← Economic Update with Richard D. Wolff
Loading summary
Transcript19 lines
- [00:10]
A
Welcome, friends, to another edition of Economic Update, a weekly program devoted to the economic dimensions of our lives. Jobs, debts, incomes, the growth of some parts of the world economy, the shrinkage of other parts, and how it impacts all of us. I'm your host, Richard Wolff. I've been a professor of economics all my adult life. And in a way, I hope that that has prepared me to provide these comments on what's going on in the economy today. I want to begin by presenting to you some of the findings of the World Wealth Report. This very important periodic document took time out this year to take a look at the last 40 years, the period since 1980 of looking at what has happened in the world economy and what it tells us. So important are these results that the Harvard Business Review for The month of March 2018 devotes a long, detailed article to this wealth report. And what I'm presenting to you is a mixture of what the report contains and the and what the Harvard Business Review also has to say about it. Let's start at the top and then look at it with some detail. Inequality in the world has sharpenedly worsened over the last 40 years. Let me explain. There has actually been a shrinkage of inequality, less inequality, when you compare countries to countries, mostly that has to do with extraordinary improvement in the economic performance of China. And then also India and Brazil. They have gotten relatively richer fast. And the rest of the world, particularly the older, wealthy partswestern Europe, North America and Japan, have grown much, much more slowly, if at all. And so there's been a little less inequality country to country. But the price of that has been a staggering increase in inequality inside countries, literally all countries. Growing inequality in China, in India, as I will come back to, as well as in the United States, Western Europe and Japan and so on. That's what I want to talk to you about. Over the last 40 years, the share of income of the top 1% of people in the world, the top, the richest 1%. In 1980, they together got 16% of the world's income. They were only 1% of the world's people. They got 16% of the world's Income. By 2016, that share of the top 1% had risen from 16, which is what it was in 1980, to 20%. Wow. That means the rich got much richer. The rich got a bigger share. Not only did their income go up, but it went up faster than everybody else so that everybody else had to make do with a smaller share share. Let me look at this in some detail so you can see the most Remarkable of it. From 1980 to the present, the income of the top richest 0.001%, that's really the richest of the rich in America, went up by 600%. You heard me right. From 1980 to 2016, the income of the richest 0.001% went up 600%. The bottom half of the American people, that's 160 odd million people, the bottom half saw no income increase at all over the last 40 years. That is, if you adjust the money they earned for the prices they had to pay, they went nowhere. I want to let that sink in. The richest people got an increase over 40 years of 600% and the bottom half of the population saw no increase at all in Europe. Just to give you another kind of comparison, that top 0.001%, that income grew, but it grew five times more more slowly than in the United States. The Europeans didn't experience the level of growth of the top at the expense of everybody else the way they did in the United States. So that the bottom half in Europe over 40 years grew by 26% over 40 years. That's not much, but it is better than zero, which is what their American equivalent, the lower half in America, which was able to do compare China and India. China grew much faster than India, but unlike India, it didn't have a growing inequality like the Indians did. Yes, inequality in China grew, but it grew much more slowly than the inequality of India. And that tells you as much about what is happening to divide Asia as as any other statistic I can think of in the United States. Then the bottom 50% income share decreased from 20% of total income to 10%. Let me drive that home. The bottom half of the American people lost half of the share of total income produced in America compared to 1980. It has been a disaster for the bottom half, which is the biggest clue I can give all of you about how to understand American politics right up through Mr. Trump. But where the Harvard Business Review article falls down is to explain why did this happen? What causes this staggering growth? But even before I do that, I want to use these data to make a powerful point. We have been told for the last century that capitalism is going to enrich the rich. Yes, indeed. But we're all going to benefit because it's all going to trickle down. The rich being better off will make us all participate in their good fortune. These statistics show for the last 40 years. That is cold stone wrong. That doesn't happen. It doesn't trickle down here in the United States even more dramatically than anywhere else in the world. The rich got much, much, much richer. And the poor went absolutely nowhere. Nothing trickled more. My friends, if you want to help the people, the majority, the bottom 2/3 of this country, you're going to have to help them. You're going to have to deal with them. The notion that you can make the rich richer and feel good that it'll all trickle down is revealed by the last 40 years to be the phoney oni story it always was. As to some of the reasons, in 1980, the United States had the highest minimum wage in the world. But since then, the minimum wage again adjusted for prices, how much the minimum wage actually pays you versus the prices you have to pay. The minimum wage has fallen by 30%. Let me compare that to France, where the minimum wage has gone from 1980 to the present by up by 300%. It's tripled. Let me drive it home again. In the United States, the real minimum wage fell by 30%. In France it rose by 300%. We're not talking small differences here. There's a reason why the bottom half in Europe didn't fare as badly as the United States. Because they're treated better. They have a national health Service and a national health insurance program that that helps them. Higher education is becoming more and more costly in America, requiring families to take out debt. In more and more European countries, higher education is becoming free, no charge at all. Let me give you a little example that struck me. When