A Contract For Americans (2/10)

Medicare For All – Saving money on our biggest bill

Right now, the United States spends nearly $12,000 per person on health care. That’s 65% more than Switzerland and 71% more than Germany. However, we spend $5,790 per person (including partial benefit enrolees) on Medicaid.  Think about that for a minute..  We pay about HALF the amount for health care for our citizens who are, by and large, requiring the most health care.  (Side note – Medicare is mostly age-based and for the elderly, Medicaid is run by the states and based on income more like an anti-poverty and disability program).

And what do we get for our money? The average life expectancy in the US is now 76.6 years in 2021, down from 78.8 in 2019. Think that sounds good? In Japan, it’s 85 years overall, with 88 years for women. What do you think Japan pays for healthcare. It’s $4,961. We’re paying 2.4 TIMES what Japan pays and 10% less ‘life’ for all that expense.

So how about Medicare-for-all?  Think we can’t pay for it?  Well we’re already PAYING more than double so we’d be SAVING money!  ….and we could END the abomination that ONLY exists in THIS country known as “Medical Bankruptcy”.

As of 2019 (before some Medicare financial juggling was done), we spent $796 billion on Medicare. It’s really hard to nail down what Medicare-for-all would cost per-person. We know that covering the elderly costs ABOUT the national average ($12,000) but that’s also the demographic that needs the most services. The whole idea of insurance is to spread the risk. So maybe using Japan as an example isn’t 100% fair – after all, they have a different lifestyle and MUCH healthier food habits (which could be a topic for another post). What about the UK? The UK spends just over $4,400 per capita for their NHS and they have a life expectancy of over 81 years. Or how about Canada? At $4,402 per person and a life expectancy of 82 years, what are they doing right that we’re doing wrong? Single-payer health care.

An example? Over the past couple of years, my wife and I have needed MRIs. First we had to get them approved by the insurance company. My wife needed to go through TEN MONTHS of useless, ineffective therapy because the doctors couldn’t diagnose her problems – TWICE – that the MRIs, when finally approved found INSTANTLY. In my case, I “only” had to go through 4 months of therapy before my therapist angrily went to bat for me to get an MRI because her therapies weren’t having an effect (I had a stress fracture in my leg that an X-Ray didn’t see and my wife had ligament damage in her shoulders and ankle). Keep in mind that I have GOOD health insurance that costs $20,000/year in premiums (between ‘my’ share and my employer’s share). …and that’s before all the deductibles, co-pays and out-of-pocket exceptions.

When I saw the bill? It was over $5,500 for the MRI. Reduced in price over $1,000 for the insurance company but still left me with a $600 deductible/co-pay (remember, we waited MONTHS for this IN PAIN). However the RETAIL price for an MRI (which isn’t covered by Quebec’s health care plan but CAN be covered by an MRA) outside of Montreal is $501.29 USD. Why my insurance company doesn’t put me on a bus to Quebec and save a couple thousand dollars, I don’t know. That’s the WALK-IN price. …and they don’t hide it. Try to get that from an American clinic.

We need to examine whether or not the profit motive should be paramount in health care.

Also, keep this in mind – we pay more for the same prescription drugs compared to other countries.  WAY more..  You can look at per-capita spending. You can look at drug prices themselves. Many of those drugs are manufactured here in the US and shipped overseas.  Even if it’s just next door in Canada.  You could look at India.  You can look at Europe.

That we allow this profligate spending for the benefit of health insurance and drug company shareholders is stunning.

Medicare-for-all would save a BOATload of money. The people making billions off of other people’s misery would have to just sit on those billions. Doctors and nurses wouldn’t have to fight with every different insurance company – the savings in standardization alone (only having to have one set of records) would be immense.

Oh – and those clerks and other line workers who would be out of work at those insurance companies? They can be hired at HHS to help administrate Medicare and Medicaid with the influx of millions of new subscribers. I’m sympathetic to them. They aren’t the ones making my wife go through years of pain. They aren’t the ones screwing us over.

Every other industrialized country does this better than we do. It’s just another example of how those who sloganeer about the US being the best country in the world have their head in the sand.

Medicare-for-all. Do you think I’d trade $20,000 in premiums for a 4% income tax? The math says it’s a no-brainer. It gives workers a raise, saves employers money and covers the less-fortunate. It ought to be a law that, on your pay stub, you not only see how much YOU pay for health insurance but your employer’s part as well (typically from more than twice to four times as much as the most common splits are 80/20 or 70/30).

