Turns out Bernie overestimated revenue from his single-payer offsets, falling $3T+ short: https://t.co/RKsoIcFpoz pic.twitter.com/bAn2q9H58H
— Loren Adler (@LorenAdler) February 3, 2016
The Committee for a Responsible Federal Budget ran the numbers on the Sanders’ healthcare plan and its financing and depending on the assumptions, the Sanders plan is either $3 trillion dollars short over 10 years or $14 trillion dollars short over ten years compared to what the campaign is claiming.
That Sen. Sanders has shown a commitment to paying for his new initiatives and has proposed specific concrete changes to do so is quite encouraging. However, by our rough estimates, his proposed offsets would cover only three-quarters of his claimed cost, leaving a $3 trillion shortfall over ten years. Even that discrepancy, though, assumes that the campaign’s estimate of the cost of their single-payer plan is correct. An alternateanalysis by respected health economist Kenneth Thorpe of Emory University finds a substantially higher cost, which would leave Sanders’s plan $14 trillion short. The plan would also increase the top tax rate beyond the point where most economists believe it could continue generating more revenue and thus could result in even larger deficits as a result of slowed economic growth.
Sanders is not running in the Republican primary where the ability to propose programs with multi-trillion dollar piles of bullshit is an asset. His campaign should respond to CRFB and Thorpe’s cost estimates on a non-ad-hominem basis to explain why their estimate that single payer is a net neutral fiscal move instead of a massive budget buster.
Felanius Kootea
People won’t get as sick because preventive care? Pharmacy costs will come down? A 90% tax on income over $1 million will generate enough revenue? Middle class citizens will be happy to pay a little more in taxes to cover the gap since they are getting excellent health care for free? I’m looking forward to Bernie’s response.
dedc79
Richard, would single-payer (if we were ever to find a way to fully fund it) put you out of a job?
Felanius Kootea
Oops I used the dreaded Ph4rmacy word and am stuck in moderation.
Rafe
Well the CRFB is a known right wing outfit, so we need to take their so-called analysis with a grain of salt.
http://www.sourcewatch.org/index.php/Committee_for_a_Responsible_Federal_Budget
gendjinn
Criticisms from the “Fix the debt” group. Oy vey.
The Other Chuck
Consider the source: Judging by CRFB’s front page, they sure love the word “reform” a lot. As in privatization. I don’t think Sanders’ numbers are realistic either, but neither am I inclined toward trusting a bunch of budget hawks who appear to be clamoring for austerity at best and outright looting of the public treasury at worst. C.R.E.A.M. indeed.
Kazanir
Let’s stipulate that Richard’s premise is correct. In the Democratic primary the numbers do, in fact, have to add up.
That said, here are Drs. Himmelstein and Woolhandler on why Thorpe’s analysis is full of shit: http://www.huffingtonpost.com/david-himmelstein/kenneth-thorpe-bernie-sanders-single-payer_b_9113192.html?1454092127
And while the CFRB thing is new, you can imagine just how much confidence I have in their analysis not also being full of shit…
Tim C.
Is there a CBO score for Bernie’s plan? I ask because I know they point out GOP idiocy in this regard.
ellennelle
taxing capital gains and dividends as income really brings in $0?
plus, dedc79 asks a good question. i’m on medicare, and tho i am grateful for the provisions compared to what it was, i was just utterly appalled at the complications and too many choices and comparisons and deadlines, and rules and prices, on and on and on, ad nauseam, enough to make anyone sick.
and i have a phd, am a healthcare provider; i shudder to think what folks with 8th grade educations and no resources, not to mention suffering illnesses, have to go thru. it truly seems designed to make folks give up and decide on whatever, inevitably making some error that will – inevitably – cost them.
bottom line, the very thought that anyone would profit from someone else’s illness or health needs is just plain immoral to my mind. i defy anyone to claim otherwise. i’m not talking about making a living – even i do that, but it’s modest, proud to say – i’m talking about the killing insurance companies make, and they are simply unnecessary! health insurance is the completely unnecessary middleman, and needs to be killed to make room for simple, straightforward health CARE.
and YES, i would absolutely pay more in taxes if it meant i no longer had to pay premiums, co-pays, deductibles, and fight for whatever i needed, let alone just understand the gobbledygook.
you do a great job of making some sense of the insane and endless insanity that is our healthNOTcare system, richard, but seriously – would you not prefer to put your genius to work to render your job obsolete? would you not prefer that the endless problems you have to simply explain were to be set on a path to extinction?
WarMunchkin
I will say this – prior arguments about health care led me to believe that there was some progressive policy organization or another that had already figured this stuff out, and it was just a question of having the votes to get this going. If Dems actually did want single-payer for decades now, where are our numbers? And related: it’s awfully convenient that the only financially viable universal healthcare plan in existence is an originally conservative plan that was invented by Mitt Romney.
lihtox
When things like this come out, it’s really helpful to have a point-by-point rebuttal (such as the one by Himmelstein and Woolhandler, thank you #8) vs. “consider the source”. Ad hominem attacks may convince the choir, but when arguing with the outside world it’s good to have some ammunition.
