65% Now Hold Populist, or Mainstream, Views

55% Favor Repeal of Health Care Bill

I find his polls as good as any. He shows 54% favor repeal of the new health care law, with 70% of seniors against the Medicare cuts.

The lack of understanding of the monetary system is taking an increasing both economically, politically and socially.

With almost 20% of the workforce unable to find full time work, and near record low capacity utilization in general, our leaders saw fit to raise taxes and cut spending which will lower demand and undermine their political careers to ‘pay for’ a very modest spending increase of about $100 billion a year, and with delays, of the perhaps additional $1 trillion of fiscal adjustment needed to get us back to full employment in a reasonable time frame.

Also, part of the rise in costs goes to insurance reserves which are a demand leakage.

The politics get uglier by the day, and from watching the news over the weekend the loudest health care protest seems to be over the expense and how it will add to the size of the deficit. Seems this means more ‘fiscal responsibility’ is on the way, including letting the tax cuts expire next year and maybe even a VAT which is an absurdity under any circumstances, apart from a desire to cut consumption.

Add to that the reality of the eurozone actually offering Greece nothing of value, opening the way for wider credit spreads spreading to the entire eurozone.
It also looks like their combined deficits are now large enough for the added non govt financial assets to now be driving down the euro independent of the credit issues. This continues until exports increase sufficiently for the automatic stabilizers to tighten fiscal balances. They aren’t anywhere near there yet.
Additionally, the dollar index chart is beginning to pick up a bid from commodities traders as well.

31 Responses

  1. Warren,

    I disagree that the health care protest is really about the size of the deficit, or even the expense in dollar terms. It gets expressed that way because it is easier to put into a sound bite, but I think most protesters instinctively understand that the real issue is that the government is creating a new entitlement which will divert health care resources away from them. 85% of people have health care insurance, and over 75% of them are happy with it.

    Given that most people were already worried about the rising cost of health care resources, it is certainly understandable that they would be apoplectic when the government rams through a policy that will make health care even more expensive. And Medicare recipients are rightly worried that their consumption of health care resources will be curtailed.

    It certainly would have been nice if the government had a policy to increase the supply of health care resources besides making them more expensive.

    1. ESM, there was a front page article in the local paper today about health care resources being stretched by injecting millions of people into an already stretched system. Prices are rising at least in part because of increasing demand for real resources as boomers age. This is going to create a crisis in primary care, where already there are not enough physicians, since most physicians choose to specialize. Health care policy has to take this into account or there are going to be problems with some people getting care at all, not only the cost of it. This is especially true in rural areas, where primary care physicians are scarce now and their numbers are declining.

    2. Why did people go from favoring health insurance reform a year ago to opposing it now? Well, there has been a lot of anti-reform rhetoric since then, giving various reasons. It could be any of those reasons, or a combination. Also, the largest polling change occurred with seniors (65 – 80 years old). Probably they are concerned about losing Medicare benefits.

      But here is a thought. Don’t just do a yes/no poll. Ask them why they favor or oppose it. 🙂

      1. Min, one big reason that seniors were against it was that it gores after saving in Medicare through reducing Medicare Advantage benefits as a subsidy (in effect a hidden tax) for the industry. The GOP represented this as a benefit cut for seniors, although that’s not quite the case in the larger picture. There is also a lot of fat in the system than needs to be cut, and also a good deal of fraud.

        A lot of progressives, including me, oppose the bill that was passed as a giant subsidy that doesn’t address real problems. It’s not a progressive health care policy.

        Polling is difficult to construct, since Americans favor universal health care in general, but most are satisfied with the health insurance they have and are conflicted about changing anything that might affect them.

        The only real solution is a single-payer Medicare for all program, along with a health policy that increases investment in health care provision in order to handle the increased load. Private insurance programs could be optional, as in Germany. There are a lot of working models out there to upgrade the US system. But we already have Medicare in place. Expanding it is the simple, effective, and efficient way to go, rather than creating exchanges, etc., from scratch.

