The Social Contract According to Elizabeth Warren

New America (board chair emeritus Eric Schmidt, President the aptronymic Anne-Marie Slaughter), a nominally center-left Beltway think tank (funding) “took up the mission of designing a new social contract in 2007 and was the first organization [anywhere?] to frame its vision in these terms.” On May 19, 2016, New America sponsored an annual conference (there was no 2017 iteration) entitled “The Next Social Contract.” Elizabeth Warren, presidential contender, was invited to give the opening keynote (transcript, whicn includes video). Warren shared a number of interesting ideas. I will quote portions of her speech, followed by brief commentary, much of it already familiar to NC readers, in an effort to situate her more firmly in the political landscape. But first, let me quote Warren’s opening paragraph:

It is so good to be here with all of you. And yes I will be calling on people. Mostly those of you standing in the back. I always know why people are standing in the back. That’s what teachers do.

Professional-class dominance games aside, it’s evident that Warren is comfortable here. These are her people. And I would urge that, no matter what policy position she might take on the trail, these policies and this program are her “center of gravity,” as it were. Push her left (or, to be fair, right) and, like a bobo doll, she will return to this upright position. So, to the text (all quotes from Warren from the transcript). I’ll start with two blunders, and then move on to more subtle material.

Warren Does Not Understand Uber’s Business Model

Or, in strong form, Warren fell for Uber’s propaganda.[1] Warren says:

Thank you to the New America Foundation for inviting me here today to talk about the gig economy… You know, across the country, new companies are using the Internet to transform the way that Americans work, shop, socialize, vacation, look for love, talk to the doctor, get around, and track down ten‐foot feather boas, which is actually my latest search on Amazon….

These innovations have helped improve our lives in countless ways, reducing inefficiencies and leveraging network effects to help grow our economy. And this is real growth…. The most famous example of this is probably the ride‐sharing platforms in our cities. The taxi cab industry was riddled with monopolies, rents, inefficiencies. Cities limited the number of taxi licenses…

Uber and Lyft, two ride‐sharing platforms came onto the scene about five years ago, radically altered this model, enabling anyone with a smartphone and a car to deliver rides…. The result was more rides, cheaper rides, and shorter wait times.

The ride‐sharing story illustrates the promise of these new businesses. And the dangers. Uber and Lyft fought against local taxi cab rules that kept prices high and limited access to services….

And while their businesses provide workers with greater flexibility, companies like Lyft and Uber have often resisted efforts of those very same workers to try to access a greater share of the wealth that is generated from the work that they do. Their business model is, in part, dependent on extremely low wages for their drivers.

“In part” is doing rather a lot of work, there, even more than “the wealth that is generated,” because as NC readers know, Uber’s business model is critically dependent on massive subsidies from investors, without which it would not exist as a firm. Hubert Horan (November 30, 2016):

Published financial data shows that Uber is losing more money than any startup in history and that its ability to capture customers and drivers from incumbent operators is entirely due to $2 billion in annual investor subsidies. The vast majority of media coverage presumes Uber is following the path of prominent digitally-based startups whose large initial losses transformed into strong profits within a few years.

This presumption is contradicted by Uber’s actual financial results, which show no meaningful margin improvement through 2015 while the limited margin improvements achieved in 2016 can be entirely explained by Uber-imposed cutbacks to driver compensation. It is also contradicted by the fact that Uber lacks the major scale and network economies that allowed digitally-based startups to achieve rapid margin improvement.

As a private company, Uber is not required to publish financial statements, and financial statements disseminated privately are not required to be audited in accordance with generally accepted accounting principles (GAAP) or satisfy the SEC’s reporting standards for public companies.

The financial tables below are based on private financial statements that Uber shared with investors that were published in the financial press on three separate occasions. The first set included data for 2012, 2013 and the first half of 2014… The second set included tables of GAAP profit data for full year 2014 and the first half of 2015; the third set included summary EBITAR contribution data for the first half of 2016.….

[F]or the year ending September 2015, Uber had GAAP losses of $2 billion on revenue of $1.4 billion, a negative 143% profit margin. Thus Uber’s current operations depend on $2 billion in subsidies, funded out of the $13 billion in cash its investors have provided.

Uber passengers were paying only 41% of the actual cost of their trips; Uber was using these massive subsidies to undercut the fares and provide more capacity than the competitors who had to cover 100% of their costs out of passenger fares.

Many other tech startups lost money as they pursued growth and market share, but losses of this magnitude are unprecedented; in its worst-ever four quarters, in 2000, Amazon had a negative 50% margin, losing $1.4 billion on $2.8 billion in revenue, and the company responded by firing more than 15 percent of its workforce. 2015 was Uber’s fifth year of operations; at that point in its history Facebook was achieving 25% profit margins.

Now, in Warren’s defense, it is true that she, on May 19, 2016, could not have had the benefit of Horan’s post at Naked Capitalism, which was published only on November 30, 2016. However, I quoted Horan’s post at length to show the dates: The data was out there; it wasn’t a secret; it only needed a staffer with a some critical thinking skills and a mandate to do the research to come to the same conclusions Horan did, and Uber’s lack of profitabilty, information that is easily accessible, is a ginormous red flag for anybody who takes the idea that Uber “generates wealth” seriously. How is it that the wonkish Warren is recommending policy based on what can only be superficial research in the trade and technical press? Should not the professor have done the reading?[2]

Warren Does Not Understand How Federal Taxation Works

The second blunder. Warren says:

First, make sure that every worker pays into Social Security, as the law has always intended. Right now, it is a challenge for someone who doesn’t have an employer that automatically deducts payroll taxes to pay into Social Security. This can affect both a worker’s ability to qualify for disability insurance after a major [injury], and it can result in much lower retirement benefits. If Social Security is to be fully funded for generations to come, and if all workers are to have adequate benefits, then electronic, automatic, mandatory withholding of payroll taxes must apply to everyone, gig workers, 1099 workers, and hourly employees.

