BREAKING: Harris puts forward a credible plan to cover all Americans that is a mix of ideology & pragmatism.
Democratic plans do have key distinctions from one another, but more important is the massive chasm from life & death under Trump.https://t.co/o0IBDbhjjT
— Andy Slavitt (@ASlavitt) July 29, 2019
I’m sure more knowledgeable commentors will have more to say about this proposal, but IMO, it’s not a bad starting point…
Three key things the Harris health care plan changes from Sanders plan
• Allows a private insurance option via Medicare Advantage
• 10-year transition (instead of 4)
• Swap in Wall Street trading tax, swap out middle class taxeshttps://t.co/v3e1GC4kdK
— Sahil Kapur (@sahilkapur) July 29, 2019
The campaign is calling this Kamalacare.
They are embracing it and signaling that they're willing to fight for it.
I like that kind of boldness.
https://t.co/Ifladyeh84— Florida Chris (@chrislongview) July 29, 2019
Politically, Harris's plan seems to turn a little bit on an overly literal interpretation of polls showing Americans not wanting to eliminate private insurance. What a lot of voters who say that really mean is they don't want to lose their *current* (usually private) insurance. https://t.co/IpgZjCi7CQ
— Nate Silver (@NateSilver538) July 29, 2019
And my understanding of Harris's plan is that people *would* see their current insurance discontinued (after a 10-year phase-out period). Then they'd have a choice of the government's Medicare plan or a privately-run Medicare Advantage plan that meets Medicare requirements.
— Nate Silver (@NateSilver538) July 29, 2019
The first twitter-based attacks, on the other hand, only make me *more* convinced Harris has a sound plan:
She uses the actual Medicare program. It’s Bernie who says he’s for Medicare and then fundamentally alters it. *His plan* alters the structure of the Medicare program. So this is a lie ????? https://t.co/ogAxOPt3UU
— Regina ?? (@regwag2003) July 29, 2019
People should push back at this, *regardless* what plan you support. Such dishonesty in the field of healthcare reform will only prevent such reform from getting done. https://t.co/gvW2Ixzgze
— Mangy Jay (@magi_jay) July 29, 2019
"Why does the Sanders camp aim for further confusion & not clarity? "Evidence suggests a combination of cynical ruthlessness at the top and a devotion further down in the ranks that seriously clouds critical thinking & leads to cultish acceptance of whatever leadership says. IMO.
— Dr. Aphra Behn (@Shaker_aphra) July 29, 2019
As I explain, in 2017 Sanders and M4A advocates bamboozled most of the Prez candidates into thinking the plan was quite popular. Alas, decisive public majorities oppose it. https://t.co/mB9rkXeHch via @TPM
— Josh Marshall (@joshtpm) July 29, 2019
The Biden campaign joins Sanders and Co. in attacking Harris and her healthcare plan. Biden spox Kate Bedingfield just released this statement: pic.twitter.com/bFuF22kLAK
— Chelsea Janes (@chelsea_janes) July 29, 2019
Amazing how many people on here who proclaim their love of the Medicare program and tout how popular it is then go on to ignore what it actually is: a system of public insurance with a private insurance option that millions choose. It also has copays and deductibles.
— Neera Tanden (@neeratanden) July 29, 2019
Don’t use its popularity and then act like it’s a completely different plan. That’s not being straight with people.
— Neera Tanden (@neeratanden) July 29, 2019
Baud
I’ve defended Biden against unfair attacks before, but that statement is shit.
Mary G
@Baud: He’s hired some nasty women. Looks like the Republican strategy of having their token women blast Dem women.
I like the 10-year transition and the financial transaction tax a lot.
Sab
I cannot even figure out what her plan is from this post. Sorry Anne Laurie. I admire you, but this is clickbait gibberish. What is Harris proposing?
There was a time when my life depended on these discussions. I care about them a lot.
Luthe
Since this thread is open:
I survived my first day at work! And they want me to come back tomorrow (silly people).
Baud
@Mary G:
I’ve liked nasty women since 2016. We need another name for people like her.
Baud
@Luthe: Congrats.
Baud
@Sab:
https://www.npr.org/2019/07/29/746051105/kamala-harris-releases-medicare-for-all-plan-with-a-role-for-private-insurers
Miss Bianca
@Baud: How about “wicked women”? Yes? No?
Cacti
Will she bail on this plan tomorrow and say she misunderstood the question?
Baud
Her plan may be credible, but my plan is incredible.
@Cacti:
Doubtful.
Jim, Foolish Literalist
Baud
@Miss Bianca:
A possibility.
MisterForkbeard
@Cacti: No.
mrmoshpotato
@Luthe: ?
Mnemosyne
@Cacti:
Sorry, to what are you referring? I assume it’s to something that actually happened and not yet another internet urban legend about Harris, but I could be giving you too much credit.
Cacti
Snark aside, her plan sounds more feasible to implement than Wilmer’s with one exception:
That it can be paid for without raising taxes on anyone making less than $100k per year.
Brachiator
@Luthe:
Congratulations!
Cacti
@Mnemosyne:
When she raised her hand that she would eliminate private insurance, then walked it back the day after.
Baud
@Jim, Foolish Literalist: Welcome to Hillary’s world.
Miss Bianca
@Baud: We could always go with “Monstrous Regiment”, but that might be too obscure.
dmsilev
@Sab:
As I understand it, the centerpiece of her proposal is to allow people the choice of opting in to Medicare but not to force them to do so. Very similar to the “public option” proposals from 2009. I’m hardly an expert on such things though; I’m sure David Anderson will have an analysis of it at some point, so wait for that for definitive discussion.
Brachiator
@Cacti:
How would the cost compare to current employee costs for health insurance?
Baud
@Miss Bianca:
That’s what Google is for.
Ruckus
@Sab:
Here is the answer from Kamala herself, on her site.
I’d like to see a few details fleshed out and see what she thinks of how much seniors pay now for Medicare coverage, especially against SS earnings.
But it sounds like a reasonable plan now, remembering that whatever system we build, if it removes the level of private healthcare insurance we have now there will be a massive fight. And not just from the insurance industry, because people don’t trust the government, until they have to of course.
Mnemosyne
@Cacti:
I would have walked it back, too. There is NO healthcare system in the world that eliminated private insurance. They even have it in the UK. It’s a stupid thing to make people “pledge” since it’s impossible.