        We might be on the way there today, if Obama had used his political capital wisely instead of going for a “bipartisan” approach that was doomed from the get-go.

  2. “…their combined deficits are now large enough for the added non govt financial assets to now be driving down the euro…”

    Assuming that most of the EU countries don’t cheat, their deficits cannot exceed 3%, correct? That is smaller than the US deficits. Why would it then drive the euro lower?

  3. I think people are all too familiar with the horrendous record of government cost projections and instinctively know that the program will cost more (and deliver less) than its promoters would have you believe. People also conclude correctly that taxes will be going up as a result

    Prediction: Legislation will be introduced at some point that mandates doctors have a certain percentage of their income or billing come from Medicare/Medicaid (possibly exempting obstetricians!) as docs refuse to accept ever lower reimbursement rates from Medicare. Senior voters will begin to scream that yes, their medical costs are covered, but they are unable to find doctors willing to treat them.

    1. Yup, this system is badly broken and it can’t be papered over. Real reform is necessary and that means addressing real problems, not “costs” as the Obama agenda did. It just kicks the can down the road a bit.

      The one thing that the Democratic victory establishes is that healthcare is to be considered a right of citizenship (but not yet a human right), instead of a privilege, and that health care is a necessity rather than just another a commodity. That’s a big step forward.

    2. Jason

      I think you make a common mistake that so many on the rabid right make when criticizing govt programs this way; “people are all too familiar with the horrendous record of government cost projections and instinctively know that the program will cost more (and deliver less) than its promoters would have you believe.”

      Is the problem with “government cost projections” or just cost projections in general? Have you looked ever at the bullshit companies put out in their quarterly reports and on the financial news stations? They are no better at cost projections because all attempts at cost projections require GUESSING the future!

      One thing the govt CAN do is actually fix a cost if it desires. Or it can fix a supply if it desires. It has a monopoly power that it CAN use. As distasteful as that is to some it has that power and SHOULD use it at times and for certain things. There are many companies who harbor the desire to be monopolists but usually we have determined that a private monopoly is not good for consumers. A govt monopoly isnt necessarily good for consumers but it COULD be under certain conditions. I think in the provision of basic health care it might be good.

  4. ESM,

    We aren’t resource restrained, our restraints are the political power of rent-seeking actors. First off, as I mentioned the other day, we make it difficult for foreign doctors to continue working here after US training, the number of residency slots (funded by Medicare), the number of medical school slots and length of med school (funded mostly by state governments) are limited– there’s no reason for every med school to not adopt (as Nova Southeastern and some other universities have) a med school program of 6 years of 12 month schedules for college and medical school combined instead of 8 years of 9 month schedules that is the norm. Similarly, the educational requirements for new pharmacists, nurse practitioners and physician assistants keep rising (if nursing groups could get away with abolishing two year RN programs they would), even while existing “guild” members are grandfathered in under the old rules, leading to shortages in every medical field.

    What’s more, everyone wants to limit what their competitors can do. Dentists don’t want dental hygienists working unsupervised, neither want the Native Alaskan program of tribal dental therapists (which have provided school-based dental care in New Zealand for 100 years) to expand to the rest of the country. Doctor groups limit how much nurse practitioners or physician assistants can do unsupervised, their scope of practice varies widely depending on the state (and none of those three groups like that New Mexico allows pharmacists to prescribe drugs in some circumstances).

    I could go on, if we were really resource-constrained, we’d look at how the military and the aforementioned Native Alaskan health system handle bona fide resource constraints… the equivalent of paramedics are given the training and equipment to treat medical conditions (phone assistance and medevac flight available when necessary) that in the civilian world only physicians (or dentists) are legally permitted to handle.

    Since we’re not resource-constrained, let’s focus on making medical education (at every level) competency-based and not credential-based and eliminating any scope of practice regulation that is motivated by restraint of trade instead of public health, safety and welfare.