It is laudable that Warren wants to bring all workers in the retirement system. But as NC readers know, Federal taxes do not “pay for” Federal spending, and hence Warren’s thinking that Social Security will be “fully funded” through “payroll taxes” is a nonsense (and also reinforces incredibly destructive neoliberal austerity policies). I will not tediously rehearse MMT’s approach to taxation, but will simply quote a recent tweet from Warren Mosler:

And if Mosler isn’t good enough, here’s John Stuart Mill on currency issuers:

Again, is it too much to ask that a professor do the reading? After all, MMT gotten plenty of traction, even in 2016. The Sanders staff, for example, could have been helpful to her.

Warren Supports Medicare for All Only Nominally

Warren is indeed a co-sponsor of Sanders’ (inadequate) S1804. But read the following passages, and you will see #MedicareForAll not where her passion lies:

As greater wealth is generated by new technology, how can we ensure that the workers who support the economy can actually share in the wealth?

(The idea that workers “support” “the” [whose?] “economy,” instead of driving or being the economy, is interesting, but let that pass.)

Warren then proceeds to lay out a number of policies to answer that question. She says:

Well, I believe we start with one simple principle. All workers, no matter where they work, no matter how they work, no matter when they work, no matter who they work for, whether they pick tomatoes or build rocket ships, all workers should have some basic protections and be able to build some economic security for themselves and their families. No worker should fall through the cracks. And here are some ideas about how to rethink and strengthen the worker’s bargain.

So, she’s not just laying out policy for the gig economy (the occasion of the speech); she’s laying out a social contract (the topic of the speech). Picking through the next sections, here is the material on health care:

We can start by strengthening our safety net so that it catches anyone who has fallen on hard times, whether they have a formal employer or not. And there are three much‐needed changes right off the bat on this.

I hate the very concept of a “safety net.” Why should life be like a tightrope walk? Who wants that, except crazypants neoliberal professors, mostly tenured? She then makes recommendations for three policies, and sums up:

These three, Social Security, catastrophic insurance, and earned leave, create a safety net for income.

Hello? Medical bankruptcy?[3] She then moves on from the “safety net” for income to benefits, which is the aegis under which she places health care:

Now, the second area of change to make is on employee benefits, both for healthcare and retirement. To make them fully portable. They belong to the worker, no matter what company or platform generates the income, they should follow that worker wherever that worker goes. And the corollary to this is that workers without formal employers should have access to the same kinds of benefits that some employees already have.

I want to be clear here. The Affordable Care Act is a big step toward addressing this problem for healthcare. Providing access for workers who don’t have employer‐sponsored coverage and providing a long term structure for portability. We should improve on that structure, enhancing its portability, and reducing the managerial involvement of employers.

Remember, this is a Democratic audience, and what do we get? “Portability,” “access”, and reduced “managerial involvement.” That’s about as weak as tea can possibly get and and not be water, and this is a liberal Democrat audience. (“The same kinds of benefits that some employees already have.” Eeesh.) But wait, you say! This speech is in 2016, and in 2018, Warren supports #MedicareForAll! For example, “Health care: Supports the “Medicare for All” bill led by Bernie Sanders” (PBS, January 17, 2019). But notice how equivocal that support is. Quoting PBS again, Warren “called that approach ‘a goal worth fighting for.'” Rather equivocal! And following the link to that quote, we find it’s from a speech Warren gave to Families USA’s Health Action 2018 Conference. The equivocation is clear:

I endorsed Bernie Sanders’ Medicare for All bill because it lays out a way to give every single person in this country a guarantee of high-quality health care. Everybody is covered. Nobody goes broke because of a medical bill. No more fighting with insurance companies. This is a goal worth fighting for, and I’m in this fight all the way.

There are other approaches as well…I’m glad to see us put different ideas on the table.

So, we have a gesture toward #MedicareForAll. But then, Warren, instead of going straight on into detail about how #MedicareForAll would work (“You get dental!”), immediately backtracks and emits a welter of detail about minor fixes improvements, on the order of “portability,” “access,” and reduced “managerial involvement.” (Different details from her New America speech, but details still). Then she moves on to Massachusetts. Read this, and it’s clear where Warren’s heart is:

Massachusetts has the highest rate of health insurance coverage in the nation. We are the healthiest state in the nation[4].

That didn’t just happen because we woke up one morning and discovered that insurance companies had just started offering great coverage at a price everyone could afford.

We demanded that insurance companies live up to their side of the bargain. Every insurer participating in our exchange is required to offer plans with standard, easy-to-compare benefits and low up-front costs for families. Last year, we had the second-lowest premiums in the ACA market of any state in the country. Massachusetts insurers pay out 92% of the dollars they bring in through premiums to cover costs for beneficiaries – not to line their own pockets.

The rules are tough in Massachusetts, but the insurance companies have shown up and done the hard work of covering families in a responsible way. We have more than double the number of insurers participating on our exchanges, compared to the average across the country. They show up, they serve the people of Massachusetts, and they still make plenty of money.

Look, we still have plenty of work to do, particularly when it comes to bring down health spending, but we’re proud of the system we have built in Massachusetts, and I think it shows that good policies can have a real impact on the health and well-being of hard working people across the country.

Never mind that Warren can say, virtually in the same breath, that insurance companies “still make plenty of money” and “we have plenty of work to do… to bring down health care spending.” RomneyCare was the beta version of ObamaCare. We tried it, as a nation, starting in 2009, and here we are.[5] If that’s what Warren wants, fine, but why not simply advocate for it?

Warren Has No Coherent Theory of Change

Except, perhaps, one distinctly slanted toward insiders. “Work hard and play by the rules” is a Clintonite trope, but let’s search on “rules” and see what we come up with. More from the transcript:

But it is policy, rules and regulations, that will determine whether workers have a meaningful opportunity to share in the wealth that is generated.

