On September 19, Katherine Q. Seelye, a New York Times “reporter” provided one of the most biased “hit pieces” I’ve seen yet on Medicare for All. The piece is called “Medicare for All? ‘Crazy,’ ‘Socialized’ and Unlikely,” implying that Seelye thinks it’s all three. But what does she say to support her implied characterization. Well, “crazy” is mainly supported by a reference to a scene in the West Wing where Alan Alda, playing a right-wing Republican Presidential candidate refers to extending Medicare to every American as “crazy.”Just as scenes from the television series “24” are often cited by Republicans as an authoritative justification for torture, Seelye, too, appears to believe that right-wing opinions expressed by a fictional character, played by a Liberal, also deliver authoritative verdicts on a policy proposal like Medicare for All. Alan Alda must have gotten really annoyed when he read her piece. Right after her reference to Alda’s comment on Medicare for All, she says:
”Talk about reality TV.
”Extending Medicare to all has seemed like a good idea to many — except to those who call it “socialized medicine.” Or crazy.”
But does she support her view that “Medicare for All” is “socialized medicine”? Not really. Medicare for All, of course, is socialized insurance, not socialized medicine. One would think that a New York Times reporter would know the difference. But perhaps not in 2009, in what may well be the twilight years of our once proud newspaper icons. There is at least some indication, however, that she does know the difference, since she quotes Stuart Altman of Brandeis as saying: “The financing system very much dictates the delivery system,” and Robert Moffit of the Heritage Foundation who says: “. . . extending Medicare would mean too much government intrusion.” Neither of these, of course, while unfriendly to Medicare, support the view that it is “socialized medicine.”
Up to this point, then, Seely’s commentary on the Medicare for All proposal is just name-calling; a replay of what the right-wing attack machine has to say about it; and an example of what 5 year-old children in kindergarten do, but not a serious piece of journalism in what claims to be a great newspaper. But fear not, from that point on, Seelye expands her analysis by dividing her remarks into three categories: not in this congress; financing and delivery; and as for the money.
Under “not in this Congress”, she mentions that there is not much support in this Congress for HR 676. She also mentions that Medicare for All is very unpopular with the insurance industry which has a strong grip on Congress. She also goes on to argue:
”. . . Medicare reimburses doctors and hospitals at much lower rates than private insurance companies do. So, in general, health care providers oppose extending Medicare because they fear being driven out of business.
”For another, paying for such an expansion would almost certainly mean a big tax increase on the middle class. (Supporters argue that a tax increase would be somewhat neutralized by the elimination of premiums that people pay now to insurance companies.)
”Stuart Altman said . . . it would be extremely disruptive . . . When Bill Clinton wanted to restructure the whole delivery system, what scared people so much was the potential disruption”
Taking each of these in turn: 1) everyone knows that only progressives support Medicare for All, that they’re not a majority in Congress, and that a large number of both Democrats and Republicans have been bought by the insurance companies . But what happens if the progressives refuse to pass anything else other than HR 676? Then the President and the blue dogs won’t be able to pass health care and they will have a disaster in the 2010 elections, while the progressives remain relatively safe. So, the question then becomes how can we get the progressives to refuse to compromise in order to move the Democrats toward Medicare for All? That doesn’t depend on Congress. It depends on what kind of movement can be developed outside of Congress to stiffen progressive resolve. 2) Medicare may reimburse providers at lower rates than private insurers, but surveys show that a majority of doctors now support either Medicare for All or a strong PO, in preference to the present system. Doctors, at least, seem ready to sacrifice some compensation for the privilege of practicing medicine again, rather than playing the game of getting insurance company reimbursement. In addition, for both doctors and hospitals, Medicare, as a single payer system, will greatly simplify the insurance paperwork burden on both doctors and hospitals. That’s going to save money for both of them and will compensate in part for the differences in reimbursement rates. Finally, in recent years, private insurance companies have pressed doctors and hospitals on reimbursement rates in order to increase their own profits. So, the discrepancy between private and public insurance reimbursements has been declining over time.