Bavarian policymakers, Bavaria is the southern part of Germany, tried to introduce small university fees in recent years, a referendum was called in which the Bavarian people fundamentally and overwhelmingly rejected the imposition of fees. The two parts of the world, Europe and North America, are different. And nowhere does it show in the less serious inequality growth in Europe than in the United States. But fundamentally, capitalism has shown itself in the last 40 years to be an engine of unequal economic development. Unequal development. It is not the alternative. The only reason capitalism, temporarily after the 1930s, made less inequality was the massive uprising of people across the world demanding a better treatment than what capitalism was giving them. And they got it for a while. The New Deal in America, social democracy in Europe. But as soon as capitalism could recover and resume its normal momentum, its normal way of development, inequality was the gift it gives. No trickle down inequality is the cost of the capitalist system for the majority. I want to move next to an institution that isn't part of the normal capitalist arrangement here in the United States. I want to talk to you Briefly, about the ymca. This is a charitable institution, been around in the United States for a long time, usually providing all kinds of services to working people, poor people, athletic facilities, social benefit programs of various kinds. But I want to talk to you about the problem of the YMCA because it illustrates a larger point. The YMCA in particular I'm going to talk to you about is the YMCA in Chicago, one of America's biggest cities. The head, the CEO they call him, which is already a hint. The head of the ymca, a social service organization, is given the same title as the head of a capitalist corporation. Chief Economic Officer, CEO. The CEO of the Chicago YMCA is Dick Malone. In 2016, his total income, salary and bonus came to $580,000 for the year. That's over half a million dollars. The workers at the Chicago ymca, the people who clean the YMCA buildings, who make sure that the water in the YMCA swimming pool is safe for children to go into, etc, etc, earn in the range of get ready now $11 an hour to $15.50 an hour. Let's do that again. The workers get 11 to 15 bucks an hour. The the CEO gets half a million dollars a year. This grotesquerie led finally after years to the workers, those earning 11 to 15, to call a strike on March 1st of 2018, a one day strike to protest this grotesque inequality. They were organized by the seiu, the Service Employees International Union, and that negotiations between the two sides are continuing. Why did I bring this particular little strike to your attention? Because the inequality of capitalism spreads beyond the corporation. It is replicated sadly in institutions that are not profit making, corporate driven institutions. The YMCA is a social service or organization. No one expects it to run a profit. No one demands that it compete against other social service organizations to earn a profit. Yet the infection, if you like, the disease of capitalism spreads and makes a YMCA replicate what goes on in corporations. Wild overpayment of the people at the top. Gross underpayment of those who do all the work until it's unbearable. They contribute to the inequality because they allow the model of capitalism to be reproduced in their own ranks. The next economic update I want to bring to you was stunning and I'm sure caught many of your attentions as well. This has to do with an event in Quebec, Canada. 700 physicians, residents and medical students rejected a pay raise that had been negotiated by the federations that represent them. My goodness. An organization of these doctors called Medecins Quebecois pour le Regime in French, because it's Quebec, of course, said we Quebec doctors who believe in A strong public health system oppose the recent salary increases negotiated by our medical federations. My goodness. In February, Quebec's legislature gave another increase to the 1,000, excuse me, to the province's 10,000 medical specialists. The average salary for a specialist in Quebec is already high ready $400,000 annually. And so these doctors, these 700 out of those 10,000 said, wait a minute, there's something wrong. We are already very well paid and this system is giving us an increase. While there aren't enough supplies, there aren't enough nurses, there aren't enough other workers in the health system to provide a decent health system. We don't want our increases. We'd rather see the money go to make a better health system. Now, I want to explain to all of you what this means. This is very important. It's not just about the generosity of of these specialists. It's not just about the wonderful model of workers who care more about the service they're part of than grabbing a little more money for themselves. Granted, they're already very well paid. But I want to talk to you about again the capitalist model. You pay the people at the top a great deal, and part of that money is to keep down everybody else because. Because you know something? It's been learned by capitalists that if you pay the top a lot, you can avoid having to pay the mass of your workers what they really ought to be paid. It's cheaper to pay those at the top a lot more than it is to give everybody a fair shake. And so you're top heavy with overpaid folks at the top. And you know something? This happens everywhere outside of the corporation and in it. Corporate executives at the top are paid enormously. And part of their job is to manipulate and control everybody else, because the people who run the system understand in the end, it's cheaper to pay the top a lot more if it avoids having to pay the mass of people a decent salary. You see it in the university with top heavy folks at the top. At the administrators, you see it at the ymca, you see it in the medical profession. You see it everywhere. Messing up the average worker by overpaying those at the top and telling them we'll pay you extra. You keep the lid on all of those fellow workers. Well, 700 courageous doctors and medical professionals in Quebec understand this game and said no. As if to illustrate it, here's the next update. The uuk, which is an organization of lecturers and other staffs in universities across the United Kingdom, started a two week strike period on March 1st, why? Because again, the conditions of their teaching and the quality of the education they can bring to the people