Nurses: Paul Krugman Gives ‘Shallow Political Advice’ On Health Care Reform

Yves here. I wish National Nurses United were backing a Canadian-style health care system for two reasons. One is the obvious: that as many readers have pointed out, even though Medicare is a big improvement over the private insurance most people have, it still is inferior to the medical systems of pretty much every advanced economy. The Canadian version is robust and would be a good template for the US.

I’m sure many of you will pipe up with your own anecdotes, but here are a couple. My mother has over $300 of co-pays on drugs a month. She also had to pay $40 for each 45-minute physical therapy session and is limited to ten a year, when at her age she should be getting it pretty much all the time (potentially some in a small group setting, which is likely also to be outside the Medicare framework). A woman I know who is around 70 had a very bad leg fracture, which required her to spend three months in a facility for recovery and rehab. She got a bill of $25,000, which nearly bankrupted her.

I have an insurance plan that was sorta crappy in the mid-1980s but now is a very good plan by virtue of the terms not having changed since then. I don’t know how I can do so but I intend to hang onto it after I am 65, since it is better than Medicare in important ways. A reader said he did that, so input on this front would be very much appreciated. Of course, emigrating to Canada would be even better but that is hard to pull off at my advanced age.

The second reason is that having the nurses, with their brand cred, pumping for Canadian-type care, would help undercut one of the big lines of attack against single payer” “Oh it will be like those terrible socialized medicine programs in [fill in the blank].” Proponents of single payer need to keep debunking these canards on a frequent basis. See this clip, which Lambert featured recently, for a great example:

By Michael Lighty, Director of Public Policy at National Nurses United. Originally published at Alternet

With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strikes Back.

In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. There are many ways to achieve “universal coverage,” we’re told.  “Overhauling” the entire system is too hard, healthcare is too big a part of the economy, and politicians will not take out the health insurance companies.

Yet, the alternative approaches to reform pose the same political problems: the insurance industry is likely to fight the elimination of their profits (Dutch and German health insurers, for example, are non-profit), and the severe reductions in executive compensation, elimination of shareholder dividends, and rate setting, all of which go away under European-style health insurance.  The benefits and rates are government mandated, the companies are essentially payment administrators.

Either this regulated system of private health plans lowers prices through government –set rates and negotiations, or it fails to do so and costs shift to individuals.  But it is still the government role as rate setter/price negotiator that matters. Wouldn’t it be more straightforward and simpler to improve and expand Medicare?

Still, the pundits say it’s best to search for incremental reform of the insurance-based system, and live (or not!) with the results. In other words, the best health reform we can do is a version of what we have. Worse, it props up and reinforces a profit-focused system that is antithetical to the very concept of healing. Advocates of Medicare for all, and other non-reformist reforms, are looking to solve problems immediately, not accommodating the status quo.

Progressives are badly served by shallow political advice from the likes of Paul Krugman. It obscures the reality working people actually face and undermines the fight for our values and program.

Our health is not a commodity, it doesn’t belong in the “market,” it is a human right. Those who advise us to settle for models of national health systems in other countries are missing the fundamental difference from the broken U.S. scheme. What Australia, the Netherlands and Switzerland all have in common is they do not conflate “coverage” with healthcare. Those countries guarantee healthcare.

Having health insurance in America doesn’t prevent medical bankruptcy or denied care. In the U.S., employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies.

Only 55 percent of employers offer coverage. Why would we try to buttress a system that is failing workers, hurting business, and shrinking? From 60 to 70 percent of healthcare spending comes from taxes. We’re just not getting our monies worth. We are wasting 20 cents on the dollar when we pay for private health insurance, wasting huge resources that could go to higher wages, child care and pensions.

Alternatively, single payer is the reform that establishes health security, and enables greater equality and freedom, values worth fighting for.

Ironically, healthcare reform efforts have sought to “improve and expand” every element of the present system, except the program that is popular and works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand “individual purchase,” so we’d all be on our own when dealing with insurance companies, drug companies and hospital corporations.

It is precisely profit-focused healthcare industry that has caused the problems of escalating costs and restricted access. Rising premiums pay for rising prescription drug costs, which hospital corporations pass on to patients and drive up their own rates as they leverage their market share. As a result, each sector’s revenues and profits increase. The industry imperative of revenue and profits has replaced caregiving as the basis of healthcare in the US (see Elizabeth Rosenthal’s book “American Sickness.”)

We are not “starting from scratch,” as Krugman contends (which he did not in 2005) but instead there exists a model in the U.S. for how single-payer financing could work – Medicare, which if improved and expanded to all, could confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system.

