Category Archives: Medicare for All

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.

Medicare for All is Impossible… Until it Isn’t

Bernie Sanders is the best candidate. He has a big base and his supporters are electrified. His policies are progressive and will really help Americans. We’ve been talking about single-payer healthcare for decades with no action. Everyone says no, it can’t be done, it’s foolish, it’s unrealistic… until it isn’t. They said the same thing about declaring independence, abolition, trans-continental railroad, women’s suffrage, prohibition (beginning and ending), Civil Rights Act, desegregation, moon landing, eradicating smallpox, black president, gay marriage, orange president, you name it. The naysayers will always naysay (haters gonna hate as Taylor Swift says), and they are often wrong… and AFTER we get Medicare for All and the Green New Deal they will change their tune and pretend they “knew” it was coming all along.

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.

On Medicare for All and Bernie Sanders, February 23, 2020

Here are my February 22–23, 2020 statements on Medicare for All and Bernie Sanders on Twitter and Facebook. Congrats to Bernie for winning the Nevada caucus in a landslide!

The United States of America is the granddaddy of all unions. The Constitution was ordained “in Order to form a more perfect Union.” #Medicare4All puts the power of that big, beautiful union behind YOU. Hospitals will benefit—more are closing in states that REFUSED Medicaid!

If “socialism” is the bogeyman, why did Republicans expand* the Child Tax Credit in the 2017 Tax Cuts and Jobs Act and make it refundable to those who didn’t pay in? Shouldn’t it be eliminated?

*Only thru 2025 whereas giveaways to the rich are permanent.

Look at—it’s a 4% new tax for Medicare for All at all brackets, plus higher taxes at high income levels (like it used to be before 1987), which is much less than what most Americans spend on healthcare already. #Medicare4All

Bernie Sanders’s movement is electric and we must unite the left behind him. He will crush the incumbent child-caging pardon-selling blowhard and bring systematic change benefitting 99%+ of Americans that is so long overdue. #Medicare4All #GreenNewDeal #NevadaCaucus #BlueWave

False equivalence fallacy from right-wing propagandists: Bernie has 3 houses! He’s just as bad as BP and the Koch brothers!

I think an insurance intermediary would raise costs overall… Somewhere. Either on the government, the plan member, or both.

The Urban Institute is estimating that Bernie’s plan will cost the federal government an additional $3.2 trillion a year, which of course is a massive expansion of federal spending added to the existing $4.6 trillion budget. But, this doesn’t involve new costs—but rather a shifting from individuals, employers, and state and local governments to the federal government. The 4% Medicare for All flat income tax makes up for it on individuals while being more equitable than what we have now, whereas governments and employers should also be expected to chip in.

The Urban Institute is predicting increased overall healthcare costs nationwide due to more people receiving more healthcare, although lower per-unit costs. As long as they are receiving necessary care, this is an improvement over going without. Keep in mind there are several versions of Medicare for All. Bernie’s eliminates deductibles, co-pays, co-insurance, and prescription costs, and also doesn’t include a means test. Social Security isn’t means tested either—even Warren Buffett can get it.

Medicare for All may seem radical now, but if you step back, what we have now with so many different systems and uninsured people is actually pretty radical. If Social Security and Medicare didn’t exist, we would think it’s awful to propose these programs now along with adding a 15.3% payroll tax. If the natural splendor of Manhattan wasn’t leveled in the early 19th century, we would never do it now… bad analogy, I know. 🙂

Note that the Urban Institute is refuted by many on the basis that administration of health insurance and care is 34% of total costs but, like with existing Medicare and Medicaid, this will be much lower under Medicare for All.

On Bernie Sanders’s Tax Plan vs. France’s Failed 75% Income Tax Bracket

A brief rebuttal to Jon Hartley’s article in Forbes about France’s failed 75% income tax bracket for income above $1 million Euros per year, in respect to Bernie Sanders’s proposed tax brackets and 4% Medicare for All income tax.

Well, we’re talking about 56% as the top marginal rate under Sanders’s plan at a much higher income ($20 million and above married), plus state income tax if any… California’s top bracket is 12.3% so that’s 68.3% combined. Other states have lower or no state income tax like Florida. The author of that Forbes piece is “a Republican economic-policy adviser” who writes for National Review. He even cites experts who say the correct tax rate is 50–65% to avoid capital flight in Europe, which is much higher than present U.S. top rates, and don’t forget that the wealthy tend to have a lot of income from capital gains that they can time disbursement of at their discretion.

Of course there are some prominent New Yorkers moving to Florida purportedly to escape taxes, but these are the people whose businesses are typically mobile and allow that. California is known for high taxes yet so many wealthy individuals and corporations are still based there. Why?