are of Britain is being attacked and they won't have it. Another example, Oklahoma. Oklahoma is a state here in the United States which has the following statistic it has to be ashamed of. It has the lowest paid public school teachers in the 50 states of the United States. They were so moved by the strike of public school teachers in West Virginia that that they are now planning to do it themselves. They're going to have a strike and their union, unlike the one in West Virginia, the affiliate of the National Education association is saying they will be part of this. They saw the writing on the wall in West Virginia. Once again, teachers are saying, you cannot treat us as if we don't matter because. Because it's an insult not only to us as professional teachers, but to the people of this state into whose care you have entrusted their children. What kind of a commitment to the future, to children is shown by paying your teachers less than any other state in the union? At this point, I want to make a usual break and remind you that we maintain two websites that we urge you to make use of. The first is rdwolff with 2f's.com and the second one is democracyatwork.info. both of them allow you to follow us on Facebook, Twitter, Instagram. Both of them allow you to communicate what you like about this program, how you would like us to change the program, and so on. And both of them provide you with extra material. They are available to you 24. Seven, no charge whatsoever, ever. For those of you that are listening and would like to see this program instead as a video, as a television program, we urge you please go to patreon.com on the Internet p a t r e o n patreon.com economicupdate and that will allow you to view this program as a television. I also want to remind you, as we did last week, to take a look at these two programs that we provide podcasts that you can find as well on our website. The first is Left Out, a monthly podcast that does all kinds of interesting interviews I think you will find extraordinarily interesting. And also another one called Puerto Rico Forward that offers really extraordinary insights into the history and and struggles of the Puerto Rican people. At this time, I encourage you to give them a listen. We're very proud of adding them to what we do on our websites. And you can also find Left out and Puerto Rico Forward on itunes, Google Play, as well as our website. I think you will find them as valuable and useful as I do. My next update goes to Africa with the American Secretary of State Rex Tillerson. He gave a lecture recently in Africa warning African countries to be wary of making commercial dealsloans building projects with China because he said the Chinese may take advantage of you if you make those financial deals. I blew my socks off. Here is the American Secretary of State telling Africans who starting with the slave trade have understood that dealings with the West, Europe, Americain any economic way is a long term project of destroying Africa in many ways giving advice that they should be wary of somebody else who might do that to them. There's something horrifically absurd in the very spectacle. And his inability to recognize the absurdity of what he was doing tells you a lot about the Trump administration if you didn't figure it out already. And just as Mr. Tillerson was giving that little story, what was going on right nearby in the Democratic Republic of the Congo. Guess what? Apple Computers and other companies were negotiating with the government a new set of deals. What were the deals about? Cobalt. Turns out that the Democratic Republic of Congo is a place where cobalt is importantly located and can be mined. And if you want to do anything with modern batteries, you need cobalt. So the companies are cutting the deals with Congo exactly as endangering the future of Congo the way Mr. Tillerson was advising African countries not to do. That's because what Apple does is what these companies have always done. And what Mr. Tillerson does is the BS veneer as if he didn't know and understand as the former head of Exxon, heaven help us exactly what the realities. Here are the final economic update we have time for allows me to introduce you all to the jccu. What does that mean? That's Japan's Cooperative Consumer Union or to be more accurate, Japan's Consumer Cooperative Union. It is one of the largest co op associations in the world. It's been going in Japan since 1950. It now includes 334 co ops that are members of that building it is servicing. Get ready for this. It's a powerhouse. 37% of Japanese households are members of the JCCU. They are a big powerful co op organization. They prove that in that capitalist economy co ops can become a very important part of the economy. They have a specialty in grocery stores in delivering grocery and other items across Japan. They are much bigger in delivery than Amazon has been able to be. They are bigger than Amazon and do not fear the Competition with Amazon. 90% of their members are females who do the Ordering for households in Japan. Here's the interesting thing. With millions and millions of members with a very powerful role in the economy of Japan, they really are ready to take the next step. Because a consumer co op, and this is so important to understand, is a way for people to cooperate in the act of consumption, in buying things that they need, food, clothing, shelter and so on. But it is not yet about being cooperative in the production side, in cooperatively producing as well as cooperatively consuming. What could be done by consumer co ops is to say what we consume collectively and cooperatively, we also want to see produced in that way. We want to see a production side of the economy. The enterprises where goods and services are produced, factories, offices, stores, we want them to work cooperatively in the same spirit that we have consumed cooperatively. The millions and millions of Japanese that are fiercely loyal members of their consumer cooperatives want to get the same benefits of lower prices and better conditions for consumption. They want to see that also done for the workplace. Better conditions, better solidarity, a better life. What they're not willing to say yet, but I'll say it for them, they want to go beyond the capitalist workplace, the top down hierarchical inequality producing economic system that we suffer under. And they want to move to something else. They've already figured it out by cooperatively buying. Now they want to take the next