Tag: Healthcare

“Unleash,” Huh?

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Obviously, fixing healthcare is not easy, at least not if you are devoted to looting the market.

For the rest of us, Single payer, or better yet a government owned National Health Service, works.

For the Free Market Mousketeers™ though, they have to come up with a “solution” that will, “Unleash entrepreneurs.”

Yes, the problem with looters infesting our healthcare system is more looters.

Change a few words, and you have the National Rifle Association to everything, “More Guns.”

If you add the word, “Disruption,” you would win bullsh%$ bingo.

If You See Evil, You Will Find Private Equity

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It turns out that the explosion in out of network balance billing, which results in horrific bills, is largely being driven by private equity.

It’s not a surprise. Private equity is morally indistinguishable from a Colombian drug cartel:

I have to confess to having missed how private equity is a central bad actor in the “surprise billing” scam that is being targeted by Federal and state legislation. This abuse takes place when hospital patients, even when using a hospital that is in their insurer’s network, are hit with charges for “out of network” services that are billed at inflated rack rates. Even patients who have done everything they can to avoid being snared, like insisting their hospital use only in-network doctors for a surgery and even getting their identities in advance to assure compliance, get caught. The hospital is in charge of scheduling and can and will swap in out-of-network practitioners at the last minute.

Private equity maven and co-director of the Center for Economic and Policy Research Eileen Appelbaum explained in an editorial in The Hill in May how private equity firms have bought specialist physicians’ practices to exploit the opportunity to hit vulnerable patients with egregious charges:

Physicians’ groups, it turns out, can opt out of a contract with insurers even if the hospital has such a contract. The doctors are then free to charge patients, who desperately need care, however much they want.

This has made physicians’ practices in specialties such as emergency care, neonatal intensive care and anesthesiology attractive takeover targets for private equity firms….

Emergency rooms, neonatal intensive care units and anesthesiologists’ practices do not operate like an ordinary marketplace. Physicians’ practices in these specialties do not need to worry that they will lose patients because their prices are too high.

Patients can go to a hospital in their network, but if they have an emergency, have a baby in the neonatal intensive care unit or have surgery scheduled with an in-network surgeon, they are stuck with the out-of-network doctors the hospital has outsourced these services to….

It’s not only patients that are victimized by unscrupulous physicians’ groups. These doctors’ groups are able to coerce health insurance companies into agreeing to pay them very high fees in order to have them in their networks.

They do this by threatening to charge high out-of-network bills to the insurers’ covered patients if they don’t go along with these demands. High payments to these unethical doctors raise hospitals’ costs and everyone’s insurance premiums.

Balance billing is a huge problem.

A bigger problem is private equity and the rest of the looting schemes favored by Wall Street.

We need changes in laws pertaining to things like derivatives, bankruptcy, and corporate looting to stop this bullsh%$.

This is What Pay-Go is Supposed to Do

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Remember when Dems put PAYGO in the rules package and people like me (who raised hell) were told not to worry because it would be waived off as necessary to pass important legislation? https://t.co/Pd97gv8sqq

— Stephanie Kelton (@StephanieKelton) July 18, 2019

I’m always that Pelosi’s insistence on Pay-Go rules was profoundly self destructive.

I used to believe that this was a short-sighted policy driven by a need to appeal to the inside the Beltway pundits for whom deficits are important whenever Democrats take power.

I increasingly believe the affection of Pelosi, and the rest of the Democratic Party establishment for Pay-Go is more about having an excuse for not doing the right thing, because they don’t want to do the right thing.

Case in point, Democrats using Pay-Go to gut funding on community health centers:

Several Democratic lawmakers are accusing members of their own party of advancing a plan that would have the effect of cutting health care services for millions of Americans in poor and rural parts of the country — a charge fiercely denied by the package’s supporters.

Rep. Frank Pallone Jr. (D-N.J.), chair of the House Energy and Commerce Committee, is pushing a bipartisan plan that would provide flat levels of federal funding for hundreds of community health centers nationwide, at about $4 billion for the next four years. A similar plan is advancing in the Senate with the support of Sen. Patty Murray (D-Wash.), the top Democrat on the Health, Education, Labor and Pensions committee.

Lawmakers face a September deadline for the community health centers, after which their funding would begin to expire, likely leading to steep cuts.

