Health Costs And Benefits

Americans have been arguing over health care (actually, health insurance) for my entire life–and as I frequently mention, I’m old. Every time the federal government has extended access to health insurance, conservative politicians have insisted that America cannot afford it.

“Medicare for All” proposals invariably meet with outrage–and disinformation. In addition to insistence that universal health care would bankrupt the country,  opponents used to warn that extending access would ruin what they say is the “best medical care in the world.”

That claim that “we’re number one” has diminished considerably, as more people have recognized that we’re actually number thirty-seven or thirty-eight, and that the only people who receive the “best” medical care are people who have lots of money. But Republicans have continued to insist that America just can’t afford universal coverage.

Which brings me to a very interesting report in The Hill, titled “22 Studies Agree: Medicare for All Saves Money.”

The evidence abounds: A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money.

Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage.

The studies found that Medicare for All would eliminate three-quarters of the estimated $812 billion the U.S. now spends on health care administration. Administrative costs in the United States are so high because insurance companies–and there are hundreds, if not thousands of them– individually negotiate benefit rules and rates with thousands of hospitals and doctors. They also require different billing procedures , use different forms and have different rules for submitting claims.

The studies estimate that savings from Medicare for All would be about $600 billion per year. And that’s not including savings on prescription drugs, estimated to be another $200 or $300 billion a year if we paid about the same price as other wealthy countries pay for their drugs.

Even more savings are possible in a Medicare for All system because, like every other wealthy country, we would have a uniform electronic health records system. Such a system generates additional savings because system problems would be easier to detect and correct. A uniform claims data system helps reduce health care spending for fraudulent services. In 2018, total U.S. health care costs were $3.6 trillion, representing 17.7 percent of GDP.

The “cherry on top” of these calculations? Savings were calculated assuming the elimination of deductibles and out-of-pocket expenses.

The article also pointed to something that is not widely understood: government already pays approximately two-thirds of all American health care costs. A few years ago, when I participated in a multi-disciplinary study, the calculation was that some seventy percent of all health costs were being paid for by some unit of government– not just via Medicare and Medicaid, but also through the VA, CDC awards of research dollars,  federal, state and local health care programs, coverage for government employees (including thousands of employees of public schools and universities), and ACA tax subsidies for private insurance.

A more expansive and accurate cost/benefit analysis would also include things like the decline in bankruptcies–some 50% of personal bankruptcies are due to medical costs not covered by insurance.–and evidence that crime and other forms of social discord decline sharply when social safety nets improve.

Here’s my question: if Medicare for All improves health care and costs less, what is the real reason so many Republicans oppose it?

Comments

It Isn’t Just Media Literacy

Americans today face some unprecedented challenges–and as I have repeatedly noted, our information environment makes those challenges far more difficult to meet.

The Internet, which has brought us undeniable benefits and conveniences, also allows us to occupy “filter bubbles”—to inhabit different realities. One result has been a dramatic loss of trust, as even people of good will, inundated with misinformation, spin, and propaganda, don’t know what to believe, or how to determine which sources are credible.

Fact-checking sites are helpful, but they only help those who seek them out. The average American scrolling through her Facebook feed during a lunch break is unlikely to stop and check the veracity of most of what her friends have posted.

There is general agreement that Americans need to develop media literacy and policy tools to discourage the transmittal of propaganda. But before we can teach media literacy in our schools or consider policy interventions to address propaganda, we need to consider what media literacy requires, and what the First Amendment forbids.

Think about that fictional person scrolling through her Facebook or Twitter feed. She comes across a post berating her Congressman for failing to block the zoning of a liquor store in her neighborhood. If our person is civically literate—if she understands federalism and separation of powers– she knows that her Congressman has no authority in such matters, and that the argument is bogus.

In other words, basic knowledge of how government works is a critical component of media literacy.

It isn’t just civic knowledge, of course. People who lack a basic understanding of the difference between a scientific theory and the way we use the term “theory” in casual conversation are much more likely to dismiss evolution and climate change as “just theories,” and to be taken in by efforts to discredit both.

