Private insurers will make a lot of money off Medicare-for-all, but that’s okay: everyone will be covered and overall costs will go down

There are a number of myths floating around the mainstream news media that portray Medicare-for-all as politically unviable, too expensive and impossible to implement.

The biggest misconception is that there would be no place for the politically powerful private insurance companies if everyone is on the government plan. This myth proposes that the eradication of private insurers makes passing a Medicare-for-all bill virtually impossible. If it did pass, consumer choice in plans would be severely limited, because private sector competition creates choice. Yet even a cursory look at the real world proves that only people with no actual experience of Medicare could seriously entertain the idea that Medicare-for-all would eliminate private insurers.

Private insurance has been an integral part of Medicare for decades, in three ways:

  • Private insurance companies offer supplemental plans that pay for the 20% of medical costs that Medicare doesn’t cover.
  • Private insurers also sell Medicare Advantage plans, which replace Medicare coverage with coverage through a private insurance company that Medicare pays for. Typically these plans offer a dental and eye benefit and wellness programs, but they also usually force participants to use a limited healthcare network of physicians and facilities. All of the Advantage plans saddle participants with co-pays.
  • Private companies offer prescription drug policies (Medicare Part D).

I doubt an American single-payer system could exist without the support of private companies. What’s more, private companies should embrace the Medicare-for-all concept. Although they will be forced to offer less profitable policies, tens of millions more people will be covered, a bonanza opportunity for private healthcare insurers. Moreover, the more people who are covered, the lower the overall cost of healthcare coverage, which will cut costs at the level of the individual insurance provider.

The next myth is that Medicare-for-all will give people less choice. Nothing could be further from the truth. For one thing, people don’t get that much choice to begin with. Virtually every private healthcare insurer offers the same portfolios of benefits, with the same perks like wellness classes and on-line tools and apps, differing only in the size and composition of their provider networks and the combination of deductibles and co-pays they require. Everyone offers annual physicals. No one will pay for custom shoes unless the patient has diabetes. Cardiac stress tests, yes. Coronary calcium tests, no.

In fact, I would assert that Medicare offers more choice than private commercial insurance. For the past 15-20 years, it has been impossible to find a commercial plan that didn’t have co-pays or deductibles. I know, because I tried many times, having gotten use to buying healthcare plans without co-pays or deductibles for the employees of my company before the insurers did away with premium-only policies. (BTW, my company always paid the entire premium for employees and their families.)

By contrast, Medicare offers people the option of buying a supplemental plan—from a private insurance company—that pays all the costs that Medicare doesn’t cover without a deductible or a co-pay. That’s the kind of choice that appeals to this American!

Perhaps the most egregiously wrong-headed myth about Medicare-for-all is that it will be so expensive that it will bankrupt the country. That makes no sense, assuming that the money that companies and individuals now pay for commercial insurance goes towards taxes to pay for Medicare-for-all. It’s true that more people will be covered, but research and the results of Obamacare show that the more people who are covered, the lower the cost to insure each. The uninsured tend to wait until they are very sick to seek medical care, often using the very expensive emergency department. Society pays for those costs in one way or the other. It is much less expensive when people get regular check-ups, get their flu shots and other needed vaccinations, and are encouraged to go to the doctor as soon as they get sick. Most economic estimates predict that Medicare-for-all will eventually drive down the cost of medical care.

But who will pay? That’s the big question and the big fear. The answer, however, should be obvious: raise the Medicare tax on both employers and employees so that the additional tax collected is somewhat close to the current total cost for non-Medicare related commercial policies. We could exempt employees earning under a certain amount, but not their employers. We would, of course, have to make certain the tax applied to sole proprietors, freelancers and the companies who hire gig economy employees. At the end of the day, though, rich folk will tend to subsidize a Medicare-for-all system, while poor people will pay less than what they use. The same will be said for healthy people and young adults who will use the system less and the elderly and infirm, who will use it more.

This solution will leave some companies and individuals paying less for healthcare than they currently do and some paying more. But let’s remember that when governments decided to standardize weights and measures, merchants with scales that were “light” made less money as they adjusted what a pound meant up and merchants with “heavy” pound scales made more as they started selling “pounds” that weighed less. Likewise, when governments decided to prevent bakers from putting sawdust in bread—some bakers made more money and others made less. When American governments in the first half of the 20th century decided to tax mass transit systems while subsidizing the construction of highways, some companies and individuals made more money and some made less. When a government decides to go to war, change a safety standard, ask for a new piece of paperwork, or do just about anything, someone is going to make more money and someone is going to make less. That’s the nature of all economies. Don’t mistake these comments as an argument against regulation, though: the decisions of companies and consumers also always economically benefit certain parties and hurt others. Just ask towns when factories move away or the employees of small downtown stores when Wal-Mart builds a super store at a nearby mall. Or the people who manufacture Cleveland Cavalier paraphernalia.

Political questions always come down to who benefits and who pays. In the case of Medicare-for-all, a system can be created in which everyone, including the private insurance industry, benefits, except those rich folk who don’t like to subsidize the health care of others, those racists who don’t like society to help minorities, and those fanatics deathly afraid that people will like Medicare-for-all so much that they’ll start doubting the ideology of the free market which to many conservatives is their most cherished religious belief. In other words, only those who believe in or benefit from the politics of selfishness should fear Medicare-for-all.

In defiance of Nov’s blue wave & will of the people, NRA pursues challenging NYC’s strict gun law & Trump acts to make it easier to sell AK-15’s abroad

The blue wave that swept Democrats into office on the local, state and federal levels has given progressives and centrists hope that legislatures will soon start passing tougher gun control laws.

