By Matt Bruenig
the Congressional Budget Office (CBO) released an estimate of the cost of implementing a single-payer health insurance program in the United States. The CBO’s report is more exhaustive than any other recent study on the subject and concludes that replacing our current system with a single-payer system would insure every American while reducing overall health spending in the country.
Modeling the cost of a single-payer program is relatively straightforward. You begin with the status quo health care system and then make educated guesses about the following questions:
- How many more units of health care services will be demanded and supplied when price barriers are removed?
- How much more efficient will health insurance administration be after enrollment and payment systems are radically simplified?
- How much money will be saved by reducing the payment rates for health care providers and drug companies?
The CBO answered these questions for four different single-payer designs and found that a single-payer system would save $42 billion to $743 billion in 2030 alone.
Separately, the CBO took its most costly single-payer option — a program with high payment rates to providers and drug companies and low cost-sharing for individuals — and added long-term support and services (LTSS) to it to produce a fifth cost estimate. In that estimate, total spending rises by $290 billion.
The CBO option that most closely approximates current Medicare for All proposals is Option 3, which features low payment rates and low cost-sharing. That option produces $650 billion of savings in 2030. Adding LTSS to that option, which also approximates what many current Medicare for All proposals do, looks like it would bring the savings down to around $300 billion.
More interesting than the CBO’s headline finding is the extremely detailed inquiry they do into each specific variable and the comparison of the results of their inquiry to the results of other similar studies.
The thing that stands out the most to me in this comparison is the CBO’s deep dive into administrative costs. Medicare for All advocates have historically pointed towards the 2 percent administrative costs of traditional Medicare as what we should expect in a Medicare for All system. Critics of this view have typically argued, among other things, that Medicare’s low administrative costs are a mirage driven by the fact that their per-enrollee administrative costs are being divided by disproportionately large per-enrollee health care utilization.
This rebuttal never really made any sense. Private Medicare Advantage plans have a similarly sick and elderly enrollment population, but manage to spend a whopping 13.7 percent of their revenue on administrative expenses. The CBO’s analysis, which starts with the current Medicare administrative costs and then determines how each element of those costs would go up or down in a single-payer system, seems to put this claim to bed once and for all.
Indeed, the CBO finds that the current Medicare administrative costs that are often touted by advocates are actually higher than the administrative costs you would expect in a single-payer system because a large share of those costs are tied up in tasks like eligibility determination and collection of Medicare Part B premiums that would no longer exist in a Medicare for All system.
Thus, the payer administrative costs we could expect under single-payer are not the 6 percent touted by Urban and Mercatus. They are not even the 2 percent of the traditional Medicare program. Rather, they are more like 1.5 to 1.8 percent. These other estimates are therefore missing hundreds of billions of dollars of savings per year on this item alone.
Overall, the study confirms what serious Medicare for All analysts have known for some time now. It is possible to provide high-quality public health insurance to every person in the country while also saving money overall on health spending. The barriers to the policy are not technical deficiencies or costs, but rather political opposition from Republicans and conservative Democrats who would rather spend more money to provide less health care.
The NYT reported an “embarrassment of profits” for some of the largest health insurance companies, a doubling of profits in the second quarter of 2020 compared to 2019. These obscene profits are coupled with staggering increases in wealth for billionaires in the healthcare sector. Their wealth has increased by 36.3% from 402.3 billion to $548 billion between April 7 and July 31, 2020. All this stands in sharp contrast to failing rural and inner city hospitals, smaller medical practices and the hundreds of thousands of unnecessary COVID deaths. For journalists and talking heads in the mainstream media, this dysfunctional monstrosity is just the acceptable reality of our healthcare system. Discussing any responsibility or alternatives are disregarded.
By Ed Grystar, Dissident Voice.January 19, 2021 | STRATEGIZE!
To say that there’s a political disconnect in the fight for a national single payer health care delivery system is to state the obvious. The struggle for M4ALL has grown due to decades of grassroots organizing alongside the gradual worsening of Americans’ health insurance coverage, with support now reaching 70% in the general public as reported by FOX News after the November elections.
Yet now in the middle of a pandemic, where the USA accounts for a quarter of the world’s infections, and a third of the deaths, the USA’s for-profit healthcare system has no national plan or coordinated response. Instead, since so few Americans are going to the doctor this year, there is resounding joy in the industry as profits mount simultaneously with the despair of millions. The NYT reported an “embarrassment of profits” for some of the largest health insurance companies, a doubling of profits in the second quarter of 2020 compared to 2019. These obscene profits are coupled with staggering increases in wealth for billionaires in the healthcare sector. Their wealth has increased by 36.3% from 402.3 billion to $548 billion between April 7 and July 31, 2020. All this stands in sharp contrast to failing rural and inner city hospitals, smaller medical practices and the hundreds of thousands of unnecessary COVID deaths. For journalists and talking heads in the mainstream media, this dysfunctional monstrosity is just the acceptable reality of our healthcare system. Discussing any responsibility or alternatives are disregarded.