Here, workers are passive, acted upon by rules, and those who create them. But Warren contradicts herself: “Lyft and Uber have often resisted efforts of those very same workers.” Here, workers are active. But if workers are active in the second context, they are also active in the first! Where does Warren think change comes from? The generous hearts of Uber managment and its marks investors? More:

Antitrust laws and newly‐created public utilities addressed the new technological revolution’s tendency toward concentration and monopoly, and kept our markets competitive. Rules to prevent cheating and fraud were added to make sure that bad actors in the marketplace couldn’t get a leg up over folks who played by the rules.

Note the lack of agency in “were added.” Warren erases the entire Populist Movement! She also can’t seem to get her head round the idea that workers didn’t necessarily play by the existing ruies in order to create new ones. And:

Workers have a right to expect our government to work for them. To set the basic rules of the game. If this country is to have a strong middle class, then we need the policies that will make that possible. That’s how shared prosperity has been built in the past, and that is our way forward now. Change won’t be easy. But we don’t get what we don’t fight for. And I believe that America’s workers are worth fighting for.

Now, on the one hand, this is great. I, too, believe that “America’s workers are worth fighting for.” What Warren seems to lack, at the visceral level, is the idea that workers should be (self-)empowered to do the fighting (as opposed to having the professional classes pick their fights for them). Here is Warren on unions:

Every worker should have the right to organize, period. Full‐time, part‐time, temp workers, gig workers, contract workers, you bet.

Very good. More:

Those who provide the labor should have the right to bargain as a group with whoever controls the terms of their work….

The idea that workers themselves should control the terms of their work seems to elude Warren. This erases, for example, co-ops. More:

Government is not the only advocate on behalf of workers.

“Not the only?” Like, there are lots of others? This seems a tendentious, not to say naive, view of the role of government. More:

It was workers [here we go], bargaining through their unions [and the qualification], who helped [helped?] introduce retirement benefits, sick pay, overtime, the weekend, and a long list of other benefits, for their members and for all workers across this country. Unions helped build America’s middle class, and unions will help rebuild America’s middle class.

Here, at least, Warren grants workers (partial) agency, but only through the institutional framework of unions. That distorts the history. Granted, “helped introduce” is doing a lot of work, and who they were “helping” isn’t entirely clear, but the history is enormously complicated. (Here again, Warren needs to do the reading.) For example, the history of the weekend long predates unions. And “bargaining through their unions” isn’t the half of it. Take, for example, the Haymarket Affair. From the Illinois Labor History Society:

To understand what happened at Haymarket, it is necessary to go back to the summer of 1884 when the Federation of Organized Trades and Labor Unions, the predecessor of the American Federation of Labor, called for May 1, 1886 to be the beginning of a nationwide movement for the eight-hour day. This wasn’t a particularly radical idea since both Illinois workers and federal employees were supposed to have been covered by an eight-hour day law since 1867. The problem was that the federal government failed to enforce its own law, and in Illinois, employers forced workers to sign waivers of the law as condition of employment.

Fine, “rules.” Which weren’t being obeyed! More from the Illinois Labor History Society:

Monday, May 3, the peaceful scene turned violent when the Chicago police attacked and killed picketing workers at the McCormick Reaper Plant at Western and Blue Island Avenues. This attack by police provoked a protest meeting which was planned for Haymarket Square on the evening of Tuesday, May 4. Very few textbooks provide a thorough explanation of the events that led to Haymarket, nor do they mention that the pro-labor mayor of Chicago, Carter Harrison, gave permission for the meeting…. Most speakers failed to appear…. Instead of the expected 20,000 people, fewer than 2,500 attended…. The Haymarket meeting was almost over and only about two hundred people remained when they were attacked by 176 policemen carrying Winchester repeater rifles. Fielden was speaking; even Lucy and Albert Parsons had left because it was beginning to rain. Then someone, unknown to this day, threw the first dynamite bomb ever used in peacetime history of the United States. The next day martial law was declared, not just in Chicago but throughout the nation. Anti-labor governments around the world used the Chicago incident to crush local union movements.

This is how workers “helped introduce” the eight-hour day.

Yes, America’s workers are “worth fighting for.” But they also fight for themselves, and are fought against! Warren’s theory of change — which seems to involve people of good will “at the table” — cannot give an account of events like Haymarket or why, in the present day, it’s Uber’s drivers who are also the drivers of change, and not benevolent rulemakers. Warren’s views on the social contract are in great contrast to Sanders’ “Not me, us.”

NOTES

[1] Warren is far stronger in areas where she has developed academic expertise than in areas where she has not.

[2] Google is Google, i.e., crapified, but if Warren has retracted or changed her views on Uber, I can’t find it. She was receiving good press for this speech as late as August 2017.

[3] Oddly, bankruptcy is where Warren made her academic bones. I’m frankly baffled at her lack of full-throated advocacy on this, especially before a friendly audience.

[4] Warren, by juxtaposition, suggests that Massachusetts’ health insurance coverage causes it to be “the healthiest state in the nation.” This post hoc fallacy ignores, for example, demographics and the social determinants of health.

[5] Warren focuses on health insurance, not health care. I’m nothing like an expert in the Massachusetts health insurance system. However, looking at this chart, I’m seeing all the usual techniques to deny access to care: Deductibles, co-pays, out-of-network costs, and (naturally) high-deductible plans. Health care should be free at the point of delivery. Why is that so hard to understand?

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

86 comments

  1. Burritonomics

    I quickly went over the (188 page!) report referenced in Warren’s claim that “Massachusetts has the highest rate of health insurance coverage in the nation. We are the healthiest state in the nation”. It should be noted I went in with the expressed purpose of finding something to be snarky about, and I found it.

