Trump’s Eviction Moratorium Opens the Door for Medicare for All by Executive Order

Yves here. The idea of Medicare for All as an emergency program (which would hopefully become normalized) via executive order is wonderfully appealing. But I thought all spending had to be approved by Congress…while the Trump eviction freeze does not increase Federal outlays, but simply imposes costs on landlords.

Even assuming there was a way to square that circle, the executive order would make it a temporary program…and I wonder about the administrative ramifications. A lot of doctors don’t take Medicare. Could they be required to as a Covid emergency measure? And what about the operations side? Doctors who “don’t take Medicare” presumably aren’t set up administratively to do so. What would it take on the medical establishment end to process those claims? And does the government have the operational capacity to process greater volumes?

This is before getting to the horrorshow of all those Medicare Parts B and beyond….But it doesn’t have to be well thought out to be a hugely appealing campaign promise.

By Thomas Neuburger. Originally published at DownWithTryanny!

Donald Trump declares a coronavirus national emergency on March 13, 2020 (source)

On September 1, the Trump administration announced a nationwide moratorium on evictions to last until December 31, a full four months. The reason for the moratorium, according to a White House spokesman, was to make sure that people “struggling to pay rent due to the coronavirus will not have to worry about being evicted and risk the further spreading of, or exposure to, the disease.”

The moratorium applies only to people “who would otherwise be eligible for federal stimulus funds in the previous CARES Act, which went only to people with certain tax income levels and citizenship status.” The ban also requires that renters “self-certify” to become eligible. As Politico put it:

“The new ban covers tenants who certify that they have lost “substantial” income; that they expect to make no more than $99,000 in 2020 or received a stimulus check; and that they are making their “best efforts” to pay as much of their rent as they can. Tenants must also certify that an eviction would likely make them homeless or push them to double up with others in close quarters.”

It should be noted that the ban does not cancel rental obligations; it just delays payment. Also, as the order itself states, “Nothing in this Order precludes the charging or collecting of fees, penalties, or interest as a result of the failure to pay rent or other housing payment on a timely basis, under the terms of any applicable contract.”

As a solution, it’s better than nothing, but it only defers the pain.

About Half of All Landlords Will Suffer Too

The order provides no funds for relief to landlords. For the many landlords who are, in fact, millionaires, billionaire, and large, well-funded corporations and venture capital firms, this may look to many like just desserts. For the other half of the landlord population, however, especially the minority who own just one or two rental properties, this could spell financial disaster as great as the disaster their tenants are facing.

It’s hard to get figures for the breakdown of the wealth among landlords, but the industry-friendly article in Politico quoted above implies that the wealthy landlord group, while “a fraction of the market,” is in fact almost half — which technically qualify as “a fraction,” but a sizable one. The article states that “a little over half the rental housing in the country” consists of small properties with between one and four units per building — which means that a little under half of the market consists of large buildings.

The Politico article, clearly industry-sourced, then focuses on the suffering of a percentage of the percentage of small owners, ignoring completely the mega-owners, just as it ignores the suffering of the renters themselves, except to emphasize how many of them pose an economic danger to landlords. Still, small owners are left in the cold by the administration’s ban, and their distress will be real.

What Makes This Declaration Legal?

The authority for this action comes from the Centers for Disease Control (CDC) and the Surgeon General, who reports to the Department of Health and Human Services (HHS) — not from the Housing or the Treasury departments — and it’s based on the stated need to prevent the spread of disease in a crisis.

The applicable language states (emphasis added):

[Title 42 U.S.C.] §264. Regulations to control communicable diseases
(a) Promulgation and enforcement by Surgeon General

The Surgeon General, with the approval of the Secretary, is authorized to make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession. For purposes of carrying out and enforcing such regulations, the Surgeon General may provide for such inspection, fumigation, disinfection, sanitation, pest extermination, destruction of animals or articles found to be so infected or contaminated as to be sources of dangerous infection to human beings, and other measures, as in his judgment may be necessary.

This declaration and the unusual legal authority on which it is based has many important ramifications. For one, it opens the door for Medicare for All by executive order.

Ramifications of Trump’s Moratorium

We can discuss Trump’s action in several ways, each of which could become an essay on its own.

