Tag Archives: cost

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?


A Few Thoughts On The Recent Shutdown…

According to a number of reports, Donald Trump’s poll results declined significantly during the government shutdown. Since I cannot fathom why anyone still does support this ridiculous and pathetic man, I’ll leave it to others to mull the implications of those polls.

The shutdown and its aftermath were instructive, however, on a number of dimensions.

First and foremost, it delivered a striking rebuttal to the GOP’s constant refrain that government is never the solution, it’s the problem.  A post to Daily Kos  noted that the constant media references to 800,000 government employees understated the wider effect of the shutdown:  at least 40 million people were affected in one way or another. Many  endured long security lines at the airport, and uncertain safety in the air. Others couldn’t get tax questions answered (no one answered the IRS phones).

Businesses that depend upon patronage from government employees have seen steep declines: everything from food trucks at the National Mall to landlords accepting Section 8 vouchers, to cafes and delis accustomed to drawing their lunch crowds from nearby government buildings have seen fewer customers.

It’s not just business. Even anti-government ideologues rely on federal food inspections.  Even elderly Fox News viewers expect and need their Social Security checks. Local governments require the dependable remittance of federal program dollars. The list goes on.

The shutdown also exposed a previously unappreciated risk to private companies and not-for-profit organizations that do business with government–or more accurately, do the government’s business. Millions of Americans are effectively government workers due to the terms of outsourcing contracts–what we like to call privatization. (Estimates of the number of people who–although not technically employed by government– work full-time delivering government services run as high as 18 million.) The shutdown idled millions of those contract workers–and unlike employees who actually get their paychecks from government–they won’t be paid for their enforced “vacation.”

And of course, economists are busy calculating the amount of the economic “hit” caused by the shutdown, and estimated to be in the billions.

All of this damage was the consequence of a profoundly stupid demand for a wall that will never be built and would do nothing to deter undocumented immigration or drug traffic if it were.

The voters who still support this President want that wall as a symbol, not a barrier; they want to send a message to folks south of the border. We don’t want your tired, your poor, your huddled masses yearning to breathe free–at least not if their skin is brown or black. I am more convinced than ever that Trump’s support comes from people who embrace a mythical American past in which white guys ruled the roost–where women were subservient and dependent, and other men were inferior by definition.

I do wonder how those supporters rationalize away the fact that Trump folded–completely caved–by accepting exactly the deal he’d initially rejected, and that the ignominious  end to his bluff was engineered by a highly competent woman.

That last fact is responsible for my shadenfreude.

I think I love Nancy Pelosi.

Texas Republicans Have a Great Idea

Republicans in the Texas Legislature want Wendy Davis to pay for the second special session called by Governor Rick Perry. Their logic is irrefutable: her 11-hour filibuster prevented them from passing their pet anti-choice policy.  That forced Governor Perry to call a  separate session so they could complete their culture-war agenda. Since it was her fault, she should pay.

I think the Texas GOP’s idea is well worth applying to another legislative body–the one that meets in Washington, D.C.

Why shouldn’t We the People require repayment, not just for the GOPs incessant filibusters ( conducted by weenies who don’t even have to match Wendy Davis’ marathon performance–who just have to intone “you don’t have 60 votes”), but for all the other childish antics done solely to prevent Congress from getting the people’s business done. (I think we’re up to 40 votes to repeal Obamacare now…The Congressional Research Service calculates that it costs $24 million to run the House for a week, so the first 33 votes cost taxpayers approximately $48 million. It breaks down to around $1.45 million per vote.)

At the very least, the Party of No should have to pay salaries, utilities and other overhead costs of keeping the Capitol Building open  week after unproductive week.

Wendy Davis was trying to prevent a bad bill from becoming law. These childish Congresscritters are not only taking votes they know to be utterly meaningless,  they are refusing to do their duty to vote on nominees to fill judicial and administrative vacancies.

When my children were toddlers, and they threw tantrums, they lost privileges. Pretty soon, they stopped throwing tantrums. I see no reason why we shouldn’t take the same approach when Congress misbehaves.

Want to argue the merits of a bill? Fine. That’s why you’re there. No penalty.

Want to stamp your foot and refuse to allow the grown-ups to do the nation’s business? That’s a no-no. Here’s a bill for what it will cost you.

Yes, indeed…those assholes in Texas may accidentally be on to something….