To be blunt about it, people fortified with basic civic and scientific knowledge are far more likely to recognize disinformation when they encounter it. That knowledge is just as important as information on how to detect “deep fakes” and similar counterfeits.

There are also policy steps we can take to diminish the power of propaganda without doing violence to the First Amendment. The Brookings Institution has suggested establishment of a “public trust” to provide analysis and generate policy proposals that would defend democracy “against the constant stream of disinformation and the illiberal forces at work disseminating it.”

In too many of the discussions of social media and media literacy, we overlook the fact that disinformation isn’t encountered only online. Cable news has long been a culprit. (One study found that Americans who got their news exclusively from Fox knew less about current events than people who didn’t follow news at all.)  Any effort to reduce the flow of propaganda must include measures aimed at cable television as well as online media.

Many proposals that are aimed at online disinformation address the social media protections offered by Section 230 of the Communications Decency Act.  I reviewed them here.

Bottom line: we can walk and chew gum at the same time.

If and when we get serious about media literacy, we need to do two things. We need to ensure that America’s classrooms have the resources—curricular and financial—to teach civic, scientific and media literacy. (Critical thinking and logic would also be very helpful…) And policymakers must devise regulations that will deter propaganda without eviscerating the First Amendment. Such regulations are unlikely to totally erase the problem, but well-considered tweaks can certainly reduce it.

Comments

HR 1

HR 1 was the first bill passed by the House of Representatives after the Democrats won control in 2018, and it languished, of course, in Mitch McConnell’s “do-nothing-good” Senate. The question now is whether– with Democrats razor-thin control of that body–it can be passed.

Because passage is truly essential if we are to recover basically democratic governance.

There have been a number of articles and editorials about HR 1, but I particularly agreed with the headline on the subject from Esquire:“If We Don’t Pass HR 1, We Are F**ked As A Nation.”

The headline came from a quote by Josh Silver, who works for Represent.Us, a nonpartisan nonprofit dedicated to ending political corruption, extremism, and gridlock.  The organization has promoted model legislation very similar to HR I since 2012.  Silver believes that, should we fail to pass these reforms,  America will continue what he calls “our decline into authoritarianism.”

“It is these problems that the bill addresses that are the root cause of the extremism and polarization that gave rise to Trump and the new sort of anti-representative form of government that the Republican Party has chosen to embrace. And I’m saying that as a truly nonpartisan guy.”

So–what would this measure accomplish?

Title one of the bill is John Lewis’s Voter Empowerment Act. Lewis introduced it–and saw it die–in five congresses in a row. It would make voting and access to the ballot box easier and more convenient by creating automatic voter registration across the country, and expanding early and absentee voting. It would also restore voting rights for felons, streamline the vote-by-mail process, and prohibit various voter-suppression tactics currently in vogue. It would also beef up election security– promoting the use of paper ballots and strengthening oversight of election-system vendors. (It also evidently backs a  grant of statehood for Washington, D.C., although not directly.)

In my favorite part of the bill, HR 1 would take on gerrymandering. It would require states to use independent commissions subject to strong conflict-of-interest rules. District maps would be approved differently, and would be more easily challenged if they are partisan and/or unrepresentative.

Another part of the bill–called the Disclose Act– would address “dark money” in politics.

The bill would institute an “Honest Ads” policy, where disclosure requirements for online political advertisements are expanded and strengthened. It would put in place a “Right to Know” policy where corporations would have to make shareholders aware of their specific political activity. It would root out participation of foreign nationals in fundraising—a foreign money ban. It would, per the name, beef up disclosure requirements for organizations engaging in political spending, including by reinforcing the Internal Revenue Service’s powers and prerogative to investigate misuse of charities to hide the source of political money.

The bill also addresses fundraising for Inaugurations, which has previously been a way for wealthy donors to curry favor with incoming administrations.

