Monday, May 22, 2017

Beowulf — Health is the War of The State

The first step of any political reform, I’ve always believed, is to figure out how to achieve the desired goal with the minimum number of changes to the existing legal structure. [Beowulf if a lawyer.] As I’ve written before, Obama’s healthcare plan should have simply been a universal plan similar to Medicare (if not Medicare itself) that covered every American from the day they were born instead of when they turned 65. It would have been faster, cheaper, more universal (as in 100%) and more popular. It was a mistake Obama didn’t take that route and unlike Bill Clinton, he didn’t have an excuse for it....
Beowulf tells how to get there with Pete Stark's Americare and why the Democrats Medicare for All bill (HR 676) is a non-starter the way it is written.

As a lawyer, Beowulf thinks of policy in terms of the actual bills that would need to be passed into law. This involves getting from here (status quo) to there (desired objective), along with what it would take politically to do so. This is something that economists and a lot of public policy people miss.

Monetary Realism
Health is the War of The State
Beowulf

38 comments:

Penguin pop said...

And Warren went into how if done properly, universal healthcare could end up being cheaper than the botched plans we have now. In his plan, I don't recall it being government running every single aspect about healthcare, it's more about the financing there as well. Correct me if I'm wrong, Tom.

Tom Hickey said...

Right. Americans are individualistic people, and they don't want government involved any more than it needs to be.

Funding is one thing while administering is another. Americans don't like the idea of bureaucracy but they are more or less OK with funding.

The big objection to government funding is the erroneous belief that taxes pay for it in the present or future if put on the tab.

Education required. The public needs to understand government finance and also the difference between pubic and private goods.

With that understanding it's a no brainer.

There are many people that don't want the public to understand this.

Noah Way said...

Read this wrong, thought it was War is the Health of the State.

Dealing with BOcare. The good new is that I have insurance. The bad news is that it's useless.

Ryan Harris said...

The NHS is a political lightening rod. It would be nice if the US could have a system like Social Security or Medicare that isn't as controversial for healthcare.

The only problem that I see is these pay-go systems are vulnerable to top-heavy or bubbly population age distributions.

They could cause large investment swings (booms/busts) in the real economy.

Kaivey said...

Progressives are at a disadvantage because they say they will increases taxes. But with MMT, this could be reversed.

Penguin pop said...

Kaivey, even to this day, if you try to tell some of them these things, you'll get shit like "MMT is a scam" or "you're preaching supply side economics" or depending on if they were former Paulbots, you'll get responses like "MMT is correct in theory, but we have to do X, Y, and Z before we can help anyone."

I commend those who push through the bullshit and keep trying to tell the American people the truth, but it can be hard, but the tide is starting to turn and more people are learning about this stuff and getting educated.

Penguin pop said...

The most I can do from my end is keep informing people about who Stephanie Kelton is and getting into what politicians need to focus on, and when I frame it this way, people are more receptive to what I have to say, though you still get knuckleheads who want to strawman at every turn when you try to tell them that this doesn't have to be a strict set of order of operations to get the programs they need.

John said...

Tom, Americans may or may not be individualistic but most polls show a majority for single payer, and that's in a context of mass propaganda against single payer! Most Americans have done the smart thing and used their eyes: they've seen that it works elsewhere, and for all except the diehard market fundamentalists no amount of propaganda is going to convince them that their eyes are lying to them. If the Democrats had any sense, they could use health to kill two birds with one stone. If asked where will the money come from, instead of giving the sort of MMT answer that would scare 99% of the population into an early grave, instead the Democrats should simply say that they're going to go after the richest X percentage of the population. That could be a real vote winner. On top of that, they should channel some left populism and say that they don't want the votes of those richest x percent. Admittedly, this would require a very different Democratic party!

The Republicans and market Democrats revert to the line "Who you gonna believe, me or your lying eyes?" but they don't need to convince the population, who are against pretty much everything that comes out of Washington. Congress merely has to convince itself, which is about as difficult as walking and chewing gum at the same time. The people may want single payer, but their concerns are irrelevant. Most Americans don't want to start a stupid, bloody, counterproductive war on a ludicrous pretence with Iran, but the obese orange fraudster may yet give it to them.

Tom Hickey said...



This is true but it is a single question in a poll.

When other factors are mentioned, there may be conflicting answers, like are you willing to have taxes raised to fund it (which everyone believes to be obviously the case).

In other words, there are tradeoff involved in just about every decision.

Huge amounts of money get thrown at persuading people.

One of the difficulties in the US is that government programs creates entitlements for "those people," and it is pretty simple to demonize that.

This can be viewed as a game in game theory where people are willing to lose to prevent others from winning. Not rational maybe, but that's the it goes.

For example, it's possible that many Americans voted for Trump to punish the Establishment even though they thought he was an asshole and unlikely to help them much when all was said and done.

If this doesn't work out and the Establishment breaks him or gets rid of him, the next time they might vote in a bigger asshole.

Noah Way said...

the next time they might vote in a bigger asshole.