1. Clearly the primary reason for Trump’s action is political. He wants people to feel like they are getting relief from him that they’re not getting from Congress. In that, he’s right. They are getting relief from him that they’re not getting from Congress.

But in doing so, he’s just kicked the can down the road until after the election, solving none of the underlying problems in doing so. Renters will still owe rent that they can’t pay from income they don’t have, and those small landlords with mortgages are still on the hook to their own creditors regardless of having been forced to keep non-paying tenants.

2. A much more reasonable action would be the obvious, socialist one — let government write checks to landlords on behalf of renters, then work out repayment (or debt forgiveness) schemes later.

Or better, let government cover the payrolls of businesses that are suffering or going under, then forgive what’s owed afterward. After all, the root cause of the economic downturn is lost payrolls. As for repayment, this is an emergency after all, and FEMA doesn’t send bills to those whose hardship it relieves. The money spent is just the cost of the crisis.

But that’s a socialist, Sanders-like solution, and neither party wants any part of it. Thus the hesitation to act, the labyrinthine schemes, and the means-tested requirements and restrictions.

3. This action places Trump to the left of national Democrats on Covid relief. If he’s smart (he’s not), he’ll stay to their left and offer all sorts of “socialist” (Sanders-like) solutions to the economic crisis — see below for a major one. After all, Trump ran the 2016 election on a Sanders-like platform — against NAFTA, against free trade, for infrastructure-as-stimulus, against the forever war, and so on.

If he’s smart, he’ll restart that campaign. But he’s not smart.

4. The biggest thing Trump could do — and it would be a game-changer — is use the authority he’s already used under “Title 42 U.S. Code § 1395rr–1 – Medicare coverage for individuals exposed to environmental health hazards” to provide Medicare coverage for everyone in the United States “exposed to environmental health hazards.” Which in these Covid times … is everyone.

He could do this tomorrow using executive authority, the same executive authority that underlies his eviction moratorium.

The applicable section of Title 42 allows for a “Pilot program for care of certain individuals residing in emergency declaration areas.” That care can be defined as “access to all of Medicare”:

(b) Pilot program for care of certain individuals residing in emergency declaration areas
(1) Program; purpose
(A) Primary pilot program

The Secretary shall establish a pilot program in accordance with this subsection to provide innovative approaches to furnishing comprehensive, coordinated, and cost-effective care under this subchapter to individuals described in paragraph (2)(A).

The Secretary of HHS could even use this law to create “optional pilot programs” to supplement regular (and in many ways, inefficient) Medicare:

(B) Optional pilot programs

The Secretary may establish a separate pilot program, in accordance with this subsection, with respect to each geographic area subject to an emergency declaration (other than the declaration of June 17, 2009), in order to furnish such comprehensive, coordinated and cost-effective care to individuals described in subparagraph (2)(B) who reside in each such area.

For this to work, an emergency declaration must have been declared, which it has.

Eligible individuals must meet the following criteria:

(A) In general An individual described in this paragraph is any individual who—
(i) is diagnosed with 1 or more conditions described in subparagraph (B);
(ii) as demonstrated in such manner as the Secretary determines appropriate, has been present for an aggregate total of 6 months in the geographic area subject to an emergency declaration specified in subsection (b)(2)(A)…”

While subsection (3)(B) applies to individuals with named diseases — asbestosis, mesothelioma, and the like — subsection (3)(C) allows this law to apply to an individual who “is diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies, based on such medical conditions, diagnostic standards, and other criteria as the Secretary specifies.

In short:  

Trump could guarantee himself a second term if he applied this law in this way, to give the nation Medicare For All under executive order.

5. Finally, while I think it unlikely that Trump would take this avenue to gain an electoral victory, I nonetheless hope he does, for these three reasons.

First, it would give Medicare for All … to all. That would be a huge progressive win in and of by itself, a win we’re not going to get under a Biden presidency without monster effort, and win we’ve been unable to achieve since the Truman administration.

Second, it would force Biden to match him or admit defeat on ideological grounds. That’s a problem I would love for Biden to face.

An added benefit: Trump’s support of Medicare for All takes all the burden of moving Biden left off of progressives and places it onto the Republicans, who would be playing an Ace if Biden doesn’t play an Ace of his own. Let Republicans do the heavy threatening. This frees progressives to happily and genuinely support a compliant Biden (for a change).