MomSense
There are many models of health care systems beyond single payer. Given our history, culture, and Republican opposition to the safety net generally–single payer makes me very nervous. Look at the cuts and more proposed cuts to the NHS in the UK. Even if by some miracle we were able to pass a single payer plan, it would be constantly under assault and threat of cuts.
One of the problems with the constant threat of budget cuts is that it makes it almost impossible to plan, make sure you have enough new hires to meet projected demand, etc. Remember how the Republicans went nuts asking why Clinton didn’t increase security at Benghazi? I was shouting at my teevee that they had some nerve expecting the State Department to hire more security knowing that they had imposed the sequester, hiring freezes, and budget cuts.
We didn’t trumpet this point for obvious reasons of avoiding even more backlash, but the ACA is one of the biggest wealth re-distribution schemes to middle and lower incomes we have ever had in this country. Instead of chasing single payer, we could help the people who need it most by all working together to close the Medicaid gap and get all those people access to great public insurance right away.
Yutsano
@Tim C.:
The closest we could get on that would be for HR 646, if it ever has been scored by CBO.
Schlemazel
@lihtox:
I really want to agree with you but from experience the response to quality research from reliable sources too often is “Well my uncle saw this thing on Fox and they said that those guys are noted liberals and the real goal is to starve all Christians to death in reeducation camps!”
Cacti
@MomSense:
The goal should be universal healthcare. Not every country with universal care uses a single payer model.
Dogmatic insistence on a single payer system suggests its proponents are chasing a philosophical rather than public policy goal.
jl
Interesting that the same organization has the following link on their front page today:
The U.S. Spends More Per Person on Health Care Without Better Outcomes
http://fiscalfactcheck.crfb.org/the-us-spends-more-per-person-on-health-care-without-better-outcomes/
CRFB says this claim is ‘largely true’.
Uwe Reinhardt, an expert in both health economics and finance at Princeton has produced good arguments that this state of affairs is mostly due to much higher prices for health care services in the US than other countries. If Reinhardt is correct, and I think he is, reducing high prices for health care services is the problem and it has to be attacked. This is a separate issue from how to finance the system.
schrodinger's cat
What’s the complete overhaul of the employment based immigration going to cost?
This is what he wants to do:
Basically he wants every temporary employment based visa to come with a labor department certification like employment based green cards do. In practical terms he is putting up a sign which says do not apply for a job here. There is a reason why anti-immigration restrictionists like Numbers-USA like Sanders.
FlipYrWhig
@MomSense:
And always rife for politicizing, for instance abortion, IVF, injuries related to gun violence, drug abuse, obesity, mental illness, disability accommodations…
Frankensteinbeck
@Cacti:
I tend to think it’s about enemies. I’ve noticed a big focus in Sanders supporters and the ACA-wasn’t-enough crowd back when on whether or not solutions destroy big banks or the insurance industry or whatever as the definition of if they’re successful. I just want to regulate harmful industries until they have no room to abuse anymore. If that means they collapse because they depended on that abuse, fine by me, but it’s extraneous to addressing the real problem.
Richard Mayhew
@dedc79: As I have said before, yes. If it was single payer run at the state level, my employer would probably get the contract to run it as we know our shit.
National level single payer, I would be out of work in 6 to 18 months after we did a massive conversion of data to whomever is running the Fed system.
FlipYrWhig
@jl:
I think this is the missing piece, too. Because I wouldn’t want to have a single payer system that just writes checks left and right for MRIs (big ticket) and unnecessary antibiotics (small ticket, big effects) and such. But of course goring the ox of doctors and medical device manufacturers and phármaçeutical companies would breed fierce opposition — think of how hard insurance companies worked to kill reforms before, and how well they did, and people _hate_ them!
CONGRATULATIONS!
@Cacti: France. Massive cost control on pharmaceuticals and doctors expected to make house calls – thereby improving both direct knowledge of the patients challenges and eliminating the need for a dedicated office – keep the costs down to a minimum. Doctor charges a flat fee, then either subscribes or sends you to the local lab/hospital. My brother got a bad sinus infection in France. Not a citizen, mind you. About $20 US and a few days later and he was recovered.
No single payer. It’s just affordable. For everyone.
FlipYrWhig
@Frankensteinbeck: Justice as retribution looms very large in many people’s minds. Perhaps rightly. But like you I care less about swift and righteous retribution than I do about the shape of things to come.
FlipYrWhig
@CONGRATULATIONS!: I feel like the issue we should be talking about is health _access_. It also has the advantage of being something Bernie Sanders can say he actually did — community health centers — rather than his vision for a better system that has to run the gauntlet of gatekeepers and stakeholders and stand-pat-ers and emerge close to intact. I want “community health centers for all” rather than trying to do “medicare for all” all over again.
jl
@FlipYrWhig:
I think that there has to be some ‘going after’ people who charge high prices, but I think we need to be careful and not paint different parts of the US health care system with too broad a brush.
