Medicare for All or Some?

Progressives are pushing the Democratic Party to embrace a universal single-payer health care system, what is being called Medicare For All.  But is that the best way to proceed for the American people?

I am in favor of a universal single-payer system in the United States.  Where every person is covered, where there are no deductibles, where there are only reasonable copays.  

But there are serious problems with the attempt to pass a Medicare For All plan now.  How would the transition be handled?  What happens to all the insurance companies and their employees?  

And there is the fact that many people do not want to be forced to change the insurance they have now.  Obamacare had major shortcomings, so many are not confident about the government’s ability to run a plan.  Even most people on Medicare do not experience a government run plan.  They have a Medicare Advantage plan run by a private insurance company that beefs up the coverage provided by “pure” Medicare.

So I don’t think the ground work is there for a Medicare For All plan now.  Instead, I would suggest going back to Obama’s idea and have Medicare For All as an option in the insurance marketplace.  Let people choose.

At the same time, improve Obamacare by finding ways to reduce the horrendous deductibles and co-insurance that people who buy the lower cost plans have to pay.  Even with the maximum out-of-pocket built into these plans, a serious illness would bankrupt many a family.

This approach would do two things.  It would enable people to compare and choose the Medicare For All option.  The ability to choose is critical.  The second is that it would give lower income Americans who do not have employer plans more affordable health care, whether through the private option or the public option.  And it would not disrupt the lives of all the people who work in the insurance industry.

The Amorality of Donald Trump - Part 3 - Health Care

I previously wrote two posts on actions that show that Donald Trump will do and say anything he feels he needs to in order to get what he wants.  He has no morality or ethics.  It’s all transactional.  The end definitely justifies the means for him.

Today’s New York Times provided yet another example.  The Trump administration announced that they were suspending $10 billion in risk adjustment payments to insurers because a lower Federal court in New Mexico threw out the formula on which the payments were based.

Why this sudden and unusual deference to a judicial decision, let alone one by a lower court?  Because it allows Trump to do what he and the Republicans are dying to do … kill Obamacare.  

Actions taken by Trump and the Republicans have already greatly weakened the Affordable Care Act by driving up premiums substantially, making it less affordable for the very people the Act is meant to protect.  If Trump proceeds to suspend these risk adjustment payments, it will without any doubt practically kill health care access for Americans who have come to depend on the ACA marketplace for their health insurance.

Another lower Federal court in Massachusetts had upheld the formula.  If the Trump administration were truly neutral on the health care issue, they could take a wait and see attitude pending the appeal of these cases, or others, to higher courts.  The administrator for the Centers for Medicare and Medicaid had the gaul to state that “we were disappointed by the court’s recent ruling.”  Such mendacity!

People have already received notice from their insurers in the past weeks that they were requesting big increases (50%) in premiums for 2019.  And that was before this development.  A 100% increase would now not surprise me.

Trump’s Justice Department has also asked a Federal court to declare the requirement that 

insurers not reject people for pre-existing conditions or charge them more … one of the most important aspects of Obamacare that has benefited millions of people … unconstitutional.  Another betrayal of the very people who put Trump in office.

What is to become of the health of our middle class citizens who do not receive insurance through their employment?

The Unconscionable Republican Health Care Proposal

According to The New York Times, reporting on the CBO report on the Republican’s American Health Care Act, the impact of the Act on Americans in their 60s would be catastrophic.  In addition, millions of the poor who benefited from Medicaid expansion will loose their insurance.

The proposed law bases subsidies for people not on their income … like just about every other subsidy system in the world does … but on their age.  So for example, a 21 year-old would have a net (after subsidy) premium of $1,450 a year.  A 40 year-old would have a net premium of $2,400.  A 64-year old would have a net premium of $14,600!

So a 60 year-old, low-middle income person earning too much to be eligible for Medicaid and too young for Medicare, would be stuck with a huge bill that he could not afford.   All commentators assume that such people will opt out of the system which will leave them uninsured.  If the Republicans create a high-risk pool, which in the past was typically very expensive and provided bad coverage, that would not be a practical option. 

For the Republicans to do this to 60-year-olds in order to keep premiums down for the young, encouraging them to buy insurance, is evidence, if that were needed, that Republicans lack a social conscience.  It is unconscionable.

