Slog Jul 24, 2015 9:05 AM

Jeb! Bush: Let's Phase Out Medicare

by Dan Savage

Comments

1
Let's try Jeb's little experiment on his parents. Let's get them a policy with a private insurance policy. They can only use their Social Security payments, however, not any of their accumulated wealth, or even their inherited Nazi-related wealth.

Catalina Vel-DuRay on July 24, 2015 at 9:14 AM · Report this
2
the GOP plan:
1. Phase out Medicare
2. TBD
3. Freedom
Max Solomon on July 24, 2015 at 9:15 AM · Report this
3
Hey dan. This should be your next book: why conservatives in the USA and England are so whacked compared to conservatives in every other country in the world when it comes to healthcare, sex, abortion, education and infrastructure. Even most of the 1%ers in other countries are OK with abortion, OK with some kind of health care for everyone, want decent public schools paid by taxes and good roads and fast trains. It's actually good for business if your potential workers can read, write, have affordable medical care (that you don't have to pay a lot for as an employer), aren't popping out babies by the dozen, and the highways are in good repair and there are fast trains. The 1%ers in most western countries are to the left of WORKING CLASS folks in the USA. WTF, America?
delta35 on July 24, 2015 at 9:29 AM · Report this
4
@3 and for field research, of course, you'd have to go live for a few weeks Israel, Germany, France, Australia, Canada... with lots of colorful stories to tell like you had in Skipping to Gomorrah.

Oh, plus sex workers. Legal or at least decriminalized in many western countries. 1%ers and politicians in other countries wanna enjoy their hookers & rent boys without risk of arrest!
delta35 on July 24, 2015 at 9:32 AM · Report this
5
All CONgress has to do is drop the age restriction on Medicare and we'll have universal coverage. Taxes will have to go up, but it'll be more than offset by the ability to drop private and group rip-off policies.
Original Andrew on July 24, 2015 at 9:40 AM · Report this
6
@3: England? Tories are bloody Marxists compared to our Regressives. Don't dilute the problem.
Max Solomon on July 24, 2015 at 9:43 AM · Report this
7
@ 3, Two words: sadistic racism.

They'd rather destroy the whole freaking KKKountry than help someone who's poorer and darker-skinned than they are.
Original Andrew on July 24, 2015 at 9:46 AM · Report this
8
How long before Jeb releases a statement saying his quotes were taken out of context?
CC-Rob on July 24, 2015 at 9:46 AM · Report this
9
A few decades where everyone, males and females and anyone in between, does a few years of compulsory military service would do wonders for inserting ourselves in foreign conflicts.
ChefJoe on July 24, 2015 at 9:57 AM · Report this
10
Wow, way to alienate older voters, Jeb! Is pissing off the most active voter block part of your winning strategy?
Reverse Polarity on July 24, 2015 at 10:05 AM · Report this
11
There is an alternative to single-payer, Obamacare, and Medicare/Medicaid. It's government-mandated Health Saving Accounts, owned by individuals for tax-free accumulation prior to medical need in much the same way a 401(k) or similar plan is accumulated prior to retirement.
Add a safety net for the poor and unemployed (this would the remnants of Medicaid), and let young people who get sick borrow tax-free against future earnings regardless of credit status.

It's the perfect Republican solution that actually makes sense. but you'll never hear it from the likes of Jeb! or the rest of the GOP. Why? Because it puts their lobbyist buddies from the insurance companies in the unemployment line, and it involves at least one mandate, which of course is unheard of in America *cough*carinsurance*cough*.
Lance Thrustwell on July 24, 2015 at 10:26 AM · Report this
12
These phase-outs play off the cognitive dissonance of the Tea Party types who only hate government when it benefits others. They get to keep the socialized health care they love while rescuing the younger generations from its tyranny. I know it sounds dumb but it works really well with voters who have a very tenuous grasp on reality.
blip on July 24, 2015 at 10:27 AM · Report this
13
While an election cycle with a real choice on the left [not tepid, center-right pabulum] and a real choice on the right [instead of God, Guns and Gays! Oh my!] would be the best way to achieve a healthy political discourse, as long as the GOP wants to run around pissing off latinos, the elderly, and women, I'll just sit back and eat up the schadenfreude.

