Democratic demagogues about health insurance

I watched part of the Democratic presidential candidates’ debate on July 30-31. There was no shortage of demagoguery about health insurance.

Oft-mentioned was a “public option” as an alternative to Medicare for All. Except for being optional (for those not eligible for Medicare per current rules) rather than forced (Medicare for All), what exactly this meant when any of the candidates used the term was far from clear. It seems that each candidate expects each viewer to take it to mean whatever the viewer wants provided it’s very favorable. In other words, it’s like Barack Obama saying “hope and change” -- an empty warm fuzzy.

The term might refer to several different things. One of those things already exists – insurance purchased on the “marketplace exchanges” created by Obama’s Affordable Care Act. Anybody without health insurance can buy it that way. The coverage is provided by private insurance companies with the federal government having a heavy hand in controlling what’s available. Policies are guaranteed-issue, which translates to the applicants can’t be rejected for pre-existing conditions. (If a person applies for off-exchange insurance, the company can underwrite and possibly deny coverage.)

The most likely meaning is an expansion of Medicare. People not currently eligible for Medicare – mostly people less than 65 years old – could optionally enroll in Medicare. Unsaid is how much the premium would be. It seems the candidate wants the audience to simply believe it would be much cheaper than buying insurance in the private sector, or even free for many. The Medicare Part B premium is now $135.50 per month – more for higher income folks. People who aren’t eligible for free Part A coverage also pay premiums for that. The current amount can be up to $437 per month. A young person in good health could find private health insurance for much less than $135.50 per month.

A New York Times article is titled ‘How a Medicare Buy-In or Public Option Could Threaten Obamacare.’ How would it threaten it? The article hints premiums and reimbursement rates to providers. In other word, the devil is in the details, about which the candidates are silent.

Another kind of demagoguery often heard was the price of prescription drugs. It seems the candidates want the audience to believe the cost of drugs to patients is skyrocketing and drug makers and distributors are making exorbitant profits. Reality says different. This article – from the federal government’s Centers for Medicare & Medicaid Services – is titled ‘Medicare Part D premiums continue to decline in 2019’!

The ultimate demagogue, Bernie Sanders, said: “Right now, we have a dysfunctional health care system—87 million uninsured or under-insured, 500,000 Americans every year going bankrupt because of medical bills, 30,000 people dying while the health care industry makes tens of billions of dollars in profit.”

 The guy gets his “facts” from some fantasy world.

1. There are nowhere near 87 million uninsured. He included the weasel-word “under-insured.” By what standard – they have co-pays or deductibles or no dental insurance?

2. Whence his 30,000 people dying? About 2.8 million people died in the USA in 2017. Over 2 million of those were over age 65, with most of them on Medicare!

3. He probably meant “health insurance industry” rather than “health care industry” Anyway, do the 30,000 people die because the health care/insurance industry makes tens of billions of dollars in profit? If the industry made a much smaller profit, would the number dying be much less than 30,000?

4. How much does the health insurance industry pay in claims? More than $100 billion, but Bernie omits that inconvenient fact.

5. Bernie, ardent Marxist that he is, loves to deride profits. Hey, Bernie, near 100% of your salary and book royalties are profits. Profit = income minus expenses incurred to get that income, and your expenses are miniscule.