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09/18/2017 The Medicare-For-All Act of 2017: The policies (Part 2)

Lambert Strether
https://www.nakedcapitalism.com/2017/09/medicare-act-2017-the-policies.html

Comparison Chart: House and Senate Medicare for All Acts
http://healthoverprofit.org/comparison-chart/

Bernie Sanders conveniently omits funding mechanism from his single-payer plan
https://www.reviewjournal.com/opinion/editorials/editorial-bernie-sanders-conveniently-omits-funding-mechanism-from-his-single-payer-plan/

Yesterday, I wrote on the politics of The Medicare for All Act of 2017 (“BernieCare”). https://www.nakedcapitalism.com/2017/09/medicare-act-2017-politics.html


T***sition For Workers

HOUSE: HR 676:
Displaced workers have first priority to be hired into new system, 2 years salary and training support.

SENATE: Medicare-for-All Act:
Temporary worker assistance for up to 5 years, capped at 1% of total budget.

One problem with HR676 is that retraining is a crock;
Job Retraining Won’t Work. We’ll Need Government Jobs, Then a Universal Basic Income
http://washingtonmonthly.com/2016/12/04/job-retraining-wont-work-well-need-government-jobs-then-a-universal-basic-income/

It always comes up in the “sk**ls mismatch” debate, and it turns out in practice that the only jobs retraining programs create are for professional trainers (which is why the Democrats love the idea).

The Retraining Paradox. Many Americans need jobs, or want better jobs, while employers, have good jobs they can’t fill. Matching them up is the tricky part.
https://www.nytimes.com/2017/02/23/magazine/retraining-jobs-unemployment.html?mcubz=3

Other than that, both programs seem reasonable to me, especially giving displaced workers first priority; displaced workers please chime in![3]

(I’m also assuming that the liberals Ladies and Lords Bountiful don’t sneak in their usual complex eligibility requirements, especially means-testing.

For example, people should be able to cover their moving expenses to a new job without going through some sort of ritual to prove their worthiness.

Or child care during a job search. And so on and on.)

One point that I don’t see made very often: Medical coding is currently used to figure out how to bill for health care services.

This is, however, an insane perversion of the coding taxonomies, which were originally designed to classify health care delivery as such, not billing for health care.

(If you don’t see a distinction here, you may be a neoliberal.)

Credentialism and Corruption: Medical Coding, Symbol Manipulation, and Symbol Manipulators
https://www.nakedcapitalism.com/2017/04/credentialism-corruption-medical-coding-symbol-manipulation-symbol-manipulators.html

If we could re-engineer medical coding[4].

By using its taxonomies for the purpose for which they were originally designed, we might learn a lot about how to deliver health care, besides saving a large number of sk**led and well-paying jobs.


“How Are You Going to Pay For It?”

Unfortunately, as most NC readers know, the political class is brain-damaged about taxes (and in the sort of way that markets-first neo-liberals like.

Since one effect of the brain damage is horror and repulsion at the concept that government — or even associations of volunteers assisted by government — can or should do anything).

Some approaches to the Market State: I
http://www.correntewire.com/some_approaches_to_the_market_state_i

So, “The Federal government, as the currency issuer, would write a check for wh**ever Congress authorized” isn’t an answer that the political class can (as yet) process, at least without sparks and smoke coming from their ears.

First International Conference on Modern Monetary Theory
http://www.levyinstitute.org/news/first-international-conference-on-modern-monetary-theory

Once again, and at a high level, here’s how the Swedes think about taxes:

Blyth: “Guess what the most popular government institution in Sweden is, year after year after year in surveys:

The tax office.” Blyth then goes on to explain the policies that brought about that outcome.

Obviously, we’re not at that point yet, and if it’s a prerequisite for passing #Medicare-For-All, that policy is in trouble.

Nevertheless, we see what can be done.
(My father, for example, always paid the maximum in taxes, in gratitude for the New Deal and his service in World War II, followed by the GI Bill.)

Failing a revolution in attitudes toward tax, and failing an understanding by the general public that Federal taxes don’t fund Federal spending, we might try something like this (making up the figures):

Q: “How Are You Going to Pay For It?”
A: “Out of my right pocket, instead of my left.”

Q: [expression of bewilderment]
A: Right now, I pay $6000 a year for health care out of my left pocket, to the health insurance companies. Under #Medicare-For-All, I’d pay $4000 a year for health care out of my right pocket, on April 15.

There’s no difference. I mean, except for the $2000 I’d save.

And no tax on time, a doctor of my choice instead of effing narrow networks, no co-pays, no [family blogging] paperwork when you’re coping with your diagnosis, and so on.

A strategy like this might work as a sorely-needed conversation starter, at least. (Hat tip for pockets metaphor to you-know-who-you-are.)


Conclusion:

Obviously, there’s much more to be said about #Medicare-For-All.

But what amazing progress in eight years, and against massive opposition, not only from conservatives, as we might expect[5].

But especially from the liberal Democrats whose policies, politics, and persons were discredited in 2016.

Hopefully, it won’t take another eight for the political class to do the right thing.

NOTES

[1] One topic I need to understand, and do not, is the institutional imperatives and constraints within which Sanders and Conyers are working.

The West Wing retells this famous story (so famous I can’t find the original): http://www.movietvquotes.com/w/west_wing_quotes_2.html

There was a freshman Democrat who came to Congress 50 years ago. He turned to a senior Democrat and said.

“Where are the Republicans? I want to meet the enemy.”

The senior Democrat said, “The Republicans aren’t the enemy. They’re the opposition.

The Senate is the enemy.”

(In other words, our bicameral legislature is working as designed;

See Federalist Papers 62.)

Both Conyers and Sanders, in addition to their personal visions of what #Medicare-For-All should look like, will have had to write their bills to acquire co-sponsors in their respective Houses.

For example, I’d speculate that the long phase-in for Sanders care is about sponsor acquisition, and the same for the inclusion of for-profit facilities, as long as they meet standards. ‘Twas ever thus.

[2] It’s dangerous to assume that our body politic is healthier than it is, and our political class less corrupt.

Like it or not, breaking the political power of the health insurance industry is central both to passing #Medicare-For-All, and to keeping it (and us) healthy after its passage. If the health insurance industry is still in a position to bribe its way back into power.

After #Medicare-For-All is passed, we might as well not have passed it at all, because the same logic of making profit by denying care will still drive the system.

[3] I wish I knew how health insurance back office operations are geographically distributed. Partly to know how eliminating/repurposing them would affect the 2018 and 2020 e******ns —

“First, the mill closed; then, the Aetna call center closed….” — but also to know how often health insurance jobs are the only good jobs, or the only jobs, in their communities.

[4] Another reason to make for-profit entities go away.

[5] And even some of them are willing to throw in the towel.