunger – no stats for that.
;-)
Brachiator
@Paula:
Would Bernie have a voting bloc, ardent or otherwise, that would comprise a majority in the House and Senate?
Very unlikely.
? Martin
Yeah, I didn’t see how Sanders plan could cut health expenditures to the degree it claimed.
And I’m not sure why he’s going to such a large ask. Expanding Medicare A makes sense. Medicare B+D less so. Aim for a two-tier system like much of Europe – single payer catastrophic care and market-based doctor + other. Insurance companies won’t necessarily fight this since their worst risk exposure is in the single payer part.
It requires redefining Medicare A and Medicaid, which is a political risk in itself. But there’s a reason why Medicare was created and why it was part A at the outset. Start there. If the political winds and economics blow B into the picture, then fine, but you’ll have done a fuckton of good just getting A under everyone’s feet.
Botsplainer, cryptofascist tool of the oppressor class
Richard is clearly a running dog lackey of a revanchist oligarchic reactionary and can thus be dealt with swiftly as the Revolution proceeds to its inevitable conclusion.
gene108
@ellennelle:
The point about actuarial values (AV) of plans is that for a sizeable portion of the population, they will be worse financially after we go to single-payer, because there plans cost them less than what they would be getting covered under a single-payer system.
This is one reason getting to universal coverage has been so hard. For those people, i.e. the majority of Americans, up and until the last 10 years or so, their employer based insurance covered damn near everything with very little going out of pocket.
Due to the ramp up of costs over the last 15 years in medical spending employers are offering less generous plans and having to charge more for them, because costs go up every year after year.
People with employer based coverage had less to lose in 2009-2010.
I lot of single payer advocates seem to be salivating for the chance to wipe private insurance out, but private insurance companies are not responsible for driving the cost of health care spending. If anything they try to keep the costs down, with what ever limited leverage they have over providers, because they are on the hook for paying providers.
If the government could step up and put in stronger regulations on what providers can charge for different services, you will see a change in what health car costs.
You can keep them around, but have very clear rules for how to bill, what can be charged, bill codes, etc., so things are uniform across insurers.
The insurance companies really are not a factor, with regards to wasteful* spending.
I think that’s what is being debated in this thread. It is not a given that everyone will have more to spend in their pockets because of single payer.
Getting the plan design correct is important.
Medicare has gaps, as described above, which would make it worse for people in some cases, such as having a major surgical procedure.
For example, you pay 12k for family insurance through your employer. This payment is pre-tax, so you do get a tax benefit there, which will vary depending on earnings, but could net out what you pay to be more like 9k.
Anyway, tax savings aside, you have a 3k deductible and 20% co-insurance.
Under the PPACA the annual out of pocket maximum for a family is about 13k.
You get hit by a bus.
You go to the ICU. Your medical bill is $300,000. You are on the hook for 13k. A big chunk of change.
We go to Medicare for All. You have Medicare Part B, which pays 80% of your bills, leaving you on the hook for 20%. You need to pony up 60k. A bigger chunk of change and probably leaving you worse off.
Therefore what critics of Sanders’ single payer notion are saying is the devil is in the details and Sanders has provided very few details.
EDIT: * What is wasteful is very subjective. A rarely used drug combo maybe needed by someone, because they do not respond to conventional treatment for something like high blood pressure. Who decides the cost / benefit here? Right now there’s very little done to look at cost / benefit. If it costs a ton of money, relative to other options, but has a benefit we go for it. Costs be damned, if the patient can afford it.
MomSense
@Paula:
Nope. Not true at all. I was volunteering for OFA and ACLU, later HCAN which was a coalition of a bunch of labor and other groups. The President even joined OFA conference calls to update us and thank us throughout the process.
jl
Thanks to RM so much for this post with the links, which I will surely read.
IMHO, there are some crucial points not discussed in the links I’ve had time to read (very quickly), and I think they are important points. And they concern the idea of using Vermont’s experience to estimate the costs of a federal single payer plan, at least from what I have read.
One was mentioned, which was cost control. Hsiao’s original plan had strong regulatory power for cost control. Shumlin backed off from those, that reduced savings, and one reason a detailed financing plan was put off. Vermont also had to deal with regulatory limits on states, crucially ERISA, but also others, that meant VT had to entice employer plans into joining the system rather than having coercive regulatory power. VT was counting on waivers and legislation to solve that problems but they failed.
