Comments by "Xyz Same" (@xyzsame4081) on "It's Time: Bernie Sanders Announces 2020 Run" video.
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Greetings to your mum: I know the systems of Germany and Austria (from experience - they are good). They operate at 60 - 65 % of the U.S. healthcare expenditures per person (that means ALL that is spent in the country, the budgets come from wage deductions matched by employers. And since it is tied to wage and affordable - like in the U.S. there must be a lot of extra gov. funding. Plus whatever patients spend extra, not too much - think some dental costs, or homeopathy, TCM, ...)
Those subsidies go into a system with very streamlined administration, hospitals of which many are non-profits run by the cities, so there is bench marking. The public non-profit insurance agency * bargains with all players in the system. But Big Pharma is the only large and powerful for-profit actor. Luckily those corporations have very standardized, internationally comparable products.
* in reality there are several of them, per state or for certain professions like railway workers. But that does not matter much. There are no networks (for hospitals for instance) and most doctors have contracts with all the "agencies". And they share information (about costs) within the country.
Europe alone has plus 550 million people.
In that environment even tiny Iceland with 300,000 people gets reasonable deals for medical drugs. They can find out what other countries with 10, 30, 60, 85 million people are paying. If only behind closed doors. The non-profit public national insurance agencies do not compete with each other (no reason to guard their information and to not share good negotiation results.)
I think the contracts with the Pharma corporations may require them to not disclose the prices or more specifically the discounts ... Well, the info is a list, that is easily copied. I am sure most countries have a general idea about how much is really paid. The information ripples through the continent.
Iceland could also buy with other nations.
The U.S. government already pays around 65 % of U.S. healthcare expenditures - but those subsdies fund a lot of things that do nothing for the good and efficent delivery of care. The 65 PERCENT of expenditures is NOT the bad thing - it is the expenditures in total that are way too high.
Medicare is a public program, old people naturally need more care and cause higher expenditures. Most costs pop up towards the last 5 - 10 years of life.
- Of course Medicare is also funded (partially) by wage deductions.
Anyway:
Technically MfA can be done - a lot of money goes to
1) dysfunction (it is a lot of work to make customers and doctors jump through hooops and deny care) and
2) high profits.
It is a political problem
the elected "representatives" mostly screw the voters. In the GE in 2016 just shy of 139 million people used the vote - 250 millions have it. but much more would use the vote if you give them something to vote FOR.
if the Sleeping Giant - the regular people - would not have only 55 % turnout but 75 - 80 % - as is usual for important elections in other democracies - it could be done and quickly. Who is going to stop plus 200 million people who WANT something ? and are shown a specific, finished ! plan how to get it ?
btw the Medicare For All Plan of Sanders is the best (see next comment with link).
Booker and Harris have a private-insurance-company-FRIENDLY version. That would undo a lot of the potential cost savings - the system would not be as streamlined, as simple in the administration. More complexity means that the insurers can squeeze in their profits here and there - the consumers and even well-meaning regulators cannot keep up, complexity favors the big corporations
(never mind how skilled the industry is in gaming the system, they are really well trained. In Germany they would never be able to pull it off - they do not have the staff, the software, the systems, the mindset, ... And the patients know good care with no hassle and would not tolerate that nonsense).
it is really a lot of work to rig the system, especially when you have to do it in an inconspicious manner. (not that they are subtle about gaming the system right now).
For profit insurers are not needed for a functioning system at all - but they hate to lose all the profits and the Democratic party hates to lose their legal bribes.
you can imagine that not much love was lost in the 1950s between Germany, UK France, Netherlands, Belgium, .... But they all agreed on one thing: they wanted good healthcare for their citizens, and that you cannot leave THAT service to the for profit insurance companies.
A FUNCTIONING free market requires that all participants have about the same power - with healthcare the patients are by far the weakest participants. That is why healthcare is such a terrible fit for private for-profit. Profit is a toxic incentive with healthcare and healthcare insurance AND medicine is naturally complex so abuse cannot be prevented.
That is why all other wealthy nations decided after WW2 to not play the "for-profit" game in the first place. (Only Switzerland has mostly private insurance companies offering coverage. it works, care is good but costs are comparable to the U.S. levels. But at least the Swiss are getting something good for it and everyone is insured, and denying care or coverage is not tolerated. They also pay medical staff well.
The single payer nations all did their own thing (based on same core principles) - and they ALL beat the U.S. It is not even close.