Finally, for Biden to match Trump’s offer of Medicare for All with his own would ensure a Biden victory, perhaps by a landslide. After all, Biden today is running, and possibly winning, on a single platform — not being Trump. Imagine his margin of victory if he ran on Medicare for All as well as not being Trump.

Trump wouldn’t have a chance if Biden did that, and Biden would be hailed by history as literally the savior of this generation. That’s a whole lot better than than the legacy he’s on track for now — being the not-Trump, slower-paced sinker of it.

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65 comments

  1. Skip Intro

    Of course Biden’s raison d’être is to prevent Medicare For All, and winning the election is, demonstrably, not a priority. OTOH, Kamala could easily shiv her insurance industry owners, if she thought it would work for her.

    Reply
    1. Susan the other

      Gotta wonder how, as all our social and environmental problems reach critical mass, the stressed-out insurance industry is keeping up. At best, with accounting tricks and all, they are breaking even. Insurance is only a good bet when things go right 51% of the time. If everything is going to hell insurance is an impossibility. The FIRE industry (great acronym) knows this is the end, I’m sure. The only reason we do not get something as sensible as M4A is because everyone previously vetted in profiteering on risk is now maneuvering to find a new position somewhere in the middle between the government and the people who own it. And creeps like Biden are doing all they can to delay and deflect how dire the whole situation is.

      Reply
  2. John k

    trump mowing down 19 reps in 2016, including job! Who burned 150 mil, and followed with far better funded Hillary and msm, demonstrates To me he’s got very good political instincts.
    His rent moratorium is thinking outside the box, IMO he’s thought of at least temporary m4a. Maybe depends how desperate he feels, and that depends on polls in six states. I’m sure he wreally wants to win, would hate being a loser. But he can’t wait until the last minute.
    I don’t think Biden, or his donors, can take the whiplash from shifting from ‘I’ll veto it’ to ‘I’ll pass a better one than trump.’ Dems would rather lose than distress their donors.

    Reply
    1. Larry

      Rent/mortgage forgiveness would be the real play. People know that bull is coming due still and that the order effectively delays the inevitable.

      Reply
  3. ChrisAtRU

    I have long felt that this was a plausible scenario, but as the author surmises in (5): I [too] think it unlikely that Trump would take this avenue to gain an electoral victory.

    IMO, a certain series of events had to play out to make it highly beneficial for Trump to do so, but things have not shaken out in a conducive manner. When the author notes that “for Biden to match Trump’s offer of Medicare for All with his own would ensure a Biden victory, perhaps by a landslide.”, he articulates something that Trump, for all his craziness, would not be willing to risk. Trump (and the GOP by extension) needed to be behind by more, for one. It would have created the kind of desperation necessary to stave off defeat. If the presidential race doesn’t tighten to the degree it did in 2016, and there is real dread that the Democrats could win a majority in both houses, there is still a slim chance. However, Trump would wait late to do it. Doing so has two advantages:

    1. Give the Dems enough rope to hang themselves. Biden operatives telegraphing austerity, bemoaning the budget and the candidate himself refusing to embrace #M4A help Trump with the set up. The alternate ending of Biden saying “Me Too” on #M4A is that if done late enough, Trump just goes, “You’re only saying so to win, and you’re lying, because 2 weeks ago, you said …” – he doesn’t have to shoot anyone on 5th Avenue to get his base to rally behind him.

    2. Doing it late also means team Dem has less time to react. If he does it soon – a month or more out, for example – then it plays out like the author says: Biden says “me too” on #M4A; suddenly Bernie is back on TV lauding his “good friend” Joe for “doing the right thing”; #MSNBC talking heads talking up Joe moving left. However, if Trump does it say, the week of October 19th … like middle toward the end of that week, is a week or two of Biden trying to walk back his veto talk going to convince anyone he’s really going to do it?

    I dunno …

    In any case, if Trump is going to do it, then like Captain Jack Sparrow, he must wait for the opportune moment

    Reply
  4. Zamfir

    I don’t see why a left platform would obviously help Trump, when it comes to votes?

    First, he has the serious challenge to convince people that it is for real – even though he had 4 years in the office without doing the stuff that he would be promising. How many people would believe that, who are not already voting for him anyway?

    But if he passes that large hurdle, he has to pass the significant second hurdle: convince his 2016 republican voters that he is lying, and that they can safely vote for him without getting the left wing program.