History repeating itself. In my experience every president has been worse than the previous one. Applies to congressional, state and local politicians, too. It will be interesting to see how they sabotage the next progressive candidate. Russian mole? It's working so well now ...

The only ray of hope I see is congresscritters getting threatened by constituents. But the end result of that will be that they all get taxpayer-funded personal security details.

Ryan Harris said...

Looks like California isn't getting single payer. Need to have a sovereign currency, perhaps?

Ignacio said...
This comment has been removed by the author.
Ignacio said...

Need to get rid of privileged cartels.

Matt Franko said...

"There are many people that don't want the public to understand this."

Stated again with absolutely no evidence.... "neo liberal conspiracy!"

I'll tell you what there is though: "There are many people that DO want the public to understand this."

And there IS evidence they are failing miserably....

Matt Franko said...

"Privileged cartels"

Here those cartels are the healthcare systems owned and operated by the academe....

"Single payer!" is an absolute cave in to these academic monopolies who are imo too stupid to come up with a price they would have to commit to...

Ignacio said...

I think they won't "commit to less", they need to keep their outrageous average salaries in everyone involved in the industry, that's money come out of your pockets guys. Directly or indirectly. The healthcare industry seems to be structured there as a winner-take-all zero-sum industry to extract as much money from the public as possible (they probably learned their lessons in the business schools, by economists and other hacks selling the whole "greed is good" shit). That's why they won't "come up with a price", they know the public would say FU if they ask for their stupid average salaries.

The whole HC industry in the USA is more or less 100% more inefficient than rest of the developed world, you can't have universal HC with those prices. You have to purge a lot of the inefficiencies as well as the privileges. For instance, administrative costs are like 25-50% higher than other nations, that's a lot of money.

What Democratic Californians (and by extension other states) want is probably squaring the circle: keep the extractive nature and structure of the industry as it without changing the status quo, while providing service for everyone. Well, grow up, it's not going to happen.

You want universal healthcare? Get money out of politics first or else. being 'or else' just keep going down the rabbit hole of a dysfunctional system. The "sovietization" of the USA was never more apt than now, you guys are heading there fast and cannot even see it (not much better over here either unfortunately with the clown-fiesta in Berlin/Frankfurt and Brussels).

Matt Franko said...

"It would create a new single-payer program called AmeriCare that would take on everyone ensured by Medicaid and SCHIP, and would automatically enroll all children at birth. It would pay the same rates to providers as Medicare, meaning it’d be considerably less generous to doctors and hospitals than private insurers.”

Maybe we could just make the providers slaves?

Matt Franko said...

I vote for healthcare slaves....

Matt Franko said...

"administrative costs are like 25-50% higher than other nations, that's a lot of money."

They still are COSTS....and legitimate costs when you have an insurance type of approach where there is no scale or guarantees... the providers have to submit itemized claims literally down to the individual bandaids (dressings)...

You can eliminate those costs with scale and guarantees... and STILL make a ton of munnie

The guy who sells Trump 100,000 guaranteed bars of soap at a time for a very low unit price STILL makes a ton of munnie...

Matt Franko said...

The incompetent left looks at those administrative costs and immediately thinks they are illegitimate.... because they are too stupid to figure out what is going on...

Ignacio said...

Yes, but you have to actually eliminate those costs (and others). Those are not costs generated OUTSIDE of the HC sector that then they are passing to you by extension, they are generated BY the HC sector to charge you more money. I'm sure the HC/insurance, etc. is not on board with it, as those costs to the public are part of their profits.

I'm just saying you are dreaming if you think you can get that shit done without destroying lobbyists. Anything that hurts the industry bottom line will never pass on Congress unless there is enough pressure from the people to do it. The other party (the HC industry) has nothing to lose by blocking the whole thing with their bought out puppets in DC as long as the population keeps putting the puppets there.

Matt Franko said...

Here:

http://www.medtronic.com/content/dam/covidien/library/us/en/services-support/reimbursement/reimbursement-coding-guide-wound-care-supplies.pdf

Code A6196 if less than 16"^2

Matt Franko said...

Somebody has to be paid to code in all of this information.... and it is a LEGITIMATE COST incompetent lefties....

Matt Franko said...

Those costs are a legitimate cost created in the business process we have in place...

To get rid of them you have to change the business process by establishing scale and guarantees...

This is imo what Trump is attempting to do with the monthly advanced tax credits... i.e. create scale and guarantees...

Noah Way said...

"Single payer!" is an absolute cave in to these academic monopolies who are imo too stupid to come up with a price they would have to commit to...

Prices are set by the middlemen - the insurers and their diagnostic codes - what they "allow". Which keeps going down to rack up their profit. Meanwhile the providers keep raising rates to compensate. Look at a bill, payments are running about 15% of charges. And that's just the tip of the iceberg. Narrow, non-competitive "networks" (monopolized markets), for-profit vs. for-health systems, etc., etc.

I need a hernia repair and nobody can tell me what it will cost. I'm the meat in the sandwich.

Ignacio said...

Nah, they don't want the status quo to change, if they wanted they would have changed it long ago, because it's not rocket science (double the cost, half the service of the average developed nation, it's not a small difference to have figured it out by now after decades of building up inefficiencies).

