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Bob Pollin & Michael Lighty hold that Medicare for All does not have into include private insurers like Medicare does today

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MARC STEINER: Welcome to The Real News Network. I’m Marc Steiner, great to have you all with us.

As Medicare for All gains traction among Democratic politicians and much of the American public, there are details the most are not attending to. There’s a debate over whether Medicare for All is viable and right, as we’ve heard before, and there’s an issue in the argument being positioned now about how we pay for it, where does private insurance fit in. And let me just read you these two quotes from a New York Times article that kind of set it up for us. One quote was “Billy Wynne, a health care lobbyist who used to work for Senate Democrats, said: ‘The literal meaning of Medicare for All would include Medicare Advantage. But that is not what most supporters of Medicare for All have in mind.’”

Then, later in the article, talking about his vision for Medicare for All and Medicare Advantage and how that fits in, Adam Green, who is a founder of Progressive Change Campaign Committee said this: “No, absolutely not. Why would it? Medicare for All, in the end, means fundamental systemic change. People would no longer be at the mercy of for-profit insurers that make money by denying people care.” So there it is, and this gets to both the fiscal and politically critical questions about who pays for healthcare in America.

Who pays for a new healthcare system that would be Medicare for All? How does it get paid? Does the government pay, since it’s a public system, or is it given up to the private insurers, who can raise costs and define what kind of care we can get? Today, private plans cover more than one third of the sixteen million Medicare beneficiaries and growing. And how do we define those roles of those plans? Should this be the role of private health insurers? Should the government take over and guarantee all the costs if we had Medicare for All? These are the questions that have to be answered in the question of what we mean by Medicare for All, and not just how much it costs, but how it gets paid and who administers it. So as progressive and Democrats gain steam and support in creating Medicare for All, these questions have to be answered.

And we are joined by Robert Pollin, Distinguished Professor of Economics and co-director of the Political Economy Research Institute, known as PERI, at the University of Massachusetts Amherst. He’s the author of numerous books, and recently co-author of the recent study Economic Analysis of Medicare For All, that shows, in part, the private supplemental plans are not necessary. And we’re also joined by the man he credits with inspiring this study, Michael Lighty, who’s a public policy expert, Healthcare for All activist, former union leader and union activist. And Robert and Michael, welcome back to The Real News. Great to have you with us.

So let’s just begin. There are two issues here, it seems to me, and they’re very large issues. One is political and also economic. And Bob, let me start with you, because in the last interview you had with Sharmini, the three of you, you made it very clear about how we could begin to think about paying the costs given the cost of healthcare in America, the trillions of dollars we pay for healthcare in America. But what about this transition, then, that takes place? If we have Medicare for All, the move I can see in Congress would be whether we keep up Advantage, we keep up the private insurers, that’s how we’re going to get people to pay for it, all the extras they want. So what does that mean economically? Has that been analyzed at all?

ROBERT POLLIN: The principle behind Medicare for All is that we have one system, that the insurance function is fulfilled by the government program. By doing that, we save a huge amount of administrative costs. We save hundreds of billions of dollars, which enables us to run a system that covers everybody with good quality care, and that also lowers costs.

Once we reintroduce or enable the private insurance companies to continue as part of Medicare for All, that is under something what we could call Medicare Advantage for All, we lose the capacity to achieve savings, we increase the administrative burdens, because exactly the kinds of problems that we have now with multiple payers, with different rules, different kinds of processing claims, different kinds of requirements for seeing a doctor or seeing a specialist. So the basis of Medicare for All that makes it work is its administrative simplicity and overall fairness. Once you start compromising on that, then you no longer have all the benefits that can be delivered to people via Medicare for All.

MARC STEINER: So Michael Lighty, I mean, one of the questions here is a political question as well, a deep political question. It’s taken a lot of debate and conversation, and not always very clear for many people, to get to a point where many Democrats, especially newly elected Democrats and the majority population now, seem to say, “I would like Medicare for All, I want my healthcare covered.” But the politics of battling the health care industry will be as fierce if not more fierce under Medicare for All in saying, “You’re not going to wipe us out, we’re going to be the ones doing this.” And right now, if you’re on Medicare, you could pay 250, 300, 350 a month extra just to get prescription plans and to get the additional coverage you need to see doctors beyond going to the hospital. So where do you think this takes us?

MICHAEL LIGHTY: Well, I think you laid it out exactly right. I mean, I think it takes us to the fight that we can’t avoid. And a lot of the Democrats that come up with alternatives to what we mean by improved Medicare for All, say for example a buy-in proposal or even this notion of Medicare Advantage for All, these are attempts to avoid the fight. Because as Bob says, you have to put the insurance function in the hands of a publicly accountable program and eliminate the profiteering, the marketing, and the waste, inefficiency, administrative burdens of the private insurance system. And so, even advocates who say, like in that Robert Pear article, “Oh, we should go to Medicare Advantage,” but they say we should heavily regulate the insurance companies as a utility.