” goring the ox of doctors and medical device manufacturers and phármaçeutical companies would breed fierce opposition — think of how hard insurance companies worked to kill reforms before, and how well they did, and people _hate_ them! ”
It used to be different, but recently, I don’t think there is much evidence the primary care workers, primary care docs, nurse practitioners, pharmacists, many primary care dental workers are highly paid compared to other countries with cheaper systems and better population health outcomes, for example.
The problem with US drug prices will be difficult to solve without changing the way we pay for R&D, and tackling problems with the current US (and historically very extreme for compared to US history and other countries’) patent and IP economic and legal system.
But, reform is always tough. People sometimes talk as if it happened in other countries, like Australia and Switzerland, or UK all easy-peasy, cause they are all obedient commie socialists and no problem. Actually, there were huge protracted battles in those countries too, with lots of ugly compromises and incremental progress with some set-backs. No reason why it won’t be a difficult long protracted battle here too.
gene108
@WarMunchkin:
My basic issue with Sanders is how is he going to get Congressional Democrats to go along with his plans?
If single-payer was something Democrats wanted to pass, they would have passed it sometime between Truman proposing national health insurance, in the 1940’s, and 2010.
@MomSense:
1. A non-single payer / NHS style system won’t lead to the destruction of private health insurance, as an industry, which seems to be a goal, in and of itself, for some on the Left.
2. I agree with you about a single-payer system being constantly under attack and putting all our heatlhcare access “eggs” in the single-payer basket is just asking for Republican ratfucking and poison pills. Unlike Canada, Scotland and other countries, we have a retrograde conservative Party that wants to upend the gains people made in the 20th century and return us to a pre-1890’s legal and social framework.
3. Close to 50% of the country supports this conservative Party and their goals.
jl
@CONGRATULATIONS!: France had, by far, one of the sloppiest mistake prone health systems 20 and 30 years ago. They managed to become one of the less sloppy systems. That of course, did the US the favor of allowing us to become the sloppiest and most mistake prone.
Issues like improving access and continuity of care, reducing medical and durg errors, will also reduce costs as well.
Richard Mayhew
@The Other Chuck: Looking at their board and their history, I disagree with their recommended policies most of the time BUT I trust their ability to actually analyze a budget and count to eleven with their shoes on
MomSense
@CONGRATULATIONS!:
And if we were designing a system from scratch, I would jump on the France model. How do you transition from what we have now to that? There would be immediate consequences (some I would cheer!) and the people, organizations, and institutions would fight these changes. In order to get the ACA passed, we had to peel off big pharma by not going after pricing and other matters. I wasn’t happy about it at all. Sen. Rockefeller certainly wasn’t happy about it since he had sponsored so much legislation dealing with big pharma. We couldn’t have won the fight going against insurance companies, some of the providers groups, medical equipment corporations and pharmaceutical companies.
I think we have to win battles and live to fight another day. This is what bugs me about the whole left/right filter. Sanders may be “to the left” of Clinton on health care but if his more left policy doesn’t go anywhere and dies in committee, her “not as left” policy, if passed, moves us to the left of the status quo. Whatever policy is passed will be exactly as left, progressive, or liberal as the 60th vote in the Senate and the 218th vote in the House.
Richard Mayhew
@jl:
Basically we get a decent deal on anyone whose title does not end in “-ologist”
FlipYrWhig
@jl: I’ve been called out for painting doctors with too broad a brush before. Mea culpa! I suppose I mean “specialists.”
On a vaguely similar topic, I’d love to see advertising for medications be banned or regulated out of existence. It feels like drug companies thrive on pushing out always-expensive old pills in new bottles, then duping suffering people into paying top shelf prices for them. Aargh.
jl
@gene108: Any system that reins in opportunities for local and regional monopoly and oligopoly profit, as well as profiting from socially wasteful cherry picking and asymmetric information, and skimping on quality of care when it is difficult to observe, will be under constant attack. Single payer is not unique in that either.
Cacti
@jl:
Realistically speaking, a single payer system would probably not be fully implemented within the lifetime of candidate Sanders, or even candidate Clinton, and certainly not before the end of two Presidential terms. It would likely be about a 2-decade process from start to finish.
FlipYrWhig
@gene108:
Especially when part of the patter is that both parties are dominated by corrupt entrenched interests.
Frankensteinbeck
@Richard Mayhew:
Among other things, primary care physicians don’t financially benefit from unnecessary medications and high end tests. I think one thing we badly need is more doctor led (and less insurance led) standards of care.
The Other Chuck
@lihtox:
Just stop with the Latin, people. Yes, the fallacy makes an argument not logically sound, but this is not a college logic course. Skepticism and doubt about the source (and I am NOT saying their numbers are bogus, just suspicious) are perfectly reasonable tools to employ in rhetoric and just plain living in general.
p.a.
I’m in no way qualified to judge these particular numbers (any numbers actually), but can someone explain the big picture fact that every major Western European country has more rational and better healthcare coverage than the US and why every proposed US plan is explained away as an economic non-starter or pipe-dream?
Not talking POLITICAL realities, just financing issues.
