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Three Approaches to Healthcare Policy: A Glossary

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Healthcare is one of the top issues on the minds of the American people, yet many are misinformed about policy packages that could provide it. During both the 2016 and 2020 primaries, multiple versions of what was called “Medicare for All” were proposed by various candidates. Sanders, Warren, and Yang all had their own proposals. While, at the time, Sanders’ version was the most comprehensive in terms of providing healthcare to humans living in the United States, it still fell short- especially on the economic assumptions underpinning how Sanders proposed the nation would “pay for” his version of Medicare for All. Let us set the record straight on those assumptions. 

As we know, federal taxes do not and cannot finance federal spending. United States dollars collected by the federal government as a tax are deleted, destroyed upon receipt. In other words, taxation is the death of those dollars taxed. Federal spending as determined by Congressional appropriations are the birth of new United States dollars. Because the USA has a free-floating unpegged fiat currency, the limits on what can and cannot be funded by the federal government, as well as our net money supply, are determined by real world constraints, rather than an artificial constraint- such as a gold standard. Those constraints are what economists call “real resources”, in other words the raw materials, infrastructure, technology level, and labor power accessible to be bought in that same currency. 

Yes, the US federal government is the sovereign over the US dollar. This means that it, and only it, can issue the dollar. It also means that it is impossible for another country to lend us any of our own currency on an ongoing basis. Only the US government can create or destroy net money supply in the US dollar, as a matter of legal and political reality.  

This brings us to today’s definitions. We will be setting the record straight for three key concepts in the fight for healthcare as a human right. Those three concepts are represented by the phrases “Medicare for all”, “national single payer”, and “national health service”.  

National Single-Payer 

This concept refers to one entity being the sole payer of healthcare costs for the entire nation. Since we understand the federal government’s sovereignty over the dollar and, therefore, the economy, we should also be able to understand that the only entity that can be a single payer is the US federal government.  

Under the current status-quo, the private health insurers serve as death panels. Unelected, unaccountable individuals with no real medical training determine on whims governed by corporate policy that ensures capital accumulation, whether your healthcare or everyone else’s is paid for. This system is further stratified by the existence of several individual conglomerates that “compete” with each other for overall profitability and other corporate metrics. This competition means they have an incentive to deny more and more care in order to maintain and expand profitability.  

Only the federal government has the capacity to fund healthcare in its entirety. In fact, our status-quo of corporate death panels masquerading as providers of healthcare is heavily subsidized by the federal government, and the subsidies became enhanced and guaranteed under Obamacare also known as the Affordable Care Act. Private insurers, by design, can’t pay for needed care for most people, much less all the people in the United States, even with incredibly decadent subsidies from the currency issuer.  

National single payer removes this stratification of healthcare payments while removing the profit-motive from determining whether care is paid for. It is, in and of itself, an incrementalist reform to the problem of healthcare in the United States. It does not address the profit motive in healthcare services rendered or the development of new medications and technologies for ensuring good health. It is incrementalist in large part due to its allowance of the continued abusive market power of private clinics, small businesses doctors’ groups, corporations, and others, rendering healthcare services only if they make private profit. 

In short, national single payer removes all the other payers of healthcare costs, private, public, and individual, and makes it so that one, single entity- the US federal government would be solely and directly responsible for paying all healthcare expenditure for everyone in the country.  

Medicare for All 

This definition is easier to come by. Medicare for All is the bare minimum federalized policy that would create a single-payer system for healthcare in this country. Anything less, including state-by-state healthcare reforms, are not single-payer and are not Medicare for All. The movement for subsidization of healthcare costs by the federal government on the backend could have called it anything, however, Medicare for all is the colloquial shorthand for such policy. Some groups now fight, instead, for “National Improved Medicare for All”, or NIMA, which is a more comprehensive version of the policy that covers hidden healthcare costs like long-term care in addition to ensuring direct healthcare costs are covered. 

This policy, if it is truly a federalized policy, is a deflationary policy. It removes expenditures and labor power from being caught up in profit-based healthcare billing and coding as well as abusive and exploitative healthcare administration costs that currently are a backbone of the status-quo healthcare patchwork in place now.  

National Health Service 

A national health service is the severing of healthcare provisioning from industry and the profit motive. The USPS is a hollow shell of the idea of a national mail service, due to privatization and the lack of federal funding. A national health service would be funded directly by the currency sovereignty of the federal government, as the USPS should be. All healthcare, for everyone within the country, would be free at the point of service.  

Creating a national health service would require mobilization of resources to provision and incentivize healthcare careers, medical research, and the build-up of facilities and infrastructure to provide healthcare. In other words, taking it from legislation to realization will take time. The legislation itself doesn’t take time, only political will. Once passed, there would need to be a mobilization of resources. Unlike national single player, which only assumes the cost of the current system, a national health service would build a more robust system and assume the cost. 

Many have advocated for a national health service in the United States. This includes 2020 Presidential Candidate Howie Hawkins who ran on the green party ticket, and myself in my own bid for Congress. A national health service would fully federalize the entirety of the health care industry, starting with payment for services (national single-payer), while mobilizing to absorb the entire private apparatus of using healthcare for profit extraction into an accountable, democratically controlled public apparatus guaranteeing healthcare services as a human right.  

This means that healthcare research, pharmaceutical research, healthcare providers, healthcare facilities, and all other aspects of a robust healthcare system would be publicly controlled and federally paid for. All healthcare workers would be employed directly by the federal government. This would likely create further deflation. In both the PatriotCare proposal I designed, and Howie Hawkins’ NHS proposal in 2020, there would be a form of community control. This means that there would be publicly accountable stewardship of the federally financed national health system.  

A fully-realized national health system fully removes profit-motives from all aspects of production and provision of health services and technology. It creates a “for use” healthcare production model. The integration of community controls further curbs the potential for corruption in the new system, because those administrators who remain would be locally elected and under the mandate of the voters for the region in which they are steering healthcare decisions. Additionally, federal funding implies federal oversight, so minimum standards of care would not be so easily corrupted by mobs of those who hate public health. 

Minimum Standard 

Each of the above definitions is a minimum standard. It is entirely possible that future movements may come up with more robust versions. Keeping that in mind, each of these three definitions are the minimum acceptable compromise for using the relevant phrase to describe a policy proposal. 

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