Keep at it boys.
Ophian on July 24, 2015 at 10:30 AM · Report this
14
Lance @11, Obamacare was the republican solution to healthcare. We now have, more or less, what the Heritage Foundation dreamed up instead of universal coverage and access to preventative medicine. The conservatives just moved the goal posts and convinced half the country that the sky was falling because Socialism!
Ophian on July 24, 2015 at 10:37 AM · Report this
15
@11: Explain how that covers the poor, or someone whose account has yet to grow to the size necessary to cover a catastrophic illness or accident, or someone who develops, say, a chronic medical condition that takes them out of the workforce and quickly burns through their medical savings account. (Spoiler alert: It doesn't, it doesn't, and it doesn't.)
Dan Savage on July 24, 2015 at 10:38 AM · Stranger Staff
16
The idea of a 401k providing a secure retirement - particularly without Social Security and Medicare - is just a joke. All it would take is one typical elderly affliction (broken hip, cancer, etc) to bring that all crashing down. And the idea of living to an advanced age and seeing that magical 401K getting low is a pretty grim thing to contemplate.
Catalina Vel-DuRay on July 24, 2015 at 10:45 AM · Report this
17
@16: This is, of course, the way to ultimately move the remaining homes owned by the under-$10M set into the portfolios of the giant national and regional real-estate management and private-equity firms.
rob! on July 24, 2015 at 10:58 AM · Report this
18
@3

I prefer the Underwear Gnomes plan (which incidentally was also the GOP plan for the Iraq War) :

1) Phase out Medicare.
2) ?
3) Profit!
CPN on July 24, 2015 at 11:07 AM · Report this
19
@15:

That's precisely the point - it doesn't. Even if you start putting into a HSA in your early 20's, there's still a very good chance you won't have enough accrued by your 60's or even 70's to cover truly catastrophic procedures such as chemo/radiation, organ replacement, or cutting edge genetic-based treatments, so you'll still either have to sell all your worldly goods, or rely on the generosity of friends and family. And heavens forfend you get sick in your 30's or 40's, because then you're well-and-truly screwed. But, according to the GOP that's the price you should pay for having the moral depravity to get sick in the first place.
COMTE on July 24, 2015 at 11:13 AM · Report this
20
@19 & @15 (Hi Dan!) The degree to which various safety nets need to be in place is not clear in this scenario; I freely admit I don't know the ins and outs of it, and you're right that HSAs would be inadequate in many cases. The government would need to step in then, because we can't have people left out in the cold through no fault of their own. But the big advantage HSAs have that single-payer doesn't is that it preserves market forces - i.e. competition and consumer choice - driving prices down. Single payer is a good idea and I'm all for it over what we had and even currently have under Obamacare. But the one thing it doesn't do is provide a natural and efficient way of containing costs. HSAs are one idea for doing that - maybe they won't work, but it seems like no one's really even studying the idea outside of a few think tanks and academics. Don't worry - I'm not talking about throwing people to the wolves here! I just want something that provides the best outcomes in the long run.
Lance Thrustwell on July 24, 2015 at 1:06 PM · Report this
21
No tax payer abortions until Planned Parenthood stops the illegal activity of harvesting fetal tissue for profit.
raindrop on July 24, 2015 at 1:12 PM · Report this
22
Oh Raindrop. Don't be such a drip.

Harvest away - that's what I say! (yes, I know Raindrip's premise is inherently flawed, but I thought I would respond in a way that was equally simple-minded, but on the other side. )
Catalina Vel-DuRay on July 24, 2015 at 1:34 PM · Report this
23
Compulsory military service!
Reference a country where they don't think of jailing stone throwers for up to 20 yrs for your example next time, maybe.
LavaGirl on July 24, 2015 at 2:00 PM · Report this
24
@20 Health care does not fit well into a market-driven model. Too much of it is due to accidents - do you really shop around for the best prices for repairing broken bones and treating spinal chord and head injuries when you're involved in a car crash for example? Then there are serious or chronic illnesses - do you decide to go without insulin because all the drug stores are charging too much? Market forces can only work effectively when you can say: You know what, I don't like the prices, so I'll just keep looking or wait until things go on sale or look for a cheaper substitute. For so much in the health care realm, that is not possible.
PlaidWoman on July 24, 2015 at 2:00 PM · Report this
25
Before Social Security, most older people who were no longer working lived in poverty, because few were able to save enough during their working years to afford a decent retirement. Before Medicare, older people who got seriously ill or injured and could not afford to pay out-of-pocket got minimal health care - and were basically left to die. No insurance company would cover them. Older people have been the biggest beneficiaries of the most far-reaching progressive programs in US history. Yet they keep voting for Republicans, who have been opposed to these programs from the start and keep trying to destroy them. A big majority of older Americans are white. I think the reason they vote Republican is that a lot of the white voters have deep-seated prejudices against non-whites, gays, immigrants, etc. and the Republicans have been very good at cynically exploiting these prejudices. It will be interesting to see if they wake up to what the Republicans are doing and vote their self-interest instead of their prejudice for a change.
PlaidWoman on July 24, 2015 at 2:35 PM · Report this
26
@20, market forces only work if the patient has sufficient time to consider all the options and the risks and the prices. In any kind of urgent situation, the patient will have none of that, and market forces are useless. Even in ideal circumstances, market forces would incentivize patients to sometimes choose the least expensive care, which might prove more harmful in the long run. Or to skip getting care entirely to save money, only to make matters far worse later.

Most doctors prescribing medications don't have a clue what they cost. They don't know and they don't care. They prescribe what they think will work best. How is a patient supposed to exercise market choices in that kind of situation?