    Reply
    1. Yves Smith Post author

      Lambert argued, and I think he was and is correct, that Trump attracts “volatility voters” as in people who want to poke the system in the eye. They will bet on change because the status quo has done badly by them. And many of those voters, correctly, identify the preening top 10% professionals that Thomas Frank skewered so adeptly in Listen, Liberal as their enemy.

      Trump did campaign to the left in the Republican primaries. Remember his empty promise to break up the banks? Trump did move to the right after he’d cinched the nomination.

      He did at least kill the TPP and has been trying to present his trade wars with China as a win for American workers.

      Reply
      1. Zamfir

        I am sure he can campaign on trade wars, and get a net gain from it. After all, he actually did that in his first term. And trade wars are, on the whole, not unpopular among traditional republicans. There might exist genuine supporters of free trade, but they are rarely strong supporters.

        “Medicare for all” strikes me as rather different from trade war. That really has strong, committed opponents among republican voters – people who don’t want any risk of paying for other people’s health care, people whose self-image is about being strong good people who don’t need handouts.

        That group might be a minority even among republican voters, but it is not a small minority. And they currently like Trump, and think he’s one of them.

        Is there any way how Trump can convince currently neutral voters that he is serious about Medicare for all, without also looking as if he is betraying a part of his core supporters?

        Reply
          1. Big Tap

            Medicare at 55 was Hillary Clinton’s 2016 proposal. She was more to the left than Biden. But Fox News says that Joe’s a Socialist.

            Reply
            1. MichaelSF

              Then the lower Medicare eligibility date in 2016 must mean that HRC was a card-carrying Communist. I never doubted it. . .

              Reply
        1. Code Name D

          This is what I am hearing from the right-rank-n-file, supposedly quoting sources from inside the Trump campaign. That Trump is aware and speaks to the attack-from-the-left strategy on occasion. The problem is that Trump has surrounded himself with establishment Republicans who are becoming increasingly belligerents about following orders and just doing their own thing. They even have a name for it, the “Bolton Effect.” Indeed, they claim is that the “Biden/Socialist” angle is largely a product of establishment.

          The prediction is that we may see a “shake-up” where Trump throws some of the more belligerent advisers under the bus and peruse a more lefts approach. This could even be his October surprise. Of-course they tend to give Trump a lot more credit than he deserves.

          For starters, October is mighty late in the game to launch such a major campaign re-tool. If even he did do it, it might be too late for voters to absorb the transition. And if the Biden/Socialist rhetoric is largely establishment, why dose Trump usually lead with it in his rallies?

          I tend to think that with Trump, what you see IS what you get. He doesn’t bluff because he doesn’t know how too. On the other hand, Trump is noted for his unpredictability. To see him launching a paint-by-numbers style campaign is a major warming flag that Trump is preparing a surprise for Biden. If the right-wing you-tubers are correct, we should see a campaign shake-up in the next few weeks, followed by a major left-ward tac.

          Like Lambert, I am willing to bet Trump will not do it. But I sure as hell wouldn’t put any real money behind it.

          Reply
          1. Hepativore

            There is a lot of stuff that is very popular and simple to do and if campaigned on or implemented would probably cause the candidate to win in a landslide. The trouble is the financiers of either party have the final say and would refuse to let the politicians they fund defy them.

            Another angle Trump could take is attacking from the right on healthcare in addition to attacking from the left. He could point out how health insurance companies gouge employers and corporations in terms of the cost of proving health plans to their employees that contribute to high overhead costs for labor. Even among establishment Republicans, I often wonder why they are so comfortable with their corporate clients being ripped off by health insurance companies as part of an employer-provided system. Think of how much money employers could save without having to provide health plans.

            Reply
        2. tegnost

          Aside from the fact that we don’t have anything vaguely resembling free trade, the supporters of globalized trade structured under technocratic laws (see TPP) are generally democrats, and thus the russia hysteria.

          Reply
      2. XXYY

        He did at least kill the TPP and has been trying to present his trade wars with China as a win for American workers.

        Another thing Trump should get “credit” for is not starting any wars, invading any other countries, or ramping up any existing wars. (He made a half-hearted feint toward Venezuela, but backed off rather quickly when it proved a comical fiasco.)

