Tag: Medicare for All

Wake Up To Monday’s Hot Links

The Daily Escape:

Cypress trees, Lake Verritt, LA – November 2023 photo by Rick Berk Photography. Note the egret in the background.

For today’s Wake Up Call, we return to a staple of yesteryear, some hot links that caught Wrongo’s eye over the past few days.

Wrongo isn’t happy with how the Ukraine War has slipped from the consciousness of America’s media and thereby, from our view. Saturday’s WSJ offered an intriguing idea with its column, “Does the West Have a Double Standard for Ukraine and Gaza?” (free link). The article makes two excellent points. First, how these two wars have divided the world. Here’s a view of the division:

From the WSJ: (emphasis by Wrongo)

“Outrage and political mobilization have become subordinated to geopolitical allegiances—a selective empathy that often treats ordinary Ukrainians, Palestinians and Israelis as pawns in a larger ideological battle within Western societies and between the West and rivals such as China and Russia.”

Second, the article concludes by saying that the main difference between the two wars is that the Israeli-Palestinian conflict, with all its complexities, lacks the moral clarity of the Ukrainian resistance to Russia. They quote British lawmaker Alex Sobel:

“There is no moral justification for the Russian invasion. Zero. It’s just about Russian imperialism….But in Israel and Palestine, it’s about the fact that there are two peoples on a very small amount of land, and political and military elites on both sides are unwilling to settle for what’s on offer.”

Yes, America may have the moral high ground in both cases, and views can differ on how both wars are being waged. But as the article says in its second paragraph:

“The Russian invasion of Ukraine in February 2022 was unprovoked, while Israel sent troops into Gaza because of a mass slaughter of Israeli civilians…”.

Make of the article what you will, but it’s important to think through why you (like Biden) think both wars are morally equivalent.

Link #2 is apropos of the COP28 conference now underway in Dubai. Grist Magazine has an article: “Where could millions of EV batteries retire? Solar farms.” As solar energy expands, it’s becoming more common to use batteries to store the power as it’s generated and transmit it through the grid later. One new idea is to source that battery back up at least in part from used electric vehicle batteries:

“Electric vehicle batteries are typically replaced when they reach 70 to 80% of their capacity, largely because the range they provide at that point begins to dwindle. Almost all of the critical materials inside them, including lithium, nickel, and cobalt, are reusable. A growing domestic recycling industry, supported by billions of dollars in loans from the Energy Department and incentives in the Inflation Reduction Act, is being built to prepare for what will one day be tens of millions of retired EV battery packs.”

More:

“Before they are disassembled…studies show that around three quarters of decommissioned packs are suitable for a second life as stationary storage.”

Apparently there are already at least 3 gigawatt-hours of decommissioned EV battery packs sitting around in the US that could be deployed, and that the volume of them being removed from cars is doubling every two years.

Link #3 also shows the impact of the Inflation Reduction Act. Wolf Richter writes that:

“In October, $18.5 billion were plowed into construction of manufacturing plants in the US ($246 billion annualized), up by 73% from a year ago, by 136% from two years ago, and by 166% from October 2019.”

More:

“The US is the second largest manufacturing country by output, behind China and has a greater share of global production than the next three countries combined, Germany, Japan, and India.”

All of this construction spending will take time to turn into production. When these new plants are up and running and producing at scale, manufacturing’s share of US GDP will rise. And much of the new construction is happening in fly-over America, which can use the help.

Finding factory workers in sufficient numbers to support the new capacity will be a key. America has energy in abundance and has robotic manufacturing. So pulling production from overseas with fewer workers needed will be a giant plus for the US.

Link #4 is a downer. Civic Science says in this week’s 3 things to know column, that “Nearly 3 in 10 Americans say they have had to forgo seeing a doctor in the past year due to costs.” Here’s their chart”:

Civic Science says that 12% of US adults have had to miss or make a late payment on medical bills in the last 90 days, a two percentage point increase over September 2022.

A far larger percentage of Americans – 27% of the general population and about 30% of respondents under 55 years old or with an annual household income under $100,000 – report they could not go to a doctor in the past 12 months because they could not afford the cost. Gen Z adults and households making between $25K-$50K are more likely to have held off seeing a doctor due to cost (34% and 31% respectively).

We all know that medical costs have continued to rise and that medical debt is the leading cause of personal bankruptcy in the US. If Congress was really interested in helping provide for the general welfare, they would deal with this out of control problem.

Time to wake up America! There’s plenty going on that isn’t getting visibility in the mainstream media or on social media. You have to cast your net widely to be on top of the good and bad happening in the US.