Alternative approaches to universal coverage (though even with the Affordable Care Act, 28 million people remain uninsured) depend on using huge tax subsidies to enable individuals and businesses to buy insurance coverage. Without those subsidies – in California alone they amount to over $100 billion – health insurance is a failed business model. Taxpayers prop up the insurers profits for the honor of paying $2000 in deductibles and potentially under the ACA over 9.5 percent of our income in out of pocket costs.  In California, this means 15 million people are uninsured or underinsured.

Truly controlling costs requires eliminating the waste and inefficiency of the private payers – Medicare administration cost 4-5 percent compared to up to 12 percent for insurance companies (before profits). The inherently wasteful insurance company bureaucracy doesn’t go away when everybody has to buy one of their health plans.

Ultimately, what we must face is an issue of power. Can we collectively organize a health care system without the imperatives of revenue and profit? Only if we build a movement for health justice that demands guaranteed healthcare for all as a human right. Only collectively through government do we as a society have the resources and standing to secure that right. Only through an Improved Medicare for All can we achieve health security, not subject to the market power of health care corporations.

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57 comments

  1. jackiebass

    Your 70 year old friend should have been covered for 100 days in a skilled nursing facility. As long as she was in a hospital, I believe for 3 or 4 days, before being transferred to the skilled nursing facility. Medicare pick up 100% for a time and then they pay 80% for the rest of the 100 days. Physical and occupational therapy is limited, and I don’t know what the limits are. If you have a supplemental insurance it should cover what medicare doesn’t. If you need more than 100 days you can go on medicaid. There is a catch though. You have to spend your own money(assets) before you qualify.Medicare coverage is pretty good up to a point. If you require long term care it sucks. You end up losing all of you assets. Long term planning can minimize some of this but most people put off planning until it’s too late. The high cost of long term health care is the biggest reason for an elderly person ending up broke and poor. I think this is unique to the US.

    1. Yves Smith Post author

      This woman is very high functioning and used to run a real estate business, so I can guarantee the bill was not a result of a screw up on her part. First, she may have been in a hospital for longer. Her leg was shattered. Second, I know she required tons of rehab. And she has a house so she’s not eligible for Medicaid.

      1. ChiGal in Carolina

        If the house is her primary residence, that is one asset they will let her keep. Medicaid can recover costs from her estate though, although only a fraction of what they can recover do they actually “claw back”.

        1. Yves Smith Post author

          She’s still working and generates a good income when she does (I guesstimate $50,000, although she didn’t work when she was hospitalized and it took her a while after that for her to feel energetic enough to get back in the saddle, and it could be higher), so I don’t see how can qualify.

        2. tegnost

          …although only a fraction of what they can recover do they actually “claw back”.
          Do you have a citation for this statement? I’m curious if it’s true, first of all, and if it’s true what criterion is used to pick who gets nicked, for instance if you’re poor but own a house as a friends mom was and did then you lose your house but if you’re rich and can create a trust behind which you can protect your assets then you don’t. This world where they could take it but they won’t attributes a benevolence to an industry that literally never gives up on trying to collect.

          1. ChiGal in Carolina

            Sorry for formatting and delayed response. I researched it when working hospice as I was assisting patients/families with discharge planning. That was about 5 years ago and I no longer have my source material.

            This is from a PDF from longer ago I just found by googling. Per this, few states recover as much as 2% of what they spend on long-term care.

            TABLE 3: Revenue as Percentage of Medicaid Long-Term Care Expenses
            Total Amount
            Recovered
            ($ millions)
            Total LTC
            Expenditures*
            ($ millions)
            Amount Recovered as % of
            LTC Expenditures
            Alabama 4.0 1,072.4 0.37%
            Alaska 0.0 255.0 0.00%
            Arizona 1.6 27.7 5.78%
            Arkansas 1.6 750.4 0.21%
            California 53.9 4,141.4 1.30%
            Connecticut 10.7 1,869.2 0.57%
            Delaware 0.5 249.7 0.20%
            Dist. of Columbia 1.7 293.5 0.57%
            Florida 9.3 3,345.4 0.28%
            Hawaii 2.5 211.8 1.18%
            Idaho 5.6 306.1 1.83%
            Illinois 17.0 2,728.3 0.62%
            Indiana 7.5 1,448.9 0.52%
            Iowa 10.8 996.7 1.08%
            Kansas 5.8 775.7 0.75%
            Kentucky 2.6 1,021.6 0.25%
            Louisiana 0.1 1,187.3 0.01%
            Maine 5.0 550.3 0.91%
            Maryland 5.0 1,486.1 0.34%
            Massachusetts 28.0 2,740.8 1.02%
            Minnesota 16.6 2,383.1 0.70%
            Mississippi 1.7 789.0 0.22%
            Montana 2.0 241.8 0.82%
            Nebraska 1.2 584.7 0.21%
            Nevada 1.2 202.6 0.59%
            New Hampshire 4.0 317.1 1.26%
            New Jersey 5.6 3,311.1 0.17%
            New Mexico 0.0 531.3 0.00%
            New York 27.2 15,944.7 0.17%
            North Carolina 5.0 2,171.8 0.23%
            North Dakota 1.8 281.8 0.64%
            Ohio 13.9 4,511.2 0.31%
            Oklahoma 1.8 877.0 0.21%
            Oregon 20.0 899.1 2.22%
            Pennsylvania 24.4 5,729.9 0.43%
            Rhode Island 3.6 433.0 0.82%
            South Carolina 4.9 873.0 0.56%
            South Dakota 1.2 223.8 0.54%
            Tennessee 3.1 1,354.8 0.23%
            Utah 2.3 279.8 0.82%
            Vermont 1.0 196.3 0.51%
            Virginia 0.9 1,185.1 0.08%
            Washington 11.6 1,555.6 0.75%
            West Virginia 0.4 633.2 0.06%
            Wisconsin 17.6 2,211.4 0.80%
            Wyoming 1.3 156.1 0.83%
            Total 347.4 84,034.0
            Avg. (Median) 7.6 (3.8) 1,594.3 (875.0) 0.69% (0.57%)
            *Source: Medicaid Financial Management Reports (CMS-64): Combined costs for nursing facilities,
            public and private intermediate care facilities for people with mental retardation, and home and
            community-based services for FY 2003. Total amount recovered includes both state and federal share