    One of the metrics under “core measures” of clinical care was Preventable Hospitalizations. As it states in the report itself: “Preventable hospitalizations reflect the efficiency of a population’s use of primary care and the quality of the primary health care received…Preventable hospitalizations are more common among people without health insurance and often occur because of failure to treat conditions early in an outpatient setting”. Wow! With such bang up health insurance in MA, one would figure they would do great on this metric. Nope! MA ranks 37th in the country. Many more such examples can be found, I’m sure.

    I have a real dislike of these “who’s best” lists, regardless of topic. Rarely do they (the aggregated ratings) contain insight beyond that captured by the individual metrics.

    Reply
    1. lambert strether

      Massachusetts is #1 on mortality (though they have issues with opioids). They have median US age, so it’s not the enormous Boston student population. So they’re doing something right, I’m just not sold it’s health insurance or, more to the point, health insurers. They do have more physicians (and psychiatrists) per capita.

      Reply
    2. lambert strether

      Massachusetts is #1 on mortality (though they have issues with opioids). They have median US age, so it’s not the enormous Boston student population. So they’re doing something right, I’m just not sold it’s health insurance or, more to the point, health insurers. They do have more physicians (and psychiatrists) per capita.

      Reply
      1. Joe Well

        What is “mortality” in this case? I’m curious about this because people often casually say that US health outcomes are worse than in other countries by looking at life expectancy (which I guess is not the same as mortality), and that comparison is rarely done on a state by state basis in the US.

        Massachusetts is roughly tied with the other top ten states in life expectancy, which are almost all “blue” states. Worldwide, life expectancy among highly developed countries is roughly similar, within a few years of each other. The US comes out towards the bottom (no. 31), but only by about 1-3 years.

        Also amazed just now to see that Asian American and Latino life expectancy are so much higher than for white and black Americans. Does anyone know anything about that? I’m really stunned.

        Usually, lower life expectancy for blacks is given as evidence of inequality, but the white-black gap (about 1-2 years) is tiny compared with the black-Latino and black-Asian gap, or for that matter, the white-Latino or white-Asian gap, which are more like 5-10 years. I’m really floored by that.

        In general, looking at the numbers just now has shaken my assumptions about poor US life expectancy and also racial disparities and I’m wondering if I’m misinterpreting them.

        Reply
        1. Joe Well

          Wow, you learn something new every day.

          Apparently there is something called the “Hispanic Health Paradox” that has been studied intensively for over 30 years. The biggest reason seems to be much lower rates of smoking. There also seems to be a filtering effect whereby healthier people migrate to the US. Anecdotally, I’d suggest much lower rates of alcohol and drug abuse, but the article doesn’t mention that.

          So, why Mass. has a relatively high life expectancy could in part be due to it having one of the earliest and most aggressive anti-smoking movements. I’m guessing historically high smoking rates (up to 50% of adults in the 1950s with huge second-hand exposure) could also account for poorer health outcomes today.

          Reply
      2. BoyDownTheLane

        One of my favorite pictures (the one I have not yet taken) would have been an elevated shot of the intersection at Longwood and Brookline Avenues (379–385 Brookline Ave) at noon on a clear, sunny spring day to see the murmuration of medical staff running between appointments, lunch, rounds, etc. The intersection is surrounded by arguably some of the finest medical institutions in the Western world (Beth Israel Deaconess, Dana-Farber, Brigham & Women’s (where Atul Gawande, author of the book “Better” and the whole entire concept of positive deviance, once held court), Harvard Medical School itself with its etched-in-granite entrace to the Countway Library that reads “Ars Longa, Vita Brevis”, and the Harvard School of Public Health.

        The murmuration of white coats may be at that moment the greatest single concentrated density of medical excellence at one time. It is easy to scoff. I’ve been the recipient of bad medicine myself, but also far more high-quality, life-saving medicine. But the public health movement in Massachusetts has been around for a very long time and is supported by and engrained within governmental regulations, oversight and policy. Insurance plans covering most of the state ranked, typically and for years, #’s 1, 2, 3 and more. The Healthcare Effectiveness Data and Information Systems report out results that are painstakingly gathered, audited to improve performance. It is fair to say that a major part of the intersection between computing and medicine was born and is overseen across the river in Cambridge. Organizations that collect or audit data for health plans and providers are screened, trained and certified by NCQA ( https://www.ncqa.org/about-ncqa/ ). In addition, there are national, regional and state associations devoted to quality improvement and toi improvement of access. The National Association of Community Health Centers (those clinics funded Federally to serve the under-served for free or on a sliding scale) “works in conjunction with state and regional primary care associations, health center controlled networks and other public and private sector organizations to expand health care access to all in need.” There are CHC’s dotted everywhere around the country (albeit not enough of them), and there is a state association in almost every state. No one can ever be turned away from a CHC, especially for lack of ability to pay; the Federal government underwrites their care.

        Reply
  2. nothing but the truth

    govts can call force us to call toilet paper a pound, but i doubt they can make it worth a pound of sterling silver – if they pretend that they can produce any amount.

    Reply
    1. Adam Eran

      If government printed a trillion-dollar bill on toilet paper, then accepted it in payment for a trillion dollars of taxes, it would be worth a trillion dollars.

      Can they produce any amount? What’s the limit on how many points the scorekeeper at the ballgame can produce? Same limit for the government. The real economy limits how useful the dollars are, but there is no real limit to how many that government (with sovereign, fiat currency and a floating exchange rate) can produce….just as there is no real limit to how many zeros it can add to the accounting for a bank account (where most of the money resides).

      Reply
  3. Brooklin Bridge

    Warren’s emphasis on the economic market for health “care?” (insurance companies making plenty of money) and particularly her whole rant on the superlatives of Massachusetts insurance care (that means, care for insurance companies) , increasingly neglects health and people care as the primary concern of medicine and the people who practice it.