For the Republicans to also gut Medicaid expansion resulting in millions of the poor losing their insurance while at the same time providing for a $600 billion tax cut over 10 years for wealthy Americans, as they would no longer be subject to the taxes that had been assessed to pay for Obamacare subsidies, so that the net effect of the act is still a significant budget saving for the government, is more proof of their lack of social conscience and is unconscionable.

In their press conferences, they of course do not mention these details.  Instead, they emphasize the CBO finding that overall rates will go down, after initially rising for a few years.  And that the Act would result in savings of $337 billion over 10 years.  This is deceitfulness at its worst.

All middle-aged and older Americans, and the poor, should bombard their Congressmen with calls and emails telling them to vote No on the American Health Care Act.

When Is a Socialist Not a Socialist?

When Barack Obama was running for President, the Republican Right branded him a “Socialist.”  They have also branded Obamacare as “socialized medicine.”  These claims were so ridiculous that neither Obama nor anyone else ever took the time to set the American people straight on the meaning of these words and the lie they spoke as applied.  Thus for many, the terms stuck.

Now, because of Bernie Sander’s run for the nomination, and his self-identification as a Socialist or what he sometimes refers to as a Democratic Socialist, it is critically important for the American people (and Sanders!) to understand what these words mean before even starting to think about which candidate they prefer.

First, the meaning of Socialism:  “A system of society in which the major means of production are owned and controlled by the government rather than by individual people and companies.”  This definition is from Webster’s and is basically identical with other sources.  

Why government ownership?  The theory is that government is the desired owner because it represents all of the people rather than just a few and so decisions about production and distribution will be made in a way which better meets the needs of the broader society.  Capitalism, on the other hand, where the means of production are owned and controlled by private companies or individuals, makes its decisions on what is produced and how it is distributed based solely on what is in the best interests of the company and its owners/shareholders.

Neither Barack Obama nor Bernie Sanders has ever called for industries, for the means of production, to be owned by or controlled by the government.  Therefore, neither of them are Socialists nor do they advocate Socialism.  

Yes, I know that Sanders identifies himself as a Socialist at times, but he’s not.  I have the feeling he just likes the sound of the word, that it confirms he’s for the people and against big money, and it sets him apart.

The term “Democratic Socialism” is still Socialism as defined above, but the system of government is democratic, that is, representative.  So again, neither Obama or Sanders are or advocate Democratic Socialism.

Well what is Sanders then?  Sanders, like the European countries he often refers to, is a Social Democrat.  I know the semantics may seem confusing, but the differences are important.  

“Social Democracy” refers to a political democracy in which a capitalist system of ownership and production is regulated by the state to make it more reflect the public good and the state helps those who need help with various forms of aid, such as public aid, Medicare, Social Security, etc.  Webster’s also defines it as a state that combines both capitalist and socialist practices. 

So guess what?  The United States is a social democracy, certainly since the Depression.  Only the most radical right-wing Republicans want a purely capitalist state where there is no government regulation (and also no government aid to industry) and no government help for those in need.

The difference between today’s mainstream Republicans (radical has become mainstream for them), Hillary Clinton, and Bernie Sanders are really differences of degree, albeit great, along a continuum from little government social involvement … that is action to promote the public rather than private good … to significant government action to promote the public good.

Hillary wants more government action to help those in need, but does not want to disturb the capitalist model.  Sanders is willing to disturb the capitalist model where necessary to provide for the public good, for example, universal health insurance.  Likewise, Hillary is less willing to closely regulate the financial industry while Sanders wants rather strict regulation of that industry.  

The example of health insurance is perhaps the easiest way of clarifying the distinctions.  In the strictly capitalist model, health insurance is provided by private for-profit insurance companies and is bought by individuals or companies on behalf of employees.  The government is not involved at all.  There would be no such thing as Medicare or Medicaid.  

Even Radical Republicans don’t dare go that far.  They would prefer to remove the government from any programmatic involvement and rely on private insurers, but still provide funding through some type of voucher or income tax credit program.  Which would provide more profits for private insurers.

Bernie Sanders wants universal health care with the government being the single payer, easiest to understand as expanded Medicare for everyone.  This is the system that is in place in most European countries and Canada.  This could fairly be called socialized medical insurance, but the medical delivery system otherwise remains as is.  People can in most cases opt out of this system and choose private care if they so choose.