            1. ChiGal in Carolina

              Most states have an estate threshold below which they do not pursue recovery (wide range from $50 — $50k), and the recovered $ are funneled back into the system to continue providing Medicaid benefits to the living.

              It is true that there is a thriving industry of lawyers/estate planners who assist better off (not only the rich btw) folks to be able to put their assets in trusts the state cannot touch, thus preserving the nest egg they worked their whole lives to be able to pass on to their kids–while at the same time draining scarce monies meant for the truly poor.

              Seems to me if anyone is fortunate enough to end their working lives with a nest egg, it is an entirely legitimate societal expectation that they use it to pay their living expenses. Sure it would be nice to pass something on, but not by raiding the pitiful amount set aside for those less fortunate. The state is not the bad guy here.

              The real issue in my judgement is the corporatization of care facilities, which are outrageously expensive. And people live too long, with both patient/families and medical providers colluding to go through one costly and invasive procedure after another with no regard for quality of life.

    2. Jackiebass

      I didn’ mean to say she screwed up. I was simply trying to point out a weakness in how long term care is handled and covered by insurance. Like I said Medicare is very limited in how long they provide in hospital care. Unless she did advanced planning , she will have to spend her assets ,which includes her house, before she can qualify for Medicaid. On paper they allow you to keep a relatively small amount. The reality is when you die they take this small savings and give you $2500 for your burial. To have a decent amount for your burial you can set up an irrevocable burial trust. This is locked in and can only be used for your burial. Unless you plan way ahead to shelter your assets, you are screwed if you need long term care. I wen’t through with my mother so I’m telling what I learned the hard way.

      1. tegnost

        does the “advance planning” include creating a trust, what other methods of advance planning would you recommend to help people avoid the clawback?

    3. reslez

      Yes, my parents who just turned 60 have a supplemental policy for long term care. They told me several times how happy they were they wouldn’t have to use Medicaid. They were “protected”. Except they just found out their policy premiums are increasing 40% this year and the same amount next year, and who knows how much after that. They seemed a little shocked.

      I do my best to tell my family members what’s on the horizon for them, but they don’t believe me. They turn it into a political argument with talking points pulled from Fox news. That’s propaganda. This is reality, this is what’s coming for you. This is how the State + Big Money strip mine your estate. No, you aren’t leaving anything for your heirs. You’re going to be a financial burden to your kids if we try to take care of you ourselves, and you voted R and centrist D the entire way, you never supported universal health care, and yes you share in the blame.

      There are also filial responsibility laws in PE and NJ where they go after your kids if you require nursing home care. Coming soon to a state near you.

      1. reslez

        Adding, I wonder how much of a spike in the suicide rate there will be as families start figuring this stuff out. I love my parents but my mother has a degenerative disorder and is already handicapped. Her mind is sharp and I want her to be around as long as possible. I guess it speaks to Neoliberalism Rule #2, Die Faster.

  2. CK

    Calling Canadian healthcare robust is a bit off from reality, at least in the province of Ontario. Public healthcare doesn’t cover drugs, teeth and eye care, some physiotherapy, and it’s increasingly difficult to get not only imaging but specialists appointments for chronic spine-related issues.

    I had to pay for spinal surgeries in Buffalo NY, as specialists refused to identify crushed levels in my lumbar spine and nerve damage I suffered as a result of a serious fall. The US based surgery ended up causing further issues, but least I was offered treatment.

    Our homecare is buckling under pressure from growing needs, and waiting lists for nursing homes is in the months if not years. And believe me, not where you wish to place loved ones.

