The Right-Wing Attack on Medicare-for-All

One thing you can say about Karl Rove: the guy pretty much telegraphs his intention to lie, distort and just make sh*t up in an ends-trump-means effort to win at all costs.

For keeping Republicans in the game even as their racist white, male, uber-Christian, know-nothing political base keeps shrinking, that is an essential tactic — one Rove perfected in the seemingly impossible task of making George W. Bush into a viable candidate for Texas governor and later president of the US.

Rove applied his dissembling skills in a Jan. 31 op-ed in the Wall Street Journal, a section of that Murdoch/News Corp.-owned rag noted for its fact-challenged political screeds.

“Medicare for All” will terrify voters,” Rove predicted, in a swipe at the first campaign outing of Democratic presidential candidate wannabe (and pretend progressive) Sen. Kamala Harris (D-CA) during which she enthusiastically endorsed progressive Democrats’ most winning issue — expanding Medicare to cover everyone. Harris “made her party’s left-wing base happy this week,” Rove wrote, “but in doing so, she might have made Democrats less attractive to general-election voters.”

Rove then proceeded to trot out one lie after another — from the thoroughly discredited “research study” of Koch-brothers-funded former Social Security public trustee Charles Blahous which claimed Medicare for All would cost $32.6 trillion over the next 10 years, to a poll by the private health insurer-linked Kaiser Family Foundation purporting to show that popular support for Medicare for all, while high now, would collapse “when people hear more about its possible effects.”

If what people hear is limited to Rove’s and the Republican party’s lies about Medicare for All, to Koch-funded “research” and to the tepid criticism the idea gets from centrist Democrats like Sen. Sherrod Brown (D-OH), he would be right. And who knows? The way the corporate mass media have mis-covered “Medicare for All,” particularly when it’s being advocated by more progressive Democrats like Sen. Bernie Sanders or that favorite MSM “whipping girl” AOC, maybe Rove is right.

Rove’s biggest lie — one of omission primarily — is claiming that Medicare for All would cost over $3 trillion a year and massively increase taxes, without noting that at the same time, it would essentially eliminate private insurance premiums not just for employees, but for employers too, and that at the same time, it would also eliminate or replace programs like Medicaid, veterans care and hospital “charity” care (the latter which results in higher charges to insured patients and thus shows up as higher insurance premiums), since Medicare would be paying for everyone’s care.

Another lie of omission: Rover failed to note that even Blahous had to admit in his own study that even the Blahous study had to admit that in addition to covering the health of 30 million people currently without access to health care, Medicare for All would actually save $2 trillion over the current system during that same 10 years. (In fact it would save much more because, as a similar system of government insurance in Canada has demonstrated over more than 40 years of operation, with the government the sole purchaser of hospital, physician services and of medicine, the costs of care and treatment are driven way down.)

Another lie is claiming that it would be too expensive to expand Medicare to cover five times as many people as it currently covers. But that’s simply not true. Firstly, in 2017 Medicare already, as it presently exists covering the disabled and those over age 65 cost $702 billion for the government (taxpayers) and another 50 billion paid as Part B payments by recipients (mostly deducted automatically from their Social Security benefit checks). Medicaid for the poor cost another $553 billion, and VA health care another $80 billion. That’s a total of nearly $1.5 trillion. So even using the inflated cost estimate in Charles Blahous’s Koch-bought research, Medicare for All could essentially double all those federal expenditures for healthcare, but instead of covering perhaps 60 million people, it would cover the entire national population of almost 330 million.

How can this be? Because most of the high cost of Medicare is already going to the oldest among us. And quite obviously it is far less expensive to provide healthcare to people under 65!

Consider this. According to the Kaiser Family Foundation, people aged 80 and up represent 24% of the Medicare population, but account for 33% of the program’s cost. In contrast, people aged 66-69 represent a slightly larger 26% of the Medicaid population, but only account for 15% of its cost.

