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OpEdNews Op Eds    H1'ed 8/1/19

Stuck in a Rut of their Own Making, Progressive Democrats Need to Be Honest

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Until progressive Democratic candidates like Bernie Sanders and Elizabeth Warren forthrightly declare that Yes! socializing health care by making the government the single insurer of every American will require a hike in taxes, but that everyone will benefit in the final analysis, they will never succeed in winning over American voters one what polls show it the biggest issue this election cycle.

The most potent "third rail" in American politics is raising taxes. The reality is that this country, contrary to national mythology, was founded not on a noble passion for freedom, but on a selfish and far less edifying loathing of taxation. We are a nation of people who appear to want a lot of things like better roads, better schools, cleaner environment, government services when we need them with no waiting, and politicians who aren't corrupt, but we don't want to pay for any of it.

We know our healthcare system is gawdawful - too expensive to afford, dependent upon our hanging onto our often loathsome and oppressive jobs, long waits to get care, ever-higher deductibles that can become so high we cannot even afford them, and too many people without access to care, who end up getting seriously ill and then become our burden when they end up needing expensive free care at our public hospitals. But even though almost every other modern country in the world has managed to solve that problem (and much more cheaply than we are doing) by having the government take over the task of providing care, we don't want to hear about it because we are told they do it by paying for healthcare by higher taxation. What we don't hear is that many of those countries have higher standards of living than we do, better funded retirements, longer vacations, and free college for their kids, most of that also funded by taxation.

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Granted that the media, including supposedly progressive media like NPR, are not helping. They all keep pushing the false argument that Medicare-for-All would be "too expensive," or "impossible to achieve" given the opposition of Republicans and conservative Democrats in Congress, and of course given the American public's supposed allergy to raising taxes.

But here's the thing: People need to hear the honest story. Voters want a better, more reliable and more affordable health care system. and they are smart enough to know that talk of raising taxes on the wealthy and on corporations isn't going to do the trick alone. They know that providing "Medicare-for-All" - and that's improved Medicare, not just what the elderly currently get, with all the limitations on coverage and the need to buy Part B coverage for doctors and Part D for drugs, but full coverage of all medical treatments - will cost a lot of money and that it is going to end up requiring higher taxes. That makes them dubious.

So progressive candidates: Don't duck and weave on this. That approach won't work. Neither will saying "healthcare is a right" (let's face it, most Americans don't give a hoot about whether other people can afford health insurance or afford to see a doctor; only about whether they can afford insurance and their family can see a doctor). In fact though, you're starting from a good place, with polls showing that even with the prevailing media bias against nationalizing health care, and with Americans' prevailing lack of social conscients, a majority of all Americans favor Medicare-for-All- even 52% of Republicans!

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So go forth and start telling voters the whole truth: "Yes, you will be paying higher taxes for your universal health care coverage for all Americans. But! (and this is the important other part of the deal), you will no longer be paying - and your employer will no longer be saddled with paying - private health insurance premiums), meaning you can press for higher wages either individually or collectively as a union. You will no longer have co-pays. You will no longer be facing bankruptcy, or losing your house, if someone in our family is struck with a debilitating disease like cancer or parkinson's or AIDS. And you will no longer be indentured like a cowering serf to your employer, afraid to stand up if wronged, to agitate for a trade union or, if you already have one, afraid to go out on strike for fear of losing your employer-provided health benefits.

I should note though that in Canada, the tax to support Medicare starts at incomes of $55,000. Below that there's no tax. And Sanders' Medicare-for-All bill in the Senate (blocked from consideration by Republicans), has proposed a 4% levy, but it would not apply, he says, to family incomes below $29,000.

Meanwhile, the numbers make it clear that socialized medicine is cheaper. Our country spends a vastly greater amount both as a percentage of GDP (18%) and on a per-capita basis (a staggering $10,000 for each and every of us) on health care. And for all that money we get a great deal less - particularly with some 30 million of us, about 10 percent of the population, left with no access to health care - than the rest of the developed world gets. Those other developed nations in contrast spend between 7-12 percent of GDP and just $4,000 (UK) to $8000 (Switzerland) per capita on their people's healthcare, while having better health statistics to show for it, and with everyone being covered.

Clearly, for the vast majority of us - the poor, the middle-class and even most of the rich - national health care would mean a huge savings, even factoring in an increase in our taxes.

To say "we can't do this" as the so-called "moderate" Democratic candidates running for the presidential nomination argue, requires one to believe that this supposedly "can-do" nation of ours simply cannot do what so many other nations are able to do: to competently and with minimal corruption run a government-operated health care funding system. Besides, we already do it: Medicaid in case you didn't notice, is socialized medicine in the form of federal government medical insurance - you just have to be over 65 or disabled in order to get it, and the Veterans Hospital system is truly socialized medicine on the British National Health System model - hospitals are owned by the US govenrment and doctors and staff are all salaried employees of the federal government. And both work beautifully. Indeed in study after study, the VA's hospitals are found to deliver the best or equal to the best medical care of any hospital system in the country.

