PAUL KRUGMAN VS. WHO?

Anyone who has read the New York Times will likely recognize the gentleman on the right: He's Paul Krugman, Nobel Prize winning Economist and Columnist for the Times. It would be hard to be more distinguished than he. 

I'd be surprised if many of my readers recognized the gentleman in the left: He's Don McCanne, MD, who in addition to being a physician, has been all his life a student of health policy.  He currently serves as Chief Policy Fellow for the Physicians for a National Health Plan PHNP), a body in which he served as President in 2002 and 2003. There is no more passionate advocate for Single-Payer than Dr. McCanne, and I read his daily blog with the deepest respect.  

On Sunday, March 17, the Texas Tribune published Patrick Sviteck's story about Beto O'Rourke's pivoting on his healthcare plan preference:

In Iowa, Beto O'Rourke works to find his footing on health care

Sviteck explains that O'Rourke, never more than luke-warm towards the notion of Single-Payer, seemed more comfortable embracing a policy considerably to the right of  it -- Medicare for America.  Sviteck quotes him:

"It responds to the fact that so many Americans have said, ‘I like my employer-based insurance. I want to keep it. I like the network I’m in. I like the doctor that I see,'" O'Rourke said. "It complements what already exists with the need that we have for millions of Americans who do not have insurance and ensures that each of them can enroll in Medicare. It then suggests additional investments in that program so it becomes the program of choice, and people who have private insurance migrate over to the Medicare system."

Someone questioned him:"So the greed has to stay in the insurance industry in your opinion?"

Beto paused, then said that he didn't see it as a function of greed. "I think I have to be respectful to people who just shared with me what I shared with you: They like the program they’re in, they like the insurance that they have," O'Rourke said. "If we become too ideological or too prescribed in the solution, we may allow the perfect to become the enemy of the good. And there are fellow American human lives depending on us finding a solution."

Upon reading this,  Dr. McCanne posted a very passionate statement about 

The-Fallacy That You Can Keep The Insurance You Have

He says that virtually nobody in this country does. "The obvious point" he writes, "is that people do not have stable health care coverage throughout their lives." And as he makes clear, there are too many reasons why the insurance companies change, or their policies do, or the networks do.  I suggest you read his article I've linked above: I never knew there were so many reasons why the insurance you have can and will change, but I can testify that in my lifetime that has been my experience.  

And as for that shibboleth "freedom of choice," you have to go along with whatever your employer chooses to give you -- if he chooses anything. You get the doctors and the network that your employer chooses. But as McCanne says, with Single-Payer, you don't have to worry about doctors being in your network; You can choose any doctor, any hospital you want: they're all in the same network!  (This would be very much unlike Medicare for America, if it devolves into a two-tiered system -- one more pricey than the other -- those who belong to the medicare tier might find themselves priced out of the tier whose pricier doctors might not want to treat them. That sort of thing is happening as I write this. There is a physician in Kingston, well thought of,  whose receptionist told me: "Of course Doctor doesn't take Medicare. That's what you have? You should have told me from the get-go, and not wasted my time!" Luckily for Carol and me, we could find quite a few other good doctors in Kingston who do take Medicare.)

Thus this argument for Medicare for America -- that you can keep the insurance you have -- is, in McCanne's opinion, based upon a fallacy. And, as I said in my most recent post, Medicare for America, in my opinion, would be unlikely to last long, if for no other reason that no billion dollar company is going to sit quietly by while it is being put out of business -- however slowly. They'll deploy every dollar they have to lie, distort, and bribe.

Despite all this, Paul Krugman believes that eventually most of the Democratic candidates will be persuaded to move rightward and and embrace Medicare for America. In  his recent opinion piece,

Don't Make Health Care a Purity Test

Krugman asks, 

But even if optimistic claims about Medicare for All are true, will people believe them? And even if most people do, if a significant minority of voters doesn’t trust the promises of single-payer advocates, that could easily either doom Democrats in the general election or at least make it impossible to get their plan through Congress.

And he points out that -- just as there is more than one way to skin a cat -- there are in the world many ways proven successful in providing universal healthcare. "Every two years," he says,  "the Commonwealth Fund provides an invaluable survey of major nations’ health care systems. America always comes in last; in the latest edition, the three leaders are Britain, Australia and the Netherlands. 

"What’s remarkable about those top three is that they have radically different systems. Britain has true socialized medicine — direct government provision of health care. Australia has single-payer — it’s basically Bernie down under. But the Dutch rely on private insurance companies — heavily regulated, with lots of subsidies, but looking more like a better-funded version of Obamacare than like Medicare for All. And the Netherlands actually tops the Commonwealth Fund rankings."

Krugman then asks,  "So which system should Democrats advocate? The answer, I’d argue, is the system we’re most likely actually to create — the one that will play best in the general election, and is then most likely to pass Congress if the Democrat wins." 

He concludes, "To me, then, Medicare for America — which lets people keep employment-based insurance — looks like a much better bet for actually getting universal coverage than Medicare for All. But I could be wrong! And it’s fine to spend the next few months arguing the issue. What won’t be fine will be if activists make a no-private-insurance position a litmus test, declaring that anyone advocating a more incrementalist approach is no true progressive, or maybe a corrupt shill for the medical/industrial complex. As you might guess, my concerns aren’t drawn out of thin air; they’re things I’m already hearing."