Miss Bianca
And since it’s an open thread, and apropos of nothing except that I miss the proximity to Canada I grew up with in Michigan, a fun little article from AtlasObscura on the ubiquity and possible origins of Canada’s most notable verbal tic.
The author notes that the “eh?” has been adopted in other parts of the world, particularly the Upper Peninsula, but I can tell you as a DEE-troiter growing up across the river from Windsor, ON, it snuck into my vocabulary as well. Just the other day I heard myself saying, “how do you like them apples, eh?” and LOL’d.
Luthe
@Baud:
@mrmoshpotato:
@Brachiator:
Thank you!
Kay
I have to say I do like how Harris doesn’t explain or apologize. Good for her. Republicans never have to explain everything over and over. Anything. Ever.
Fat lot of good explaining did for Hillary.
Jim, Foolish Literalist
@Mnemosyne: I think Canada is the only G-20 country with single payer? Every other large country has some kind of public/private hybrid (IIANM). One thing Our Wilmer has been successful at is convincing a large number of people that universal health care and single payer are synonyms. And according to the very…. I’ll say “energetic” Bro on the Chris Hayes show tonight, if you just say “corporate” enough, public resistance to SP will vanish, since it’s a myth perpetrated by the corporate health insurance industry. The Yoot had learned the art of righteous bellowing very well.
HalfAssedHomesteader
Nate almost gets it right. Folks don’t want to lose thier current plan UNLESS there’s something better to grab on to.
piratedan
well… if you think about it, when you state that you’re going to end private health insurance and go to a public policy plan you’re talking about screwing around with the following:
MetLife
Cigna
Kaiser Permanente
etc etc etc
think about it, there’s easily hundreds of thousands of people working in this field, nearly every insurance company has some tentacle in this field and you’re proposing to do away with those jobs (and all of those account reps and claims processors and form coders and accounting staff) but what you really need/want is oversight and regulation so people don’t get screwed by the fine print and have some modicum of affordable coverage. You’re also pinging the crap out of the advertising companies because now an entire field of private companies are no longer buying ads everywhere trying to entice you into their sphere.
We all talk about the concepts of how this should be and what is equitable and fair and its simply not going to be an easy lift to make this happen, you need to have a transition and it will probably need to be incremental. Not saying it can’t be done, but it sure as hell isn’t going to be as easy as printing a bumper sticker and standing behind a podium and saying “make it so”.
Anne Laurie
@Sab: Okay, here’s a link to the proposal on her website, via the tweet ‘pinned’ to the top of her feed:
beef
This financial transaction tax is a crock. It’s a gimmick taking advantage of the fact that most people don’t know what high frequency traders do, except that it involves computers and is complicated. Well, I do understand what they’re doing (I have to — they’re my adversaries), and here’s what you need to know: HFT profit margins are incredibly thin. Total yearly profits for the whole industry are maybe $10 billion. That’s a lot of money for the likes of me, but it’s rounding error for the federal government. And it’s about as much money as you can hope to extract from a financial transaction tax, because it’s pretty hard to take more than 100% of what’s not already taken by existing taxes and costs.
If you want to raise serious money from the financial sector, you have to go after private equity, dividends, and long term capital gains. That’s where the money is. Listen to Willy Sutton, people!
Gelfling 545
@Miss Bianca: I have it on good authority ( was told by a Canadian Vice Consul) that when it came time to name Canada they were stuck so people just started suggesting letters of the alphabet. C, eh? N, eh? D, eh? And thus Canada was named. Sounded legit, eh?
Ken
@Jim, Foolish Literalist:
Any survivors?
Harbison
Fuckin Nate Silver. Making an approach that is carefully calibrated to appeal to the most voters into a negative thing.
This is exactly what Clinton and Obama both did and that’s why they won.
Leave the vapid sloganeering to the politics is my substitute for therapy crowd.
Dan B
I’m on Medicare and fixed income. I dream of amazing countries where you get care and no bills. On my SS it’s tough to come up with the money every month. I missed two payments in a riw and had to wait six months to get back on. My partner was on a state low income health plan – only $750 per month!
I’d love to have a public option opt in.
tobie
I think the 10-year phase-out of private insurance is a problem. Group insurers will have no incentive to provide subscribers with service, if they know they’ll be squeezed out of the entire group plan market in 10 years. The plan also doesn’t do enough to change the co-pay structure in Medicare as far as I can tell. DeLauro’s/Schakowsky’s Medicare for America proposal is superior on these scores. I don’t know if they include dental in their improved and expanded Medicare plan, but that’s important and I’m glad Harris included it in her proposal.
Jim, Foolish Literalist
I haven’t watched CSPAN in years. Does Steve Scully follow the model of asking dry questions in a robotic tone and not reacting? This should be good for about fifteen more scandals and a couple dozen “I was at Ground Zero” level delusions/lies
Ken
@beef: Interesting, I hadn’t realized HFT had such low profits for such a huge investment in processing power. Any idea how the dollars/kWh compares to bitcoin?
lamh36
Evening BJ.
One class final done…one more left.
But this one teacher is so darn flaky. She does everything online, but she ALWAYS late and she hasn’t even graded the last quiz or the last 3 homework assignments and still hasn’t put up the damn final.
Ugh…last week she said was was flying to Puerto Rico, so who even knows if she’s back in town…Tomorrow is the last day of finals for the Summer semester…smh…man if this lady post that darn final late tomorrow evening, folks are gonna be pissed
SMH…anyhoo…after she FINAL posts the final online, that’ll be my the end of the summer semester and I’ll have 3 weeks til the Fall semester.
Come on lady…damnit…
Sab
@Anne Laurie: Thank you, and Ruckus and other commenters.
Candidates healthcare plans mean a lot to me. I am safely on medicare now, but a couple of years ago life was scary although I thought I had done everything right to be safe my whole life.
Turned out no. But Obamacare saved me.
Barbara
@Sab: A transition over 10 years for everyone to be covered by Medicare as it currently exists, hopefully with some tweaking to modernize coverage and reimbursement policies.
Another Scott
@beef: HFT is rent-seeking. Why shouldn’t it be taxed and discouraged?
Dean Baker (from 2014):
Makes sense to me.
Cheers,
Scott.
