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How to pay for Medicare-for-all

Elsewhere, the economist argument that fee-for-service must be juicing spending has not held up either. Maryland undertook a major reform to many of its hospitals, moving to a “global budget program” in which several hospitals were paid a lump sum for the whole year instead of per procedure. A study released this year found it “did not reduce hospital use or price-standardized spending as policymakers had anticipated.” Moreover, many other countries have used fee-for-service billing (both today and in the past) and have not experienced anything like America’s turbo-charged cost increases.

So what is going on? Returning to the Papanicolas study, two big, obvious things jump out: drug prices and administrative costs. America paid roughly twice the rich country median for drugs in 2015, at $1,443 per person, with $1,023 of that in the form of retail pharmaceuticals. France paid $697, while the Netherlands paid just $466. Secondly, fully 8 percent of American health-care spending goes to administration — as compared to Germany at 5 percent, Canada at 3 percent, or Sweden at 2 percent.

Thus the first priority for a Medicare-for-all bill must be to cut administration spending to the bone. Given that this is largely down to providers having to navigate the hellishly complex and fragmented status quo system, this should be quite easy. Aiming for Canada’s level would be a good goal, since it would be a fairly similar program (and global budgeting can help here). Using 2015 figures for consistency, getting down to 3 percent saves about $160 billion (5 percent of $3.2 trillion) a year.

Smashing down drug prices would be harder politically, but conceptually simple. As Japan’s medical price regulator does, you simply survey the drug market and set prices given an overall budget of (let’s say) $725 per person. That’s still on the high side among rich countries, allowing for higher prices for drugs requiring expensive development and production, but with the main objective of halting rampant, merciless price-gouging. Given that 84 percent of U.S. drug consumption is generics, this should almost exclusively hurt Big Pharma companies charging rip-off prices — as they charge Americans more than twice the U.K. price for arthritis medication Humira, more than three times the U.K. price for cholesterol medication Crestor, more than three times the German price for diabetes medication Lantus, and more than four times the French price for asthma treatment Advair. The Medicare price-setting board should also have the power to force recalcitrant pharma companies to license their patents (which are a government-granted monopoly in the first place, after all) to a generics manufacturer if they won’t play ball with a valuable treatment.

This is a pretty lengthy op piece by Ryan Cooper of The Week.


Therefore, the new Medicare agency would need to wage an all-out war on cost bloat and waste. As detailed above, it should immediately smash down administrative costs and drug prices. For services, it will probably have to start by mandating all providers use existing Medicare prices, which will save a considerable amount right out of the gate. But the agency should immediately conduct an extensive national audit of provider cost structures to root out waste and fraud, and adjust prices accordingly.


Client just left who told us that his thrice-weekly hemodialysis treatments cost $22,000 each and the doctor who pokes his head in for a few seconds to ask, “is everything ok?” gets paid $4,000 each time.

He said that the last time the doctor asked him if everything was okay, he told the doctor that his back was giving him trouble and the doctor replied, and I’m paraphrasing, “no, I’m only asking about the area around the needle entry point”, and then left.

I guess with so many people not able to receive healthcare, they have to gouge those who do to make up the difference?

U.S. health spending twice other countries’ with worse results

The U.S. spends about twice what other high-income nations do on health care but has the lowest life expectancy and the highest infant mortality rates, a new study suggests.


my link goes to page not found. fyi thanks for the article, tho. sure i can find it.




I will have to look at this NBER paper a little more closely to see what the survey entailed. But this is laughable in general because Medicare is a socialist program.


Really. The stupidity is just galling! 🙁


Us seniors here aren’t worried!!! :O) someone must be whispering in their ear (like Trump and co.)


Terrific news! 🙂 Greenpeace is an old lefty/lib org. which has ecology cred up the wazoo and back. Sure hope they can back neolib Trudeau off! There are certain suspects on here who are trying to give me a big head. 🙂 LOL. Seriously, appreciate the compliments. I do have a big fat mouth when it comes to politics. T and R to y’all!!


Well ORL you cut to the chase and cut though the Bullshit



promoted to admin, but joined all by himself. not much an exoneration, really.


Dissent Is Being Muzzled Across Our Planet

In addition to 5 arrested in India just now, the author roams through several countries, Turkey and Bangladesh among them, with many examples. We, of course, have our own.

Four writers and activists—Gauri Lankesh, M.M. Kalburgi, Govind Pansare and Narendra Dabholkar—had been killed in sequence. The police have now begun to unravel the plot—tracing weapons to the sewers of the Hindu Right. It is almost as if these current arrests come to distract attention from those who actually created a criminal conspiracy to assassinate Lankesh, Kalburgi, Pansare and Dabholkar (a point made in a statement released by Indian writers). It is a cliché of the right wing to divert attention from real problems toward manufactured crises. There are real problems here—a right-wing conspiracy to kill dissenters, a collapsed Indian rupee, no hope of economic recovery. The economic slide cannot be stopped by a knife in the gut of a left-wing activist or a nuclear test or another trip overseas by the itinerant prime minister. What can derail the conversation is for every household in India with a television set to be transfixed on what appears to be a totally fallacious series of arrests.

