In your 2/15/19 issue Jonathan Cohn highlights several theoretical and pragmatic issues surrounding the Medicare for All type of a National Health Plan, as embodied in the House bill, HR 676, first introduced in 2003 by Rep John Conyers of Michigan and most recently being reintroduced with significant modifications as HR1384 by Rep Pramila Jayapal, D-Wash. I am not aware of any poll showing the American people to prefer our current needlessly complex, dysfunctional, multi-payer, for-profit system over a simple, publicly financed, privately-delivered care under a social insurance system.
Depending on how the survey/poll question is worded, people are willing to trade a higher payroll deduction/tax if self-employed for total elimination of premiums, high deductibles, copays and other high out of pocket expenses. This is evident among the population across a wide spectrum of socioeconomic status, from the well-insured upper middle and middle class to the underinsured and uninsured who number about 70 million lives, per the best estimates by the Congressional Budget Office. Presidential candidate Sen Bernie Sanders in 2016 did a yeoman’s job of putting the topic front and center of the national conversation and public debate.
The concept of a national health plan for America and the history of several failed attempts to implement it, goes back to the Progressive Era under Presidents Teddy Roosevelt to Woodrow Wilson and to the attempt by FDR in the mid-1930s who, in the face of fierce opposition scaled back from including healthcare under the new Social Security Scheme, where as his Labor Secretary, Frances Perkins, was known to have pushed for a comprehensive plan for securing social justice for the ill and the elderly; and again to the early 1970s, when President Nixon upstaged Sen Ted Kennedy’s proposal for a national healthcare plan, basically modeled on the then-new and unfolding Medicare-Canada program, with introduction in 1972 of the Health Maintenance Organizations (HMOs), which, along with its several subsequent iterations, soon became a ubiquitous bane on the healthcare scene over the decades since.
Regarding the cost of a National Health Plan, Democratic sponsors of Medicare for All and Bernie Sanders do have projections and illustrations that speaks to this. A prototypical family of four consisting of two adults and two children, earning $55,000.00 a year, will pay a total of about $5,000 per year from payroll, split roughly evenly between employer and employee, and obtain comprehensive coverage of ALL medically necessary care including long-term care, dental, vision, hearing and mental health services. Currently, a similar average family’s bill for healthcare stands at $22,000 per year, including out-of-pocket expenditures and wages diverted as employer contribution.
With a 4.75% payroll deduction, inclusive of the current 1.45% Medicare portion of the FICA withholding, and a 4.75% contribution from the employer, it has been estimated by several leading healthcare economists that the nation can afford to provide universal coverage, costing about $400 billion dollars LESS than our current annual tab of $3.5 trillion, constituting 18% of the GDP!
A recent study by Mercator, a conservative think tank, estimated the cost of a Medicare for All program to be around $33 trillion over a decade, yet it reluctantly concluded that it will be cheaper than our current national healthcare expenditure at $3.5 trillion a year, which is consistent with estimated savings of about $400 billion annually, per several healthcare economists, such as Gerald Friedman at Amherst, Jonathan Gruber at Harvard, Ken Thorpe at Emory, Uwe Reinhardt at Princeton and others.
Professional income of doctors, nurses and other healthcare providers will remain mostly unchanged, depending on specialty, practice model and region, as evidenced by available, comparable and credible data from our Canadian counterparts practicing under their public system, showing a stable, steady and modest increase in income when compared to the pre-Medicare era in the country to our north.
Bifurcating operating budgets from capital budgets of hospitals and a prospective payment mechanism in a non-profit setting has worked successfully in all other advanced-economy nations, where expansion of services and creation of new facilities are, by design, aligned with the healthcare needs of the community and the region served, rather than being driven by “need to capture an ever increasing market share.”
Price negotiation for drugs, medical equipment, devices and hospital care using the monopsony clout of a national system lay at the core of the reasonable and fairly-structured cost-control strategy that prevails in most other industrialized countries that do treat provision of healthcare as a public good and not as a commodity in the market place. We certainly are an outlier and an oddity among advanced nations when it comes to efficiency, sustainability and equity in healthcare financing and to a lesser extent in delivery, with our top-heavy distribution of specialty services and understaffing of primary care and scarce rural access.
The nation that mustered the public will and purpose to put a man on the moon, unleash the energy enclosed in an atom, defeated the Nazi-fascist powers in World War II and banded together as one People Indivisible in September 2001, can and must generate the political will in our elected leadership at all levels to enact a publicly funded, privately delivered system in this country, more than a century after Chancellor Otto Bismarck launched one in Germany in 1880s. It is highly feasible and doable if We the People take our destiny in our own hands and persuade, pressure, beseech and browbeat the leaders that hold power in our name, to eradicate the unconscionable national scourge of medical-care denial, based on income, race, gender or geography ,once and for all from this land we call home: America the Beautiful.