Finally, VT has a very concentrated insurance and provider market for major cost drivers of care, particularly inpatient care. So understanding what kind of pricing would reflect average costs was difficult, and another reason to put off a detailed financing plan, especially after Hsiao’s strong cost-effectiveness regulatory regime was scrapped.
So, it will be interesting to read through these analyses to see what the assumptions are.
I wasn’t happy with Sanders’ roll out of his single payer plan, since its lack of details on important issues of cost-control, benefit design, and pricing would invite exactly these kinds of attacks. I think people are over looking the importance of what the econ bizz calls ‘price finding’ which means, how to determine what prices for services will cover average costs of provision. I hope RM is sympathetic, since he has written about the effect of regional and local insurer and provider market concentration on prices, and how the prices in such markets can diverge from average costs.
Also, the issue of how to ‘say NO’ in a way that is politically feasible in the US, and will not produce public fear and outrage needs to be tackled.
I’ve read some analyses of the Sanders plan which seem more to be shallow and ‘savvy’ attacks on the very idea that the US can ever get a cost-effective health care system that provides something better than the worst population level health statistics of two dozen other high (and recently some middle) income industrialized economies. Some just said ‘Well, powerful interests make a shitload of money off the system and can’t do nothing about that’, and others have said ‘the US can’t say NO, so we are doomed’. I’m not saying that the Thorpe analysis implicitly makes these assumptions, but something to look for in his analysis.
I think the country needs a plan that helps with ‘price finding’ and dealing with regional and local market power, and helps with ensuring cost-effective care. To some extent, focusing too much on what type of financing system is used to pay for it distracts from those issues.
Anyway, I’ll read what Thorpe says with great interest.
FlipYrWhig
@Paula:
A/k/a “he didn’t. Even. Try.”
So, by this theory, the ardent voting block thunders with rage and then… Republicans are so scared they vote the way Bernie voters like? Does that sound like something Republicans are in the habit of doing? If it didn’t work when children were gunned down in an elementary school, it’s not going to work reinstituting Glass Steagall.
FlipYrWhig
@ellennelle: Yes, American politics is full of good and helpful plans being adopted because they are good, and rarely are things like “changing what half the population is used to doing” obstacles to accomplishing them.
Richard Mayhew
@Jake Nelson: That might work — biggest problems against the idea:
a) Supreme Court and the freedom to contract argument as we are in a near Lochernian majority right now
b) Availalbility of appointments. If we are to assume that there are some specialties with legitimate shortages, 150% of Medicare is a price ceiling way below the current market clearing rate. I am thinking dermatologists for one group and pediatric endocrinologists for another — Those docs right now are getting commercial rates of 225% to 400% Medicare and they still have 6 month waits
Richard Mayhew
@Botsplainer, cryptofascist tool of the oppressor class: Tumbrels or hungry ducks — which version of the Revolution are we in this week?
FlipYrWhig
@ellennelle:
Are all grocery store dollars wasted because they’re a profit-sucking middleman between the people and their food? Does the fact that we don’t have a single-payer food infrastructure where the government runs all the stores, thereby avoiding food deserts and bolstering public health, mean that all politicians who don’t support this have been corrupted by Big Grocery Interests?
jl
@gene108: I agree that Sanders hammers too much on insurance companies. There is not enough savings in their administrative costs, and not in insurance company profits. Profits of the whole insurance industry (health, life, property, disaster) as a percent of GDP is less that the gap between what the US pays for health care and other high income industrialized coutries (again, as a percent of GDP).
What insurance companies are forced to do in order to control their short run costs, may increase expenditures. But that is not a story of evil profiteers, but of desperate amoral corporations trying to survive in a bad system (and some profiteering as well, of course).
AliceBlue
Charles Gaba (aka Brainwrap) said something along these same lines over on DKos and the Bernistas turned on him like a pack of hyenas. The viciousness was unbelievable.
different-church-lady
Richard Mayhew: newest enemy of the Revolution.