To help you wake up, we turn to Shane MacGowan, frontman for the Irish group the Pogues who died last week. He left behind a body of work that merged traditional Irish music and punk rock. He wrote many songs that could easily be mistaken for traditional Irish tunes including this one, which was also used as the music for wakes by the Baltimore Police Department in the great, great HBO series, “The Wire“. Here’s “The Body Of An American” from their 1986 album, “Poguetry in Motion”:

RIP Shane.

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Saturday Soother – June 18, 2022

The Daily Escape:

Rainy morning, with Vista House at Crown Point in right foreground, Columbia River Gorge, WA – June 2022 photo by David Leahy Photography

Wrongo has written before about the crushing burden of consumer debt in the US. Medical debt is an American disgrace, and Noam Levey, Kaiser Health News (KHN) Senior Correspondent has written an excellent piece about it. He says that 100 million people in America, some 41% of adults, owe some level of debt to healthcare providers.

But most studies don’t reveal the actual extent of the debt because much of it appears as credit card balances, loans from family, or payment plans arranged with hospitals and other medical providers. To calculate the true extent and burden of this debt, KHN partnered with NPR, and the Kaiser Family Foundation (KFF) to conduct a nationwide poll designed to capture not just bills patients couldn’t afford, but other forms of borrowing used to pay for health care.

The results are contained in the KFF Health Care Debt Survey. The KFF poll found that half of US adults don’t have the cash to cover an unexpected $500 health care bill. As a result, many simply don’t pay their medical bills. The flood of unpaid bills has made medical debt the most common form of consumer debt in America.

Over the past five years, more than half of US adults report they’ve gone into debt because of medical or dental bills. Moreover, a quarter of adults with health care debt owe more than $5,000, and about 20% with any amount of debt said they don’t expect to ever pay it off.

Debt incurred for health care is forcing many families to cut spending on food and other essentials. The poll also found that millions are being driven from their homes or into bankruptcy:

So, if 100 million people were in debt and 17% declared bankruptcy or lost their home, that’s 17 million people! The KFF poll found that the debt is also preventing Americans from saving for retirement, investing in their children’s educations, or buying a home. And debt from health care is nearly twice as common for adults under 30 as for those 65 and older. And that age cohort is supposed to be much healthier than the elderly.

Perversely, about 1 in 7 people with medical debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills. An even greater share (two-thirds) have put off care that they, or a family member need because of the cost.

Hospitals are among the culprits. They are capitalizing on their patients’ inability to pay. Hospitals and other medical providers are pushing millions of patients who can’t afford to pay into credit cards and other loans. These are high interest rate loans, carrying rates that top 29%, according to research firm IBISWorld.

This collections business is fed by hospitals, including public university systems and nonprofits granted tax breaks to serve their communities, who sell the outstanding debt to collections companies.

Welcome to the best country on earth, (maybe) one that doesn’t have the best health care system (and certainly one without  health insurance for all). We have a system which shackles 100 million people to medical debt while at the click of a computer mouse, we send $billions in armaments overseas before those same dollars are recycled into the coffers of our Military-Industrial complex.

That’s all for this week. It’s time for our Saturday Soother, when we take a break from the J6 public hearings and whether Ginni Thomas was another Trumpist plotter. Let’s focus on calming ourselves for whatever insults are coming next week.

Here at the Mansion of Wrong, we’re engaged in an air conditioning project, adding more central air to our home. Hey, we’re aware of the crummy stock market, and the rampant inflation, but consume we must.

To help you clear your head on this warm weekend, grab a seat outdoors and brew up a cup of Supernatural coffee ($18.45/12 oz.) by Lee, MA’s own Barrington Coffee Roasting Company. This espresso is said to have flavors of Concord grape, dark chocolate, plum and tangle berry pie!

Wrongo has no idea what tangle berries look like, much less what they taste like.

Now, put on your wireless headphones and listen to the “Adagio for Oboe, Cello, Organ and Strings”, also known as “Elevazione” or “All’Elevazione” by Domenico Zipoli.

Zipoli was an Italian Jesuit priest who lived much of his life in what is now Argentina. He studied with Scarlatti, became a Jesuit, worked as a missionary, and died in 1726 in Argentina at age 38. If fate had granted Zipoli another 20 to 25 years, he might be regarded today as a major composer. Here it’s performed in 2015 by the Collegia Musica Chiemgau conducted by Elke Burkert :

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Monday Wake Up Call – June 15, 2020

The Daily Escape:

Bright Angel Trail, in the middle foreground, Grand Canyon NP – photo by glowrocks

The chickens are coming home to roost. Michael Flor was originally the longest-hospitalized COVID-19 patient. Somehow, he survived. He came close enough to death that a night-shift nurse held a phone to his ear while his wife and kids said their final goodbyes.

Today, he’s recovering at home in West Seattle, WA. That’s the good news. The bad news is that he just got the bill. From the Seattle Times:

“The total tab for his bout with the coronavirus:…$1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.”

More from the Seattle Times:

“…the charge for his room in the intensive care unit was billed at $9,736 per day. Due to the contagious nature of the virus, the room was sealed and could only be entered by medical workers wearing plastic suits and headgear. For 42 days he was in this isolation chamber, for a total charged cost of $408,912.

He also was on a mechanical ventilator for 29 days, with the use of the machine billed at $2,835 per day, for a total of $82,215. About a quarter of the bill is drug costs.”

Those charges don’t include the two weeks of recuperating he did in a rehabilitation facility.

Since Flor has Medicare, it is unclear how much he will actually have to pay out of pocket. Further, since Congress set aside more than $100 billion to help hospitals and insurance companies defray the costs of the pandemic, it’s possible that Mr. Flor may not have to pay even the out-of-pocket charges normally billed by his Medicare Advantage policy, but that remains to be seen.

The insurance industry has estimated treatment costs of COVID-19 could top $500 billion, so unless Congress steps up with more money, co-pays for COVID will soon become injurious.

One outcome of the pandemic may be that America takes a closer look at universal health insurance. There are many detractors in Congress, but the sticker shock that so many families will see from COVID-19 cases may restart the discussion. Medicare for all could work: A single payer with a set system of prices would be good for employers and employees alike.

It will be hard. Universal health insurance is such a tough problem to solve that only 31 out of 32 developed nations have managed to do it.

A second issue for today is the killing of Rayshard Brooks in Atlanta over the weekend. From the Atlanta Journal-Constitution:

“Officers were called to the restaurant after receiving a complaint about a man asleep in his vehicle, which forced other customers to go around his car to get their food at the window. The man, Atlanta resident Rayshard Brooks, was given a field sobriety test, which he reportedly failed…”

Brooks grabbed a cop’s Taser. More:

“…surveillance footage from the Wendy’s appeared to show Brooks turn toward the police and attempt to fire the Taser as he ran away. That’s when the officer chasing Brooks pulled out his gun and shot him…”

Tasers are a form of de-escalation instead of using firearms. The Taser momentarily incapacitates, but ultimately doesn’t threaten life. So shouldn’t it follow that if a suspect steals a cop’s Taser and threatens to use it, the cop can’t just shoot him dead since he’s being threatened by an ultimately harmless weapon?

The cops had his car, it’s likely they knew where he lived. They could have picked him up at any time. Instead, they killed him. The police tried to do something, the suspect resisted, and in the heat of the moment, the cop escalated to show that he’s in charge. It was a terrible reason to kill someone.

Time to wake up America! We have both out-of-control policing and out-of-control capitalism harming our society. To help you wake up, listen to Sly and the Family Stone’s 1969 song, “Everyday People”. This is Playing for Change again, along with Turnaround Arts students. Trust Wrongo and watch:

Sample Lyric:

Sometimes I’m right and I can be wrong
My own beliefs are in my song
The butcher, the banker, the drummer and then
Makes no difference what group I’m in
I am everyday people, yeah, yeah

And different strokes for different folks
And so on and so on and scooby dooby doo-bee
Ooh, sha sha
We got to live together
I am no better and neither are you
We are the same whatever we do

Of course there was racism back in 1968, but the musicians were preaching integration. Despite the racism back then, people were optimistic. Compare that to today.

Those who read the Wrongologist in email can view the video here.

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Warren’s Mistake on Single Payer

The Daily Escape:

Mount Shasta, CA – November 2019 photo by pkeller001

Wrongo wonders if Elizabeth Warren has made a big mistake in her policy for Medicare for All. She started out running to reform capitalism, but through the debate process, she’s evolved towards single payer health insurance as a main policy. Months ago, she was an increasingly skilled campaigner whose laundry list of policy proposals made her stand out from the pack. Now she’s for nationalizing health insurance, which doesn’t seem to be on brand.

Two of her main rivals, Biden and Buttigieg, essentially want to extend Obamacare while leaving the 170 million Americans covered by private insurance with their current plans. While on her left, her other main opponent, Bernie Sanders, also wants to nationalize health insurance.

The latest New York Times/Siena College poll of Iowa Democrats shows Warren, Sanders, Buttigieg, and Biden bunched within a 5-point range. And while Warren leads, the poll found more sentiment among primary voters for improving the private health insurance system than for scrapping it in favor of single-payer.

Worse for Warren, she and Sanders are both sufficiently well-funded and popular that neither can easily emerge from Iowa or beyond as the candidate on the left. It’s similar on the moderate side: Neither Biden nor Buttigieg are going away after Iowa either.

Buttigieg is a gifted politician. He’s correctly discerned that the path to marginalizing Biden lies not in attacking him, but in confronting Warren on single payer, which he did in the last debate. He would rather that Sanders was the front-running lefty heading into Super Tuesday, than have to confront Warren.

A few more debates, and Mayor Pete may be the last standing moderate alternative to Warren and Sanders, assuming Bloomberg doesn’t get traction along the way.

Sanders is a much better candidate than he was in 2016. He’s making inroads among African-Americans and Hispanics. AOC, a very popular symbol of youth and progressivism, supports him. Sanders is doing well enough with young progressives to keep Warren from now moving closer to the center on single payer.

She went from cautious on single payer to all-in. First, she allowed that there were multiple paths to universal coverage. In an attempt to simplify during one of the debates, she said: “I’m with Bernie”, without having a firm plan.

When pressed by Biden and Buttigieg to specify how she would pay for her vague plan without raising taxes on the middle class, she dodged the question, saying that overall health insurance costs to the middle class would go down. She finally produced a white paper that described a 10-year $20.5 trillion plan to fund Medicare for All without raising taxes on the middle class.

Her opponents are using her proposal to define Warren to their own advantage: Biden and Buttigieg say it’s too radical and too expensive; Sanders says it’s inferior to his plan. While single-payer is popular among Democratic primary voters, several polls of swing state voters suggest that the majority favor a more moderate health insurance plan.

That would seem to be an invitation to embrace positions most Democrats actually prefer.

Warren’s problem is that she seems married to a health insurance program which leaks votes and positions her in a fight for the left of the primary electorate. However, we’re in a time when a coalition of minorities, suburban swing voters, and persuadable blue-collar whites are what’s needed to win states like Pennsylvania, Michigan, and Wisconsin.

Warren should return to her roots of tax and capitalism reform. These are popular policies with Democrats, even with those who are against mandatory single payer health insurance. The continuing rise in inequality requires us to do something to narrow it.

And Warren’s wealth tax could do just that, and finance more robust social programs and spending on infrastructure. The US mostly taxes individuals on the income earned from their jobs and investments, while a wealth tax would levy taxes on assets like stocks, yachts, artworks and vacation homes.

Both Sanders and Warren have an asset tax plan. In Warren’s plan, all net worth under $50 million is exempted, compared to $32 million for the Sanders plan. Business Insider says the Sanders plan would bring in $4 trillion in government tax dollars over a decade. And, Warren’s version would total $500 billion less in the same period.

During this primary season, moderates and progressives will have to understand clearly why they are Democrats, and how they will bridge their differences by November 2020 and deliver massive turnout.

Both wings need to remember that it isn’t enough to win the White House. Legislative gridlock must end.

It wouldn’t hurt if Warren did some thinking about her single payer plan, too.

 

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Sunday Cartoon Blogging – November 10, 2019

Bill Gates is the second-richest person in the world, with a net worth of $106.2 Billion. Here’s what Bill Gates said about Elizabeth Warren’s tax plan:

“I’m all for super-progressive tax systems….I’ve paid over $10 billion in taxes. I’ve paid more than anyone in taxes. If I had to pay $20 billion, it’s fine. But when you say I should pay $100 billion, then I’m starting to do a little math about what I have left over….You really want the incentive system to be there without threatening that.”

Here’s what would actually happen to Gates under Elizabeth Warren’s tax plan: (emphasis by Wrongo)

“The Warren campaign calculates that under Ms. Warren’s plan, Mr. Gates would owe $6.379 billion in taxes next year. Notably, that is less than Mr. Gates earned from his investments last year. Even under Ms. Warren’s plan, there’s a good chance Mr. Gates would get richer.”

Gates won’t have to pay as much as he thinks. The fundamental question is whether it’s ok for a billionaire to add 6% less to his massive fortune under Warren’s plan? Can billionaires still be successful executives if they don’t pocket every last penny they can lay their hands on?

Billionaire Michael Bloomberg doesn’t think the current Democratic presidential field is sufficiently deferential to the rich, so he’s running to make sure we get there.

When you think about it, two billionaires, Bloomberg and Steyer are running as Democrats. A third, Howard Schultz, billionaire behind Starbucks, tried to run as an independent. All wanting the job of billionaire Donald Trump.

Billionaire Mark Zuckerberg has said he would fight the Warren’s taxes on billionaires. Tim Perkins, a billionaire venture capitalist compared the “progressive war on the American one percent” to the Kristallnacht and anti-Semitism in Nazi Germany.

Billionaire Stephen Schwarzman, Chairman of Blackstone, compared a tax increase for people like him to Hitler’s invasion of Poland.

Why does anyone care about the tax concerns of these people? They never have to think about money, and neither will their heirs. It’s a familiar story, the astronomically rich are willing to donate large portions of their wealth, so long as interfering with their cozy power relationship with politicians is off the table.

On to cartoons. No plan goes unpunished:

America has a difference of opinion on health insurance:

Bill Barr waves his God flag:

GOP wants to take a few shots at the whistle blower:

Trump misunderstood which turkey could do him a favor:

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Saturday Soother – November 9, 2019

The Daily Escape:

Arashiyama Bamboo Forest, Kyoto, Japan — hat tip to blog reader Ottho H. for finding this photo.

The first flakes of snow fell on the fields of Wrong on Friday. Temps were around 24° at daybreak, with winds of 20+ mph, so it felt like winter. We’ve emptied the fountain that birds have used since the spring as a source for drinking water. Other than cleaning leaves out of our gutters, which won’t happen until most of the Oak leaves are down, we’re buttoned up for winter.

What’s not buttoned up is the 2020 Democratic presidential nomination. Michael Bloomberg has finally jumped in. The story is that originally he believed Biden would win, so he stayed out. But, most of us believed despite the polls, that Biden had no chance. First, because he is certain to blow himself up as he has in the past. Second, the smell around his son Hunter’s role in Ukraine makes it difficult for Dad Joe to stake out a winning moral position opposed to Trump and his kids.

Back to Bloomberg, as the NYT’s David Leonhardt says:

“I’ll be surprised if Michael Bloomberg wins the Democratic nomination. We are living in a political era characterized by economic dissatisfaction and populism, and a 77-year-old Wall Street billionaire doesn’t look like an obvious nominee for a left-of-center party during such a time.”

It’s difficult to know how this shakes out. First, is Bloomberg serious this time? He’s been down the road this far at least twice before. Second, if he’s in, who gets hurt?

Does Bloomberg hurt the moderates Biden and Buttigieg, while simultaneously helping Sanders and Warren? Is that his plan? Or is Bloomberg underestimating Biden? He can’t hope to dent Biden’s strength with non-whites, so what’s his path to the nomination? Lots of questions.

Finally, in a follow-up to yesterday’s column about Elizabeth Warren’s Medicare for All plan (M4A), here’s a Cook Political/Kaiser Family Foundation opinion poll about M4A in the key Midwestern battleground states:

It doesn’t seem that Warren’s plan can be a winner in the Midwest.

We’ve had enough of politics and political problems for this week. It’s time to build a fire and have a Saturday Soother. Let’s start by brewing a mug of Bengal Spice Tea from Celestial Seasonings. Wrongo prefers his with a side of single malt. Now, sit by the fire and contemplate where all of your winter jackets and gloves are hiding.

Next, watch the embedded video by the Apartment Sessions, a Brooklyn NY-based multimedia artist collective that produces monthly videos with a rotating ensemble of NYC/New England-based professional musicians. This performance was recorded for Halloween on a moving “J” train in the NYC subway. They perform Stevie Wonder’s “Sir Duke”, with Ben Levin on the Telecaster. Wrongo knows that few people click through to watch the video, but today’s is a must watch.

It’s the most fun any of us are likely to have in the NYC subway:

Stand clear of the closing doors please.

Those who read the Wrongologist in email can view the video here.

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Is Warren’s Medicare For All Plan Realistic?

The Daily Escape:

Gros Morne National Park, Newfoundland, CA

Let’s talk about Sen. Elizabeth Warren’s recently announced Medicare for All (M4A) plan. She, along with other 2020 presidential candidates have endorsed some form of M4A. Bernie has a plan. Yang has a plan. Mayor Pete has a plan, called “M4A for those who want it”. Biden is against M4A, pushing an extension of Obamacare instead.

The multiple Medicare for All proposals are unclear to most of us.  Presently, Medicare is primarily a government program for older people that pays a portion of their medical expenses. Participants pay premiums. Medicare Part B pays about 80% of medical expenses. The participant either pays the remainder or, has a supplemental secondary insurance.

Medicare for All is a single payer, government-pays-all concept.

One part of Warren’s (and Bernie’s) plan is forcing people who have private insurance to move to the M4A coverage. According to the US Census Bureau, 66.1% of the population had private health insurance in 2018. Of that number, 217.8 million are covered by private plans, of which 178.4 million are insured through their employers, so that means 218 million Americans would have to move from their current plan to a plan that doesn’t yet exist

In rough terms, the US spends about $4 trillion a year on health care, split almost evenly between government programs and the private sector. The $2 trillion in private-sector costs are also split roughly in half, with about $1 trillion each spent by households (premiums, and out-of-pocket money) and by employers (their share of premiums).

To pay for her plan, Warren needs to raise $2 trillion in government revenue to replace the spending of the private sector. She starts with the $1 trillion that employers are spending and requires them to redirect this money to Medicare via a per-worker fee.

Finding the other $1 trillion is trickier. Warren raises taxes on corporations and the wealthy, whose taxes have declined significantly in the past 30 years. Even after all of the increases she has proposed, tax rates on the rich would still be lower than during the Eisenhower administration.

In addition, by the time M4A had taken the place of private insurance companies, Warren thinks that 2 million jobs would be lost in the health insurance business, and other health-connected services. The principle purpose of a health insurance company is to pay for people’s health care needs. Its goal isn’t employment of workers. Most who would lose their jobs can always transfer those skills to another sector.

As long as the total number of patients doesn’t decrease, we won’t be seeing laid-off doctors or nurses.

Warren’s plan is a detailed policy road map. It’s not draft legislation, but there’s enough detail to write the bill, making it the first time a presidential candidate has gone beyond the arm-waving we usually see around single-payer. Whether you like her plan or not, her focus clarifies the debate.

The best feature is the plan’s aggressive approach to cost control. We can question whether the plan’s too optimistic: it may be unrealistic to get all of the cuts to health care administration, drug costs, and bend the overall growth curve of health care costs by as much as she’s assuming.

The NYT’s David Leonhardt makes the point about the least popular aspect of M4A: the fact that it replaces private coverage. Warren isn’t letting people opt into Medicare, she would force them to join:

“The biggest weakness of Warren’s approach is that it tries to bulldoze through the sizable public anxiety about radical changes to the health care system. Warren would not let people opt into Medicare, a wildly popular idea. She would force them to join.”

Warren makes the point that not all who have private coverage love their health insurer. It’s clear that Americans are far less happy than citizens of peer countries that have universal coverage. But even if not really popular, doing away with private health care will be disruptive.

Also, we’re not as healthy as those in countries with universal coverage. In particular, life expectancy is much lower (the US ranks 37th world wide), and we’re paying far more per capita for health care than anyone else.

“Free enterprise” health insurance simply isn’t working for Americans, and the dissatisfaction is real.

Can we do better? Is Elizabeth Warren’s plan the right amount of aggressive change, or would a more incremental approach be more palatable to voters in 2020?

Wrongo likes Elizabeth Warren and many of her positions. Her goal of fixing a broken health insurance system is right on, including her drive to cut health care costs aggressively. But her plan to eliminate all private health insurance is divisive, and may not bring about the desired goal of universal coverage.

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Last Night’s Debate and Medicare For All

The Daily Escape:

Dix Pond from the Dix Mountain trail, Adirondacks, NY – July 2019 photo by Shelley VK

A few thoughts about last night’s Democratic debate. Tom Sullivan captured Wrongo’s thinking:

“Watching Part One of the second Democratic debate was an endurance contest. CNN’s 30-second response format was a disaster, barely giving candidates time to formulate a sentence before being cut off. Questions from CNN moderators seemed designed not to probe policy issues, but to get candidates to snipe at each other.”

And snipe they did. The fringe and vanity candidates tried very hard to tell us which policies wouldn’t work. They were enabled by CNN’s question-askers, who mostly asked gotcha questions designed to provide sound bites for Republican attack ads down the road.

Elizabeth Warren won the night by responding to a poor-mouthed critique from Republican-lite John Delaney about health care:

“I genuinely do not understand why anyone would go to all the trouble of running for president just to get up on this stage and talk about what’s not possible. #DemDebate pic.twitter.com/cOCz5TS3AF”

— Elizabeth Warren (@ewarren) July 31, 2019

But, let’s take a moment to talk about the topic that took about most of the first hour of the debate: Medicare for All (M4A). Wrongo wants to remind everyone about an Upshot article on Monday in the NYT by Austin Frakt and Elsa Pearson. It asks, “What Would Medicare for All Cover?” From the article:

You can divide current Medicare coverage into two layers.

The first is relatively transparent. Traditional Medicare does not cover certain classes of care, including eyeglasses, hearing aids, dental or long-term care. When the classes of things it covers changes, or is under debate, there’s a big, bruising fight with a lot of public comment. The most recent battle added prescription drug coverage through legislation that passed in 2003.

So the authors say that a Medicare for all program that excluded all private insurance coverage, and that resembled today’s traditional Medicare would leave Americans with significant coverage gaps. And therefore, we should have a debate about what M4A would cover.

The writers go on:

…there is a second layer of coverage that receives less attention. Which specific treatments does Medicare pay for within its classes of coverage? For instance, Medicare covers hospital and doctor visits associated with cancer care — but which specific cancer treatments?

The devil is always in the details.

Although Medicare is a national program, most coverage determinations are local. Private contractors that are authorized to process Medicare claims decide what treatments to reimburse in each of 16 regions of the country:

What people are covered for in, say, Miami can be different from what people are covered for in Seattle. Many treatments and services are covered automatically because they already have standard billing codes that Medicare recognizes and accepts. For treatments lacking such codes, Medicare makes coverage determinations in one of two ways: nationally or locally…..There are more than 2,000 local coverage determinations….National coverage decisions, which apply to the entire country, are rarer, with only about 300 on the books.

Wrongo wasn’t aware of these differences in coverage, and that is something to talk about if/when M4A is seriously discussed in Congress.

It seems that what should be covered by any health insurance program is an evolving target, informed by changes in treatments and their reported efficacy.  The issue isn’t unique to Medicare. Wrongo prefers the decision to include or exclude a treatment not be made by an insurance company that can make more profit based on what forms of healthcare are offered.

For example, in many private plans, cataract surgery isn’t covered, while Medicare does provide coverage for a basic lens replacement.

And we shouldn’t allow the perfect to be the enemy of the good. In this country, tens of millions of people have no coverage, and tens of millions more are either under-insured, or face very high deductible plans. By contrast, throughout all other developed countries, every person is covered for all medical needs.

A few things to think about between here and the 2020 election.

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Who The Dems Should Nominate for President

(There will be no Thursday column this week. Wrongo is in NYC.)

The Daily Escape:

The Passion Facade, La Familia Sagrada by Gaudi, Barcelona, Spain

Wrongo has been highlighting several people who have big ideas that could move our country toward reform of capitalism. One issue that impacts that reform is health insurance, and many Congressional candidates who won in the 2018 mid-terms ran either on preserving the ACA, or on implementing Medicare for All.

Talk has started on the 2020 presidential election, and the almost 30 potential candidates that seem set to try for the White House. Now that a Texas judge has declared the ACA unconstitutional, and should that decision be upheld, health insurance should be a big issue in 2020.

For Democrats, politics is a game of good policies badly presented. For Republicans, politics is a game of bad policies skillfully presented. With that in mind, let’s turn to Sen. Chuck Schumer (D-NY), who on Sunday with Chuck Todd, refused to endorse Medicare for All. Instead, he said: “there are lots of different routes” to a universal healthcare system.

Though Schumer says he will support a “healthcare plan that can pass,” there is no evidence that any of the alternatives to Medicare for All have a better chance of passing than Sanders’ single-payer plan that was introduced last year. In the House, a majority of the Democratic caucus supports single-payer.

This is what we have to look forward to in 2019 and 2020. The Dems old guard will try and triangulate on policy in an attempt to corral a few Republican Senators. Nancy Pelosi is not a fan of Medicare for All.

A few of the old guard are running for president, including Bernie and Joe Biden. On the progressive side of the Democratic Party, there is a big age gap to a few relatively young politicians who are clearly progressive-purists.

Benjamin Studebaker has a provocative column, “Why We Cannot Nominate a Young Person in 2020”. His argument is that Democrats who are between 40 and 60 may have the right level of experience and political gravitas, but they all grew up in the Party of the Clintons:

…the overwhelming majority of Democratic politicians in their 40s and 50s are centrists who came of age politically in the ‘90s and ‘00s. These are people who got into Democratic Party politics because they grew up admiring the Clintons….They have spent their political lives working with Gore and Kerry and Obama and that’s the discourse they swim in. Corey Booker is 49. Kamala Harris is 54. Beto O’Rourke is 46. Kirsten Gillibrand is 52. Amy Klobuchar is 58. This group has…been tutored in triangulation from the time they were political toddlers.

Studebaker says that we can’t count on any of these candidates if we want Medicare for All, or a host of other policy improvements. He thinks we need someone who was too left-wing for the Democratic Party in the 1970s, and there is only one such person left alive: Bernie Sanders.

Wrongo isn’t sure. The NYT’s David Leonhardt, in his “Secret to Winning” column, says that the Democrats need a candidate who can, and will run as an economic populist:

They need a candidate who will organize the 2020 campaign around fighting for the little guy and gal….It would be a campaign about Republican politicians and corporate lobbyists who are rigging the game, a campaign that promised good jobs, rising wages, decent health care, affordable education and an end to Trumpian corruption.

Leonhardt thinks that several of those younger Democrats can do the job. He says that the formula is: Return to an updated New Deal. Put the public interest first, not the interests of the over-privileged elites. Force corporations and the rich to pay increased taxes.

Norm Ornstein notes that by 2040, 70% of Americans will live in 15 states, which means that the other 30% of the country will choose 70 of our 100 senators. And the 30% that are in charge of the Senate will be older, whiter, more rural, and more male than the 70%.

Whomever the Dems nominate must have a plan to successfully strip away a few red states. Economic populism can help do that, since it helps the working classes and unemployed. Higher taxes on corporations and the wealthy, a higher minimum wage, and universal health care coverage are the cornerstones of the winning strategy.

The nominee must be someone who is authentic, not someone who is simply an ideologically pure lefty.

Being authentic means someone who doesn’t poll test every idea, and doesn’t base their messaging on what the editorial board of the NYT or WaPo thinks are the right ideas.

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Send Establishment Democrats to the Bench

The Daily Escape:

City Hall Subway Station, NYC – via @themindcircle

We live in disorienting times. Disorienting in that our society, and our values, are in motion. We are no longer anchored by social mores, beliefs, or any shared vision of the future. Our politics are evolving as well. We can’t simply blame Trump, or those who elected him for taking us to this scary place. The bipartisan consensus that’s ruled this country since the 1940s — neoliberal domestic policy, and neoconservative foreign policy ─ no longer produces the same results for our citizens that it has produced since the Eisenhower era.

Establishment Democrats bear some of the blame. And looking forward to the mid-terms and beyond, they have failed to do the simplest work — forming a worldview, then persuading others about their vision, and the steps to achieve it.

We can also blame establishment Republicans, but they have collapsed. The new right is much farther right, more authoritarian, and whiter. And who would have thought they would be the pro-Russia, anti-FBI, anti-DOJ, and (maybe not a complete surprise), the pro-police state party?

History shows that when society turns like this, the establishment parties can disappear, as did the Federalists and the Whig parties. And when one party changes, the other must as well. After Lincoln, neither the Republicans, nor the Democrats, were the same parties.

Perhaps it’s time to take these words in the Constitution to heart:

…to secure these rights, Governments are instituted among Men, deriving their just Powers from the Consent of the Governed…

Therefore, if the Dems are to win back the hearts and minds of the people, regardless of what the banks and corporations want to do, Government must be the advocate for the People.

That requires that our political parties confront the banks, corporations, military contractors, and the other oversized creatures that feed at the government trough.

Is that something that the establishment Democrats (Wrongo likes calling them the “Caviar Dems”) are willing to do? They used to champion social and economic justice, but not so much today. Today, they follow the same neo-liberal economic policies that Republicans champion.

And with few exceptions, they are as neo-conservative on foreign policy as any Republican.

Republicans have undergone a different mutation. They celebrate the globalized economy, and support the domestic gig economy as a means of growing corporate profits. They still celebrate Christian values, so controlling Supreme Court appointments is their great achievement, along with ruinous tax cuts.

America’s corporate tax revenues are going down, while social and infrastructure costs keep rising. So far, under both parties, government has continued to spend money it doesn’t have. It borrows, and pretends that everything is under control.

Now, after 10 years of economic expansion, we continue to pile up deficits. What’s going to happen in the next recession? The truth is, we are poorer, and weaker, as a country than we think. But few politicians are willing to help us face reality.

We see both Bernie Sanders and Alexandria Ocasio-Cortez, the Democratic nominee for Congress in NY, describe themselves as socialists. But, in fact, that’s not what they are. Merriam-Webster defines socialism as:

Any of various economic and political theories advocating collective, or governmental ownership and administration of the means of production and distribution of goods.

Obviously, they hope to take over the corporate-friendly establishment Democratic Party, but if you call yourself a socialist, then, at a minimum, you need to advocate for government ownership of the means of production, i.e., industry. You’re only a socialist to the extent that you advocate that.

Will Bernie or Alexandria nationalize General Motors, Apple, or ExxonMobil? No.

Even advocating for “Medicare for all,” isn’t socialism. Neither Medicare, nor other single-payer programs like Medicaid, are really socialized medicine. No one is advocating for an actual government takeover of hospitals, or turning doctors into government employees. If they really wanted socialized medicine, their cry would be “VA for all,” not “Medicare for all.”

Sanders and Ocasio-Cortez are social democrats. In a social democracy, individuals and corporations continue to own the capital and the means of production. Wealth remains produced privately.

But taxation, government spending, and regulation of the private sector are much more muscular under social democracy than is the case under today’s neo-liberal economic system.

Joel Pett has a great illustration of the difference between Sanders/Ocasio-Cortez and Republicans:

It’s time for the Dems to change direction. Carry the “Medicare for all” banner proudly. Work to end income inequality. Work to add jobs for the middle class.

Send the establishment Democrats to the bench.

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