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Apr 4Liked by Alan Unell Ph.D.

Congressional Budget Office 200-page analysis (Dec 2020) found that a public system (read: single-payer universal healthcare) could reduce our "national health spend" by up to $650 billion a year or more. Most of these gobstopping net-cost savings came from reduced admin costs.

I don't recall whether the admin costs identified in the CBO's analysis include — along with public costs (i.e. government costs) — provider costs (e.g. medical practices, hospitals, etc) and generic business costs (such as HR departments in companies and small businesses that offer employee healthcare and therefore must manage this crazy burden).

I gotta go back and look up this stuff.

Off the cuff, here's one factoid: on average, medical practices must employ two billing clerks for every three physicians. Think about that.

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author

Thanks Ira - I appreciate it. I think the admin staff was part of the $400 billion yearly savings, but I will check. I like the way you frame the billing staff. They would be unnecessary. HR 3421 - Medicare 4 All, actually includes 5 money in the budget for 5 years to retrain those kind of employees that would be displaced. I think Pramilla Jayapal did a great job on that bill.

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Apr 3Liked by Alan Unell Ph.D.

Hi Alan,

This is a very informative post. Thank you!

Although I agree with you that universal healthcare makes the most sense, too many of our elected officials and candidates are facing headwinds of public opinion. They may, however, be able to make greater headway by emphasizing the corrupt nonsense of blocking Medicaid expansion while driving money that could pay for healthcare to inefficient gatekeepers.

In addition to Heather Cox Richardson’s telling us that blocking a safety net is an old argument that began with racism and privilege, there is a traditionally conservative belief that only those who have put in the work deserve fair treatment. That research is Moral Foundations Theory. Here’s a link to that research:

https://moralfoundations.org/

A moral foundation is a strong emotional tendency to favor what one considers a moral outcome. It’s like an instinct, a strong and adaptive feeling that is stronger than strictly rational decision-making.

This link takes you to a chapter of a book by social psychologist Jonathan Haidt, where if you scroll down to page 7, you’ll find a detailed discussion of each moral foundation, including fairness.

There is also research, possibly by retired Prof. Bob Altemeyer, on people who support authoritarians. The idea is that people who grew up in conservative communities have a belief in self-sufficiency that affects their interpretation of what is fair. Here’s a link to Altemeyer’s work:

https://theauthoritarians.org/

Finally, perhaps you can clarify in a brief summary how taxes are raised to benefit the local economy by providing more healthcare coverage. If we’re going others who have not been tuned in, we need to counter the reactionary mantra that liberals love to tax and spend that has been promoted since the Reagan Administration. When everyone pays their fair share of taxes, including rich people and corporations, we can fund services and invest in public works and infrastructure that benefits our economy and improves living conditions.

Along this line, recently, Robert Hubbell recently pushed back against another one of these reactionary talking points that the “deep state” is really comprised of dedicated citizens who are the civil servants who provide services to ensure public safety and respond to emergencies, including the activation of the Army Corps of Engineers to restore the Port of Baltimore after its catastrophic bridge collapse.

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Thank you, Gary. I will read the references - the better informed we become, the more we can do.

I will explain the taxes separately in another article, but it relies on 2 factors

1) states are allowed to the services provided by hospitals to offset their Medicaid expenditures (I think most people don't even see that in the bill).

2) As more people require health services more people enter the workforce to accommodate them and those additional employees pay state and local taxes, purchase things and pay sales tax etc

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