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The many flavors of Medicare-for-all

2018-11-27

Dylan Scott joins Sarah and Matt to break down eight different plans circulating to expand government health insurance programs. References and further reading: Sarah breaks down five competing health care plans from Democrats Dylan lays out the Urban Institute’s proposed health care plan   A white paper finds ICE partnerships with local police led to a decline in elementary-school enrollment of Hispanic students Are you interested in more discussions around health care policy? Join our Facebook community for conversation and updates. 

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Yeah. This is Marquez Brownie Acre and Cuba HD, and this is Andrew Manga Nellie. We will introduce you to our podcast way, form the new sedition to the Vocs media podcast network, so I've spent over ten years, reviewing tech products and consumer electronics for millions of people on the incubation- to channel and now on the way forward, ass Andrew, and I use that experience to dig even deeper into latest tech for smartphones too. I max to electric cars. So if you're gadget, lover or attack head or if you just want to figure out whether the latest gadget is worth your harder in cash, give us a lesson say can find way: form the empty beefy podcast on your favorite Pakistan. Every Friday see over there,
and what makes it up a lot of practice below and welcome to another. So did the reason, the Fox media. I cast my work. I met you. He placed his here today with Sarah Cliff Dylan Scott, and I know ball- reliance on the norms of american politics. Even Donald Trump is keeping these thanksgiving to Christmas season. A little bit sleepy, I would say in the in the new cycle, so we are, are able to live up to our
deals and takings back a little bed CERN Dona working on a great project. Right now we're they are reading all of the different democratic Medicare for all plans, and they will explain them all to you in text form soon, but here in audio form. I had some some questions about this. I'm gonna, be there, Sir straight man, the dough, Pierre, so never air mad. So many care, it's like it's a thing. Old people get it. Some people are old so many care for all to me like will take Medicare this successful programme for old people and what is that all people have it right never never so cynically like Medicare Smet who care for all. Ok, so done, and I want a lot of time over the past few weeks reading through. I think its total of eight indifferent plans to- all Americans, access to public health ensure as retraining and even more complicated than here.
Yes, it is, as our President Assad who knew health care could be so complicated, and so we looked at this universe of eight plans, anything just to step back for a little that two things that are really startling to me. One and we talk about Islam in the pot gas as a Democrat, seem really sat under
weighing health care that the issue was not enough for them that they seem really sad. Even after all, the political rancor, unlike pulse care, just like hasn't been a political winner for either party, mean I suck into Senator Brian shouts, who has one of these proposals who was saying he sees the next two years as a time to kind of sort out. The differences between these eight proposals have hearings, call up experts like figure out. Ok, where do we stand on healthcare but really engage in this debate? So so there is a desire to return to healthcare in there is a desire to go much further than the affordable care act. It's pretty stunning to me that if you look back in two thousand, eight you'd have like a single leading Democrat running on America for all platform. You know, eat John words. Hillary Clinton Brok Obama had much more moderate plans now, as we go into twenty twenty it seems like,
any contender whose, in this space is running on expanding public health, insurance, Meta, Bernie, Sanders, Comma Harris, Corey Booker, you know anyone. You Elizabeth warn anyone you look at has basically signed on, so we thought to be helpful to look like. Ok, what is the universe of ideas that Democrats are going to be dry from, and I think they essentially fall till. I see two buckets and you anymore buckets of that. You could pick up so what? Them is kind of similarity idea that your mentioning that of giving everyone Medicare, you know we have a plan in there in the it offered by Bernie Sanders. We have a plan in the house, that's gonna be taken over by Rep J, Nepal with them two thousand leaving office and both of these plans they give public
health insurance to all Americans, but it's something looks very different than the current Medicare programme, which will talk about a little bit more and that's kind of the most extreme change. Then you, this other bucket of plans at lets. People buy into public health insurance in those are the ones done, has been looking at a little more than I have, and then you also one think tank plan that creates a new government programme entirely, so actually buckets? My eyes are kind of the three things the dead are on the menu of options. Broadly that all these eight plans fall into either move when the government interference, let people guy by governments or create a new programme that people can bye bye yeah. Well, whatever the third bucket, I guess, there's a plan from the centre left Think tank called the Urban Institute. That's called Healthy America. And it's basically designed you know Medicare for all the problem with it, as will get into. Is that sort of disrupts the entire healthcare system as exist right now,
Healthy America from the Urban Institute was basically designed to be as undistributed as possible, and so that plan does it actually combines the Obama Carom marketplaces with the Medicaid population, while also introducing a new public option plan, so it sort of a a totally difference and off a different way to expand health coverage, whereas you know, there's a lot of similarities between the Medicare for all plans and even the different Medicare by and plans. But the urban Institute is kind of charted out this other way of expanding coverage by combining Obamacare and Medicaid. That would cover a lot more people, but would not achieve universal coverage in the same way. That Medicare for all, was what, let's less defined terms I go. What does it mean to by in two public programme of details, various where there are basically three plans, one from Jeff murkily and Chris Murphy in the Senate, another from Janshah, Caskey and Sheldon White House and another from Michael Bennett and Ralph Higgins
and basically they the similarly on what they all share. Is that right now the Obama care marketplaces are out there. They have a bunch of different private plans that people can choose from if they dont get insurance to their work and what he's Medicare by M plans would do is they would basically add another plans, the individual insurance markets that would be run by the government and would fall under the Medicare brand Now there are some important differences in terms of like. If you get insurance through your work like we do, we would you be allowed to buy it that plan or not, but the long and short of it is on the Obamacare market places where people buy insurance right now there would now be another option. That's called Medicare that good bye and I think something important that the term you use have liked as Medicare brand, could I think one thing that's a little understood about Medicare? Is it actually isn't that comprehensive coverage so, and it's very confusing universe of coverage. So there's actually three parts to Medicare part
