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Take It From an Economist, Medicare for All Is the Most Sensible Way to Fix Health Care

Take It From an Economist, Medicare for All Is the Most Sensible Way to Fix Health Care

Gerald Friedman

There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.

We spend more per person than any other country on health care, but we aren’t getting any bang for our buck.


Of course Medicare for All is the most sensible, but it has zero chance of actually happening. Instead we should try to learn from places like Switzerland that includes private insurance companies and works reasonably well.

Although Medicare for all will never be initiated by the best Congress money can buy, there is hope that one of the 50 states will launch a single payer program that will provide an even greater economic boom for that state than taxes on legal pot have. At that point other states will launch their programs. That is how single payer evolved in Canada after Saskatchewan got the ball rolling.


If this is the only way we can get there (how Canada did with one province first), then I support it (I live in CA and certainly support our efforts). However there is a downside which is if the program really is what we want over the whole US but only implemented in a state or two, those states would obviously get significant immigration of very sick people that are screwed over by the private system in their states. This then drags down the metrics of the states that do Single Payer because they have to tax more to provide the same benefit.

Is anyone working out a concise wording of a litmus test we can ask the candidates? I’m getting sick of even Tulsi Gabbard dropping the line about continuing private insurance. How about something like:

Do you support Medicare for All as defined in H.R.1384 as the primary push forward to health care reform with the understanding that the role of private health care will be greatly diminished (no duplication of coverage)? Do you support incremental bills that keep a much greater role for private insurance as an option if the first path fails?

If there answers are no/yes, you lost my vote. I’m yes/no, but if the answer is yes/yes, then I will still consider voting for you depending on your perceived level of commitment.


It’ll probably be CA in the US.

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One thing to keep in mind with this process kicking off in one State first is this.

Canadian Provinces are much larger and the population tends to be concentrated all along the Southern Border. During that time people were much less “mobile” if you would. What this meant is that when Saskatchewan implemented its plan it was highly unlikely for persons living in other Provinces to try and take advantage of it. One problem the USA might run into if they try this strategy is that the State that first implements it might see a lot of people from neighboring States try and take advantage. This would lead to that State serving outside the State residents without having them as a tax base . This would result in the costs being much higher than projected.

Now one can certainly implement a number of measures at the State level to ensure only State residents can access this system but this adds layers of bureaucracy.

I am not sure of how they can work around that.


I don’t understand your position. Medicare for All (which I’d call a true single-payer system that minimizes the role of private insurers who “add no value” and “drive up costs”) is, as you say, “the most sensible” system. Yes! Agreed! But it will never happen in the US because – ?

Cost-efficiency and common sense be damned. Let’s be “reasonable” and keep those insurance industry contributions flowing.

Let’s see, what else can we be reasonable about:

  • Finding a cure for cancer. Would be great, but just too hard.

  • Supporting the Green New Deal (or whatever they call it). What, with all that good coal, oil, and gas still in the ground?

  • Abolishing the Electoral College. No way. How else can the tyranny of the majority be overruled by the tyranny of the minority?

  • Putting a man on the moon. Oh wait, we did that. Defeatism wasn’t all the rage back in the 60s.


“Take It From an Economist, Medicare for All Is the Most Sensible Way to Fix Health Care”

CD, you might want to rethink this headline. After all, Milton Friedman was an economist…

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There is a WP story (https://www.washingtonpost.com/graphics/politics/policy-2020/medicare-for-all/?utm_term=.9c3049ed87ce) which puts the candidates in 4 bins:

What should happen to private insurance?

Essentially Get Rid of it: Sanders

It can stay for now: Buttigieg, Gillibrand, Williamson, Yang

We don’t need to get rid of it: Booker, Castro, Delaney, Gabbard, Hickenlooper, Inslee, Klobuchar, O’Rourke

Unclear: Harris, Warren

It would be nice to get Warren and Gabbard fully aligned with Sanders on this one.


Gabbard is from Hawaii. Not many Americans will travel there for M4A medical care. Gabbard is a piker on this topic, imo. It’s a no-brainer for a captive market like that.
Incidentally, the #1 prescribed drug in Hawaii is Pineapple flavored Viagra served with Mai-Tais in tourist traps for free, after 10:00 PM.