    As an average Joe, meaning not part of the medical world, I have come across a surprising number of doctors in both social circumstances as well as health issues of my own and of my extended family, where doctors have complained about the ever worsening constraints imposed on them by insurance companies. I know at least three doctors who retired early because of it and one of them talks about it being a significant problem in keeping highly qualified doctors in general practice. From ever more ridiculously short visits, to constant refusal to cover such and such a drug, to all manner of schemes to improve patients health by overseeing and controlling what the doctor does to finding ways to monitor what the patient does; what he or she takes as medicine and exactly when and how often – cutting the doctor out of the loop completely. Improve the patient experience my *ss. It’s horrible and it all comes down to ever new ways to reduce coverage – to make more money.

    Perhaps I’m being a little unjust, but Warren seems fine with this “system” where the gate keepers make, “plenty of money,” as long as people are going in and out of doctors’ offices in countable droves as if on run-away conveyer belts. I should at least allow that many of her superlative claims are accurate (or somewhat accurate) and that there is fairly wide coverage in this state but nevertheless stress that our excellent medical facilities in Boston proper are due to historical reasons and NOT to RomneyCare.

    Reply
  4. deplorado

    Thank you Lambert, for your cogent and discerning analysis as always. I’ve long ago disabused myself of the notion that E. Warren is more than “lipstick” on the usual “pig”, but it was good to have written support for that thesis and I will save it for my reference.

    What worries me more though is Sanders’s bill…and why he wouldn’t go all the way?… Would you do an analysis of that please – will really appreciate it.

    Thanks!

    Reply
    1. Lambert Strether Post author

      > why he wouldn’t go all the way?… Would you do an analysis of that please – will really appreciate it.

      I think he’s calculated what can make it through the Senate. But I think he’s negotiating with himself. Still waiting for Jayapal’s bill.

      Reply
      1. Carla

        Sanders has given Jayapal the blueprint for crapifying HR-676.

        Bernie’s bill seriously damages his credibility, and that’s too bad.

        Reply
        1. Jeff W

          I’m hoping that single payer proponents like PNHP and Russell Mokhiber can, with the support of the public, persuade Sen. Sanders to align his proposal to be more like HR 676—which would be in keeping with his call for “revolution.” I’m not sure that, at that point, Bernie wants to be on the wrong side of the issue and against some of the staunchest proponents of single payer. But that might be a bit optimistic.

          Reply
      2. GF

        Lambert, can you do a similar analysis of every Dem running? To make it less onerous, maybe a simple table with check marks as to where the candidates stand on each area of concern? Each area of concern can be explained concisely above the table. Thanks

        Reply
  5. Joe Well

    The vast majority of Massachusetts health plan providers are nonprofit HMOs so I’m baffled by the idea that they are making tons of money since legally they are not supposed to.

    The most obvious difference between Mass and the rest of the country is precisely the preponderance of nonprofit health plans (it’s not commonly called health insurance here) and nonprofit hospitals. The idea of for-profit health plans and hospitals freaks me out.

    It’s worth noting that Mass health coverage seems to have gotten worse in recent years, though I don’t know how much of that is due to Obamacare. High deductibles, coinsurance, confusing in-network requirements combined with poor documentation and even poorer customer service to tell you what is in-network and what is not. I just got a surprise $370 bill for a provider that supposedly was out of network even though I had checked extensively that they were in-network. That is the first time that has ever happened to me in Mass. Not to mention the confusing and unnerving notices I got the last few months saying I was in danger of losing coverage. A great big ball of Weberian beaureaucratic stress.

    Reply
    1. bob

      Non-profit health insurance Company–

      https://www.democratandchronicle.com/story/money/business/2014/04/25/former-excellus-ceo-package-total-m/8155853/

      The final retirement package for former Excellus BlueCross BlueShield CEO David Klein likely will exceed — by millions — the $12.9 million the company reported to the state in March.

      $29.8 Million in retirement. Non-profit for who? It’s a complete misnomer and a huge problem in the discourse of healthcare. Hospitals are usually non-profits too. They non-profitly charge you $80,000 for a few stitches and some aspirin.

      Reply
      1. somecallmetim

        Health Care Economist / Professor Uwe Reinhardt used to comment that in the current system non-profit hospitals (The Sisters of Mercy, with a token nun on their board, in his telling) were subject to the same forces as for profit hospitals.

        He also said Massachusetts has the only adult health care system, and the other states are all adolescents.

        Reply
    2. johnnygl

      We’ve got for-profit hospitals…cerberus took the caritas network. The hospitals dominate this state. The rest of us are just living here.

      Reply
      1. johnnygl

        Special thanks to the catholic church for selling such an important institution to a monster that guards the gates of the underworld.

        I bet it was to cover the costs of child predator priests.

        Reply
      2. Joe Well

        Wow, I’d missed that (moved out of state, then came back). Thanks for the update. It looks like the Catholic Church (former owner of Caritas) has further enhanced its legacy in Massachusetts. However, I believe it is still true that the hospital market in Mass. is dominated by nonprofits (albeit greedy nonprofits).

        And yes, hospitals and hospital chains (e.g., Partners Healthcare, which is nonprofit) pose huge challenges to managing healthcare costs in Mass. as the numerous Boston Globe investigative series attest, by using their market power to raises prices.

        My concern is when the market becomes dominated by for-profit actors, the profit-seeking, which is already bad with nonprofits, becomes even worse, especially in an ultra-expensive market like Greater Boston.

        Reply
        1. BoyDownTheLane

          I think the phenomenon is closer to that of the mega-corporation wherein the competition is underway to see who can, by being the biggest on the block, race on ahead into a monopooly. Once a monopoly is achieved, with bennies in terms of negotiaiton with vendors and especially payors, the capitalism becomes a totalitarian glop.

          Reply
    3. Oh

      Non Profit is just a label applied to organizations based on IRS regulations. It doesn’t mean they don’t make a profit. They just increase the “reserve”.

