Thread by @AlexandraErin

We have answers to the question "How do we pay for Medicare 4 All?" Some of them quite detailed.

No one has managed to come up with an answer to "How do we afford not having it?" We as a nation literally cannot pay for healthcare. This is a huge ongoing crisis.

The closest we can come to answering it is to pretend that, well, the fallout of individuals not being able to afford healthcare is limited to those individuals.

This is a lie. It costs everyone. It drags the precious economy down.

The person who goes bankrupt because of medical expenses and loses their house... that's a blow to the neighborhood they lived in. A bank has replaced a profitable asset (a mortgage) with a depreciating asset (an empty house).

The family struggling to pay for healthcare is paying money into a system that doesn't actually produce anything except profit for the top. Take away that struggle, they are doing business with their neighbors. Ordering products. Buying services.

Creating jobs!

Defaulted medical bills (including from those much-exaggerated can't-refuse-anybody free ER visits that the right likes to pretend is the same as free healthcare) get passed onto everybody else, meaning we're already "socializing" costs, but inefficiently.

ERs don't do routine preventative and diagnostic services or non-emergency treatment of chronic conditions, which means by the time someone winds up in an ER, the care they need is 1) more expensive and 2) less effective.

All of this is a huge drain on the stuff that the people gibbering about the terrible specter of socialism actually do care about: productivity! Consumer confidence! The freedom of the marketplace!

Socialize the medical system and we will be paying less money for better outcomes. We're already spending more money on healthcare, collectively, than it would take to treat everyone for real. And for all that money, we get the worst healthcare in the so-called developed world.

If we could be getting more while paying less, THE INVISIBLE HAND OF THE FREE MARKET demands that's what we do.

Market economics dictates that we adopt socialized medicine.

Anybody who disagrees doesn't actually care about what they're telling you they care about.

"But people will have to wait for treatment!" They do already, sometimes until they die. "But there will be rationing." There already is rationing and it's killing people. "But the government will decide what treatment you get." Less so than for-profit insurance companies do now.

Universal healthcare, free at point of service, paid for by public money, is the best deal we could take. We would pay less and get more.

And it would make the "free market" freer by removing artificial constraints on things like job mobility.

"Private industry is more efficient than the government." Efficient at what? For insurance companies, it's making money. This efficiency comes in the form of them taking more profit by charging more and providing less. It's efficient *against us*.

f course, replacing most of the concept of health insurance with a public institution will displace some jobs, and we should take care of the people affected by that but "socialism" is a better solution than propping up an industry that is robbing and killing us.

Our concept of business ethics right now is that the main fiduciary duty of a company is to generate ever-growing profits for its stakeholders. This means a for-profit insurance company is doing wrong when it takes care of us. Its "job" is to take our money and keep it.

Any money that an insurance company spends on paying for actual health care is regarded in the business world as a failure, with some failure being inevitable, but regrettable nonetheless.

They will take more and give less, if they can get away with it.

Now, the ideal of the free market is that if they jerk us around we can take our business elsewhere, but healthcare is so expensive and byzantine that most of us can't afford it, except when subsidized by an employer who has the benefit of negotiating in bulk on our behalf.

But this leaves us in a pinch where if our employer isn't great we can't "vote our wallets" by leaving because we need the healthcare and if our healthcare (which we didn't get to pick directly) isn't great we can't "vote our wallets" because we need the paycheck.

In theory an employer offering bad healthcare benefits is a bad employer who should be "corrected" in the market by leaving their employ, but jobs aren't fungible, we can't just leave and go across the street to another employer with the same circumstances but better insurance.

This makes the "free market" as it applies to health insurance NOT REALLY VERY FREE AT ALL. Our nominal power to negotiate and force companies to compete for our business is severely constrained and diluted by circumstances.

If a restaurant, movie studio, or video game company wants our business, it has to contend with the fact that we could stay home and feed or entertain ourselves in lots of other ways, on top of there being other restaurants and media companies.

But the alternative to healthcare is stay home and administer home remedies and hope you don't die of an infected tooth or hangnail that spreads, or untreated cancer, or whatever.

We aren't really "customers" with the same choice.

So the fact that the consequences of voting our wallet and staying home means we might die and the fact that our negotiation ability is at a remove through our jobs (which, again, without which we might lose our ability to secure food and shelter and healthcare, and maybe die)...

...means that the vaunted competition that is supposed to make the free market efficient and fair just doesn't happen. It doesn't apply. We are at the mercy of corporations who, again, are instructed by society that their highest good is separating us from our money.

And it doesn't have to be this way! We could eliminate the whole predatory, unnecessary layer that is the for-profit health insurance complex and replace it with a public agency whose highest good is getting the most treatment for the least money.

And at that point, multiple massive distortions of the "free market" disappear. We gain more power to change jobs if another employer is offering us a better deal. Free market competition! Great, right? We've got more money that we can spend on things we want.

We don't have people losing cars and houses and apartments and education plans and jobs because they had a medical emergency they couldn't pay for. We eliminate a lot of bankruptcies. Financial planning becomes more predictable. Consumer confidence goes up. Spending goes up.

Every business that is providing something people want benefits from the increased stability! Demand for basically everything rises! Jobs are created! Workers are less stressed and fearful and exhausted and so are working better!

Where's the downside for "capitalism"?

I'm a fan of the free market. I think customers benefit when companies compete for their money. I think companies benefit when workers compete for their money.

But our for-profit healthcare system distorts this whole thing so badly that this is basically not happening now.

If you like "capitalism" in the sense of a market-based economy where entities compete to trade what they have for what they want... a little "socialism" around the edges is a good thing, a necessary thing.

If we could decouple our thinking in the business world from the current fiduciary duty we choose to imagine businesses owe, then "profit" becomes the reward for doing a good job at whatever the business does, and that's FINE. It's good, it's great, it's the ideal.

But we can't there as long as we're treating everything as though it's just another fungible option among many where people could freely vote their wallets. We can stay home from the movies if the options stink, go watch a play or a TV show. Can't do that with cancer treatment.

Democratic socialism, social democracy... related and overlapping concepts, I'm not actually that interested in wanking over the distinctions. The point is, you can have social features on a market economy.

And you can't have a market economy for long without them.

In the competition that makes a market economy work, the reward for winning is also the means by which the game is played, which means each round is *less* competitive than the one that came before.

Competition is a finite resource, which means it's unsustainable.

The more that this competition extends into areas in which negotiation and competition are stifled, the faster the process by which the competition breaks down becomes until the "free market" becomes a fiefdom of company towns.

And so the distortion caused by our for-profit healthcare industry is speeding up the demise of the free market. A public option would slow that down. Eliminating health insurance as it exists now and replacing it with some form of single payer system would go much further.

To make a long story short (TOO LATE!) - we can't afford to keep the health insurance industry around. Can't afford it. How do we pay for it? Nobody has an answer for that. We can figure out how to pay for Medicare 4 All, but not how to pay for health insurance.

And while we're figuring out how to pay for healthcare under the private insurance model, we should ask... wait, what are we paying for?

Mostly to prop up an industry whose goal is that we should continue paying them to exist. Literally no purpose. They produce nothing.

I don't actually have one of those fancy employers I referred to, so if you got something out of this thread, please feel free to tip your weird Twitter pundit.

paypal.me/alexandraerin