avian d C was repealed briefly existing repealed in the nineteen. Seventy is, I believe, Medicare part a covers hospital services. Medicare part B covers Doktor, Medicare, part DE covers drugs and there's a lot of gaps. Coverage, there's nothing that covers dental or vision. There are deductibles for these programmes for Medicare Part DVD, your visit ones? You pay a premium. I think it's about like a hundred and fifty a month, right now and at most Medication rallies, they actually buy supple mental coverage, so these policies called met, a gap policies that cover the gaps and Medicare pretty significant market in. I think one of things all these, plans have in common, even though they vary in a lot of ways? Is they don't really see signing beginner millions of Americans up for, like Medicare is party Indeed, with them all the different sort of cost sharing, they see something called medic
that looks a lot more like employer sponsored insurance words like not a separate plan, veer doktor visits in hospital visits and your drugs. It's one plan that kind of has the type of coverage you'd expect from an employee are sponsored pleasure. I actually. This is really important, and this is a underpaid I was being all cheeky about it right, but a big part of the political logic of Medicare for all right. If I ask the Meda care for all proponent in the street like why That's a good idea that people should run on something that they will tend to say is that many cares very popular people really like Medicare, so we're gonna give Medicare to all, and I think, if you look at the most like superficial polling, the tends to show what broad popularity for this. That's. What it's driven by right, like Medicare, is popular programme. People like it, but it's him poor to understand. When you get into the deeper politics. When Donald
start saying they want to repeal Medicare. They want to take your Medicare Medicare as we know it like those actually true, not in the way he is lying. I mean that there is an aspect of truth. Yes to it, right, like medic here as it exists. Right is a programme for elderly people. Its single payer structural programme covers a lot of things. It supplemented, though, for most people for for middle class and apple retirees, supplemented with private met a gap insurance and for low income and really supplemented with medically medicated right Benyamin aid, but I think more importantly, as what more affluent people are doing, because I don't I mean that's like part of the politics of this right is like Hulu
is red and then also a lot of people use Medicare advantage programmes these days right where the government is like the opposite of a public option like the government programme pays for you to get private insurance. Is what sense I tweet twenty five or thirty. I did its thirty something sent this seriously it significantly so it so. A large share of elderly people are using Medicare to purchase subsidize private insurance. And the consumer, A call national nurses, Union Bernie Sanders House. Progressive carcass view is that the private insurance industry in the United States should be done wayward right so like people who were enjoying their Medicare advantage plans that they really are gonna lose them. Well. They're gonna depends on language path you go to, and I think this is an interesting difference between the sender
and House Programme Caucus plans and the centre for american Progress land, which has, I am saying that present on the people who are most jazzed up about these slogan, Medicare for all are also most committed to like actually not having the programme that occur as it currently exists. Exist anymore, where they want to create a much more comprehensive way. Like the vision, estimating Bernie Sanders and the nurses is that health care should be available for free at point of service right yeah, essentially unlimited quantities and that's just that's That's not what Medicare it right. I mean yeah Medicare. I think in all of these cases is a misnomer, really like the most ambitious single pair plans, yes kind of creating a whole new health care plan that basically covers every imaginable service to your point: map free at the point of sale. So to speak and
Even the Medicare by and plans that I've been looking at are actually really Obama care plans like they cover the ten Ascensional health benefits, as dictated by the Asia. They base their cost, sharing on the different metal tears that oh bomber carry uses for its plans, but they just use. At a care brand because it so popular sonata. Yet none of these plans, as actually detailed, our Medicare, but I think what Democrats have learned is that those three words very, very popular, and there also beautiful it's beautiful? How valuable that they are? It's interesting to me that, in this constellation of many plants like actually, nobody is proposing that, like actual better care should be made available, everybody right, particularly given that actual my there is in fact popular. It has also like a program like China have been like built together with all these blocks. Silver time, unlike if you are starting from scratch, like I see you know,
ample. They started with the hospital and doktor services and the ninety nine or no early, two thousands. They are on drug services and kind of bad. The point right now. You know better than eighteen. Sixty one Medicare and Medicaid we're being created, prescription drugs. This warrant is expensive, our right now and at the time it felt okay to make a plan that didn't cover prescription drugs how would you know you're getting million dollars coming out alive. Americans are struggling with drug costs. It just doesn't seem like good makes sense to create a plan that doesn't covered thanks? But I think I mean one of the interesting things to watch in this debate. As you have, I could say the Sanders plan, for example, which offers robust coverage of not just The benefits required under Obama CARE, but also covered for dental cover provision all of this at no cost to the unruly, whether in the kind of debate and drafting process. If that starts,
Looking more like traditional Medicare, because benefits get paired backer, there's some kind of cost sharing that gets introduced because you know the rules in Medicare doesn't have such a robust benefit packages. That is expensive. So you have to raise revenue to do that and I think that's where things will be interesting to see- is whether the Sanders plan like moves more in the direction of traditional Medicare, because traditional Medicare is cheaper for the government to provide than like Sanders version of medical, and I think particularly the caution It is interesting weight and because the dental it's very easy enough to see why you push for them. Cause you believe in it. You bargain it away to keep the price tag down. Lots of countries very alert their coverage I gotta think, but it, but the cost sharing part seems to be a significant conceptual and philosophical disagreement.