Pallone said the plan would provide the security of the longest guaranteed funding commitment ever secured by the clinics, averting the September cliff. But flat funding would not keep pace with medical inflation, likely forcing the community health centers to serve about 4 million fewer people annually by 2023 than they do now, said Leighton Ku, professor of health policy at George Washington University’s Milken Institute School of Public Health.

There is always money for a free for the next bloated defense program, but when you want to provide poor people with basic healthcare, we must be fiscally responsible.

The neoliberal consensus of the Democratic Party leadership is bad politics and bad policy.

This Is the Saddest Thing That I Have Read in a Very Long Time

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A Philadelphia man walked out of a would-be robbery after telling the cashier that the money in the till wouldn’t be enough to fund his daughter’s kidney transplant operation, according to police.

………

The store owner told police that the man waved his gun in the air and demanded cash, according to CBS 3. But after getting at least a couple hundred dollars, he changed his mind and gave the money back.

Clearly, our healthcare system is the best one in the world.

Interesting Data Point

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Elizabeth Warren seems to have a detailed plan for everything, with one exception she has no plan on healthcare, not even an explicit endorsement of a vague form of “Medicare for All”.

This is clearly an intentional omission, since her whole brand is about having a plan for EVERYTHING.

Considering that she has staked out a position just to the right of Bernie Sanders, I consider this to be an important tell: She will not fight for a truly universal healthcare system:

In a recent MSNBC town hall, Elizabeth Warren put her policy platform on full display. Through emotional, personal anecdotes and with a depth of understanding, Warren gave the impression of a candidate well-aware of the problems faced by working Americans and armed with the policies needed to solve them. She detailed her plans to achieve universal childcare, cancel the bulk of existing student debt, and create over a million green jobs by progressively taxing the richest Americans. She boldly criticized Joe Biden’s conservative record and decried the greed of large corporations.

The performance supported Warren’s reputation as a candidate with a “plan for everything” — a reputation emphasized repeatedly by MSNBC moderator Chris Hayes throughout the event. Taken as a whole, however, the town hall revealed an alarming gap in Warren’s policy repertoire, one that has gone mostly ignored to this point in the campaign: she has no plan for fixing the broken US health care system.

Warren had several opportunities in the town hall to address the health care crisis. Instead, she avoided the topic almost entirely. Even when discussing issues directly related to health care like repealing the Hyde Amendment and improving access to hearing aides, she neglected to propose a comprehensive policy solution.

Unfortunately, this was not a simple case of forgetfulness. In fact, it continues a disturbing trend with the Warren campaign. Check her website: in a long and thorough issues page full of bold plans to alleviate Americans’ suffering, Warren makes no mention of health care. View her campaign materials: Warren has yard signs dedicated to several of her major policy proposals, but not a single one about health care. Follow her campaign appearances: you’ll hear the usual platitudes (“health care is a human right;” “everyone deserves access to care”), but you won’t hear her endorse a specific policy.

………

Take for instance Warren’s March town hall on CNN. When asked directly whether she supports Medicare for All, Warren suggested that Medicare for All is merely a slogan for expanded public coverage, rather than a specific piece of single-payer legislation.

“When we talk about Medicare for All, there are a lot of different pathways,” she said, before listing a slew of incremental proposals without explicitly endorsing any of them, from lowering the age for Medicare eligibility to allowing employers to buy in to Medicare. “For me, what’s key is we get everyone to the table on this.”

Taking this answer at face value, it seems Warren sees herself pursuing an incremental approach that expands public coverage while preserving the private insurance industry should she be elected president. This would likely surprise many of her supporters, who might view her cosponsorship of Sanders’s Medicare for All bill as an endorsement of single-payer health care.

It’s fair to ask why Warren, who supports bold, progressive policies on a number of major issues, is avoiding the most important issue to voters. It could be a reluctance to attach herself to a rival candidate’s signature policy, or it could be a way to avoid conflict with the powerful health care corporations in her home state of Massachusetts.

Either way, it meshes well with a years-long effort by Democrats to blur the meaning of Medicare for All by gesturing goodwill toward single-payer advocates while attempting to redefine the phrase and apply it to public option proposals that preserve the private insurance industry. By following this playbook, Warren is actively supporting the corporate effort to kill the growing Medicare for All movement.

I wouldn’t go quite that far, but her reticence is unsettling.

Our Broken Healthcare System

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Remember when I wrote about how the healthcare industry wants to repeal anti-kickback laws?