I mean, we’re even talking economic basket cases like Italy (ranked just behind France as #2)
gene108
@FlipYrWhig:
I sort of wonder what Sanders makes of Sec. of State Kerry. The guy was born rich and married richer. His wife owns a big chunk of Heinz, which is a yooooge company. Per Sanders, I think this would mean Kerry is “tainted”, because of his corporate connections (in bed :-0)
Kerry also seems to be a pretty good Sec. of State.
jl
@Richard Mayhew: And, working conditions for primary care workers, from what i can see, stink in the US.
I’ve been recruited to do grunt work in teaching some interprofeessional education, even though I am not a clinician. So, I cannot deliver gory war stories, but can harangue them on comparative health care systems.
So, I see the documentation and pics form medical goofs in US health care, and pics of the working conditions. Some of the stuff is unbelievable. It is god damn chaos.
Some people will find it hard to feel sorry for professionals who make high five to low end six figure salaries doing ‘brain work’ with high prestige But whoever calls the tune in US health care is just as happy sticking it to whoever they can, both primary care workers and patients.
Quite a few foreign clinicians I meet here doing research view the US health care system with a fascinated horror and say they would not work here for any amount of money. Foul and chaotic working environment is one of the reasons.
FlipYrWhig
@gene108: I’m sure he’d say it’s not about individuals, it’s about the system. I have no problem believing in the claim that money warps politics. It’s kind of self-evident. I’m just not sure that “the billionaire class” is the reason why we have a stunted welfare state in America or a clunky economic recovery.
DCF
Via The Center for Media and Democracy (Sourcewatch):
http://www.sourcewatch.org/index.php/Committee_for_a_Responsible_Federal_Budget
Linnaeus
@FlipYrWhig:
It may not be the reason, but one of several contributors to the problem.
Chyron HR
@gene108:
Only if he puts ketchup on his steak.
gene108
@FlipYrWhig:
Limiting the influence of money in politics is a worthy goal.
Senate Dems passed legislation after CU to do this. It died in the House, IIRC.
It is just Sanders seems to conflate associating with the rich to be a cause of corruption, no matter what.
Right now that is his line of attack on Hillary; she is corrupted because she has a SuperPAC supporting her.
FlipYrWhig
@Linnaeus: Right, but for Bernie Sanders there’s really only one problem and it’s that wealthy interests pervert the process and manipulate the people, so you need to rise up and show that you’re not going to be manipulated anymore. I think deep in his heart he believes that racism, sexism, and other kinds of bigotry are just tools that the powerful use to brainwash us.
WarMunchkin
@gene108: These discussions are about a single-payer system on the merits, not about the political wrangling. If the math doesn’t work for single payer, then that should really close the book on it for Democrats – but we’ve been advocating that in some form for years and years now, so what, nobody ever bothered to look at the math?
And only now are we finding this out, after implementing Romneycare? Forget the politics just for a second – the argument here is that a single payer plan is wrong on the merits.
laura
California got very close to adopting single payer for all when der Gropenfeuher was governor. Twice, Senator Sheila Keuhl got the bill through both houses with Republican majorities both times, to then be vetoed due to concerns about the insurance industry which was a large source of political funding.
The Bill had been rigorously vetted, and the Lewin Group determined t hat it would have immediate, lasting and growing savings.
While it was killed in the crib, it did have the effect, briefly, of controlling premium increases.
I negotiate public sector employee contracts and Healthcare is an annual pay cut.
Feature or bug – you decide.
I’m not familiar with the plan Bernie is floating, but it stands to reason that if a very well designed plan such as that we almost adopted in California could be used – and avoid reinvention of a wheel, why ever not use it?
Greg Miller
Richard, these folks are linked to Pete Petersen, which makes their so-called “bi-partisan” bona fides suspect.
Linnaeus
@FlipYrWhig:
Sanders may very well have an overly reductionist view of social problems, although I don’t think he’s entirely wrong, either. These issues all overlap to some extent.
Davis X. Machina
@FlipYrWhig:
More than a century of mainstream socialist theory maintains precisely this... change the prevailing mode of production and all existing social relations of necessity will also undergo profound change.
As a set of priors this notion is pretty pervasive on the left-broadly-considered, and always has been.
jl
@laura: Arnold wanted to model the California system after the Dutch model. He flew in some Dutch consultants and experts and had a fancy confab. IIRC, his proposal roughly followed that plan
Netherlands has problems that in some ways resemble those in the US: lots of opportunity for using local monopoloies and vertically integrated systems to harvest socially inefficient profit opportunities. Clinicians I’ve met from there complain about growing problems of insurer and provider network games similar to that of PPACA Exchange system. But I think on a far smaller scale per capita. From what I have read, the Dutch have tried to control that through financing reforms, which some say are, slowly and in a disorganized way, driving them towards a single payer system.
If you search ‘WHO European observatory on health’ you can read a good country report on developments there.
Roger Moore
@FlipYrWhig:
This. It’s an especially good idea because most of the medications that get the biggest advertising push are ones that are of questionable utility. If their drug were treating an important medical condition and were genuinely better than the alternatives, your doctor would want to prescribe it for you without you needing to push. It’s the ones that are barely better than placebos, treat “lifestyle disorders”, have terrible side effects, etc. that really need massive ad blitzes.