Right. That leg isn't just about saving money right, like I think, there's like a real view among a lot of people in health policy community that it is important to our side of a handful of a central benefits to have cost sharing to like reduce system utilization rate unnecessary correct. That kind of thing there's like another view that, like the provision of health care, should be taken out of five, Where'd like we don't charge ten dollars to like go to second grade, and then they will let people can afford the ten dollars right. It's like schools, free yeah- I guess it is a point of principle. This is a place where you see a lot of the plans. Split and you see a lot of international example split, so I think actually this idea of no cost sharing, which means you know when you go to the doktor, there's no fee at the point of service, no co insurance, no co pays
click kind of rare among single by our countries. It's how Canada structures there system and you don't have to talk to senator centres about this he's really inspired by the canadian model. An interesting as you know, he's someone who's railing against the millionaires and a billion years, but he doesn't even think those people should pay a fee when they go to the doktor. His argument is really one: that's Rudin inequality everyone should have free access to our health care system. Money, too, should be a factor in a partially on moral grounds of a party partially interest, administrative simplicity. If you dont to collect you, if you have kind of income tethered co payments, then that's a lot of administrative work cannot figure out. Who is Kobe men who doesn't see you get rid of that most european countries, though they do charge fees at the point of service there not high. You know. Sometimes they are as low as ten bucks and often low income residents are excluded from them, but that's a real point of difference. Actually, I think philosophical point of difference between the Sanders and House progressive caucus.
Plans and buying plans, which I think, a lot of those kind of keep the structure of employer sponsored insurance me, including like their Medicaid by and which is another one we haven't talked about, but similar to the Medicare by unless people pay for a spot in the medicate programme, it kind of his ok with keeping those fees at point of service, but I think that two big, both logistical and philosophical difference that exists- How Democrats think about what they want our future health care system. To look like I mean, I think, it's worth recognising that all of these plans seem to agree that people are paying too much money out of pocket right now, like what, with the Medicare by and plans? You know under Obamacare the lowest package that benefits package that you could buy cover sixty percent of gas, but them care by and plans are all peg to either plans that cover seventy percent of cost or in the case of the murkily Murphy Billig actually covers aid percent of car, so these would be more robust insurance packages. Then a lot of people by unlike the Asia marketplaces right now, but yes, they do
So, at the same time, thirty percent can be huge driver. Let the Sanders clamorous that zero risk had to rise. You know, I don't know the answer to how much of this is sort of pragmatism versus philosophy, because I do think you know one of these selling points of the meadow. By an plans. Is this isn't going to require a lot of new net revenue because we are going to charge people premiums and we're going to try to as much as possible? Have the people who are buying into the programme cover the costs of the programme, whether through premiums or cost sharing? I think Democrats, our kind of fixated on what's the actual universe of the possible, and so I think that one of the big selling points there- yes, is this- that this does require big tax revenue, increases and and isn't going dont radically disrupt the insurance market for people who get it through work, and so I don't know how much that's a philosophical thing worse has just recognising some of the realities of the system of labelling,
Maybe we should distinguish like two axes of difference here, right that they keep the sort of total price tag down. One is like by in verses taxpayer finance right, because, like one dialogue, you have we had this aside. It happen a lot of this around the Sandridge Plan, is Bernie. Sanders is gonna, give free healthcare to everybody, and then conservative says well that sounds great, but it costs sixteen trillion dollar hours and then the proponents says yeah but total. U S: health expenditures are seventeen trillion dollars, so actually this is saving money So when somebody else says like ha ha ha, you say you saving money, but wait until you have a twenty five percent value added tax and then we'll see. And then we have a kind of standoff right in which the Burma camp is saying, which is true that, like you, could write a financing mechanism for this plan that would make the aggregate costs be lower, and then the conservatives are saying, with leg:
cannot guns at the ready. Like will write me the plan, and then I will identify all the people who are worse off right under this financing plan and I'll get them to kill it, and then the people in the center scamper like, but we'll see right right and we we don't actually so one potential solution to that is to just like shrink it. So let the number goes down. Well, it's like we're, not gonna covered dental. After all, we're gonna have a fifteen dollar co payment. You knows so you you bring it down. So that's one thing right is like the coverage could be is less expansive, but the other is instead of saying what we're gonna have this huge tax Hague, but the tax eggs? Ok, because right now, you're paying all these premiums is, you could just redirect the money right leg? That's like that. By an idea like you could do like Bernie CARE, but as a by at least in principle. Yes,
really similar to the by an options but I'm married, that that the ones that exist are much less robust than than the single power plant, but you could imagine way by an option of of burning splash labour, that is to say, like look we're going to put on the table the price controls, administrative savings and like, if you want it, MR person, who is already paying a lot for health insurance like you. Just get this instead here, and I think I may it gets to a question of is the point, this expansion of public health insurance, a significant redistribution of wealth and, like some both in gas and some people think no, unlike what you think about that question really drives what kind of healthcare system you're going to structure lake no one has done a great job writing out the financing of this. Yet that's one place where you know both from the house. Progressive caucus end from Sanders Office you have a menu of options for financing, but because we don't actually fully now at this point how much
Either these plans cost. We don't even know what our revenue would be needed. Accept we just no. It would be alive, but when you look at the It means that in a senator Sanders and a house progressive carcass of land out for financing the pretty soon are in that they basically target the wealthiest Americans. It should come as no surprise, and you know both of those groups of people are okay, saying you know. Wealthier americans. They are going to pay more into the system than what they get out of it, because they are going to be more significantly subsidizing low. Come Americans. The by plans, don't really require that cross subsidization, it's more like an individual you know I look at you. I looked at Brian shouts is medicate by Un Plan, for example, the idea there is like Aye, sir. A cliff wanted to buy and Medicaid. They would give me a premium. Thou be expected to cover. You know my car,