They claim that it hinders innovation, and I say that they are trying to pick our pocket.

Well, it turns out that the entire kickback issue is far less hypothetical than I had anticipated:

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians across the nation, the federal government charged in a lawsuit filed this spring.

In addition, Wheeling paid an obstetrician-gynecologist a salary as high as $1.3 million a year, so much that her department bled money, according to a related lawsuit by a whistleblowing executive. The hospital paid a cardiothoracic surgeon $770,000 and let him take 12 weeks off each year even though his cardiac team also routinely ran in the red, that lawsuit said.

Despite the losses from these stratospheric salaries and perks, the recruitment efforts had a golden lining for Wheeling, the government asserts. Specialists in fields like labor and delivery, pain management and cardiology reliably referred patients for tests, procedures and other services Wheeling offered, earning the hospital millions of dollars, the lawsuit said.

The problem, according to the government, is that the efforts run counter to federal self-referral bans and anti-kickback laws that are designed to prevent financial considerations from warping physicians’ clinical decisions. The Stark law prohibits a physician from referring patients for services in which the doctor has a financial interest. The federal anti-kickback statute bars hospitals from paying doctors for referrals. Together, these rules are intended to remove financial incentives that can lead doctors to order up extraneous tests and treatments that increase costs to Medicare and other insurers and expose patients to unnecessary risks.

As I’ve previously observed, when an industry wants regulations removed to encourage “innovation”, or for that matter “disruption”, it’s because they want to steal from the rest of us.

This is Maximum Joe Biden

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Let’s start with the facts: Michael is not on a government plan. He’s fortunate to be covered by his wife’s private insurance.
– Team Bennet https://t.co/9FopYinzJu

— Michael Bennet (@MichaelBennet) May 31, 2019

The depressing thing, is that it’s Michael Bennet.

Making the argument that you are not being a hypocrite for opposing Medicare for all because you are not on a government plan, because you are on your wife’s college professor benefits is lame.

It’s Joe Biden riding a yak, and claiming that it’s a unicorn lame.

Great Googly Moogly, this guy is like the patron saint of centrist Democrat lame.

On the bright side, the comments on the tweet, which excoriate the distinguished gentleman from Colorado are an absolute hoot to read.

Not Enough Bullets

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The highest pay packages go to CEOs at healthcare companies. For the third time in four years, chief executives in the healthcare field led the S&P 500 in terms of total compensation. The typical CEO in the industry made $16.1 million last year, which means half earned more than that, and half made less.

A look at the top and bottom-paid CEOs last year, by industry, as calculated by The Associated Press and Equilar, an executive data firm:

1. Healthcare, median compensation of $16.1 million, up from $14.7 million a year earlier.

I so want the guillotine concession when the sh%$ hits the fan on the dysfunctional healthcare system in the United States.

Someone Is Looking to Steal from Us

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Specifically, the healthcare executives who are calling for a rollback on anti-kickback laws.

They claim that this will allow for, “Innovation.”

What they really want is a way to goose their profits and their salaries, because this about self-dealing, not improving the quality or efficiency of healthcare.

Whenever I hear someone talk about how deregulation will allow for innovation, I am reminded of Paul Volker’s quote on financial innovation, that, “The only thing useful banks have invented in 20 years is the ATM.”

Let us be completely clear, this is about legalizing larceny, nothing else:

Beth Hughes’ job involves closely partnering with physicians to sync Sioux City, Iowa-based MercyOne’s operations and move the health system forward. But one regulation continues to stand in her way—the Stark law, the president of MercyOne’s Western Iowa region said.

The Stark law is meant to curb Medicare and Medicaid spending by prohibiting a physician for making referrals that financially benefit the doctor. That combined with the federal anti-kickback statue have impeded new payment models by limiting incentives used to reward progress, providers said, noting that they can incur significant financial penalties even if they didn’t intend to violate the regulations.

………

“Being creative with value-based care flies in the face of fraud and abuse laws,” Hughes said as organizations like MercyOne aim to reduce hospital readmissions and length of stay. “You can try to get an exception, but most people are discouraged because it is a long and arduous process. Those laws may be inhibiting our ability to creatively align ourselves with providers.”

More than 36% of 162 healthcare executives surveyed by Advis said that fraud and abuse laws don’t support new models of care—the most common answer to what regulations stand in the way of changing healthcare for the better. Fraud and abuse laws were followed by Medicare conditions of participation and state licensure laws as well as limits on telehealth reimbursement.