Miss Bianca
@FlipYrWhig:
oh yes – a ban on advertising prescription drugs on TV, just like the ban on advertising liquor and cigarettes. Lord, it sure would be interesting to see who crawled out of the woodwork to defend the rights of the poor drug companies if that legislation got prooposed…
Miss Bianca
Apparently, I’ve just lost the right to edit my own comment, so “prooposed” will just have to stand…
Applejinx
@p.a.: I’m pretty sure it’s because every single shitty thing we have in America that is ‘politically impossible’ to fix in any way, is a thing that’s making various people incredibly rich on a daily basis.
And those people can afford to bribe politicians, buy newspapers and get articles written (see: anti-global-warming) to convince people of whatever they want. Money talks and everything else can suck it.
Certainly this is true of the pharmaceutical industry, which has largely captured healthcare. Martin Shkreli is the face of this industry, but you can’t think he’s in any way unique: there’s dozens, hundreds of them like that. He decided all his horriblest decisions in conjunction with other people at his workplace who cheered him on, but he ended up the sole face of the problem because he’s an idiot.
Why can’t we have nice things? Money, and who’s making it.
FlipYrWhig
@Davis X. Machina: To wit, Applejinx.
Linnaeus
@Davis X. Machina:
That said, it’s not like leftist thinking never evolved beyond Marx.
Benw
“You want us to respond to your table in a non-ad hominem fashion? Put some fucking uncertainties on it. Then we’ll talk, you smelly, rock-faced buffoons.” – the Sanders campaign.
Richard Mayhew
@WarMunchkin: No, the argument here is that single payer is big, its complicated and it is expensive and it needs to be addressed as such including responses from advocates when their numbers are called into question.
Shygetz
@MomSense: What makes you think Hillary’s (or any Democratic president’s) more moderate health-care plans have a snowball’s chance of being passed? I haven’t seen any projections that give Democrats any chance of winning the House AND the Senate, much less filibuster-proof majorities in both.
The major difference between Hillary and Bernie will not be in legislative policy preferences, it will be in foreign policy, executive and judicial appointments, and executive rule-making. In all three categories, I prefer Bernie. All legislative plans do is give us an insight into what the candidates priorities and viewpoints are.
Alex.S
From what I understand, we don’t know the payment rates or cost controls in the “Medicare for All” plan. Especially since Sanders’ plan doesn’t exist currently in the United States, having no copays or deductibles. All we have is the tax plan and a couple of tables worth of savings on administrative costs and drug costs (drug costs saved were more than current drug spending in the first release).
I think the numbers add up by assuming a massive reduction in payments to health care providers — I believe at a rate lower than Medicare’s current payment levels. But that’s not touching cost control questions, which currently don’t have an answer since there’s no method in the system to convince doctors or patients to not spend money.
Davis X. Machina
@Linnaeus: There’s a demotic, or vulgar ‘Marxism’ on the left hat sails and has sailed through the decades largely unconsidered and unchallenged, except by professionals
People don’t even know the extent to which they’ve been influenced by it, while they’re living it.
It’s like Catholicism…
FlipYrWhig
@Shygetz: YMMV, but I don’t think Bernie Sanders has any idea about foreign policy or any approach to it beyond “foreign wars are usually bad.”
Brachiator
@WarMunchkin:
That single payer is the best of all possible health care plans is an article of faith for progressives. And sometimes, like Bernie, they also use the magical invocation, “just like other advanced countries,” or “just like Europe.” But somehow along the way, they stopped trying to craft an actual plan or model.
NCSteve
The claim that taxing capital gains as ordinary income results in negative revenue is a big red flashing warning light of right wing ideologically-based hackdom. They mark themselves as the same people who say cutting taxes on the rich increases revenue.
I really wouldn’t be surprise if Bernie’s numbers didn’t add up, but these people totally discredited themselves with that statement alone.
FlipYrWhig
@Brachiator: Re: WarMunchkin’s point, AFAIK the basic issue is that you can’t do single-payer without cost controls of some sort, or else it’ll be preventive MRIs on demand for everyone with the government footing the bill, and the costs will spiral up and up and up. But cost controls mean saying no, and saying no to sick people or doctors or drug-makers introduces obvious political difficulties.
Linnaeus
@Davis X. Machina:
There is a “vulgar Marxism” still around, yes. Largely unconsidered and unchallenged? I disagree, although I suppose it depends on who you talk to, professional or not.
NCSteve
@Brachiator: It’s the progressive equivilent of “taxing capital gains as ordinary income will result in less, not more, revenue. Notwithanding that we ran that experiment before and it turned out not to be true.)”