generally it, and I would pay that premium and I'd be paying my share into the medicate programme and to make a programme would be negotiating prices for me and you know providing that kind of insurance coverage. If I did some kind of catastrophic unexpected event, but so that those are two different visions of you know what role you think healthcare plays in equity inequality in the UK. States that he see emerging from these different plans. Let us take a break and then yeah. I want to talk about that. That distributional angle. If you like, basically anyone listening to this right now, I'm willing to bet that you are you're dealing with stress, maybe there's it of it like an overwhelming amount, or maybe it's more like a low but steady, drumbeat background stress. Remember how you are experiencing stress. It's likely effect. Mood you energy in so many other areas of your life, you feel, like stress, is starting to take over straining relationships and shorten your temper. It's probably tend to unload and better health
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by sort of musing large scale buying power right- and this is something it's very important too- that the discourse around the Sanders plan right is that by implementing Medicare type COS controls you bring system wide costs down, even though your created this much more expansive programme- and I think, is important for people to understand that conceptually. This is like almost an unrelated top right like if you think that the kind of price controls that are in vision and in centres is proposal are viable or which I mean I think they may be. You could just do them right like you could raise. No taxes provide no health care to any body. Just put price controls on operates at an end and things would become cheaper right and presumably the uninsured rate would decline and people
we miss you gotta admit, we'd, have to see how it should wow. That's actually that's kind of similar to the planned that the centre for american progress has offered, which they call Medicare extra for all, right, which you know essentially going back over to this Medicare advantage. Discussion. We're- earlier like right. Now we have public. And that also has these tightly regulated private competitors, the son of american first plan actually envisions. You know that sort of scheme the government would do price setting. The government would tightly regulates, which benefits are covered buddies of private insurers were allowed to sell and compete against the public plan which kind of another vision that looks like kind of similar like a German are a swiss health insurance plan. Origin like the more liberal versions of Obama, correct so it's something I was reminded of during the like Nancy Pelosi, re essentially to the speakership- is that you know the house democratic,
It's the at a time when, like Medicare for all as a slogan, was not really gaining steam and when single payer was not on the table as as a policy area, they pushed a version of the affordable care act that from fifty thousand feet up was the same like the regulated subsidize marketplaces, private bob Bob ah, but in the details, was actually quite different, dried and like had this public option and caution seem to me to be more than ready was like the left wing of the Asia debate. Sort of coming back. I feel like what what's happening here. Is people see two problems. One is that we still have a thirty million people who are uninsured and that sort of like the moral urgency and the other pre piece of it, is that people are paying much money out of their pocket for health for their healthcare, and so like those problems, we know how to solve by just spending more money like the federal, like a kind of what a bomb occur, did
We just started spending a lot more money on individual insurance subsidies and Medicaid an we covered, a lot more people and that there was less under insurance insurance and so that sort of the real sort of tactile problem that all of these plans have been designed to solve As the Eurotunnel, I kind of like the back end of it, sort of this. This more like systematic system of hospital pricing, prescriptions, our prices, and what have you that lake is invisible to a lot of people, and so I just don't think these plans have been necessarily designed like with that in mind. So much you know, mean wonder like like what plan are we solving here right,
the great my very cynical view of this- which I don't know if it's right but is like the problem to be solved- is that because Hillary Clinton did not become president of fear, emerged in democratic party circles that Bernie Sanders would become the nominee in twenty twenty and that the problem is a competing. Plans are designed to resolve is the problem of beating Bernie Sanders primary election? By think I mean there is also an actual problem they are solving. I think you see a lot of Democrats. You feel like they see a lot of people who are frustrated with the healthcare system that they see, I did not go as far as they wanted it to be. As they are trying to compromise, and now it's like well well like Who are we compromising with this point? And this kind of like where we want to take things that,
I think one of the EU would not see you not see that interest in, like going back to healthcare and expanding public insurance, If you didn't see a lot of people really really frustrated and feeling like the USA reforms didn't fixed their problems. I think, while keeping the gets that I I started, thinking is playing a key role in all. This is the rise of deductibles. Which have just like hugely skyrocketed over the past decade, which mean that Americans are a lot more exposed to the actual cost of their health care, and I think that Kind of an under noticed factor in all this you know a lot of you are paying that the prices out of pocket they can live with that shit. Hunters really expensive. That was one of the policy goals that the Obamacare people had. What was one of policy goals was to expose patient
more to the actual costs. Can I think, I'd like very unpopular get as a policy goal, but it is a very unpopular policy need ironing out of you oversight. I agree I mean it was but like really right like before the whole want to beat Bernie Sanders in an election problem arose for the Democratic Party. I think that they were fairly comfortable with the high deductibles situation that there was a an intended result. Rightly they wanted to avoid, aid like catastrophic things, but like there was all this bending the cosgrove staff. There was this series of proposals random. Unlike anything Barack Obama, didn't get everything he wanted done in Congress. He had this like raft of staff. Hillary Clinton picked it up. They were gonna tweak that this in that formula that will get to increase the match and who there is a belief that the individual mandate had happened
fractured quite stringently enough. We had talked about you know whether they were being a little too politically cowardly in implementing the open involvement roles, but there was a vision right and like the people behind that vision. We'll both behind the SBA and the people behind the like here's, how we want to improve the Asia and the people who are saying in the early days the twenty. Sixteen primary like. Let's not go back to the drawing board with us like, let's improve it like they did not die in a plague and in fact their writing these plans. You know I mean I think listeners are aware that I am not personally like a hard core member of that Bernie called and yet I grow more sympathetic as I watch those kind of playing out, because it's like is the view that Bernie was right or that he wrong.