  5. I assume you all like my health care proposal i just pasted on Facebook?

    A Progressive Health Care Proposal from a Tea Party DemocratShare
    Today at 5:06pm
    Let’s cut to the chase with the answer first:

    Everyone gets $5,000 on January 1 each year to spend on health care.

    $1,000 is for preventative care, and the other $4,000 is for all other health care needs.

    If you need more than that you are covered by a form of Medicare.

    At year end you get the unused portion of the $4,000 as a gift with no strings attached.

    You are free to buy any private insurance or medical plan you wish.

    I used those particular numbers as a reasonable starting point for discussion.

    Children under 18 would be covered by Medicare and not participate in this plan. I don’t want to give parents a cash incentive to not take their children to the doctor.

    This proposal is progressive because the $5,000 is worth a lot more to people with lower incomes than to people with higher incomes.

    It also utilizes competitive market forces to help contain costs by maximizing personal choice and tapping into America’s unparalleled ability and enthusiasm to shop.

    It doubles available doctor patient time as doctors would have to discuss costs with their patients instead of with insurance companies.

    It reduces the Medicare administrative burden for current Medicare participants as they would be on their own up to their first $5,000 of expenditures.

    The cash back incentive serves to minimize overuse.

    It is fiscally responsible as the total medical costs to our nation will fall dramatically even as available doctor/patient time dramatically increases.

    It is a populist, bottom up solution for universal health care with appropriate incentives to minimize abuse, corruption, and fraud.

    Everyone is free to select their doctors.

    The government is not involved in the doctor patient interaction up to the first $5,000 dollars, and all are free to not use the Medicare option if they so desire.

    Tax increases are not appropriate as the spending related to this proposal will not only not be inflationary but will serve to reduce prices and costs. In fact, the deflationary and competitive aspects may even lead to a tax cut to sustain aggregate demand.

    This progressive proposal is more than consistent with core Tea Party and traditional populist Democratic values:

    It reduces the participation of government in the actual health care process.

    It employs competitive market solutions.

    It increases personal freedom.

    It works from the bottom up.

    Additionally, this proposal removes all of the unfair financial burdens of health care from the States, and removes health care costs as marginal costs of production from small and large businesses alike.

    It’s a win/win/win for our national health, our health care, and the American economy.

    Thanks for your consideration.

    Warren B. Mosler
    Candidate for U.S. Senate from Ct.

  6. One of the problems with the current system is uneven billing. My wife developed an infection Saturday evening that I recognized as cellulitis, which needs to be treated promptly with antibiotics. The only option was the ER. The doctor confirmed my diagnosis and prescribed an antibiotic. The statement arrived today. $619 for about a five minute consultation. My wife is on Medicare and has supplemental insurance, so the cost to us will be zero. Medicare will pay the hospital maybe $100 and the supplementary will be similarly low due to negotiating power.

    However, someone without insurance would be billed for the full amount. Aware of that, the person might be tempted to wait until Monday for treatment at a doctor’s office, which would be relatively inexpensive in comparison to the ER. But the situation could be quite serious by then and require hospitalization. Cellulitis can also become life-threatening if left untreated too long. There are serious trade-offs here that people are being made to accept in the name of cost-control.

    This doesn’t happen in other developed countries. I was talking to an emergency medic in London not long ago and he explained that no matter who you are, you get emergency treatment without cost. I have an American friend who received such treatment and when he offered to pay something toward the cost, he was told that there was no way of handling even donations. Quite a difference from the US, where the first person one encounters is the cashier.

    1. Tom Hickey:

      Do you care about facts at all? My wife sees almost 100 ER patients a week (yes she is doctor) and about 80% of them do not have insurance and they end up getting treatment free. ER cannot discriminate based on ability of patient to pay.