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@edwinswezey5028 MfA would be rolled out over 4 years. I live in a single payer nation. "public option" has the potential to undo the reform in the early years. The private insurers would be able to make seemingly good offers to the young and healthy. 90 % of speending is for 10 % of the insured They just have to do the purges right - and they are good in doing purges. the costly patients would land with Medicare Agency and they already have the old (by far the most costly group).
It would be easy to badmouth Medicare ("too expensive") and a little defunding would go a long way to really kick them (whenever the Repubs and sellout Dems get the chance).
It also undermines solidarity between the insured, the young have an offer that looks much better (but is of course still overpriced). There is more political leverage to fund the system properly if the young and the old, the affluent and the regular and lower incomes get the same coverage by the same insurance and can use the same facilities.
No nation has a "public option"
That should give you pause.
Public option means that some or many people have full coverage by a private insurer. And the people CAN opt out. - In reality it is the insurers that chose whom they want as client - they steer that ith the offers they make.
The MfA bill has the crucial features / rules of the systems that function so well in other countries: 4 continents, many nations and cultures, more than 70 years, more than 1,5 billion people have been covered by such systems, 50 - 54 % of the U.S. spending per person. so the U.S. had USD 10,260 in 2017 and most countries were in the range of USD 5,200 - 5,700 per person per year).
There is no need to reinvent the wheel if there is such a well tested blueprint.
One obvious flaw (except for the cherrypicking and deception of the public what is a "good" and cost-efficient offer when the profiteers can cherrypick):
The chance to streamline admin is squandered. There will be Medicare (like now) and many other insurers with all kinds of offers and exceptions of coverage. The doctors and nurses will continue to have to quarrel with them when they should pay for more costly procedures. The insurers still will employ the hordes of beancounters to "optimize" their profits, to purge citizens and companies from the pool, to pay for marketing, etc.
That spending does nothing to make the DELIVERY OF healthcare better for the insured.
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2) Times are hard for regular (German) journalists, they have to take all the gigs they can .... even if it is a smear job...
In the current neoliberal order in Germany and the EU - the German citizens might like the Sanders ideas for their country as well. "We should Re-INTRODUCE them in Germany as well". - The political leaderhship in Germany supports the NATO hostilities against Russia to a degree - but the population is not nearly as negative.
For them left populism (inspired by a Sanders presidency) would mean the revival of the good old times.
Sanders ALSO had Dr. Stephanie Kelton as financial advisor for the campaign in 2016. Unlike Dr. Jill Stein Sanders did not talk about QE For The People or MMT or Debt and Interest Free Money to finance public investments - but he must know the concepts. He just does not highlight it.
Labour in the U.K. also got more vague about the concept. Corbyn talked about QE For The People openly in 2015. They call it Public Investing Bank now. That does not sound as unusal to uninormed voters (most) and is not as "offensive" - or Big Finance and the media on their behalf would immediately go ballistic. They know what is looming - but they cannot draw attention to the issue preventively - citizens would inform themselves on the internet it they make a big fuss. (so they do the Anti-semitism smear instead). As long as Labour stays under the radar they cannot start misrepresenting the idea - it would be odd and out of context.
MMT (or whatever name the concept of direct money creation of government with help of the central bank is given) overturns what people think they know about money, government funding, etc. So one would need some time to explain it.
It is not that it is that complicated - more that you have to unlearn all the nonsense and half-truths that pass for economic and monetary theory. Mainstream media and establishment politicians (and of course Big Finance, but also the "investor and landlord class") do not want the unwashed masses / voters to understand the concept.
MMT has huge potential (also some limitations of course) - but if used wisely it could do a lot of good. But that would make "We cannot finance that" or "How are we going to pay for it" or "We must privatize the public services" obsolete. If a public service is essential and can attract profit oriented investors - the money of course can be found (well CREATED). contrary to neoliberal claims public mass servies are well run in most cases. Railway, sewage, water, street maintainance can by inefficient. But most can easily compete with private-for profit. and in most case they are better. Limit the salaries for top management as to not attract former politicians in search of a cushy post - and you will get good performance.
Public providers ususally do not squeeze the last cent out of their work force, and they may not be the niches of high creativity and entrepreurial mindset - but on the other hand they also avoid the inefficiency of having to pay profits to the shareholders. Mass services that do not need a lot of individual products, creativity, constant innovation or sophisticated marketing and need to be run like a clockwork (think hospitals, railway, public healthcare insurance agencies, ..... ) are a good fit for non-profit public agencies. Same for natural monopolies or things that have a very long investment horizon (think 30 - 50 years).