@Brachiator: Hey, hot Nobel on Pulizer action!
different-church-lady
@AliceBlue: The only heartening thing is Gaba’s subsequent lament and call for decency got about twice as many recs as the average DKos polemic that makes the list.
jl
@? Martin:
” And I’m not sure why he’s going to such a large ask. Expanding Medicare A makes sense. Medicare B+D less so. Aim for a two-tier system like much of Europe – single payer catastrophic care and market-based doctor + other. Insurance companies won’t necessarily fight this since their worst risk exposure is in the single payer part. ”
I agree with that. Though not all two-tier systems cut things up the way you describe. And quality of the mandatory tier for everyone determines the size of the supplementary tier. As i’ve mentioned in previous threads, the supplementary tier in Switzerland has been shrinking rapidly recently.
What puzzles me is why Sanders did not put out a more detailed plan. I read news articles reporting features of draft plans, and a European-style two-tier system was described in one of them, with a single payer mandatory coverage market, and a supplemental coverage market. If those stories were accurate, Sanders could have put out a more detailed plan, but chose not too. Which puzzles and frustrates me.
Steve LaBonne
This is a fair criticism, but it’s also fair to point out that Obama had nothing resembling a fully thought-out proposal in 2008. In particular he ran against the individual mandate, which as we know is essential to any ACA-like plan.
Hillary Rettig
Richard thanks for posting – appreciate the detail and (as a non-insurance pro) lucidity. I agree that proposals have to be credible.
different-church-lady
@Gin & Tonic: Sit tight — I’ll go say something about Snowden in that other one…
Germy
@FlipYrWhig:
Well, I do know my local grocery store chain (two of them within walking distance of my house) consistently mislabels the prices on their items and every time my wife or I go there we find some mistake on our bill (always in THEIR favor) that we have to have corrected for a refund. They paid a fine to the state attorney general for deceptive practices, their produce is stale, and their packaged goods are overpriced.
I prefer frequenting our farmers markets because the food is more reasonably priced, fresher and my money goes to the producer of the food.
So yes, I do see my local supermarket chain as a profit-sucking middleman.
rikyrah
thanks for this Mayhew
guachi
Reduce spending $324 billion when total spending is $305 billion. That’s Republican level fantasy economics.
No… that’s actually worse. At least it’s plausible in some universe that the economy may grow the absurd 4-6% that Republican candidates claim it will.
DBaker
@Cacti:
Greenwald:: “The economist Dean Baker — previously cited as a financial reform and economic policy expert by Krugman, but who now most assuredly does not “lean Hillary” — quickly reacted to his formal exclusion by Krugman from the Club of Seriousness”
Reality a/k/a the horse’s mouth: “Krugman is largely right, but I would make two major qualifications to his argument. The first is that it is necessary to keep reminding the public that we are getting ripped off by the health care industry in order to make any progress at all. The lobbyists for the industry are always there. Money is at stake if they can get higher prices for their drugs, larger compensation packages for doctors or hospitals, or weaker regulation on insurers.”
Reason 572 that I stopped reading Greenwald long ago – a completely intellectually dishonest argument in implying that Dean Baker actually disagreed with what Krugman wrote when it is clear that he does not.
Just Some Fuckhead, Tone Police
I had a feeling I’d find some tone problems in here when I saw “Bernie” at the top of the post. I don’t understand what the Clinton supporters’ end game here is but it can’t be helpful to keep adopting a very shitty, sarcastic tone. You do not reflect well on your preferred candidate. I’d hate to see her lose because you can’t control yourselves.
DBaker
@jl: I believe that there were very solid reasons during the ACA original debate that the private option was discussed, mostly that Medicaid for all was not feasible because the implementation of single payer would involve depriving too many people of the benefits they already had. The single payer option has flown completely down the memory hole, while I believe it is actually the best of a bunch of bad solutions.
I will readily admit that Bernie is doing a better job in dispelling the usual “you can have you cake and eat it too” pie in the sky that all modern day politicians subscribe to by actually saying that there is a “pay for”
(For example – more tax cuts means growing economy and government will just magically pay for itself regardless of whether bridges are falling down, for example), but not properly thinking out major tenants of his healthcare is very problematic.
I lean Hillary but my heart lies with Bernie as with many people that I know. Idealism gets you only so far while pragmatism gets you further, especially in an environment where the right wing in this country owns most of the media and pushes the goal posts in its direction every day. That said, political activism will push policy in the proper direction – see the fight over Social Security circa 05 and 06 for a prime example that surely can be replicated.
sharl
@DBaker: Are you yourself that Dean Baker? If so, it is a pleasure and honor to see you in this here pit of vipers! {Watch your step, Sir!}
FlipYrWhig
@Germy: True, grocery stores are sucktastic and there’s a whole politics of food that few people talk about. But it’s not a shibboleth on the left.