Maybe some people still really believe this absurdity that the US government cannot do anything well or efficiently. It is a shiboleth of the libertarians, and a standard talking point for conservative Republicans who like Hari Krishnas mindless chant that "business is always better at doing anything than government." (Question: Have you tried getting customer service for your computer, bank or cell phone from some business lately? Which is worse: that or calling the DMV or Social Security administrartion? I'll take the latter hands down.)

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But this mantra flies in the face of reality. Despite the stale nasty jokes, the US has an amazing government postal system that for less than it costs to pay for a short stop at a parking meter can deliver a letter across the country even from and to a small rural address, reliably and in 24-48 hours, even in bad weather. We have a US Coast Guard that can rescue capsized boaters even in a hurricane. We have a government space program that can put rovers on mars and even the planets of Saturn. Surely we can run a quality health insurance program that covers everyone and does it cost-effectively.

But here's the rub. Everyone who earns enough to have to pay income taxes will pay for Medicare-for-All with a higher tax bill, just as we pay for our Social Security retirement program. (Actually current Medicare, limited as it is, is also loved and ardently supported by its elderly and disabled recipients and their families, and it is funded already by a payroll tax, which people don't seem to mind much.)

I think that the Democratic candidate who leveled with the voters and just stated it this way, explaining that we all need to be willing to pay a bit more in taxes in order that all of us can have our own government-funded national health insurance program (just like they have had in Canada by the way for almost half a century now), would be enthusiastically supported by most American voters, including many Republicans. We can argue about the finer points like whether the tax should be a flat one like Social Security, with the same percentage levied on everyone, or everyone up to a certain income level, or a graduated one where the poor pay nothing if they owe no income tax, or a small amount, the middle class pay a smaller percentage, and the wealthy pay more commensurate with their income tax rate. These are minor technical issues. The main point is to simply explain forthrightly that such a program will require a tax hike, but the the net cost to virtually everyone will be lower than what they are paying now in premiums, co-pays and out-of-pocket, not-covered costs for things like drugs, medical equipment, etc., not to mention taxes and higher insurance premiums to cover the "charity" treatment costs of those hospitalized with no insurance.

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Dave Lindorff is a founding member of the collectively-owned, journalist-run online newspaper www.thiscantbehappening.net. He is a columnist for Counterpunch, is author of several recent books ("This Can't Be Happening! Resisting the (more...)
 

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PCM

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If brevity is the soul of wit, this has to be the wittiest article you have ever posted, Dave!

[And in case my comment makes no sense later on because someone fixed the problem, the body of the article is missing entirely at OpEdNews. You can find it here, however.]

Submitted on Thursday, Aug 1, 2019 at 9:54:13 PM

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Actually, I do have a few substantive comments to your article (which I read at TCBH).

* Don't be so sure Medicare For All would mean significantly higher taxes. First, we already bear close to the highest healthcare-related per-capita tax burden in the world. The problem is that a big chunk of those taxes go to pay for price-gouging and administrative featherbedding and skimming. Single-payer dramatically reduced price-gouging and administrative overhead, so the same tax revenue can cover a lot more actual care. Second, depending on how progressive the tax structure we adopt to fund Medicare for All turns out to be, tens of millions of poorer Americans may end up with lower taxes, those in the middle may end up paying roughly the same, and those at the top may end up paying more. Third, total healthcare expenditures (public/taxpayer-funded plus private/out-of-pocket) will indisputably go down in the aggregate, and (based on the tax scheme assumed in the last comprehensive funding study), 95% of Americans would end up with more money in the their pockets at the end of each. Further, the 5% richest who end up paying more would be protected from ever being saddled with a surprise catastrophic uncovered out-of-pocket expensive (so common today with off-formulary chemo and biologics and out-of-network providers).

* Medicare For All is not socialized healthcare; it's socialized health insurance. Most care would still be delivered by competing private providers. The VA and Britain's National Health Service are socialized healthcare. Most care is delivered by salaried civil servants.

Submitted on Thursday, Aug 1, 2019 at 10:33:24 PM

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* Your Swiss statistics are a good reminder of how much higher Swiss per-capita income is than American per-capita income. You see, the Swiss spend less than 12% of GDP on healthcare while we spend just about 18%. In absolute terms, they spend only 20% less than we do, but relative to income, they spend closer to 35% less. And imagine how much less the Swiss would spend if they bargained fees and prices on a national rather than a cantonal basis! (Surpise! Swiss prescription-drug prices can actually be higher than American prices! Cantons with populations smaller than a lot of American cities don't have a whole lot of bargaining power!) How much bargaining power would a single buyer representing 330 million people weild? (Answer: the highest of any healthcare system in the world.)