Medicare-for-all. Do you think we’d have more trust in doctors if we didn’t have to avoid them because of the cost? Do you think we’d be healthier if we got health care sooner rather than waiting until the pain is too much? What do you think the ramifications are if we went to medical professionals instead of Google?

Who stands to profit if we don’t? Insurance companies.

Who stands to profit (and live longer) if we do? We The People.

The Contract For Americans

It’s so easy to be against something – anything. What should we be FOR?

When the Democrats were in power some years ago, I criticized the Republicans for being “the party of ‘no'”.  Didn’t matter what the issue was, whatever the Democrat’s position was, the Republican position was “no”.  They never said much about what they were for, just what they were against.

Now that the Republicans are in power, the Democrats are, at times, doing the same thing.  I’ll give a little slack to them because of the incredible array of things they have to say “no” to all the time – it’s like a never-ending circus with rapid-fire monkeys being shot out at us at a rate that is truly bewildering.  Before anyone can produce a well-reasoned and articulate response to whatever Trump has tweeted or whatever some other Republican has said or done, there’s another piece of idiocy that needs to be addressed.

So what can the Democrats do?

I suggest they take a page out of the Republican’s book and do something the Republicans did very well when THEY were in this situation.  Back in 1992, the GOP was on the wane.  Bush Sr. failed to get re-elected to the Presidency and Bill Clinton moved into the Oval Office.  The Democrats were on a roll as the economy was recovering from Bush’s recession.  In 1994, however, the Republicans came storming back.

Why?  They produced “The Contract With America”.  A list of eight reforms and ten bills that they promised to immediately initiate, should they be elected.  This gave the public something concrete and simple to understand.  Quite frankly, many people on both sides of the aisle could agree on many of the provisions.

The Democrats today are on their heels – winning small special elections, but nobody has emerged as The Next Big Challenger to President Trump.  This year, we have the mid-term elections where every member of the House of Representatives is up for re-election.  As unpopular as Trump and the Republicans are, for reasons that could take up an infinite number of blog posts, I don’t get a sense of what Democrats are FOR – other than being more reasonable.

So here’s my idea.  The Contract For Americans – and highlight the fact that this is for THE PEOPLE.  Put it in the form of a Top Ten list (after all we have some pretty short attention spans) and make an easy sound bite to explain each of the proposals.  Mind you, these are my proposals – though I think the Democrats could use them.

The Contract

1) Taxes – Returning To What Worked

The immediate repeal of the “Tax Cuts And Jobs Act”, passed last year by the Republican Congress and signed into law by President Trump, which is slated to return us to Trillion Dollar Deficits.  This was bad from the get-go as all the enormous corporate tax breaks are permanent while the minuscule individual cuts are temporary.  Add to that the fact that people will have to pay taxes on their other taxes (like state income, property, sales, etc) and on the alimony that they paid to an ex-spouse and you have a bill that was targeted AGAINST Americans.

Not only will these bogus cut be reversed, but tax rates will be restored to what they were in the 1990s when we were actually running a governmental SURPLUS.  If not for the policies under George W. Bush (tax cuts, wars, Farm Bill, Prescription Drug Bill), they were predicting, in 2001, an elimination of the entire Federal Debt by 2010.

2) Medicare For All – Save Money On Our Biggest Bill

Right now, the United States spends over $10,000 per person on health care. However, we spend $5,790 per person (including partial benefit enrolees) on Medicaid.  Think about that for a minute..  We pay about HALF the amount for health care for our citizens who are, by and large, requiring the most health care.  Our Medicare spending pretty much parallels the average spending for OECD countries – take a look at the second chart in the first link up there.

So how about Medicare-for-all?  Think we can’t pay for it?  Well we’re already PAYING more than double so we’d be SAVING money!  ….and we could END the abomination that ONLY exists in THIS country known as “Medical Bankruptcy”.

We need to examine whether or not the profit motive should be paramount in health care.

Also, keep this in mind – we pay more for the same prescription drugs compared to other countries.  WAY more..  You can look at per-capita spending. You can look at drug prices themselves.  Even if it’s just next door in Canada.  You could look at India.  You can look at Europe.

That we allow this profligate spending for the benefit of health insurance and drug company shareholders is stunning.

3) Public University Education For All – Trade Schools Included

This was an idea that started to gain traction when Bernie Sanders started promoting it.  Free tuition at public (not private) universities.  Radical?  Not if you live in Europe.  Germany and several other countries offer their citizens free university educations (sometimes there are some small fees).