Sab
@Barbara: Thanks. You are in my top five commenters for why I come here.
Martin
I’m not completely sold on her plan, but I think it’s more realistic, and achieves most of the right goals. I appreciate that people are afraid of changing health insurance, and building around something that has existed for some time should help with that. My concern about this plan is that even the people on Medicare don’t understand Medicare, particularly Part C. It’s biggest benefits are that it’s a plan – we can see what we get, what it costs, and how to pay for it.
My preference would have been to take a different approach. Put everyone on Part A (hospitalization). Let people buy into Part B (physicians), or go to the private market under a Medicare approved plan. The difference is that I wouldn’t give a private market option for hospitalization, mainly because it’s a part of health care where the market doesn’t work, and thats where a LOT of our excess spending goes. Healthcare in the US isn’t expensive because of insurers, it’s expensive because of poor allocation of resources, billing costs, and a host of other things. Plus, the government mandates that people get most of Part A provided whether they can pay or not, so by fully socializing that part, there’s no longer a mandate that is out of alignment with how payment is made.
Part B isn’t really where people live or die, so give people the option. Overall, I think Harris’ plan is heading in the right direction. I like the pay-fors.
Martin
@beef: You’re missing the point. The point is to create friction for high frequency traders so they can’t be high frequency traders any more, because they make it impossible for regular investors like you and I to compete. Yes, it doesn’t amount to a lot of money, but it does redistribute the benefits of the market more broadly.
HRA
@Miss Bianca:
I was born and raised to my start of teen years in Windsor, Ontario. The first time and only time I heard eh being used was by the French Canadians when I went to Tecumseh, Ontario to stay at my aunt and uncles home. That is not to say others did not adopted it for themselves. It is having not personally heard it in my environment there.
Chetan Murthy
@beef:
Two thoughts: (1) if this tax merely kills-off HFT (and raises no $$), GOOD.
(2) Why should we think that it’s only aimed at HFT? All short-term trading gains should be taxed, and heavily. There is no good economic rationale for allowing people to profit from assets held shorter than a few days, for sure. Uh, other than that “completing markets” derivatives-uber-alles bullshit, that Yves Smith showed pretty conclusively *was* bullshit, in _Econned_.
Felanius Kootea
@top I think that this plan is an improvement over straight up abolishing private health insurance. I do wonder, like a commenter above, what happens to people who actually like or work for managed care organizations like Kaiser Permanente? I want nothing to do with Kaiser as a healthcare provider after a bad experience many years ago, but my husband swears by them and likes the convenience of being able to get everything (see primary care provider and specialist, pick up meds from pharmacy and get eyeglasses) done in one location. I have a PPO plan with a major insurer and he has Kaiser and pays way less than I do for care.
Kaiser now has its own medical school. What happens to that? What happens to all the Kaiser nurses and doctors? Allaying people’s fears will go a long way.
Still, the healthcare plans being proposed by any of the Democrats are miles ahead of what Republicans would like to do.
@lamh36: Good luck on the final!
Barbara
@Martin: Saying that Part B isn’t where people live and die just isn’t true, not anymore. Medicare pays for nearly all oncology treatment through B.
One of Medicare’s persistent weaknesses is that it consists of 3 silos, A, B, and now D. No other coverage, private or public, works this way. Part C works as well as it does because it integrates the three otherwise fragmented benefit categories.
Chetan Murthy
@Felanius Kootea:
How does Kaiser deal with Medicare patients today? I’d think that that just transfers over, no?
Ken
@Another Scott:
See, there’s my argument for Tobin tax in a nutshell. Around here, every fast food restaurant has to collect a 9% sales tax on every transaction, and they manage to make a profit. If your industry can’t survive a 0.03% tax, maybe you should consider doing something more economically valuable with your time, like flipping burgers?
tobie
@Barbara: If the move is to Medicare as it currently exists, than I’m on the losing end of the stick. My current healthcare plan has a better reimbursement schedule than Medicare. I suppose I could put my employee contribution to buying a supplemental policy. Maybe that’s how this is designed.
smintheus
A 10 year transition is basically an invitation for voters to think that if they don’t like the legislation once it’s enacted, then they can just elect a Republican president to scuttle it before it can take effect. And it’s an open invitation in any case for the next Republican president to scuttle it, as inevitably he will.
I do like the tax on financial transactions, though.
Barbara
@Felanius Kootea: The answer as to what happens to insurers is, Medicare Part C.
HalfAssedHomesteader
@Mary G: I like the idea of a long-ish transition even if 10 years is a bit too long given our electoral realities. I’d like to hear more ideas about how a transition would occur and less dishonest assumptions that it’s a giant waterfall 10 years out.
Barbara
@tobie: Sorry, can’t analyze every permutation of every single benefit plan and how it would stack up to Medicare.
Felanius Kootea
@Chetan Murthy: I honestly have no idea, was being lazy and didn’t google before posting. Just googled and it turns out Kaiser does take Medicare but does not treat “Medicare supplement” members (whatever that means) at Kaiser facilities. But yeah it looks like there’s a path forward for people on Medicare with Kaiser, so my concerns are probably unfounded.
ETA:
@Barbara: Thanks!
Ken
@Barbara: As has been observed, healthcare is hard.
joel hanes
@beef:
Even if the per-trade tax generates no revenue whatsoever, it will be sound public policy, a social good, if it removes the some of the potential profitability from high-frequency trading, and thus reduces the amount of high-frequency trading that occurs.
Chetan Murthy
@Felanius Kootea:
Well, there’s all those middle(wo)men who spend their days trying to push sick people out, up-code procedures, and deny payment for upcoded (or not) procedures. All deadweight loss. And all those jokers are gonna fight tooth-and-nail.
Steve in the ATL
@Another Scott:
1. HFT should be illegal; and
2. If no one has the balls/ovaries to do that, then regulate and tax the shit out of it.
Chetan Murthy
@Another Scott: Pulling out the money quote:
Two observations: (1) $40B/yr is obviously not just coming from HFT
(2) It assume that the HFT segment will be destroyed, so no $$ from there anyway.
tobie
@Barbara: I wasn’t expecting you to but I do think people will be asking what this means for them.
Barbara
@Chetan Murthy: Do people think Medicare doesn’t require coders? Medicare has had a correct coding initiative for decades, and uses the same codes private insurers do. Medicare is as complicated as any private insurance plan.