step, which they are uniquely powerfully positioned to do in Japan because they've done such a fine job of the consumer cooperation. Now we can move on to cooperatizing workplace or as we like to say here, democratize the workplace. Make it be a place that serves people, not requiring people to serve it. Listen up CEOs, from corporations on over to the YMCA, time for change. We've come to the end of the first half of this economic update. Thank you very much for being with me. We're going to take a short break and then we'll be back with an interview I think you'll find remarkably exciting and important. Welcome back friends to the second half of Economic Update for today. Well, there is no more important topic that I can talk to you about than health care and the insurance that is or isn't available to make sure that everybody gets the kind of health care that a decent civilized society ought to provide to everybody. So I'm very happy to be able to talk today with Tim Faust and let me tell you a little bit about him before we turn to the conversation. Tim Faust is a single payer activist with the Democratic Socialists of America. He has been traveling the country talking about Medicare for all and about the broader fight for health, justice, justice in how we're treated and how we're charged for being treated. He is currently a student in the Master of Public Administration, or Policy Administration, rather, at NYU and with his partner produces Heavy Medical, a podcast about health policy and metal music. His book, Health Justice, Single Payer and what Comes Next, is scheduled to be published in September by Melville House Publishers. His writing has appeared in Jacobin, Vice, Splinter News, and other places. He lives in Brooklyn, New York, and runs an independent wrestling league in Austin, Texas. So it is with great pleasure that I welcome Tim Faust to Economic Update.
- [29:33]
B
Professor Wolff, thank you for having me. I'm happy to be here.
- [29:36]
A
Good. So let's start. Tell me in a summary way, since you're a specialist in this, what the situation is with medical insurance, with having the security to know that if and when you need medical care, the payment part of it is taken care of, that it is something you can rely on, that you don't have to make yourself crazy with anxiety about because you've been traveling the country. You know a lot of stories of people, what's the condition of medical insurance? And what's the case that can be made just on the grounds of basic human decency for there to be such a system?
- [30:15]
B
Sure. Over the past 60 years, we've outsourced the provision of health care and the provision of health care insurance to a big web of private companies and public partnerships where private companies can't make a profit. And kind of through that web. Well, I mean, let me talk about the results, Right. I've been driving around the country, talking to people, kind of seeing what's happening on the ground. And here are some things that I've seen. Right. I met a couple in South Carolina who have a beautiful son, little kid. About two years ago, the mother had an ectopic pregnancy, basically a surgical miscarriage. And they went to the hospital thinking, oh, we're insured, we're going to be okay. No, it turns out the husband had received a raise of about a dollar an hour a few months prior because he was receiving subsidies through the ACA Exchange. The amount he had to pay because of his raise changed, and that wasn't communicated to his insurance company. So it turns out in the middle of the hospital, they found out they'd been denied all their insurance claims, and they have a lifetime of debt that the kid's gonna grow up having. I met families in South Carolina also who have ruptured septic tanks in their backyard because no one's spending the money to repair these PVC tubes. So they're getting sick, and now hookworm is. Back in the rural south, I met folks, I made two friends across the river in Jersey, a disabled person named Steve and his PCA named Kyle. Steve can't get work, not because he doesn't want to or isn't able, because if he makes too much money, if he makes more than $273 a month, Medicaid in New Jersey will deny all the funding for his home health, which he needs at least 40 hours a week to take care of himself. His home health aide, Kyle had to move back home, living with his parents from Jersey, their best friends since childhood, because he had too much insurance debt and can't afford to work. So he's getting paid to be a home health aide to Steve, but isn't getting paid enough? He's getting paid $12 an hour, so he can't even dig himself out of his own medical debt. I met folks, union organizers in Philadelphia who can't negotiate for workplace safety or contracts. They have to spend every negotiating period fighting for worse and worse, more expensive insurance. And I met dozens of people across the Midwest who have seen their friends and families killed by by the opioid epidemic. And I mean worse than that. In rural Indiana, you've got children killing themselves in elementary schools because schools can't fund the mental health or services required to help kids because they have a robust school voucher system. Rich parents pull their kids away. And the people that are left, these necropolitan people, people who aren't counted because people who use opioids are criminals, so they're discounted entirely from discourse, are thrown to the curb, and their families suffer. And this is the result of our medical healthcare system right across the entire spectrum, Whether you've got lux private care or whether you're dependent upon the whims of public interest, whether or not you're deserving or undeserving poor, you are cared for or thrown to the curb, but regardless, you're being charged more. 75% of all medical costs in America stem from preventable conditions. But nobody is spending the money to prevent them, right? So we've kind of. If you're an insurer, if you're a payer like an insurance company, it's just not profitable to take care of sick people or poor people. So you outsource them to Medicaid or you kick them off your rolls. But if you're a provider, like a hospital or a hospital corporation, it's Very, very profitable to provide people with the most expensive care as late as possible. So kind of across these two truths, we've built a model in which people are made sick and then punished for being sick. And nobody has the agency or the ability or the incentive to change a goddamn thing.