I strongly suspect that no one has ever “run the numbers” because as soon as they try to model it, they run smack into the startup costs and gigantic nuclear bomb of employment dislocation that results from putting private health insurers out of business. Is the Federal government going to build it’s own ginormous buildings to replace the gigantic buildings where insurance company employees process claims, revenue and disbursements, monitor utilization and claims fraud and do all that other stuff? Wait for the private insurers to go broke and buy up their buildings and systems? Where does the software come from? How do you go about staffing up this bureaucracy? Sure, there’ll be a lot of unemployed insurance industry looking for a job, but the agency has to be built, staffed, organized and in place before those people can/have to leave their jobs. And their skills aren’t automatically transferrable. And most of them have to take the civil service exam to even qualify.
Going to single payer quickly would be like dropping a bomb on about ten percent of our GDP. A government plan that competed freely with private companies, like in John Edwards’ 2012 plan, might have, and could be, a path to making the transition sufficiently deliberately to avoid cratering the economy, but comes with its own economic baggage.
MomSense
@Shygetz:
The Patient Protection and Affordable Care Act already passed in 2010. There are tweaks that may be possible especially if part of larger legislation.
Closing the Medicaid Gap is something that can be organized around right now. I would love to see the Sanders and Clinton campaigns ask their supporters in non-expansion states to agitate and work their legislators and governors immediately.
jl
@FlipYrWhig: Again, we need to be careful. What we can easily see are expenditures, not costs (at least costs in any meaningful economic sense of real resources needed to provide another unit of good or service). Expenditure is cost times quantity. Three ways you can control expenditures (or, vulgarly referred to as ‘costs’) Reduce price of equal quality MRIs and keep quantity the same, or keep price the same and reduce quantity. Or, reduce both.
MRIs are very expensive in the US compared to other high income industrialized countries. Why is that? (Edit: and more MRIs in situations with rather obscure justification, adjusted for case mix and patient preferences for tx. Japan has far more, but consistent with its patient preferences for how to be dx’d and tx’d, and MRIs much cheaper in Japan)
So, when you talk about expenditure (‘cost’) control, are you assuming we have to keep the price the same and we have to reduce quantity?
From end of you comment, seems like you are aware of the price/quantity issue, But I want to make that point very clear. A big problem in US is not high consumption of health care, but high expenditures due to high prices.
lol
@Kazanir:
Sanders assuming savings of more than 100% on prescription drug costs tells me he had underpants gnomes write up his health care “plan”.
Brachiator
@Shygetz:
The Affordable Care Act has been passed and implemented. Have you been away?
It will be easier for a Democratic Party president to defend it from attack, and perhaps tweak it, than it would be to get a new plan passed.
And if the Democrats find a way to win both houses of Congress, then Sanders or anyone else can propose a new plan, and take time to make it workable.
jl
@jl:
“Expenditure is cost times quantity.”
Oops. No. I meant to type:
“Expenditure is price times quantity.”
The Raven
The CRFB supports such crackpottery as Bowles-Simpson and expansionary austerity. It is possible that this work is correct — “even a broken clock is right twice a day” — but that’s not the way to bet, and your citing their work casts doubt on your other work here.
Please, Mr. Mayhew, check out your sources before citing them. At least have some care for your own credibility.
As to running the numbers, the truth of the matter is that all numbers from such a vast reform would be estimates. The sensible thing to do would be to implement experimental plans in individual states, backstopped by the federal government in case things go sour, gather data and then make decisions, but the insurance industry is likely to prevent any such experiment from going forward. Other branches of health care are similarly likely to prevent effective action, or even research, in cost and price reduction. It’s a thoroughly corrupt system that is making most of the participants scads of money, and reforming such systems is difficult.
Brachiator
@FlipYrWhig:
Yep, makes sense that this would be a challenge. But it seems that instead of people just chanting “single payer, single payer,” they can look at the various universal health care systems that exist, and consider new ideas and craft something that would work for the US. Or look to revise the Affordable Care Act.
FlipYrWhig
@The Raven:
Maybe they should call them “Wyden Waivers.”
Shygetz
@Brachiator: I noticed that the ACA was passed…during the brief moment of Democratic control of both houses. That moment has passed, and shall not return in the near future. Neither Bernie nor Hillary will allow Republican roll-backs of ACA, so that’s a wash. Based on the current resistance to any positive “tweaks” to the ACA, that’s also a wash–the Republican legislature will not allow any positive tweaks to pass at a political price we would be willing to pay. The likelihood of significant improvements to the ACA is about equal to the likelihood of implementation of single payer. What in recent history causes you to think differently?
jl
@FlipYrWhig: I guess I am picking on you today.
A caution there is that in the US limits on what states can do and regulate in health care (ERISA is a prime example) limit the feasibility of what kind of experiments that they can do. I think one good thing the PPACA did was put a floor on the quality of the experiments that states can do, but it might be harder to remove the ceiling.
One reason that VT’s single payer ran into trouble is that they could not get all the waivers that they expected.
And, since Bernie-bashing seems to be the fashion here, Sanders was involved in trying to get some of those waivers through. So, that is another reason why Sanders is foolish, when asked about the VT failure, to just say “Ask the Governor of VT”. Seems to me Sanders knows quite a bit more about why the VT plan failed, but for some reason, chooses not to discuss it. And there are plenty of reasons he could give that would not make his single payer plan look bad. So his refusal puzzles me. Maybe he feels like full stump speech mode is the best way to win. But if so, I think he is, in my view, sorely mistaken, though people can disagree about that.
