Josh Dunigan |||

Bernie Part Two - Medicare for All

This is an add on to part one analyzing the history, legislation, actors, and research for and against medicare for all. The goal is to just show that the concept is not radical, that it is not throwing money at a bad system, but restructuring the entire system to work in the interests of all people, not just the rich and powerful. I am assuming that you think that it is the right thing to do, if not, you need to convince me that my part one is wrong.

Warning - this is no where near academic, I make cheap jabs, I make appeals to emotion, I am angry. However, there is no possible discourse after something like all the arguments for Medicare for All. So I am angry, does not mean that it makes me wrong, makes me human.

A history of propaganda and fear mongering

How did we get to this situation? Namely, why is our healthcare so expensive for worse quality of services and coverage then other nations, why are so many Americans uninsured or uninsured, why do people die from rationing insulin or choosing between heart medicine or something else, why are so many Americans addicted to opiods, why are drug prices so god damn expensive, why are people forced to stay at a job due to needing health care, why all of this? Why all this given how fucking wealthy we are?

The idea was floated by FDR during the great depression in the 30s, but he had to go up against the American Medical Association. Then during WW2, companies were limited from offering an increase in wages to employees and found a way to still offer financial value by giving employed people the opportunity to get health care through work. Note, this excludes people who were unable to work (simply by nature) or by accident, in that, they did not have a job or their boss did not want to give them insurance. Harry Truman in the 40s tried to get a national health care program implented as well, but the fear mongering began with the rise of communism and socialism and Soviet Russia propoganda. Using the momentum, the AMA cemented the idea that private insurance is the move. Kennedy then started to shift his political goals, to chip away at the stigma by trying to ensure that we take care of our elderly, disabled, and the poor at the least. However, Kennedy’s goals had to be taken on by Johnson who succeeded in getting Medicare and Medicaid passed.

A national plan was proposed again, by Edward Kennedy, but Nixon said no despite the incentives of the private industry being aligned with giving the least amount of medical care, the least quality, and for the highest price. Reagan, conservative icon, cut Medicare, Medicaid, and loosened regulations. Bill Clinton tried to take the issue up again, giving a bipartisan option of public and private options, but as you guessed it got shut down. He at least passed CHIP to insure millions of children. Then Bush came along and decided to try something called Medicare Part D.

Fun fact : Medicare Part D made it such that Medicare was not able to negotiate drug prices (unlike the VA), which some estimates by economists say cost between 2006-2013 332 billion dollars to 563 billion dollars. Additionally, the congressman who championed part D, Billy Tauzin, and 14 congressional aides went and worked for the lobbies who wanted this bill to get passed. It was known that this was going to cost taxpayers more money and threatened people to keep it quiet. I call this the fuck-it-and-chuck-it strategy. Republicans from America to Britain do this. They nuke some part of a liberal” plan so that it is doomed to fail or cause issues down the line, then blame the liberals that it is too socialist and they need to privatize it. However, it does not work in Britain, at least Boris Johnson and others have continuously failed since people love their healthcare there.

Then the President we stopped-and-frisked while in office ended up passing the Affordable Care Act, Obamacare (easy name to get people to hate it without ever reading about what it is or what it is trying to do). Before Obamacare, 1 out of 7 Americans were denied health insurance due to pre-existing conditions”. This means that since you are already sick (even cancer), the private insurers know that you will definitely use the insurance and will not make high margins on you. Obamacare prodded people in the market via a mandate to get insurance. This was a way to make it such that at the very least, all Americans would get healthcare coverage, private or not. Then Trump, the Grim Reaper, and Paul Ryan worked to get it repealed. Paul Ryan did his job and bowed out of congress, the Grim Reaper stacked the courts for conservative judges for a whole generation (despite saying Obama could not do this exact same thing), and Trump still is trying to repeal Obamacare in his entirety, or maybe do nothing about it. Either way, now here we are and Bernie proposes his 2019 Medicare For All bill.

Medicare for all : The not dogmatic, propoganda fueled summary

Subtitle - I read it

People think that, because of Fox News and the like, it is just throwing money into a broken system, it won’t fix anything, and it is going to be too expensive. But we already do pay for it. We have the highest per capita expenditure for some of the worst healthcare in any first-world nation. We do not pay for it with a tax, we just pay it to the companies. We are paying for a shitty system that does not even cover everyone. Without doing anything, we are projected to spend 50 trillion dollars over the next 10 years on health insurance, either from our taxes or our bank accounts. The right wing plan to do nothing would actually cost us more than Medicare for all.

