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Thread: How to Think about “Medicare for All”

  1. #1
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    How to Think about “Medicare for All”

    James A. Morone, Ph.D.
    October 25, 2017DOI: 10.1056/NEJMp1713510

    In April 1946, President Harry Truman introduced a single-payer health plan and met the same reaction that would greet Senator Bernie Sanders (I-VT) and his colleagues when they proposed “Medicare for All” in September 2017. “It is believed by competent Congressional observers to have little chance of approval,” reported the New York Times back in 1949. Newsweek was blunter: “No chance at all.” Neither Truman nor Sanders even bothered to include financing for their plans. Truman had no more success with a scaled-back proposal to cover only people over 65 years of age, but 13 years later President Lyndon Johnson signed the Truman revision into law as Medicare, declaring that the United States was finally harvesting “the seeds of compassion and duty” that his predecessor had sown.1

    snip

    …Canadian health costs were indistinguishable from those in the United States until Canada finished introducing its national health insurance program in 1971; then, health care’s share of the Canadian economy flattened out dramatically. By 2014, according to the World Health Organization, Canada spent 10.4% of its gross domestic product on health care, as compared with the 17.1% we spent in the United States.

    snip

    …Skeptics emphasize the new taxes that Medicare for All would require. In a white paper accompanying his proposal, Sanders fills in some vertiginous details: raise marginal income tax rates to 40% on incomes from $250,000 to $500,000; raise rates to 52% for incomes above $10 million; and tax capital gains and dividends like income from work. Do those kinds of increases doom Medicare for All? Perhaps just the reverse, for this is one of the few policies that directly confronts American inequality.

    No other country has experienced a rise in inequality as steep or as high as the one we’ve seen in the United States. In 1970, standard inequality measures pegged the United States at roughly the same level as France and Japan; almost 50 years later, U.S. inequality levels are closer to those of Mexico and Brazil than to those in Northern Europe.4 Today, the top 1% of households control 38.6% of the country’s wealth, far more than the bottom 90% (which controls just 22.8%). The median white family (in the exact midpoint of the income distribution) is 10 times as wealthy as the median black family. Intergenerational economic mobility has stagnated.5 Political scientists generally believe that rising inequality and slowing mobility have a destabilizing effect — and they may be driving the angry populism that is now stirring on both the left and right ends of the political spectrum.

    http://www.nejm.org/doi/full/10.1056/NEJMp1713510

  2. #2
    Veteran Member cpicturetaker12's Avatar
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    Universal health care, single payer--Medicare for all. It's coming. I'm betting sooner than any REPUBLICAN wants to admit.
    Thanks from labrea

  3. #3
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    This plan is really Medicaid for all. Not Medicare. Medicare only pays 80% and there's a monthly fee and a deductible.

    My only beef with it is the mislabeling.

  4. #4
    Thought Provocateur NightSwimmer's Avatar
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    Quote Originally Posted by Blueneck View Post
    This plan is really Medicaid for all. Not Medicare. Medicare only pays 80% and there's a monthly fee and a deductible.

    My only beef with it is the mislabeling.
    I agree. UHC should cover everything without the need to purchase private sector supplemental insurance. It should also cover eye care and dentistry.
    Thanks from Blueneck

  5. #5
    Galactic Ruler Spookycolt's Avatar
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    Quote Originally Posted by NightSwimmer View Post
    I agree. UHC should cover everything without the need to purchase private sector supplemental insurance. It should also cover eye care and dentistry.
    Why should I have to pay for other people's healthcare?

    Dumb idea.

    They should let everyone sign up for it then jack up the taxes on those that use it.

    Let those freeloaders pay 40%.

  6. #6
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    Quote Originally Posted by labrea View Post
    James A. Morone, Ph.D.
    October 25, 2017DOI: 10.1056/NEJMp1713510

    In April 1946, President Harry Truman introduced a single-payer health plan and met the same reaction that would greet Senator Bernie Sanders (I-VT) and his colleagues when they proposed “Medicare for All” in September 2017. “It is believed by competent Congressional observers to have little chance of approval,” reported the New York Times back in 1949. Newsweek was blunter: “No chance at all.” Neither Truman nor Sanders even bothered to include financing for their plans. Truman had no more success with a scaled-back proposal to cover only people over 65 years of age, but 13 years later President Lyndon Johnson signed the Truman revision into law as Medicare, declaring that the United States was finally harvesting “the seeds of compassion and duty” that his predecessor had sown.1

    snip

    …Canadian health costs were indistinguishable from those in the United States until Canada finished introducing its national health insurance program in 1971; then, health care’s share of the Canadian economy flattened out dramatically. By 2014, according to the World Health Organization, Canada spent 10.4% of its gross domestic product on health care, as compared with the 17.1% we spent in the United States.

    snip

    …Skeptics emphasize the new taxes that Medicare for All would require. In a white paper accompanying his proposal, Sanders fills in some vertiginous details: raise marginal income tax rates to 40% on incomes from $250,000 to $500,000; raise rates to 52% for incomes above $10 million; and tax capital gains and dividends like income from work. Do those kinds of increases doom Medicare for All? Perhaps just the reverse, for this is one of the few policies that directly confronts American inequality.