Richard Mayhew
@Steve LaBonne: Disagree, with the exception of the mandate, the Obama primary campaign healthcare plan had a skeleton that could be built on. The idea was private insurers issuing highly regulated policies on a common marketplace of some sort with significant financial assistance with community rating and guarantee issue of some sort financed by a combination of taxes and cost savings in other federal medical programs.
Marcelo
@Lord Baldrick: Pierce’s takedown of the Wapo article wasn’t so much anti-Clinton as it was anti-Fred Hiatt, and a fair rebuttal of the Wapo page that didn’t contain anything too objectionable about Clinton directly. IMO.
Noclue72
Richard Mayhew must be a cowardly Baby Boomer!
He is an enemy of the revolution and must be destroyed!
Now somebody get on that while I fap to pictures of Bernie Sanders.
Betty Cracker
@jl: I worked for Big Insurance many years ago, and damned if they weren’t pretty fucking evil. For example, one of my assignments was to write a letter to subscribers notifying them of a mandatory PSA test benefit but to word it in such a way that every man who received it would cross his legs tightly and throw the letter in the trash.
ellennelle
@FlipYrWhig:
wrt the middlemen grocers, yes, most – not all – are profit-sucking middlemen, particularly the supermarket chains with shareholders etc. i don’t think there’s much dispute about that. hence part of the push to buy local.
the thing about healthcare insurance, tho, is that we do not need it. we require a conduit to get food to the table from the fields if we are not working them, but healthcare is not the same, and operates quite well in most developed countries without the insurance companies adding a profit-making barrier between me and my doctor.
as a provider myself, i can tell you those in my industry completely and totally abhor, despise, and thoroughly loathe insurance companies. they make all the decisions about who gets treated and how, even with the minor changes with ACA. it’s an unnecessary firewall for the distribution of healthcare. help me understand the morality in that, please.
the medical community is all for single payer, and quite frankly, i would not really trust the integrity of a caregiver who wanted to keep fee for service. profits over patients is not my kind of physician, quite honestly.
jl
@DBaker:
‘ I will readily admit that Bernie is doing a better job in dispelling the usual “you can have you cake and eat it too” pie in the sky that all modern day politicians subscribe to by actually saying that there is a “pay for” ”
I agree. But I think that Sanders needs to start explaining in more detail how that works to get most people a better deal in the long run. Otherwise the inevitable attacks against him as a big government tax and spend paleoliberal who will destroy economic growth and take us back to the (mythical ) post-WWII liberal dystopia will stick.
And I can see how those kinds of attacks can be made to stick. Part of the long con of the reactionaries is to use carefully hidden policy choices (often using the levers of coercive big government power) to redistribute income and wealth upward, and blame liberal policies for the pain.
I’ve known a few Europeans who have complained to me about US taxes being too high. I ask what they hell they are talking about. They say that while they pay less as a fraction of their income, they can see nothing that they get for it. So relative to what they expect to be the social benefits of taxation, US taxes seem to high. So, if that is the gut perception of the average person living in the US, the reactionary attacks (which seem to trigger an almost Pavlovian reaction among voters) needs to be very aggressively countered. And I don’t see Sanders doing that yet, and not in the right way (that is, still too much in stump mode, and not enough in explaining and persuading mode).
jl
@Betty Cracker: I will not argue about the capacity for evil of insurers, and many providers. Just saying that their evil, in the current system, is not profitable enough to get all the necessary savings out the proceeds of their wickedness.
Linnaeus
@Just Some Fuckhead, Tone Police:
Yeah, I’m kinda with you on this, and it’s one reason why I’ve been reluctant lately to enter threads about the Democratic Primary here, even in the case of a very substantive and informative post like this one. It’s getting old.
japa21
@Just Some Fuckhead, Tone Police: Wow, that sounds kind of like the old “Nice little place you got here. It would be a shame if something happened to it.”
I am not a big fan of the tone of either side right now, although I do like both candidates.