What Hillary wants is Obamacare.  This is a system that still uses private insurers and so it cannot be called socialized medical insurance because the insurance is not provided by the government.  But the government both regulates and provides subsidies so that those who cannot afford the insurance can still obtain it.  It’s better than what we had before, but it’s a clunky system and there are lots of shortcomings just from my own personal experience.

Bottom line.  The whole “Socialist” or “Democratic Socialist” harangue is a red herring.  

It would be helpful if Sanders started getting his terminology correct and made the point expressed in this post that most everyone regardless of political party is on the same continuum, just at different points of the spectrum.  We are a social democracy, even if not a very progressive one.

This does not lessen the differences between the parties or candidates.  But it does remove scare terminology from the debate and instead places the question clearly where it should be … how much help should the government provide its citizens, directly or indirectly?  Is health care a basic right that everyone should have?

Education and Health - Fundamental Rights

We have been bludgeoned over the past few years with the Republican’s mantra that if you haven’t made it, it’s your fault (see my post, “The Mendaciousness of the Responsibility Game”).  So it was with a huge feeling of nostalgia that I was reminded recently of a time not so long ago when a large segment of Republicans had a very different perspective on life and the role of government, or at least the role of the broader society.

In reviewing a new biography of Nelson Rockefeller, the reviewer noted Rockefeller’s credo, “If you don’t have good education and good health, then I feel society has let you down.”  WOW!  How times have changed.

If someone said that today, even if a Democrat said that today, they would be viewed as a left-wing radical.  It sounds so over the top.

But it isn’t.  Let me quote, as I often do, from the Declaration of Independence, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed . . .”

If one is going to have a meaningful right to life, liberty, and the pursuit of happiness, certainly two of the most essential elements of that right are having a good education and having good health.  No one would argue with that.

But the Declaration goes further and states that the purpose of government is to secure these rights, which in this context would mean access to good education and access to good health.  I am not downplaying the importance of personal responsibility.  As the old saying goes, “You can lead a horse to water, but you can’t make him drink.”  But it is the government’s responsibility to provide the water.

So at a minimum, the government is responsible under this standard for supplying access to a good education (meaning good schools, good teachers, etc.) and good health (meaning comprehensive health care ... medical, psychological, and dental ... that is affordable or free, depending on your circumstances).  Note: Obamacare has not come close to providing the latter because although the basic premiums may be affordable due to government subsidies, the large deductibles and out-of-pocket caps of the basic plans discourage people from getting health care except in emergencies.

If that is the minimum, you might ask, what else is there?  While good schools can make a huge difference even in the midst of a bad inner-city neighborhood, growing up in an area where poverty, drugs, and crime are the norm and often impact family life creates major obstacles to being able to take advantage of a good school.  

Government, together with private agencies and organizations, must do much more to improve the broader context within which such children grow up.  Whether it’s creating more jobs, providing adult education, making prisons focus on rehabilitation, creating social policies that encourage two-parent households (as opposed to the old welfare rule that broke up families by penalizing them if an adult male was living in the household) ... there are ample ways that government and society working together could dramatically change the context of inner-city life.

It is time for Rockefeller’s credo to become the credo of government and of our society.  It is past time for this great, rich, but unconscionably unequal, nation to live up to the promise stated in the Declaration of Independence.

Republicans’ Seven Biggest Lies

The propaganda theory of “the big lie” is that if you tell a lie big enough often enough, people will begin to believe it, and the Republicans are masters of this tactic. The Republican Party has been selling the American public a bill of goods and unfortunately the public is falling for the scam. They want the average American to think that they are going to protect their interests and that the Democrats will ruin them.  This is a classic “big lie” if ever there was one.

Their “argument” is based on the following subsidiary lies, which fall predominantly into two categories … the economy and health care/Obamacare:

Lies About the Economy

Lie #1: The financial crisis and joblessness is the fault of big government, of government regulation.

            Fact:  The financial crisis was caused by rich investment bankers and mortgage brokers trying to find a way to make a fast buck at the expense of ordinary Americans or small-fry investors. It happened because people in the financial industry are greedy and cannot be allowed to regulate themselves.

Lie #2: The financial crisis continues because of the failure of the Obama stimulus package and the increasing government deficit.

