Category Archives: Letters

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.

On Corporate Privilege, Share Buybacks, Trickle-Down Economics, Taxation, and Anti-Competitive Actions

My response to a commentator arguing for trickle-down economics and against corporate taxation, and claiming he could not think of examples where a large corporation bullied small businesses, and claimed not to recall or understand instances when Walmart would sell at a loss to drive small businesses under:

Dr. Lt. Col. [Name], a scholar, helicopter pilot, military tactician, and financial advisor, can’t think of an example of big companies bullying small companies? Doesn’t understand markets? I’m having a hard time believing this.

Your questions and statements can be easily researched online and answered or discredited. Corporations avoid taxes all the time.

The Walmart story is well-known and you must have been living under a rock if you didn’t hear about it. It goes back to 1993 at least. They would sell certain items at a loss until local shops went out of business, and then raise their prices back up. This isn’t capitalist, but rather anti-competitive and unfair.

Corporations do not go to their customers directly to raise additional funds to pay taxes. They have the money, and the successful corporations do something with it. Being flush with cash, many are buying back shares… and executives coordinate the share buybacks so they can sell their shares at a high price, and this is legal. Meanwhile, many such corporations are paying low wages and bullying cities like Deltona (Amazon warehouse) into tax breaks when they could be paying higher wages or at least covering their employees’ Medicaid and food stamps. Wouldn’t it be nice if we could unionize cities, counties, and states nationwide to say no to bullying for tax breaks like Amazon having a phony competition for their 2nd headquarters on who can offer them the most taxpayer subsidies?

The idea that tax breaks lower costs to consumers is pretty rich. If consumers are willing to pay a certain price for an item or service, the price won’t come down either way.

“More money to give to their employees and stock holders”—really? They will raise pay to employees only if they must to compete for labor. You can’t argue for trickle-down economics, which is the idea that the market is fair and will take care of itself benefitting the 99% by eliminating taxes for the 1% and top corporations (which is corporate welfare for them as they are still benefiting from the USA’s many resources and public items such as financial markets, roads, natural resources, education, and so forth). Trickle-down economics has been empirically discredited.

If anything, the stock holders benefit the most, and it’s really getting tacked onto the national debt as the Tax Cuts & Jobs Act of 2017 was a total robbery to benefit big corporations and share holders. And, as you know, I’m a big advocate for owning pieces of the big corporations via index mutual funds, but half of Americans own no stocks, and you shouldn’t need to just to get a rebate from the U.S. Treasury.

Also, your idea that more consumption is good is under severe pressure in light of the climate crisis, which you cannot discount as a retired lieutenant colonel in the U.S. Army. The U.S. military knows the climate crisis is happening and they are making all sorts of preparations.

It’s pretty crazy that the United States is only 4% of the world population yet is home to 55% of publicly traded corporations by valuation. Given our immense wealth and prosperity, it’s crazy we are not investing in the American people by funding their medical care and education, at the very least. When you wonder why the young people are upset, or scoff at their preferred presidential candidate (Bernie Sanders), try to see things from our perspective and question the underlying assumptions that we have all been inculcated with.

Comments to Republicans on Wealth Inequality and Corporate Welfare

My comments in response to Republicans for Trump, critical of welfare queens, who say people need to work hard to succeed, and who say Bernie Sanders wants to give everything away for free and ruin our country. (Mostly white seniors saying this, while on Medicare, Social Security, and having grown up in a different economy that was more favorable in several key ways.)

We have the greatest wealth inequality since the 1920s and the American dream is dead for many. Look outside your bubble a little bit. I’m not saying the economy isn’t strong but it’s not working for everyone and Trump is pouring gasoline on it with $1 trillion deficit spending per year and pushing the Federal Reserve for rock-bottom interest rates. It won’t last forever.

The 52% proposed tax is fake news. Bernie has proposed this tax bracket on the portion of income above $10 million per year or $20 million if married.

If you want to look at freeloaders look at your mega-wealthy and big corporations. They make the food stamps look like scraps. Under the new Republican tax law the top 379 profitable corporations paid 11.3%, not 21%. These are just profitable corporations. Others, like Amazon for many years, keep expanding or use tricks to appear unprofitable and pay a 0% federal corporate income tax rate.

On Behavioral Bias, Framing, Status Quo Bias, the “Socialism” Bogeyman, and the USA’s Present Lack of True Capitalism

My writings to two commentators on Facebook about Behavioral Bias, Framing, Status Quo Bias, the “Socialism” Bogeyman, and the USA’s Present Lack of True Capitalism.

Richard Thripp (Me): Libertarian principles sound good as ideals but don’t hold up well with actual humans. If you live in a food desert, you’ll eat more junk food. If not for Social Security, Americans will NOT put aside huge sums of money throughout their working career for their retirement.