JR
@beef: Yep, long term capital gains is the big money pile. But you don’t see anyone proposing taxing it as regular income. And so we get Warren Buffet talking about his effective 15% personal tax rate for eternity…
Martin
@Barbara: Most other single payer health systems do work this way though. There’s usually a socialized equivalent to Part A and a private market (heavily regulated) equivalent to B.
But if we want to move oncology from B to A, I don’t think too many people will argue.
Chetan Murthy
@Barbara:
I was careful to write “up-code”. By which I mean the corrupt reclassification of work from one code to another, more-expensive code. And sure, the government gets robbed, too. But from everything I’ve read, the private insurers get robbed worse, b/c they can just pass along cost to their policyholders, and heck, they take the same percentage off the top, so it’s kinda a win-win for their execs. There’s fraud everywhere, but I’ve read that Medicare is actually pretty well-run.
tobie
@JR: Long-term investments are also a part of people’s retirement portfolios. That’s one reason touching it has become the third rail of American politics.
lamh36
Mnemosyne
@Jim, Foolish Literalist:
The UK has a single provider model, which is extremely unusual. Most other countries (including Canada and France) have some form of single payer.
Wilmerites tend to conflate single provider (the UK) and single payer (lots of other places), but, really, every country has a unique system.
@piratedan:
Those are three different things. I’m not sure about MetLife — do they sell health insurance on the East Coast or something? Out here, they seem to be life insurance and supplemental insurance.
Cigna is a health insurance company — they contract with doctors and hospitals to provide care at a set price.
Kaiser Permanente is a healthcare provider — they own the doctors and hospitals. That’s why they don’t accept Medicare Advantage patients from outside of the Kaiser system. They are their own health insurance and healthcare providers rolled into one as a closed HMO.
Basically, if you take Cigna + Tenet you get Kaiser, except Kaiser is a nonprofit. IMO, the true source of problems in our system is for-profit healthcare, not private companies. You can have nonprofit private providers and run things just fine — IIRC, that’s essentially what the French system is.
p.a.
What happened in 1965/66. How many millions of 65+ got on Medicare? How long was the rollout? Smooth, or clunky? What was the AMA’s position pre-during-after? We know Rethugs were noNoNO. I know it was a different political climate, but the nuts-and-bolts are ~the same, just writ large for the bigger population. (And those were union days, so I assume a substantial %age of 65+ had medical coverage as retirees or active workers. Is this wrong?)
L85NJGT
@HalfAssedHomesteader:
Start with union households being asked to have shittier plans at the same or higher cost (they just binned the Cadillac tax ffs). That’s the first cut out for an important constituency, and it’s turtles all the way down. We have a hybrid system, there are inefficiencies in the as-built environment, with some interests that can be rolled, and some not.
The important pieces are universal coverage, and progressive subsidies.
beef
@Ken:
I’m not sure that the processing power involved in HFT is all that impressive. The telecom engineering gets pretty nifty, but they’re not really crunching epic amounts of data. Certainly not, if compared to the likes of Google, Amazon, or even CERN. Financial data just isn’t that big. Heck, I wouldn’t be surprised if Apple uses more compute power for Siri than HFTers use for their trading.
At any rate, data centers consume maybe 3% of power use worldwide. HFT is a miniscule fraction of that. If you want a concrete (over)estimate, imagine 100 firms each running 10000 cpus at 200W 24 hr/day 365 days , which comes out to 1750 GWh/year. Energy consumption per $ of net is ~175 W/$. That’s about .004% of global energy consumption, which is something like 50000 TWh/year. Interestingly, GDP is about 100T $/ year, so the average energy consumption per $ of gross is 500 W/$. Not quite apples to apples here, but it’s similar enough to give some comfort. HFT isn’t consuming grotesque amounts of energy for the value produced. Try cement or steel production if you want bad W/$.
I don’t know the numbers for bitcoin, but it’s inefficient by design, so I don’t expect a low W/$. But I have enormous uncertainties in my estimates of the profits of the bitcoin industry.
Brachiator
@Sab:
The Democrats need to collect testimonials like this and deploy them during the campaign.
A few years ago, I had to have a little procedure done, and I overheard a patient say exactly the same thing to a nurse, that Obamacare had saved his life.
Yarrow
@Mnemosyne:
Agreed. If the healthcare system is for profit then profits have to be found somewhere. Customers will pay that price.
Brachiator
@JR:
I don’t necessarily have a problem with a lower tax on capital gains. But I would get rid of the zero percent threshold.
jl
The devil is in the details of these plans that attempt to blend Medicare for All with private health insurance. Need much stronger regulation of private insurance in order to produce a stable system, and to prevent private insurance industry from cream skimming and privatizing gains from covering healthy people and socializing losses from finding ways to kick sicker people off their insurance.
Can, or will, Harris push for that needed much stronger regulation? That is my question. If it is true that Harris is going to model private insurance on Medicare Advantage plan, that might get us half or more of the way towards where we need to be. Ten year transition period seems to long and leave proposed system liable to attack, though.
But I prefer all of these various approaches to a Medicare system, since there is more active discussion of what needs to be done. We could get to a good system with PPACA, but the very moderate advocates of that haven’t shown any inclination to talk about the much stronger insurance and corporate provider regulation that is needed. That huge void is a big problem for taking them seriously.
Chetan Murthy
@beef: @Ken:
Here’s a different way of understanding the reason that HFT can’t be a crazy energy-consumer. The point of HFT is that the exchange (e.g. NYSE) puts out a feed of orders (buy/sell), and the HFT guy wants to be able to respond to an order, before anybody else. To that end, he rents space in the same datacenter as the NYSE’s computers. Le’ts do some simple math:
(1) light travels 300m in a microsecond
(2) and 300km in a millisecond
(3) So if you co-locate, but can’t decide whether to (e.g.) respond to a “sell” order with your matching “buy” in less than a few milliseconds, somebody across the river, across town [who, b/c he’s farther away, gets the feed with greater delay than you do], who can decide faster, can beat you, even if you’re right next to the NYSE’s computers. This puts a bound on how long you can spend thinking about what to do, right? And that means you have to use lower-level mechanisms to do that thinking. HFT is esoteric b/c they use stuff like FPGAs and hire really skilled coders to get the “decision time” down.
