On Medicare for All As a Single-Payer System, B.S. Jobs, Agriculture, and the Physician Shortage

This is from an email I wrote to friends discussing Medicare for All as a single-payer system, bullshit jobs, agriculture, and the physician shortage.

I have endorsed Medicare for All (M4A) as a single-payer system rather than public option. I think it would be harder to raise revenue for it as a public option. Companies offering subsidized private insurance probably would not be asked to pay the 7.5% employer payroll tax that Bernie Sanders has proposed, for instance. I’m largely endorsing Bernie Sanders’s version which is universal healthcare for all. Clint (my Democratic primary opponent for Florida’s 6th Congressional district) has “Medicare Available to All” on his website so I presume that means a public option?

Basically, M4A single-payer is like a huge self-insurance program backed by the full faith and credit of the United States. Medicaid seems comparable, but even then you still have to pick 1 of 4 plans in our area (UnitedHealthcare Community Plan, Molina, etc.). Bernie’s plan has no co-pays, co-insurance, deductibles, or premiums, except for a small co-pay on prescription drugs. There would still be out-of-pocket doctors such as most plastic surgery and orthodontic treatment. Doctors could still opt out of M4A entirely like they do now with insurance. (I have not double-checked this but I can’t see them being forced to participate if they just want customers willing to pay out-of-pocket such as those who cater to the rich.)

Our healthcare system can be framed so many ways. I think it should be emphasized that this is a domestic humanitarian crisis that has been going on for decades now but is getting worse. Some estimates are that 50,000 Americans die a year due to lack of healthcare access. Many more are financially disadvantaged. With Medicare for All, we can really help the American people and take away one of the great burdens of living in this country. It’s also a golden opportunity to increase the focus on preventative medicine including exercise, nutrition, and routine checks. I would even like to see farm bills come out of Congress that stop or reduce subsidies (about $15 billion a year) to massive farms growing unhealthful foods such as corn and soy. Only 3% of American cropland is used for fruits, nuts, and vegetables, which is much less than would occur without the bizarre subsidy system encouraging outrageous amounts of corn being grown as feed, ethanol, and high fructose corn syrup.

Shenkar Vedantam did an interesting episode of the Hidden Brain podcast on “bullshit” jobs. The guest, David Graeber, has gained a lot of traction writing about jobs that are often well-paid, but basically pointless. It’s not employees’ fault that they get roped into this sort of uninspiring, unfulfilling, nonsensical work, but that doesn’t mean it can go on forever. This kind of work is a drain on the economy. I also advocate for the IRS pre-filling tax returns for people based on incoming data (W2s, 1099s, etc.), and offering a competing online tax filing platform, for free. TurboTax and H&R Block receive a lot of unnecessary payments from the American people, and until recently TurboTax was tricking people into using the wrong version and then forcing them to pay or make a new account through the free-file link and re-key all data.

I know this will make a lot of people very upset, but the sprawling insurance / billing industry has a parasitic impact on our overall economy. Bernie Sanders’s plan includes a high level of funding to temporarily pay people working in this industry and help them transition to some other line of work. At least they won’t have to worry about health insurance. I know many readers will fire back that the government has lots of bullshit jobs, and I think those should be cut wherever they are. Some argue Trump is doing this, but of course he’s not—he cuts many jobs that are quite necessary and fires competent people to replace them with sycophants. The State department has been sacked, which is quite short-sighted. The CDC isn’t prepared for coronavirus due to key funding and personnel having been cut. Also, there are plenty of unnecessary jobs in large corporations as well. As an aside, I would hit back at the McKinsey-sponsored view that middle management should be sacked and control consolidated in favor of a special class of CEOs and other high-paid executives that float around between businesses in many different industries. I would also mention that more rural hospitals are closing in states that refused the ACA expansion of Medicaid. M4A could be a net benefit to the healthcare industry. I think we need to address the whole educational pipeline too—it’s crazy that we have only 1.1 million MDs/DOs compared to 1.35 million lawyers in this country, and that I was fully taxpayer funded as a PhD student but medical students must pay huge amounts and then endure grueling, low-paid residencies. Advanced nurses should also be allowed more autonomy to practice without a doctor present.

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