If this doesn’t sound like a license to cheat and steal, you have the political and financial acumen of Little Orphan Annie.

When the DCCC Calls for Money………

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Remember Nancy Pelosi’s promise to the insurance companies that there won’t ever be Medicare for all.

I am not suggesting that you close your wallet for the 2020 election season, but I AM suggesting that allowing the party establishment to decide where YOUR money goes is a sucker bet”

Less than a month after Democrats — many of them running on “Medicare for All” — won back control of the House of Representatives in November, the top health policy aide to then-prospective House Speaker Nancy Pelosi met with Blue Cross Blue Shield executives and assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices, according to sources familiar with the meeting.

Pelosi adviser Wendell Primus detailed five objections to Medicare for All and said that Democrats would be allies to the insurance industry in the fight against single-payer health care. Primus pitched the insurers on supporting Democrats on efforts to shrink drug prices, specifically by backing a number of measures that the pharmaceutical lobby is opposing.

Primus, in a slide presentation obtained by The Intercept, criticized single payer on the basis of cost (“Monies are needed for other priorities”), opposition (“Stakeholders are against; Creates winners and losers”), and “implementation challenges.” We have recreated the slides for source protection purposes.

An added benefit to not giving to the DCCC is that the DC consultants won’t siphon away 60% of your donations to line their own pockets.

Our Dysfunctional Healthcare System

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250 hospitals have have joined a consortium to manufacture their own generic drugs, in order to deal with the price gouging and shortages:

Hospitals have a creative plan to tackle the high price and frequent shortages of generic drugs.

The nonprofit company, dubbed Civica Rx, was first announced in early 2018, and has gained a lot of attention from other hospitals around the US who are interested in being a part of the venture.

On Monday, the organization said that another 12 health systems had joined its ranks, including Illinois and Wisconsin-based Advocate Aurora Health, Michigan’s Spectrum Health, and NYU Langone Health. Together, they make add another 250 hospitals to the venture.

They join a slew of hospitals, including Catholic Health Initiatives, HCA Healthcare, Intermountain Healthcare, Mayo Clinic, and Providence St. Joseph Health that serve as governing members. The Department of Veterans Affairs is also consulting with Civica to make sure the agency is getting what it needs for patients. 

……… 

To start, Civica will focus on making 14 drugs that are used in hospitals, typically injectable drugs. Those are expected to come in 2019. The company’s priorities include making essential medicines that have been on the FDA drug shortage list, and taking on decades-old drugs that have artificially higher prices because they don’t face any competition. 

………

For years, health systems have been on the hook for skyrocketing drug prices for injections or drugs delivered through IV solutions. And as of Thursday, there were 205 drugs currently facing shortages, according to the American Society of Health-System Pharmacists. Those shortages include everything from bags of saline solution to common antibiotics and a type of epidural used for pregnant women during childbirth.

This is an indication of a profoundly broken system.

Remember When the Koch Brothers Funded Study on Single Payer?

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The headline number was supposed to be the taxes required, but even with their money skewing the analysis, courtesy of the best minds at George Mason University that money can buy, the savings were in the trillions of dollars. (Self own time)

Well, some good folks at my alma mater ran the numbers without a thumb on the scales, and the savings are even more eye poppingly huge:

Medicare for All advocates just received an early holiday present: a new study from the Political Economy Research Institute (PERI) at the University of Massachusetts-Amherst finds that single-payer health care will save the US $5.1 trillion [as compared to the $2.054 trillion from the Mercatus Center study noted above] over a decade while drastically cutting working-class Americans’ health spending. It’s the most robust, comprehensive study yet produced on Medicare for All, which has long been in need of easily citable research.

The study analyzes Sen. Bernie Sanders’s Medicare for All Act from top to bottom, elaborating on several key aspects of the bill, including what the transition to a fully public, comprehensive, free-at-the-point-of-use health care system might look like and what impact the program will have on US residents. Most significantly, it answers the most common question single-payer advocates face: “How will we pay for it?”

The findings are impressively thorough. Reaching nearly two hundred pages in length, the report has been praised by health policy experts for its sound methods and clarity. Alison Galvani of the Yale School of Public Health predicts it will become recognized as the “seminal analysis” of Medicare for All.