Commentator: I know a lot of Democrats think they know better than the average person, and you very well might. But I would recommend that you don’t publicly admit that you think you know better than the average person.

Richard Thripp (Me): This isn’t about me at all. Please read a bit about behavioral economics, nudges, and psychology and get back to me. Take a cognitive psychology course… or even a free online course or watch some videos. People are vulnerable to psychological tricks like framing effect, anchoring, and so many others. It’s why As Seen on TV ads are so effective at selling junk at huge markups. This isn’t about being arrogant or superior. Even highly educated professionals are vulnerable to these phenomena. Ignoring them or wishing them away by pretending people know best is foolish.

Commentator: Dr. Thripp, I know you wrote your dissertation on this sort of stuff, I know you are literally an expert and that is fine. I know that you’re right, you’re missing my point. It’s not that you are incorrect. I’m stating that a message that can be distilled down to “regular people are too stupid and/or can’t be trusted to take care of themselves so the government has to do it for them” isn’t going to win you any votes that weren’t already going to vote Democratic in Volusia County.

Richard Thripp (Me): I wouldn’t phrase it that way but I suppose there is danger in the Republicans phrasing it that way or critical commentators doing so? But they would do that anyway and are already doing it. I would be more optimistic in saying when we set up people to succeed, they will make great decisions. The idea is that the naysaying logic of people being able to take care of themselves can be used against Social Security too… but we have Social Security, have had it for 75 years, and it works well and is very popular.

There is also a status quo bias favoring what already is happening and disfavoring any change. For instance, corporate welfare and giveaways to the rich are happening, so we get a lot of people saying its justified and they earned it. Even Michael Bloomberg is out-of-touch… in his first debate performance he could have been magnanimous and even inserted some self-effacing humor about his $62 billion fortune but instead he argued he deserved every cent… which could literally buy 1,250 Orange Avenue bridges in Daytona Beach, 6,500 Matanzas Woods Parkway interchanges on I-95, or 310,000 houses at $200,000 each. Is that fair?

Richard Thripp (Me) to another commentator who presents socialism as a bogeyman and Millennials as having a victim mentality and being lazy:

It’s not an either/or and even small business owners like yourself are getting squeezed when big firms, super-rich people, and big corporations get too many tax breaks, lack of enforcement, lobbying to get laws their way, privilege, corporate welfare, and giveaways. You can worry about the bogeyman of socialism by the government… and then your small business is crushed by Walmart, Amazon, Zillow, or some other behemoth that was created not by free-market capitalism, but corporate crony capitalism.

Discussing Medicare for All and Wait Times

My comment discussing wait times and Medicare for All with a friend who has Canadian friends who sometimes come to the USA and pay out-of-pocket for faster treatment:

I think Medicare for All will be better for everyone overall. Some reports being put out are backed by vested interests in the present system… they will say long wait times are inevitable with M4A but I don’t agree and other reports such as this one are more fairly written.

One item mentioned is that it would help if advanced nurses had more autonomy. In Florida presently they can only work in a practice overseen by a physician although a Florida Senate Bill is trying to change this.

Of course, if we stopped treating MDs and DOs so badly in terms of how much they have to borrow to get through school and low-paid residencies working way over 40 hours per week, that would help. As a PhD student I was fully taxpayer funded… but med students must pay huge bills? We about 1.1 million doctors vs. 1.35 million lawyers in the USA. Pretty ridiculous. This will take a while to change of course.

What kind of specialists are your Canadian friends waiting for? I think overall, Canadian health outcomes are better. From an NPR All Things Considered interview:

On the issue of long wait times and physician availability

I think its critical for people to know that when Canadians are seriously sick — when the issue is urgent — they don’t wait. So this myth that people are sort of dying in the streets, waiting for care is just that — a myth. Part of the reason that we know that is because our health outcomes are good. When compared to the U.S., outcomes for a whole variety of different diagnoses — including life expectancy, including infant mortality — all of these things actually, the Canadian system delivers as good or better care on average across the population than we see in the U.S.

But you are absolutely right, when people have a non-urgent issue in Canada, sometimes they wait. Sometimes they wait, in my opinion, too long. That’s something we’re really grappling with here is trying to figure out how we’re going to deal with that.

Some articles are from biased sources. For instance, Sally Pipes and the Pacific Research Institute are not neutral sources… They endorse libertarianist principles which don’t hold up well in the face of actual data.

A note on libertarianism:: Libertarian principles sound good as ideals but don’t hold up well with actual humans. If you live in a food desert, you’ll eat more junk food. If not for Social Security, Americans will NOT put aside huge sums of money throughout their working career for their retirement.