But -necessarily- that means, you’re not farming our your problems to a thousand machines, etc, etc, etc. B/c that would take -time-.
ETA: In reality, it’s a few hundred microseconds, the time they have to decide.
Omnes Omnibus
@Miss Bianca: How many of you are actually green? And do you contract out the flying monkeys for like cockail parties and Bar Mitzvahs?
@Miss Bianca: John Knox?
Brachiator
@Mnemosyne:
Other nations with universal health care regulate it, but do not necessarily eliminate for profit entities.
patrick II
@Another Scott:
If it wipes out the practice of high speed trading, what is there left to tax that would return $400 billion?
jl
I think one reason to support these Medicare/private blends is misguided and completely wrong, which is the hope that the insurance and corporate provider industry will not oppose them as strongly as a Sanders style 200 proof Medicare for All plan. I’ve already seen ads that try to lump them all together, Sanders Medicare for All, to the mildest public option proposal as commie death machines. (OK, not in so many words, they aren’t as goofy as the GOP or Trumpsters), but that is the clear subtext.
Insurance industry will fight ferociously against anything that cuts into their profits by a penny. So, just forget that rationale for a moderate proposal. Just pick what you think is the best one on substance and be prepared for insurance industry to try to nuke it, whatever it is.
beef
To those wishing for the destruction of HFT: You don’t know what you’re talking about. I trade against HFT firms, and I don’t want them to go away, because they provide far cheaper service than any alternative I’m aware of.
HFT traders are basically in the business of selling insurance. Grandma owns some stock, and she wants to sell it. If she takes the HFT price now, she has her money and she’s transferred her risk (of price change) to some HFT. They offload that risk as quickly as they can — think minutes to hours — and they get paid a miniscule amount for this, because they’ve competed their margins down to almost nothing. Anyone thinking that HFT players are screwing them either couldn’t complete with them (e.g., former execution traders) or fundamentally misunderstands what’s going on when they make market transactions.
In any case, I hope people can at least take away from the conversation some understanding of the scales involved: HFT gets way too much attention relative to its importance in the financial industry. Meanwhile, the boring stuff like private equity gets away with paying 1/2 the tax rate the rest of us do on massive flows of cash.
Omnes Omnibus
@HRA: Well, it has crossed Lake Superior and moved into the Michigan’s UP. From there, it has crossed into Northern WI and MN. As has an adaption of the “aboot” sound.
Chetan Murthy
@patrick II:
All the other trading. HFT refers to a specific form of trading, where traders decide whether to buy/sell based on information they get and place their orders, before others (who aren’t doing HFT, and might be really far away) even get a chance to -see- the information. But for instance, day traders aren’t engaging in HFT. Most trading isn’t HFT. This Tobin tax is on all trades, across a wide variety of assets.
ola azul
@Omnes Omnibus:
Ufda!
MomSense
Ugh, modern job hunting means you have to do a different resume for every damn job offering. If you don’t put all the specific buzz words from the listing in your resume the algorithm will reject you.
I hate buzz words!
Can we replace the computers with human beings?
Omnes Omnibus
@MomSense: I know people who have put every industry related buzzword into a footer on their resume in white on white. Human can’t see it, but computers can. I never tried it so I can’t speak to results.
Chetan Murthy
@beef:
This is pernicious nonsense. HFT firms use the fact that they get first crack a the stream of buy/sell orders, to beat other players. But the -basis- of capital markets and the efficiency claims that are made for them, is that all players have access to the same information more-or-less at the same time. There used to be -regulations- to ensure this. Furthermore, the “insurance” thing is also bullshit for two reasons:
(1) HFT is there to buy the stock you want to sell, unless the markets falls hard, in which case, no, they’re not there. B/c they’re going to want to sell on that stock, soon after they buy it from you. If they see the market falling, they’re not going to want to take that risk.
(2) There have always been what are called “market-makers” who perform this function: HFT guys aren’t unique in doing this.
But the real problem is the first one at the top: HFT firms benefit from unfair trading advantages that are not available to other participants. And this is inherently wrong, b/c it doesn’t benefit anybody. For every dollar that an HFT fund makes, somebody else lost a dollar.
Another Scott
@beef: Yeah, they just wanna help Grandma.
Sure:
I guess they don’t understand what HFT is either, huh.
:-/
FWIW.
Cheers,
Scott.
Mnemosyne
@Brachiator:
IIRC, there is no other country where the actual healthcare providers (i.e. hospitals and medical groups) are run as for-profit private companies. Almost every country has for-profit insurance companies that are allowed to sell supplemental insurance for stuff like upgrades to your hospital room. Most pharma companies worldwide are for-profit as well.
Or, to put it another way, there is no other country that I’m aware of where cancer patients are expected to make a profit for the hospital that treats them.
ola azul
@MomSense:
I’m sorry, MomSense. I’m afraid we can’t do that.
dnfree
If people aren’t on Medicare themselves, or close observers of a parent or someone else on Medicare, they really don’t understand what these proposals are or how they would work. People might think it’s a wonderful plan that pays for everything, for instance.
Before I went on Medicare, I went to a presentation by the one and only Advantage plan available in our area. The plan representative even said, IF you have known health conditions (which many people in their sixties do), and IF you can afford it, you will have better coverage with conventional Medicare and a supplement plan than with Advantage. I have supplement plan F (which is going away because it’s too generous), and it has covered some major health issues without costing me a penny out of pocket. No co-pays, no deductibles. But the supplemental insurance is expensive, and goes up with age.
Advantage plans are great for people who don’t have expensive health issues. I’m covered anywhere in the country by any medical facility that accepts Medicare. Advantage plans have a limited network. It isn’t anywhere near the panacea it is presented as.
MomSense
@Omnes Omnibus:
I love that idea. I’m going to google it and see what I find.
ola azul
Oops. Fucked up correx to bad link by reposting. Lo siento.
beef
@Chetan Murthy:
Your cost estimate is bullshit, because you’re making the incorrect assumption that most HFT power consumption is from the hardware executing trades. Running simulations to decide what logic the hardware should run is a more significant cost.
Likewise, HFT is market making; they are the same thing to first order. Like it or not, they’re selling price insurance. If you don’t want what they’re selling, you can go to ICE or Jane Street and get hosed.