- [33:44]
A
You know, I would add only this. I encounter huge numbers of older people. By older, I mean 50 years of age or older, who all say the following thing. Every time I have to deal with the medical insurance industry, whether it's the government programs or private insurers, however sick I am, the process of dealing with paying for it makes me sicker. It's kind of. It's become a joke, but it's a joke that's repeated a thousand times a day by people for whom the whole insurance system is outrageous on a level that upsets your very equilibrium as a physical person.
- [34:29]
B
It's disgusting. There's the current president of Physicians for Our National Health Care Plan submitted a. But wasn't accepted for a new diagnosis in the dsm, which is the big diagnostic manual, which was private insurance Induced Stress Disorder, which abbreviates the pissed. There's also a legal professor in University of Tennessee at Knoxville named Zach Book, who has posited the idea of financial toxicity, which is that medical debt and the process of going through it or trying to get rid of it is itself a consequence, a medical symptom that's stressful. It makes you sicker. And so, yes, even the act of negotiating or maneuvering insurance itself makes people get sicker and delay care.
- [35:08]
A
Well, let me pose to you then, partly because it's in our culture the kinds of questions that I'm sure you've heard before, but that I want our audience to hear you respond to. What's the economic case for a proper, well functioning, comprehensive national health insurance program? Because we are told what we have is the best we can do because we can't, quote, unquote, afford more. What's the economics here as you've encountered it, that makes the alternative case, but.
- [35:43]
B
We literally can't afford not to right now. Health care spending grows year over year, massively for a bunch of okay and not okay reasons. Right? Okay reasons include people living longer with chronic conditions, therefore more expensive to treat, great, great use of money, not okay. Reasons include the, I think $750 billion of annual medical waste a year, which is high prices, overcharging, overspending, and also just outright fraud. The result is that gross medical spending right now is about $3.1 trillion a year. In 2027, it'll be $4.5 trillion a year if nothing changes. A federal universal single payer, which is basically one giant insurance company that insures all people regardless of income, sickness, ability to pay whatever that guarantees full care for all people, has the ability to, through massive buying power or through legislation, basically keep spending flat. We can go from 3.1 trillion to 3.2 trillion over the next decade as opposed to 4.5 trillion over the next decade. So we can't afford not to. We're losing money by refusing to have any kind of common sense measures of how health care works. In other countries that have either a single payer model or a multi payer model like Germany, you've got still a federal agency that basically sets prices or sets price bands for private or nonprofit insurers to use. We have nothing like that. So there's massive upward inflation. I mean, you look at, I think Deloitte, Deloitte Consulting is a consulting group that really kind of, I think, stuck out in developing the idea of medical and hospital care consulting over the past 20 years. I think they invented a $34 billion revenue stream just from teaching hospitals how to upcode things and how to, how to build more things to more people. For example, the crazy idea that you can have one anesthesiologist or one neurosurgeon have a bunch of surrogate like assistants that perform surgery for them, but get to bill at the higher rate for the higher doctors. Even though you're getting surgery by a pa, you're getting billed at the neurosurgeon, which of course is much more expensive. They can have four of those people operating at the same time. That's four times the revenue, things like that, charging more for facility fees, charging more for different kinds of drugs, letting doctors own their own MRI facilities that they then of course refer into so they get a profit. All these different kinds of ways of nickel and diming at a massive scale. A bunch of payers like insurance companies who are too small to do anything about it. Right. Really the economic argument for a single payer is that it has massive buying power. Right? Now, if I'm an insurer, if I'm a little private insurer like Aetna, one of the largest companies in the US I still can't really go head to head with a hospital in an area, right? If I want to negotiate a claims, if I want to negotiate coverage with a hospital in, let's say Pittsburgh, where there's one major hospital, they kind of get to set what their prices are, I can't say no as an insurer because they have the actual supply of health care that can be provided. So they get to set prices sky high and I can't do anything about it. And honestly, so long as the government's subsidizing me to insure people, I don't really care because my revenues go up year over year at the same time. But these hospitals do negotiate with large federal entities like Medicare. Medicare negotiates on behalf of 44 million people. So when they