Shygetz
@FlipYrWhig: Actually, I agree. Where we may differ is that I think this simplistic vision is already preferable to Hillary’s nuanced yet hawkish (relative to Bernie, not to the Republican carpet-bombers) vision of foreign policy.
The Raven
@FlipYrWhig: we have to also be willing to fund them, though, and cash-strapped states and voters in a bad economy aren’t likely to do so.
FlipYrWhig
@jl: @The Raven: I think Bernie Sanders needs to explain why single-payer failed to launch in Vermont and why that doesn’t bode ill for extending the approach to the USA.
@The Raven: Bernie Sanders should float new funding for Wyden Waivers, then. I’ve already said I think he should push harder to scale up community health centers. I’d much rather see the debate go in the direction of filling in the gaps the ACA left behind, as opposed to “what I’d _really_ like to do is start over with a single-payer system.”
Brachiator
@NCSteve:
I think some see putting the insurers out of business as a good thing. I guess that part of the cost would be any transition and any new group of employees. But yeah, this would have to be a consideration.
I don’t know whether anyone thinks that single payer just means a big pool of money without any need for administration, fraud prevention, etc. On the other hand, there are claims that most of the other countries with universal health care plans have lower admin costs, so obviously there must be some basis for comparison.
The Raven
@FlipYrWhig: “Make no little plans. They have no magic to stir men’s blood and probably will not themselves be realized.”
I suspect Sanders would be delighted with a good compromise; he is a veteran legislator, after all. Whether his supporters would be happy with a compromise is another thing; legislators are supposed to compromise, presidents, not so much.
@Brachiator: heavens, Medicare with its elderly population has lower admin costs. There is no need to travel to other countries to see that.
Brachiator
@Shygetz:
ACA exists. People are getting coverage. Clinton or Sanders (and Obama for now) should call their bluff. “Where is your alternative plan?”
Otherwise, people who are covered may make noise for improvements to what is no longer theoretical. There may be other approaches. The bottom line is that there is now more of a political cost to doing nothing. The situation on the ground is not the same as it was before ACA became real.
Brachiator
@The Raven:
I also hear claims that Medicare is inefficient, that fraud is under-investigated, that doctor complaints are not addressed. And there are other questions as to whether simply expanding Medicare is a reasonable proposition.
mclaren
Easily fixed. Slash Shithole America’s bloated insane military/national security budget by 50% from its annual outrageous 1 trillion dollars (50 billion NRO satellite surveillance + 50 billion NSA + 60 billion CIA + 73 billion military pensions, weirdly not included in the official U.S. military budget, har-har + 20 billion “black” DOE budget, a stalking horse for particle beam weapons and laser death rays entirely military in function + 60 billion Department of Homeland Security + 2 billion TSA + 598 billion for the “official” U.S. military budget = 902 billion. See this article about America’s 1 trillion dollar national security budget for a more detailed breakdown.).
Bingo! You’ve now gone from a 3 trillion dollar shortfall over 10 years to a 2 trillion dollar surplus over 10 years.
Now shut up, Mayhew, and stop smearing Sanders with your obviously ignorant and sociopathic lies and fake garbage math. Go back to your Republican buddies and yuck it up with them about how many poor people you condemned to die screaming in agony by jacking insurance premiums and sneaking in “drive-by doctoring” fees to increase your profit margins. Asshole.
smintheus
Why in the world are you giving credence to a Pete Peterson organization? There isn’t a single person on their board whom I’d trust implicitly, and lots of people I distrust automatically. If their numbers had credibility, then it wouldn’t be hard to find a credible organization that was making the same case against Sanders’ budgeting.
mclaren
My Fermi estimate of the U.S. military/national security budget, broadly defined, was inaccurate. The actual spending is much higher. While my back-of-the-envelope estimate above includes some public information, many of the biggest-spending U.S. military budget line items, such as JSOC global black ops, the CIA’s drone assassination program, and the Air Force’s Aurora hypersonic unmanned attack craft program, are all “black” items not listed in the regular budget.
As a result, a better estimate of actual annual U.S. military budget spending comes from groups like PolitiFact that have run through detailed lists of spending and allotted to the military all spending which is both specifically identified as such and “black” projects not accounted for officially. When you run that kind of analysis, you come up with this chart, which shows total U.S. military at 57% of the annual U.S. government budget + 6% for the U.S. military veterans’ benefits including pensions, which (as mentioned previously) weirdly are not counted as part of U.S. military spending, but obviously are part of our annual military budget.
57% of 6% = 63% of current U.S. annual budget expenditures, which in fiscal year 2015 comes to 3.8 trillion dollars. Doing the basic math (and not the phony garbage math Richard Mayhew likes to scam you with) we come pu with total U.S. military/national security spending, broadly defined, as 0.63*3.8 trillion = 2.394 trillion dollars per year.