This amounts to over $1500 a year savings for every man, woman, and child in the United States.

We need to do it now.

Private Equity Kills Grandma

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The Carlyle Group took over HCR ManorCare, a nursing home chain, and turned it into a charnel house:

To the state inspectors visiting the HCR Manor­Care nursing home here last year, the signs of neglect were conspicuous. A disabled man who had long, dirty fingernails told them he was tended to “once in a blue moon.” The bedside “call buttons” were so poorly staffed that some residents regularly soiled themselves while waiting for help to the bathroom. A woman dying of uterine cancer was left on a bedpan for so long that she bruised.

The lack of care had devastating consequences. One man had been dosed with so many opioids that he had to be rushed to a hospital, according to the inspection reports. During an undersupervised bus trip to church — one staff member was escorting six patients who could not walk without help — a resident flipped backward on a wheelchair ramp and suffered a brain hemorrhage.

………

Under the ownership of the Carlyle Group, one of the richest private-equity firms in the world, the ManorCare nursing-home chain struggled financially until it filed for bankruptcy in March. During the five years preceding the bankruptcy, the second-largest nursing-home chain in the United States exposed its roughly 25,000 patients to increasing health risks, according to inspection records analyzed by The Washington Post.

………

The rise in health-code violations at the chain began after Carlyle and investors completed a 2011 financial deal that extracted $1.3 billion from the company for investors but also saddled the chain with what proved to be untenable financial obligations, according to interviews and financial documents. Under the terms of the deal, HCR ManorCare sold nearly all of the real estate in its nursing-home empire and then agreed to pay rent to the new owners.

Taking the money out of ManorCare constrained company finances. Shortly after the maneuver, the company announced hundreds of layoffs. In a little over a year, some nursing homes were not making enough to pay rent. Over the next several years, cost-cutting programs followed, according to financial statements obtained by The Post.

That sale and lease back arrangements are a central part of private equity looting.

The financialization of our economy is a very bad thing.

The Vampire Squid Abides

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Goldman Sachs has made the most reprehensible healthcare decision of the year, which is saying a lot, when they decided that it makes no sense to invest in cures, because if you cure someone, they won’t buy any more of the drugs.

Basically, they redefined medicine as hooking patients into a lifelong pattern of drug use:

Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering “gene therapy” treatment: cures could be bad for business in the long run.

“Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.”

“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies,” analyst Salveen Richter wrote in the note to clients Tuesday. “While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

F%$# the Vampire Squid.  They, and f%$# the whole degenerate for-profit health care system needs to be dismantled root and branch.

Only In the United States

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Insurance groups are recommending GoFundMe as official policy – where customers can die if they can’t raise the goal in time – but sure, single payer healthcare is unreasonable.

h/t @DanRiffle pic.twitter.com/zetPW0MgDd

— Alexandria Ocasio-Cortez (@Ocasio2018) November 24, 2018

Yes, this a copy of a letter from an insurer that is asking someone to do a GoFundMe before they will approve a procedure.

Alexandria Ocasio-Cortez is rightly horrified by this, and so should we all.

It’s Getting to be a Real Whine and Cheese Party, Isn’t It?

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Specifically, now we have Arizona Senate candidate Martha McSally complaining that her vote to end protections for people with existing conditions was a vote to end protections for people with existing conditions:

Soon after she assumed office to represent Arizona’s Tucson-based district in the House of Representatives, Martha McSally voted for a Republican-backed measure to repeal the Affordable Care Act.

 McSally’s “aye” vote for H.R. 596 was recorded on the evening of Feb. 3, 2015, and came as her party was intent on undoing, tweaking or rolling back the controversial 2010 health care law implemented by President Barack Obama and Democrats.

 A year later, McSally voted again to repeal the law.

………

 And in May 2017, McSally voted for the GOP’s American Health Care Act, which revived their hopes of repealing central portions of the Affordable Care Act, often referred to as “Obamacare.” That legislation, if passed, would have reduced the federal deficit but resulted in 23 million more uninsured Americans through 2026, a Congressional Budget Office analysis found, though McSally’s campaign says that estimate was based on “bad projections” about the Affordable Care Act that never materialized.

 McSally urged her colleagues, gathered on the day of that 2017 vote in a private meeting, that it was time to get this “f—ing thing” done, according to the Associated Press. 

………

McSally told The Arizona Republic on Saturday that she’s being “character assassinated” by her critics on health care.  