This post did not have a “tone” about it.
jl
@Betty Cracker:
Put it this way, the sheer immensity of the senseless waste of the US health care system is so huge, it dwarfs the profits of wrong doing, even in the context of the US way of corporate business. Which is mind boggling, but I think is true.
It is mind boggling almost on the scale of monster black hole astrophysics. But unbelievable mind boggling things are sometimes actually true.
Betty Cracker
@jl: I agree there. Just wanted to make sure we weren’t letting the evil bastards off the hook!
the Conster
@Botsplainer, cryptofascist tool of the oppressor class:
LOL. We’re days away from the Berniebots declaring President Obama an enemy of the revolution.
A thing on twitter being discussed today is a response from an unemployed New Hampshire voter being polled on why Ted Cruz (“the smartest guy in the bunch”) is his first choice:
I’m sure he’d be open to discussing the finer points of socialist dialectic and the differences between “Socialism” and “Democratic Socialism”.
P.S. I’m not a Hillary supporter – just amazed at the seemingly endless supply of naivete on the progressive left.
Cacti
@the Conster:
I thought it was understood that Obama was an enemy of the revolution.
Bernie is kind of running against the last 8-years, but on the Democratic ticket. I don’t think I’ve ever seen anything quite like it.
kc
LOL at a bunch of liberals gloating over the unworkability of single payer health care.
kc
@Just Some Fuckhead, Tone Police:
Heh heh heh.
Noclue72
Don’t worry Cacti, we Bernistas will haul you and the traitor Obama before a tribunal of dudebros and have you sentenced to 50 years of reading the Communist Manifesto or something.
PhoenixRising
…lemme put some fresh batteries in my calculator and whip up some numbers with a sharp pencil…
There is roughly a 0% chance that those who are already winning in the current system (folks who are fairly healthy [no family member has been hit by bus or LT chronic or acute expense disease], splitting their health costs with an employer, getting tax deductions for their portion AND a floor for benefit structure from the ACA, yet whine about how expensive health insurance is and how hard it is to get to see their preferred provider) and who vote are going to support Bernie Sanders’ revolution, if this is a sample of its actualization.
So…it’s been fun, and my reward for listening to Bernie is a Paul Simon earworm that’s been going on since Monday’s town hall with the ads. Maybe I can see a doctor for that in April.
‘ “Kathy, I’m lost”, I said
Though I knew she was sleeping…’
the Conster
@Cacti:
Yeah – the Obama Coalition has noticed.
FlipYrWhig
@ellennelle:
I have never heard this before. I hope it’s true.
I still think the grocery store example is salient. Why doesn’t the state manage a network of distribution points to get food to the public? PX for all! On the merits of policy, I think it holds up. (Underneath it all, I’m a diehard statist.) On the merits of politics, no one pushes for it, but not because of The Establishment, but for other reasons, for instance, because it sounds like something East Germany would do. And that’s partly why single-payer isn’t on the map in the US — because to millions of people it feels vaguely oogy for health care to be something that involves The Government more deeply than it does now.
ETA: And I wish it weren’t so, but 100 years of imagining communist dystopias leaves a mark on the psyche.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@kc:
There. FIFY.
gene108
@jl:
When DKos was pushing for the public option, back in 2009-2010, there seemed to be an undercurrent that part of the goal of the healthcare reform plan would be to eliminate private health insurance companies, as much as achieving affordable coverage for everyone.
I think abolishing private health insurance, for some Lefties, is a worthy goal in and of itself.
Maybe Sanders is one of those Lefties.
Steve LaBonne
@Richard Mayhew: That’s a hell of an exception. You know better than most that the entire plan was totally unworkable without that feature. So I’m afraid I don’t quite take your point.
different-church-lady
@Just Some Fuckhead, Tone Police: Which criticisms of
HillaryBernie are allowable?FlipYrWhig
@gene108: Maybe we should confiscate privately owned farms and have agrarian reform to make them all collective. I’m sure that’ll go over well in Vermont.