As you can see, 2.394 trillion dollars a year is quite a bit larger than the 1 trillion per year Fermi estimate above. We are much better advised to go with the higher 2.394 trillion dollar estimate, even though of course the Pentagon has not passed an audit in the last 30 years even though it is legally required to do so, because there’s so much graft and corruption and thievery going on in U.S. military procurement that it is physically impossible for the Pentagon to pass an audit.
This considerably raises my earlier estimate of a 2 trillion dollar surplus over 10 years, by cutting America’s insanely wasteful military/national security budget by 50%, to a whopping (23.94 trillion/2) – 3 trillion = a 8.97 trillion dollar surplus over 10 years. That’s nearly enough to cover even the higher 14 trillion dollar figure Mayhew slings around.
Once again: cut U.S. military from 2.394 trillion per year to half that, 1.197 trillion per year, and the savings over 10 years add up to 11.97 trillion. Subtract the 3 trillion deficit over 10 years Mayhew gins up and you get a surplus of 8.97 trillion over 10 years. Or alternatively, subtract the 14 trillion over 10 years and you’d have to run an annual budget deficit of (11.97 – 14) trillion/10 years = 200 billion dollars worth of budget deficit per year to cover every last jot, tittle and iota of nationalized single-payer health care Bernie Sanders has promised even at the very worst and most extreme cost estimates.
200 billion dollars of budget deficit per year is modest and entirely reasonable for what Bernie Sanders is proposing. Moreover, giving every U.S. citizen single-payer nationalized health care would boost productivity so much that tax revenues would undoubtedly skyrocket to more than cover that modest budget deficit…something Richard Mayhew does not tell you, because he’s lying to you as usual.
It seems almost superfluous to point out that Richard Mayhew is also lying to you by using the higher estimate of 14 trillion per year ofr total cost of medical services. Mayhew is lying to you because a nationalized single-payer system would slam down costs tremendously. Without the ability to charge whatever-the-fuck they feel like, doctors and hospitals and medical device makers would have to drastically reduce costs, because the single payer system would inform them: “We will not pay $1850 for an MRI. We will pay what France pay for an MRI, $250.” Costs would plummet and the entire U.S. health care system would immediately find itself awash with a massive surplus and the big problem would be findining a useful way to spend all that money on effective health care (probably preventive care).
But once again, Richard Mayhew will never tell you this. He’s too busy lying to you in a frantically failed effort to convince you of the grotesque lie that the insanely overpriced health care in America with its shitty sub-par health outcomes is actually the best we can do as a society.
mclaren
@smintheus:
That’s the Mayhew technique. Scam, lie, dredge up the most dishonest accounting you can find by scraping the bottom of the barrel of the most flagrantly fake bookkeeping ginned up by the most far-right partisan hacks you can find, and then pass off the phony numbers as though they were honest reasonable estimates from well-intentioned accountants.
As a famous British blogger pointed out back when he entirely discounted the phony Iraq war estimates, he knew it was a scam because of what he had learned at an expensive business school. First, solid business plans do not need lies to sell them. If you start hearing lies, you may be certain that the business plan is not solid. As we can see from all the lies Mayhew has covered up in the “esimates” he reports above, the Pete Petersen accounting is not a solid business plan for health coverage — it’s a partisan hit piece confected expressly to destroy Bernie Sanders’ candidacy with fake numbers.
The second thing that famous British blogger pointed out is that once an accountant has proved himself unreliable, you cannot use his baseline figures in any way, shape or form, even as a starting estimate. That is most certainly the case with Pete Peterson budgeting. Let’s recall that Peterson was one of the main guys behind the big push for austerity a few years ago on the alleged grounds that out-of-control U.S. deficits would soon send inflation soaring out of sight unless we slashes social security and medicare expenditures.
As Paul Krugman and Brad DeLong and many others have detailed, Peterson was lying. The promised inflation never materialized. The research papers on which those inflation claims were based turned out to be garbage.Peterson was running a scam.
Now Richard Mayhew is trying to run another scam by reporting Peterson’s scam as though it were solid accounting instead of the tissue of fake numbers and bogus lies it actually is. And, once again, it’s a tissue of fake numbers and bogus lies because the Peterson estimate doesn’t take into account the tremendous cost savings to be had once single-payer kicks in and MRI costs drop from $1850 to $250, hip replacement costs drop from $70,000 typical in the U.S. to the more usual $8,000 charged in a single-payer health care system like Spain, and instead of charging $10 for an aspirin, the true cost of 20 cents kicks in — as will happen in a single-payer nationalized health care system, because the single payer does actually have the power to control costs by refusing to pay exorbitant fees for procedures and medicines.
Freemark
No matter how it is looked at single payer would achieve huge overall costs savings. To suggest otherwise requires ignoring logic and basic math skills. Whether Sanders tax suggestions for paying are 100% accurate is really unimportant. Health care spending would be greatly reduced and in almost any scenario the vast majority of Americans would save money and have better coverage. Anyone who attempts to make it sound like Sanders plan or almost any other single-payer plan will cost more than what we currently spend per capita has to be purposefully lying or willfully ignorant.