Paul Krugman and the Bull Profile Series
This is a bull.
Abstraction and abstract art - Imagery which departs from representational accuracy, to a variable range of possible degrees, for some reason other than verisimilitude. Abstract artists select and then exaggerate or simplify the forms suggested by the world around them.
See how easy that was?
This was a series of six lithographs done by the iconic Roy Lichtenstein. You can see how, at each step he removed some of the details, exaggerated some of the forms, added [in some of them] some extraneous information, and re-arranged some things. Along the way, each successive image clearly resembles the one preceding it, but what you have at the end doesn't look a damn thing like the original.
- Oh no, you're not really going to use art theory to bash Paul Krugman, are you?
Oh yes I am.
Let me show you two schematic charts I’ve used over the past couple of years to describe two different approaches to near-universal coverage.
First, single-payer. This relies on taxes, collected from everyone — but with the well-off paying more — to provide a basic health benefit to everyone. Schematically, it looks like this:
He's right on target there, that's pretty much how single payer works. A good use of abstracting the useful information, presenting it, and leaving off the extraneous.
And here he glosses over the intermediate steps on his way to the yellow and white geometric shapes with black and red accents bull:
Now consider the type of plan we’re actually about to get. (It’s labeled “Hackerish” on the slide because the genesis of the plans offered during the Democratic primary was a proposal by Yale’s Jacob Hacker.). This plan combines three main elements: community rating, so that premiums can’t be based on medical history (which means that coverage becomes available to people with preexisting conditions); an individual mandate, so that healthy people are in the pool, keeping premiums down; and subsidies, to help lower-income families afford the premiums. The subsidies are ultimately paid for with taxes on the relatively affluent. So the picture looks like this:
At this level of abstraction, it’s basically the same as single-payer.
Like the final bull in Lichtenstein's series, this is something decorative you can hang on your wall, but it's missing some important parts if what you were looking for was something closer to the real thing.
Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies.
It's been mentioned before, and by people smarter than me: health insurance is not health care. Forcing people to buy insurance they can barely afford too often leaves with too little money to pay the co-pays, the deductibles, the myriad other out-of-pocket expenses that you only find out about when you get expensively sick.
And community rating? Where everybody has to pay the same premium, no matter how much they can afford? One of the beauties of single payer as practiced in America's Medicare, in Canada's Medicare, in Australia's Medicare, is that for the most part everybody pays what they can afford -- lower income people pay lower taxes, higher income people pay higher taxes. Sure, sometimes you may still need some subsidies to help the very least well-off with even the meagerest of expenses, but no community rating needed.
And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.
There's still a lot of brouhaha over what the mandated medical loss ratios should be, but the law is supposedly going to dictate that insurance companies have to spend [depending on who wins this round] something like 80% of your money on your health care. On paper, the insurance companies all make it look like their profits are running at a mere 3%, but there's a lot of hocus pocus that goes into producing those numbers. The bottom line here of course is that if you had real single payer, about 98% of your money would go to paying for your health care.
So yeah, the government is going to pay for health care for a lot more people than it does now [just like single payer would] but it's going to funnel huge amounts of money [20% of $200 billion a year is $40 billion a year] to already-bloated corporations that are strangling us [which single payer would not do].
That $40 billion per year would pay for all the health care for every single undocumented alien in the country, but I guess it's morally better to give fatcat CEOs and investors the money instead, because at least that's legal.