put out their agenda saying here's how much we're gonna pay for a knee surgery, X dollars with Y and Z adjustments based upon like location, need, whatever, hospitals can either take it or they can leave it. And if they leave it, they leave access to those 44 million people, which they refuse to do. That's too much money being passed up. Hospitals will always take some revenue for delivering care as opposed to no revenue for providing care. So the Medicare gets to play a much more aggressive game. And what they're willing to pay and also how they're willing to structure payments than insurance companies do, an expanded Medicare for All and improved Medicare for all. Because Medicare as it exists now, now is insufficient for the needs of people. Negotiates on behalf of 300 million plus people. And so therefore what it can do, the price bands it can set are much, much more aggressive. The kinds of things it can fund are much, much more aggressive. And the ability for people to get care, they don't need to worry about increases. I've got a good example of kind of how this shakes up. Appalachian Maryland is a de facto single payer area. The single payer is Medicaid. Appalachian Maryland is a part of the US that we've stripped and burned and ravaged for the past 40 years. Now all of a sudden, nobody there has employer sponsored insurance because there's no employer to sponsor insurance in the first place. We've hosed these people over both ways. And now Medicaid's basically the de facto single insurer in the area. And there's one provider, there's one hospital group really in the area. There's supposed to be many, but of course they aggregate because you can make a whole lot more money if you aggregate your provider groups. And now there's one with just serving that entire region. And because it's not profitable, for example, to provide rural care or provide outpatient primary care, if outpatient primary care, maybe you get billed, you can bill a couple hundred dollars tops for treatment, but inpatient surgery, you can bill $2,000 a night. So if you're a hospital, makes a lot more sense to pull out of rural areas, let folks come to you and then fill all your beds every single night, build massive wing expansions. And it's kind of raking that money over time. This will was running the Maryland state coffers. And Maryland as a state can't print money, has a balanced budget, has a lot more limitations than the federal government was kind of getting drain dry by paying for Appalachian Maryland. Until the Maryland Medicaid commissioner, I think her name was Shannon McMahon, no relation to the WWE. McMahon said enough was enough and put a new capitation rate in place. Medicaid in Maryland was going to pay this hospital chain a flat. I think it was $100 million a year plus inflation. And they had to provide care to all patients, go forth and make your own profit. And then what happened is that hospital group began doing a lot of the good things you would hope a good health care provider would do. They reopened primary care clinics, put doctors back in rural areas and did all the things that may because now they were incurring costs for providing too late or too expensive care. They tried to undo their own trend and put people back and they turned, I think at 8% profit the next year, which is all unheard of. And people got access to better care earlier in life. A single payer can do these kinds of things and our fragmented multi payer model simply cannot. On the economic case, like all the problems of health injustice in America, like unsafe housing which makes you sick, lack of housing, I think, I mean obviously you get sicker and dire much sooner of exposure than cancer. For example, I think a hospital in Chicago and a hospital in Orlando experimented with the radical idea of providing, providing housing to their poorest, sickest patients, ended up saving millions of dollars per year because they weren't coming to the hospital when it was cold outside. Single payer won't solve the problems of structural violence and how care is afforded, racial and sexual violence. But it's the only tool we have that can possibly be used to counteract these things, right? Like the fragmented, commodified, privatized, with occasional federal justice model has had 50 years to try to reckon with this and here's the result. People are dying, they're getting worse care. Life expectancy fell for the first time last year by a tenth of a year, which of course is a theft of 400,000 years across a generation of people born last year. But of course, as you know, that decreased life expectancy only Exists for poor people. Right. Rich folks get to live 12.5 years longer than poor people.
- [42:57]
A
Well, you've been thinking about this, you've been experiencing this, you've been traveling. You have these stories you to tell. How do you account for it? Why is it possible here in the United States to have a system that works as poorly as you've just summarized it, while costing us more than health care costs anywhere else in the world? This is stunning that the United States should have mediocre outcomes and the highest possible cost way ahead of anybody else. What's causing it? Why is this happening? Why are we subject to this?