And no, obviously, they’re not looking out for Grandma. They’re just worried that one of the other HFT firms is going to beat them to Grandma. It’s textbook market competition.
chris
Past my bed time but I’m curious about this trading tax. IMHO a percentage just makes it harder for the little guy so why not have a flat tax per trade. The top stock on the NASDAQ today was Mylan. 61,207,80 shares traded in, get this, 272,157 trades. A 1 or 2 or 3 cent flat tax per trade looks pretty good, no? Now consider the top 20 volume list in front of me shows about two million trades. That’s the top 20 out of around 3300 listed stocks on one exchange. Tax all trades on all the exchanges and pretty soon you’re talking real money.
Jim, Foolish Literalist
I was scrolling through podcasts on my phone today and stumbled across one from over a year ago, when Willard had just declared as a candidate for Senate, McKay Coppins said he was confident Romney would adopt a position of principled Republican check on Donald trump. I am a bit– a very little bit– surprised he didn’t try to step into the John McCain role for the media, they want so badly to love him.
L85NJGT
@Chetan Murthy:
That’s old school stuff.
There is a shift from fee for service to value based healthcare payment, and to a digital world where algorithms can do in real time what took an army of auditors years to suss out.
Jager
@Felanius Kootea:
I’m Kaiser member, I’m on Medicare. I buy my supplement from Kaiser for $8.00 a month. My co-pay for drugs is minimal. I pay 16 bucks for three months of coumadin and another 16 for my blood pressure medicine. My 1/4ly lab work (blood tests) costs 30 dollars. A Doc visit is 15 and the eye operation I had for cataracts cost me 250 out of pocket, my share of the cost of the 450 dollar lens. I had the AARP plan for a year before I joined Kaiser. I paid 120 a month for it. Kaiser is the best health plan I’ve ever had. Mrs J is too young for Medicare and has the Covered California Kaiser silver plan, her cost is a little over 400 a month and it’s a solid plan. Kaiser is an outstanding organization. My old neighbor is a Kaiser doc and told me I was out of my effing mind for going with AARP as a supplement, I took his advice.
ola azul
Page loads, finger hits link — oops! no it don’t! yer off galavanting to somewheres else!
Dumb 2001: A Space Odyssey joke. Prolly not worth the trouble.
Was tryn’ta commisserate ’bout my frustrations with the digital world, din’t come off, sorry MomSense.
Chetan Murthy
@chris:
You might think so, but note that “the little guy” shouldn’t be trading much anyway.. If he is, he’s getting robbed much more by the transaction fees that his broker charges already. Or by bad prices his broker quotes him.
Chetan Murthy
@beef: Again, this is pernicious nonsense. Read the Dean Baker column that @Another Scott linked-to, for more information. HFT is front-running. And that should be a a crime, but they’ve cleverly arranged things so that it’s not (yet).
Oh, and sure, it’s complicated stuff. Which is why you shouldn’t believe somebody who gets paid for believing the stuff is Great For Grandma; instead, listen to people like Dean Baker, who have a track record for telling the truth.
Aurona
I currently do ‘mystery shopper’ audits of both Medicare Supplement plans and Advantage plans with major carriers in my area, always at open enrollment. This is a very sound plan from a consumer point of view. People do like to have the option of private insurance and when it’s vibrant, costs go down and quality of service goes up, which has happened here. The no copay and no deductible option – which I currently have on my Advantage plan, is smart and doable.
Mnemosyne
@Jager:
Kaiser can be great as long as you don’t have any problems that are unusual. They really have trouble with edge cases. IIRC, Kaiser Northern California actually lost their transplant certification a decade ago because they fucked up too many people’s organ transplants.
patrick II
@Chetan Murthy:
Thx Chetan.
different-church-lady
@Another Scott:
As far as I can tell that’s true for about half of everything that goes on in this economy.
eldorado
not as bad as her terrible student load forgiveness proposal but still, it’s bad. make things simple and easy for people. and don’t bs about 10 year timelines.
“when I’m elected you will show your id and see your doctor.” that’s it.
piratedan
@Mnemosyne: they are intertwined, MetLife offers long term health care insurance (i.e. supplemental health coverage coupled with Medicare), and while Kaiser is indeed a provider, its not as if they’re not heavily threaded with people who perform tasks that require coding, billing, and a pre-ponderance of all things medical. What I am saying is that there are multiple facets to the “private healthcare insurance” entity and waving a slogan at them has little to do with actual reform and providing actual coverage. One of the absolute best things that was jump-started by the ACA were the tax credits that allowed hospitals to upgrade and modernize their equipment which coincided with the advent of genetic solutions to a wide range of medical maladies and also additional approaches advancing patient care solutions where diagnostic tools and reporting saw an improvement in turning around the time it took from obtaining a sample to reporting of findings to speed diagnosis and treatment. All of that was made possible by more modern equipment in each hospital and medical organization that piled onto the opportunity. You guys talk about driving the profit out of healthcare, but without a financial incentive from somewhere, a good many of these advancements simply don’t happen in stasis.
Eolirin
Does KamalaCare meet the 218/50/5 threshold it needs to in order to have even a chance of becoming law? And that’s assuming dems nuke the filibuster.
If it doesn’t, and I don’t think it does, it’s nice to know she’s pushing something a bit more sensible than some other candidates, but the specific details don’t really matter that much. The president doesn’t get to write the legislation.
I don’t think we get anything though congress that isn’t an expansion of the ACA, unless Roberts decides to kill it this time after having backed away from that when it would’ve been politically safer to have done so. We’re more likely to get a further expansion of Medicaid for low income folk (increase the fpl percentage and move federal funding to 100%) and lowering the Medicare age to say 55 than to fundamentally realign things yet again. Also makes sense to push for some more regulation, especially on providers and drug companies. And any of that is going to be hard as hell to accomplish as it is.
When we’re going to have so many pressing issues to resolve post Trump and when the lift on climate change is going to be difficult enough and far more critical, it makes this particular fight not worth having, and far more likely to result in disillusionment and midterm losses than anything productive. We have serious crises ahead of us, we can’t be expending political captial foolishly.
This is the one policy area where Biden seems to actually be in the right, even if that response from his camp is ridiculous and clearly made in bad faith.