With millions losing their job-based health coverage, millions more stuck with high insurance costs and lower benefits, Medicare for All is once again deemed off-the-table by all major politicians, including even its biggest proponents.
This disconnect comes on top of a worsening economic crisis threatening to push millions out of their homes while half the population is living paycheck to paycheck, poverty rising and food insecurity is growing. On the other side of the class divide, trillions of dollars have been showered on the wealthy and corporations via the misnamed CARES ACT, and the world’s billionaires have increased their wealth 10.2 trillion during the COVID pandemic. If there’s ever a perfect storm of economic, social, and public health crises, it is now.
The Republican leadership has taken advantage of this crisis and assigned blame to the largely unpopular ACA and fixated on its destruction. It has spent its political energy focusing on the high costs and other weaknesses of the ACA while never offering anything as a credible replacement.
On the other end of the aisle, President Biden has clearly stated his opposition to M4ALL, promising to veto the bill if passed. Democrat House leader Nancy Pelosi is equally opposed, making the chances of a vote remote under the current leadership. The current Democrat platform focuses on “strengthening” the ACA, an easy attack vector for Republicans who are able to exploit the real failures of the ACA and continue to disorient the public.
With these pitiful responses, disillusionment with the system is prevalent, and Americans are looking for alternatives.
Controlled Opposition Or Bottom Up Independent Movement?
Which brings us to the nub of the issue. The M4ALL movement has grown, support is high and the need greater than ever. Grassroots organizing, the COVID-19 death spiral, combined with the continued deterioration of coverages and rising insurance costs has moved public support to a higher level despite a blizzard of attacks by opponents ranging from the insurance industry, media talking heads, politicians of both parties, unions, and liberals.
As it currently stands, the public overwhelmingly favors M4ALL, and the main legislation, HR 1384, has over 100 cosponsors. Yet there’s no clear strategy or energy emerging to push the bill forward in Congress or mobilize public support at this crucial time.
Despite an even deeper crisis than the 2008 recession, we are headed for a repeat of 2009, when the late John Conyers sponsored SP bill had more co-signers than any other healthcare legislation at the time, but was ditched by Democrats in favor of the ACA, a bill written by the insurance industry.
Once again, Democrats are poised to join with Republicans to scuttle the immensely popular bill in favor of the insurance industry again, all under the meek disguise of “getting something accomplished”.
Clearly, the M4All movement needs to rise to the occasion — or else risk jeopardizing its own credibility. Not only has public opinion overwhelmingly shifted in favor of M4All, but large numbers of Americans are ready to fight for it as well. The Bernie Sanders 2020 campaign drew huge amounts of activists out week after week for canvassing racked up a record number of donations.
Now with the Sanders movement gone, and the pandemic exposing the injustices within the healthcare system, M4All supporters are looking for answers.
The recent proposal by Jimmy Dore, YouTube political comedian, to force a vote on M4ALL in the House galvanized supporters, drawing tens of thousands to virtual town halls, but was overwhelmingly refuted by the officaldom of the Medicare for All movement. This has brought light on all the weaknesses of the present approach — an insider strategy that gives Congressional Democrats and the organizations that align with them too much power to unilaterally determine the direction of the struggle, while stifling voices in the grassroots. At this crucial moment, the strengthening of a popular movement is pushed aside for the sake of maintaining favorability within subsets of the Democratic party. In reality, grassroots energy is the real source of power. Rather than hitch their horses to insiders, movement leaders must drive the car, act and work in a non-partisan fashion to actually build real power.
Where some critics of Dore agree with building a mass organizing force, they scoff at his proposal and instead say work must be confined within select electoral races tied to the Democratic party and insist congressional supporters like Jayapal and Ocasio Cortez are “allies” and should not be subject to criticism. Besides the “Squad”, there are already over 100 co-signers of HB1384. What is their role in strengthening the grassroots movement? Will they hold town hall meetings and build public coalitions in their district?
Movement leaders must realize that the members of Congress must be dealt with from positions of principle and independence. Otherwise, the insider compromises progressive reps are subject to trickle down to the movement. If AOC says Medicare for All is off the table, the movement is weakened if there’s not leadership elsewhere standing up and pushing it forward. Public support is strong but we are up against an industry that is prepared to spend whatever is necessary to fight us at every turn — leadership is crucial.