        Most previous US presidential administrations (going back to WWII and before) have made a point of using the US military liberally to create havoc and kill millions around the world. Trump seems to have no interest in or taste for this, for whatever reasons. It’s definitely something that should go in the plus column for the Trump presidency, intended or not. (In fact, it’s notable that the last four years have been free of the constant “who are we going to invade next” news coverage that is usually a staple of the media.)

        I fully expect a Biden victory to lead to more wars, just as a Clinton victory in 2016 almost certainly would have. Biden seems to be attracting the same cabal of neocons around him.

        Reply
        1. marym

          Trump “ramped up” drone strikes, civilian casualties, arms trafficking, and the defense budget.

          I agree it would be worse with Biden.

          Reply
          1. orlbucfan

            Quite a few Americans have died from CV, and more will die from the fires and storms set off by climate change. tRump is already sounding the alarm to his yahoo followers to get their gunz ready to fire if he loses the election. Mebbe he hasn’t started any new wars overseas, but he sure is making up for it right here at home!

            Reply
        2. ChrisFromGeorgia

          Well, he did almost start one with Iran. It seems that only fate intervened when the Iranians showed admirable restraint after their general got assassinated (clearly an act of war.)

          No doubt a Biden administration will get more effective results in dragging us into a war. nobody wants, and that only benefits the MIC.

          Reply
          1. John Rose

            You are ignoring the missile strike of the US airbase that has been conveniently ignored by the media since it illustrates the vulnerability of many US assets abroad and on the seas.

            Reply
      3. Ford Prefect

        Would he campaign for Republican Senators for whom all of these concepts are anathema?

        Is he just looking for election slogans, or expecting to actually get soemthing done? To get something done with this agenda, he would need at least 55 Democratic votes in the Senate I think (51 would do it if Schumer would eliminate the filibuster).

        Or is he juust going to be the chaos president, saying anything to get elected while positioning himself to be unable to deliver any of his promises other than judges.

        Reply
        1. Yves Smith Post author

          I don’t understand the point of your comment.

          The discussion is whether Trump might propose M4A in the last weeks of his campaign as a hail Mary pass. He would presumably do something that out of pattern for him because he looked fatally behind.

          If he actually managed to get elected, that would enable him to argue he had a mandate.

          Neuburger argues Trump could do M4A using emergency health care powers. If you buy THAT point of view, he does not not need the Senate.

          Reply
          1. vlade

            Moreover, he would not have to succeed. He might not even try – all he would, absolutely, need to do is to promise. He’s very good at promising.

            Reply
  5. Bob Hertz

    As a rule, the uninsured don’t vote.
    And if they receive Medicaid, they don’t vote for the party that brought them the benefit.

    Tennessee and Kentucky had major increases in the Medicaid population, but the recipients did not vote or kept voting Republican.

    Reply
    1. tegnost

      I have never heard of this rule, but if it’s true it would support the articles contention that M4A would be a game changer. The uninsured, for whom trump axed the $700 penalty, and of whom I am one, might disturb the force with a vote for someone who actually going to do something concrete as opposed to whatever punishment inspired plan the corpo dems come up with

      Reply
  6. marym

    Making current Medicare available to all isn’t M4A. Also, wouldn’t it still need to be funded, which wasn’t required for the eviction moratorium or the payroll tax postponement?

    Reply
    1. run75441

      marym:

      To your point on funding. The resulting letter from the GAO with regard to the Risk Corridor program in answer to then Senator Jeff Sessions’ letter, the Administration can not appropriate funds for programs, only Congress can do such. https://www.gao.gov/assets/670/666299.pdf

      GAO Letter to Senator Jeff Sessions. September 30, 2014: Discussion; “At issue here is whether appropriations are available to the Secretary of HHS to make the payments specified in section 1342(b)(1). Agencies may incur obligations and make expenditures only as permitted by an appropriation. U.S. Const., art. I, § 9, cl. 7; 31 U.S.C. § 1341(a)(1); B-300192, Nov. 13, 2002, at 5. Appropriations may be provided through annual appropriations acts as well as through permanent legislation. See, e.g., 63 Comp. Gen. 331 (1984). The making of an appropriation must be expressly stated in law. 31 U.S.C. § 1301(d). It is not enough for a statute to simply require an agency to make a payment. B-114808, Aug. 7, 1979. Section 1342, by its terms, did not enact an appropriation to make the payments specified in section 1342(b)(1). In such cases, we next determine whether there are other appropriations available to an agency for this purpose.”