Meanwhile back at the ranch—or in Trump’s case, the garish, overpriced resort—those who want to expand the sale of guns and the rights of gun owners to create unsafe environments for everyone else are winning two major victories, both of which will lead to an increase in gun-related crimes, deaths and acts of terrorism in the United States and around the world.

When I write “in the United States,” I specifically mean my home town of New York City. As Amy Davidson Sorkin describes so well in her “Talk of the Town” article in the February 4 New Yorker, the New York state affiliate of the National Rifle Association and two Bronx gun owners are trying to get the Big Apple’s gun law declared unconstitutional by the U.S. Supreme Court. The law is so tough that gun owners can take their guns out of their home only if they are unloaded and in a locked case.  It will be the first time the Court will be considering gun rights since its awful 5-4 decision in D.C. v. Heller that proposed that the Second Amendment gave people an absolute right to bear arms that had nothing to do with serving in a government militia. With Brett Kavanaugh on the court, it’s likely that the New York City gun law will be overturned.

I take this lawsuit personally. In fact, it pisses me off bigly. One of the reasons I moved back to New York seven years ago after being gone for decades was because of the extremely tough gun control laws. It’s a no-brainer to figure out why New York has among the very lowest rates of crime, violent crime and murders anywhere in the United States. It is effectively illegal to carry a gun in the street and there is a relatively low level of gun ownership. Every legitimate study on the issue shows that the lower the number of guns in a locality, region or country, the fewer deaths and injuries from guns; the higher the number of guns, the higher the deaths and injuries from guns. No wonder New York is so safe. I can’t be the only New Yorker offended to the quick that these Bronx bozos and the NRA want to force their minority views on the overwhelming number of New Yorkers who like to be able to walk the streets and ride the subway safely. Keep in mind that large majorities of Americans, including gun owners, want stronger gun control laws, including the banning of assault weapons like AK-15’s and wait periods for all gun purchases.

Gun sales are down in the United States, primarily because gun owners loaded up on weapons during the Obama years, when they feared administrative action to regulate firearms ownership. But while enjoying success in corrupting and intimidating legislators on all levels of government, the NRA has not been able to grow its market, as the number of gun owners has declined steadily over the past 50 years. Of course, each of these gun owners own more guns than they used to. There are, however, still only so many guns the shrinking number of gun owners can afford to buy.

Luckily for U.S. firearms manufacturers and unfortunately for everyone else, the Trump administration intends to rescue them from a shrinking market by making it easier to sell AR-15s and other weapons to individuals in other countries by loosening export regulations and oversight. Many American gun and ammunition manufacturers that sell primarily to consumers will no longer have to register with the State Department, which currently licenses international arms sales, or to pay the department an annual fee. Instead, those sales would be licensed by the Commerce Department, which has a simpler process and does not charge a fee. According to the New York Times, the State and Commerce Departments privately told Congress that they intend to finalize the new rule soon. Once the administration gives Congress formal notice of the rule change, lawmakers will have 30 days to decide whether to intervene. It’s unlikely that Congress could permanently prevent the rule from going into effect unless the Democrats controlled both houses.

So it looks as if the federal government is going to facilitate the spread of the epidemic of mass shootings from the United States to the rest of the world.

As is usual with gun laws and gun violence, the hands of both major parties are dripping in blood. The Times reports that the Obama administration originally wanted to make a similar change. They were about to complete the rule when the Sandy Hook massacre occurred. Even though the rule change affects sales outside the United States, the Obama administration thought it was politic to drop the idea.

Trump uses threats to public safety that don’t really exist to justify building a wall along our southern border with Mexico that we don’t really need. Yet he and the Republican Party ignore the pressing need to strengthen gun control laws. Instead, they create more of a danger to the public by supporting laws, regulations and lawsuits that make it easier to buy guns or give gun owners more rights in the public square.

Let’s face it. The GOP has become the party of death and the culture of death. While both parties are dominated by militaristic thinking, the Republicans spend far more on the armed forces than the Democrats and start more wars, which after all, help their crony defense contractors and suppliers. Republicans are just as enthusiastic about helping commercial gun sales, as shown by their eager embrace of every proposed law and regulations of the gun lobby.

But the conservative predilection for death goes well beyond support for gun manufacturers and policies that kill people. We can start with their approach to healthcare, which denies coverage to people who can’t afford it to save wealthy taxpayers a few bucks. The GOP’s environmental and energy policies support the coming death of other species and millions of people in areas suffering extreme weather events. The GOP’s support for gutting social welfare programs shows a mean-spirited disregard for human life. The immigration policy if taken to its extreme will lead to the death of the American economy, since native-born Americans are reproducing at very low rates which, if unaugmented by immigration, will result in a rapidly shrinking population within a few years.

Even the GOP’s support of laws that prevent abortions is pro-death. Here’s my reasoning: You can’t die unless you are born. By forcing unwanted births and then shredding the social net that helps children in impoverished circumstances, anti-abortion laws almost by definition add to the toll of human suffering, including some number of unnecessary premature deaths.

The Democrats aren’t much better when it comes to killing people outside the country, but their domestic policies for the most support the health and well-being of the population.

I would like to write that never has a political party been so dedicated to death and so fascinated by destruction as the current edition of the GOP. But then I remember our genocide against the Indians, our dropping of two atomic bombs on Japanese cities, slavery’s destruction if human life. That’s just in U.S. history, and doesn’t consider the Soviet Union, England, France, China or Rwanda. The collective thinking of individuals that occurs in political parties too often falls prey to the dark nightmares of its most blood thirsty members.