Monday, August 7, 2017

Krugman: You Can Have Single Payer Health Care When You're Dead

Despite the palpable spike in my blood pressure whenever I read something by Paul Krugman, nevertheless I persisted.  And the ensuing pounding sensation in my ears this morning did not disappoint.

In a piece ironically titled "What's Next For Progressives?" the star New York Times pundit suggests that we stop being so damned unicorny and fight for universal pre-K as a worthy substitute for the impossible dream of maintaining our lives and livelihoods when we get sick or hurt.

Not that he personally has anything against a single payer health insurance system, of course. It's just that such a program would be too hard to sell to anti-government Deplorables.  It's just that a public program would put all those private insurance executives and claims adjusters and rent-seeking lobbyists out on the street. Or should I say, out on The Street?

No, it's simply that the desperate people insanely clamoring for a single payer program are unreasonably forcing Democratic politicians to take a litmus test for purity. Making candidates promise Medicare for All would essentially be inviting them to lie, and goodness knows, they don't want to also be faced with a lie detector test should they have the amazing good luck to win any more elections on their feeble incremental platforms.

On behalf of the Clinton-Obama wing of the party, Krugman chides:
So it’s time for a little pushback. A commitment to universal health coverage — bringing in the people currently falling through Obamacare’s cracks — should definitely be a litmus test. But single-payer, while it has many virtues, isn’t the only way to get there; it would be much harder politically than its advocates acknowledge; and there are more important priorities.
What could possibly be more important than life and good health, you may ask?

Why, saving the predatory insurance cartel which helped save Obamacare by altruistically pushing back against Republican repeal, of course! Blue Cross/Blue Shield saved the day for Blue Cross/Blue Shield. Let's give three cheers for the oligarchy.

Also more important than the lives and well-being of 330 million American citizens is the convenience of those who currently obtain their insurance through their employers. No matter that a program like HR 676 would require no effort, automatically enrolling everybody, Krugman claims to be worried that transitioning from private to public would cause a massive outbreak of Post Traumatic Stress Disorder among the current beneficiaries of for-profit coverage.
Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.
This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?
As economist Robert Frank and others have demonstrated, this premiums vs. taxes argument doesn't hold water. But Krugman not only refuses outright to discuss the specifics, he dismisses them out of hand. He doesn't tell his readers that for one thing, administrative costs for a government run insurance program would only be two percent of the total budget, as opposed to the six percent costs of running a for-profit system. Further reducing costs would be the government's ability to negotiate lower prices for drugs and other services. And most important, a Medicare for All plan would be virtually repeal-proof. If everybody enjoyed the same benefits, the divide and conquer politics of resentment would be a thing of the past.

So Krugman pulls the old bait and switcheroo. If centrist Democrats (he calls them  "progressives" solely for purposes of propaganda) can't deliver on single payer health care, perhaps they'll get some political mileage from pretending to care about Our Children. Krugman has suddenly discovered that "we" neglect the nation's children. But rather than suggesting a living wage and/or guaranteed income for their parents, an increase in food assistance, a federal jobs program and subsidized housing, he tosses out the crumbs of pre-K and paid parental leave.

My published response:
Health care is either a basic human right, or it isn't.

Incremental improvements to, and more public funding of, our for-profit predatory health care delivery system are not going to cut it. A system in which some lucky people are insured and some are not is, in fact, the very antithesis of social and economic justice. It's health care apartheid.

Whatever happened to "justice delayed is justice denied?"

Krugman maintains that it would be "too hard" to educate people that paying premiums, via taxes, to a centralized government-run Medicare for All-type system is fairer and cheaper than paying premiums to private corporations whose CEOs make obscene salaries and whose wealthy investors suck profits from the pain of ordinary people.

Krugman is squandering an enormous opportunity from his popular perch in the op-ed pages to do some of this educating himself. Of course, his claim of "impossibility" is not true at all. According to most polls, between half and two-thirds of the American populace already support a single payer system.

So he should have titled this piece "What's Next For the Plutocrats Running the Place?" As established by Gilens and Page in their Princeton study, it's the rich donor class which despises the idea of true universal health care.

The only "progress" the billionaires care about is the progress of their own wealth and their own dynasties as the chasm between rich and poor grows wider by the day.

The rest of us can't wait. Single Payer or bust.


Kat said...

I think he raises a few valid points, but for a better discussion of the issue the (sorry to say) Nation had a better article. If you read through it you can see what Dean Baker has to say about taking a more piecemeal approach. I agree with this. I don't think everybody would love Medicare right away. It would be under attack from day one. Plus, I think you underestimate the opposition. It is not just insurance companies that are against it. You have physicians, hospitals, pharma, medical device companies, durable medical suppliers, etc.
There are many ways to improve the health of our citizens. Improving access to medical care is just one way.
Single Payer is not the slayer of neoliberalism. After all, Australia, Canada, and Sweden have it. And hell, Great britain goes even further with a national health service-- hardly a socialist utopia there.

annenigma said...

