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Pramila Jayapal, Ady Barkan, and Nancy Pelosi. YouTube screenshot

The House of Representatives held its first hearing ever on Medicare for All yesterday, and, as if it were a magical wormhole into a sane parallel universe, the discussion was detailed, based in fact, and decidedly non-screamy. How the hell did that happen in a congressional hearing in this hellworld? We'll take it!

Yes, yes, everyone involved was very clear on the fact that Rep. Pramila Jayapal's Medicare for All bill won't go beyond the House with this Senate and this "president." Doesn't matter -- this was a chance for supporters of M4A to make the case going into 2020 and to get a head start on future legislation. By all accounts, the hearing before the House Rules Committee was a serious discussion of how single-payer could be implemented, including a serious discussion of some of the hurdles that would have to be overcome. And -- and this is the weird part -- even the Republicans at the hearing appeared to take it seriously. Sure, their invited witnesses were right-leaning, but they were at least health policy people, not raving loonies from wingnut media.

Former Health and Human Services Secretary Donna Shalala, now a Democratic congresswoman from Florida, told Roll Call the whole thing was the "smartest hearing I've ever been in [...] It's thoughtful. People aren't grandstanding." Could it ... could it become a thing?


The committee heard a statement on the urgency of treating healthcare as a basic right from healthcare activist Ady Barkan, who came to national prominence in 2017 when he pleaded with Jeff Flake on an airplane, urging him not to kill Obamacare as part of the GOP tax scam. Barkan has amyotrophic lateral sclerosis, which has progressively diminished his ability to move; most recently, the disorder has left him unable to speak, so, as he noted in his statement, this is the first time he's testified before Congress with a computerized voice, not his own. Give a listen:

Ady Barkan Complete Opening Statement (C-SPAN) www.youtube.com

Barkan offered a concise argument for switching from the insane hodgepodge of medical systems currently in place to a truly universal system that covers everyone, noting that America has the highest per capita healthcare costs even though we leave tens of millions without care at all. He pointed out that even with his very good insurance, his family has to somehow scrape together $9,000 a month so he can live at home -- the alternative would be to go on Medicaid, but that would mean living in a nursing home away from his wife and toddler son.

So we are cobbling together the money, from friends and family and supporters all over the country. But this is an absurd way to run a healthcare system. GoFundMe is a terrible substitute for smart congressional action.

Amen. Barkan is simply pissed that, with "so little time left together," the stupid healthcare system "forces us to waste it dealing with bills and bureaucracy." And amen again.

Beyond the practical policy arguments -- which he certainly outlined -- Barkan framed Medicare for All as a matter of quality of life, for all of us:

Our time on this earth is the most precious resource we have. A Medicare for All system will save all of us tremendous time. For doctors and nurses and providers, it will mean more time giving high quality care. And for patients and our families, it will mean less time dealing with a broken health care system and more time doing the things we love, together.

Some people argue that although Medicare for All is a great idea, we need to move slowly to get there. But I needed Medicare for All yesterday. Millions of people need it today. The time to pass this law is now.

Beyond Barkan's very real embodiment of why we need change, the discussion focused on how we get from where we are to a single-payer system. Cost, of course, is the chief scare point, but scare stories about the costs of single-payer conveniently ignore the fact that we're already paying through the nose to cover fewer people than a single-payer system would. A shift to single-payer would probably cost about as much, but cover everyone. As Vox notes, even one of the Republican witnesses, Charles Blahous of the Mercatus Institute, "acknowledged [...] much of that would just be a shift from the private sector to the public."

People would pay taxes instead of health insurance premiums and existing federal funding for Medicare, Medicaid, and Obamacare would be repurposed for the national health plan.

Blahous, remember, authored that study for Mercatus (remember, funded by the Koch brothers!) that found a Medicare for All system would actually save trillions of dollars over our current unsystematic mess of healthcare "systems."

Another witness, Dean Baker, a senior economist at the liberal Center for Economic and Policy Research, agreed with the Koch guy, though you'll never get a libertarian to admit it:

Medicare for All is affordable [...] The bulk of the payments should be coming from shifting employer premiums basically to taxes, so it's not additional money out of workers' pockets.

One of the Republicans on the committee, Rep. Rob Woodall (R-Georgia), fretted over such a "tremendous increase in tax burden for the country" (please ignore it being balanced by the disappearance of private insurance costs!). Ady Barkan asked for the chance to respond:

"One thing I can't help but think about today, Congressman, is how we always seem to find the money for things like tax cuts for the wealthy and for corporate tax cuts," Barkan told Woodall. "We never ask where the money will come from when we declare war. We always seem to just find the money."

"We only ask how we'll pay for it when it comes to our health," he continued. "This is such a clear problem with such a straightforward solution. We can save taxpayers money. We can save money for families."

As to the notion that the lower provider reimbursements under Medicare would crash the healthcare system, yes, it's true that doctors and hospitals would get lower payments than they do from private insurers. But there's a strong argument to be made (as it was during the debate over Obamacare a decade ago) that the expanded number of people coming into the system would balance that out, with the added benefit of healthier Americans who aren't trying to treat cancer with GoFundMe campaigns.

Further, one of the witnesses, the Commonwealth Fund's Sara Collins, explained there's little evidence that high private reimbursements are anything but an artifact of a really inefficient insurance system, not a reaction to doctor-robbing Medicare/Medicaid reimbursements:

If that were the case, we would see consistently higher margins all the way across the country. Instead, we see a lot of variability across the country. The way this works is that private providers are negotiating with their commercial carriers prices that work the best for them.

In concentrated markets, they get higher prices and insurers want them in their network. So they concede to those higher prices. They then take that negotiated rate to employers. Employers have to pay higher premiums. They reduce their workers' wages, they increase their deductibles, and those costs get ultimately shifted to people.

So there really isn't evidence that the cost-shift argument is the reason for higher prices. It's really these not-transparent price negotiations that happen in the private market.

Heavens, you mean the invisible hand of the market drives inefficiency? Well slap my ass and give me a 50-dollar aspirin!

This may have been the first hearing on Medicare for All, but it's not going to be the last. The House Budget Committee has scheduled a hearing for June, and House Ways and Means Committee Chair Richard Neal (D-Massachusetts) plans hearings soon as well. Oh, shit. Devin Nunes is on Ways and Means, so let's not get too optimistic over the prospects of that hearing being called "smart."

[NYT / Vox / RollCall / Ady Barkan statement at US House of Representatives / Image: Screenshot, Rebel HQ on YouTube]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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