Here’s another way of looking at it: Aside for infants, who all spend a short time in hospital unless they were born at home, hospital use and length of stay rise significantly the higher in age people are. For example, only 21 in 1000 children aged 1-17 need hospital care in a given year, vs. 79 per 1000 in the 18-44 age group, 109 per 100 in the 45-64 age group and 261 per 1000 in the 65-84 age group. Furthermore, the days stayed (and the costs) per stay increase with age: 3.6 days/$9900 per stay for the 18-44 cohort, 4.9 days/$12,900 per stay for the 45-64 cohort and 5.2 days/$13,000 for the 65-84 cohort. Clearly, expanding Medicare on down to younger age cohorts, or all the way down to infants would be far cheaper than the added number covered might at first suggest.

In other words, the government and thus the taxpayers, will already spend half that $32 trillion just covering a small portion of the US population. But by roughly doubling what it is already spending, even using Blahous’s exaggerated estimate, all Americans would be covered by Medicare.

But remember, without being included in Medicare now, what people are currently paying for private insurance coverage — both out of their own paychecks, and through their employers — are huge premium payments, co-pays and out-of-pocket costs for health care that they would no longer be paying themselves or as insurance premiums if covered by Medicare for All.

According to data from the federal Medical Expenditure Panel Survey for 2017, some 152 million Americans — workers and their families — receive their insurance through their employers. The average cost of that coverage, in terms of premiums and deductibles, was 12 percent of median income, and was typically higher for those earning lower incomes, and higher still in states where unions are less prevalent and wages are generally lower. Worse yet, the trend in recent years has been towards workers paying an increasing share of premiums, and being slammed with ever higher co-pays and deductibles. Over all, job-linked insurance coverage was found, in 2017, to cost an average of $7240 per employee.

Typically, that study reports, employees pay only about 25% of the premium for their employer-based health insurance, with the employer paying 75%. Remember that since funds an employer pays for its workers’ insurance is money that could have otherwise been paid in higher wages or salaries, so it’s all really coming out of the workers’ pockets.

Since we don’t have a way to easily break down how many workers in each income category are paying for their insurance (but we do know that the quality of that insurance coverage is typically much worse the lower the income of the worker), it’s hard to put a figure on how much workers pay collectively for their employer-based coverage plus out of their own pockets, or how much employers pay in aggregate, but it’s clearly much more than $1.5 trillion a year, and much more than $15 trillion over 10 years.

Like the government that is already paying $1.5 trillion to fund federal programs to pay for health care for the elderly, the poor and veterans, we US citizens are all paying considerably more than another $1.5 trillion in insurance premiums, co-pays and deductibles ourselves.

What is unarguably true is that if the US were to switch from a primarily job-based insurance system of health care to a government Medicare-for-All system in which the government is the insurer for everyone (what they have had in Canada since the 1970s) all that money being handed over to the insurance industry would vanish, saving American workers and their families that much money.

Certainly it is true that Medicare for All would mean higher taxes, but the trade-off, which Rove and Republican (and conservative Democratic) opponents of such an approach conveniently and deliberately never mention, would be in everyone’s favor. Why? Because the increase in tax bills would be far less than the premium payments that we pay now. How can we know this? Because administrative costs, now eating up between 15-30 percent of the health care dollar, would go way down (Medicare’s administrative costs are and would continue to be minimal). And removing the profit motive from the system would also drastically reduce fraud, which the FBI reports currently ads up to as much as 25% of all US health expenditures.

Furthermore, those higher taxes for a “single-payer” health program like Medicare for All could and probably would also be at least to some extent progressive, like the tax code, with low-income families paying less, or at very lowest incomes nothing, and the wealthy paying more.

What’s not to like about that?

The reality is that the US, with its prevailing employer-based health insurance system, supplemented by very costly programs like Medicaid and the Veterans Administration to provide medical care for some of those outside that system, in total spends vastly more than in any other modern nation for health care. Whatever the state-funded or state-run health care system one looks at, whether it’s Canada’s single-payer system with the government as insurer and with private and public hospitals and private doctors delivering the care, or a nationally owned and operated system like the UK’s National Health where hospitals are government owned and doctors are government employees, or something in between, the total outlay on health care, both as a share of GDP and on a per capita basis is typically half of what it is in the US.