In the period ahead, the peoples expectations will grow and the need for M4ALL will become clearer but so will the power of corporate Democrats who now control all branches of government. They will muzzle any grassroots mass actions and push the insider strategy and demand obedience.
Movement leaders should be wise to exploit a house vote, which would help many to understand the huge disconnect between Congress and the public. Actions like this can aid in forming a diverse coalition of labor, racial justice, and public health organizations to push for large demonstrations, public hearings, and petition drives. This is what we need to build towards: a united bloc of grassroots organizations and unions to push legislators to act.
Labor Needs To Step Up And Fight
However, labor and other organizations that should rise to the occasion and provide resources and independent leadership at this critical juncture are simply not capable, largely due to their deep ties to the Democratic party.
Organized labor has been in a steady state of decline for the past few decades. Rather than use popular struggles such as M4A to try to gain back some ground, it has largely doubled down on the business union model of operation, which treats employers as “partners”, abandons the role of membership education, mobilization, and community outreach to increase union strength and the labor movement at-large.
The lack of an organized independent current inside labor challenging the dead-end strategy of cooperation holds labor back. Witness labor’s silence over the past months on demanding wages be paid and healthcare for all workers during the pandemic, something almost all other developed countries have done. Despite hundreds of resolutions over the past decade supporting M4ALL at all levels of labor, real support is weak and ultimately folds when the Democrats give the orders. It has no real life or energy outside of a small handful of unions, and much of labor officialdom is indifferent or simply hostile to M4A, seeing brokered insurance plans as one of their last few selling points of a union to many workers, despite the share of unionized workers dropping yearly. This puts most of the top labor leadership at odds with both the growing mass of unorganized workers without unions and public opinion who are sympathetic to M4ALL and need real healthcare.
In order to win M4A, other popular programs, and stave off its own decline, labor needs a mass upsurge against the corporate domination of society and its political allies. History shows that when labor engages its rank and file into popular action, it can sweep away major hurdles that seemed impossible to overcome. The passage of Social Security in the 1930’s is one such example.
It needs an internal revitalization that advocates a fighting alternative program that mobilizes and puts people first instead of taking cues from “corporate partners” and Democratic politicians as to what is on and off the table. Building this necessary independent movement will ultimately clash with the party, and this is why Dore’s proposal has struck such a nerve. The multiple unfolding crises have put the need for a fundamental change in plain sight and progressives need to rise to the occasion.
If our only hope for Medicare for All is phone banking for intermediate legislation deemed “on the table” by the progressive caucus and working to elect more progressive Democrats to Congress, the movement will never actually move forward. With an independent movement that doesn’t take cues from “allies” in Congress, but instead uses them to help move the agenda forward, we can reach a stage where it isn’t an isolated YouTube personality making such a suggestion but membership-led organizations, backed with the participation of ordinary people, who see themselves playing a real role in this fight.
Ed Grystar is Chair of the Western Pennsylvania Coalition for Single Payer Healthcare. He has over thirty years experience in labor and health justice movements. Served as President of Butler County (PA) United Labor Council, AFL-CIO from 1987-2002, Western PA Labor coordinator for Jesse Jackson for President in 1988, PA coordinator for Dennis Kucinich for President in 2004. He has worked for a number of healthcare unions.Health CareMedicare For AllSingle Payer Health Care
Joe Biden must put an end to business as usual. Here’s where to start
In this time of unprecedented crises, Congress and the Biden administration must respond through unprecedented action
Democrats must summon the courage to demonstrate to the American people that government can effectively and rapidly respond to their pain and anxiety Photograph: Rex/Shutterstock
20 Jan 2021 951 The Guardian
A record-breaking 4,000 Americans are now dying each day from Covid-19, while the federal government fumbles vaccine production and distribution, testing and tracing. In the midst of the worst pandemic in 100 years, more than 90 million Americans are uninsured or underinsured and can’t afford to go to a doctor when they get sick. The isolation and anxiety caused by the pandemic has resulted in a huge increase in mental illness.‘This is our historic moment of crisis and challenge’: Joe Biden calls for unity in first speech as president – liveRead more
Over half of American workers are living paycheck to paycheck, including millions of essential workers who put their lives on the line every day. More than 24 million Americans are unemployed, underemployed or have given up looking for work, while hunger in this country is at the highest level in decades.
Because of lack of income, up to 40 million Americans face the threat of eviction, and many owe thousands in back rent. This is on top of the 500,000 who are already homeless.
