The further to the left or the right you move, the more your lens on life distorts.

Tuesday, April 23, 2019

Medicare for All

I have on a number of occasions suggested that far-left economist and columnist, Paul Krugman, often operates on the edge of ideological madness. But even crazy people have moments of clarity. Krugman recently wrote this about the new healthcare holy grail for the Democrats: "Medicare for All."
“A Medicare for All plan would in effect say to these people, ‘We’re going to take away your current plan, but trust us, the replacement will be better. And we’re going to impose a bunch of new taxes to pay for all this, but trust us, it will be less than you and your employer currently pay in premiums.’ ”
The thing that fascinates me about socialists (and make no mistake, the Democratic party is embracing socialism enthusiastically) is that they believe that big government is efficient and effective, and cares (about you) in ways that big business does not. Never mind that there are thousands of examples of big government inefficiency; no matter that there is so much fraud and abuse in government programs that they are literally uncountable and untraceable; never mind that the image of uncaring government workers is a justified stereotype across virtually every government agency. No matter that without a profit motive, big government has no incentive whatsoever to pair down costs, look for more efficient methods or otherwise keep expenses under control. In fact, there's a perverse counter-incentive to do just the opposite. The Dems believe that "this time will be different!" But, why exactly?

The problem is magical thinking—the belief that if you're on the side of virtue (and Dems believe this unequivocally) you can wish away inefficiency, ineffectiveness and uncaring people. Never mind the cost, say the magical thinkers, we'll just raise taxes on the rich and add a "small" payroll tax for everyone else. Somehow, magically, the payroll tax will be smaller than the collective cost of medical premiums because—socialism!

The editorial board of the Chicago Tribune comments on this fantasy:
A 2016 study by the liberal Urban Institute estimated that Sanders’ program would boost federal outlays by $32 trillion over a decade. To put that in perspective, remember that total federal expenditures this year will be about $4.4 trillion. Advocates say a single-payer system would eliminate so much waste that it would reduce overall national health spending, but the Urban Institute found it would raise costs by a hefty 17 percent. Nor have Sanders & Co. devised a way to pay for that: The liberal Tax Policy Center found a funding shortfall of $16.6 trillion over 10 years, which roughly equals the entire federal debt currently held by the public.
But cost isn't the only issue. In order to keep costs from bankrupting a country, medical procedures will be rationed. In the U.K., a new study indicates that many elderly are relegated to blindness because they no longer qualify for timely cataract surgery (a simple procedure currently in the US). That won't happen here, argue the proponents of Medicare for All, but as cost pressures rise as they surely will, how can that promise be kept?

And, then of course, there's something that most American cherish—freedom of choice. James Freeman comments:
One section of [Bernie Sanders' "Medicare for All"] bill, entitled “Freedom of Choice,” includes the following text:
Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.
In other words, you are free to choose any doctor the federal government allows you to choose. On at least one point, Mr. Sanders is being honest. He’s not even trying to sell the Obama whopper that patients will get to keep the plans and the doctors they like.
That's sooo socialist. Big government and its minders (i.e., Bernie and his democratic socialist crew) will make us all dependent on government for our care, and then make those care decisions for us all. After all, it takes a village.

And if you say, "Screw it, I want to go my own way?" Freeman notes what socialists have in store:
Section 107 of the draft bill states that once the plan is fully implemented: shall be unlawful for—
(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or
(2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
Of course, none of those concerns are worthy of consideration because when you're on the side of the angels, details and freedom of choice don't really matter. The prevailing attitude seems to be—give us control of governance, and we'll figure stuff out so that social justice is achieved. But what about ...

-- Availability of the care (e.g., specialists, clinics) you need?
-- The quality of care you get?
-- The length of time you'll need to wait for care?
-- The on-going cost to the country?
-- Freedom to choose your doctor, your provider, your hospital?
-- The impact of stratospheric taxes on the economy? jobs? businesses?

No worries about any of that ... the Democratic Socialists will figure it all out. Or they won't.


In his recent town hall on FoxNews Network, Bernie Sanders presented the usual tropes about the high costs of medical care in the USA, the avaricious greed of insurance companies, and the claim that somehow—magically—Medicare-for-All would reduce the costs of medical care. Sure, he said, taxes would go up, but less, he claimed, than the current cost of health care premiums. He never provided any evidence that would be true. Never addressed the roll that a massive government bureaucracy plays in siphoning off tax money to perpetuate itself, rather than applying that money to medical care. He promised that everyone could keep their hospital and their doctor (gosh, does that sound familiar?), and laughably, suggested that we should use the VA as an example of well-run government care (that would be the same VA that has patients wait for months or years for procedures). He suggested that Medicare is loved by all seniors, but forgot to mention that the program is projected to go bankrupt in less than a decade.

Bernie did what all socialists do—he made attractive promises that he knows he can't keep. He offered "free" stuff that isn't free at all. He used class warfare as a lever to gain support. He relied on the innumeracy of broad swathes of the electorate to promise solvency, lower costs and better care, when experience outside our country (think: the U.K NHS) indicates that none of those things will be achieved without confiscatory taxes, the rationing of care, and a reduction in freedom of choice. Bernie is a likeable con man, much like another committed socialist, Hugo Chavez, was at the beginning. Think about that for just a sec.


Just this week, the Trustees of Social Security and Medicare announced that both programs are in serious financial trouble and will become insolvent in about one decade. Kate Davidson reports:
WASHINGTON—Social Security’s costs are expected to exceed its income in 2020 for the first time since 1982, forcing the program to dip into its nearly $3 trillion trust fund to cover benefits.

The new projection, released Monday by the trustees of Social Security and Medicare, is rosier than one made in their 2018 annual report, which anticipated the program would run in the red by the end of last year.

The improved forecast stems in part from the health of the labor market, which has boosted workers’ paychecks and fueled higher tax revenue. But the programs’ unsustainable long-term outlook is little changed from last year.

By 2035, the trust funds for both programs will be depleted, and Social Security will no longer be able to pay its full scheduled benefits unless Congress steps in to shore up the program, according to the report. The program’s income comes from tax revenue and interest from its trust fund.

“Both Social Security and Medicare face long-term financing shortfalls under currently scheduled benefits and financing,” the trustees wrote, urging lawmakers to take action sooner rather than later to give policy makers enough time to phase in changes.

Without changes, by 2035 Social Security recipients will get only about three-quarters of their scheduled benefits.
Of course, this long-standing reality has no bearing on the fantasy thinking of politicians like Sanders or most of the rest of the Democrat presidential field. Somehow, magically, they'll fix it all, and save money, and provide even higher quality medical care to EVERYONE.

Yeah ... right.