Yeah I mean I do think that he tapped into something- and obviously I'm not saying he is the his primary success was only a result of embracing Medicare for all. But I do think that was a really animated issue for him in it probably show his success probably showed a lot of the establishment. Think tank types around here, how animated an issue healthcare could be, and we just saw that in the mid term, elect This last share too, and so I think there has been. I was thinking, listen, do you guys go back and forth it certainly. Can it not be both the dread of there? Is this sort of self evident myth, not crisis than serious problem, that a lot of people are running into? You know, deductibles are not just high in the balmy care plans there going up for me love, employer based insurance to so people feel a sort of pinch when it comes to health. And at the same time I do think we're seeing a sort of reaction of well
Bernie Sanders has sort of set out. This he's planted his flag and he has identified what his health care vision would be, and we can either keep talking about Obama CARE and how we're going to fix it, or we can at least attempt to match him and his ambition and rail I think I see both things happening at once way. Emmy there is an element of like this does both of us, but I mean this is a question of lake. Our people insufficiently subsidized in their health insurance or aren't day, and I feel like I e. The establishment has like taken a pure wet on this subject without really at least to me like explaining their their reason and then they seem gun shy about when it comes down to like, like there
nervous about like robust Medicare for Iraq, is involves big tax increases but, like you could scale it back a little bit, but like that's the basic idea right like if you want people to get health insurance and for the health insurance to be cheap for everyone. That's like You have lied, tax increases or if you have the old view that I guess I never heard it like officially recounted between the time when, like Barack Obama was for bending the costs curve and when Barack Obama was listing. Medicare for all is an exciting new policy idea. Like the view was that healthcare is excessively subsidized right? I guess I'm curious what you Sarah cause, you ve done a lot of reporting on the lake Healthcare as a human right question and, like I We think that it, like me, Matt you alluded to it before, but I feel like part of this is like is health care of just a fundamentally different thing than a lot of other commodities, or is it more kinda like food and housing? I guess I like even more important, maybe the most things I don't
but that seems, I think, it's sort of like we're almost dying about healthcare sort of like still sort of a a business in a private market where you know you have prices and cost of people have to pay. Where is, I think, its animated alot of people- is this idea that health care is something else that the government should be a lot more involved. Even then, it is now in providing it to people me. I think going to your point. I know if our absent host as Recline Wazir, the thing he would say at this point is that this kind of points to this tension and confusion that often exists in our health care debate around like what cost control actually means for the government. Controlling costs means the government spending less money. So we have high deductibles. We have mechanisms to try and encourage you to think twice about going to doktor, encourage you to look not be a wasteful, under, except those are exactly the things that you know as a patient. I feel like are not
controlling Michael US, their driving my caused a hugely because I was then there's this deductible and really expensive for me to go to the doktor for me to get my prescription drugs and I in a weird way. This actually reminds me of some of the stuff. We saw the republican repealed. Where we constantly sob hawaiian enriched ricotta having like the doctors and Obamacare too high. The generals are bad and then they would introduce plans that made the deductibles way way higher, because you know we needed to do cost control and like we needed to save money and a lot of people. Do this and be outrage and say you know. That's gonna cost me a lot of money for the government to save money, and I think this is a constant. Point of tension and american health policy, where you know what you mean by controlling caused depend so much on where you sit, and these two things are intention. You know controlling a patient's, individual costs means, Spending more and part of the government controlling government spending on health care means the patient spending more
and you do at the end of the day, like those high deductibles, they are great for controlling hoss. There really unpopular with people- and I think to captain Democrats- are confronting this part of the affordable care act that people don't like. When you do cost control of rights, but I mean people also don't like it when they have to pay taxes ray yes. Yes, I think all of us like like when we can go to whatever doctor we like fir wood, no cost and like not pay higher taxes, for that's a really difficult healthcare system Well, it seems like the system. People really really really want is a system in which a very opaque sat of background tax policies encourage employers to give you a very generous insurance plans, do a lot of implicit subsidies.