      Reply
  6. Brooklin Bridge

    I should add (if my earlier comment get’s posted), it’s even more surprising how many doctor’s seem just fine with all the negative changes being brought about by insurance companies’ intrusive quest for control and I don’t mean just the ones who say nothing.

    That is, some doctors seem to enjoy the vestiges of the glow of community respect and honor that once went with being a doctor all while doing almost nothing other than sheep herding patients through the office in good file while staff (not the good doctor) attend to making the visit digital and storing it away in some cloud.

    Reply
  7. Tomonthebeach

    I agree with Warren Mosler that Elizabeth Warren’s apparent ignorance of MMT, much less mastery of it, makes here a lame candidate in my book. She needs to get woke pretty quickly or settle for some cabinet appointment.

    Reply
    1. Joe Well

      You don’t even need MMT. When asked how the federal government can pay for something, people can just answer, “the same way we pay for military and intelligence spending.” Any politician who won’t say at least this is deeply suspicious.

      Reply
      1. Jeff W

        That’s the way to go rhetorically, I think. Let those who have been printing money for banks and wars explain and defend it (if one has to do so)—they’re the ones who have been implementing MMT in practice for years.

        Reply
    2. Lambert Strether Post author

      > settle for some cabinet appointment

      I think that’s her level (or Veep), and I think that’s a level where good work can be done. I don’t trust her political judgment (Cherokee debacle) and I don’t trust her habits of thought (markets first), but there’s no question she’s a skilled bureaucratic infighter, and those talents could be put to use for a better cause. Sanders needs a Cheney (but without Cheney’s twisted sneer, and all it implies (I mean, Warren, for all her faults, never shot an old man in the face, and then got him to apologize for getting in the way)).

      Source for Mosler quote?

      Reply
        1. nycTerrierist

          not because I’m a Warren fan —
          but she might reassure ‘centrist’ Dem voters and get them on board for Bernie.
          It is obvious he is the most electable candidate – the only one who is sure to
          beat Trump.

          Reply
          1. Oh

            If the objective is for a candidate who can bear Trump, just put “None of the above” on the ballot and that will do it. That way we don’t have to play the “lesser of the evils” game.

            Reply
            1. nycTerrierist

              Agreed, I too won’t play ‘the lesser of two evils’ game —
              but I would love to elect Prez Bernie.

              Who would make better use of that bully pulpit?
              Imagine how far Prez Bernie could go to educate the public?
              and move the proverbial overton window in the right direction,
              which is far far left!

              Reply
              1. jrs

                Bernie is the lesser of two (or however many) evils in some ways though (with certainty on foreign policy and probably how he would realistically govern), so it’s just a question of when there is enough good to vote for someone.

                Reply
      1. Jeff W

        lambert

        don’t trust her political judgment (Cherokee debacle) and I don’t trust her habits of thought (markets first)

        I don’t either—and there ‘s something about her emphasis on rules, policies and procedures I don’t like either. If everything can just be made “fairer” (“play by the rules”) and more “transparent,” then everything is just darn swell. It negates and is oblivious to power relations. (You can see it even in terms of the Cherokee debacle which Warren viewed in terms of “transparency,” rather than as a power play/bullying.) She gets the surface manifestations but not the underlying dynamic—what appears on the surface is, for her, the problem.

        Reply
  8. David in Santa Cruz

    In The Unwinding, George Packer quotes Elizabeth Warren as describing her political views thusly:

    “I was a Republican because I thought that those were the people who best supported markets”

    I’m glad that she’s out there, I’m glad that she’s talking, and we need an open and transparent nomination process, but Bernie Sanders remains the only (potential) nominee who comes close to representing my views. Good piece.

    Reply
  9. emorej a hong kong

    The transcript could easily have been a speech by Hillary (and even delivered to Goldman Sachs if Hillary had had the foresight to realize that every speech would become known to everybody in the Internet age — before Russiagate was leveraged into Social media banning of anti-establishment speech).

    The speech’s date (May 19 2016), was two days after Bernie won the Oregon primary by 14%, and two days before Hillary won the Washington state primary by 5%.

    Reply
    1. Lambert Strether Post author

      I kept hearing Warren’s words in Clinton’s voice. That said, on examination, she doesn’t speak or reason in the same way, at least when I’m doing a close reading of a text, so my reaction isn’t really a fair one.

      Reply
  10. Synoia

    It was going to be BS directly after this:

    New America (board chair emeritus Eric Schmidt…

    The Eric Schmidt who took Google down the primrose part of spying on everybody.

    Warren is centrist.

    Reply
  11. flora

    Thanks for this post.
    And thanks for the reminder that the 8 hour workday and the 40 hour workweek were not ‘given’ to workers, they were won by workers.

    Reply
    1. Lambert Strether Post author

      Thank you. I was really struggling with that part. I might try characterizing Warren’s theory of change more precisely in future, but workers winning (as opposed to having things won for them) does not seem to figure largely in her thinking.

      Reply
      1. Left in Wisconsin

        To me, that is the core liberal/left distinction. Which is why even something like Fight for $15 is really a liberal strategy, not a left one.

        Reply
        1. jrs

          isn’t it because the left strategies didn’t work in that case, attempts at unionization of fast food workers failed is my understanding.

          Reply
  12. Matthew G. Saroff

    I made an a similar observation on my blog.

    Compare these two quotes on Pharma looting.

    Warren:

    Giant companies may hate my Affordable Drug Manufacturing bill – but I don’t work for them. The American people deserve competitive markets and fair prices. By fixing the broken generic drug market, we can bring the cost of prescriptions down.

    Sanders:

    If the pharmaceutical industry will not end its greed, which is literally killing Americans, then we will end it for them.