DCF
@Lord Baldrick:
What The Washington Post (and Nearly Everyone) Gets Wrong About Bernie Sanders
Every presidential campaign is necessary aspirational.
http://www.esquire.com/news-politics/politics/news/a41608/bernie-sanders-washington-post-response/
The Case for Bernie Sanders
His critics say he’s not realistic – but they have it backwards
http://www.rollingstone.com/politics/news/the-case-for-bernie-sanders-20151103
I grew up in a nation that – undeterred by the inherent/monumental difficulties – put a man on the moon within a decade of JFK’s inauguration challenge. I now live in a country where ‘pragmatism’ – as defined by the interlocking directorates of Wall Street and a political establishment beholden to its desires – is a euphemism for glacier-like incrementalism and negativity – a ‘can’t do’ attitude. At times like these, I honestly fear for the future of the United States – and the world which looks to it for aspiration and leadership.
Soylent Green
I once worked in a hospital billing office, a room full of low-paid drones whose job was spend all day calling rooms full of low-paid drones at the various insurance companies and ask “Why haven’t you paid us yet?” Their job was to answer “Gosh, I don’t know. We’ll look into it.” I suppose this is one of society’s paths to full employment.
the Conster
@FlipYrWhig:
I have had this argument on FB now about 100 fucking times, in a 100 different threads. All I keep ever coming away with after asking how this is all going to work exactly, with Paul Ryan and Mitch McConnell controlling the legislative agenda, is that I’m an arrogant tool of Shillary and the Establishment. OK, yeah, sure. I want some sweet sweet Shillary bucks.
Fair Economist
@Richard Mayhew:
I’m trying to figure this out without going through Thorpe’s analysis, which it obviously deserves, but which I just don’t have time to do today. He’s basically granting Sander’s (reasonable) claim that single-payer would drastically reduce healthcare costs, while saying that most people will be paying more. This seems pretty silly on the face of it.
The key, I think, is that the vast majority of private healthcare costs are carried by *employers*, not the insured. It’s the employers who will be getting the large majority of the considerable financial benefits of single-payer.
Orthodox economic theory says that the reduced costs to the employer will result in huge wage increases to employees, and that’s what would result in the typical person being better off. Of course orthodox economic theory also holds the credit market problems that created the Great Recession are impossible, so it’s not always a great guide.
Thorpe is probably not accounting for this possible compensation to ordinary people.
Rob in CT
I could understand providers preferring to deal with 1 payer instead of many, but I really doubt that the “medical community is all for single payer.” Really, really doubt it.
Why? Single payer, done properly, will involve significant income reductions for providers, not to mention those providers who make good money would pay significantly more in taxes to fund the system. Also, it’s not gonna cover everything. Today, the evil for-profit insurance company denies a claim. Tomorrow, medicare does. Either way, you’ve got a 3rd party interfering with care. Unless we’re assuming medicare will never say no, in which case cost control is out the window.
I’m pro-Bernie. But this sort of thing worries me. His campaign needs to sort this shit out, pronto.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@DCF:
That’s a bad example to begin with when you’re talking about nationalizing health care. NASA shopped out research & development to the private sector to no small degree, and it shopped out all production to the private sector, with people in all 50 states getting jobs through the Apollo project. And thanks to the Davis-Bacon Act, even those in right-to-work states got the prevailing union wage to do their jobs.
FlipYrWhig
@Rob in CT: And if one of the big gripes about Hillary Clinton is that she knows she’s going to be dinged as secretive and untrustworthy, so why does she keep giving the punditry and the public fodder for reinforcing that view… well, one of the obvious hurdles for Bernie Sanders was always going to be “everything he says sounds good, but how is he going to pay for it?” and yet he hasn’t succeeded in deflecting that, either.
japa21
It is the very unworkability of Bernie’s current plan, in so far as he has outlined a plan,, that makes me want him to stay in the Senate.
Trying to push for single-payer, right now, from the Oval Office, not only is impractical, it also would hamstring anything else he wants to do. One of the reasons Obama probably excluded single payer right from the beginning is that he knew even mentioning it in any sort of a positive way would doom any chance at healthcare reform.
But I still want a voice out there pushing for it, keeping it in front of people. The same as with many of Bernie’s other goals. And he can do that in the Senate.
Cacti
@DCF:
Matt Taibbi is the poster boy for 1-percenter professional nepotism.
Why does his get a pass from Bernfeelers?
the Conster
@japa21:
Google “Joe LIeberman Ben Nelson public option”. I don’t know why people don’t remember this, but there were a half dozen Senators who took turns being president for a day, threatening to blow everything up if this was in the bill. The “Obama didn’t want it” canard makes me go black inside.
japa21
@Fair Economist: Richard actually addressed that in his post. He is highly skeptical that employers would do that (I am sure some would but not all). After all, despite increased profits and record productivity employers have not shared that wealth with their employees.