For example, a right wing, Koch backed study, found that we would save us a 2 trillion dollars, give us better health care, insure more people, and improve wages in America. Even that is a low estimate. Other policy experts accounted for errors in the analysis that state we will actually save an additional 15 trillion dollars in the same time window. But, but, I was told it would cost 32 trillion dollars”. Yes, just like how the right’s policy of do nothing will cost us 50 trillion dollars.

Right now, corporations tax” you. After all is said in done, health insurance corporations profited a total of 100 billion dollars in 2018. Part of the cost for healthcare goes just to rich people’s banks and shareholders for these companies. However, Bernie plans to tax the millionaires and especially billionaires, closing wall street’s loopholes of getting taxed less than a blue collar worker on billions of dollars and taxing them, and corporations who have abused the poor and working class people for far too long. A lot of the costs in our country go to redundant paperwork and administration done by all the insurance companies. The estimated savings from this would be half a trillion dollars a year with having just one provider, the government. Additionally, we pay an insane amount for drugs. Despite us funding them using public tax payer money for research, drug companies turn around and say charge thousands of dollars for life saving drugs. Bernie’s plan will save 100 billion dollars a year by limiting the prices on drugs.

The Yale study

A peer reviewed, [testable study](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext#%20, drawing from comparisons with other nations and even a tool for policy makers to test the data and play with the numbers. Here is a summary of some key points from the article.

Introduction

78 millions do not have adequate health insurance, that is, either do not have it or the out-of-pocket costs are too high proportional to their income. If Obamacare is repealed in its entirety, an additional 21 million Americans will be at risk of falling into that camp, totalling almost to 1/3 of our population not having adequate health insurance. We spend 18% of our GDP on healthcare while ranking below 30 countries in indicators of good public health like preventable deaths, infant survival, maternal mortality, and life expectancy.

The study finds that we could reduce our national health care expenditure by 458 billion dollars, a 13.1% decrease of our expenditure in 2017. Additionally, the Medicare for All Act would save 68,500 peoples lives, merely preventing deaths of 10s of thousands Americans. If Obamacare was to be repealed by the right, an additional, relative to right now, 38,500 Americans would die. That is a net difference of 107,000 people living or dying a year.

The study notes that estimates have ranged from a 16.9% increase in spending to a 27% decrease in total healthcare spending for Medicare for All. Even with a 16.9% increase, it would mean that 10s of millions Americans can afford to be healthy and worry more about enjoying life and retiring instead of going bankrupt, and most importantly save 10s of thousands of lives. The goal is to use the success of Medicare, barring the costs that are attributed to part D (thanks republicans).

Where medicare for all starts saving Americans money

Part of the idea is implementing the Medicare fee schedule across all hospitals and clinics. This fixes the problem of private insurers charging inconsistent prices and varing levels of quality of services for the same things at different locations. In California, a regular child birth can more than 10 times expensive than other areas of the US. Also, the increase in fees does not mean better medical care. The average cost of giving birth in the United States is 14,910 dollars while Spain’s is a mere 2,333 dollars and the US neonatal mortality rate is double Spain. A similar correlation is found with appendectomy fees, ranging from 9332 to 33,250 with an inverse correlation between the cost and outcome. Meaning, that the more you pay does not guarantee a better outcome. California has the highest rate for appendectomies and the highest rates of morbidity and perforation in the US, which is funny since California also is one of our wealthiest states (makes sense that you can charge more money out of people just to survive if they have more money). Applying consistent fees like Medicare for services would save an annual 100 billion in spending a year on healthcare.

As mentioned above, due to the mess of private insurance, we spend 768 billion on billing and adminstrative tasks a year. A unified system could reduce this expenditure by 284 billion a year. Since Medicare for All eliminates the problem of unpaid bills, hospitals would also save 35 billion a year. Since there is a lot less administrative work and paper work, providers have more time to focus on their job of providing the best care they can for their patients and reduce their workload and freeing up time for people to go to the hospital more, since most Americans put it off anyway since it is too expensive which likely accrues worse, more expensive, and preventable issues down the road.

