If you Like Sanders' Healthcare Plan, Please Stop Calling it “Single Payer”

The latest version of Bernie Sanders’ Medicare for All plan (MFA) has a lot to like. Sanders is right, America needs a healthcare system more like those of other wealthy countries. But, if you like Medicare for all, please stop calling it “single payer.” The single-payer label distracts attention from the main goal of healthcare reform, it energizes the opposition, and it is not an accurate description of the Sanders plan.

The goal is universal access

Single-payer is not the goal of healthcare reform. The goal is universal access to health care. No, not “access” in the sense some Republicans use it, that is, as the opportunity to buy into the system if you can afford it. True universal access would mean a system in which anyone who needs health care can go to the doctor’s office, the hospital, or the pharmacy and get what they need with the certainty that they can afford it, no matter how modest their means.

Single-payer is better understood as one way of getting to the goal of universal access. Under a true single-payer system, when you went to get care of any kind, you would just show your healthcare ID card and the government would directly reimburse the provider in full. That would be nice. The problem is, no such system exists anywhere. Not even in the universal access systems we admire most—Sweden, the UK, New Zealand, or whichever is your favorite. In all of those countries, the government pays some of the healthcare bills and private sources pay some. As the chart shows, the government contribution is greater than it is in the United States almost everywhere, but it is not 100 percent anywhere.

Can Angola's New President Overcome the Curse of Riches?

The people of Angola did something recently that they had not done for a long time: They elected a new president. The winning candidate, João Lourenço, will take over from President José Eduardo dos Santos, who came into office in 1979. Lourenço, who is from the same party as dos Santos, the People’s Movement for the Liberation of Angola, received two thirds of the vote. That result is expected to stand, despite doubts about the count voiced by his opponents.

During the first two decades of dos Santos’ rule, Angola struggled with a deadly, on-again, off-again civil war. After the MPLA prevailed in 2002, Angola embarked on a peace-and-oil expansion, with GDP growing by an astonishing 22 percent in 2007 alone. The global financial crisis brought the Angolan economy back to earth, however. The following chart, from the latest FocusEconomics Consensus Forecast for Sub-Saharan Africa, details the slowdown. Not only has the growth of GDP slowed, but so have analysts’ estimates of future growth. Low oil prices, and the expectation that they will remain low for the foreseeable future, are a major factor behind the growth pessimism.

Building Bipartisan Healthcare Reform with Conservative Bricks

Republicans now control both chambers of Congress and the White House, yet they have been unable, on their own, to fulfill their pledge to repeal and replace the Affordable Care Act (ACA or “Obamacare.”) The Democratic leadership, for the time being, seems content to watch Republican failures from the sidelines. Meanwhile, however, rank and file voters from both parties are becoming impatient. A Morning Consult/Politico poll taken in March found that 72 percent of Democratic voters, 71 percent of Independents, and 75 percent of Republicans thought the parties should work together more on healthcare reform. 

Just what kind of healthcare program might draw enough bipartisan support to pass both houses of Congress? No ACA replacement could draw significant Democratic support unless it clearly moved closer to the goal of universal, affordable health care, not away from it. At the same time, since Republicans control the committees and leadership in the House and Senate, any reform would have to start with ideas that have an acceptable conservative pedigree. 

The practical question, then, is whether it is possible to build bipartisan healthcare reform from conservative bricks. Here are three conservative ideas that might do the job.

Little-Watched Non-Employment Index Confirms Strength of Job Market Recovery

As the Fed hesitates over the pace of further monetary tightening, some critics say that standard unemployment data from the Bureau of Labor Statistics (BLS) overstate the strength of the recovery. By focusing on the number of employed as a percentage of the labor force, the critics say, the BLS ignores those who have dropped out of the labor force altogether. However, a little-watched indicator from the Richmond Fed, the Non-Employment Index (NEI), suggests that the critics are wrong.

The labor force, which forms the denominator of the standard unemployment rate (also known as U-3), consists of all persons who are working or have actively looked for work in the preceding month. People who want a job, but have stopped working, are omitted from both the numerator and denominator. In a typical month, there are millions of such labor force dropouts, even though they are not reflected in the standard statistics.

In an effort to take at least some of those labor-force drop-outs into account, the BLS publishes a supplementary index known as U-5, which includes discouraged and marginally attached workers in both its numerator and denominator. These groups include all those who want a job and have looked for one within the past year, but not within the past month. Discouraged workers cite their belief that there are no jobs to be found as their reason for not looking for work. Marginally attached workers give other reasons, such as family responsibilities. People who say they want a job but have gone longer than a year without looking for one are not counted in either U-3 or U-5.