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Ridiculous. Multi-payer systems are more inefficient, and the idea of going through another drawn out process to create an overly complex system, which will thereafter be picked apart piece by piece by the right wing judges in the courts is crazy. We cannot do single payer right now because of who is in office. THEY make it impossible. If the best policy is impossible, then it points to a system issue, one dominated by corruption. If we cannot put in place the best, most efficient and popular option, how in the hell are we ever going to at least mitigate the environmental crisis, which is far more complicated and requires far more radical changes? And if we can’t put in place a system that people prefer over the ACA and what the right offers, if there continues to be a huge gap between what people want on policy versus what the state does, then it again points to the need of structural changes. If we can’t get relatively moderate changes like single payer, even bigger problems will be even more impossible to implement. God help us if we don’t figure this out once the environmental crisis hits.


There are eligibility requirements that vary among the provinces - you can’t just show up and get treated. For example, in Alberta you are eligible when you establish residence but in British Columbia you must reside in province for two months plus the balance of the month in which you moved there before you are eligible for benefits.

So was Marx and Keynes. So? It would be one thing if this was a theoretical debate, but it isn’t. We can study actually existing single payer systems and compare them to ours, we can study traditional Medicare versus private insurance, and we can analyze why there are qualitative differences.

The problem with single payer at the state level (beyond some of what you mentioned) is that states do have to be mindful about spending in downturns. The federal government doesn’t need to cut back spending in a recession, since it can create our currency when it wants and needs. So, in a recession, when taxes going to the state decline, the federal government can still spend on particular programs. The demand can be kept constant, in other words, which simply results in fiscal deficits (a non-issue). However, in a recession, when tax revenues decline, it may result in states cutting back funding for the program, having to borrow or increase taxes. All of that might be possible and no big deal, or all of that might completely undermine the program, which would then be used by its opponents to argue that single payer can’t work.

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I believe that Canadian single payer is run by each province following standards that are nationwide ?

Just as each US state has an insurance commissioner who regulates insurance within each state, state regulation of single payer will be the most consumer friendly way to go.

Any program run by DC will be subject to the one stop bribe shop on capitol hill. Think Medicare not being allowed to negotiate drug prices and not covering naturopathy or acupuncture.

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Understood , but the times are very different today than they were 40 years ago as far as fake IDS go and the like. Just as example it was found in one of the Maritime provinces that twice as many health care cards had been issues then there were people living in that Province.

You then have the issue of what to do when a person is travelling when one travelling in one State and gets illk in another. In your Alberta to BC case charges would be made back to Alberta but Alberta is still under the umbrella of the National act. This will not happen if there a single State involved. Who would they bill back to?

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Yes there a National plan meaning if I am travelling anywhere in Canada I am still covered. What happens is the given Province bills back to the Government of the other Province.


Does piker in this context mean “one who does things in a small way”? She signed on to HR676 and HR1384, but I wasn’t happy with her answer at the town hall on private insurance and was much happier with Bernie’s answer to this question. As a (nominal) contributor to her campaign, I plan to write her about it.

In general, yes–but THIS Friedman is the genuine article! Mostly below the radar, and absolutely absent from the MSM, heterodox schools of economic thought (think “Protestant” in opposition to the orthodoxy of the Church of Rome) have recovered from being purged from many economics departments in the 1970s in favor of the “New Classical Economics” (old wine in old bottles with shiny new labels and just enough abstract math to buffalo the uninitiated). They have been rampant now for some two decades. Certain key figures, Gerald Friedman among them, also Stephanie Kelton and her mentor, the late Fred Lee at UMKC, and Jamie Galbraith (son of John Kenneth Galbraith), have spurred its acceptance. But the main driver of this revolution in thinking has been the obvious and abysmal failure of “mainstream economics” (technically, “neo-classical,” of “new-old”) to do anything but cheer for and justify the One Percent. Keep an eye out for “Modern Monetary Theory,” Keynes on steroids with data to back it up along with coherent and comprehensive theory.


How about a photo I.D. medical card.