Market forces work great for commodities that are plentiful, easy to understand and compare. Market forces have already proven to be very ineffective in health care, where even the medical professionals don't know the cost of treatment.

Finally, if market forces worked, we should have pretty cost effective medicine already. We don't. Canada and all European countries with single-payer systems provide better health care for less money than the US.
Reverse Polarity on July 24, 2015 at 2:53 PM · Report this
27
@26 Excellent points, especially the last one.
PlaidWoman on July 24, 2015 at 3:08 PM · Report this
28
Here's what has me pounding my head into my desk: The U.S. already covers the difficult to insure, i.e. the people with huge health care costs (read: the old and disabled). Given that we're already doing the hardest part, why not go all the way and expand Medicare to cover everyone?

It can't be because there's a lot of money to be made in covering the young and able-bodied, is it? And because those companies making all that money contribute heavily to the GOP? After all, one man's inefficiency reductions is another man's lost profits.
I Hate Screen Names on July 24, 2015 at 3:57 PM · Report this
29
@ Lance Thrustwell -

Here, watch "Why Are American Health Care Costs So High?"

http://m.youtube.com/watch?v=qSjGouBmo0M

It's a fairly short video and it'll give you a completely new perspective on that whole "preserves market forces - i.e. competition and consumer choice - driving prices down" thing.
MiscKitty on July 24, 2015 at 4:07 PM · Report this
30
Well, I for one cannot afford five thousand dollars a year for *no other benefit* than having the luxury of there being only a ten thousand dollar deductible on *any single individual claim*. In a compulsory system, I'd be homeless; on this system, I'm quite prepared to die at the first serious illness, or at least I shall be as soon as I can decide on how to revise my will. With any luck, there will be a cause within the next few years worthy of a political suicide, as I've probably already outlived all my purpose in existing.

(Sorry for the rotten mood; I've been hearing a lot of ghastly evopsych LMB-worthy stuff this evening that would be quite adequate grounds for suicide if I believed a tenth of it.)
vennominon on July 24, 2015 at 7:24 PM · Report this
31
Lance Thrustwell, the point of insurance is to take advantage of the law of large numbers and risk pooling. The bigger the pool, the more risk pooling and the lower average cost to each person covered. Why?

Insurance has one price component for expected risk, and one for the variance in that risk. Lets forget for a moment about he factor for the greed of the executives. The larger the pool the lower the need for the variance protection. Law of Large Numbers. So to take things to the logical conclusion, single payer is the only way to minimize the cost of providing risk management. And it is trivial to show that this solution delivers pareto optimality and maximizes social benefit or minimized social cost.

This isn't liberal clap trap thinking, it was I fucking learned at University of Chicago when I was still a conservative "George Bush" republican. This was or less on on the first day of Micro form Nobel Winning Economist Gary Becker. The protege of Milton Friedman. I mean this is as fucking conservative an idea as is fucking possible.

.But just as I lost the wool over my eyes and realized that the conservative agenda I was being force fed was all bullshit, conservatives for got about this little lesson. The result today is I am happily bisexual, my wife and I are swingers, my conscious is clear that I support and agenda to the left of Bernie Sanders and I realize my privileged status. The fucking conservatives , on the other hand, found Jebus and and are committed to a fuck the unlucky economy. And HSA's are just that. There is no smaller pool than an HSA. GUess wrong or get cancer young and you're fucked. Just like you were if you had a lot of stocks in your IR and planned to retire in 2010. Fuck you for not being in the 1%
wine-o on July 24, 2015 at 7:53 PM · Report this
32
@11 Agree with you on HSAs. Pair with single payer catastrophic insurance.

Great book on the topic: Catastrophic Care by David Goldhill

http://www.amazon.com/gp/aw/d/034580273X…
Cynara on July 24, 2015 at 8:01 PM · Report this
33
“The leech's kiss, the squid's embrace,
The prurient ape's defiling touch:
And do you like the human race?
No, not much.”
vetted on July 24, 2015 at 10:54 PM · Report this
34
@22: Well, its so egregious that California's Democratic AG is launching an investigation.
raindrop on July 25, 2015 at 10:26 AM · Report this
35
@34 Historically infanticide has some pretty conservation roots. It is straight up market forces, I want this kid, I don't want that one, oh crap I can't afford this one so let's cut my losses.

Yes it is a bloody business but it is the 3rd oldest profession. Right after prostitution, and motherhood.

Do we harvest the results of infanticide of course we do. Sometimes years after the result see the industrial prison complex. Or more commonly the military, there is a reason we call it an "infant"ry That's Capitalism we monetize everything.
Machiavelli was framed on July 26, 2015 at 12:13 AM · Report this
36
@34, Kamala Harris is investigating the sketchballs who made that video because they broke a bunch of laws.
blip on July 26, 2015 at 7:09 PM · Report this
37
@34: It's hilarious that that link proves the opposite of what you think it does.
chi_type on July 26, 2015 at 11:33 PM · Report this