May 29, 2011 at 10:13 am
On occasion, I hope to answer a few questions posed in the comments section. I won’t get to all of them, of course, and I’ll avoid the rhetorical ones (“How can you be so wrong about everything all the time?!?”). I may change the wording a bit for clarity.
Q: Is in fact a form of Medicare for all (with supplemental insurance policies to cover elective procedures) fiscally and socially responsible?
A: I think so, though I note you didn’t include “politically viable.”
This is really a question about whether it would be viable to have a single-payer, run by the gov’t, for national health insurance. It’s important to note that under Medicare for All, the insurance part of system would be public, but the services themselves would remain private, as they are today (outside of the VA system, that is). In other words, we’d be more like Canada, which has something close to Medicare for All, than the UK, which has a public delivery system as well.
With its lower overhead, non-profit status, less need for advertising, strong bargaining clout, Medicare for All has had a lot of supporters over the years. The late, great Senator Ted Kennedy was a long-time advocate. I also supported the idea in one of my books on this stuff. But at least during the health care debate, even including an optional single-payer plan within the current system was too much for the political market to bear.
Q: What gives you confidence that the subsidies and exchanges will be of any more use to the uninsured young in being able to afford health insurance than the vouchers would be for seniors under the Republican plan?
A: First of all, remember that “subsidies and exchanges” are not the relevant comparison to the Republican’s plan to privatize Medicare. Under the Affordable Care Act, Medicare retains the guarantee that makes it such a valuable program in terms of health care security for seniors.
But instead, let’s ask the question will the exchanges lower health costs throughout the health care system? First of all, we’ll have to see if any of this stuff works, including the much more important cost saving mechanism, the independent board (IPAB). Smart people without a vested interest think it will, like the folks at CBO, but we won’t know until we try.
But the exchanges are more about coverage than cost savings. The fact that they provide a pooling mechanism for folks who would otherwise have to shop for coverage on the more expensive individual market should help a bit. But if there are real savings here, the kind we need to avoid the continued attack of the health care spending monster, it will be because IPAB identifies cost-effectiveness savings that move from the Medicare side of service provision to the private side as well.
Q: OK, so IPAB *is* allowed to “deny certain types of care.” It is *not* allowed to “ration health care, raise costs to beneficiaries, restrict benefits.”
Is it just me, or does this look like a contradiction? Who is defining the meaning of words here? Does anybody know what the law actually says?
A: Look, every insurer already denies “certain types of care” and always will– it is a non-economic fantasy to think otherwise. You can call any denial of anything you want “rationing” but you then have to admit that there’s tons of rationing going on all the time. And btw, the current system is of course fraught with rationing by price, as about 50 million uninsured would be happy to explain to you.
Q: Why does nobody mention raising wages, thereby helping to close the growing productivity/wages gap? Have we all simply bought into the Republican cant that higher wages cost jobs, so we can’t go there? When did raising the minimum wage in the past result in massive unemployment? Wages increased most during the Clinton Administration, which also brought about the biggest increase in jobs, and an elimination of the budget deficit to boot. Don’t put all the burden on putting more money in people’s pockets on tax cuts. Some of those record profits could be shared with the workers who helped create them. Raise the minimum wage. Strengthen labor laws.
A: Ok, maybe I’ll tackle some rhetorical questions.
Raising wages in the private sector is not typically the purview of government, with the exception of the minimum wage, as you suggest. I’ve actually started to hear a little bit of buzzing around that idea and I agree that it should be in the mix.
But to really get sustained wage gains across the board, you need much lower unemployment, so that instead of an excess supply of workers chasing too few jobs, you create more of a situation where the job market is tight enough that employers must share their productivity and profit gains more broadly in order to get and keep the workers they need. Especially at a time like now, when there’s still considerable excess capacity in the economy, there is a role for government (and the Fed) to help create the conditions for stronger job growth.
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