Meanwhile, the wealthiest people in this country are becoming much richer, and income and wealth inequality are soaring. Incredibly, during the pandemic, 650 billionaires in America have increased their wealth by more than $1tn.
As a result of the pandemic education in this country, from childcare to graduate school, is in chaos. The majority of young people in this country have seen their education disrupted and it is likely that hundreds of colleges will soon cease to exist.
Climate change is ravaging the planet with an unprecedented number of forest fires and extreme weather disturbances. Scientists tell us that we have only a very few years before irreparable damage takes place to our country and the world.
And, in the midst of all this, the foundations of American democracy are under an unprecedented attack. We have a president who is working feverishly to undermine American democracy and incite violence against the very government and constitution he swore to defend. Against all of the evidence, tens of millions of Americans actually believe Trump’s Big Lie that he won this election by a landslide and that victory was stolen from him and his supporters. Armed rightwing militias in support of Trump are being mobilized throughout the country.
In this moment of unprecedented crises, Congress and the Biden administration must respond through unprecedented action. No more business as usual. No more same old, same old.
Democrats, who will now control the White House, the Senate and the House, must summon the courage to demonstrate to the American people that government can effectively and rapidly respond to their pain and anxiety. As the incoming chairman of the Senate budget committee that is exactly what I intend to do.
What does all of this mean for the average American?
It means that we aggressively crush the pandemic and enable the American people to return to their jobs and schools. This will require a federally led emergency program to produce the quantity of vaccines that we need and get them into people’s arms as quickly as possible.
It means that during the severe economic downturn we’re experiencing, we must make sure that all Americans have the financial resources they need to live with dignity. We must increase the $600 in direct payments for every working-class adult and child that was recently passed to $2,000, raise the minimum wage to $15 an hour, expand unemployment benefits and prevent eviction, homelessness and hunger.
Despite what you may have heard, there is no reason why we cannot do all of these things
It means that, during this raging pandemic, we must guarantee healthcare to all. We must also end the international embarrassment of the United States being the only major country on Earth not to provide paid family and medical leave to workers.
It means making pre-kindergarten and childcare universal and available to every family in America.
Despite what you may have heard, there is no reason why we cannot do all of these things. Through budget reconciliation, a process that only requires a majority vote in the Senate, we can act quickly and pass this emergency legislation.
But that is not enough. This year we must also pass a second reconciliation bill that deals with the major structural changes that our country desperately needs. Ultimately, we must confront the grotesque level of income and wealth inequality and create a country that works for all and not just the few. Americans should no longer be denied basic economic rights that are guaranteed to people in virtually every other major country.
This means using a second reconciliation bill to create millions of good-paying jobs rebuilding our crumbling infrastructure and constructing affordable housing, modernizing our schools, combatting climate change and making massive investments in energy efficiency and renewable energy.
It means making public colleges, universities, trade schools and Historically Black Colleges and Universities tuition-free and forcefully addressing the outrageous level of student debt for working families.
And it means making the wealthiest Americans and most profitable corporations pay their fair share of taxes. We cannot continue to allow profitable corporations like Amazon to make billions of dollars in taxes and pay nothing in net federal income taxes. And billionaires cannot be allowed to pay a lower tax rate than working-class Americans. We need real tax reform.
There is no reason Joe Biden could not sign into law two major bills that will accomplish most of the goals I listed above within the first 100 days of the new Congress. We cannot allow Mitch McConnell and the Republican leadership to sabotage legislation that would improve the lives of millions of working Americans and is wildly popular.
Let us never forget. When Republicans controlled the Senate, they used the reconciliation process to pass trillions of dollars in tax breaks primarily to the top 1% and multinational corporations. Further, they were able to confirm three rightwing US supreme court judges over a very short period of time by a simple majority vote.
If the Republicans could use the reconciliation process to protect the wealthy and the powerful, we can use it to protect working families, the sick, the elderly, the disabled and the poor.
New polling results revealed that people with low incomes agree upon a range of policy solutions to poverty and hunger.
“Rising hunger in America is a moral and policy failure—addressing it should never be a partisan issue.”
—Rep. Marcia Fudge
Conducted in November by the Colorado-based firm Kupersmit Research on behalf of the national anti-hunger direct service and advocacy group Hunger Free America, the survey found that many people across the country with household incomes of $50,000 or below share views about raising the minimum wage as well as expanding access to and benefits of public assistance programs.
According to the poll, 73% of Americans living in or near poverty somewhat or strongly agree that “the U.S. government should enact the policies and programs necessary to end U.S. hunger by ensuring that all Americans can afford and access sufficient, nutritious, culturally compatible food.”
