A Quick Note About Single Payer

My God, that would bankrupt the insurance companies!!!! It’s not like they make enough profit from car insurance, home insurance, insuring businesses, or the like, you know ….

Furthermore: You’re asking modern-day bureaucrats to consider writing laws and regulations with a sense of logic, reason and scruples?
How out-of-touch can one be?
Corruption, duplicity, and double-standards are the rule of the day ….

I agree, Ian, but it ain’t gonna happen for all the obvious reasons.

Health Insurance, or access to healthcare at all, is more and more being used like anti-vagrancy laws (Jim Crow Laws) were used to keep Blacks slaves in the South long after Emancipation. In future, if you want access to even sub-standard but not terrible healthcare, you will have to find it through an employer. Many employees will be slaves to their employers, because if they have a preexisting condition, and many people do despite what conservative lawmakers say to the contrary, you will not be able to get insurance if you leave your current employer and thus will not have access to affordable healthcare and thus you will effectively have no healthcare at all.

Krugman has a great article about it. I watched a documentary on Netflix last night entitled Blood On The Mountain. It’s excellent. A movie you should watch that complements it well is Matewan. America is ever-so-surely becoming the Company Town and the people Serfs. I truly believe this is Trump’s idea of Shangri-La — he and foriegn potentates enjoying the greatest chocolate cake they’ve ever eaten on gold furniture solemnly & hypnotically rubbing their grubby paws on glowing orbs as The Little People cheer him on with an emphatic cacophony of melodic Black Lung Death Rattles that rivals the Mormon Tabernacle Choir on its best day.

The Unfreeing of American Workers

The encyclopedic massive bills detailing implementation rules are, I think, not from bureaucrats nor even from politicians nor even from wonks. They’re from corporate lobbyists. Most bureaucrats prefer laws that can actually be implemented; abandon simplicity and implementation slips away into the thickets of complexity. Politicians do want to be able to claim that this or that undeserving group will not be allowed to leach off the program that he set up, so he’ll add some pet rule like checking beneficiary citizenship that requires a whole set implementation rules. Despite their reputation for detail-oriented smarts, most wonks are pretty mediocre. They tend heavily towards cut-and-paste because they consider themselves too valuable to work through the details of what they’re proposing. The result is a mess of contradictions. On which they rest quite happily because they think focusing on the overall goal is something ignorant people do. So from politicians and wonks you get moderate screwing up.

But the lobbyists! They’re there to subvert any efforts at the public good into corporate looting opportunities. For that you need very specific tax loopholes and specific financial incentives, and blocks to most cost-saving procedures and rules insuring that only certain licensed providers can be remunerated and that the remuneration must be high and protected for future years, and . . . .
So they dance into the legislative rooms with hefty campaign contributions, which, remember, are not bribes, and pages of text already written up to their corporations’ financial advantage. The campaign contributions convince the politicians of the corporate concern for the common good and a 2000 page bill is passed.

I fear Hugh is right. The Dems will be all for it when they are powerless, but find a zillion reasons not to do what they promise if they actually get power.

Jon Walker notes that Trumpcare got through the House despite facing the opposition of virtually all the medical-industrial complex:

https://shadowproof.com/2017/05/14/trumpcare-shows-majority-politicians-willing-vote-health-care-industry/

Republicans were able to get some lobbying cover for voting against the health care industry because the AHCA is also a big windfall for top executives in every other industry. The same dynamic would exist for Medicare-for-all: American business leaders are starting to acknowledge our dramatically overpriced health care is crippling every other sector. As Warren Buffett recently told investors, “medical costs are the tapeworm of American economic competitiveness.”

However, I am less optimistic. That is because American CEOs are far less interested in the long-term prosperity of the corporations they are supposedly working to protect than in protecting their own pockets. Even though it’s quite true that Medicare-for-All would provide huge competitive benefits to their companies, removing a trillion dollars from the cost of providing health care coverage to their employees, if it costs the CEOs more money in taxes personally, then they’ll be against it.

The stayed corporate Democrats do not want single payer health care. They are just slightly less assholey than the Republicans. This is not going to change.