Chetan Murthy
@piratedan:
There is ample evidence that, for instance, for-profit hospital chains don’t achieve any economies of scale as they grow — indeed, they gain pricing power, and start extracting rents instead. Yes, money will always be an incentive. But what we have today is a perversion, in which money is basically the only incentive.
As they say, “markets in everything”.
L85NJGT
@different-church-lady:
Manufacturing is 12% of GDP. We’d have to bulldoze an ungodly amount of garbage directly into landfills to get to the 28% that it was back in the good old days of 1958.
trollhattan
Who’s in your wallet?
Zelma
Is anyone going to talk about medical costs because that’s the driver of many of our problems. I think the attraction of “Medicare for All” is the implied recognition that it would put caps on the outrageous charges that appear on many folks bills. When I went on Medicare, I was flabbergasted by the huge differential between what the providers charged and what Medicare allowed. I was in the middle of cancer treatment when I turned 65 and was stunned by the difference between what Medicare would pay and what I (or rather my employer who was self-insured) had been paying previously.
So I think part of the rationale for the “For All” people is that it could rein in costs. Of course, the implication of this is that not only the insurers but also the providers will oppose a “For All” program.
David ??Merry Christmas?? Koch
With Wilmer sinking like a rock, candidates now realize it’s was a mistake to chase after the tiny rose twitter vote.
Hopefully Warren figures this out and embraces a public option route.
piratedan
@Chetan Murthy: in my earlier entry, I stated that the biggest player on this needs to be regulation, which is something that the GOP loathes and tbh, most of the insurance companies when they had to comply with the ACA, complied with the ACA, overhead allowances went down, more money went to covering the policy owners like they should have been all along. I’m not looking at advocating a return to the “glory days” where HC execs got to buy multiple houses on the backs of denying claims so they could revel in hookers and blow, far from it. Just saying that a healthy system should include some sort of lever (be it profits, be it incentivized, something) that still allows for innovation and development. I have no problem if you want to make private insurance companies like long term bond investments where you cap their profit at 5%, but just also saying that as medicine begins to break down the human genome and can actually begin to target gene specific solutions is that in a non-profit system, there’s not a helluva lot of incentive to “go there” and when we rebuild the system, there has to be some entry point somewhere to allow for this, profit seems to be a relatively tried and true method, but I’m open to other potential motivators. It’s like if we make private health insurance obsolete, where do those jobs go? Do they all migrate into government positions?
This is hard stuff but we generally only see the personal cost, what does it cost me and my family without any kind of understanding or consideration of other costs or even of the “industry” itself.
Chetan Murthy
@piratedan:
Um, insurance companies play no role in this. None whatsoever. Hospitals play almost no role in this. And ….. well, we live in America, not in Soviet Russia. The idea that somehow we’re going to destroy the profit motive …. that’s not going to happen. But as i wrote above, it seems clear that large hospital chains (like large banks) don’t actually do their jobs more efficiently than smaller chains. Instead, the larger chains just use their pricing power to extract greater rents. And then there are “pharmacy benefit managers” and who-knows-how-many-other-middlemen out there. All extracting a rent, and doing nothing for the goals you outlined.
And even the innovation to which you refer: over and over, we learn that in fact all the key funding came from the government. For which the government gets no equity stake, btw.
Laurent Castellucci
@Miss Bianca:
Probably too obscure but I love that you referenced it.
Ruckus
@chris:
What would it look like to a small volume trader if the trade tax was on volume? Or to the large volume trader? The answer is, if there is a benefit for small or large volume trades, that is what would happen in the market. I don’t see how to tax trading fairly, across the board. A very large trade may have a financial advantage because the trade may be made just slightly cheaper to sell the volume or the opposite, just depends on how the tax is applied. The stock market is not all that dumb about making money. Now some of the traders are/can be but they usually loose in the long run and walk away. My point is that taxing trades quite possibly should be done but the effect has to be seen and worth the effort to bother. It has to be gamed out.
On the other hand having so much money movement as a capital gain that avoids more than 15% tax is an issue. It is of course also why the stock market actually exists in it’s current form. If some of that capital gains was taxed as normal income and the wealthy were taxed at a reasonable level we’d collect a lot more. It needs to be gamed out.
Chetan Murthy
@Ruckus:
Uh, I suspect that if you start with the Wikipedia article on “Tobin tax” (Prof Tobin, who originally proposed (a more-limited version of) the idea in 1972) and read some citations and such, you’ll find that indeed it -has- been gamed-out, and to great detail. This isn’t new.
opiejeanne
@Miss Bianca: Er, are looking for a name for our women heroes or the idiot attack-tokens?
My Side of Town
I switched to Medicare Advantage on Jan 1 of this year. I think it is much better than straight medicare and my provider pays most of my Part B premium, plus I get some dental and an interested primary care doctor who insists on seeing me at LEAST 4 times a year and as often as I think I need her. Harris’ plan sounds like it will preserve all that and yeah there are copays and oop costs, but they are the same as medicare. So what’s not to like?
Jay
So, I read the 5 part series “Bundyville”,
https://longreads.com/2019/07/15/bundyville-the-remnant-chapter-one-a-quiet-man/
There’s scary stuff bubbling along in the American Id.
Ruckus
@L85NJGT:
The problem is that we do more and do it better with a smaller percentage of the people than we did 50 yrs ago. Same as in agriculture, we grow more with a smaller percentage. The production has gotten more efficient. So we have to find other things for some people to do. We still make stuff but it’s too expensive here to make cheap stuff, especially when other countries now can do the work. 50 yrs ago they mostly couldn’t, now they can. I know a Chinese man who immigrated here in 1949. Thirty yrs ago he was dying and wanted to go home to the old country to be buried in his home town. The entire family went with him and were amazed when they went to leave he was packing. They asked him why. The translation I was given was along the line of, “This place hasn’t changed in 50 yrs, people still live in huts with dirt floors, fuck this I want to be buried in a better place.” He came back and died. Got a fancy funeral with a limo, an LA city councilman, far more than I’ll get.
Our country isn’t a lot better than what that gentleman saw in his homeland. Here’s an article from Business Insider about the poorest city in each state. Interesting read. I can’t seem to get to a link right now, I put it in a comment in the last 2 or 3 days.