'Single Payer or Bust' should be the Dems new motto, or 'No Guts, No Glory'.

So what's wrong with Democrats that they won't latch onto the biggest issue of our time and run with it and on it?

It's ALL about protecting Capitalism, not people. Phooey.

stranger in a strange land said...

"If an elderly but distinguished [economist] says that something is possible, he is almost certainly right; but if he says that it is impossible, he is very probably wrong."

Arthur C. Clarke

Jay–Ottawa said...

"If you read through it [the Nation article] you can see what Dean Baker has to say about taking a more piecemeal approach."

Over at the Jacobin, a den of commies if there ever was one, a labor representative is worried about the same thing: " As long as the ACA fire hose keeps spraying money at the health care industry, jobs will balloon accordingly. If the water pressure drops, the consequences will be real and drastic, even if the overall result is more equitable and more affordable health care."

Yes! Agreed! Absolutely! I like piecemeal. Because if the fragile US tries to put every citizen on Medicare at once, its ERs will be drastically overwhelmed by hoards of displaced private insurance workers with heart palpitations, the first in line being their CEOs denied their obscene salaries. Do gooders must be careful about the unintended consequence they are so often to blame for. For instance, Ralph Nader's fixation about automobile safety did, among other unintended consequences, cause seat belts to wrinkle millions of freshly-ironed shirts morning after morning across the nation.

So let's go along with the piecemeal approach Wells Fargo style (in slow and easy stages) suggested by Dean Baker and our favorite concern troll, Paul Krugman, who cares so very much he stoops first to help the wee ones in the crib-to-kindergarten cohort. Let's expand Medicare for all s l o w l y, one age cohort at a time, starting with those babies. Say otherwise and you're a Herod. Checkmate, Ryan, McConnell, Trump.

That kind of piecemeal approach won't shake the health insurance money tree so hard it will drop all its leaves at once. Its army of clerks, who currently keep track of every damned band-aid and scalpel by patient ID, will thus have time––years even––to seek more productive work.

Just keep that ball rolling slowly towards the goal. Once the nation gets over the initial jolt of caring for its littlest ones, we can go to the next age cohort, on and on, piecemeal, until by the time those wee ones reach 65, they will meet themselves coming down the hill of Medicare for seniors.

Rome wasn't built in a day. BTW, neither was universal healthcare in the topmost nation of the Western Hemisphere. It was started by one provincial prime minister, Tommy Douglass of Saskatchewan, in the early 1960s. Then it was seen as a pretty good idea by other provinces and the federal government until, finally, all provinces had Medicare (that's what Canadians called it back then).

We've read quotes from Baker, the Jacobin and Krugman. Time to quote a heavy like Laozi: " A journey of a thousand miles begins with a single step."

Elizabeth -- Marysville said...

I really don't think anyone is looking at Single Payer as the "slayer of neoliberalism". I didn't read the Nation article, so perhaps my strawman argument sniffer is misfiring.

Capitalism is what it's all about. Services such as health care, education, safety (EMS services) should never be profit-driven. Quotas become important, leading to cherry-picking and weeding the neediest and/or poorest from necessary services.

Neoliberalism allows the conditions for which people need health care: crop/food/livestock pharmaceuticals (chemicals); oil industry byproducts in our air, water, and plastics; etc.

Neoliberalism allows for the crimes against humanity such as those perpetrated by Monsanto. Monsanto and their ilk should be locked up, only allowed to see daylight when their scientists have developed the antidotes to their poisons. They should be using their billions for this research and not be allowed to make one more cent of profit, EVER.

"Piecemeal", when MILLIONS are already being poisoned and cannot afford decent food to support a healthy immune system; when hundreds of thousands go bankrupt from ONE MAJOR ILLNESS or ACCIDENT; when MILLIONS still have no insurance whatsoever; when MILLIONS who DO have insurance don't see the doctor because of DEDUCTIBLES and COPAYS (which really should be called DISINCENTIVES) UTTER BULLSH*T.

annenigma said...

Elizabeth - Marysville wrote "Monsanto and their ilk should be locked up, only allowed to see daylight when their scientists have developed the antidotes to their poisons." Don't give them any ideas!

Too late I'm afraid. In true Capitalist/Wall St. fashion where profits are made both from creating and treating a disaster, they seem to be working on your suggestion - although the antibiotics may be *tainted. The pharmaceutical/chemical giant Bayer is merging with Monsanto, pending approval, in a $66B deal.