There is more advice from Rodolfo Walsh. He writes in his letter that even if the military junta in Argentina kills the last guerrilla, that would not end matters. The many currents of resistance will not vanish. Instead, Walsh writes with great feeling, the survivors will be “aggravated by the memory of the havoc that has been wreaked and by the revelation of the atrocities that have been committed.” This hope is not for India alone. It is for Bangladesh, for Uganda, for Turkey… for our planet, really. One hopes that the survivors, those whose hearts remain beating on the hopeful sides of their chests, will not stand by silently as the last people of feeling are arrested and murdered.


I may be wrong, but I don’t see Bernie at the Capitol for the McCain memorial.


i hope he doesn’t get pilloried for it.


Ten Years After the Financial Crash, the Timid Left Should be Full of Regrets

Capitalism’s near-death experience with the banking crisis was a golden opportunity for progressives. But they blew it.

Elliott explains it in terms of how economics is taught at our universities. An he hasn’t given up.

There are plenty of lessons that need to be learned. One is that progressives have to win the battle of ideas, and that means taking back control of how economics is taught. Some steps have been taken to address this issue since the financial crisis, with George Soros bankrolling the Institute for New Economic Thinking, a forum for heterodox thinking. But even though the collapse of 2008 was the result of failed economics, those responsible for the duff theories remain well dug in on university campuses. Progress has been slow.

A second is that a progressive political agenda starts at the top, with an over-arching critique, and works its way down to specific policies. That was what worked in the 1940s, when the postwar consensus was built on a simple concept: never again. Control of the commanding heights of the economy and demand management flowed from that.

A third is that progressives have to be clear about what they want. The left remains divided between those who think – as Bill Clinton and Tony Blair did – that the only choice was to work with the grain of global capitalism; those who think, as Roosevelt did, that a more root-and-branch approach is needed; and those who think capitalism is so rotten it is beyond saving.

A fourth is that a bit of humility is needed. There is no question that the nature of the conversation has changed since the crisis, in part due to austerity, in part due to an overly lenient approach to the banks. But there are things about modern life that people like: the ease of communication and travel; the fact that for the same outlay as 10 years ago they get a more sophisticated mobile phone or a better restaurant meal. When the radical left has actually been in power it hasn’t always covered itself in glory.

David Hillman, the director of Stamp out Poverty and one of the organisers of next month’s UK protests in the City, puts it this way: “There was a very short period when the powers that be were on the back foot. Progressive forces were not able to take advantage. Nothing substantial has changed and we are sleep-walking into another crisis.”

That just about sums thing up. Progressives don’t really deserve a second chance, but they may be presented with one all the same. The question is whether they will be better prepared to take it this time.


I just noticed that my twitter ‘Trends’ list does not include anything on the McCain funeral going on right now, but has two Aretha Franklin-related trending conversations.

On a related note, this is the picture that was just now on CNN.com’s home page. That’s Ariana Grande singing Aretha’s ‘Natural Woman’.

Maybe it’s just me but, especially if one is given a front row seat, wouldn’t it be more respectful to listen to the young lady singing right in front of you at a memorial service, instead of yapping into the ear of the person sitting next to you?? smh


bill’a never been a great respecter of women.


Ooops, Bill may not have been LISTENING to Ariana, but…



Maybe Bill really likes the song.

But I don’t understand why he got to sit in the front row though.




Donna’s really taking it well!

Curses! Superdelegate is vanquished!

I’ve had my wings clipped, my cape ripped, and my super powers stripped. My irresistible Kung Fu grip on the Democratic Party is being pried loose by well-meaning citizens who may yet endanger the very fountainhead of their freedom.

You see, since time immemorial, we superdelegates have stood as the guardians and protectors of the secret machinations of the Democratic Party, keeping it safe from outsiders and agitators. We were ever watchful, always ready to spring into action should unorthodoxy raise its ugly head.

But now, a simple Democratic National Committee vote has effectively left us neutered — stripped of our awesome powers, left helpless and weak like Superman zonked by kryptonite, Batman without his utility belt, or a hammerless Thor.

No, that’s not from The Onion, it’s Donna Brazile’s USA Today opinion piece.

We’re not there to circumvent the will of the voters. We’re simply there to vote. Well, not anymore, we’re not.

According to the new rules, we superdelegates won’t be able to vote on the first ballot at the convention. Or on any ballot, unless there’s a tie or some other sort of deadlock in the process.

So, we superdelegates are now what? Merely the mechanism you default to in case of a tie? Great. I’ve fought for the Democratic Party my entire life, and now I’m one notch above a coin toss.

Was she drinking some vino when she wrote this?

Well, I can still go to the convention as a superdelegate, and do everything in my power to help Democrats win elections. I earned my place at this table. Hell, I helped build the table. So when you’re sitting at it without me, please use coasters. I don’t want any stains on it.


