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Sep 22 2017

Socialized Medicine!

Or Bust.

Ding Dong? I would be remiss not to recognize John McCain’s public stand against Graham-Cassidy (Johnson-Heller, let’s not forget those assholes) makes it immeasurably difficult to achieve 50 Senate votes (and a tie-breaking decider from Mike Pence) given Rand Paul’s (give it up for the Freedom Caucus) earlier principled stand, Susan Collin’s almost assured ‘No’, and the Republican’s slim 52-48 majority, but until the uni-whale-scorpio-Pega-squid-icorn girl busts her brothers I won’t quite believe it.

From the top of another hill, a figure appears, a shaft of light shining off his auburn hair. It was Carl, the Red-headed Paladin from the land of Internius. He–
Carl, now you’re just getting ridiculous.
I don’t see why I can’t be in this story. Besides, it’s totally better this way.
I don’t care, read it the way it’s written.
Fine. Suddenly they all found out a way to settle their differences, and it wasn’t long before a peace accord was drafted and signed.
Cut it out, Carl! Read what it really says.
That’s what it says. Look, see for yourself.
Hmm, both contracting parties, undertake to maintain peaceful and friendly relations between them, in the mutual ib- Oh! Come on Carl! Whatever happened to Candavere, what about Jeremiad?
Well, I suppose I could just skip to the epilogue, sir. Hmm. Having signed the peace accord, the happy wanderers returned to their village as heroes. The rain stopped, and Candavere kept her date with Jeremiad. As they danced, she was as happy as a young girl could be. Especially as she was now back to normal. Well, almost. But even as the heroes recalled their tales of glory, the evil Malifishmirtz slipped away, bent on laying the groundwork for a sequel. But for now, all was right with the world, and everyone in the village agreed that it was the best Midsummer Woad-Gathering Harvest Bonfire’s Eve ever. Certainly the first one to have ten thousand monsters. The End. How was that, sir?
Okay, I guess.

On to happier topics.

It seems the Wild, White-Haired Socialist Menace never referred to in polite company (or by Beltway Bootlicking Punditry at least) as Bernie Sanders may be a cannier warrior than certain circles give him credit for. Let us not forget no less august a figure than Lindsey (better bring him a stack of fainting couches) Graham declared- “It’s either this (Graham-Cassidy-Johnson-Heller) or we’re going to Obamacare and Berniecare. Now, Berniecare is full-blown single-payer socialism. It is his dream and that’s where Democrats are going.”

Horrors!

Let’s take a teensy peek at what a better, more Socialist future might look like.

The benefits of Bernie Sanders’ ‘Medicare for All’ plan
By Marcia Angell, Boston Globe
September 21, 2017

Medicare, the current program for Americans over age 65, is a single-payer system, which means it is financed and overseen by the government, even though most providers are private. It is by far the most popular and efficient part of our health care system. In fact, many 64-year-olds can hardly wait to be 65 so they are eligible for it. Unlike private insurers, it doesn’t pick and choose which patients it will cover and for what medical conditions. All seniors are covered for the same package of benefits.

But Medicare isn’t perfect. Benefits aren’t comprehensive (for example, there is no dental coverage), copayments are rising, and there is profiteering by providers. Sanders’ plan would introduce reforms that would help with those problems. It would expand benefits greatly, and out-of-pocket costs would be eliminated except for a small copay for prescription drugs.

Even people who think this all sounds wonderful are concerned about the costs. Won’t taxes increase? How can we possibly afford single-payer health care? But in fact, this concern stems from a misunderstanding. Yes, income taxes and government expenditures would increase, but those increases would be offset by the enormous savings in premiums and out-of-pockets costs. This trade-off is not sufficiently understood, because the Congressional Budget Office estimates only costs to the federal government, not to patients. The fact is that if out-of-pocket costs are included, we would probably break even in the first year and in later years we would come out ahead, because inflation would be curbed.

Obamacare has many virtues. It expanded access to about 20 million people, and it ended some of the worst abuses of the private insurance companies, such as denying coverage because of preexisting conditions. But it did little to rein in cost inflation, because it left our health system in the hands of private insurance companies, profit-oriented providers, and the pharmaceutical companies, all of which could pretty much name their price. As expenses rose for employers who provide health insurance, their answer was to cap their contributions. And as expenses rose for insurance companies, their answer was to shrink benefits and increase deductibles and copayments. Americans found that having insurance was not the same thing as getting adequate health care. Moreover, about 30 million Americans remain uninsured.

The fundamental problem, the problem that underlies all the others, is that the United States has a market-based system. We’re the only advanced country that does. The systems in the other countries vary in details — some have single-payers like Medicare, others have tightly regulated private insurers — but they all have in common universal coverage in predominately nonprofit systems. In all of them, government sets benefits and prices in one way or another, including prices of prescription drugs, and administrative costs are much lower. And it works. Their health systems spend on average less than half as much per person as we do (that gap is growing), and their health outcomes are generally much better.

In contrast, we have chosen to entrust our health care mainly to the commercial market. But while markets are good for many things, they are terrible for health care. Markets seek to expand, and each element in a market (think cars) tries to grow its share of the total by attracting more paying customers. But we want the health care system to shrink, not to keep growing. Health markets also can’t distribute care rationally. The people who most need care are usually the least able to pay for it. So providing it according to the ability to pay instead of medical need inevitably introduces inefficiencies and inequities. Moreover, health businesses usually don’t compete on price, but by marketing to affluent customers.