Can it him hidden hands right? I mean, or alternatively I mean I don't know the math, and I give it really is true that you can just give everybody free health insurance with sixteen trillion dollar tax increase, but the tax increase. Well, I just come from billionaires. I mean that does pretty good, I think people would like that you're, not a billiard you're, not a billion with a lot of money. Doesn't love you a little bit of influence. Maybe, but maybe they don't. I mean it's just it's weird, because I think there's this tremendous fear of the tax implications of the centres plan, but also there is no written down like here's, what we're actually posing. So the whole thing seems alarm is like a little frozen. Yeah? Well, the air. I wonder if Democrats will find the by and plans to be sort of the elegant solution to a lot of this, because it is, you can say, you're offering Medicare for all, because everybody or a lot of people would be able to buy into it, but it just does not,
choir the same kind of scary tax. I couldn't, I really am purposes money or asking people to pay, but this you'll their own. My guest now and at this point in the debate as I like, how much does it cost and what sort of tat increases. Does it require, and we just don't have that Yugoslavia was like not scored these plans. I think they need to be like a flash out a little bit more, and so until we have that information like a lot of this debate, feels kind of theoretical may in terms of understanding. You know like what taxes would be required and like who would pay those tax as the other side of this e? U both have that side and the other key financing part that we don't fully fleshed out yet is like,
Stu doctors and hospitals get paid. That's like the other lover you can write, you can increase taxes, you can also temp down. I and you know what we're paying for healthcare. We have really really high prices in the United States higher than any of our poor countries, but a lot of veto industry depends on those high prices and you can bet there is a very strong lobby to who am prevent those prices from going down right now. Medicare is kind of middle of the pack in terms of the prices that it pays a pace, less than private insurance appears more than Medicaid. And so you see kind of some variation between these different plans, unlike where they would set prices Euro, some using Medicare payment rates, some using some of the Medicaid payment rates. Some using like one hundred twenty five percent of Medicare said that that's the other lever, that's going on. That has a lot of complicated politics around it. But if you want to tempt down on the tax increases the way you do, that is by clamping down on prices. But then you have like a you know, that's one fifth of the economy and there, Sir,
what's going on there? That's gonna make that part of big challenge. This is where to put my cynics hat on but pointed the other direction. I get frustrated that, like I feel it were three years into Bernie Sanders, making a serious quest to become president of the United States and its clear at this point that, like the function of his Medicare for all plan, is to advance. That goal is such that they haven't yet is it they are like will fully not answering these questions and the Bernie verse has developed a set of very effective. I think political and rhetorical strategy is,
for the purposes of winning. An argument that please out in front of a left wing audience right but like that are not addressing the the garlic if you want not just for Bernie Sanders to become president in January of twenty twenty one. But if you want a bill along these lines to pass, you can start in February of twenty twenty one like doing the math on how low can you cut hospital room? this meant rates before rural hospitals clothes. Now it's obvious you can cut it. Some like there is definitely like pricing power in the system is also obvious. You can cut it. Ninety five percent right, so it's like how much can you cut it? Like I dont know, unlike will not venture an opinion on this, but like you would have to
find out the lights and, like frankly like in Vermont, you could ask people like this is not a state that is like unfamiliar with the problem of providing health care facilities and low population density areas like you could start asking these questions and trying to present a well worked out. Ski or you could try to preserve your set of talking points where, like now I, u know Senator Chump say oh bernie, how are you gonna pay for that that he comes back with like well? Why did you vote for, deficit financed increase in military spending, and it's like boom. You lost three votes, and I already unlike its great there's, a great set of arguments like if we can afford this. We can afford that if we could bail out Wall Street, we can get people's health care and like good for you re, but it's like the we legislate
works is, you do at some point have to start answer these questions not like we call him quote, could pay for this, but like here is actually what the proposal to do it is unlike they could. They could go take a week, long retreat and work this out and like to just not, I feel like they have it made the transition for so long they were just fighting to get a seat at the table and for the idea of Medicare for all single parity even be taken. Syria. Lee and now I do think they ve accomplished out like that right and window has shifted, but they have not now moved on to your point out of the two, the actual point, what are they going to tat kind of where we're like? That's what we're writing this peace right now, and I should like the debate- is, as I think it is like an important she knew when I talk to Democrats, they foresee especially using their new power in the house to hold hearings on like these issues and to actually talk this soon. I think then, we'll get like a sense of like House serious, are they about moving forward on this because of it
at the end of the day like if you want to pass something you're going to have to figure you're going after eight the bill that says like? Ok, here's other taxes, change and here's how the provider reimbursement rates change ends that becomes unavoidable at some point, and you know what I've been talking to legislators and health staff for this peace. They kind of sea the next two years as the time to like work These questions. What happen I don't know like their super hard questions and they lead to like the most popular parts of these proposals, kind of being fleshed out, and you don't laid on the table, but I think if they, if they do, follow through on kind of how they see the next two years and healthcare like those of the types of questions that are going to be, debated in the run up to twenty twenty. I think the other thing we're going to start seeing is you know this almost like policy, I marry going on as we start seeing candidate store their head in the ring to run for president, which could be soon like. I was looking back President Obama
