It strikes me as a surprisingly cool idea, and surprising to come from Krugman. Michael Pollak
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At first glance it does seem cool. But then I thought about it. We used to have the equivalent of this system, but you have to be at least sixty to remember it.
I reached deep into my childhood memories and got out my birth certificate. I was born in Los Angeles County General in 1942. My mother was unemployed (listed occupation as homemaker) and my father worked at the LA Examiner as a copy reader. Copy reader is lowest of the low of actual newspaper work, a cut or so above copy boy. I am certain the pay sucked. We lived on 60th Street, near La Brea and Slauson---a spread of cheap LA bugelows, apartments, 2 and 4plexes. I remember seeing some outside front yard baby photos. The front of the 4plex was plain LA stucco with dark trim. This was at the south western end of LA metro sprawl. I'd have to research this, but the old man was making less than a union autoworker in a factory.
(I looked up the address on mapquest. I could follow the likely route the old man took to work off the pre-freeway grid. He went up to Slauson turned right and took it all the way to Alameda, turned left to get to the downtown grid and parked in an all night parking lot as near to the old Examiner building as he could get. I am sure he was on the night shift. He lived on dinner food or take out some copy boy got for him nearby. This was real forties grit. Most of his copy was LA crime plotter, Hollywood gossip scandle, Mikey Cohen's latest, traffic accidents, and an occasional heartwarming school kids story doing for the troops overseas. Moms was bored to death at home at night listening to the radio and drinking quietly into oblivion. The old man kept all the big headline stories of the war. I found them in my closet later and used to go through them.)
We were better off than the lower working class of say construction labor or running machines at American Can.
In their socio-economic context, my parents could afford delivery, pre and post natal care out of a tight paycheck. Nobody had health insurance, in fact I am not sure it was even invented yet.
I got regular check-ups that I remember from about age five or six, going to Dr. Marks' office. My mother was single by then and worked as a beginning elementary school teacher in the LA district on a temporary credential. Judging from later family arguments, the pay sucked. I always dreaded going to Dr Marks. At one terrible point, he threatened to cut my tonsils out at County. I remember visits there. Giant scary place with black and white tile floors, green walls and deadly smells of rubbing alcohol and carbolic acid cleaners. Later I remember getting shots at school. When I occasionally needed stetches, off to the doctor.
What I am trying to describe is we had the kind of system Krugman imagines and it was destroyed by a combination of crushed wages, attacks on public health, and corporatization of health care.
When my son was born, thirty years later in the early 70s, we paid for the delivery and first year doctor visits out of pocket. Thereafter as needed. I was working but had not signed up for healthcare coverage. The delivery included an over night stay for the ex and several days for the kid who had to be watched for jaundice. I paid it off on a monthly plan at the hospital. There was some nominal charge for pediatrician office visits that was about a week, maybe two for groceries.
By then the public county hospital system was on its way to destruction under the governor Reagan's assault on public health and the state's county hospital system.
My parent's world of medical care for the working class was gone. On the other hand during the 70s around here, you could get similar care for much lower cost, if you used the family planning and city clinic system that used a sliding scale. The ex preferred her own oygbn because we had known him for years.
After a working life filled in with the next thirty years of neoliberal bullshit, dot, dot, dot.
I can't afford Medicare part B because they deduct over a hundred a month, and there are more deductions for part D, the drug coverage. Together these deductions cost about half the price per month I pay for a medication I use. The coverage is totally inadequate. I rarely need to see my doctor and his rate is less than the price of a single month of part B deductions. I see him about once a year. BTW, this medication has doubled in price in the four years I've used it.
The Medicare system is totally broken.
Even if we had Medicare for all with its deductions and co-pays, the US public would still be strapped to get adequate care. For example there is no dental, eye glasses, or eye exams, unless the eye exams are related to a disease or medical necessity. Being able to read or see where you are going is not a medical necessity. Having teeth in working order that are not outright killing you from infection is not a medical necessity.
People who have not worked with these healthcare systems have no idea what goes on. Medicare invented denial of service and has co-evolved denial of service practices to a high art with its private third party cohorts. In fact the entire bureaucracy of even the Medicare system was developed to provide claims denials and not pay for healthcare.
My medical plan is call a cab, put the fare on the ATM, get dumped in Highland County Hospital and drag myself toward the crowded chair banks in front of the ER like the rest of the victims of capitalism.
They practice the triage system at Highland, which means, critical first, acute second, everybody else pull a number and wait.
CG