Question for those more knowledgeable about Bernie’s plan. Would people still be paying a premium?
Medicare recipients pay a premium which is income related. Because when my wife retired she took a chunk of her IRA out as cash to pay off a bunch of debts, it counted as income and her monthly premium went up by $70. It should go down next year, but it was a shocker.
And as pointed out, unless there is an out-of-pocket cap, medical expenses for a lot of people would increase tremendously. And if there is an out-of-pocket cap, then the cost to the government would increase significantly.
Just Some Fuckhead, Tone Police
@different-church-lady: If you want to make ______________ lose, keep on doing ______________________. I’m fed up with supporters of _______________ and I know ___ is too.
Botsplainer, Cryptofascist Tool of the Oppressor Class
@Cacti:
The Revolution will use such allies as are necessary to attain temporary necessary gains; after the Revolution, he will be judged for his correctness and re-educated as necessary.
japa21
@the Conster: I know.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@Botsplainer, Cryptofascist Tool of the Oppressor Class:
More tumbrels, or staked out above an ant colony after being dipped in Mrs. Butterworth’s Syrup?
No, wait: Vermont organic maple syrup.
Fair Economist
@japa21:
How come I can’t find that bit, even scanning through the post? But anyway, it indicates that a single-payer plan needs to lean harder on a payroll tax than Bernie’s does. Also, there needs to be more consideration of the role of supplemental plans, since many will need supplemental plans to mimic their current situations. Presumably, we’d have current employers with good healthcare plans offer substantial supplemental insurance but that needs to be justified and accounted for.
different-church-lady
@Just Some Fuckhead, Tone Police: Now ____________ is a candidate I can get behind!
DCF
@Temporarily Max McGee (Soon Enough to Be Andy K Again):
It appears you missed the point of my post; aspiration and a ‘can do’ approach have largely been replaced, in this day and age, by desperation and defeatism.
I’m sure the ‘1 percenters’ are delighted by your response.
different-church-lady
@Botsplainer, Cryptofascist Tool of the Oppressor Class:
Especially when he realizes that in order to keep his shtick intact, he needs to start dropping bombs on Bernie too.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@DCF:
No, I got the point. All other things being equal (well, except that the cost of healthcare was much lower in the ’60s, and that employers covered more of the healthcare costs then) people react differently to getting single-payer healthcare than getting well-paying jobs. And don’t forget that there were plenty of people in the ’60s telling us that we should be focusing more upon domestic policy than on the space race- but don’t let Martin Luther King ruin your little slice of aspirational dreaming.
Botsplainer, cryptofascist tool of the oppressor class
@Temporarily Max McGee (Soon Enough to Be Andy K Again):
The staking shall be done politely, with proper respect necessary to show the solemn inexorability of the Revolution.
The vanguard of the proletariat must eschew superfluous displays of excess cruelty.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@Botsplainer, cryptofascist tool of the oppressor class:
Well, that and you don’t want to contribute to the Prison-Industrial Syrup Complex.
DCF
@different-church-lady:
Red-baiting and re-education camps? Really? Why are you here on BJ? Shouldn’t you be busy perusing World Net Daily and The Drudge Report?
President Obama would like a word (or two) with you about that approach….
Botsplainer, cryptofascist tool of the oppressor class
The Bernie clown car drives into the ditch, but the bumper stickers can still be viewed from the road.
jl
If we vote Baud! 2016, your health will be so shot so fast having fun, no worries about health insurance. Die young, and everyone will be too bombed out to worry about how the corpses look.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@DCF:
https://www.youtube.com/watch?v=-CxX8nvLalE
Bobby Thomson
@Steve LaBonne: it would have required bigger subsidies and been a more obvious gateway to single payer – and the subsidies have always been the pressure point.
Bobby Thomson
@Fair Economist: I wish I could live in your world where profits are passed on to employees.
Cacti
@Botsplainer, cryptofascist tool of the oppressor class:
But can they be seen from the moon?
We choose to see revolutionary bumper stickers from the moon because it is hard.
Cacti
@Fair Economist:
Given that you’re an economist and all, what is your take on the 6.2% across the board tax on employer payrolls.