Ruckus
@Chetan Murthy:
Should have been clearer about who should game it out. The markets have and will continue to. The good traders have and will continue to. Not sure anyone in congress has. Pretty sure most of the rest of the country has no idea whatsoever. The markets and the traders naturally will, it’s their business. But their business runs/prejudices a dramatic part of our economy and most everyone else has no idea. It’s almost like being a good citizen means we should know this stuff. But we can’t all know it, game it out. The politicians need to game it and understand it. I’d bet some do, but I’m also pretty sure most don’t.
Chetan Murthy
@Ruckus:
I think you’ll find that lots of respectable economists have actually looked into this thoroughly. And sure, there are dis-respectable economists. But there are all good ones, who take their work seriously. People like Dean Baker, or Paul Krugman, or Brad Delong. Perhaps our Congresscritters haven’t looked into it thoroughly. But OTOH, I wouldn’t be surprised to find that Harris has respectable economists on her team, who have educated her to the extent possible in a presidential primary campaign.
Mnemosyne
@eldorado:
You realize that’s not how Medicare currently works, right?
So what’s your proposal to get from what we currently have with Medicare to your utopian vision of what you want Medicare to be? Harris gave us her specifics, so pony up.
Yarrow
@Ruckus: That’s funny. I know an older woman who was born in China and moved to the US as an adult. She’s now a naturalized citizen. She’s visited China and her family there many times over the years. She decided she wanted to move back to China and live there the rest of her life. Moved and stayed about four months until she moved back to the US. Said China was too modern now.
Mnemosyne
@piratedan:
And yet, oddly enough, they still manage to have medical innovation in socialist hellholes like France and Germany. It was a French scientist who discovered the AIDS virus during the worldwide search, but ended up being forced to share the discovery with an American who whined loud enough. Bayer hasn’t stopped developing drugs just because Germany has universal healthcare.
The difference is the locus of the profit. Do you expect the materials to be sold at a profit — the hospital gowns, the beds, all of the accoutrements— or do you expect the patient to create a profit?
In most countries, companies expect to make a profit on the items that surround the patient. In the US, companies expect to make a profit on the actual patient. That’s why insurance companies delay or block people from getting treatment — every time you need a medication or a treatment or a surgery, you’re cutting into their profit. Because YOU are the commodity, not the medication or the hospital gown or the other things that other countries make their profits from. The PATIENTS THEMSELVES are the creators or losers of profit.
That’s the problem with for-profit healthcare.
Steeplejack
@Felanius Kootea:
I don’t know what this means. I have Medicare and a Medicare Advantage plan through Kaiser, and I get treated at Kaiser facilities.
I was just at my local one on two consecutive days last week: dermatologist ($30 co-pay), optometrist ($5). Oh, and I called on Monday and got the appointments for two and three days later. Could have had one of them (can’t remember which) on the same day I called!
ETA: I don’t know how Kaiser could treat anyone at non-Kaiser facilities, since all their doctors are employees who work at Kaiser facilities. I think they do refer certain things out, but that’s rare.
Mike in DC
@Eolirin: This. I question the wisdom of obsessing over single payer in the near term when we may well have only 1 2 year term of Congress to actually effectuate even part of a progressive agenda. Obama focused on the ACA, and as a result only about 3 or 4 major pieces of legislation got passed before the Republicans took over again. Could we maybe think in terms of 5 or 6 policy pieces, including raising the minimum wage, a climate bill, criminal justice reform, election reform, immigration reform and maybe infrastructure? We could pass an ACA expansion with tweaks to the existing law.
I have my health insurance as a result of the ACA and while it’s not perfect, I don’t feel an urgent need to pass something new and “now now now”. I’d rather we focus our energies on a plethora of other issues than spend 2 years struggling to accomplish something on a single issue, no matter how important that issue is for a lot of people. Lots of other issues are also very important to many people.
Locke
I don’t like it. 10 years to implement? Whatever plan we pass needs to have tangible benefits to the public right away or it’ll be the 2010 midterms all over again.
Steeplejack
@Omnes Omnibus:
Probably Terry Pratchett, altlhough the phrase is original to John Knox.
JGabriel
@Mary G:
The problem I have with a ten year transition is that it allows the next president – likely a Republican since, after two terms, the presidency historically flips between parties more often than not – to come in and fuck it up before the transition is complete.
I’d prefer a five-six year transition instead, so Harris (or whoever is the next Democratic president) could clean up some of the problems (and there will be problems, given the nature of Congressional compromise) before she leaves office at the end of her second term.
Steeplejack
@ola azul:
Fixed your link. Yeah, probably not worth the effort for three seconds.
Pro tip: Got to erase/overwrite the http that the link form provides for you.
Steeplejack
@Chetan Murthy:
And the percentage is so small that it doesn’t hurt the little guy much. But it hits the whales doing gigantic trades.
Harris’s proposal is a 0.03% tax? If Joe Blow buys 100 shares of a $20 stock, that’s 60 cents. For Goldman Sachs buying 1 million shares, it’s $6,000.
Hell, that doesn’t even hurt the whales very much. But it would generate a shitload of revenue.
Steeplejack
@different-church-lady:
Alien Radio addressed this in an interesting comment yesterday.
Steeplejack
@Chetan Murthy:
C’mon, dude, drop a link!
(Instead of making everyone else look for it.)
Steeplejack
Oops, I appear to be talking to myself.
patrick II
@Ruckus:
Congressmen can’t really learn all of the things policymakers should know to make good policy.There was a time before Newt Gingrich when there was a large stable of knowledge experts in different policy areas working for congress. They are mostly gone now. That leaves it to lobbyists and Alec and Heritage, etc. Thank goodness for the CBO or we would be more screwed.
eldorado
@Mnemosyne: that’s exactly my point. voters don’t cares about the specifics. don’t bother with them. it yields nothing.
Yellowdog
@Chetan Murthy: They have a MC Advantage plan which covers EVERYTHING except small visit and prescription copays. My mother had it and her last illness, which involved 2 hospitals, neurosurgery, and two weeks in ICU, cost zero dollars. But then, Kaiser is a true HMO, physicians are employees, not independent contractors.
J R in WV
@ola azul:
Hal says: “I’m sorry, Dave. I can’t do that.” Was that the one you were looking at?
Ruckus
@Yarrow:
A lot depends on the year you are talking about. China has made a lot of changes in the last 30 years, all of them towards at least making it look modern.