    Yes primary care is free, as is emergency care. Canada invested in 5 areas of healthcare 15 yrs ago, cancer, hips and knees, heart and cataracts. Robust services exist, but they are certainly not comprehensive in scope or breadt.

    At least in Ontario, there is room for improvement: allow the public funding to flow to frontline staff, as opposed to the heavy bureaucracy that supports that staff; better use of technology; and perhaps a rethink in how services are delivered.

    Time will tell whether we will continue to see healthcare diminish in size, or we are up to the challenge of improvements/new models

    1. Yves Smith Post author

      I don’t think you appreciate how lousy US healthcare is. Very few people have dental insurance. Refractions and eyeglasses aren’t included in just about any US policies. Drugs are covered, but I bet in many cases your price is lower than co-pays here. That is true for the one prescription I get from Australia, and that’s a very old drug that should be cheap by now and isn’t.

    2. Archangel

      You do know that nearly 2/3 of all bankruptcies in the US stem from healthcare related expenses, and a great many of these are people who, on paper, have health insurance?
      How many Canadians go bankrupt as a result of medical bills?

    3. Altandmain

      Agreed that Ontario is far from perfect, but as a fellow Ontarian, it is better than what is available in the US.

      1. Agree that more specialized care is needed
      2. We do need the clawbacks of vision and physiotherapy reversed
      3. We may get a universal prescription plan in the future

      https://beta.theglobeandmail.com/news/national/with-universal-drug-coverage-canadians-could-save-billions-study/article34141670/?ref=https://www.theglobeandmail.com&service=mobile

      The big one though is dental. We need to get a universal plan for our dental care. Another thing that is important is to get a higher doctor to patients ratio.

      It is not a perfect system, but way better than the other alternatives.

  3. Eclair

    Where to start! Whenever I read the words of a mealy-mouthed pundit cautioning moderation, even one who is a Nobel Laureate, I think of Martin Luther King’s Letter from the Birmingham Jail:

    ” I must confess that over the last few years I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro’s great stumbling block in the stride toward freedom is not the White Citizens Councillor or the Ku Klux Klanner but the white moderate who is more devoted to order than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says, “I agree with you in the goal you seek, but I can’t agree with your methods of direct action”; who paternalistically feels that he can set the timetable for another man’s freedom; who lives by the myth of time; and who constantly advises the Negro to wait until a “more convenient season.” Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.”

    For-profit health insurance companies have had a great run for their money; it’s time they take their wads of cash and slither off to to become non-profit, heavily-regulated boutique firms serving a niche market. But they are not going to go without a firm push.

    Easy for Krugman to advocate ‘reform,’ when he has never had to worry that an emergency room visit
    will preclude eating anything other than ramen noodles for the next two weeks. Or, experience, as a Medicaid recipient, being labeled as poor, and thereby stupid, lazy or simply unloved by god. Or old and past your sell-by date.

    A young woman and her two children stopped by our house yesterday to look at a bedroom set we were offering her; twin beds, mattresses and a dresser. They have been living in a camper owned by my brother-in-law, on his land in the country, since they were evicted from their apartment. They will be moving into a rental house this weekend but have nothing other than their clothes. She has lupus. And a missing front tooth. She has worked for years at the same service job. She is a universe apart from Krugman’s privileged academic world. Access to free or low cost health care for her and her children would remove one big worry from her life.

    1. ChiGal in Carolina

      Hey Eclair, asked at the Farmer’s Market yesterday and the key thing is to have a “certified” kitchen. Fiddlehead Farms only does preserves and condiments though, so I guess that was worth it to them.

      He said tomatoes are different cuz of acidity and for those products they have to provide a sample along with the ingredients list. But it’s a one-time thing only when they first come out with a new product, not for each subsequent batch.

      Passing along his sympathies!

      1. Eclair

        Thank you, ChiGal! I checked in on Tuesday with the Amish woman who makes the preserves. The saga continues; the lab the PA health inspector recommended came back with the results which were just fine. BUT …. that was for one test only, the other required test, they don’t do … that’s another lab and another fee … and another couple of weeks, before the jams and pickles are ok’ed for sale, which pretty much wipes out the big summer sale window.

        A ray of hope; New York State, just 10 miles up the road, doesn’t require these tests for small home producers. She has found some farm stands in NY that are buying her jams and pickles.

        Another sticking point in PA is labelling; apparently, L can relabel the jars as “Fruit Spread” and sell them. I admit I am totally confused. Meanwhile, since we are living ‘over the border,’ I took back a dozen jars … black raspberry, red raspberry, peach, rhubarb and black currant and the famous triple berry (the strawberry is sold out). With each piece of toast piled high with fruity jam, I send ‘loving’ thoughts towards the PA Dept of Health.