Some of this is so absurd it makes me think of a study not to long ago that found the best way to push someone off a position is not to push against it, but to push for it in such an extreme manner it turns people away.

Sometimes i think some of these people are secretly working for us….


I posted something similar to this upthread. Donna deserves all the sympathy that we can muster. LOL


Wow. Us rabble will prolly stain it with all our food and babies and fun. Sorry if you can’t handle life, ya know. Maybe go somewhere else, like a fancy older community? Just sayin.



This simple tweet “REALLY MAKES ME THINK” about them controlling the narrative!

Just a few thoughts.

The run up to the Iraq War.

The glorification of the White Helmets.

The use of chemical weapons in Syria.


One would have to search very hard to find any coverage of this ongoing struggle.


Yay, a bit of good news:


In other good news.


30 August 2018 – 04H00
France’s ban on bee-killing pesticides begins Saturday

© AFP/File | Many French beekeepers have seen hives mysteriously die off, which scientists believe is due in part to neonicotinoid pesticides
A ban on five neonicotinoid pesticides enters into force in France on Saturday, placing the country at the forefront of a campaign against chemicals blamed for decimating critical populations of crop-pollinating bees.

The move has been hailed by beekeepers and environmental activists, but lamented by cereal and sugar beet farmers who claim there are no effective alternatives for protecting their valuable crops against insects.

With its ban, France has gone further than the European Union, which voted to outlaw the use of three neonicotinoids — clothianidin, imidacloprid and thiamethoxam — in crop fields.

Heavily agriculture-reliant France banned these three neonicotinoids plus thiacloprid and acetamiprid, not only outdoors but in greenhouses too.


Could this be the start of PUMA 2.0?


This is where us pushing from the inside can turn the Dems into the Whigs and create an opening for another party, though personally I dont think the dems will do that and will instead slowly transform into our party, as the parties have usually done from internal pressure, the Whig situation was the exception.

A lot of these dems are really just repubs anyway and half the reason the right is so far right is because the dems have moved to their old position, forcing them right to create difference.

I suspect if we move the party left it will make the old mod repubs go back to their rightful party and pull it back towards the center in the process as we move the dems left to make room.


Oh admit it. You’ve been wanting to join the Republicans for a while. 👋



It looks like both sides can play the sanction game!


Russia will stop shipping U.S. astronauts to the International Space Station (ISS) in April 2019, Russian station Kommersant FM 93.6 has reported.

Deputy Prime Minister Yury Borisov reportedly said the return flight of a Soyuz-MS next year “will finalize the fulfillment of our obligation under a contract with NASA.” With new crew-carrying vehicles still under development, the move may leave the U.S. unable to send astronauts to the ISS.

But Sergei Krikalev, director of Russia’s human spaceflight program, told Russian news agency TASS that the country may yet renew the NASA contract. “The next contract is under discussion, but so far there have been no concrete decisions,” Krikalev added.


A bit more info.


Discussions on the next contract are already underway between Roscosmos and NASA, but “there have been no specific decisions yet,” Krikalev added.

The discontinuation of the Space Shuttle program seemed like a minor inconvenience in 2011, when the US and Russia were on relatively good terms. Today, however – amid a bitter political stand-off between the two nations – the fact that the US has to rely on Russia in some aspects of its space exploration is considered humiliating by some people in America.

The late Senator John McCain was among the most vocal critics of the situation, in which the US pays Russia millions of dollars each year in return for space engines and rides to the ISS. Vice-President Mike Pence last week pledged that the US will “very soon” be able to take people into space without Russia’s help and will return to the moon by 2024.



What if Bernie had made that statement?


bet this was after Bill’s ogle.


Good point.


Now Why is PP supporting Tom Carper Over Kerri Evelyn Harris?

CRPER has a record of anti-choice and anti-women votes. In 2003, he voted for the so-called Partial Birth Abortion Ban Act, which banned late-term abortions even when a woman’s health was in jeopardy. Planned Parenthood unsuccessfully sued to overturn the law. In 2006, Carper voted with Republicans for the Child Interstate Abortion Notification Act, which would have forced clinics to notify parents of teenagers if they had crossed state lines for an abortion. (Carper later voted against a more extreme version of the bill.)

Carper was also one of just four Democrats who supported the confirmation of Brett Kavanaugh to the D.C. Circuit Court in 2006, paving the way for Kavanaugh’s nomination to the Supreme Court, which reproductive-rights activists believe imperils Roe v. Wade. Carper now says he regrets the vote: “If I had known 12 years ago how Judge Kavanaugh would have ruled on any number of issues, including health care and the environment, I never would have voted for him in 2006,” he wrote in a recent statement. “I have no intention of voting for him now.”

Reached for comment on these votes, Planned Parenthood Action Fund Political Outreach Director Wendi Wallace pointed to the organization’s Congressional Scorecard, which tracks votes on key bills going back to 2011. Carper scored 100 percent supportive of women’s health, with votes against measures to defund Planned Parenthood, block abortion access and gut the Affordable Care Act.


They no longer even attempt to hide the fact that they are a functionary of the establishment.

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