            Fact:  The Obama stimulus package, while not creating many new jobs, resulted in preventing the elimination of millions of jobs, especially state and local jobs.  This kept the country out of a second Great Depression.

            Fact:  Once the stimulus funds were spent, Republican-led efforts to slash the budget in order to cut the deficit have made the jobless crisis far worse by reducing support for state and local governments, causing increased unemployment in that area that the stimulus had prevented and stalling the recovery.

            Fact:  The deficit, while large and undesirable, is more of prac†ical concern to investors in government bonds, and interestingly rather than fleeing from US bonds, investors continue to flock to them as a safe haven in this volatile global financial market.

Lie #3: The key to getting the American public back to work is cutting taxes for the rich and corporations, as well as cutting the deficit.

            Fact:  Cutting taxes for the rich only helps the rich get richer.  There is no trickle down effect, as was proven during the Reagan years.   Reducing corporate taxes only results in corporations and their investors making more money; it does not encourage investment and job creation unless the tax cuts are specifically tied to that effort. Corporations are into doing more with less labor; they have no interest in job creation or giving raises.  It’s not that they don’t have the money … they are sitting on $1.74 trillion … yes trillion … dollars of cash.

            Fact: Income inequality between the very rich and the rest of us is worse now than at any time in US history.  And income stagnation for the average American is a real crisis. 

            Fact:  Cutting the deficit by cutting funding for all sorts of programs and support for state and local governments will only make the job situation even worse by increasing layoffs at all levels, as it has already done.

Lie #4:  The answer is not the government; government is the problem.

            Fact:  The crisis was caused by market forces working in a for-all-practical-purposes unregulated atmosphere.  Its only guide was greed.  Even Alan Greenspan has admitted that his theory that the market would be self-regulating was an error.  The answer to protecting the American public from this type of thing happening again is regulation of the financial sector that has teeth in it.  The Republicans are dead set against such regulation. The Democrats support it.

            Fact: We got out of the Great Depression through massive government spending including the WWII effort.  In a financial crisis, the private sector has no interest in investing.  Their only concern is protecting or growing their profits.  Thus they find ways to do less with more, which is great for their shareholders, but bad for the American worker.  We need more government stimulus, hang the impact on the deficit, in order to get the unemployed back to work.

The Lies About Health Care/Obamacare

Lie #5: Obamacare will get between you and your doctor and reduce the quality of your medical care.

            Fact: There is nothing whatsoever in Obamacare that would do this.  It is built on the existing private insurance system. It is not a “government takeover” in any sense, which Medicare actually was, although interestingly everyone loves that.

Lie #6:  Obamacare will force individuals to get health insurance. The implication of this is that individuals who cannot afford health insurance will be forced to buy it or suffer a penalty.

            Fact: One of the main drives behind the enactment of Obamacare was to provide health insurance to the millions of Americans who don’t have it as part of their jobs and who can’t afford to buy it.  It does this by subsidizing health insurance for those who can’t afford it. The individual mandate will provide health insurance and proper medical care to millions of Americans who currently can’t afford access.

            Fact: Republicans have for the last 20 years urged the individual mandate as part of any health care reform.  It was central to the bill that Governor Romney supported in Massachusetts. Now they are against it solely because it’s a Democrat-passed program.

Lie #7: Obamacare will ration health care.

            Fact: There is nothing in Obamcare that would ration health care. There are measures in the law that encourage the medical profession to apply their group knowledge more consistently so that everyone gets the best care and money is not wasted on unnecessary or counterproductive procedures.

            Fact:  Contrary to the statements of Republican talk show hosts and some Congressmen, there is no “death panel” in Obamacare. What the law does encourage is for doctors to talk about end of life issues with their patients so that the patients’ desires regarding various levels of medical effort will be known and respected.

Bottom line … Republican politicians and radio talk show hosts have presented a Big Lie to the American public. And by saying it over and over again, and by the Democrats not effectively countering the lie, a large segment of the American public has come to believe the lie. But in fact, Republicans are only concerned with protecting the interests of the rich and corporations; they have no concern for the average American. It is instead Democrats who are fighting to protect the well-being of the average American.

There is no question that government is not the entire solution … the private sector and individuals have a major role to play … but government is certainly a necessary part of the solution.