Wednesday, January 20, 2016

More PK and Single Payer

Paul K has another item on the unfeasibility of Single Payer.  This one utilizes the not uncommon mislabeling of  Vermont's attempts as "Single Payer."

A better account of Vermont's almost , but-not-really, single payer plan is at PNHP--.
Covers most of the same territory as the Kliff article-- but is more informed on single payer , e.g. --" It’s a misnomer to label Vermont’s Green Mountain Care plan 'single payer.' It was hemmed in by federal restrictions that precluded including 100 percent of Vermonters in one plan, and its designers further compromised on features needed to maximize administrative savings and bargaining clout with drug firms, and improve health planning."

I would add that Vermont's small population, and therefore, risk pool would hamper even a true single payer process. But, Single Payer would still be best. This was, indeed, a political/organizational failure, not an economic one.

Further-- it is also inaccurate to include doctors (and other practitioners) in the list of those who will be negatively financially impacted. Institutional costs-- pharma, hospitals and the like will be reduced. But practitioners will actually be more empowered, and less burdened, so as to be able to be appropriately compensated. Canadian institutional costs are far less than ours, Canadian practitioners-- particularly primary care physicians-- are compensated similarly to U.S.'s--- especially once you take the weight of insurance required work off of their backs. 

And BTW, Colorado Care's universal care initiative  to be voted on in November is not Single Payer either.  From funding tab of summary : ColoradoCare will serve as a supplemental plan to Medicare and will apply to become a Medicare Advantage Plan. For any other health insurance plans that are in effect, ColoradoCare will be a secondary payer, up to the payment level of ColoradoCare coverage.

Tuesday, January 19, 2016

An Appeal to Paul Krugman

Paul, Paul

You have recently expressed rejection of the idea that we can adopt single payer, expand coverage and services and still save lots o' money. 

Please, Please, if you haven't already, read Lewin report 2005 on California Single Payer and any of several of Gerald Friedman's  economic review of several SP plans, including for New York. (And just about every, if not every, SP study done.) They all consistently point out the savings and expansion in coverage and services that you decry as impossible.   Perhaps you have strong economic disagreement with them.  If so, I am sure we would be happy for your insight.

Saturday, January 9, 2016

Why Economists Took So Long to Focus on Inequality

Over at Bloomberg Views Justin Fox has an excellent article of the same name.  In fact it inspired my thoughts.  He does  a very good job of explaining the what--  needing data--  but not so much the why.   As always, "The Grail Question,"  -- Who does it Serve? helps us focus on understanding the underlying dynamics. 

The push for "data" to prove what we already know is a time honored delaying tactic.  It is endemic and, in  general, serves those who, we already know, will be disadvantaged once what we already know has been sufficiently "proven."

E.g. ,  We knew not only that there was growing inequality but that it is harmful to society ("children and other living things." ) Yet, for 30 years "no one had the data"  for what we all could see if we only looked. No one had the data for "welfare queens" either but that seemed more readily believed and influential in our economic and political discourse.  

End of the day--  there are plenty enough resources for education, mental health, health care, the 99%... It is just that it all resides in the pockets of those who are benefiting from a rigged system  (euphemism for--"they stole it !") and are "awaiting the date."