One billing and administration system

The adminstrative costs for private insurance accounts for 12.4% of the spending of insurance companies, compared with 2.2% of Medicare. A single payer system could then save about 219 billion dollars annually by consolidating insurance into the same framework Medicare uses. This would also include getting rid of the the outrageous executive salaries and compensation bonuses, some who earn more than 20 million annualy. The Secretary of Health and Humans Services salary is capped at a measely 210,700 which is only double my entry level college salary, I know people who make more at my age.

Having one billing and administration system makes it easier to detect fraud in the system since the data is all in one unified place. This could save the US about 85.7 billion a year which is how much fraud takes from taxpayers. Taiwan reduced 8% of their national spending with fraud detection when they moved to single payer.

469 billion dollars were spent on pharmaceuticals in the US in 2017. Insulin is 10 times more expensive here than Canada. If all of America is under one payer, we have the ability to negotiate prices with the wealthiest nation on the planet with drug companies. The authors note that this was helped made possible by the fact that Citizens United opened the way for drug companies to pay billions of dollars to make policy in their favor, which our friend mentioned above and his aides took to the motherfucking bank. The VA is allowed to negotiate drug prices, however, and their drugs cost about 40% less than Medicare does. Using the same savings (a conservative estimate) would mean that we could save 180 billion a year on drug costs.

The authors note that someone may respond with but innovative research is used with that funding!” To which the authors note that there is no correlation that shows innovation and research has increased with profit gains for companies, it actually is the opposite and research spending has declined as companies grow. This could be due to the fact that people misunderstand how the market truly works and need to brush up on their economics and history.

People get healthier by going to the hospital more

38 millions of Americans, the uninsured ones, usually tend to forego necessary treatments. Uninsured individuals use the health care services in our country at half the rate. Also, the 41 million underinsured Americans use the healthcare system at 86% the rate of adequately insured people. Medicare for All would make it such that 100 million Americans get the treatment they need to live and also just to be normally healthy. Going to the hospital more regularly, getting routine tests, could save more money down the line by stopping the disease before it gets worse and more expensive and they also may not be able to work. Imagine a world where you can detect early cancer and fight it while you have a good chance, or one where you detect it. Maybe my uncle would still be alive. Maybe our family friend would have found his heart disease before suddenly dying. Maybe someone’s boyfriend might be alive, their mother. Maybe our loved ones would just die less, if we gave our own bodies maintenance checks more than our stupid cars.

The bottom line

With these savings, we would spend about 3.034 trillion a year on healthcare, which multiply by 10 is where we get out 30 trillion dollar number over 10 years. However, it is 458 billion dollars less than what we spent in 2017.

  • 59 billion in savings on hospital care
  • 23 billion in savings on physician and clinical services
  • 217 billion on adminstrative / paperwork / executive overheads (yes rich people are a burden)
  • 177 billion on drug prices
  • decrease from 10,739 to 9,330 per capita spending (which adequalately insures 100 million people and lowers burden on middle working class), a 13.1% decrease in spending on healthcare

Misc other things of note

Medicare for All includes the 1.5 million, give or take, positions that will be elimated due to redundancy in adminstration costs. There is a plan in place to transition those people such that they do not just become poor and jobless and the money we save each year on health care spending will cover the costs of this transition.

Many people would just be saved from this plan as well, but there is room as well downn the line that shows not just dying, but having your workers be healthy allows them to be more productive as well. It is worthwhile in the short term to fix problems as they arise, instead of how much the long term costs are going to be as the condition gets worse. However, capitalism as it stands now does not give a shit about long term health of people. What is important is hitting those quarterly profit and revenue goals so that your stock price goes up and your shareholders are happy. American men die 28% higher from cardiovascular diseases than Canadian’s since a lot of it is preventable. It is not like American hearts are different than Canadian hearts, but our health care is.

This is not even a complaint that is crazy. There are many people who are advocating for getting rid of this short term mindest of companies and think on the long term. The incentives of a corporation does not align, at this moment, with health care. Additionally, life and death, the right to just not be sick and in pain and suffering, are not things that should have a price tag on it. Just because life is immeasurable and you cannot put a price tag on a human beings life does not mean we should be able to pay any price to survive.

An estimate 5.4 billion dollars is lost a year due to lost productivity from just prostate cancer. The spouses, forced to take care of their sick loved one, account for an additional 3 billion a year in lost productivity.The loss attributed to absenteeism, disability, and premature mortality costs us 73.7 billion dollars a year. Healthy people can work more, good for capitalism, so any free market competition 9-5 believer should love Medicare for All right?