But what about here?  Would it work here?  IT ALREADY HAS.

California used to offer free tuition to it’s in-state students.  This was their policy until the 1970s.  Some colleges in New York were also free – again, into the 1970s.

Sanders said we could pay for this program by instituting a 0.5% tax on stock trades.  How much would that be?  Well, it could raise $350 BILLION per year over the next several years.  That pays for a LOT of college.  And the impact?  You’re talking about $5 for every $1000 worth of stocks, bonds or derivatives traded.  A small price to pay to have more engineers and doctors paying into Social Security versus “gig economy extras”.

4) Infrastructure – The Job That Keeps On Paying Off

You know, if we return to the tax policies that produced a surplus back in Clinton’s day, THIS would a good place to spend that money.

Roads, bridges, tunnels, levees, dams, water treatment facilities, sewers – all this stuff is falling apart.  We need a LOT of construction workers making decent money working on these projects – and they’ll spend their salaries, growing the economy futher, aka “The Multiplier Effect”.  The Congressional Research Service recently published a report stating that a 1% of GDP increase in public capital investment would increase labor demand by 1.13% in the short term – these would be those “good jobs at good wages” stuff that politicians like to talk about.

5) Ending the wars – Military Common Sense

$5,000,000,000,000

That’s Five Trillion Dollars.  That’s what the post 9/11 wars have cost us through FY 2016 and, with interest on the debt included, we’re looking at $8T by 2053 if we don’t change our ways.

To link it to the previous subject – fixing everything on the list from the American Society of Civil Engineers would cost $3.3T.  The ASCE is only too happy to list the details here.

You read that right.  For less than half the cost of blowing things up and pissing off people all over the world, we could have more employment, better public facilities, smoother roads, stronger bridges and so much more.

In addition, we need to actually listen to our military leaders sometimes and remember what the military is for.  It’s for defending the country – not a jobs program for defense contractors.  For example, we have to stop buying tanks and other equipment that the armed forces do not want and do not need!

6) Legalize Marijuana and Reform Prison Policy

As of July 2017, Colorado surpassed over a billion dollars in tax revenue from legalized marijuana.  Washington is now looking at over a quarter of a billion dollars per year.  Canada just legalized it and the citizens there want the tax revenues to go towards their national health care system instead of anti-drug campaigns.

Now look at the fact that whites and blacks use drugs in almost the same percentages, yet blacks are arrested FAR more often.  This mass incerceration is expensive and racist.  Drug offenses make up 46% of the federal inmate population.  We could save a lot of money (and ruin far fewer lives) with legalization.  After all, alcohol is legal..

Which brings up the second part of this subject – the prisons themselves.  Private prisons are an abomination.  What started out as a way to save money has become a horror.  Private prisons contract with the government and have minimum quotas on the number of prisoners.  This means the state is guaranteeing a certain number of prisoners to the private company.  This means the state has a vested interest in keeping people in prison – regardless of crime or guilt.

And they’re not even saving money.  In Arizona,  for FY 2010, the average per diem cost was $48.42 in public prisons vs. $53.02 per day in privately operated facilities.  In 2013, the nation’s largest private prison operator had a profit of $300M on revenues of $1.6B (about a 19% profit margin).  This money went from taxpayers paying for the prisons to the CCA shareholders.  Is that something we want to be doing?

If I were emperor, private prisons would be banned.

7) We’re Not Coming For Your Guns – Understanding the Second Amendment

“A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” – United States Constitution, 2nd Amendment.

“Back in the day”, ‘well-regulated’ meant ‘well-trained’, meaning you knew how to not only fire, but maintain your weapon.  The “Militia” was anyone who was available to answer the call to arms.  The people were meant to have the right to own guns in that context.

But, just as the Constitution has provisions for for denying certain rights to people under certain conditions, gun rights should be no different.

It should be the default position of the government that a citizen over the age of majority should be allowed to have a firearm.  However, the government should also be able to show good cause as to why someone should NOT be allowed to exercise that right.  The mentally ill, convicted felons, spousal abusers – they all come to mind.

I find it fascinating, in a depressing way, that today’s conservative thinks that a convicted felon, upon release from prison, should NOT have the right to vote but SHOULD have the right to have a gun restored!

“Well regulated” could be considered analagous to what we do with driving – you have to study up and take a test to prove you can handle exercising your rights.  If you do something bad, like driving drunk, those rights are removed.  And let’s not forget the militia part.  Ok, so we don’t all have to enlist in the Army or National Guard – but consider how the military handles the situation of allowing their people to have firearms.  It’s not like they hand out pistols at the induction hall.