………

“Well, Sean, I did vote to repeal and replace Obamacare on that House bill — I’m getting my ass kicked for it right now because it’s being misconstrued by the Democrats,” she said. “They’re trying to, you know, invoke fear in people who have family members or loved ones with pre-existing conditions.”

 ………

Everywhere she goes, [McSally’s Democratic opponent Kyrsten] Sinema said, people “are concerned about Martha’s attempts to roll back protections for people with pre-existing health conditions, which she has done several times.”

(emphasis mine)

It’s a well deserved ass kicking, stop whining.

You deserve every bit of opprobrium that you have earned for trying to take people’s (still pretty dysfunctional) healthcare away.

The Goal of Privatization is Not Efficiency, It’s Larceny

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Case in point, Iowa, where a timid Obama administration allowed the Republicans there to privatize medicaid, and the rate of cost increases have tripled:

The average cost of insuring an Iowan on Medicaid has climbed nearly three times as fast since the state hired private companies to manage the program, when compared to the previous six years, new state figures show.

Since fiscal 2017, the first full year of privatization, the per-member cost of Iowa’s Medicaid program has risen an average of 4.4 percent per year, according to the non-partisan Legislative Services Agency. In the previous six years, the per-member cost rose an average of 1.5 percent per year, the agency said.

The new cost figures come amid continuing controversy over whether Iowa should have hired private companies to run the $5 billion program. The shift’s supporters said it would slow growth in health care spending on the more than 600,000 poor or disabled Iowans covered by Medicaid.

………

The Medicaid cost increases for this fiscal year are partly driven by an 8.4 percent raise the Iowa Department of Human Services agreed last month to give the two managed-care companies running the program. That raise, which includes state and federal tax dollars, will send $344 million more to Amerigroup and United Healthcare this fiscal year, which runs through June 2019.

Anyone want to guess how much of those increases get recycled through to campaign donations?

Epic Fail by Koch Suckers

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Yes, Bernie Sanders is thanking the Koch Brothers

In the wholly owned Koch industries subsidiary formerly known as George Mason University, their even more owned think tank known as the Mercatus Center released a study on Medicare for all.

They headlined that it would cost the federal government $32 tillion over the next 10 years. What they relegated to the small print was that it would save $34 trillion over the same period.

Oops:

The US could insure 30 million more Americans and virtually eliminate out-of-pocket health care expenses while saving $2 trillion in the process, according to a new report about Medicare for All released by the libertarian Mercatus Center.

In the report, Charles Blahous attempts to roughly score Bernie Sanders’s most recent Medicare-for-All bill and reaches the somewhat surprising (for Mercatus) conclusion that, if the bill were enacted, the new costs it creates would be more than offset by the new savings it generates through administrative efficiencies and reductions in unit prices.

……… The net change across the whole ten-year period is a savings of $2.054 trillion.

When talking about Medicare for All, it is important to distinguish between two concepts: national health expenditures and federal health expenditures. National health expenditures refer to all health spending from any source whether made by private employers, state Medicaid programs, or the federal government. It is national health expenditures that, according to the report, will decline by $2.054 trillion.

Federal health expenditures refer to health spending from the federal government in particular. Since the federal government takes on nearly all health spending under Medicare for All, federal health expenditures will necessarily go up a lot, $32.6 trillion over the ten-year period according to Blahous. But this is more of an accounting thing than anything else: rather than paying premiums, deductibles, and co-pays for health care, people will instead pay a tax that is, on average, a bit less than they currently pay into the health care system and, for those on lower incomes, a lot less.

………

But the real game here for Mercatus is to bury the money-saving finding in the report’s tables while headlining the incomprehensibly large $32.6 trillion number in order to trick dim reporters into splashing that number everywhere and freaking out. This is a strategy that already appears to be working, as the Associated Press headline reads: “Study: ‘Medicare for all’ projected to cost $32.6 trillion.”

………

But even if you take the report’s headline figures at face value, the picture it paints is that of an enormous bargain. We get to insure every single person in the country, virtually eliminate cost-sharing, and save everyone from the hell of constantly changing health insurance all while saving money. You would have to be a fool to pass that offer up.

The real problem that Mercatus has with Medicare for all is that people named Charles G. Koch and David H. Koch will be paying more in taxes than they will personally get in benefits, so it must be fought tooth and nail.