      Administrations can transfer funding to make Medicare available. It would be interesting to see how some Repubs such as Representative Fred Upton (MI) and others vote.

      Reply
      1. Billy

        Didn’t Bill Clinton shift social security trust fund money around to “balance the budget?”

        How about President Trump shifting money from the Pentagon to social security and medicare?

        Reply
        1. run75441

          Billy:

          It does not matter what Clinton or Trump did and it does not apply in this case. .Representatives Kingston and Upon added Section 227 to the 2014 CRomnibus Budget bill which blocked the transfer of funds from other programs.

          Reply
    2. Starry Gordon

      Trump doesn’t need to actually do it; he just has to say he is going to do it. Biden and Company are now so far to the right in so many areas that it will be easy to run to their left. And it would be the kind of trick Trump likes to do.

      Reply
    3. Harris

      Neither Medicare or Social Security is currently being funded. Trump announced a tax holiday on the payment of taxes by individuals and companies.

      Reply
      1. edmondo

        Funding is a non-issue. Trump just used FEMA money to pay unemployment claims. Since no one went to court to stop him, do we not have a precedent where whatever the Dictator in Chief wants, the president gets. Congress is superfluous

        Reply
          1. orlbucfan

            Yeah, but at least FDR didn’t destroy the country. tRump is proving to be at least somewhat competent in that regard.

            Reply
  7. km

    Trump has had three years to hand down an EO enacting M4A. Some folks also hold out hope that Trump is going to end the stupid wars, when all he needed do is sign an order and the troops are on their way home.

    In each case, if Trump has any intent of doing these things, what’s been taking him so long? He’s been president for over three years. The COVID has been a thing for months now. What’s the excuse?

    For that matter, even if Trump does enact M4A as an emergency measure, (really, because he is facing the prospect of losing the election), what’s to prevent him from rescinding the order once re-election is secured?

    Reply
    1. Yves Smith Post author

      EOs are typically PR gestures. 80% of Trump’s EOs were sheer theater because it would take legislation to do what the EO called for. It was beyond the authority of the executive.

      The eviction EO relied on existing legislation for health emergencies. The M4A proposal would have to rely on that, which means its effect (even if you got around the funding issue) would time limited to how long were were arguably in a situation where the use of emergency public health powers was legit.

      Reply
  8. Noone from Nowheresville

    I suspect that what we really want is more of a national non-means tested Medicaid no balance billing system rather than Medicare.

    Reply
      1. Noone from Nowheresville

        Yeppers. Know that but we are talking about simply extending Medicare to the masses as opposed to the current M4A bills. Many regular people would be happy on a certain level, yet shocked by the complexity and expenses of regular Medicare. That said, it could be a good starting point for something much much better.

        From all I’ve read, Jayapal’s bill is the best so far.

        Thanks for the links.

        Reply
        1. marym

          You’re welcome! Apart from whether Trump would do this or not, imo anything that makes our system more complicated and fractured is a step backward, not forward. The ACA is an example. The Medicaid expansion and some of the protections help a lot of people, but it added complexity, furthered privatization, and hasn’t been a starting point for something better.

          Reply
          1. Billy

            I will vote, and urge my friends, to vote for the presidential candidate more likely to implement M4A and withdraw troops from the Middle East.

            Social issues are irrelevant.

            Reply
        2. Oh

          Jaypal’s bill is certainly the best on M4A. Bernie’s bill included too many organizations that sucked out money. Original Medicare covers only 80% of the costs becuse it was crappified to make MA look good.

          Reply
  9. whiteylockmandoubled

    For someone whose opinions are usually so well-grounded in data, Yves repeats health care industry talking points and mainstream media myths rather frequently when it comes to health care. There are lots of reasons that it would be difficult to do short term Medicare for All via Executive Order, but Yves’ concerns about doctors are all based on absolute bullshit from the industry, episodically (and hysterically) repeated in the New York Times and other corporate media. Anyone interested in actual data on the subject should visit the CMS website and peruse the anuual reports by the Medicare Payment Advisory Commission. Published every March. The physician section is always Chapter 4.