      Warren: your proposal is interesting, especially the deflationary forces it could potentially unleash. The interplay between monetary base and inflation (or lack thereof) is most interesting aspect of MMT to me right now. Throw in medical malpractise reform and you have very interesting proposal

      1. Zanon, perhaps I did not make myself clear. I was not saying that people are denied treatment at the ER. I was saying that if not insured or indigent, they have to pay the full price. This influences decisions regarding life and death matters due to cost. That is not a satisfactory situation in my view. I have been in this situation myself during period in which I was “self-insured.” There’s often just too much uncertainty to assess risk properly and people should not be put in that situation in the first place “to bring down costs.” This is false logic, based on skewed priorities.

      2. Tom Hickey:

        Maybe I did not make myself clear. Do you care about facts at all?

        People who have money and do not have insurance are charged non-negotiated rate by ER, but they end up paying whatever they negotiate with hospital. Collection is below 30%.

        And yes, this is downside of self-insurance, no matter whether we are talking about healthcare or anything else.

        But Obama just outlawed catastrophic insurance which is what most self-insured people need AND it is essentially what Warren recommends.

  7. 80% of them do not have insurance and they end up getting treatment free. ER cannot discriminate based on ability of patient to pay.

    Zanon, That’s not because of the Hippocrates Oath, its because of a federal law that requires hospitals (and by extension, the doctors they give privileges do) that accept Medicare or Medicaid, to stabilize anyone who comes in with a medical emergency including women in labor.

    Politically, there’s no way that law is going away but there’s a whole bushel of bad things going on– 1. Physicians like your wife are obligated to provide uncompensated care as a condition of employment. 2. The indigent aren’t hounded by bill collectors, the hospital may write off the uncollected bills as a loss, but the collection agencies they sell them to do not, 3. Quick and fatal is covered, slow and fatal is not. If that cough turns out not to because of pneumonia but lung cancer, the hospital has no legal obligation to provide non-emergency care even when the patient faces certain death without treatment. 4. Because the indigent can’t afford preventative care and the only primary care available is in the ER, the indigent clog ER waiting rooms, making it more difficult for anyone else who is obligated to go to the ER because of a medical emergency.

    Warren, your plan looks good. I wonder if making a portion of the payroll tax a healthcare saving account would fly better than giving a flat sum to everyone annually. A flat sum of $5000 would overincentivize the poor and underincentivize the wealthy (though the $1000 held back is clever). However, setting the prepaid savings/deductible at 2.9 or 7.65 percent of your wage income (if any) hits everyone proportionately the same. The patient would see a price list before service and a bill afterwards, but the govt. would reimburse all claims at time of service (Taiwan single payer system eliminates an enormous amount of admin costs because provider billing is integrated with the electronic medical records, as the doc updates the records, invoice sent in automatically). At the end of the year, you’d get a list of your total charges and total Medicare taxes. Any taxes you didn’t spend would be refunded.

    To follow up on Zenon’s point about medmal. Government doctors (like at the VA) have never had to buy medmal insurance, lawsuits are defended and/or paid out by our old friend Tsy. Congress has extended this same medmal coverage to doctors working for nonprofit Community Health Centers. There was a failed amendment (link below) to the House bill that would have extended federal coverage to any doctor treating a patient with Medicare or any other government plan. I’d add that to Warrencare. Zenon’s wife could reallocate what she spends on medmal premiums to what’s important, Zenon! :o)

    1. Beauwolf:

      Of course it is because of Federal Law! Where did I ever suggest anything different?

      And I am no fan of it. At very least, you could change taxes so uncompensated care is treated as charitable contribution and can be written off.

      I do not know how slow and fatal (lung cancer) is dealt with. Certainly it is beyond ER.

      Also, problems of indigent are much worse than you think. The number of indigent in ER who come in because of mouth cysts because they never clean teeth is quite staggering. Toothbrush and toothpaste are within means of very poor, and yet they do not clean their teeth. Problem is not lack of dental care or medical care or insurance. It is that these people do. not. clean. teeth.

      What to do?

      I am all in favor of EVERYONE allocating more of their income to their own families of course.

      1. I do not know how slow and fatal (lung cancer) is dealt with. Certainly it is beyond ER.

        Its not. The Journal of Public Health published a study last year estimating that 45,000 Americans die every year because they lack of health insurance.