Ahmed Kutty M.D., Peterborough, N.H.
Re: “Trump Ignites a Perilous New Nuclear Arms Race” by Katrina Vanden Heuvel [3/1/19 TPP]. What we are witnessing in the current proliferation of nuclear weapons is a replay of what we’ve all seen in cops and robbers films: Two guys pointing a loaded gun at each other’s head.
Well, it doesn’t take a genius to understand that if each guy pulls the trigger at the same time, they’ll both end up dead. Don’t the experts who lead countries with nuclear arsenals realize that what they are risking is exactly the same? Except, of course, that their bravado will result in death to millions of people … and render much of the world uninhabitable?
Why is it that those leaders are unable to understand what is already obvious to all of us ordinary people?
David Quintero, Monrovia, Calif.
It’s impossible to come to terms with the scope, depth, gall and lethal audacity of the United States rationalization for publicly choreographing a government coup in Venezuela. Members of the Trump administrations are trumpeting their deep, passionate concerns over human rights violations as over throw justification. It’s an extraordinary achievement that these individuals can showcase their human rights concerns for Venezuela without doubling over in hysteria or turning into a pillar of salt given our unwavering alliance with Saudi Arabia.
Criticizing Venezuela over their human rights record while simultaneously partnering with Saudi Arabia as they orchestrate a protracted genocide against Yemen is on a par with Adolph Hitler showcasing moral outrage over reported corruption in the Swiss fashion and garment industry prior to his 1939 invasion of Poland.
First there’s that messy little issue of over throwing elected governments and installing torturers and mass murderers as our puppet heads of state of which we have a glorious history. Ask Guatemalans and Salvadorians how that has worked out. However, this grotesque violation of international law pales in comparison with our unholy alliance with Saudi Arabia.
The United States is the willing and proud partner in crime with Saudi Arabia and we are talking about crimes and criminality on a truly epic scale. What the Saudi’s are doing to Yemen with our full support, assistances and endless military aid is perpetrating one of the century’s great genocides. Thousands have already perished and 13 million are at risk for starvation. The human, environmental, social and political costs of the destruction of Yemen may never be fully realized. However, we the people, who apparently have all reason if not sanity impaired by the political opioid we call “American Exceptionalism,” seem oblivious of our direct and damning role in this seismic global tragedy.
We indeed need a moral and intellectual wake up call. One small step towards a better future is recognizing and calling out immediately the lies our demagogues express about “human rights” concerns. The survivors of the Yemen genocide could offer true enlightenment here.
Jim Sawyer, Seattle, Wash.
After 20 odd years of myriad attacks by American imperialism against Venezuela’s Bolivarian revolution, (including a coup d’etat in 2002, Bernie Sanders should be able to articulate a robust progressive response to the many years of crippling sanctions that Mark Weisbrot [in “Trump’s illegal regime change operation will kill more Venezuelans,” 3/1/19 TPP] correctly describes as illegal under international and probably US law. It should be obvious that they serve only to pave the way for one more domino to fall in America’s dangerous game of regime change roulette.
That Bernie’s only able to offer lame liberal platitudes that play into the machinations of the Bolton/Abrams/Rubio troika proves that he’s not ready for prime time on the international stage.
Robert McAllister, Lantana Fla.
How many times have we heard that the progressive proposals endorsed by the Democrats will break our economy, will be rejected by the moderate voter? Sen. John Cornyn (R-Texas) quoted Mussolini in saying new benefits will strangle our freedom:
“We were the first to assert that the more complicated the forms assumed by civilization, the more restricted the freedom of the individual must become.” — Benito Mussolini
Well, surprise! These proposals aren’t some pie-in-the-sky ideas; most of the developed countries already have them. Our problem centers around how the rich and corporations, since the 1970s, bought favor from our politicians to the extent that our workers are starved while the rich and the corporations hoard the money that should be shared by the middle class. It is high time that our “moderates” learn they can claim what should rightfully have come to them in the first place by getting out and voting.
Lee Knohl, Evanston Ill.
You know, our illustrious president has used illegal immigrants’ labor for years to benefit and enrich himself, but now all, of a sudden, it’s a major problem for America. Look, how stupid does Trump think the American people are? In his own mind, he thinks he’s “Making America Great Again.” In reality, he’s “Making America Grate Again.”
Mike Eklund, Mercer, Wis.
From The Progressive Populist, April 1, 2019
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