- [43:29]
B
Well, you've got a combination of massive upward pressure on prices, which I think is honestly providers acting badly and nobody able to stop them for profit to get more money. Absolutely. And even nonprofit companies like upmc, which is the Pittsburgh hospital complex, they're not any better. Right. UPMC hasn't paid their water bill in 20 years. They're finding every way they can to max. I think UPMC received something like $3.8 billion a year in like tax savings for me, not for profit. And they invest something like less than a quarter of that back into the community. Like, they're not. Nobody's doing good. I think a good example of this is Cleveland Clinic. Right. Cleveland Clinic is one of the best hospitals in the world, bar none. If you want a brand new heart, you want to go to Cleveland Clinic. Now that new heart's going to come from somebody uninsured, of course, who could afford to get one. But the area around Cleveland Clinic is one of the worst parts in Cleveland, and nobody in that neighborhood can afford to get care in the hospital built in the middle of it. Right. I think you kind of got this genuflection to the 1% in how healthcare is designed and afforded. We're building five or $600 million laser surgery machines that exist. You have three, I think, in New York, two in like Oklahoma City that are only applied a very small portion of patients who can pay very, very large prices. Right. Insurers have over time, kind of abdicated their response. Responsibility to care for people by only caring people who are profitable. If somebody is sick that for example, somebody with hemophilia can cost up to a million dollars to take care of. Right. So if you're an insurer and you're insuring, let's say maybe 10, 20, 40,000 people in a given area, the additional incremental impact of that hemophilia patient is massive. So what you begin doing is changing Your formulary to make the drugs a person with hemophilia needs more expensive to that person so they don't go to get insured by you in the first place. It's a game of passing the buck eternally. Insurers have no long term investment in a person's well being because you're going to change insurers every couple of years and eventually, God permitting, go on Medicare. So there's no long term investment on behalf of insurers. All the structural problems that cause poor health outcomes like housing, food stability, domestic violence go entirely unaddressed. People get sicker and sicker. It gets consolidated in poor people who nobody cares about. They get pushed into Medicaid and then states run massive. These people don't deserve Medicaid. They're not working. Why of course they're all working, but they're not working. Why do we give them anything? It's the exact same anti welfare movement we've seen since the 60s, just kind of for a new generation and there's no end in sight. I think a cool example of that cool, of course is sarcastic is the recent batch of work requirements Medicaid waivers you see in Tennessee, Arkansas and Indiana. Right. We know what happens when you impose work requirements on people. Most people get care. Everybody else is already working to begin with. And you save money because people aren't getting care at all. And you spend more than my money on administering the program. Right. It costs way more money to administer monthly re enrollment checks to build the massive computer infrastructure needed to kind of monitor people to micromanage their lives than it does to actually save money in Medicare allowance. But yet we see these bills passing in three states with five more on the way. It's an assault on the idea of who deserves to be taken care of. This is a thing we've seen and all these things kind of congealed. This is not a new fight, right? You look at like the anti welfare, like welfare movement kind of kicked up in the 60s and 70s with the great Society programs and then there was a massive in the 80s pushback against it. Right. You have the idea of oh, welfare queens, which is a terrible term, are like getting ahead, right? Because the idea of welfare in America, where we have a really, I think, bizarre work ethic, is that welfare should be just one click worse than the worst paying job. Right? Because you want to punish people for not working. Right? So if they can't work up the gumption to go work 10 hours a day in backbreaking labor, then by God let's make their lives hell because that'll help incentivize them to go into the workforce and also, like, depress wages. Right. Make the worst possible labor as bad as possible. And because the alternative is so much worse. And you kind of saw a reaction to that after welfare movements expanded in the 60s. Right. If you go back to. And like, the level of micromanagement is insane. I think King v. Smith, which was an Alabama law, meant that it was overturned in the Supreme Court, but it meant that a woman who had sex with somebody was no longer eligible to. To receive Medicaid or welfare benefits for her children. Right. Extreme micromanagement of what a poor person is allowed to do or is not allowed to do. And of course, that compounds if that poor person happens to be a woman or happens to be a person of color. It's a massive outright war on people who are unprofitable to take care of. And that's where a lot of these problems are consolidating. But things have gotten so bad that now these problems aren't just limited to poor people. They're going all the way upstream. Costs are skyrocketing, and insurers can't do anything. All they can do is beg the federal government for more subsidy money. Either Medicare Advantage adjustment premiums, risk adjustments in the ACA model just bleed more money from the federal government. Otherwise, they kick folks off their insurance plans and they go on Medicaid anyway.
- [48:36]
A
And then they can use the argument that it's costing so much money. Having shifted the burden of taxation onto the average person, they set up that endless struggle between those who are required to pay the taxes to support the people that are either sick or not working. You blame them rather than there are no jobs for them, or there's no decent housing or decent diet. So you've got this wonderful setup of the struggle of those who still have some support, a job, some healthcare. Exactly. Against those who don't. So they fight each other while the wealth and the power continues to be organized.