    This is a not an insignificant difference

    Reply
    1. Yves Smith

      Tell me what about Warren not understanding how federal taxes work, which is fundamental to formulating sound fiscal policy and spending plans, not being serious about fixing our health care system, or praising the predatory gig economy, is “good”.

      Reply
      1. RepubAnon

        On a side note: self-employed workers pay more out-of-pocket into Social Security than W-2 employees. W-2 employees only pay half the Social Security tax – employers pay the other half via a “payroll tax.”

        The self-employed pay both the employee’s half of Social Security, and also pay a “Self-Employment tax” (the employer’s half of Social Security). The logic is that if you are both employee and employer, you should pay both halves.

        Reply
        1. Yves Smith

          This is thread jacking, plus so what? If you are self employed or employer-employed, on your salary, what you get is a net wage. In fact, positioning the self employed as a victim of this arrangement is BS. The self employed can run way more expenses through their businesses than normal W-2 employees can and can minimize wages and take more as profit share. Help me.

          Reply
    2. Ape

      Or lesser of two evils?

      There really needs to be a good discussion again about reform versus structural change without Chait-like pretensions.

      The question isn’t just whether we’ll get there in time, but whether reform even out runs reaction. Once you take out patriotic myth, it’s not obvious whethervthe good in the long term is even worth bothering with.

      Reply
  13. The Rev Kev

    I can’t help but think that if you are talking about the “Next Social Contract”, them you should put something in there that if you have children going hungry then something has gone wrong with your society. Not being snarky here as I believe that a fundamental purpose of society is to protect those in need. An earlier society talked about ‘women and children first’ and they were not too far off the mark here.
    She was invited to talk about the gig economy but in reading her speech I was under the impression that she wants the Federal government to underwrite the costs of workers for corporations to ensure that maybe these workers have food to eat while working for these very same corporations. I suspect that this is the thinking behind letting Amazon workers go for Federal assistance for the sheer basics of life while Amazon makes off like bandits.
    No. The way to go is to enforce corporations like this pay a living wage and not to have them count on the country to make up the difference. If they start to protest, then start to talk about looking over their accounts for any discrepancies to make them back off. That’s how they got Al Capone you know. Not for being a gangster but for not paying his taxes while doing so. And do the same for mobs like Uber and Lyft and all the other corporations.

    Reply
    1. Lambert Strether Post author

      Or, in the words of the Jacobin — also a Twitter riff — Warren is a “I’m gonna call the manager” liberal. AOC, from her waitressing/bartending experience, knows all about that sort…

      Reply
  14. Left in Wisconsin

    Sigh. Nail hit squarely on head. The one thing I will say to Warren’s credit is that she has learned in some specific ways that the world isn’t invariably the pure meritocracy that is so instinctively part of her world view. That said, it seems clear there will always be plenty that she is simply not capable of seeing, so she will always say and support things that are just wrong. She will not be leading the revolution.

    Reply
    1. Carey

      Yes. Warren’s “solutions” are penny-ante, even in her bold (heh) primary formulations.
      Imagine what they’d look like in January 2021, as a substantial part of the citizenry
      withers, and worse.

      She presented well on R Maddow though, so there’s that. /s

      Reply
    2. Lambert Strether Post author

      It may be that Warren, like Clinton, is simply not a very imaginative person, and that extends to not being able to imagine what life is like outside her own class (as FDR for example was clearly able to do).

      Reply
      1. emorej a hong kong

        –except that Warren came from a much humbler family, and started at infinitely more humble educational institutions, which gave her a (now missed) opportunity to:

        (i) denounce Harvard for using Warren’s grandmother’s story, about Native American ancestry, to reduce pressure for more substantive diversity,

        (ii) demand that Harvard give more opportunity to teachers, like Warren, who excel despite not having Ivy League backgrounds (which is the real way that Warren added to Harvard’s diversity), and

        (iii) counterpunch on Trump’s ‘rich-kid’ preferential entry into Wharton (or was it “affirmative action for attention deficit disorder victims”?).

        After to **Triangulate between Harvard & Trump** should have been seen, by any competent politician or advisor, as:

        (a) The 1st “to-do” item for any Harvard-affiliated politician since Trump won the Republican nomination, and

        (b) The fattest side-of-barn target zone in the history of American politics.

        Reply
        1. Yves Smith

          Oh come on. It isn’t just Harvard. No major law school has law faculty that doesn’t come from Harvard, Yale, or (sometimes) Columbia Law Schools. This is true even at places like Northwestern. And no one thinks Trump got where he got due to having gone to Wharton. He got money from his father and worked in his father’s business.

          Reply
      2. Fred Grosso

        She my not be imaginative enough for the elite pundits, but she is empathetic and in that she towers over any one else you can forsee as a candidate in 2020.

        Reply
  15. Carey

    >But it is policy, rules and regulations, that will determine whether workers have a meaningful opportunity to share in the wealth that is generated.

    How generous… the *people who do the work* will be allowed, in Warren’s vision, to
    have *a share* of what they themselves created, after the requisite skimming by the Few,
    of course.

    So cool

    Action for the Common Good.

    Reply
  16. dbk

    Thanks very much, Lambert. Such comparison-contrast analyses are really helpful in gaining an overall understanding of where candidates stand on key issues (well, key issues for progressives).

    My current impression is that all today’s front runners (Warren, Harris, Gillibrand, for example) represent variations on a theme – one will be more “liberal” than another on one issue, another on another, etc.

    No likely candidate appears to fully embrace Bernie-like policies down the line except Bernie. And that raises the specter of another intra-party struggle of the type we witnessed in 2016, which the British Labour party seems imho to be writhing under now (Brexit aside).

    Re: Warren as Veep/cabinet. Veep, I don’t think so, but cabinet-level appointment, yes. She could do solid work there.