From 'Bayer and Monsanto: A Merger of Two Evils'

"Who thinks it’s a good idea to entrust the job of “feeding the world” to the likes of Bayer, a company that—as part of the I.G. Farben cartel in the 1940s—produced the poison gas for the Nazi concentration camps, and more recently sold *HIV-infected drugs to parents of haemophiliacs in foreign countries, causing thousands of children to die of AIDS."

For more about Bayer, see Wikipedia

Elizabeth -- Marysville said...

Good point, Annenigma!

What I was thinking, but not expressing well, was of a sort of chelation therapy to remove all the toxins these chemical companies have made, not just to counteract them (a la drug therapy to counteract side effects from other drugs -- e.g. benztropine).

The existence of these horrible chemicals is so acceptable in the U.S., I hear Roundup commercials on the radio. I remember a TV doctor once saying how eating fruits and vegetables with this stuff on them is better than not eating fruits and vegetables at all, as if it's a given we are going to have to live with things the way they are.

Kat said...

I don't think that was what was necessarily meant by piecemeal. I do actually think lowering the age for medicare eligibility is one way to get a start, however. But more importantly I do think it is a good idea to consider all the opposition and how to proceed. I don't think Baker is shilling for Obamacare just because he raises some objections to immediately instituting medicare for all. There are many interest groups involved. Considering the number of doctors who complain about medicare reimbursement rates, you have to understand that many are part of the opposition. I did read that among physicians it is now 48/52 in favor/opposition to single payer which is as high as it has ever been. Probably some of this is due to the fact that physicians are now more likely to be employees of HCO's and probably some is due to the fact that there is now less disparity between what insurance pays and what medicare pays for procedures. (Probably having more women physicians than ever helps too.)
I read a letter to the editor from the American Diabetes Association. The writer was voicing their opposition to 'step therapy" where insurance companies require that doctors try the older cheaper drug before moving on to the newer (much more expensive) drug. So, this was characterized as bottom line focused executives intruding on the doctor's autonomy. here's the problem-- if the government was the main negotiator they would (rightly) do the same thing (older drugs are usually safer and SE's are more well known)and then can you imagine the hue and cry as pharma whips up a "patient advocacy group" discrediting "government buraucrats"?

Kat said...

I forgot to add that you can go to the diabetes association's web page and see how much pharma donates.

Kat said...

Someone mentioned Elizabeth's Rosenthal's book "An American Sickness" a while back. I had read it. I don't necessarily agree with all her prescriptions, but I do think she does a generally good idea of describing the problem and the various interest groups. I would recommend it.

Jay–Ottawa said...


Lots of doctors, I mean those objecting to private or public insurance ever telling them which diabetic med to jot down on a prescription pad, just might be bought by the pharmaceutical company that makes that new and improved diabetic drug, which the doctor, for some reason, insists on prescribing. (As you know, the step programs were invented by healthcare panels, not bean counters.) So, in all, we have not only big pharma raising a hue and cry but also the docs who are in the pocket of big pharms along with the diabetics who were propagandized by big pharma's adds in the ADA journal.

As indicated above, part tongue in cheek, I'm a little suspicious of calls for incrementalism on a program the US is generations late in enacting: healthcare as a right and properly funded. Are the forces against single payer concerned about the general welfare and good administration, or are they merely resorting to an old delaying tactic for private gain?

In any event, if we must outfox the foxes to get moving on single payer, I offered another stepped approach (the adding of age cohorts one at a time) to avoid both the fake hues and cries of the compromised and uninformed as well as the real problem of bureaucratic overload. We saw what happened at HHS when the ACA overwhelmed the system trying to implement it. There are good reasons to phase in a giant program for 330 million people.

As for those laid off insurance clerks, they are not the best argument for incrementalism. With age cohorts being added one at a time to Medicare, the lights won't go off everywhere at once across the insurance world. In any event, HR 676 already takes those clerks into account by setting aside a bundle of retraining money. Laid off clerks will number into the thousands; the sick of course are counted in millions. Priorities?

Finally, we need to step back to understand why single payer never makes it to the table in the first place. The root problems are found outside the circle of stakeholders within the healthcare community. Andrew Bacevich has just put forward a 10-point platform to make America great again.

The Republican, Democratic, Libertarian and Green parties are too compromised to be interested in the Bacevich Platform. Until an entirely new party rises up to put the US back on the tracks, the civic reforms advocated by Bacevich (and many others) will go nowhere. And because his platform hasn't got a chance, neither does Medicare for All.

annenigma said...

Yup, the NYT wasn't only trying hard to make Trump the issue, but it turns out they got it wrong about the climate report itself. The Trump regime didn't miss any deadlines and didn't suppress the climate report. More fake news from the 'failing NYT' as DJT calls them.

'New York Times Guilty of Large Screw-Up on Climate-Change Story'