Majorities of those polled said boosting the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps, would help some or a lot, and that all school meals should be “universal, free, and nutritious, regardless of family income.”
Raising the federal minimum wage—currently just $7.25 an hour—was also popular among respondents. When asked to describe the three most important things “that need to happen or change so that low-income Americans are able to have a better quality of life and a more secure economic outlook for the future,” responses included:
- “I need a higher minimum wage, lower health insurance costs, and more affordable housing.”
- “Easy access to resources and easy application process, raise minimum wage to $20, and have free healthcare for everyone.”
- “Having the rent not be so high, not having landlords trying to evict people, and being able to get a job.”
Other respondents suggested having a federal jobs guarantee, more labor unions, a universal basic income (UBI) program, a solution to the climate crisis that centers renewable energy, higher taxes on wealthy people and companies, and one application for all government assistance.
The poll found that majorities of low-income Americans support increasing government subsidies for home purchases and believe that it should be “free to open bank accounts, cash checks, pay bills, and pay for things by smart phone and/or at stores without hassles, fees, or fine print.”
While all the respondents have low incomes, they are diverse in terms of age, race, and political party, and live in rural, suburban, and urban areas.
The survey results, released just weeks after the divisive presidential election, show that 67% of low-income Americans agree that “if the U.S. government decided to spend as much as necessary, we could eliminate U.S. poverty, homelessness, and hunger.”
Hunger Free America CEO Joel Berg on Thursday expressed hope that President-elect Joe Biden and Vice President-elect Kamala Harris—whose victory this month denied President Donald Trump and Vice President Mike Pence a second term—will learn from the findings.
“In the last election, virtually the only thing that united the most pro-Trump rural counties and the most pro-Biden cities was high levels of poverty and low levels of income,” Berg said. “Instead of assuming we knew what people in and near poverty were going through and what policies they wanted, we asked them. We found from this new ground-breaking research that most low-income Americans face multiple barriers to getting ahead.”
“The good news is that we also found that low-income Americans of all parties, regions, and races broadly agree upon a bold policy agenda for government to make work pay and ensure that everyone has high-quality, affordable healthcare, housing, and food. We hope the incoming Biden-Harris administration can find common ground with the incoming Congress to make such goals a reality,” he added, while calling on businesses to also step up and “pledge to pay all workers a living wage.”
“Low-income Americans are sending a clear message to elected officials in both parties,” said the research firm’s president Benjamin Kupersmit. “First, they demand government intervention to raise wages, to lower costs and remove barriers to basic necessities, starting with healthcare. Second, they want to reform the safety net so these programs are expanded to be sufficient and re-designed with compassion and dignity for people working as hard as they can, or facing significant disability or illness.”
The poll results come as Republican lawmakers and the Trump administration are under fire for months of delayed Covid-19 relief for Americans, despite the intense need and multiple measures passed by the Democrat-controlled U.S. House, and as progressives are maintaining pressure on Biden to avoid appointing a “corporate Cabinet,” and instead nominate people committed to serving public good.
Among the potential Cabinet picks favored by progressive activists and advocacy groups is Rep. Marcia Fudge (D-Ohio); earlier this month, more than 50 organizations came together to send a letter to the incoming president urging him to nominate her to lead the U.S. Department of Agriculture.
“Congresswoman Fudge is a skilled and compassionate leader of unparalleled reputation and integrity,” the groups’ letter explained. “She has long been an ally to farmers, food-chain workers, consumers, and rural communities. She is best positioned to help the department navigate today’s unprecedented challenges—from the ongoing rural crisis, to climate change, to the pandemic’s rupturing of our food system.”
In a statement about the survey, Fudge said Thursday that “today, hunger, poverty, and inequality are all on the rise across America. This new poll not only identifies the barriers low-income Americans face to getting ahead, it also shows there is broad agreement on the policy solutions that would give them a hand up during this difficult time.”
“From raising the minimum wage and ensuring access to healthcare to boosting SNAP benefits, these are commonsense solutions that Congress can act on now to help struggling families put food on the table,” she added. “Rising hunger in America is a moral and policy failure—addressing it should never be a partisan issue.”
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Hunger Free America
Policy Views of Low-Income Americans
November 25, 2020
Prepared by Kupersmit Research
807 interviews were conducted among American adults in households with annual incomes below $50,000. We then divided our results by age, with 587 respondents aged 18-64 (page 1) and 220 respondents aged 65 and over (page 17).
Read the full survey results:Policy Views of Low-Income Americans.pdf