Why Not Universal Coverage?

Imagine if you decided to quit your job. Or if you were fired? What if you wanted to start a new business? Or go back to school? Or take a few months for travel or to write the next Great American Novel?

How would you maintain health insurance coverage for yourself and for your family?

You might get expensive COBRA coverage. You might go to healthcare.gov (when it is not down for maintenance) and find insurance on the ObamaCare exchange. You might go without insurance for a while and hope that you and your family do not get sick or injured.

But what if your health insurance were guaranteed to you and your family as a public good? Would you be more inclined to start a new business? Or get more education or job training? Or spend more time volunteering or pursuing something creative? What if you had less stress about finances or the unexpected?

Now picture a Congress that has more time, energy, and political capital to address the most pressing needs of the country and the world -- climate change, crumbling infrastructure, corporate greed, income inequality, poverty, famine, displacement, violent conflict -- because they are not fighting over health care.

Finally, imagine if, as a country, we spent 9.7% of GDP on health care like the UK, or 11% like Sweden, or 10.9% like Japan, or 11.3% like Germany, or 9.6% like Australia instead of 17.2% of GDP on health care (data from Organisation for Economic Co-operation and Development). If we spent only 12% of GDP -- still more than other OECD countries (except Switzerland, 12.4%) -- on health care, we would save almost $1 trillion every year and $10 trillion over 10 years.

How to spend that money is for another post, but for some perspective: we could rebuild the entire US highway system twice over every year, or pay off the national debt of almost $20.5 trillion in 28 years, or give our 3.2 million public school teachers a $300,000 raise.

1. Guaranteed health care. 2. Lawmakers focused on other major national and world problems. 3. $1 trillion in savings. This is the dream of single-payer advocates, such as Vermont Senator Bernie Sanders.  For the average American, it's win-win-win-win: greater economic and personal freedom, less stress, fewer medical bankruptcies (or none!), no news stories about the next GOP attempt to trash ObamaCare, more public and private dollars for investments in America's and the world's future.

So what is the hold up? One trillion dollars every year. The difference between what we spend on health care (17.2% of GDP) and what other wealthy countries with excellent health care spend (12% or less) is $1 trillion of fat that now goes to insurance companies, hospitals, pharmaceutical companies, medical device manufacturers, nursing facilities, pharmacists, doctors, shareholders of the medical-industrial complex, and thousands of industry lobbyists. A lot of people are made wealthy by the inefficiency of our health care system. And, right now, these powerful interest groups have more sway with lawmakers and public opinion than single-payer advocates.

That is starting to change.

Up next, driving the change to single-payer.

Catching Up -- Lightning Round

Executive Orders

1. January 23 -- Reinstating the global gag rule (restricting international funding for organizations that provide abortions or information about abortion). Bad for the health, independence, and self-determination of women around the world.

2. January 23 -- Freezing the federal workforce (hiring freeze). Hard to see how the federal government can do all that it does effectively if it cannot hire people to do the work. Of course, dysfunction may be the goal. There is an exception for positions related to military, national security, and public safety. Some of our biggest and/or notable public safety threats are climate change, drinking water contamination (Flint, MI and other cities), and guns. So, naturally, I expect the hiring freeze does not apply to the EPA, NOAA, OSHA, HUD, USDA, HHS. And there will be new hires at the CDC to research gun violence.

3. January 24 -- Expediting environmental reviews on infrastructure projects. The opposite of a health-in-all-policies or kids-in-all-policies approach. Profit for crony capitalists now; environmental cleanup ... someday.

4. January 25-27 -- (1) The wall, (2) Pursuit of undocumented immigrants (includes defunding so-called sanctuary cities), (3) Visa and refugee program reforms (includes so-called Muslim ban). These actions hurt immigrant and refugee children and their families. They are unnecessary for increasing our security and improving our economy. They will instead worsen our security and decrease our economic growth potential. Children don't migrate, they flee. Here is an excellent article on the harms to children of Trump's immigration ban.

5. January 27 -- Strengthening the military. Already more than half of our discretionary spending goes to the military. Imagine if we spent just some of that money on foreign aid, education for women and girls around the world, climate change research, global renewable energy infrastructure, and diplomatic missions. If we did that, I think our need for military defense would be much less. And the world would be better off to boot.

6. January 30 -- Reducing regulation. An arbitrary mandate that for each new regulation, two are struck. This is premised the false notion that regulations, by definition, are bad. Robert Reich makes excellent arguments that refute this idea in his book, Saving Capitalism: For the Many, Not the Few and in abbreviated form in this blog post. Regulations are instrumental to a functioning democratic capitalist society. Regulations protect us from corporate abuses that privatize profits and socialize costs (see #7 below). Regulations protect our life savings, keep our food supply safe, and decrease water and air pollution. This is not to say that regulations should not be reviewed, or that some may be outdated or ill-conceived. But they are not inherently bad.

7. February 3 -- Financial system regulations and the fiduciary standard. This is likely to relax regulations that were put in place during the Great Recession to prevent future financial calamities. Steve Mnuchin, the new treasury secretary, profited from the housing bust. Imagine who might gain from the next preventable financial collapse?



January 13 -- Budget Resolution clearing the way to repeal the ACA. Since this passed, Republicans in Congress seem to be having difficulty replacing the ACA. That's because it is a good policy that helps millions of Americans.

January 24 (House) -- Permanent ban on the use of federal funds for abortions or health insurance that covers abortions. This will make health care less affordable and reproductive health care less attainable. Each year, hundreds of thousands of women make the heart-rending decision to have an abortion. That number is declining, probably due to increased access to contraception through the ACA. Instead of restricting access to legal abortion we should expand access to contraception and comprehensive sex education. When unintended pregnancies are carried to term, we should support moms and families with the social safety nets they need to thrive.

February 2 -- Repeal of the stream protection rule. Makes it easier to mine coal and pollute ground and surface water. No explanation needed here, except to say: If we want to decrease the impact of global warming, instead of burning more coal, we need to sprint in the opposite direction and invest heavily in renewable sources of energy. We cannot continue to support an industry that is contributing to our planet's demise. Clean coal isn't.

February 3 (House) -- Repeal of rule that addresses waste generated during oil and gas production. See above. Once again privatizing profit and socializing costs, spoiling our planet.

February 7 (Senate) -- Approval of nomination of Betsy DeVos to be Education Secretary. Belief in the value of public education is a prerequisite for this post. Fifty Republican Senators and VP Mike Pence thought otherwise. Of note, DeVos had donated $26,000 to Republicans on the Senate HELP committee from 2014 to 2015.

February 8 (Senate) -- Approval of nomination of Jeff Sessions to be Attorney General. The nation's top law enforcement official is now someone who has a sketchy history of racism, is a hardliner on immigration, and is a climate-science skeptic. He is also so close to President Trump that his independence cannot be trusted.

February 10 (Senate) -- Approval of nomination of Tom Price to be Secretary of HHS. A list of Price's qualifications to be HHS Secretary: he is a physician. All indications are that Price will be an instrument of destruction on the ACA and Medicaid, harming low-income children and children with special health care needs.

February 13 (Senate) -- Approval of nomination of David Shulkin to be Secretary of the VA. Shulkin is highly qualified for the job. The VA has very little impact on children. However, children of vets will benefit if and when their parents get improved access to mental and physical health care.