3) The bogeyman of a big tax increase on the middle class if Medicare is extended to everyone, is disingenuous. First, even if a tax increase were equal to the average cost of health care plus 2.5% Medicare Administrative costs, people would be paying 27.5% less than they have been paying for private insurance. So even in such a scenario any tax increase would be more than offset by the absence of insurance premiums they had been paying. In addition however, since Medicare costs are lower than private sector costs, the necessary tax increase would be still less. Further, the tax increase on the middle class can be further moderated by making all tax increases progressive. Restoration of 50% marginal tax revenues for the top brackets, and introduction of two other new brackets above the 39% marginal tax rate, will do wonders for making any middle class tax increase minimal, and for saving even more middle class money relative to the tax/elimination of premium trade-off I talked about above. Finally, the whole argument here, is premised on the idea that the transition should be deficit neutral. That’s nonsense. Obama’s stimulus bill was inadequate. In the short run, we need more deficits, not less, to stimulate the economy.
4) Seelye’s final point relating to this Congress is that it would be too “disruptive.” This notion however, is just more rightist labeling. If Seelye wants to claim that the negative impact of the transition to Medicare for All will exceed its positive impact, i.e. that its real costs will exceed its real benefits, then I’m all ears to hear that argument. But to just quote some academic who claims it would be too “disruptive,” is just an exercise in appealing to authority and labeling. It is a claim that is unsupported by argument, and that just expresses a generic opposition to change. Since it’s change we want, we can safely ignore this piece of nonsense.
Under financing and delivery, Seelye quotes Altman who says: “The financing system dictates the delivery system.” She then references Moffit, “a former health official in the Reagan administration,” who said “extending Medicare would mean too much government intrusion;” who also claims that there won’t be much support for this beyond liberals; and that it’s a “philosophical question” about whether “. . . you want to give the Government that kind of power.”
Frankly, these points are pitiful in their bald weakness. First, while the financing system certainly effects the delivery system, to say that it dictates it’s functioning is to engage in simplistic economic determinism. In any case, Seelye does nothing to outline how Medicare for All would influence the health care delivery system, or what kind of impact it would have beyond extending coverage to everyone. Second, the point that extending Medicare would mean too much government intrusion is, indeed, a philosophical question, or as I would put it, an ideological question. It’s not surprising that a former official in the Reagan Administration would view it as too much Government intrusion, however, contrary to Moffit and Seelye’s view and to the factual claim they make, that popular support for it would not go beyond liberals, other Americans have a much different view of the matter. They are a) pragmatic and less ideological than Moffit and Seelye, and also b) surveys have repeatedly shown that a substantial majority of Americans favor health insurance reform that would establish a Government-run single payer insurance system like Medicare.
Next, Seelye discusses “as for the money.” Here she begins with a quote from Moffit claiming that extending Medicare won’t save money, and that Medicare will go broke if changes are not made. She then quotes Jonathan Skinner of Dartmouth to provide a more “balanced” view. Skinner says that Medicare would immediately save a lot of money by cutting administrative costs substantially. However, he claims that it would also “probably require a tripling in payroll taxes just to pay hospitals alone,” and also would “do nothing to control costs.” He also called Medicare “dysfunctional” and said that:
“It provides the wrong incentives to doctors. This would be extending that dysfunctionality to the entire population.”
These final points in Seelye’s Medicare for All hit job, also are less than persuasive. First, even though Medicare has financial problems right now, these have been greatly exacerbated by the Bush Medicare “reform” providing exorbitant subsidies to private insurers in connection with the Medicare Advantage Plans. HR 676, the Conyers-Kucinich Medicare for All bill, would get rid of the Bush reform. In addition incorporating a larger risk pool ,will lower Medicare’s per person costs and do much to end its financial problems.
Of course, Skinner is right that Medicare for All saves administrative costs, but neither he nor Moffit admitted that it would save $400 billion per year in such costs, which would do much to fund the extension of Medicare to everyone. In addition, the notions of a tripling in payroll taxes and inability to control costs are both highly suspect points. Seelye needs to cite the figures showing such an increase, if she expects to be believed by anyone except right-wing pundits. As for controlling costs, it is hard to see why Medicare should be any worse at this than private insurers are. Right now, the rate of increase in Medicare costs is much less than that in private insurance, suggesting that public employees are controlling costs much more effectively than their private counterparts. None of this takes into account the intention of the Administration to achieve substantial savings in Medicare, an intention which seems much more serious than any corresponding motivation in the private insurance sector. This whole question of costs is one that might have been clarified by full CBO scoring of HR 676. But, of course, the Administration blocked that when it took Medicare for All “off the table.” Nevertheless, numerous articles have appeared that suggest that Medicare for All would score better than any of the bills under consideration now, including the Baucus bill.