Submitted on Thursday, Aug 1, 2019 at 10:33:49 PM

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Also, the Swiss have the next costliest system to the US (still only two thirds of what our "system" costs) because they don't have single payer or nationalised health care like the Brits. They have a workable version of Obamacare, only much better. The big improvement is that they told all their insurance companies that if they want to sell lucrative gold-plated health insurance plans to the wealthy (elective designer surgery, single-occupancy rooms, fancy meals, etc.) they first had to offer unlimited amounts of at-cost basic health plans that meet standards for coverage set by the Swiss parliament. That's what Obamacare decidedly does not do.

Dave Lindorff


Submitted on Thursday, Aug 1, 2019 at 11:06:27 PM

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The Swiss also set the "medical loss ratio" on the standard non-profit package at 95% versus 85% for large-group plans and 80% for small-group plans in the United States. (For those who are math-averse, that equates to a "cost-plus markup" of 17.6% on large-group plans and 25% on small-group plans -- which is a pretty sweet deal for American health insurance companies, especially given how dramatically they've been consolidating and divvying up markets to avoid competition.)

One thing Swiss and American insurance companies have in common, however, is that they can both play the market with their insureds' premiums -- which make for a massive investment fund in both cases -- and profits are not factored into the medical-loss-ratio calculation. If the insurance companies play their cards right and avoid undue risk, it's free money for them -- money that is essentially legally stolen from their insureds. (I'm guessing that American insurers can drag out disbursements to providers for far longer than Swiss insurers, for a bigger float to play with. In France, last I checked, "national insurance" was paying providers in full within 7 days of the date service was provided. I don't know what the standard delay is in Switzerland or the United States.)

In the run-up to Switzerland's last single-payer citizens' initiative -- which failed, thanks to the German-speaking cantons -- I saw a lot of the exact same arguments that Democrats used to rationalize blackballing single-payer in Congress back in 2009/2010.* I actually wondered whether Swiss insurers and banks had hired the same PR firms the Dems' principals in Big Health had used! The truth, however, is probably that Swiss PR firms just saw a winning tactic and copied it.

Submitted on Friday, Aug 2, 2019 at 3:22:18 AM

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* The real reason, of course, was that Dems were getting an adequate cut of the take from the status quo ante, in the form of campaign support, family payoffs, and deferred personal payoffs. Obamacare may have smoothed out a few of the more egregious rough edges, but in its essence it institutionalized that status quo ante. In fact, Big Health profits have actually increased! Also, the for-profit health sector controls American reporting on healthcare, courtesy of $14 billion a year in direct-to-consumer advertising (plus I don't know how much in public media underwriting). Few media outlets will be willing to bite a hand that generous unless they are certain that revenue lost will be replaced by advertising from other sectors. Accordingly, they can be counted on to do their best to torpedo pro-single-payer politicians (while maintaining a facade of journalistic neutrality), and calculating politicians know this. If you ever see ostensibly pro-single-payer politicians being given a genuinely fair shake by American media, you can be fairly confident that they have given clear behind-the-scenes signals to the right people that they have no intention of pushing it through.

Submitted on Friday, Aug 2, 2019 at 3:24:07 AM

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I think I make all that clear. The bottom who make less than $29,000 a year, according to Sanders, would not pay any Medicare tax. I agree if there were a steeply progressive Medicare tax, a lot of the lower middle class would not pay much if anything in taxes, but this is the United States. We don't do steeply progressive

taxation. The likelihood is that it would be more of a flat tax like the current Medicare tax and like Social Security. At least it should be on all income, which would help. But the main point is that even if it were a flat tax, people would be paying less to be fully covered than they pay now to be partly or minimally covered for illness.


Dave LIndorff

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Submitted on Thursday, Aug 1, 2019 at 11:02:49 PM

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My apologies for a couple of typing screw-ups:

* "at the end of each" should read "at the end of each year"

* "out-of-pocket expensive" should read "out-of-pocket expenses"

(Post-surgical meds have made my typing and proofreading even worse -- which is totally superfluous, seeing as how they were already declining quite nicely on their own!)

Also, I'm pretty sure I included a working link to the original TCBH article ("here") that is now de-linked. Since the article is now showing up at OEN, it no longer matters.

Submitted on Friday, Aug 2, 2019 at 1:55:51 AM

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i agree with the article 100%.Progressives have to start stressing that even though you may pay higher taxes in the end you will pay much,much less with single payer insurance.the conservative republicans and so called moderate democrats just stress higher taxes along with the mainstream corporate news media,some how progressives must stress to the public that in the end its much cheaper and better,getting the message out is the problem

Submitted on Friday, Aug 2, 2019 at 4:20:44 PM

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