And finally, HR 1 deals with lobbying. It closes what has recently been called “the Michael Cohen exception,” where people who don’t lobby directly aren’t covered by some of the registration requirements, and it gives real enforcement power to the Office of Government Ethics. The bill bolsters ethics law in general: it requires presidents to release their tax returns, expands conflict-of-interest policy and divestment requirements, and attempts to slow the “revolving door” through which members of Congress and their staff have moved between government and the private sector, influence peddling while lobbying or serving  on corporate boards.

There are other provisions, but this overview gets at the major elements. Every citizen who has railed against vote suppression, despaired of getting rid of gerrymandering, and  cursed the outsized influence of big money in politics should lobby their Senators for its passage.

Comments

The GOP And QAnon

GOP Senator Ben Sasse says all the right things–although his voting history is, shall we say, a bit more complicated. Sasse has a recent essay in the Atlantic in which he challenges his party to choose between conspiracy and reality–between the “delusional QAnon conspiracy theory,” and rationality.

We hear a lot about Qanon, but to understand not just Sasse’s argument but the political moment we inhabit, it’s important to recognize just how insane it is.

Although there are various iterations, the basic “theory” that supporters accept requires them to believe  that a “righteous” Donald Trump (!) is leading a “historic quest” to expose the fact that America’s federal government has been captured and is being controlled by a global network of cannibalistic pedophiles. This “cabal” includes not just the despised “deep state” bureaucrats, but also the Supreme Court’s Chief Justice and at least a dozen senators (including Sasse), along with George Soros and other notable Jews. (The conspiracy borrows heavily from the Protocols of the Elders of Zion.) When Mike Pence explained that he couldn’t refuse to accept the certification of electoral votes, QAnon cultists added him to the network, ignoring his four years of sniveling sycophancy,

Millions of Americans actually believe this insanity. Virtually all of them are Republicans.

Writing in the immediate aftermath of the Capitol insurrection, Sasse makes what should be an obvious point: the GOP can be a political party, or a bizarre cult, but not both.

The violence that Americans witnessed—and that might recur in the coming days—is not a protest gone awry or the work of “a few bad apples.” It is the blossoming of a rotten seed that took root in the Republican Party some time ago and has been nourished by treachery, poor political judgment, and cowardice. When Trump leaves office, my party faces a choice: We can dedicate ourselves to defending the Constitution and perpetuating our best American institutions and traditions, or we can be a party of conspiracy theories, cable-news fantasies, and the ruin that comes with them. We can be the party of Eisenhower, or the party of the conspiracist Alex Jones. We can applaud Officer Goodman or side with the mob he outwitted. We cannot do both.

As he notes, prior to the assault on the Capitol, GOP leadership figures and consultants told themselves that they could “preach the Constitution while winking at QAnon.”  What they have discovered–one hopes–is that such a strategy is impossible. If the party does not reject conspiracy theories, it will be consumed by them.

Sasse provides a perfect illustration of the fecklessness of Republican leadership:

The newly elected Representative Marjorie Taylor Greene is cuckoo for Cocoa Puffs. She once ranted that “there’s a once-in-a-lifetime opportunity to take this global cabal of Satan-worshiping pedophiles out, and I think we have the president to do it.” During her campaign, House Minority Leader Kevin McCarthy had a choice: disavow her campaign and potentially lose a Republican seat, or welcome her into his caucus and try to keep a lid on her ludicrous ideas. McCarthy failed the leadership test and sat on the sidelines. Now in Congress, Greene isn’t going to just back McCarthy as leader and stay quiet. She’s already announced plans to try to impeach Joe Biden on his first full day as president. She’ll keep making fools out of herself, her constituents, and the Republican Party.

In the remainder of the essay, Sasse makes a bow to the obligatory “both sides” equivalence (the Left has crazy people too!), and points a pop-sociology finger at media–all media, not just social media and the Internet; he also blames the collapse of “institutions” and “America’s loss of meaning.” If you click through and read that part of his essay, you can decide for yourselves whether you find it particularly helpful or insightful. (Spoiler alert: I didn’t.)