What about Skinner’s claim that Medicare incentives are dysfunctional for doctors? Well, I’m very skeptical about such statements in the absence of empirical data comparing incentives and values across public and private sector medicine. The whole notion is belied by the fact that a heavy majority of Physicians now favor either Medicare for All, or a strong public option plan according to recent surveys. These survey results suggest that, at a minimum, doctors aren’t worried about the “dysfunctional incentives” for Doctors in public insurance plans. Also, in other major industrial nations who have single-payer plans we don’t see any motivational difficulties that doctors are having, suggesting that Skinner’s point about dysfunctional incentives in public plans is highly suspect.
While reading Seelye’s post, I found myself thinking about what could have motivated it at this juncture? Could it be that Anthony Weiner, Dennis Kucinich, Bernie Sanders, and other supporters of Medicare for All have been making some headway lately in getting HR 676 and S 703 back on the table, at a very inconvenient time for the White House? Here’s the President, who earlier marginalized single-payer advocates with White House labeling of single-payer solutions as lacking in realism, and also took Medicare for All “off the table,” making slow progress toward getting progressives to agree to his taking the public option off the table too. And suddenly, Medicare for All, which positions the public option as a compromise position, is coming back. That can’t be good for the White House’s plan to pass health care reform with 60 votes. So maybe someone at the White House calls their good buddies at the NYT and suggests a “hit job,” on Medicare for All to help to stop it from gathering a head of steam over the next few weeks, and getting good coverage when the Mad As Hell doctors get to Lafayette Park In Washington, DC at the end of the month?
I also found myself thinking about the irony of Seelye’s use of the epithet “crazy” to try to characterize advocacy of Medicare for All. Mind you, this is in the context of an existing health care system that a) kills 45,000 people every year by denying them insurance, and bankrupts another million Americans, b) “reform” proposals that refuse to capture $400 billion per year in administrative savings by implementing Medicare for All, and c) “reform” proposals that will deliver nearly $1 Trillion in subsidies over 10 years, so people can buy insurance, while mandating that these subsidies be used for the private insurers who have so miserably failed to deliver value in the past. Now forgive me, but I think it’s “crazy” to forgo savings of $400 billion per year for the purpose of maintaining the existence of an industry that is harming Americans in the millions every year and that has no redeeming social value. I also think it’s the very definition of “crazy” to do the same thing over and over again and expect a different result.
The health insurance industry has failed Americans for many decades now. The Baucus bill, and all the other bills that are “on the table” in Congress right now propose that we feed the same companies that have failed so miserably, with $1 trillion in new public money so they can cover the uninsured. Insofar as these bills carry with them the expectation that the insurance companies will behave differently, and will serve the public rather than extract profits from them by finding pretexts for denying their claims, I think they embody both “craziness” and stupidity. If we trust the insurance companies one more time, we will not get a different result. We will just get more harm to the public, more legalized bribery of public officials and more distortions of our political system. We need to pass Medicare for All, and put these companies (and ourselves) out of their misery.
Getting to the end of this hit job on a “hit job”, I think that Katherine Seelye’s article is a good example of what’s wrong with much modern journalism today. This is another article that seems put together from a set of index cards with one or two sentences on each of them, without benefit of much more than minimal transitions. It reads like a set of talking points from the health insurance industry, biased to the core, rather than a systematic presentation of the case against Medicare for All. It uses unsupported name-calling and labeling in place of making its case. For the rest, it uses appeals to authority unsupported by any reasoning, arguments, or hard facts. It is a disgrace to journalism and to the newspaper it represents. And it is a perfect example of how far the mighty New York Times has fallen, and of its loss of conviction about the importance of seeking and finding the truth.
(Also posted at firedoglake.com where there may be more comments)