Sure, they suck, so there’s that.
Sucking less than the other guys is just so disappointing. And a little frightening. My elder son is a socialist, he understands what it means but he also understands why “burn more coal!” is a recipe for not good. What he is only just starting to understand is why science, logic and better ideas don’t win elections as consistently as one might think.
Democrats are really bad at messaging.
I don’t mean avoid getting photographed with Shirley McClain or don’t talk about increasing revenue, talk about a strong economy. I mean discussing the death tax as not unfair, and trying to win people over on healthcare because access is humane and should be a human right, or even the Christian thing to do. (Who really said if you want to cut Social Security, Medicaid, welfare, food stamps, etc. you have to stop claiming to want to build a Christian nation?)
Let’s talk healthcare. First, “healthcare” has become a conflation of medical insurance and medical services. Lumping them together is bad for the D message. More of the middle could get behind improved access to services, especially necessary services or minimally necessary services (that there is no other kind is not the point), if this did not also mean access to insurance. Insurance, we all fear, that is as good or even better than ours and cheaper due to subsidies.
It is not and should not be about insurance. Even if it was, Liberals should be talking about tax cuts by making now required medical insurance premiums tax deductible. What?! Liberal tax cuts. Every Budget bill, every Defense bill every everything should have the tax deductibility of health insurance premiums attached.
Public vs. Private Health Insurance on Controlling Spending
Of course, public health insurance does better controlling costs. Lower overhead, better access, better administration. And they have the law on their side.
Of course (as more than one of the commenters points out), Altman leaves a lot out.
Example- Medicare has a bit over 50 million members, and they tend to be sicker, older and the most likely consumers of health services. Even the 10.5 million Medicare benificiaries under 65, are disabled or have ALS or kidney failure.
TRICARE would be a good comparison to the general population – at least based on age and large numbers. But it costs a little less than Medicare to run – and there is less fraud so Altman leaves it out.(I don’t have the data, but I predict it’s because TRICARE contracts out the contact management – call centers and billing and stuff. $13.50/hr with skimpy benefits vs the federal employees running CMS and Medicare.
Of course public plans that can set their own payment schedule can control cost better. Of course, a private self contained plan (like Kaiser or other HMO) can do the same but health plans that do not employ their own providers are stuck paying whatever rates they can. And public plans have no shareholders or profit seekers to satisfy. Of course, there are private non-profits too. But they still cost more and do worse controlling costs.
But here is the real dilemma: descriptors like “private” and “competition” assume a free market. Health insurance is not a free market. They also assume consumers can choose rationally based on price – and we cannot.
If I go to the Cell Phone store I get some choice. If I can get unlimited domestic voice and text with some data for $50/mo with a reasonably current and efficient smart phone or I can get the Gordon Gekko brick phone, and pay$200/mo and $1.00/min with no data or text – I know which to choose.
But if I am shopping health insurance, and I can get plan A for Premium X with high deductible, low copays and thin network or Plan B with Premium (X*1.5), lower deductible, higher copays, and broader network – which is a better purchase? What about Plan C with Premium 2*x, higher deductible, higher copays, very thin network, but I can add my spouse and unlimited dependent family members for the same premium.
Maybe I can get something like Senator Gardner’s Golden Unicorn plan, low premium, no copays, and broad network. But what if it only covers “catastrophic” events and excludes a ton of stuff that I don’t understnd or care about. And the only providers are located far from me.
The point is this – free markets work great when service providers and consumers can understand the services being exchanged through price. I’ll take the small phone with tons of service for $50/mo onver the 1980’s style brick with no service. (Though I would like to have a Gekko brick.) But markets fail when price fails to convey the necessary information for consumers to choose how much to demand or to communicate to providers how much to supply.
Markets fail for other reasons too – and if the market is for something “necessary” or a general good, then we (USA) regulate the markets and try to allow private (shareholder owned or mutal assocaitions) deliver, with subsidies and regualtions. Sometimes it has to be governement providers because there really is no private market. Electric. Gas. Air traffic Contral and other safety for Commercial aviation. Used to be telephone – but the market evolved and Judge Green gave us a whole new world of telecom.
Health insurance for sure, and medical services possibly, as a for profit, private market have failed. We should regulate them like we do for the utilities (and other markets) unless or until providers invent or innovate a new product that supercedes the need.
Should we have single payer? Of course. Not like Canada or the UK or Germany. A distinctly U.S. market, closer to the Swiss, with no restriction on supply.
But the argument, the message, to get support of we the people – mostly the center – is not, cannot be because it’s the right thing to do, because it’s humane, because human rights, because fairness and justice, yada yada yada…
The winning argument – the ony argument – is the market has failed – and single payer will cost less and deliver better.
Could be government run – just open Medicare, lowering the eligiblity age a few years at a time, charging market rates and watch Medicare outcompete every plan out there. It could be a regulated like a shareholder owned utility – like Excel or the old AT&T.
Here’s one more health insurance related example of Democratic party messaging sucks. Medicare beficiaries who oppose insurnce and health care access for others are confident in their conviction that their Medicare should be inviolate and untouchable because they earned it, they paid for it. But the current FICA taxes are NOT premiums that pay for the contributor’s future coverage. They are the taxes that earn the payor’s (and their spouses’) future eligiblity and pay for current beneficiaries’ coverage. In the future, future contributors pay for the future beneficiaries. No one messages on this. And that allows the myth to perpetuate. It solidifies the current state of Medicare – Ike was right only the stupid believe the voters will allow it to be repealed. But it is the wrong message and it allows the U.S. to continue down a stupid path.
To be continued…
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