Sanders’ Medicare for All Act envisages a four-year transition, which would begin by dropping Medicare eligibility from age 65 to 55, and enrolling all children 18 and under. Then, over the next two years, eligibility would be dropped one decade at a time, and in year four it would be extended to everyone. There would be no out-of-pocket costs, and the benefit package would be expanded. The system could be financed by an ear-marked 4 percent income tax. A family of four with an annual income of $50,000 would pay $844 a year, which is about $4,400 less than the average premium working families paid last year to private health insurance companies. I believe we would also need to move to a nonprofit provider system.

Health care is a social good, not a commodity, just as primary education, fire and police protection, and clean water are. A market-based system is not only wasteful, it’s immoral.

Unpragmatic? Even business is starting to recognize that Health Insurance Companies are useless leeches.

Even Business Leaders Are Realizing Health Insurance Companies Serve No Purpose
By Wendell Potter, Truthout
Tuesday, September 19, 2017

As the former head of corporate communications for the global health insurance company Cigna, I saw surveys on a regular basis that consistently showed a sizable percentage of Americans held private health insurance companies in very low regard and would be happy not to have to deal with them. Those surveys also showed growing support for single-payer health care. In 2007, when I was still an industry executive, a proprietary poll conducted for the industry showed that only 19 percent of Americans viewed insurers favorably. That same poll showed that 77 percent believed Congress “should do something about the unreasonable cost of health insurance and other health care services.” More people favored a Canadian-style health care system than any other potential solution.

What is different and significant this time, though, is that US business leaders are among those questioning our multi-payer system and embracing a system with just one payer, the government. That shift could prove to be the game changer that moves single-payer health care from what many pundits and politicians have considered a pipe dream to a very real possibility.

None other than Berkshire Hathaway chair and CEO Warren Buffett has joined the single-payer movement, as has Berkshire Hathaway’s Republican vice chair, Charlie Munger. Buffett told PBS NewsHour in June that a single-payer system “probably is the best system” because it could do a better job of controlling ever-rising health care costs. A month earlier, he told Berkshire Hathaway shareholders that medical costs are “the tapeworm of American economic competitiveness.”

In a Yahoo Finance interview, Munger cited the “massive amounts of excess cost” in the current US health care system — which he described as a “Rube Goldberg system that arose by accident” — as his reason for supporting single-payer health care.

The accounting and consulting firm PricewaterhouseCoopers (PwC) recently provided fresh evidence of the tapeworm in action. PwC’s Health Research Institute, which annually projects the growth of medical costs in the employer insurance market for the coming year, predicts medical costs will grow 6.5 percent in 2018, more than the rate of growth in 2017 and far more than the expected increase in the Consumer Price Index. By way of comparison, the CPI increased 1.7 percent over the past 12 months.

“With medical cost trend hovering between 6 and 7 percent for several years, health spending continues to outpace the economy,” PwC’s researchers wrote.

They went on to note that although the rate of growth in medical costs showed a temporary decline in recent years as insurers and employers shifted more of the cost of care to individuals and families, “further cost shifting to consumers is getting more difficult. Even the ‘new normal’ is not sustainable.”

US business executives have come to question the “value proposition” of private health insurers. In other words, they’re asking what, if any, value do private insurers bring to the US health care system and economy. Many are concluding not only that insurers provide no essential value, but also that they actually add costs to the system and make US businesses less competitive in an increasingly global marketplace.

Even some of the big consulting and accounting firms that do business with insurers are speculating that they may soon be “disintermediated” in the same way that travel agents were.

Some of the country’s largest employers already have found ways to bypass insurers and are finding they’re saving money while providing their workers with access to high quality care. Big enough to self-insure, companies ranging from Boeing to Walmart are increasingly working directly with health care providers in ways similar to the US Medicare program, which itself is a government-run, single-payer kind of system.

Boeing became one of the earliest direct purchasers of health care services when in 2014 it began contracting directly with hospital systems in the Seattle area for its many employees there. It has proven so successful that it has expanded its direct-contracting approach to other markets where it has large concentrations of employees, including St. Louis, Charleston, South Carolina and Southern California.

The point here is that very large employers have already concluded that they can get along just fine without private insurers. Small and mid-sized employers like MCS, however, don’t have the large concentrations of workers for direct-contracting to work. And direct contracting clearly isn’t an option for individuals and families who don’t have access to an employer-sponsored plan.

Business executives at companies of all sizes are also coming around to understand another important truth about private health insurance companies in the United States: They actually strive to make health care cost more.

Klepper wrote that this way of doing business has been “spectacularly successful” for the health insurance industry. As he noted, between May 2009 and May 2017, the stock prices of the five largest investor-owned health insurers — Aetna, Anthem, Cigna, Humana and United — increased between 387 percent and 748 percent, much more than the Dow Jones average.

The CEOs of those companies have become spectacularly wealthy as shareholder value has skyrocketed. They undoubtedly have to be concerned to hear that a growing number of business leaders are saying it’s time to give serious thought to single-payer health care in the United States.

Not long before I left my job in the insurance industry in 2008, a coworker asked our CEO during a company leadership meeting what kept him up at night. He responded with a single word that most of us, I suspect, had to look up. That word was, you guessed it, “disintermediation.”

He said he worried that someday a majority of Americans — and more specifically, a majority of business leaders — might begin to question the value proposition of insurance companies and reach the conclusion that they are little more than unnecessary middlemen.

That “someday” may be close at hand.

Friends, I’m afraid our course of action is clear. Rather than surrender to the creeping forces of Godless Communism we must sacrifice our lives and those of our loved ones to painful lingering deaths and give all our possessions to greedy Health Insurance Executives.

Wolverines!

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