Isn’t that a near certainty to put downward pressure on payrolls and/or wages?
And doesn’t this stand in contrast to existing single payer countries, who tend to favor sales or VAT as a revenue driver?
Steve LaBonne
@Bobby Thomson: No. It couldn’t work at all without the mandate if you’re going to ban exclusions for pre-existing conditions, because of adverse selection.
different-church-lady
@DCF: Yeesh… what a grouch.
DCF
@Temporarily Max McGee (Soon Enough to Be Andy K Again):
Yuck it up, fuzzball…the plutocrats and oligarchs will be laughing too – as we continue to traverse the Second Gilded Age here in the 21st century….
The Owners of the Country
https://www.youtube.com/watch?v=LbnzhTmiyec
Kerry Reid
@Cacti: Well, but Greenwald supports Citizens United. AWK-ward!
Kerry Reid
@MomSense: I worked on three special elections after 2008 through OFA and did phone banking around immigration reform as well.
jl
@Cacti:
” Isn’t that a near certainty to put downward pressure on payrolls and/or wages? ”
The conventional view is that it would. Employees would pay between 80 and 100 percent of the tax through lower wages. Lowest estimates I know of say employees pay 50 percent. But current financing system has similar effect on wages, so not sure what your point is. Am I misunderstanding something? If single payer were more efficient, and result in overall reduction in expenditures with higher quality care, the workers would be better off. To the extent insurance is portable, that would be a visible benefit.
Also, I think the macro aspect of tax incidence is being ignored. The arguments for passing on changes in cost to employees depend on the assumption of full employment. Marginal utility of time is equalized across firms, and also across market and non-market uses of labor (like house work, and education, etc.). Without full employment, the standard arguments for incidence of changes in productivity and taxes don’t work. Point is that fluctuations and visible effects of macro labor market conditions swamp those from payroll taxes, usually. Evidence is that people barely notice changes in the latter much.
Temporarily Max McGee (Soon Enough to Be Andy K Again)
@DCF:
Yeah, sure, Bernie or Bust. Spoken like a True Believer. The apocalypse is nigh. Jebus…
DCF
@different-church-lady:
I prefer ‘scold’…when you respond to alternative viewpoints with derision, sarcasm and dismissiveness, that is not a response…it is something else entirely….
By way of illustration: Lewis Black speaks at the National Press Club – April 14, 2014
https://www.youtube.com/watch?v=CXANL8m6cfg
Jake Nelson
@Richard Mayhew: Appreciate the reply, good points. Something I’ll likely keep thinking about…
Trentrunner
@ellennelle: I’m just one person, and so don’t amount to much, but I never read posts that don’t use conventional capitalization. You don’t care, so why should I?
chopper
@Trentrunner:
say it aint so!
different-church-lady
@DCF: Yeesh… what a scold.
DCF
@different-church-lady:
Thank you…I know, reality bites….
DCF
@Temporarily Max McGee (Soon Enough to Be Andy K Again):
I’m familiar with the writings of Eric Hoffer…apparently, you and different-church-lady share the same Trump-like reactions to those who disagree with you…and are blind to the redistribution of wealth that has been occurring for the past several decades….
It can’t happen here? Think again….
DCF
@Temporarily Max McGee (Soon Enough to Be Andy K Again):
That diatribe was about as coherent as Sarah Palin’s endorsement speech for Donald Trump…holy FSM….
DBaker
@sharl: nope. But he is a name sake I am proud to share.
DBaker
@jl:
The Republicans, as well as the liberal media have done at least a 35 year hit job on the fact that government is for the people and by the people and then aid that through actions of grifters like Snyder. The democrats have done somewhat of a better job lately but do themselves a disservice by using right wing memes including the Hillary is untrustworthy meme (which unwittingly aids and abets the government can do no good meme). See Eric Boehlerts writing on this.
We indeed have a problem in the US that taxes seemingly are wasted, but Europe is no utopia. A prime example is VAT, which serves as a hand break on economic activity. Because it is hidden with corporate bottom lines the European genersl public ignores it.
It is funny that when I lived in the Netherlands I was considered a right winger while here I am a liberal commie despite espousing the same views. Thats how far the goalposts have been moved in the US in 2016. “The left” in the US ignores that at their peril.