8) Constitutional Amendment: Corporations Are Not People – Removing Money From Politics

“Corporations and other artificial entities that are created by laws of the States and the Federal Government are not considered persons or citizens of the United States.” — my proposal for a 28th Amendment.

Corporations are not people.  It’s as simple as that.  I will not believe they’re people until Texas executes one.

The Supreme Court’s Citizens United decision said that corporations have free speech rights.  This has resulted in a flood of dark money corrupting our political process.

Then there was the very famous Hobby Lobby case which said a corporation actually had religious rights and could deny contraceptive coverage despite the mandate of the ACA that required helth insurance plans to cover contraception.  This despite the fact that the 401(k) program that is available to management invests in and profits from companies that manufacture contraceptive drugs, including the abotifacents that Hobby Lobby’s owners INSISTED were the reason for denying health insurance coverage to their employees.

Hobby Lobby doesn’t go to church.  The people who own the company do.

Corporations should not have “free speech” rights.

They are not “people”.  This should be obvious.

9) Social Security Reform – For Your Economic Future

In 2037, the Social Security Trust Fund’s surpluses will be exhausted.  At that point, they will only be able to pay 76% of planned benefits.  As of this writing, that’s 19 years from now.  I’m supposed to retire in just over 12 years.  If I live to be 75, I’ll be in the generation that sees this promise broken unless we do something.

So what can we do?

Well, there’s the “FICA cap”.  What this means is that Social Security and Medicare taxes are only assessed on the first $128,400 of income (for 2018).  After that, you “get a raise” in that FICA taxes are no longer collected.  This only applies for ‘normal’ income. Anyone who gets their income from dividends or stock options (like the 1%) doesn’t pay this tax on those ‘earnings’ at all.

If we removed the FICA cap, we could fund Social Security for another 60 years!  That’s a powerful argument.

Social Security has been the single-most successful anti-poverty program in the history of the country.  It needs to be fixed, not cut as Paul Ryan, Mitch McConnell and the Trump-led-Republicans would do.

10) Living Wage – For Your Economic Present

They (the GOP) told us that the tax cuts were going to result in more money for workers.

They lied.  I’m shocked!  Shocked, I tell you!

Guess where the money went?  A lot of stock buybacks and dividend hikes – meaning more money for the corporate owners.  Before it was signed into law, various think tanks predicted that 12-13% of the ‘windfall’ would go to workers, so it wasn’t exactly a surprise that corporations would benefit.  Compared to what happened, that would have been good.  The reality?  3.3% of the tax cut windfall went to employees by one scorecard – $6B out of $177B.

Corporations never went to kindergarten so they don’t know how to share.  So what can we do?

Gradually raise the minimum wage to $15.  Companies that pay their people well have lower turnover, higher job satisfaction and lower expenses.  In addition, putting more money in the hands of poorer people spurs economic expansion because they SPEND the money – they don’t stash it away in the Cayman Islands.  The argument that a higher minimum wage results in more unemployment has been disproven these days in Seattle, and that’s nothing new as history has shown.

Besides – if your company requires its workers to live below the poverty line and be eligible for federal and state welfare programs to feed them so that the owner can make a profit – that business shouldn’t exist.

But what about others?  How about limiting the deductibility of executive compensation to a certain multiplier of the company’s average worker’s salary?  Since 1965, the ratio of executive salary to worker’s salary has gone from 18 times a worker’s pay to 220 times a worker’s pay.  This is patently ridiculous.  Let’s say, for round number’s sake, that we set a policy of 100x worker’s pay for executive pay.  If a company wants to pay the executives more, they would have two choices.  Either hike worker wages to raise the threshhold, or lose the deductibility of the excess compensation and pay the taxes on that money (in addition to the income taxes that the executive will pay).

“Trickle Down Economic Theory” doesn’t work.  Thinking that a corporation will rain its largesse down to the people is thinking of the most naive kind.  A corporation has no soul.  You generate economic growth by people wanting to buy more goods and services.  With more money, people buy more things – as opposed to stashing their money overseas.

Finally

The Republicans are great at staying on point and hammering said point home – even when it’s wrong.  But in today’s “sound bite” mentality, people aren’t into reading position papers or the official Party Platform planks.

Take these ideas and make quick commercials about each proposal – like a continuing story (Part 1, Part 2, Part 3, etc..) and show the people how we all benefit.

As long as we have the vote, it’s never too late.