Universal Catastrophic Coverage Would Make an Excellent Centerpiece for the Next Round of Healthcare Reform

Republican attempts to reform the U.S. healthcare system have fallen short, yet again. Sen. John McCain, who cast the deciding vote against the last-ditch version of repeal-and-replace put forward by the Senate leadership, told his colleagues,

We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

More tinkering won’t do it. It is time to get serious about keeping the promises GOP leaders made at the very outset of the debate over healthcare reform—not just to repeal Obamacare, but to replace it with something that provides “coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances,” while ensuring “more choices, lower costs, and greater control over your health care.” There is no point in making a new push for healthcare reform without putting some bold new ideas on the table. 

Universal catastrophic coverage (UCC) would make an excellent centerpiece for the next round of healthcare reform. In fact, UCC is not even particularly new to the conservative playbook. Respected thinkers like Martin Feldstein, who would go on to serve as Ronald Reagan’s chief economic adviser, promoted the idea already in the 1970s. In 2004, Milton Friedman, then a fellow at the Hoover Institution, also endorsed the concept. UCC would make healthcare affordable, both for the federal budget and for American families. And because it would throw no one off the healthcare roles—not 22 million people, not 2 million, not anyone—it offers a realistic chance of the bipartisanship that polls show both the Republican and Democratic rank and file want.

Climate Change Will (Probably) Not Destroy the Global Economy but That Doesn't Mean We are Out of the Woods

Climate change is on course to do a lot of harm to our planet. That is why concerned economists like myself advocate measures that would at least slow the pace of damage and give us more time to adapt. Paradoxically, though, economists rarely discuss what global warming is likely to do to the economy itself. Will climate change destroy the global economy as it raises sea levels, intensifies extreme weather, and kills our crops? The answer turns out to be more complex than you might think.

It is certainly not as simple as David Wallace-Wells endeavors to make it in his widely read New York Magazine article. In it, Wells describes an uninhabitable earth and a devastated global economy by the end of the century. Here is how he explains the economic consequences of climate change:

The most exciting research on the economics of warming has also come from [Solomon] Hsiang and his colleagues, who are not historians of fossil capitalism but who offer some very bleak analysis of their own: Every degree Celsius of warming costs, on average, 1.2 percent of GDP (an enormous number, considering we count growth in the low single digits as “strong”). This is the sterling work in the field, and their median projection is for a 23 percent loss in per capita earning globally by the end of this century (resulting from changes in agriculture, crime, storms, energy, mortality, and labor.)

Tracing the shape of the probability curve is even scarier: There is a 12 percent chance that climate change will reduce global output by more than 50 percent by 2100, they say, and a 51 percent chance that it lowers per capita GDP by 20 percent or more by then, unless emissions decline. By comparison, the Great Recession lowered global GDP by about 6 percent, in a one-time shock; Hsiang and his colleagues estimate a one-in-eight chance of an ongoing and irreversible effect by the end of the century that is eight times worse.

The scale of that economic devastation is hard to comprehend, but you can start by imagining what the world would look like today with an economy half as big, which would produce only half as much value, generating only half as much to offer the workers of the world.

The problem, however, is that the paper to which Wallace-Wells refers says nothing of the sort. The paper was written by Marshall Burke, Solomon Hsiang, and Edward Miguel, and published in Nature in 2015. The authors do not say that climate change will make the world economy of the future smaller than it is now, but rather, smaller than it would be without climate change. Here is a quote:

[U]nmitigated warming is expected to reshape the global economy by reducing average global incomes roughly 23% by 2100 and widening global income inequality, relative to scenarios without climate change. [Emphasis added.]

Latest Senate Healthcare Bill is a Step Toward Universal Coverage but Not Bold Enough

 Universal health care access is coming to America. As I wrote a few weeks ago, it is time to stop fighting it and make it work. In principle, Republicans agree. After all, from the very start of the repeal-and-replace debate, they have explicitly promised “coverage protections and peace of mind for all Americans.”

The latest version of the Better Care Reconciliation Act (BCRA) takes new steps toward universal access, but it is not yet bold enough. If our Senators only had the courage, they could build on these ideas to craft a plan that would satisfy both conservatives and moderates in their own ranks. Furthermore, it could become a way for the GOP to work together with Democrats, which polls say is what the public wants.  Here is how it could be done.