That said, Sasse is clearly correct when he says the GOP cannot be a “big tent” that includes people like Jeff Flake, Ben Sasse and even Liz Cheney–people we may strongly disagree with but still recognize as serious adults– together with lunatics like Marjorie Taylor Greene, Jim Jordan, Devin Nunes and Louie Gohmert.

No tent is that big. Sasse is clearly correct when he says that the Republican Party must choose between insanity and reality.

Comments

Antifa And The Right

Sometimes, when I was a little girl (eons ago–it may have been the Ice Age) and had done something I knew was forbidden, I would protest innocence: it wasn’t me! It must have been someone else! To which my mother would respond with an old verse:

Last night I saw upon the stair
A little man who wasn’t there
He wasn’t there again today
Oh, how I wish he’d go away…

These days, the “little man who wasn’t there” is likely to be a member of Antifa–currently the favored scapegoat of the Right. “It wasn’t us! It was Antifa!!”

Just who– or what –is Antifa? After an inquiry from a lawyer friend, I decided to do some research.

Is Antifa the the highly organized group of “terrorists” portrayed by Trump Republicans–a source of rioting and looting?  Or is it more accurately described as an idea–a dismissive label for people opposed to fascism and white supremacy?

Actually, according to an investigation by CBS News, it’s something more than a description of people opposed to fascism, but considerably less than an organized movement. (I’ve noticed that the quarrelsome Left has a lot more trouble organizing than the authoritarians on the Right.)

In general, people who identify as Antifa are known not for what they support, but what they oppose: Fascism, nationalism, far-right ideologies, white supremacy, authoritarianism, racism, homophobia and xenophobia. Some antifa activists also denounce capitalism and the government overall.

To the extent they “belong” to anything, Antifa followers tend to be members of small, local cells that sometimes coordinate with other movements, such as Black Lives Matter. Self-described Antifa members have organized to confront Patriot Prayer, the Proud Boys, and other far-right groups during public demonstrations, typically through researching and tracking those organizations, although some confrontations have become violent.

CBS was able to confirm only one instance in which a person self-identifying as Antifa was linked to a deadly attack at a protest. Michael Forest Reinoehl, 48, was considered a prime suspect in the August 2020 killing of a right-wing activist who was shot during demonstrations in Portland. (Reinoehl was later shot to death by federal authorities as they moved to arrest him.)

Given the hysterical accusations from Trump, Cruz and others, it is noteworthy that the Trump administration’s own Department of Homeland Security and FBI didn’t share the view that Antifa poses a significant threat to domestic law and order.

A DHS draft document from September 2020 reportedly named white supremacist groups as the biggest terror threat to America. That same document doesn’t mention Antifa at all.

The FBI also considers far-right groups the “top of the priority list.” FBI director Christopher Wray said in February 2020 that the FBI places the risk of violence from racially-motivated extremist groups “on the same footing” as the threat posed by foreign terrorist organizations such as ISIS and its sympathizers.

Antifa has certainly been involved in sporadic violence, and to the extent that its members have broken the law, they should be punished. But according to the FBI and other government agencies, a number of rumors about Antifa have been spun from whole cloth– sometimes by people later identified as right-wing extremists. According to the CBS report, Twitter shut down multiple “Antifa” accounts in June of 2020 that were later found to be fake. Those fake accounts were advocating violence against white suburbs; subsequent investigations tracked the accounts to Identity Evropa, a white supremacist organization.

In the wake of the Capitol insurrection, Trump and several Republicans insisted that the rioters were really Antifa. Thanks to the behaviors and selfie-documented identities of the participants, that didn’t begin to pass the smell test. As Forbes Magazine reported:

FBI Assistant Director Steven D’Antuono said Friday there is no evidence that Antifa activists were involved in the violent riots in and around the U.S. Capitol on Wednesday, debunking the baseless conspiracy theory propagated by several prominent Republican lawmakers and right-wing pundits that anti-fascist leftists—not a pro-Trump mob—were responsible for death and destruction at the Capitol.

As my mother would have said,

Last night I saw upon the stair
A little man who wasn’t there
He wasn’t there again today
Oh, how I wish he’d go away…

Comments