    1. “A lot of doctors don’t take Medicare.” Massive load of bullshit. In 2019 (March 2020 report), in the aggregate, 2.4% of clinicians (25,000/1,012,000) who treat Medicare-eligible patients didn’t take Medicare reimbursement. 70% of those are either dental or behavioral health providers, areas in which Medicare benefits are scandalously inadequate, which is an ongoing critical policy problem having nothing to do with general Medicare physician participation. Other than that, a grand total of 7,500 clinicians (25,000*.3) treat Medicare-eligible patients off the physician fee schedule.

    2. It is flatly illegal to treat a Medicare beneficiary without being registered with CMS. Doctors determined to price gouge their rich Medicare patients have to sign an opt-out agreement with the federal government. So the question about how the 7,500 doctors who “don’t take Medicare” will be enrolled with Medicare is a nonsense thumbsucker based on nonsense “reporting” by rich reporters who have no idea what they’re talking about. I suppose there may be doctors who don’t treat Medicare-eligible patients because they don’t even want to bother submitting a form to the government for the right to rip their patients off, but, honestly, who cares?

    Medicare beneficiaries have comparable, and in many cases better access to physician services than privately insured patients. They consistently report shorter wait times than privately insured patients. There are systemic problems — especially the growing inadequacy of primary-care supply, which is in part a function of much lower reimbursement than for specialists, which is why MedPAC consistently argues for rebalancing payments, and why both the Sanders and Jayapal bills include provisions to shift some payment from specialists to primary care doctors.

    On July 4, 1948, exactly zero British physicians took the NHS. By December 31, over 90% did, in a country without computers or an existing centralized billing bureaucracy with which doctors were already registered. If Medicare is how doctors are paid, they’ll participate, and, at least administratively, all of them already do.

    Reply
    1. hoonose

      As a recently retired internist I’ve had the wonderful pleasure of caring for our seniors for over 45 years. And then the last few years enjoying the benefits of Medicare myself. So much simpler, easier and cheaper than my wife’s BXBS Obamacare.

      Most docs don’t want single payer with its inherent income and control risks. Many patients want some choices with their HC and insurance, and many docs also want choices in the plans they participate. But IMO dropping the enrollment age of Medicare (as opposed to M4A) to 50-55 is a huge but still incremental change. Of course that gives millions more the benefits of Medicare, but also at the same time it relieves the private sector of much of its age based risks. And that should lower premiums there.

      Only one doc that I know of out of dozens who care for seniors in my rural AZ town of 50K does not take Medicare.

      Reply
    2. Oh

      Providers taking Medicare also get paid faster (in less than 30 days) as opposed to 60 to 90 day wait time for MA. Billing is easier too unlike the different forms that insurance companied require. Based on my limited info most doctors in my area take Medicare. I seriously considered switching to Original Medicare because (1) You can go to any doctor in the US and not have a primary care physician and (2) you can go to any hospital. I did find out however, that the coverages were crappified to make MA look good.
      The insurance companies force people on Original Medicare to take a separate policy for drug coverage and penalize you if you don’t enroll in that policy at the same time you opt for Original Medicare,

      Reply
    3. Yves Smith Post author

      None of my doctors in Manhattan take Medicare. All of my orthos insist on direct payment. My GP doesn’t either nor do any of the GPs who are taking patients here in AL to whom I have gotten referrals (both for me and my mother whose current MD is not giving her good advice). So my sample (about 10) flatly contradicts your claim.

      And you’ve really cherry picked your data:

      Now, 81 percent of family doctors will take on seniors on Medicare, a survey by the American Academy of Family Physicians found. That figure was 83 percent in 2010.

      https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/

      19% isn’t even close to ~2%

      Reply
  10. NotTimothyGeithner

    But I thought all spending had to be approved by Congress

    No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.”

    Goiing back to the Platinum Coin. The Treasury Secretary has the authority to use funds to Mint the Coin (platinum ain’t free) from a bill about Commemorative Coins. So it seems like the President could do this. He already has the right to expand Medicare to “disaster zones” and he has the right to Mint the Coin.