originally declared- and in February two thousand seven so really really early. So we are likely about to start see candidates declaring their candidacy for press, and see likely starting to roll out their own policies in order to make their mark on em in the healthcare space. So I think that's another place aside from the hell, is also in the presidential election that we're going to see more of this. They will see if this is serious, because if you want to actually do this, then you need to answer these really hard questions so We determine our Mps, let's take a break it and then talk about our white paper people Often ask me of prosecuting the mob is like the movies well There is violence he cracks disguised over their head and pop. Just like a melancholy. There are heads, so wasn't just permission to take em apple permission to take out his own Natalie,
but after taking down over one hundred mobsters, I can tell you this the The thing is much more interesting: barely holding former mob prosecutor and host of the new podcast up against a mom up against the mob the bail on the world's most secretive criminal organization, La Cosa, Nostra we'll talk to profit. Peters former mobsters, an undercover agents- and my Hollywood? All these stories are true. New episodes dry, every Wednesday starting September, eighth, listen and follow up Hence the Bob on Apple Podcast, Spotify or your favorite podcast app, hey are you hungry, for I had taken her latest favoured I like doing johnson- and I personally think he is the greatest action star of his time or a wild, and we take on a cold classic. We
Eddie accuracy was so good, a ruined all future political comedy or take so fanatical. It blows your mind all the way to the next stratosphere, Vendee cells, character, Dominic Tarento is a king angel man, then check out Galaxy brains, Punkahs where Movies TV and over thinking collide. Said by me. Dave shilling at me, Joan array each week on the show we blow our own minds, yours with galactic level. Take on those I Guiseppe, a movie or tv show of the moment in we run those things by our favorite comedians, an expert pals. Neither let us up shut us down tuna and follow council brains. I have a blog s or your finger upon catch them. Again. We have today vanished classmates the effect of local immigration enforcement and student enrollment, so this paper it's by Thomas D and Mark,
her feet, and it's looking at a programme that, I think, is not that well known in this sort of policy debate. But immigration, customs enforcement has the ability to form partnerships with local law enforcement organizations where local law enforcement normally does not enforce. Immigration law traditionally has not enforced immigration law but posts nine. Eleven We saw that the Bush administration generally dervish on immigration through to the immigration hawks, was sort of creating these programs. You can think of it. It it's like the reverse of declaring yourself a sanctuary. City right is like you're now like an ice. Nurse city and these proliferated under the Bush administration a bomb. I kind of salute the creation of new partnerships, but yeah left the programme intact answer. This is a paper looking at what happens when these partnerships are for
and they find a strikingly large effect on school enrollment look eyes, pernicious reduce the number of hispanic students enrolled in public schools in the district that nearly ten percent within two years and there's no displacement of non hispanic students, eyes. Partnerships don't reduce pupil student ratios are the percentage of students eligible for National School Lunch programme. The effect is concentrated in elementary school students, so evidently these partnerships- they, I guess you could call it succeed in creating a climate that is fearful for immigrant families, who appear to responding by pulling their children out of public schools and what struck me when I read it at first, I was, I call my god trump and then I like more clearly and this of the programme, continues under trap. That I believe, has been wrapped up to some extent, but the data being studied goes from two thousand and twenty.
Well as this is like. I think the kind of thing that you no good liberals and and resistance folks everywhere would be freaking out about had happened under Trump, but it was actually a bush and then Obama Initiative, and it always seems monstrous. To me, I think children should go to school yeah I mean my take away. Was specially paired with another study that that came out recently is sort of the cultural impact
you're sort of just the environment that is created by these policies. I think, does have a pretty meaningful effect on people's behaviour and select. What we saw with the ice partnerships is that you know was elementary school students who, in a lotta cases, might be you know you may have the students are U S, citizens, but their parents might be undocumented, and so that, even though you know that the student isn't technically at any risk by attending school, they have every right to be there. The parents are still much more mindful of their own immigration status and that leads them to displaced themselves and their families, and I think, what's linked to that, is that you know with elementary school students. It's probably people who have been here for a little less time who are less
that old were less established, and so they are much more responsive to a sudden increase in enforcement and so like. I think those are the sort of things that do carry forward, and now we ve seen YO. I wrote about the other day. There was. There was a study that came out about food stamp enrollment and what we saw in the first six months of two thousand aid is that food salmon, roman among immigrant families, who had been in the country for less than five years, drop by nearly ten percent, and they also had some corresponding data. That should the need had gone away, that there is still the same amount of food insecurity among those families, but they had dropped off of staff, and the obvious explanation seem to be that there was just sort of this climate of anti migrate sentiment. Even if there had been any direct changes to food stamps, people were still fearful b, as you know, they heard what was on the news. Maybe you no word of mouth gets around when somebody gets picked up by one of these ice partnerships are what have you, and so he. I think that I think the important thing for people to understand is that its.