    Reply
  17. JohnnyGL

    To those who don’t think MMT matters:

    If you don’t understand that the way to ‘pay for’ Medicare for All is by CUTTING taxes to increase demand, then you aren’t considering the loss in profits/investment/marketing/employment that would result from lower prescription drug prices for drug companies and lower reimbursement rates for medical providers.

    We’re at close to 16% of GDP in healthcare costs. If we bring that down to 14% in a year or two (hardly super-ambitious compared to other countries), that’s a 2% cost savings to the non-medical sector, which is good, but it’s still a 2% reduction in GDP. We’re going to need a boost in demand to make up for that shortfall if we’re going to avoid recession.

    Also, Republicans use MMT every time they gain the White House. They immediately launch trillion dollar tax cuts to get the economy moving (well, mostly to help their buddies, but some of eventually trickles). If Dems don’t do that (and they don’t), then they’re fighting with one hand tied behind their back (yes, I know they prefer it that way, but the point is still salient for those who actually want to govern).

    MMT 2020: Because Republicans are going to do it anyway!!!

    Reply
    1. Joe Well

      Serious question: why wouldn’t the 2% transfer of wealth from the healthcare industry to everyone else be its own stimulus? Why would it just disappear from the economy? Or are you saying that most of that reduction comes from government rather than private spending?

      Reply
      1. Eclair

        Yeah, if we look at ‘excessive’ health insurance premiums, plus paying large deductibles, as a tax, then the lowering of those premiums, deductibles, cost of prescription meds, etc., would be a tax cut. Mainly to the large working and middle class who are living paycheck to paycheck, so they would spend that ‘extra’ cash on food, clothes, fancier smart phones. Demand increases, just not in the insurance sector.

        Reply
    2. Left in Wisconsin

      GDP is a flawed measure and accepting a need to “avoid recessions” (as measured by GDP) is tying both hands behind your back. If involuntary unemployment was zero, median incomes were rising, and we were making progress addressing climate change, why should anyone care about aggregate GDP. The notion that GDP is a good proxy for those other things is not correct.

      Reply
    3. jfv

      GDP is a deeply flawed measure of the well-being of a nation.

      – It looks only at production, not at destruction of tangible goods.
      – It looks only at economy indicators. Other indicators are : amount of inequality, quality of education, amount of debt, work-life balance, unpaid work and more.
      – It never was intended as a well-being indicator, but as a productivity indicator by its inventor.

      Reading materials :
      https://www.investopedia.com/articles/economics/11/flaws-in-market-indicators.asp
      https://www.weforum.org/agenda/2018/01/gdp-frog-matchbox-david-pilling-growth-delusion/

      Reply
  18. Susan the Other

    Insurance, extortion, monopoly. All tried and true measures to maintain power. Don’t forget sabotage. And all with a veneer of justice. I’ve watched this circus closely for 50+ years. It has been on the road far too long and it’s so tattered and filthy now it’s like visiting a ruin. We need a clean slate. Squeaky clean. No “health insurance”, no implied threats, no monopolies, and no more mental glop for language. Our problems only seem insurmountable because the crumbling ideology of neoliberal capitalism is fighting to its last absurd breath. Can someone please tell me why? I want language that clearly shows that insurance and monopoly are at least first cousins if not half-sisters. Language that makes the connection between power and sabotage; between change and war. I am so sick of all the Lizzy-style verbiage I could puke. I really hope Bernie isn’t falling down this old rabbit hole.

    Reply
    1. Oh

      It’s not health insurance it’s extortion in the name of health. The public coffers should be paying for healthcare for all and drug companies hospitals and other overchargers should be regulated and sent to jail if the break the regulations.

      Reply
  19. Steven Greenberg

    Here is a quote from Warren Mosler about taxes and spending.

    I don’t like to say that taxes don’t fund spending. The word fund is ambiguous. It’s better to say the government doesn’t need your money to be able to spend. But they need you not to have it so that they can spend.

    Source of quote

    Reply
  20. Swamp Yankee

    I’m getting ready to teach the Populists and Progressives in a week or two. Warren is just a classic, almost to the “t” reiteration of the 1890-1920 Progressives. These were, like the Populists, concerned with the problems posed by the sweeping changes in American economic life after the Civil War; but whereas the Populists, as Lambert notes, were a bottom up movement, with roots in self-help organizations like The Grange and the Farmer’s Alliance, the Progressives were overwhelmingly upper-middle class college-educated urbanites (and I mean here streetcar fancy places like Brookline or West Roxbury, not the slums in the South End or the old West End, e.g., to use a Boston Example) with a top-down model of how social change ought to occur. They were typically outright snobs, and had enormous blind spots with things like race and class — and also in complicated ways with gender.

    However, even here, when you look at how many Progressives advanced claims to, e.g., Women’s Suffrage, it’s very instructive for today’s professional-managerial class. In the photograph linked

    you see picketers in front of the White House during Wilson’s presidency, each of them wearing the name of their various alma maters — Oberlin, Bryn Mawr, Swarthmore, Stanford, the University of Missouri. It’s the lineal and direct ancestor of the credentialism which underlies the 10%er class liberal worldview of the NYT and MSNBC and The New Yorker.

    So we shouldn’t expect all that much from Warren, those of us who identify with what the 18th century called “the People Out of Doors” — many Progressives were outright horrible in important ways (Woodrow Wilson resegregated the Postal Service; Teddy Roosevelt was a crazed war-monger who was eager to get into WWI), and their modern counterparts will at best, come up lacking.

    EDIT: Sorry about the long link — I can’t quite figure out how to undo it, but hopefully the photo is available for perusal.

    Reply
  21. Katy

    I find the term earned leave distasteful. It implies that employees don’t deserve time off until they have sacrificed a certain amount of time to their employer. It has echoes of the deserving poor.

    Every time a politician uses the word “employee” I now substitute it with the word “vassal.” It’s a more accurate term for the employer-employee relationship in today’s world.

    Reply

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