If the government INVESTS for the common good (not for the good of the contractors - so not for the military) - it is easy to create the budgets.
Think public education (w/o huge salaries for admin and directors). Healthcare, childcare, infrastructure (not airports and more highways). Public transportation. A public non-profit Uber, high-speed rail to replace flying in the country (China got them while Europe and the U.S. did austerity). A Green New Deal.
Jobs program whenever the economy is slow.
But all of these exciting options would diminish the power of the oligarchs and the corporations to suppress wages. Their capital (fortunes) are not needed to make investments. And they also cannot profit of privatization or becoming the landlords (extracting high rents).
If "investors" have skills to rank projects (what is viable *) THAT is a valuable skill. Or a company that supports a start-up (I heard that in a speech as advice from a successful start-up. Look for investors that do not only have money. Look for comapanies that have related products and can help you in very practical terms.
* although money and marketing and the determination to build a monopoly (Amazon) can make a lot of things viable. Fox News and Amazon made huge losses for at least 6 years.
Simply having lots of money (like many shareholders do) is not essential or useful or needed to FINANCE the PRODUCTIVE ECONOMY. Money is easy to come by for Government Of By and For The People.
Insiders understand the appointment of Dr. Kelton and Prof. Bill Black as advisors to the campaign. (I highly recommen his Ted talk, he helped the FBI with the prosecution in the S & L scandal in the 1980s - he compared that to the Great Financial Crisis).
Big Finance understands very well the symbolism of appointing these two - and unlike Obama, Sanders might not only do the talk. He could mean business.
_During the presidency Sanders CAN activate hundred to twohundred million U.S. citizens - plus inspire left movements in other countries as well. In the U.S. the banksters and the healthcare / insurance industry enrage the left and the right. Not even paid and bought for Congress can stop 200 million people that coordinate to get things done. If need be the U.S. and Senate would get plenty of new members that can be bothered to represent the constituents.
250 million people have the vote in the U.S. - in 2016 only shy of 139 millions used it. The oligarchs cannot prevent solutions that the right and the left in the country want. Not with a stubborn president leveraging the office to unite them. A president that "solves" healthcare, wages (and steps on the toes of the banks) might get a pass even by the right wingers and bigots. He can do the Dream Act, he can raise taxes for the rich and close the loopholes for multinationals. They might even accept a Green New Deal - if they do not "believe" in Climate Change they at least woul like the jobs and the energy independence (w/o fracking).
Now, we would not want the German sheeple getting such ideas from accross the pond, would we ?
Hell, Sanders might get U.S. military expenditures down. He likely would not use the U.S. military machine if the UK or France get the colonial itch and their companies have business interests in Africa or whereever (Syria ! Libya !)
Sanders is also not likely to sign the TPP or the European version TTIP.
Moreover Sanders MIGHT push the renewal of nuclear deals with Russia (Trump the fool let them expire). he might not be interested in the business of regime change, provoquing Russia at the Polish borders and what not. Enough work to bring the U.S. house in order.
It would be an uphill (and maybe dangerous) battle. But Sanders unlike Trump would be savvy and intelligent enough to restrict the deep state - at least he would have a fighting chance to stand up to the neo-cons.
(I am not sure he would chose to do it - but neither does the Deep State and the M.I.C. - I am convinced his foreign policy stance is more progressive than he admits - likely for political considerations (he got some military contracts for Vermont).
As mayor he invited Noam Chomsky in the 1980s to Burlington, that would indicate he understands some facts about the U.S. empire.
Sanders does not dig deep into the "Russian collusion" and Venezuela is a terrible dictatorship". - But he goes along with the official narrative. Which may be a smart move - that he knows very well which battles to chose. He may have his eyes on the prize - avoiding to equip his enemies with ammunition in areas where it does not matter what his real opinion is - as long as he is not in power.
He only utters mild critique on Israel. He dares to do more than almost all other politicians - but it is not much.
In 2016 he did not visit an Aipac event - he had a "conflict of schedule". Now, he politely sent them a nice message - but it is unheard off that a presidential candidate does not do the curtsey with Aipac (Ron Paul maybe dared to do the same - well you see what it got him. Shunned by the media).
It gives you an idea HOW POWERFUL the ISRAEL lobby is - Sanders is of Jewish descent, lost relatives in the Holocaust and does not take AIPAC money. But he still has to watch his back.
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