        The problem is beyond the capacity of any ER or doctor providing charity service to deal with. However, it is certainly within the capacity of the United States Government. When the EPA is doing cost-benefit analyses for new environmental regulations, it puts an economic value of $6.9 million on each life saved, and that sum was knocked down from their original figure of $7.8 million by the OMB.

        As Protagoras said, man is the measure of all things. For want of government protection of our most valuable resource, our economy pays out $310.5 to $351 billion a year in “death taxes” (to change the meaning of the term somewhat). Call me a supply sider, but I believe in cutting taxes.

      2. Beowulf:

        The Journal of Public Health study you publish is garbage. I am surprised it sucked you in and you cite it seriously.

        When I said lung cancer is beyond ER I meant exactly that — ER cannot treat lung cancer. I have no idea what happens to uninsured lung cancer victim who is young and does not qualify for medicaid. I doubt very much that they sit in their house until they die.

      3. “The Journal of Public Health study you publish is garbage.”

        The JPH is published by Oxford “on behalf of The Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom.”

        Zanon, I would be interested in why you think something that is published in a premier journal is “garbage” Usually garbage doesn’t get passed the peer referee process.

      4. Tom Hickey:

        Your naive belief in argument by authority, as well as the sanctity of peer review in today’s politicized academic environment is touching.

        Unfortunately for you, I have extensive personal experience with how peer reviewed research works and do not revere it like catholics revere pope.

        Also, please pick up any peer reviewed journal of macroeconomics and you will see it 100% full of nonsense.

        People have two options — they can either believe (and if they choose worship) others, or they can see with their own two lying engages, engage own brain, and make up own mind. I invite you and all others to do the same with this nonsense article.

      5. Zanon, I am not making an argument from authority. I am asking you to critique the paper and tell us on what basis you argue that it is erroneous by attacking the design, method or data. Obviously, a peer reviewed papers has been examined by experts who approved it for publication. That doesn’t prove it contains no mistakes, but it does require that anyone attacking it give substantial reasons so they, too, can be disputed.

        I am certainly willing to be persuaded by a sound argument based on valid logic and true premises, but I really don’t know what to make of calling something “garbage.” That is isn’t even rhetorical in contrast to logical. It is just ridiculous.

      6. My critique is very simple — i have seen first hand make-up of these uninsured, and I am willing to bet that in next decade or two, now that we have the Obama care that you quiver with such exstacy at, we will not see 5%-10% drop in mortality as the 45,000 avoidable deaths are now suddenly avoided.

        the uninsured who are dying (in general) are not dying because they are uninsured. they are dying because they lead a high mortality lifestyle, of which lack of insurance is simply one manifestation.

        please go to your local inner city ER and sit in waiting room to view parade of humanity between 6pm-6am.

        while you are at it, you should go to the celebrated almost angel-like Mayo Clinic and sit in their waiting room too!

        Using your own eyes and own brain is always good idea

      7. Well, this is anecdotal at best. But, this brings up a good point, specifically what to do with people who “choose” an unhealthy lifestyle — although others will argue that this is imposed on them by circumstance rather than chosen intentionally. Is the correct solution liberal or libertarian, for example? I tend to be libertarian in matters of informed choice, but I’m not sure that this is the case here, and I suspect it isn’t, at least entirely. It seems that society can do better at organizing itself productively.

        At any rate, it shows that the problem is not simply a health care problem but a complex one that needs a comprehensive solution extending beyond health care alone. So far, the present arrangement seems to be contributing the growth of the problem instead of solving it as more children are born into poverty and seemingly trapped in their circumstances.

        Even the middle class is deteriorating as suburban children are increasingly affected with obesity and diabetes, and are often psychologically scarred by their upbringing and environment. In fact, the explosive growth of exurbia is largely a reaction to contemporary culture. Thee is also a reaction among to traditional cultures to the export of American culture, which they see as destructive based on the results they observe.