    2. DJG

      Eclair: I have a friend with lupus. She is a well-established writer and has taken good care of herself. But health insurance for a free lance was a hassle for years, and now she is on Medicare, which simplifies matters.

      Lupus is high maintenance. This young woman isn’t being served well by the health-insurance regime, and I bet that, as a consequence of our crappy system, she doesn’t have the lupus under control. And you are right: She is exactly the kind of person we should be concerned about. Krugman can always get a supplemental policy. She cannot. She has to have excellent basic care at minimal cost.

  4. Collins

    The really big money – “the govt money”- is already going to huge companies for Medicare ‘Advantage’ Plans ( 33% of medicare age and growing ) and Managed Medicaid (65% & growing ). In some cases for Medicaid, these companies are non-profit companies which in turn are owned by for-profit companies paying their CEO tens of millions a year- your tax dollars at work.
    Both Democrats & Republicans are firmly behind this, because insurance companies capitalize the banks. Obamacare was mostly Medicaid expansion, which was – and is- incredibly profitable for these companies, Ryan Care would be as well.

    It will be Managed Medicare for All, with only truly wealthy patients having choice, by paying extra cash (preserved as an option).
    The only way it will change is when enough voters are personally damaged by the system for it to become a discrete call-it issue and an alternative candidate surfaces and the incumbent realizes he’ll lose his seat. Difficult path, but not impossible.

  5. ChiGal in Carolina

    Just for the record, the nurses are supporting national improved Medicare for all (NIMA), to include all medical (outpatient and inpatient), dental, mental health, long-term care, pharmaceuticals, and medical equipment with no need for supplemental insurance and no premiums, copays, or deductible to meet.

    Friedman’s proposal for funding HR 676 is through a combination of income taxes (3% on bottom 40% and 6% on top 60%) and surtaxes on the wealthiest and on unearned income. With the government regulating prices.

    I think this needs tweaking, and the devil will be in the details…

    1. Yves Smith Post author

      Sorry for not having understood that and pointing it out.

      Unfortunately, their own policy director isn’t doing a great job of communicating that. I can’t change what he wrote.

      IMHO the “Medicare for all” branding risks Medicare winding up being the ceiling for what we might get, as opposed to the intent that it is the floor.

      1. Darn

        Yves I was gonna write something similar to ChiGal re your intro. While Medicare for All could be taken to imply Medicare-style cost-sharing, I dunno anyone who intends this. I share your concern though think it’s a minor issue.

        Why the name? Unfortunately polling still shows a difference between levels of support for single payer depending on the wording of the question. Cost-sharing, Medicare Advantage and Medigap suck but the public has a rough idea of what Medicare is (covers everyone, government pays), and if you said Medicaid instead they would realise that plenty of providers don’t accept Medicaid.

        Single payer is just a less well-understood term, though I’m delighted that it’s now so well-recognised and well-supported by liberals. Even the original version of HR 676 was to create a US National Health Insurance Programme. Later versions of the bill just called it the Medicare for All Programme.

        There’s no way round this until the public understands the term “single payer” equally well. Phrasing like “a single payer, Medicare for all programme” as Sanders often puts it will help as you go along.

        One example of the confusion was this recent rubbish article from ‘The Nation’ which claims “near-consensus has developed around using Medicare to achieve single-payer”. Wrong. Who proposes actually using Medicare? HR 676 just creates single payer with zero cost-sharing and then labels it “Medicare”. https://www.thenation.com/article/medicare-for-all-isnt-the-solution-for-universal-health-care/

        1. Yves Smith Post author

          How about “healthcare for all”? I agree “single payer” is a terribly bloodless expression, guaranteed not to turn people one.

          1. Darn

            Unfortunately “healthcare for all” is even plainer English but is a synonym for “universal healthcare” and not “universal government healthcare programme”. I think the Medicare for All name makes the best of a bad job and it is indeed polling well as intended.

        2. marym

          There’s also nothing in the term single payer itself that excludes it been a reference a for-profit private insurance entity; or a government single payer making payments not to providers, but to for-profit managed care insurance companies.

          That’s not what advocates for universal publicly financed healthcare mean by “single payer” but we need to be sure it isn’t co-opted.

          Here’s the AETNA CEO recently talking about a “debate” on single payer but doesn’t “think the government should run it.” (He’s since reverted to fixing the ACA.)

          Here’s a 2016 LA Times article about the profits insurance companies are making from Medicaid managed care refers to the government as the “single payer” for Medicaid, but for Medicaid managed care (and Medicaid advantage) single payer pays the insurance companies, not the providers.