    Reply
    1. John k

      So according to this he has authority to expand Medicare, at least during the pandemic. The platinum coin is only needed if and when spending exceeds revenues and borrowing reaches the stupid debt limit.
      I’ve heard from multiple sources he’s too stupid to expand Medicare, IMO contraindicated by the order extending eviction moratoriums… plus, of course, his many political successes. He is routinely underestimated, starting with the clintons. He’d be so easy to beat… hugoodanode he’d breach our blue wall in flyover?!? Damn traitors…
      The danger for ins co’s is people find out just how nice it is to get care and not get bills… they’re not gonna want to go back.. huge promo for progressives, and could lead to jayapal bill forced out of committee.
      Will he do it? Speculating… He doesn’t want to, Maybe wait to see if rent moratorium does the trick. Then see what polls in the tighter swings on or about end sep are saying… he needs 5/6, must include FL…
      IMO he wants to win, does he want to win enough to alienate ins, and maybe big co’s that like to chain their workers?

      Reply
  11. Shiloh1

    See Denninger’s MarketTicker.org 6/23/2017 post, “A One-Sentence Bill To Force The Healthcare Issue”, easily found on the web. Medicare price is the highest a provider can charge, period.

    Reply
  12. Brian (another one they call)

    There are currently thousands of people working for insurance companies that know all about billing medicare. Since they will be out of work, the labor pool for those doctors not currently taking medicare (and I know that there are many who will not accept it by experience) will be ready and waiting to do work useful to the people of this nation instead of padding the rich. And these working poor will get Medicare.

    But is this just the dream of butterflies?

    Reply
    1. hoonose

      Medicare for anyone should be fine and dandy. That is assuming they have easy enough access. As a well to do retired doc, I wouldn’t leave home without it! But my wife did this summer, as we left the AZ heat for Portland. HC here is simple for me, not so for her. Her Obamacare policy only works out of state for emergencies.

      Reply
  13. Yik Wong

    “…while the Trump eviction freeze does not increase Federal outlays, but simply imposes costs on landlords.”

    let me fix that for you.

    …while the Trump eviction freeze does not increase Federal outlays, but simply imposes extra costs on tenants after the election.

    under trump’s order, landlords can charge interest, penalties, none of which can be shaken off in bankruptcy.

    Dr. Richard Wolff answers all here. https://www.youtube.com/watch?v=X5ZI6uDZlMI&t=21s
    Not that anyone will see this, but I hope the moderator will inform the author.

    Reply
    1. Shiloh1

      On the subject of rents and landlords, the local property tax entities who have not missed one check or hour of pay are strangely silent. Teacher PENSIONS line items are about half the bill.

      Reply
    2. Yves Smith Post author

      Chasing after people to get overdue rent takes time and money, and critically, chasing tenants requires spending legal $ with no certainty of getting anything. If a tenant leaves the area (and how would a landlord know where he is, particularly if he moved in with friends or family or is living on the streets) the costs of finding them and suing to try to collect rise, particularly if they have left the state. And then they need to find their bank or employer to garnish assets or wages if they prevail in court.

      Like trying to get blood from a stone. Landlords normally just take the security deposit and move on. That’s the norm in Manhattan, where rents are high and it can take 6 to 9 months to evict.

      Reply
  14. DeadlyClear

    The Eviction/Foreclosure moratorium is a bit inhibited – sounds better than it actually is. It’s limited to FHA loans. With so much paper shuffling, fraudulent assignments and Fannie Mae concealment – its quite difficult for those in need of the plan to get access. President Trump and Secretary Carson need to add the word “originally” FHA mortgages. Even that is hard to research as the original paperwork didn’t always check all the boxes.

    Reply
  15. Jeremy Grimm

    I strongly favor an expanded and greatly enhanced Medicare for All program, especially if it could cut all need for additional insurance coverages that mar the existing Medicare program.

    I am not sure what can and can’t be legally done through POTUS Executive Orders. But the notion that some kind of national emergency somehow enables an Executive Order like instituting a “temporary” pandemic-Medicare for All program greatly disturbs me. It disturbs me on account of how clearly it outlines the abdication the U.S. Congress from its obligations to serve the Common Good. That abdication contrasts most horribly with the quick, unanimous [except for some feeble objections claimed to have been made] passage of the CARES Act — to serve interests antithetical and poisonous to the Common Good. It disturbs me on account of how clearly it suggests the extent of powers the POTUS might claim and exercise on the basis of a national emergency of one sort or another. I believe that kind of power has most unhappy precedents in history.

    Reply

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