- [49:15]
B
Look at the West Virginia teacher strike. Right. It's this reflexive genuflection to the idea of austerity politics. There's not enough in this most prosperous nation of all nations to exist to go around. West Virginia teacher strike was of course, over a lot of things, but kind of front and center in the argument was their insurance plans way too expensive. They had to pay for it out of their own pocket, and they couldn't afford it anymore. And so they were begging for a increase in the freeze of their insurance premiums. And West Virginia, I think it was the governor or one of the legislators says, okay, we'll give this increase, but it's going to come at the expense of Medicaid coffers, which is barbaric. The governor of West Virginia, I think, is a multi billionaire off of the same industries that have kind of ravaged West Virginia in the first place. Even a pretty simple commercial tax or industrial tax would more than cover both the deficits in Medicaid financing and teacher salaries. Maybe treat them like people instead of like expendable workers. But no, instead these two groups are being disabled people, poor people and teachers are being pitted against each other. And who suffers at the end of the day? Well, all of them, plus children. I can't think of a more naked, brazen encapsulation of the fight being waged than this.
- [50:27]
A
Yeah, you couldn't. I know that in European newspapers where the strike was covered, they pointed out repeatedly that the state run by and for the wealthiest people in the world was saying, we'll either fund West Virginia teachers who are already among the poorest paid in the country, we'll give them a small increase, and we'll either take it out of their hide in terms of their medical assurance, or we'll take it out of the medical insurance hide of even poorer people. It was a stunning, once you sort of laid it out that way, a kind of a stunning expose of what passes for politics here.
- [51:07]
B
It's barbaris.
- [51:08]
A
Let me ask you a question. I know it's a speculation, but you're in a position to know as you travel around the country, tell me, not so much as you have, what the issues are. Tell me why it has taken so long and is still difficult to get the American people to angry enough about what it is you've just told us to do something about it. And I know that there are people that are struggling. It's not that. But why is it so difficult? Why has it taken so long? Why has it even been allowed to get as bad as it has? What's your judgment, your sense as you travel and talk to people?
- [51:48]
B
Well, there's good news and bad news on that, right? The good news is that I spoke, for example, in rural Trump county in Arkansas. We had massive turnout. I didn't change my speech one bit. And everybody stood up and cheered for it at the end, like the crisis is imminent in all of our bodies. Everybody knows somebody that they're afraid they're going to leave behind or they can't afford to help. Now GoFundMe is used primarily to take your people's hospital bills. Everybody knows the crisis is imminent and it's right inside of them or somebody that they love. I think we've been pretty thoroughly disenfranchised into believing that a better world is possible. Right? We've been pitted against each other. And you look at West Virginia and the Medicaid versus teachers, teachers unions, people are told that this is the best you're going to get. And it's tied to how worthy you are to receive care. It's tied to work. And the fear is that somebody else is going to get care you don't have access to. So you're worse off because of them, because of this mythical mooch, which is obviously false, provably false. People go to a place of fear. And I think when people go to a place of fear, it's really, really easy to tell them that this is the best you're going to get. You need to claw your way up and push folks down to get there. Immigrants are taking your jobs, poor people are taking your health care dollars. This is the total hell world you've inherited. Fear is it's person versus person, person versus body, person versus company. Here's the best you're going to get. I think that I've been really heartened by talking about not just single payer because single payers are pretty simple, pretty benign tool. It's a relatively simple transformation that I think begets a broader revolution. But talking about health justice, right? Recognizing that everybody should be afforded basic dignity. For example, if the federal state bears all the costs of providing care and all the risks and costs of not providing care, and people are getting sick and dying because they live in unsafe housing or there is no housing available, then housing is health care. And so any robust single payer program must consider the costs of housing as a way to bring health care costs down. Same with food. People don't have access to food or the time, space and material to prepare, then food is health care. So you provide food or. And the ability to prepare to bring health care costs down. People recognize that, right? Health care policy is kind of the domain of wonks. People that like looking at forms and budgets and rules and policies, manipulating it. And it's been made abstract. But really healthcare is pretty simple. It's relationship between you and your body and your neighborhood and sometimes your doctors or social workers. And I think breaking it down to no, no, you deserve dignity. And here's how the thing manifests in different parts of your life really compels people to work. In rural Tennessee, hospitals are being shut down because they can't afford to exist because Medicaid payments are being cut. In urban areas, people are getting sick and dying because they don't have housing. I mean, right now we're in Chelsea, we where there's more empty apartments than there are people to live in them because we're just building houses for the 1% or for the 1% of the 1%. I think when you kind of I've been really lucky to meet with people that are suffering and kind of show how well listen, learn about their suffering and tie it to a broader vision and a broader message, the articulation of a better world, a more humane sense of health, justice. And I think if people in rural Arkansas are ready to fight, it's our job to listen to them and put together the fight that they deserve.
- [55:01]
A
Thank you, Tim.
- [55:02]
B
Thank you for having me.
- [55:03]
A
I wish we had more time, as always, but Tim has really packed in an enormous amount of material in a short amount of time. I guess he's good at it from traveling around the country. I want to thank you all for paying attention, being with us on Economic Update today. I want to thank truthout.org, that independent and important source of news and analysis. Check them out@truthout.org and I hope to talk with you again next week. Sam. Sa.