by Rodger Malcolm Mitchell, www.nofica.com
Before you read yet another article about Medicare-for-All and the “Who Will Pay For It” question, please take some time to think about, and answer, just two questions:
- Do you believe every American should have medical care, or should some Americans be forced to do without medical care?
- If you believe every American, rich or poor, should have medical care, who will pay for it?
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Peter Suderman, the features editor at Reason.com, writes regularly on health care, the federal budget, tech policy, and pop culture. He believes the government should not pay for health care.
I don’t know why; he never says. He is a libertarian, so he doesn’t like “big” government. Why? Again, he never says. How big is too big? Yet again, he never says.
But if the government doesn’t pay, all who’s left is you.
- You pay if your company pays because your company figures the cost of health care insurance as being part of your salary.
- You pay if your insurance company pays; it’s in your premiums.
- You pay if the hospital emergency room pays because that forces the hospital to raise prices for all other services.
- You pay if no one pays, and some Americans lack health care; their ill health means they can’t be productive contributors to the U.S. economy.
- You pay if your city, county, or state pays for health care because these governments rely on your taxes to fund all their spending.
In short, there is no magic. You always have to pay, directly or indirectly. Except, there is magic. It’s the magic of Monetary Sovereignty.
The U.S. federal government is Monetarily Sovereign. About 240 years ago, the new U.S. government created the U.S. dollar — millions of them from thin air — simply by creating laws from thin air.
Since then it has continued to create laws and dollars, all from thin air. The very first dollars were not funded by taxes. They were created by laws.
And ever since then, the tax dollars you send to Washington, DC, willingly or grudgingly, still pay for nothing. Even if you didn’t send a single tax dollar or even a tax penny to Washington, the U.S. federal government still could continue spending, endlessly.
So you, as a voter, have two choices:
- You can continue to pay for your healthcare, either via direct payment from your checking account, or via indirect payment through your company’s insurance plan, or via indirect payment via higher hospital charges, or you can pay by being sick without care, or
- The federal government can pay, and it would cost you nothing.
That’s it. Just two choices. There are no other options.
All those people who complain about the cost of Medicare-for-All really are telling you that you should pay, directly or indirectly.
Keep that in mind as you read the following excerpts:
How to pay for Medicare-for-All? Multiple estimates have found that the single-payer plan, which would eliminate virtually all private health insurance, would require more than $30 trillion in additional government spending over a decade, a historically unprecedented sum.
Additional federal government spending costs you nothing. The federal government already has spent more than $20 trillion dollars, and it has cost you nothing.
How do I know? Because the federal debt is more than $20 trillion dollars, and the federal debt represents federal spending you clearly have not paid for.
Further, the taxes you paid don’t even fund any federal spending. Unlike state and local taxes, federal tax dollars are destroyed upon receipt. (The federal government creates brand new dollars, ad hoc, every time it pays a recipient.)
And if an additional $30 trillion really is needed for healthcare, that means Americans currently are doing without $30 trillion worth of healthcare. That’s way too much sickness not being treated in this, the world’s wealthiest nation.
Bernie Sanders cited a a study “that just came out of Yale University, published in Lancet magazine, one of the prestigious medical journals in the world.”
The study purports to show that Sanders’ Medicare-for-All plan would save $450 billion a year, and 68,000 lives.
A detailed article produced by Kaiser Health News and Politifact, however, (disagrees).
The Lancet study assumes, for example, that the Sanders plan could pay Medicare rates across the board.
Medicare rates are far lower than private insurance rates, and the hospital lobby is a powerful political force that has successfully fought off payment reductions in multiple venues.
Suderman ignores one simple fact: The “hospital lobby” has existed a long time, and Medicare exists — and “its rates are far lower than private insurance rates.” How did that happen?
Could it be that past left-wing Congresses were more caring and moral than today’s right-wing Senate?
Not that it really matters, for as we have said on numerous occasions, the federal government, being Monetarily Sovereign, can afford anything. In fact, the more the federal government deficit spends, the more economic growth dollars enter the private sector.
That is how economies grow.
The Lancet study Sanders cites also lowballs the likely increase in utilization that would come from eliminating copayments and other cost-sharing mechanisms, as Sanders’ Medicare-for-All plan calls for.
Although it allows that the newly insured would use more care, it assumes that the currently insured would not seek to use more health services.
As Harvard health policy researcher Adrianna McIntyre points out, that’s deeply unrealistic.
Yes, utilization would increase, and that is a very good thing, indeed.
It is quite doubtful that people would make unnecessary visits to the doctor or hospital, just because they are free. So the additional utilization would benefit healthfulness. That is the whole idea: To improve America’s health.
There are other problems as well, most notably that the study simply doesn’t account for about $4 trillion in expected long-term care spending that would be part of the bill under Sanders’ Medicare-for-All plan.
Is this supposed to be a bug or a feature? The lack of long-term care, particularly for the elderly, is a real disgrace in America. Visualize yourself without long-term care insurance and having to choose between care at a facility, and no care, dying alone at home.
The heartlessness of Suderman’s position is truly stunning.
The study handwaves away research suggesting that its headline “lives saved” figure is substantially overstated.
Is 68,000 lives saved too high and estimate? Suderman never says what the “correct” number is. How about 50,000 saved lives? 40,000 saved lives? How many saved lives are too few for Suderman to be concerned about?
The question of how to pay for Medicare-for-All has come up quite frequently in the debates, and the repetition may even be having a substantial impact on the race.
Sen. Kamala Harris (D – Calif.)struggled with the (payment) question. Her stumbles probably contributed to her declining position in the race, and she eventually left the field.
Sen. Elizabeth Warren (D – Mass.) released a complex financing scheme. This generated substantial criticism and helped demonstrate how she relies on a veneer of wonkiness to avoid tough questions.
Eventually, Warren released a second plan that called for a delayed implementation of full-fledged Medicare for All, which many (understandably) read as a sign that she wasn’t serious about the idea.
In both cases, we learned something essential about the candidates and how they respond to pressure: Harris didn’t have a firm initial grasp of the policy mechanics, and she flailed and flip-flopped in search of a politically palatable answer. Warren bandwagoned with the most progressive candidate, eventually releasing a dubious (but detailed) plan that suggested she wasn’t serious, then followed it with another one that undercut the first, all while pretending it didn’t.
The same is now true of Sanders. And his response, it appears, is to point to an obviously unsound study conducted by a sympathetic voice, and then lie about the rest of the existing research.
The Medicare for All financing question is not just a policy question. It is a test of character – and Sanders failed it.
No, Mr. (Libertarian) Peter Suderman, the Medicare-for-All is not just a test of character. It also is a test of economic knowledge, and you failed both tests.
You failed the test of character by giving the back of your hand to all the sick people who are or will, lead lives of misery or die early because they can’t afford proper care. You throw compassion to the wind, and prefer to talk about money.
And you failed the test of economic knowledge because you don’t understand the difference between federal financing vs. state and local government, business, and personal financing.
You also don’t understand the effect that illness has on America’s economic growth. (Perhaps the coronavirus will teach you.)
And while the Democrats may favor Medicare-for-all for compassionate and economic reasons, they too display a stunning ignorance of federal financing.
And that ignorance will kill a program the people of this nation so greatly need.
It takes only two things to keep people in chains: The ignorance of the oppressed and the treachery of their leaders.
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