        I don’t pretend to know what the solution is, but I do see a revolution brewing around us due to this. I would agree that order seems to be breaking down, and this is a societal problem that needs to be dealt with intelligently before it comes to a head emotionally.

      8. Tom Hickey:

        You may be surprised to learn that I lean extremely paternalistic here. I am not libertarian. We have worst of both worlds in our present United States and Democratic world — a loco parentis where “loco” is from spanish not from latin. It is better to have no parent than to have parent that is incurably insane, but of course have sane parent is best of all.

        We agree that health care is complex business, and it is complexity why i reject nonsense comprehensive obama bill. It is my knowledge of both medical, academic, and politcal industry why I dismiss reports like the one you point to as the obvious statist propganda that it is.

        by contrast, monetary system is very simple and we have same academic monolith spouting nonsense (by PhDs in Peer Reviewed Journals, some of which from Harvard I will point out to you) which NYTimes published and politicians follow.

      9. Zanon, at least we seem to agree that the Obama health care bill should never have been passed and should be repealed and replaced as soon as possible. We may disagree over the solution though.

        In my view, it is impractical to have a comprehensive national health care policy under which some are insured and some not because of uneven pricing due to negotiating power. That means either eliminating insurance, which is impractical, or universal coverage. A single-payer plan like Medicare is practical, in that if private insurers are involved in a universal plan, then subsidies to private insurers will be required for a significant segment of the population. The more efficient solution is simply to eliminate the middlemen.

        The insurance industry now in place would simply administrate the program, as they now do with Medicare. They would operate a public utilities rather than profit centers for Wall Street. Private insurers could also offer special plans for premium service, as they do in the UK and Germany, for instance. They could even operate their own luxury hospitals. But everyone would receive comprehensive basic care.

        Moreover, MMT shows how this can be provided for publicly through federal funding, without having to be funded by taxation or financed through borrowing.

        However, this still leaves the issue of cost-control. First, I would provide public insurance for malpractice, also, with capped awards. Doctors who don’t make mistakes would not be required to contribute. Those who do, would. That is, good behavior is rewarded while bad behavior is sanctioned. That would resolve the problem of tort reform, as well as relieve the pressure to over-prescribe, without disadvantaging patients that were mishandled.

        Secondly, incentives can be devised to dissuade overuse of services, as well as “waste, fraud, and abuse.” This isn’t rocket science.

  8. good suggestions, thanks.

    my idea is to get the basic proposal passed and then debate the rest. no point in delaying what might otherwise pass as it has near universal appeal?

    1. You’re quite right, your healthcare proposal (heck, your platform across the board) is superior to anything that’s come out of Washington. I forget you’re running for office so I apologize for going in the weeds with policy suggestions when your proposal is worth passing as is.

      At least until election day, I’ll make every effort to limit my unsolicited advice to politics and not policy —> Pete Peterson and his fellow deficit hawks are the enemy. Any day your opponents talk about “tightening our belt” is a good day for you, its a hook for you to pop them with both barrels. :o)

  9. And I’m waiting for someone to propose some kind of cap and trade idea on total calories as a market solution to obesity.

    It would be deemed progressive because only the rich could afford to get fat and unhealthy.


    1. Yup and the big push for school age children to exercise more and eat healthier won’t help either.

      “In the 1990’s, the National Institutes of Health sponsored two large, rigorous studies asking whether weight gain in children could be prevented by doing everything that obesity fighters say should be done in schools — greatly expand physical education, make cafeteria meals more nutritious and less fattening, teach students about proper nutrition and the need to exercise, and involve the parents…. They were not. The students could, however, recite chapter and verse on the importance of activity and proper nutrition. They also ate less fat, going from 34 percent to 27 percent fat in their total diet. Alas… “it was not enough to change body weight.”

      Of course, the two studies were and still are ignored because they conflict with what the politicians (and the public) want to believe. Unless we’re willing to adopt the Israeli system of universal military service for men and women (and the obesity issue isn’t worth that big an infringement of personal liberty), I’m not sure there’s much the government can do.

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