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matt bruenig
Huge Administrative Waste Makes Clear For-Profit Insurance Is 'Actually Very Bad': Analysis
"It is totally fair for people to identify private insurers as the key bad actor in our current system," writes Matt Bruenig of the People's Policy Project. "The quicker we nationalize health insurance, the better."
Dec 10, 2024
Last week's murder of UnitedHealthcare CEO Brian Thompson brought to the surface a seething hatred of the nation's for-profit insurance system—anger rooted in the industry's profiteering, high costs, and mass care denials.
But that response has led some pundits to defend private insurance companies and claim that, in fact, healthcare providers such as hospitals and doctors are the real drivers of outlandish U.S. healthcare costs.
In an analysis published Tuesday, Matt Bruenig of the People's Policy Project argued that defenders of private insurers are relying on "factual misunderstandings and very questionable analysis" and that it is reasonable to conclude that the for-profit insurance system is "actually very bad."
"From a design perspective, the main problem with our private health insurance system is that it is extremely wasteful," Bruenig wrote, estimating based on existing research that excess administrative expenses amount to $528 billion per year—or 1.8% of U.S. gross domestic product.
"All healthcare systems require administration, which costs money, but a private multi-payer system requires massively more than other approaches, especially the single-payer system favored by the American left," Bruenig observed, emphasizing that excess administrative expenses of both the insurance companies and healthcare providers stem from "the multi-payer private health insurance system that we have."
He continued:
To get your head around why this is, think for a second about what happens to every $100 you give to a private insurance company. According to the most exhaustive study on this question in the U.S.—the CBO single-payer study from 2020—the first thing that happens is that $16 of those dollars are taken by the insurance company. From there, the insurer gives the remaining $84 to a hospital to reimburse them for services. That hospital then takesanother $15.96 (19% of its revenue) for administration, meaning that only $68.04 of the original $100 actually goes to providing care.
In a single-payer system, the path of that $100 looks a lot different. Rather than take $16 for insurance administration, the public insurer would only take $1.60. And rather than take $15.96 of the remaining money for hospital administration, the hospital would only take $11.80 (12% of its revenue), meaning that $86.60 of the original $100 actually goes to providing care.
High provider payments, which some analysts have suggested are the key culprit in exorbitant healthcare costs, are also attributable to the nation's for-profit insurance system, Bruenig argued.
"Medicaid and Medicare are able to negotiate much lower rates than private insurance, just as the public health insurer under a single-payer system would be able to. It is only within the private insurance segment of the system that providers have been able to jack up rates to such an extreme extent," he wrote. "Given all of this, I think it is totally fair for people to identify private insurers as the key bad actor in our current system. They are directly responsible for over half a trillion dollars of administrative waste and (at the very least) indirectly responsible for the provider rents that are bleeding Americans dry."
"The quicker we nationalize health insurance," he concluded, "the better."
Bruenig's analysis comports with research showing that a single-payer system such as the Medicare for All program proposed by Sen. Bernie Sanders (I-Vt.), Rep. Pramila Jayapal (D-Wash.), and other progressives in Congress could produce massive savings by eliminating bureaucratic costs associated with the private insurance system.
One study published in the Annals of Internal Medicine in January 2020 estimated that Medicare for All could save the U.S. more than $600 billion per year in healthcare-related administrative costs.
"The average American is paying more than $2,000 a year for useless bureaucracy," said Dr. David Himmelstein, lead author of the study, said at the time. "That money could be spent for care if we had a Medicare for All program."
Deep-seated anger at the systemic and harmful flaws of the for-profit U.S. insurance system could help explain why the percentage of the public that believes it's the federal government's responsibility to ensure all Americans have healthcare coverage is at its highest level in more than a decade, according to Gallup polling released Monday.
"There's a day of reckoning that is happening right now," former insurance industry executive Wendell Potter, president of the Center for Health and Democracy, said in an MSNBCappearance on Monday. "Whether we're talking about employers, patients, doctors—just about everybody despises health insurance companies in ways that I've never seen before."
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Biden's Hands 'Will Be Bloody' If He Lets Trump Inherit Death Row Cases, Critics Warn
"President Biden came into office committing to abolishing the federal death penalty because of its fundamental flaws. Commuting the federal row is the way he can honor that commitment," said one advocate.
Dec 03, 2024
For weeks, President Joe Biden has faced calls to use his clemency powers to save the lives of federal inmates on death row ahead of a transfer of power to President-elect Donald Trump, who has said he will expand the use of the death penalty.
Biden's inaction on the issue has drawn increased scrutiny following his pardon of his own son, Hunter Biden, clearing the younger Biden of wrongdoing in any federal crimes he committed or may have committed in the last 11 years.
Presidents have broad authority under Article II, Section 2 of the Constitution to grant pardons and reprieves for federal crimes. Biden recently pardoned two Thanksgiving turkeys as part of an annual tradition to highlight these constitutional powers, but he has not issued commutations for the 40 incarcerated men on federal death row. (He did, however, order a moratorium on carrying out federal death sentences in 2021).
"If Biden does not act, there is little doubt that Trump will aggressively schedule executions in his next term. Their blood will primarily be on Trump's hands, but, if Biden does not act to prevent it, his hands will be bloody too," wrote Matt Bruenig, president of the People's Policy Project think tank, reacting to the news of Hunter Biden's pardon.
"The death penalty is a morally-bankrupt and inescapably racist institution" —Yasmin Cader, ACLU deputy legal director
The pardoning of Hunter Biden, who was awaiting sentencing in two federal cases, also prompted scrutiny around pardon actions Biden could take that are not just focused on death row.
"This," wrote Rep. