Is a Single-Payer Experiment on the Horizon?

The Daily Escape:

Breaking the Ramadan fast, Dubai – photo by Francois Nel

From Sarah Kliff:

Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status.

This is “Medicaid for All”, not “Medicare for All”, which several Democrats have proposed over the years. Medicare for all has always fizzled out, due to a lack of political support.

Medicaid for all offers an interesting alternative. Medicaid coverage generally costs less than Medicare for all because the program pays doctors lower rates. This could make it cheaper for low-income price-sensitive consumers who can’t afford the Obamacare monthly premiums. More from Sarah Kliff:

Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.

Under the Nevada bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for credits would be able to use their own money to buy in. It is likely that the plan would be sold on Nevada’s health insurance marketplace, making it a public option that competed against the private health insurance plans selling there.

Early versions of the Affordable Care Act included a buy-in provision. But the Senate was forced to drop the Medicare buy-in from its bill when it couldn’t get the entire Democratic caucus behind the idea. Health insurers fought aggressively against the idea, which disadvantages insurers by reducing their market share.

After Trump’s election, health policy experts started to explore whether it might make more sense to build a national health care system around Medicaid rather than Medicare.

Medicaid and Medicare are similar programs in that they are large and publicly run, covering 62 million and 43 million Americans, respectively. They use their large membership to negotiate lower prices with hospitals and doctors. Medicaid tends to have the lowest payment rates. On average, Medicaid pays 66% of what Medicare pays doctors. In Nevada, Medicaid pays 81% of Medicare rates.

This means Medicaid is a relatively lower-cost program, but some doctors do not accept Medicaid’s lower rates. A recent federal survey estimates that 69% of doctors are accepting new Medicaid patients, compared to 85% accepting new patients with private insurance.

States have significant control over how their health insurance programs work and whom they cover. Thirty-two states participate in a Medicaid buy-in program that lets certain disabled Americans who don’t otherwise qualify for coverage, buy into the program.

This flexibility provides an opportunity for states that want to experiment with a public program by tacking on a buy-in option. If Nevada’s bill does become law, it will show other states how such a program might work, and if it works well, other states may be inclined to try it.

States that want to enroll new populations into their Medicaid programs will need permission from the federal government. This means that the Trump administration — which has proposed slashing the Medicaid budget in half — would need to get on board with a significant expansion of the program, perhaps a doubtful possibility. But as Kliff says: (brackets by the Wrongologist)

The Nevada idea in theory shouldn’t expand federal costs. Individuals would be responsible for paying their own way onto the program, although it will likely be a challenge to set the right premium [rates] to ensure this outcome.

California is considering a single-payer bill as well. Whether other states might follow the Nevada example will depend on what outcomes it produces.

Here is another tune from the One Love Manchester concert. Watch “Happy” by Pharrell Williams and Miley Cyrus, who turn the song into a soul number, something closer to Motown than to Disney. They make it something more than it was when it was so popular. Also, the whole audience sings along, and that’s fun:

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

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Ariana Grande

The Daily Escape:

Lawn mowing in a tornado, Alberta Canada – June 2, 2017 – photo by Cecilia Wessels

Wrongo was only dimly aware of Ariana Grande before the bombing at her show in Manchester on May 22. He knew that her audience was largely young girls and women, and that her songs were affirming for young women.

He did not know that her music videos have been viewed more than seven billion times online or that she has nearly 160 million followers on Instagram. That’s a crazy amount, and actually makes her the second most followed person on Instgram in the world. If you’re a fan of her posts then you might want to save her stories using storiesig. 24 hours is never long enough, is it?

And then came the bombing at the conclusion of her concert in Manchester, and the rest of the middle-aged male world knew of her too.

On Sunday, Ariana Grande was back in Manchester at a different venue, the Old Trafford stadium, to give a concert to memorialize the victims of the bombing. Grande visited injured fans in the hospital before the concert, and met the mother of Olivia Campbell, one of those killed during the Manchester attack.

She also offered 14,000 free tickets to those who had attended her May 22 concert. About 50,000 attended Sunday’s sold-out One Love Manchester concert, and $13 million was raised for the We Love Manchester Emergency Fund, the AP reported.

Millions watched around the world on a variety of platforms. The concert averaged 10.9 million viewers on BBC One, peaking at just under 15 million. The concert was also streamed over various commercial radio stations and broadcast in over 50 countries around the world. Facebook, Twitter, and YouTube also hosted various streams.

The concert, like Live Aid and others before it, showed how uniquely powerful pop music can be, a space where emotions are expressed, processed and worked through. Pop music is often read as shallow, but events like this show how valuable it can be in the healing process for many young people.

The concert came less than 24 hours after another terrorist attack rocked London, which is about 200 miles away. It was impossible not to be moved by Grande’s duet with Miley Cyrus, re-creating their version of “Don’t Dream It’s Over” by Crowded House. In it, they showed that it’s ok for singers who are friends to play it a little loose:

After singing with Cyrus, Grande said:

I want to thank you so much for coming together and being so loving and strong and unified…I love you guys so much, and I think that all the love and unity you’re displaying is the medicine the world needs right now.

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

She closed the show Sunday night with a tearful rendition of “Somewhere Over the Rainbow,” a fittingly desperate plea for a better tomorrow. She breaks down a bit, and the British audience rallies around her and she is able to finish the song. Wrongo loves European audiences, they are the best thing about live concerts online:

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

So, give Ariana Grande a listen. She is creating a forthright kind of R&B pop, and has shown herself to be socially engaged. Her conduct after the attack, bringing together this concert and hosting it with Ă©lan, provides another reason to get acquainted.

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