Thread by @kurteichenwald

1. Let's have a serious conversation about Medicare for All, and why I prefer the public option.

People constantly point to Europe to show how MfA will work - apparently unaware that we have our own decades-long case study of how it would likely work here. And there are big...

2...problems.

This involves the government's program for kidney dialysis as adopted in the 1970s. It was something that, even as a kid, when I heard of it, I supported it. But aspirations and reality are quite different. In the decades since....

3...a serious flaw in the American health care system - and one that is beyond any rational possibility to fix - resulted in America having the highest mortality rate in the industrialized world for people on dialysis. The HIGHEST. *Everyone* can get dialysis through Medicare....

4...but they long had the highest probability of dying than anywhere else in the world. (I dug into this in the 1990s, and my articles showed how easy it was to slip into crummy care.)

The problem? Not for-profit insurance. ALL for-profit healthcare coupled with government....

5...trying to cover up failures. I believe for MfA to work - based on the experience with dialysis - we not only would have to outlaw ALL for-profit healthcare, but somehow magically change the behavior of people trying to hide failure.

What was the problem? Every one of the...

6...studies showing the economics on this pre-adoption were completely wrong on the impact on demand. They massively underestimated how coverage would change behaviors. Costs exploded beyond what the government anticipated. To deal with this, government - just like they do...

7...with the entire Medicare program - began cutting reimbursement. Dramatically.

In swooped private industry. They began cutting and cutting quality to meet the reimbursement levels (just like happens with Medicare.) Then they cut some more to increase profits. Happy with...

8...how private industry was decreasing costs, government cut reimbursement levels some more when the overall cost of the program kept going higher than anyone anticipated.

You can see what's coming: Government held down costs to the level they predicted, private industry made..

9...profits, and people started dying.

All of the activists who fought for this program patted themselves on the back and moved on. Kidney dialysis patients raged for help, but no one listened. Death tolls kept climbing.....

10..it became clear that the ONLY way this program would work would be to outlaw ALL for profit dialysis companies and then let reimbursement levels explode. But that was not going to happen, ever....

11...I heard about happening in dialysis in 1995. I wrote a 3-part series for the NY Times about it. It led to Congressional hearings, political table pounding, journalism awards & then...nothing. The world moved on. The attached article is the 1st part:
nytimes.com/1995/12/04/us/…

12...I remember the most devastating moment in this. I had a lot of dialysis patients who helped me in this. The series took about a year to report and write. Many months later, I was called and told I had won a Polk Award for it. I thought the patients would be happy to know...

13...that this had reached a lot of people in the journalism world, that the media was paying attention. I decided to call them all and let them know.

I reached the wife of the first man. He had died.
So had the second. And the third. And the fourth.

Of the 12 people who were..

14...patients who provided massive support for this project, all but one had died. When I accepted my award, I announced that fact. I couldn't help but feel that our journalistic self-celebration was pointless, that this had made no difference at all.

So, when people say MfA....

15...is perfect, I ask them for data. I ask them for explanations. I ask them for studies. And they response: "You're a republican. We know we know..." Just like those who knew about dialysis....

16...So, until someone explains to me how MfA can work in a for-profit health system, without spreading the disaster that befell the dialysis patients, I will avoid jumping on that boat. I believe public option is better because I have reason to....

17...and until someone can give me real data - not the projections of someone who supports MfA - then when I hear about it, all I can think of is our experience with kidney dialysis.

And the 11 wonderful people who died while fighting to improve the lot of others. In vain.