Complexity is used to hide all kinds of legal fraud and opportunities for illegal fraud if gettable-away-with. That is the Clintonite Scum Shitocrat Party will ignore your advice.

The only “single payer” bill the Clintonite Scum Shitocrat Party would ever support would be at least a thousand pages long.

A lot of centrist Dem politics revolves around “it’s complicated” and subjective and supremely ignorant assessments what’s “normal” (Hillary is normal and Trump is not normal, or so i have been told) and narcissistic conceptions of politics as “the art of the possible, the attainable” — these are the corollaries of prospective possibility that surround and support and precede the main event: “there is no alternative”.

Altogether, the Dem brand of neoliberalism is one big con game conducted by reactionary conservatives trying to get good and decent people to give them political support for nothing in return. It is a politics of convenient narratives that economizes on knowledge, judgement, memory and reasonable foresight to the point where people might as well be voting at random.

Single-payer is one of those no-brainer truisms of the left, like “don’t get bogged down in a land war in Asia” and prosecute fraudsters and banksters, which can be discarded as soon as the election is over, because no one was paying attention before and no one will pay attention afterward.

Medicare is highly privatized (Medicare Advantage, Medicare supplements, the prescription drug program, and the transfer of dual-eligibles out of Medicare into privatized Medicaid managed care). It’s important to distinguish between expanding access to today’s Medicare-as-we-know it, and HR 676 – Expanded and Improved Medicare for All.

Convenient summaries of HR 676 here(2 pages) and here (1 paragraph).

Medicare has deductibles, it has co-payments, it has premiums, and there isn’t an out of pocket maximum. These many problems of course don’t deal with the sudden disruption moving millions of people over to Medicare would have for the economy etc. This is pretty bad advice, and would never pass legislative muster.

@Ian Welsh

I doubt the “Vox Democrats” would (the Clintons/Obama/Booker/DWS etc). Belief the supposed superiority of the private sector is a tenet of faith for them too almost as much as it is for the Republicans (look at Clinton’s attacks on Medicare-for-All during the primaries).

@Marym

Yes, having *no* out-of-pocket expenses and recognizing that one’s eyes and mouth/teeth are part of one’s body too is extremely important. Though I’ve always said I’d favor expanding the VA too into a NHS-like system and having the NHS set the Medicare-for-all reimbursement rates for anyone choosing a private provider. No harm having a bit of public redundancy in the system to safeguard it.

@Mallam

I’m not sure what you’re saying, are you suggesting Medicare-for-All would be difficult to set up? The setup of the original Medicare system took months; ACA implementation by contrast took years. And yes, you’d throw many out of work people doing economically unproductive work, but the very people who favor Medicare-for-All also favor free college (for retraining) and also favor a truly full-employment economy. To fix the US economy we have to massively downsize a whole host of sectors which are either unnecessary or bloated, jobs that are either economically unnecessary or even harmful.

Ian;

While I agree with the strategic goal, I think the tactic should be to expand medicare downward in steps. I used to say to 50 yo, but insurance now treats a 45 yo as they used to a 50 yo, so in response, I’d say push medicare downward to 45.

This covers the group most effected by illegal, but commonly practiced, age based lay-offs which converts savings into insurance premiums. It also protects those who pay $800-900 per month premiums for insurance…that will still leave you bankrupt should you have cancer. Thirdly, bankruptcy becomes more non-recoverable as you age, you lose more, have less time to recover and are often not-hirable in their profession after 40, STEM workers are particularly effected by H1-B substitution, which ensures only youthful employees.

http://www.businessinsider.com/stressful-lives-of-older-tech-workers-2015-11

Full disclosure; none of the above would improve my life one iota, but it would help X’ers and those that follow.

PS: Only thing overlooked in discussion above is the recent discovery that Obombacare was looting Fannie Mae and Freddie Mac funds to pay insurance corps subsidies

@John

They may be able to get away with deeming driving a “privilege,”, but gun rights are in the Constitution.

Nice try, though. Ought to appeal to the simple-minded.