It's not even necessarily that you know these ice partnerships were plucking the students parents out at the hour and putting them in jail. It's just the climate that's created does affect people's behaviour in there spanned yeah me I've. I've found this paper and also the study Europe Dell, in kind of a helpful reminder of how much tone matters in policy that it's not just the policy changes or making, but it also like how you are talking about them and like how you are communicating them. That is really going to change behaviour and I think, like the magnitude of the change in this, They surprised me, you know I like we're talking about like a ten percent decline and how many students is it that arms Two hundred thousand three hundred that like that, is a huge the number of people. The thing like this kind of shook up for me as, like, I thought, tone matters, a little bed, but, like it matters a lot like retard
about a quarter million kids who are not going to school anymore, not because some policy said they couldn't go to school, but because the climate, changed in the areas where they live. So, the magnitude of the change just really jumped out at me in this particular paper in suggesting you know that they really huge and the huge consequence. We didn't even know about it. The time like one of things, it's almost like a little frustrating about this paper is like we're. Looking back at things that happened, you, the kids, you pulled out of elementary school there in their mid twenties Glad at the start of this study like as someone who was twelve Vietnam in two thousand. Is a thirty year old at this point, so we're looking back at these things that happen. While ago, that had probably really significant impact for a lot of the individual stories, not three hundred thousand, but it seems really really hard to get this data like. If you read the danish section of this paper, there are multiple, forever class
where these partnerships were than they had across per thou, with school and roman databases that this data is really really hard to get so we're only finding about out about these effects you no more than a decade after some of them have enemy. You, gentlemen tone, but I think it's important understanding what kind of tone we're talking about here, because I you also think there's. It is a join in like if you're, not an immigrant or type immigrant communities. I think this a lot of like white, liberal nostalgia for the Bush administration, which, like on a level of overt tone, was like very different. Creation than Trump and a certain like lack of comprehension as too like why latino populations are not experiencing the kind of acute anti trump backlash that you see
and professional women. But I think stories like this help explain why that is so wide that, like during the two terms of Bush and the first term of Obama, the like official tone from the White House was like way nicer to immigrants, but like the actual policy making on the ground, I think you're right I mean I do think it is a tone question, but like it's a locally readying sat right, I mean it's like the mess. It comes out that, like but The city government is like working hand in glove with me, grad to make sure were roosting out the elite rules, and that makes people be like, and maybe she said, my kid to school. Even if he's Eu Citizen, because, like schools government agency, they can find out things about your parents and at school right, and so it's like when the mayor is like working hard. Yes, it's like you know people people get worried, but that was
happening below radar of people who are not personally invested in immigration policy right, and so you, Sir, don't see these these big changes that that swept through again there's not a lot of recognition among Democrats of how much the Obama administration stepped up the pace of deportations during its first term in a kind of ultimately failed played a game legislative
word and an end. I think about all this because ever since Trump won the election has been. This I mean there's been like resistance movement, but there are some in this sort of boom market in like might makes right thinking about politics. Hillary Clinton said the rise of populism shows that Europe needs to get immigration under control. John Judas has this book about how I the left needs to handle the the populist backlash more seriously, and it's easy to forget that Lake pre Trump like this is what the establishment politicians were doing. Right was like trying to throw bones, restrictions, tests to calm people down and build support for what they hope for it. To be this, like amnesty policy and like I don't know man like every politics politics- and I guess you gotta- do it- you gotta do but like this is three hundred thousand elementary school students. So now I mean dried out and because they dropped out there now
They would be dreamers today had they graduated high school, but like there now, and so now they go on some like bad immigrants. List of you know dropouts if you're thinking the point of immigration enforcement is too like improve the labour market outcomes for less The americans- and this makes it much worse, radio under like what I like now with a tone shifted even more rapture we're already talking about a really significant magnitude. When the tunnel you're saying, was very dear friend now that you have asked the president. You know out there like seeing home like we're, liberating town yet leg. You were, I wonder, what this data would look like looked at the data, and we see some of it like in the snapped study, but a year. We can ever be dine school in Poland, we don't know you know, I don't know. Maybe these authors have this information and the polish something surrounded by it like. It would not surprise me a few sign, even greater magnitude. To this effect.
Happening right now, but we don't know about it, because there is a huge data. Agatha date is really hard to get away, but he's one of the things that bother people about immigration right like One of them is made, like you know, their use into much welfare that committing crimes. Turning our labour market outcomes like getting kids to drop out of elementary school is, can make us works one. I swear I appreciated about this study. Was you could see the argument like wealth, these families, who couldn't quote maybe shouldn't be here if they, if they pull out of the schools? Well, that's gonna legal, smaller class sizes. It might just sort of improved socio economic standing of the school in. So that would be to the benefit. You know if, if this is the way you think that would be to the benefit of the the kids who are supposed to be here, but what these researchers found is actually class sizes did not get any smaller. The socio economic growth status of the school population,
more or less the same, and so there were there was. I appreciate that they attempted to look for that suppose it benefits and yet they didn't find, and then I guess I saved some money by not hiring as many do yeah. I guess but I mean again it's like because I've saved by the labour market outcomes you know I mean there's you there's gonna be stories right, I mean look, there's gonna be somewhere in the Trump immigrant crime hotline, lie like you can have draw like precise lines between these things. Like you know, they'll give somebody leaves elementary school like their labour market outcomes as a teenager and twenty something like not can be great and a person like that is much more likely to end up involved in it go activity that worried federal system. Yeah need assistance, write them like somebody who went to school and did so in normal, but ass they went
kids are very sympathetic. Cried like a you wrote a story, the newspaper about six greater, whose mom is keeping him home from school. Every would be like. Oh what a sad story. You read the story about twenty six year old, whose on welfare and you know, hasn't held a steady job in her whole life. People you're back wow ass part of the problem, but like that's, maybe because she didn't finish school as right. I'm a man may be mad. While you can express your anger on the in a proactive way in the weeds Facebook or of absolutely venue rage and weeds Facebook Group Ass, such as e mail, weeds, outfox outcome. I think don't Scott for joining us today and competent break all this stuff down and, of course, as always, our producer Griffin, Tanner Means will be back. Fine.
Transcript generated on 2021-09-11.