The recklesness of the private health care industry is credited with creating the opiod crisis. Private insurance favoured the practice of using addictive drugs as treatment of pain instead of the short term more expensive option of something like physical therapy. Due to lax drug regulations thanks to Reagan style republican, these opiod manufacturers ran aggressive marketing campaign for three decades trying to sell opiods like McDonald’s reminds us that you can buy 2 items for 3 dollars. These companies as well targetted physicians-in-training to start prescribing opiods and funded programs that would train (they call it educated) to just prescribe a fuck ton of opiods when unneccessary. Canada has 32% lower opiod overdoses than the US.

The choice to fuck yourself

American’s love the right to have choice. Buttigieg to Paul Ryan, they say that you will lose the choice to go to who you want. Guess what, you have less choice now. Under Medicare for All, there is no out of network people, it is all in network! You can literally choose more!

Also, you are not at the mercy of your job for your medical, dental, vision, hearing, and more! Instead of your shitty boss deciding if you can afford medicine or not, you just get your medicine and you do not have to work at a place you hate. For example, 19% of women diagnosed with breast cancer were fired within 4 months of getting treatment, since your boss does not want to pay for your cancer treatments. People without insurance have a 17% increased rate of metastis and 30% increased risk of death compared to people who are insured for cancer. Truly a state of freedom, the freedom of your horrible boss to determine if you live or die! :D

Everyone knows someone with some mental illness. Everyone knows someone who is struggling with anxiety and depression. Worse, everyone knows someone who has committed suicide. Mental health coverage is included under Medicare for All. I for one would love to see my generation and the ones after get the adequate mental health care they need so that they can at least enjoy some of the good parts of life.

What now

Part one of this seriers was to use political reasoning, the nature of state, to show that it is in fact within the power of the state to do this and they should do this. We as a republic are obligated, if we are to care about freedom in any sense of the word, to implemet this. This post was to make the economical argument. There are almost a 100 academic citatations in this paper alone, and you go down those papers and there are thousands of citations as well. There is years of research and work and policy, almost a century of policy and facts that this works. We as a nation have been brainwashed into thinking it is going to be too expensive. Its too expensive and too shitty now.

We speak of the value of American lives, the Onion makes jokes like the equivalent of 5 Americans died in the middle east today”. We never asked about how expensive it was to raze the middle east over the deaths of a few thousand innocent Americans, we spent trillions and committed war crimes in the name of justice. However, the poor and sick and working class’ lives have been ravaged by crimes against humanity at home. Never underestimate the ways in which people will self-decieve themselves.

The moral argument

I wrote a post on systemic atrocity and Eddie Gallagher. At the core of a systemic atrocity is that some policy has the foreseen consequences of death. We KNOW that people will die. In the health care system, we have three cases.

The worst option is to repeal Obamacare, since even more of our Americans will die, a difference of 100,700 people from if Medicare for All is passed.

The other option is to do nothing, maybe someone has a better plan than Medicare for All. I doubt it, given that this is almost a century in the works, it has been discussed in academia forever, and we have the data from other nations that serve as scientific experiments. In this case, 68,500 will still die a year. Less than if Trump was to repeal Obamacare, but still about 70k a year dying.

The best option is they don’t die, we just do our best to prevent the foreseen consequences of the above two choices, which we can. We can afford to. Actually, we can more than afford to, it is in our self-interest and collective interest.

So, you have these three options, and this is the pure moral argument. You can choose not Medicare for All, you need to find a really convincing argument that it is not immoral.

Assume it passes

Beware of the fuck-it-and-chuck-it. Read the bill. It accounts for accountability of the public officials, accountability of the hospitals, the doctors, the drug companies, everyone involved. It calls for regular audits and performance checkmarks to be presented in congress. It calls for proper data, statistics, and academics to verify that the system is working. It is going to be a work in progress, it takes awhile to get it fully running. We have most of the infrastructure existing, but it is not going to be ideal.

If because something was not ideal we avoided it, we would never date, we could never love someone, we would turn into moral nihilists, political nihilists, science skeptics, or whatever.

All the arguments are there, the political, the moral, the economical, the emotional appeals to loved ones, the only thing that can stop this is if Americans are too self-decieved, too thoughtless, too foolish, to be intellectually uncomfortable for a bit, to feel a little stupid that they bought into lies and dogma. There’s nothing wrong with that, we all go through it. You just have to be brave enough to want to make that leap.

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