    No other country has experienced a rise in inequality as steep or as high as the one we’ve seen in the United States. In 1970, standard inequality measures pegged the United States at roughly the same level as France and Japan; almost 50 years later, U.S. inequality levels are closer to those of Mexico and Brazil than to those in Northern Europe.4 Today, the top 1% of households control 38.6% of the country’s wealth, far more than the bottom 90% (which controls just 22.8%). The median white family (in the exact midpoint of the income distribution) is 10 times as wealthy as the median black family. Intergenerational economic mobility has stagnated.5 Political scientists generally believe that rising inequality and slowing mobility have a destabilizing effect — and they may be driving the angry populism that is now stirring on both the left and right ends of the political spectrum.

    MMS: Error
    I disagree with the angle here. And this is coming from someone who has come around to supporting single payer as the probable least-worst option. Here's why.

    The greatest chance single payer has at becoming law anywhere in the near future requires taking the partisanship out of the talking points for and against it. You probably need a few Republicans to commit party treason and support single payer. The best way to do that is to stop talking about single payer in the same breath as a list of other Democratic Party talking points. "The top 1% control *squawk squawk squawk..." Enough of that shit. That isn't about the inequality the left whines about ad nauseam between the ultra rich and those oh-so poor that matters (because neither the very rich nor the very poor pays much of their own money on health as it is).

    The important inequalities that need to be illuminated are between very similar families across the country, whose small arbitrary technicality-level differences are what determines whether they pay jack shit for health care or whether they pay out the ass.

    Example #1: Two virtually identical different families of five live in Anchorage, Alaska each has annual household income of $180,000. One parent of one of the families has a Deputy Commissioner job with the State of Alaska and brings in $100,000 a year. Her spouse runs a business that brings in the other $80k. The other family co-runs a business that brings in $180k per year. The family whose primary breadwinner works for the state pays less than $1,000 per year for all the health care the family needs. No premium sharing, and relatively tiny deductible expense despite having three children and a spouse on the plan. The other family has to pay over $40,000 per year just in premiums for a "silver plan."

    Society "values" (if you will) each of these families the same. Both are "worth" $180,000 in gross income to those families, according to what society wants to pay them for their work. When two families have the same household gross income but one has to pay over 40 times the amount of money for health insurance coverage than what another family pays, just because one spouse happens to have employer-sponsored health coverage, that is the real inequality here, and that inequality is vast and mind-bending considering the otherwise sameness of these respective families.

    Example #2: Two virtually identical couples living in rural Alaska expecting their first child. One couple brings in $45,000 annually and the other brings in $55,000. The couple that brings in $45,000 qualifies for Denali KidCare and pays nothing for the transportation to where babies are delivered 3 weeks before the due date, lodging, meals, other transportation, hospital stay (C-section delivery). Nothing. Medicaid pays for all of it. Their out of pocket expenses are on nothing more than what they voluntarily decide to spend while in the big city. The couple that brings in $55,000 does not qualify for Denali KidCare but has employer-sponsored health insurance. So they do pay for travel, lodging, $3,000 of deductible expenses, and another $2,000 of co-insurance expense (because their delivery was also by C-section). So here again you have two very similarly situated families whose health care costs differ wildly based on arbitrary and small differences. One family has it made, the other is shit out of luck. This is the real inequality as it concerns health care.

    If I am the family that makes $55,000 and has to pay a fifth of my annual after-tax income to have a child, why should I be enraged about how many billions of dollars Jeff Bezos has? Should I join the Democratic Party and just incessantly bitch about how rich the rich are? We could confiscate 100% of Jeff Bezos' wealth and it would fund the nation's health for 11 fucking days. The real unfairness is that someone who earns just a bit less than me pays nothing while I pay out the ass. Or if I'm the business owner who pulls in $180,000, I am pissed that because my income happens to derive from my own business that I created with my partner, I have to pay over a fifth of my annual income just on premiums while the family next door that makes the same as we do pays virtually nothing, all because one of them happens to work for the State.

    That is the real inequality, and it's extreme and it's arbitrary and it's shitty. The thing single payer would do address THIS inequality, the real inequality as it concerns health care, is make the de facto funding of the nation's health care relative to income, by involving a corresponding income tax. Some will still whine, but they will be paying a relatively similar percentage of their income on health like everyone else with an income does, which is about as fair as it gets. What we have now is lightyears from fair as far as cost goes.
    Last edited by Neomalthusian; 6th November 2017 at 06:38 PM.
    Thanks from Ian Jeffrey

  7. #7
    Veteran Member bonehead's Avatar
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    Quote Originally Posted by Blueneck View Post
    This plan is really Medicaid for all. Not Medicare. Medicare only pays 80% and there's a monthly fee and a deductible.

    My only beef with it is the mislabeling.
    quite correct. the benefits should be based on those available in the current Medicaid system, with financing based on the Medicare Act. I've advocated this before.
    Thanks from Blueneck

  8. #8
    Thought Provocateur NightSwimmer's Avatar
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    Quote Originally Posted by Spookycolt View Post
    Why should I have to pay for other people's healthcare?
    I sincerely doubt that you could, even if you actually wanted to.

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