So you have a choice. You’re either going to be in a fight over a regulatory regime, and we see how that’s worked out with the ACA, and it’s been very unstable, not sustainable, and in fact, not universal. And then, on the alternative to that fight over regulation is a direct transformation of the healthcare system into one that will guarantee healthcare for all with no barriers to care. And that’s the fight that we have to have, and it is a fight with the insurance industry, and not just them, but with pharmaceutical and hospital corporations as well. And Bob and the PERI study that he authored shows very clearly that we can transition from the current system to a Medicare for All system. We can take care of those workers in the insurance industry, we can guarantee healthcare for all. We can literally do everything except accommodate the insurers, which is what all these alternative efforts are trying to.

MARC STEINER: So Bob, the world wants to talk to you, it’s very clear. That’s OK, as they should. But let’s talk a bit about – back up a second from what Michael was just saying from the last interview you did with Sharmini Peries here at Real News when you all were in Vermont together – this argument is going to come up again. If Medicare for All becomes the political force that could change the nature of healthcare in America, in the U.S. Congress for the next several years, the argument is going to be: the only way to make it happen is for Medicare Advantage and others to be there so that you can pay for the parts that Medicare does not cover. So what’s the argument around that? I mean, how do you push that back?

ROBERT POLLIN: The argument is that Medicare for All provides universal coverage, including things that aren’t currently covered by Medicare, such as some forms of dental care, some forms of health and wellness care. All of those things get wrapped into one system, as they are in most other advanced economies now. So when we did our study, it’s a quite extensive, detailed study, but the basic points in the study were easy to achieve because we’re basically thinking OK, how do we emulate the best features of the system, for example in Canada or in the UK or in France or in Germany. So that’s what the role of Medicare for All is, is taking the models that we have of other countries that operate fully functional healthcare systems without private health insurance.

Their outcomes are better, their objective outcomes are better in terms of standard measures like infant mortality, life expectancy and so forth, and their qualitative measures are better. That is, polls of satisfaction of healthcare consumers in different countries are significantly better on average than they are in the United States. So there is no reason to sustain the private health insurance industry. Yes, we do have to take care of the people working there, and that’s why we propose a just transition program for the workers in the industry. But private health insurance is an unnecessary burden on delivering wellbeing to people in this country.

MARC STEINER: So let’s play a little game here, in a sense thinking about how this gets sold, sold both to the left and progressives who understand what the heart of the issue is, and also kind of to the greater American public and to the political establishment. And Michael Lighty, I’ll start with you, and we’ll come back to Bob. And please feel free to jump in with each other as well. But you know that if this is pushed hard in the U.S. Congress, Medicare for All, with this new Congress coming in, a very different mindset from many of the younger people who are now in Congress, that the pushback is going to be severe. And establishment forces inside the Democratic Party are not going to want to see a Medicare for All the way you two are describing it at this moment.

So what is the politics of that, to push that, and how that happens and how that get organized, and what you’ve seen in your work as an organizer with the nurses and more? So talk a bit about that, what does that strategically look like?

MICHAEL LIGHTY: Well, I think the big picture response, Marc, is that only a mass social movement is going to have the power to overcome the huge political advantages that the healthcare industry enjoys. And so, we are really talking about both an inside and an outside game. There’s great work being done in the House of Representatives as we speak to move toward a hearing on Medicare for All and potentially a floor vote on Medicare for All. That’s a very good sign. We’ve got a build in 2019 for then making this a litmus test in 2020 among the Democratic candidates, and then elect someone who will really fight for it in 2021, not just someone who pays lip service. We’re at the point of time politically where we have to divide those who are going to fight for it from those who are just going to mouth it.

Secondly, I think it plays out in Republican districts. You know that 52 percent of voters who supported President Trump who make under 30 thousand dollars a year support Medicare for All. Recent Gallup polling, and another poll in the Fall, showed that 52 percent of Republicans overall support it, 70 percent of Democrats. The politics among voters is very good. But of course, what the industry will do is mount a fear campaign, and they’ve already started it. The administration started it in the Fall by attacking Medicare for All as a hit on seniors. But as you were just saying, Marc, seniors now pay potentially 250 or 300 dollars when you combine the deduction from Social Security, the Part B plan and the Prescription Drug Benefit.

MARC STEINER: Every month.

MICHAEL LIGHTY: Every month. And even if you’re on Medicare Advantage, you’re still paying the Part B, the deduction from Social Security and just a little bit less. So these are real out-of-pocket expenses. By 2030, a large majority of seniors will be looking at 40 percent of their income going to healthcare. So this is the major problem. When we talk about Medicare for All, the way we win it is to say guaranteed healthcare with no barriers to care, financial, racial, gender, stereotype, sexual orientation. And particularly for seniors, no copays and deductibles, no Part B or Medicare Advantage costs, go to any doctor, unlike in Medicare Advantage, and have those benefits that Bob pointed out.