          1. marym

            edit numerous typos:

            “excludes it being”
            “that refers to the government”
            “Medicare Advantage”

        3. Anon

          the public has a rough idea of what Medicare is (covers everyone, government pays),…

          A very rough idea, at best. Unless you are using Medicare it’s unlikely you understand the complexity (lots of paperwork). First, the government doesn’t pay; everybody does with deductions from their paycheck. Second, it only pays 80%, and has restrictions and deductibles. Third, it takes at least 90 days from the time medical (doctor) service is provided until payment is made and the extent of coverage is determined. (In the meantime, some medical practices will bill for the 100% cost of care to the patient hoping they will pay quickly, before CMS (medicare officials) has determined their actual monetary responsibility). Confusion abounds, until you become skilled at reading the wording on the mailed information. The confusion is likely more pronounced for some.

          And Medicare does NOT cover everyone. That’s why there is Medicaid.

          1. Darn

            The rest of my comment should have made clear to you that I understand that Medicare has cost-sharing (and I even mention Advantage and Medigap), that I am opposed to cost-sharing, and that so are the single payer proponents.

            And yes the government DOES pay, it is a taxpayer-funded programme! Using the name “Medicare for All” thus gets across that it is funded by taxes and is government programme. “Healthcare for all”, “single payer” and so on don’t have those connotations for most voters. They could be taken to mean private insurance or payment of premiums. Since the proposals are comprehensive and don’t have deductibles, those don’t matter either, though they will certainly scare off potential supporters if you, like the Nation article and what Yves wrote earlier, keep mentioning them.

            As for payment lags, at least Sanders’s bill had everyone getting a smart card. If it worked like the carte vitale in France then billing would occur instantly to the insurance company (in their case, govt in this case), and be paid within X days 99% of the time, but without the co-pays that France has.

            1. Darn

              PS It does cover everyone, in the sense of everyone who has reached the qualifying age, and when one says “for all” people will intuitively understand “the whole population of all ages”.

  6. grayslady

    It is my understanding that the “Medicare for all” slogan is being used by proponents of single payer because it has always registered well with voters, most of whom know that it allows complete choice of doctors and hospitals. The actual legislative intent of proponents is an “improved Medicare”–much closer, if not identical, to the Canadian system. IMO, one of the best aspects of Canadian healthcare is that there are no exceptional insurance programs for politicians, such as we have here. Everyone is on the same basic program. They do have private insurance available to cover expenses that are not covered by the basic plan (such as a private room in the hospital), but, as I see it, the only way to discourage that practice is to have huge penalties for using that type of insurance since it operates against the lower administrative costs that make single payer so appealing.
    Yves, you can continue to use your private insurance, even with Medicare. Medicare is billed first; your own insurance company simply pays its share of the balance on any procedure.

  7. DJG

    I agree with Yves Smith’s comment up top: Medicare is not good enough. Also, the enrollment is plain bizarre. What does one have to enroll in? Plan A, B, C, D, F? Who knows?

    A detail that I may have missed in other commentary on north-European health systems but that the author Lighty asserts:

    (Dutch and German health insurers, for example, are non-profit)

    Is this true? If so, then the U. S. can have the figleaf of the “market” yet still require all insurers to become genuine not-for-profits. But I’m wondering if other commenters can explain how well the “non-profitness” works out in the Netherlands or Germany. In the U S of A, there are plenty of non-profits that happily participate in the looting and sacking because non-profits are seldom disciplined by the legal authorities or tax authorities in the U.S.

    1. Eclair

      Gosh, yes, DJG. Medicare is not good enough. I enrolled in Medicare last October; the basic enrollment was simple. Boom, it was done. (So much for government incompetence!)

      Then came the Plans: A or B or C or D? Supplemental or Advantage? I became enraged when I realized that the for-profit health insurance industry had fixed it’s claws into and was feeding off Medicare.

      So, just on principle, I refused to sign up for either a supplemental or an Advantage plan. But, also because the Advantage plans link you to a certain geographical area and to a medical group within that area. We were planning to move.

      And, why does what passes for our national universal health plan pay only 80% of costs? Like seniors chose to have cataracts or heart attacks or strokes? Or cancer? OK, I’ll pass on knee and hip replacements. And of course the costs are high; we’re all dying of something, some of us more slowly than others.

      And, Medicare D, the drug plan, is a sick joke. Dust off your crystal ball, because you must chose a plan that includes in its formulary, the specific drugs that you will be taking for the next year. If, in January, you develop a condition that requires pseudohexadexachlorocillan to save you and your plan does not include it, then you are toast. You must wait until next year. I take a minimum dosage of lisinopril, a generic hypertensive drug. I pay $19 per month for Medicare D, $1.60 for co-pay. A month’s supply of lisinopril costs $12, if I go to a pharmacy and pay cash. But, if I don’t enroll in Medicare D from the start, I will pay a heavy penalty if and when I actually need expensive drugs and want to enroll at a later date.