So the next few months will be anything but boring! And the thing is: I'm really not 100% sure of where I am on all this.  In the readers comments section -- which I strongly urge you to read -- readers give their views about Krugman's opinions. In the first New York Times Pick, you can read:

"Private insurance is mostly there to say No, you can’t have that, but if you do, we’re not going to pay for it. And we currently pay through the nose for these companies to tell us that. Who in their right mind is “satisfied” w that? Only stupid people or people w ties to the health insurance industry. No, private health insurance, w the possible exception of “boutique” brands for the wealthy, should be abolished. I don’t often disagree w Mr. Krugman, but this time I do. Wholeheartedly. Is my view impractical? Let’s forget the polls and vote on it."

After reading this, I thought, "yes, yes! Those !*#@*! [the healthcare companies] should not be rewarded for what they've put us through! I agree 100 percent! But then I read:

"One of the problems that Progressives will have in selling Medicare for All is that they have made a compelling case for the utter corruptibility of politicians due to money in politics. The GOP over the years has made a much less honest but electorial effective case that "liberal elites" cannot be trusted. And Trump has demonstrated the weaknesses in oversight, check and balances, and the value of facts in our system of government in the face of extreme partisanship and the conservative media ecosystem. "So how do you convince the rightfully skeptical, currently insured but potentially persuadable, to let OUR Federal government take this much control over health care NOW? "Explaining all the positives of Medicare for All is easy relative to the challenge of explaining how THIS government, that will without question still be highly partisan in 2020 and still awash in big donor money, is capable of pulling this off. "Have a robust debate. If Medicare for All resonates with a solid majority of voters across a majority of states that's great. I hope it goes that way. "But if not, keep in mind that our democracy may not survive another 4 years of Trump and McConnell. Medicare for All is not the hill to die on. [Emphasis added]

After reading this, I think, OMG, of course, of course! This makes sense!

Let our good doctor, the esteemed Don McCanne -- only one year younger than I -- have the last word about what we activists for Single-Payer must bear in mind:

This is a time for PASSION. We have to get this message out there.

As with everything else, he is so right about this, too.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

BETO O'ROURKE CHOOSES "MEDICARE FOR AMERICA" (NOT MEDICARE FOR ALL)

What does he know that we don't?

Although Medicare for All  has been the rallying cry of most of the progressive Democrats in the presidential race,  Beto chooses another, seemingly more "moderate" plan. What is this "Medicare For America" that Beto should go for it? You can check it out in this link:

Medicare for America -- Beto's Favorite Healthcare plan -- Explained

It's very much influenced by a plan cooked up the Center for American Progress (CAP) last year, and presented in my blog post "Various Flavors of Healthcare Reform" (12/15).  The new plan would allow all who like the insurance offered by their employer the opportunity to keep it. Everyone else -- those who don't like their employer's plans, or who do not have employer-offered insurance, or who have either private insurance, ACA, Medicare or Medicaid, or no health insurance whatsoever -- get Medicare for America. In addition, every new-born automatically gets enrolled in Medicare for America, whose required contributions  are graduated by ability to pay, and whose benefits would be at least equal to the remaining Private Employer's Insurance which would theoretically be strictly regulated, and would cover at least 80% of the expenses incurred by the employee. But any time the employee became dissatisfied with his employer's plan, or any time his employer wanted to move him or her off it, that employee would transfer into Medicare for America.

Thus, so the story goes, as more and more newborns are enrolled into Medicare for America, and more and more currently employed people retire, gradually everyone would be covered by Medicare for America, and Private Health Insurance would just fade away, so to speak. What's not to like?

WELL!

I can't imagine anyone so naive as to suppose that during the decades-long process of conversion to Single-Payer, Private Insurance would go gently into that Good Night. No, it would fight with every dollar at its disposal, and it would exploit the public's dissatisfaction with the new system. And there would be plenty to complain about! For one thing, all the disadvantages of our badly fragmented system would be kept, with the loss of much of the savings in administrative overhead that would have helped pay for Single-Payer, thus raising the costs higher than necessary.  And with the pool of risk essentially halved, the required payments to Medicare for America would be even higher than if  all the population were paying into it. 

Moreover, medical providers, who currently spend a fifth of their time wrestling with Private Insurance, would be denied the relief that Single-Payer would have provided. And since the Private insurance folks could drop coverage for anyone too sick or frail to be profitable (they're doing it now), we'd have a two-tiered system -- one for the rich and healthy, and one everyone else, with costs spiraling out of control.  And within the first two years -- five at the most -- the public would cry out to go back to what it had before -- the Medical Industrial Establishment would make sure of that!

Truly, the only thing Beto's plan has going for it is what he may suppose is the public's unwariness that might lead it to believe two things:

1. This "incremental" approach is a good thing, and
2. Private Insurance can be trusted not to find ways -- even with "strict" regulation -- to game the system to their advantage, and to the disadvantage of everything else.

I should make it clear that even with Single-Payer, there are bound to remain a few private insurance companies, to deal with things NOT covered by Medicare for All -- aesthetic plastic surgery for example.  And there may be others.

But Howard Schultz, the ex-CEO of Starbucks, supposes that the entire Health Insurance Industry would be destroyed. "Destroy a whole industry?" he says, "that's un-American! What will they destroy next -- coffee?"  My point is that the privatization -- indeed the financialization -- of all industries is so in-grown within the body of our American life,  that there is a benefit in making the excision of this toxic mass as surgically swift as possible.  Yes, we must plan for dealing with the displacement of many of the insurance workers -- they count, too!  In this I do NOT include the hugely salaried CEOs and their ilk. They have the resources to take care of themselves. 

They also have the resources to find ways to hold on to their jobs -- at the expense and pain of everyone else.

We must fight them, opposing all their culture of greed. Despite Schultz's protestations, that is NOT the American way.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!