The politics of this are very favorable to people. We have a labor issue because many of those unions are invested in their employer sponsored plans. That’s an issue that has to be tackled politically. The biggest threat to Medicare for All is as you point out the factions within the Democratic Party who are tied to the insurance industry and don’t want to take on a fight and that the only thing that can overcome that is a social movement that really forces them to do something they’re not inclined to do and that is to make transformative change. It’s unhealthy.

MARC STEINER: So Bob Pollin, in the excellent work you did in the research piece that you put out, that you credit Michael Lighty with inspiring you to do

MICHAEL LIGHTY: Bob did all the heavy lifting.

MARC STEINER: Yes, I had said that part too. So one of the things you did in this interview I was watching that you all did with Sharmini Perez here at Real News, it was kind of talking about, highlighting in some ways, what people have to understand. Because some of us will read the entire report because that’s what we do, but most people are not going to read the entire report. And what gets them is not simple, but in kind of very straightforward ways, easily discernible to understand what this means for money, how this saves them money and how this works. How do you perceive that happening?

ROBERT POLLIN: Well, we tried to lay that out clearly. And yes, there’s a lot of details and I don’t expect 98 percent of the people interested in this to read the whole report. Number one, we try to make it really simple with respect to businesses. And we say the starting point for business premiums is that every business that is now paying premiums for healthcare for their workers will see an eight percent reduction in their premium on day one after Medicare for All is instituted. So if businesses are paying 100 dollars today, when Medicare for All starts tomorrow. they will pay 92 dollars. We try to make it very simple. Over time, there’s issues in how to actually make that functional, because there’s new businesses, some businesses have good plans, bad plans, but we wanted to keep something very simple to start out. Now, that covers about 60 percent of the additional costs that we’ll need to go into Medicare for All after we stop paying into the private system.

Now what about with households? Households, except for the top 1 to 5 percent, are all going to be paying less. We show that in some simple tables. If you are a family that buys insurance on the private exchange, what we show is that you’re going to save about 14 percent of your income through the transition to Medicare for All. That is, your income, not health insurance costs, your income effectively goes up 14 percent, because right now, you’re paying 15 percent of income for healthcare. And we get it down to 1 percent. So that’s a simple thing that people are going to be able to understand.

MARC STEINER: That’ll make people stop and listen.

ROBERT POLLIN: Yeah, and it’s real.

MARC STEINER: Right, it is, obviously, yes.

ROBERT POLLIN: It’s not made up. I saw there was an article by this woman who’s an industry PR person who says that all of our numbers are completely nonsense. Well, they are not nonsense. And as a check, if you don’t believe any of it, look, the U.S. is paying 18 percent of GDP for healthcare. Canada, UK, Germany, they’re paying between 9 and 11 percent. Even if we introduce all of the savings that we are talking about, in our Medicare for All proposal, you’re still at 16 percent of GDP. We’re not 11 percent of GDP, we’re at 16 percent. So actually, our proposal is relatively modest. But even with that, businesses save 8 percent, households save between 3 and 14 percent. That’s because we run this incredibly inefficient, bloated, unfair system, and Medicare for All is the way to get out of it.

MARC STEINER: Well, we’re about out of time. Michael Lighty, do you have a final quick thought on all of this that you’ve heard that you did not get out before we have to end?

MICHAEL LIGHTY: It really isn’t too good to be true in true Medicare for All.

MARC STEINER: Good. This is wonderful, I appreciate the two of you very much for being with us today and work you’re doing. This is really critical to our future and to what the politics of the future will be in our neighborhood, will be in our country as well. Michael Lighty and Bob Pollin, thank you so much for your time and your work.



MARC STEINER: And I’m Marc Steiner, here for The Real News Network. Thank you all for joining us. Take care.

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Robert Pollin is Professor of Economics at the University of Massachusetts in Amherst. He is the founding co-Director of the Political Economy Research Institute (PERI). His research centers on macroeconomics, conditions for low-wage workers in the US and globally, the analysis of financial markets, and the economics of building a clean-energy economy in the US. His latest book is Back to Full Employment. Other books include: A Measure of Fairness: the Economics of Living Wages and Minimum Wages in the United States, and Contours of Descent: US Economic Fractures and the Landscape of Global Austerity.

Michael Lighty is a founding Fellow of the Sanders Institute, and currently serves on the Lancet Commission on Public Policy and Health in the Trump Era. Lighty has advocated, organized and developed policy for healthcare reform nationally and in California for nearly 30 years.