Is not that I don't understand your point Matt about scales, is that is not going to happen because there is no real interest in it happening, and regardless if Trump is onboard with that he won't accomplish it (politically he is on life support, as he failed to purge the internal opposition and never had much of a back up anyway) as he cannot do it by mandate and overrule Congress (well he can try something weird, and will be the last thing he does).

Ask any lobbyist who works in this sector for what they want, pretty sure they want the status quo to continue. Even if it did make sense financially for them (which doesn't), sheer laziness and the conservative nature of business would reject any serious change probably.

Tom Hickey said...

"There are many people that don't want the public to understand this."

Stated again with absolutely no evidence....


Paul Krugman to Bernard Lietaer: "Never touch the money system!"
https://youtu.be/Q6nL9elK0EY

Paul Samuelson: The balanced budget myth
https://youtu.be/4_pasHodJ-8

Tom Hickey said...

Here those cartels are the healthcare systems owned and operated by the academe....

Insurance companies in a field that is a public good and natural monopoly, as shown by every other developed country in comparison with the US.

Tom Hickey said...

Eliminate the ins cos and have the federal government as the sole funder. Then the monopoly nature of HD is recognized and prices are set by what the government is willing to pay.

If prices are higher than they need to be (rent extraction), then the cause is corruption. Let the people deal with that at the ballot box.

Right now there is no accountability in the system.

blissex said...

TGhe technicalities are interesting and "Beowulf" is practical, but the bug issue is political will.

The assumption that everybody makes including in this comment thread is that it is all about a federal program. But Romneycare was enacted for Massachussets only before being turned into a national program by Obama.

The big question is why ever big Democratic legislatures in states like New York or California haven't created in several decades an Americare/single payer system for their states. I can imagine why states that have had Republican legislatures for decades did not, but several state have had huge "progressive" majorities for decades and have done nothing.

Does anyone have a good explanation for that glaring omission other than the hard opposition of trade unions? Trade unions in the USA are essentially guilds, and they were very keen to ensure that health care plans were solely a benefit of guild membership.

I reckon that all the discussions about federal healthcare are largely useless until someone explains why state-wide single payers has not been done for decades, except in very tentative form recently in Vermont.

First do in the states where it is "easy", and then as momentum builds up, create a federal system. Why hasn't this happened?

Jeff65 said...

Matt, the single payer doesn't pay the price. It sets the price. It's take it or leave it. This is how it actually works in a place that has single payer.

Tom Hickey said...

1. States are not currency issuers and they cannot run deficits. They have to tax or borrow based on future taxes.

2. Clout. States can't set prices the way the federal government can.

Ryan Harris said...

It's a feedback system where doctors, nurses, hospitals, finance, bond holders, patients, pharma, science researchers make up 25% of the population and vote for policy that benefits themselves at the expense of the majority who are largely unaware or unwilling to confront the spectacle of price gouging. Team politics.

Matt Franko said...

The government under pays and the corporations that provide medical care benefits to their employees and up subsidizing the rest of the insured

Matt Franko said...

Trump is trying to use the subsidies and the HCA to establish scale it guarantees which is going to lower he thinks the price of premiums and deductibles he isn't going to explain this to the Neo confederate nut jobs in the freedom caucus all they wanted to ever to do was to effectively lynch Obama by repealing Obamacare

Tom Hickey said...

The government under pays and the corporations that provide medical care benefits to their employees and up subsidizing the rest of the insured

This is why there should be single payer.

Health care is not natural rivalrous or excludable.

The country has already decided that HC should be available to all and even the most hardline proponent of HC as a privilege rather than a right say that everyone has access through emergency room.

The reason that HC is rivalrous results from creation of artificial scarcity of providers through various means such as licensing, making it difficult for providers to cross from one jurisdiction to another, and limiting training opportunity through lack of funding expansion indicated by population increase.

A single-payer solution could eliminate the rivalry and excludability easily by changing regulation and providing adequate funding for needed resources.

A single-payer that is the currency issuer could also use its monopoly power to set payment schedules fairly while making HC universally available as a public good and a social dividend in a developed economy.

Calgacus said...

Noah Way: Have you thought about Shouldice?

That's where Ralph Nader & many others went.

blissex said...

These are not explanations, they are tenuous excuses:

«1. States are not currency issuers and they cannot run deficits. They have to tax or borrow based on future taxes.»

Well, MMT correctly says that government spending has to be funded by taxes and cannot be funded by currency issue if there is full employment of real resources, and California and New York and other democratic-run states have had decades of full employment.

So this excuse really is "democrat voters in democrat-run states are not willing to pay taxes to cover the cost of universal care".
That becomes a rather more damning argument than "democrat supporting trade unions want to keep health care a guild privilege".

Also note that since 2000 the eurozone contries are not currency issuers yet most fund their universal care systems with taxes.

«2. Clout. States can't set prices the way the federal government can.»

The economy of Canada, or for that matter Denmark, is smaller than that of many democrat-run USA states, yet they don't seem to have that problem and have universal health care plans.