In 2017, health care spending in the US, including on insurance premiums, deductibles, government funding for programs like Medicare, Medicaid, veterans care, car insurance injury premiums and outlays, home insurance liability coverage , etc., totaled $3.5 trillion or almost $11,000 per person. That represented 18 percent of GDP, meaning that a staggering 18% of all spending in the US that year by individuals, private companies and the government was for health care. That compares, according to figures published by the Organization for Economic Cooperation and Development (OECD) to $8000 per capita and 12.3% of GDP in Switzerland, the country with the second costliest health care system in the world (and the only other developed country that does not have some kind of socialized medical system), $5,000 per capita and 105% of GDP in Canada and $4000 per capita and 9.5% of GDP in the UK. (All those countries have better health care statistics in terms of universal access to health care, quality of care, life expectancy and infant mortality than does the US, where despite our high spending on health care, still has 30 million, or 10 percent of the population unable to have easy or affordable access to medical care, and where the major cause of bankruptcy is a medical crisis.)

Switzerland where health care spending is $8000 per capita and 12.3% of GDP has the second costliest health care system in the world, and significantly, is the only other developed economy that does not have a government run insurance system. Instead it has a more centralized version of our complicated and totally inadequate Affordable Care Act system, where instead of a largely unregulated but partially subsidized “marketplace” for buying private insurance, the state tells its private insurance companies that if they want to sell lucrative “gold-plated” health policies to wealthier people, they have to offer, at no profit, a less fancy plan approved by the country’s parliament. And every citizen has to buy coverage or if they are poor, have it provided to them.

Clearly, unless one believes that the supposedly “can-do” US — a country that can land men on the moon, build an orbiting space station and reliably deliver the mail in two days to anywhere in the nation — uniquely cannot do anything if it is run by the government, looking at the OECD statistics, a state-run medical system, however it is funded and structured, is more cost effective and better for a population’s overall health, than the profit-driven hodgepodge we have here.

Rove claims Americans will turn against Medicare for All when they learn that it will mean they would not be able to retain their current employment-based health insurance. The truth though is that most Americans hate their current private insurance with its cost, its co-pays, its deductibles, its frequent denials of coverage, its incomprehensible rules regarding pre-authorization for treatment and denials of coverage, not to mention all the paperwork required just to get reimbursed for expenditures, especially for treatment “out of network,” for example when visiting another state.

My counter to Rove is to remind people the anxiety they have about costs, even when they are insured, when they find themselves or a member of their family diagnoses with an illness or injury and contemplate the costs they will have. In Canada or the UK, in contrast, people know that after they leave the doctor’s office or hospital, there is no bill. If it’s something chronic, they don’t worry about exhausting their coverage, or being able to continue to pay for treatment. There is no cap on coverage. Think about that peace of mind that we don’t have now.

What Rove is right about is that as Republicans gear up to begin a Rovian campaign of lies and misrepresentations about Medicare for All, people who only listen to Republican propaganda news organizations like the WSJ or Fox News, or to other corporate news organization like ABC, NBC, CBS, CNN and others that operate on the flawed “objectivity” tradition of running “both sides” of a story even when one side is clearly lying, will be misled into believing that Medicaid for All will just raise their taxes while taking away what they have.

It shouldn’t be hard to explain why Medicare for All is a much better way to deliver health care to the nation, but so far most of the news media, and most Democrats hoping to get elected in 2020, are doing a lousy job of doing it.

That pretty much gives liars like Rove a free hand to dissemble.

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Dave Lindorff is a founding member of ThisCantBeHappening!, an online newspaper collective, and is a contributor to Hopeless: Barack Obama and the Politics of Illusion (AK Press).

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