      And, in my case, I have arthritis of the spine (and ankles) as well as peripheral neuropathy in my feet. I keep it from totally incapacitating me by daily stretching and yoga, plus monthly visits to a chiropractor and bi-weekly massages. And, in the winter, soakings in hot tubs, steam rooms and saunas. I do not take any pain medication. Our current system insists we manage these conditions of aging by taking prescription drugs, which they pay for. A massage therapist or visits to a facility with saunas, thermal pools, etc., are not covered.

      And, I have not even mentioned the hours spent reading through the fine print on competing Advantage, Supplemental and Drug plans. The agony of trying to make a decision and realizing that the wrong one could bankrupt you financially. And I have a graduate degree in economics and am in good health! I try to imagine doing this on a high school education and suffering from cancer or COPD.

      1. Jim Haygood

        ‘I have not even mentioned the hours spent reading through the fine print on competing Advantage, Supplemental and Drug plans.’

        We are all consumers now, comrades, from America’s bounteous health care cornucopia. :-)

        Funny how reading the fine print of health plans resembles doing taxes: lots of obscure subsections and potential ‘gotcha’ clauses.

        Where can I find me a concierge shopping service for health coverage? Or a pert young AmeriCorps navigator, brimming with youthful enthusiasm? Sorry, hallucinating …

        1. Eclair

          Yeah, Jim. The same people that write sections of the tax code must moonlight writing for the health insurance companies. So many double negatives!

      2. Yves Smith Post author

        I’ve had hip pain as a result of a really bad fall on Jan 1. If I hadn’t been weight training for 30 years. I guarantee it would have broken my hip. But I probably have a torn labrum instead.

        It means I have to take cabs when my hip gets bothered by walking, which happens after not long distances by NYC standards.

        Recently I was apologizing to a cab driver for having him take me a short distance. He asked about my injury. He recommended turmeric milk before going to bed. He insisted on a minimum of five days.

        I’m not a placebo responder and I noticed an improvement after three days.

        Here is a recipe. You can do it via just boiling milk and adding a teaspoon of ground turmeric plus some ground pepper (which increases the bioavailability) but if you have time and can get fresh turmeric (many Whole Foods carry it), that’s better. I put some water in a blender and pulverize the root that way rather than grinding it with a mortar and pestle.

        http://timesofindia.indiatimes.com/life-style/health-fitness/home-remedies/Heres-how-you-should-make-turmeric-milk/articleshow/47467371.cms

        It is supposed to help with arthritis too. It does seem to be a way more effective anti-inflammatory than any OTC drugs I have taken.

        1. grayslady

          Glad turmeric worked for you. I tried turmeric-plus-pepper pills for several months and noticed no change in my arthritis pain. Bromelain is also supposed to be effective (an enzyme from pineapples). By the way, both turmeric and bromelain are natural blood thinners, so best not to use these even with baby aspirin.

          1. Paul Harvey 0swald

            grayslady, You might want to reconsider. From the link above:

            Remember that turmeric powder is never as effective as crushed turmeric sticks, because the chances of contamination in the powder are high, plus its efficacy is also bound to reduce during the heat-generating grinding process

        2. Eclair

          I’ll give the turmeric and pepper a try. I have a big pack of turmeric a friend brought me from India. Might as well …. Thanks for the tip,Yves.

        3. Mark P.

          It does seem to be a way more effective anti-inflammatory than any OTC drugs I have taken.

          Yves —

          I’m resident in the Bay Area most of the time, where they have legal marijuana dispensaries. Marijuana products sold include CBD — or cannabidiol — which has no THC (the psychoactive component that gets users high).

          People I know out here swear by CBD’s anti-inflammatory properties, including arthritis sufferers and cancer patients, and say it’s superior to OTC drugs. I’ve taken CBD and will testify there was no high. Above all, it seems to have no side-effects, which most definitely means none of the very nasty cognitive and addictive properties that today’s prescribed pharmaceutical products have.

          For pain at the level that anyone who’s been prescribed fentanyl is experiencing pain, CBD won’t work. But by and large cannabis is as an effective anti-inflammatory as its proponents claim, as far as I can tell. It’s also available as edible (gum) or oil, so no smoking is necessary and one can control exactly how much one consumes of the drug.

          If you have a chance and have any friends in California (or elsewhere where it’s legal) you might ask them whether they can get you some so you can decide whether it works for you.

        4. Adam Eran

          Costco sells turmeric pills (not cheap!).

          Also good as an anti-inflammatory: Green Tea

          Finally, the best anti-inflammatory of all: whole foods plant-based diet.

    2. Jim Thomson

      On medicare I also pay premiums ( although they are deducted directly from Social Security, so we do not see it openly) of around $500 per month for Part B Deductible, Part D ( drugs) and Supplemental ( pick door A through F, or maybe N, you roll the dice) to cover some of what Medicare does not.
      And this is the premium, not for any care at all.

  8. marym

    Adding to comments above:

    According to the NNU website, the bill they support is S. 915 introduced by Sanders in 2011.

    It’s a comprehensive (list of benefits), state-based, federally funded single payer plan.

    American Health Security Act of 2011 – Establishes the State-Based American Health Security Program to provide every U.S. resident who is a U.S. citizen, national, or lawful resident alien with health care services. Requires each participating state to establish a state health security program.

    Eliminates benefits under: (1) titles XVIII (Medicare), XIX (Medicaid), and XXI (Children’s Health Insurance) (CHIP, formerly known as SCHIP) of the Social Security Act; (2) the Federal Employees Health Benefits Program; and (3) TRICARE.

    Also on the NNU website, a recent post indicates they’re working with Sanders on his new bill. No link, but I recall reading during the presidential campaign that Sanders has changed to preferring a national plan.

  9. tongorad

    I cling to the naive hope that our younger generations will not be so ideologically captured by incremental politics. The goal should be the most robust universal health care in the world, and nothing less.

      1. tongorad

        That’s a rather odious link:
        Public support for ‘single payer’ health coverage grows, driven by Democrats
        Health care is not “coverage.” And the Democrats priority is to block universal health care.

  10. P Fitzsimon

    The Canadian system is administered by provinces but funded by the federal government. It seems to operate like Medicaid except that it covers all citizens and landed immigrants. Would it be better to extend Medicaid to all or Medicare to all in the U.S. ?

  11. JEHR

    After the revolution, you will be able to get your universal healthcare. It is very sad reading all the horror stories about insurance and for-profit healthcare. Our single-payer system is not perfect, but we had better fight to keep what we have!

  12. Pinhead

    “Single payer” is not a panacea. I have lived and worked for more than 50 yearsin four different European countries – France, Switzerland, Sweden, Britain – and have experienced the good and bad points of each country’s healthcare systems. All work better than America’s but there is no reason why the US cannot construct an original model that works as well as or better than others.

    What is needed is an enlightend public. That can only come from an enlightend media. Politicians will catch on fast or lose elections to others who do.

    I have yet to see an economic study that measures the profits of American health insurance companies and hospitals and doctors against the colossal and visible waste and mismangement in the French and British systems, or the profits of the Swiss system. If the Swedes do better, it is because the voters are well informed.

    Paul Krugman’s positions are debatable but at least they are comprehensible and not based on ideology. There are many other intelligent points of view to be expressed and debated. In short, call the editors of your local media and start a nationwide discussion, properly monitored.

  13. Darn

    Yves if I may make a suggestion. As you can see from this thread the “Medicare is not good enough” objection recurs several times. I would like you think that you or NC are a “name” with NNU, if not necessarily with Lightly himself, and if you made a polite representation to them to clearly DEFINE Medicare for All from the outset every single time they write an article promoting it? Lightly’s article does indeed say “expanded and improved” but does not say that cost-sharing for patients would be eliminated, even though that’s what NNU supports. Based on the experience of this thread, the problem could be nipped in the bud.

  14. Bobbo

    I generally agree with the article, but I wish the author had not ventured so far as to claim that healthcare is a human right. That will trigger the wrong reaction in too many people. Single payer should be adopted because it works better, not because health care is a human right. Too many Americans are brainwashed by rigid ideology that prevents them from focusing on the fundamental question of what works and what doesn’t.

    I have lived outside the U.S. for 15 years. I lived in one country that has a single payer public option alongside a parallel system of private insurance that gives people more options. Works better than the U.S. system at a fraction of the price.

    I currently live in another country where everyone is on the government health insurance plan, but it is a pay-as-you-go system with price controls (essentially a co-pay for everything). Care is high quality and affordable, but not free. For example, an office visit is $5, an ultrasound is $40, an MRI is $300, and two weeks hospital stay in a university hospital in a shared room is $1500. People can sign up for private insurance to cover co-pays. Everyone seems to like the system except the doctors and hospitals.

    Either of these alternatives would be 1000x better than the current U.S. system. The only quick fix to the U.S. system is single payer.

    1. Erika

      I agree that it shouldn’t be considered a human right. To my mind, a right is something that theoretically can be provided or honored regardless of a given society’s wealth. Freedom of speech, freedom of religion, these are things that technically can be honored even in an impoverished, agrarian society. But providing universal health care requires a considerable monetary investment, which many societies simply can’t provide. (In some parts of the world, providing potable water is challenging enough). Considering it a right also creates the idea in people’s heads that they’re entitled to any treatment they want at any cost. True universal systems make a lot of hard choices about life-extending treatments that cost too much for their supposed benefits. If health care is a “right”, how can any universal system say no to a cancer treatment that costs $500k but only extends life for two months?

      What health care is is a public good. A public good that becomes easier/more possible to provide the more developed a society is. A public good that makes life more livable, families happier and more cohesive, and businesses more successful. But it’s still not a right.

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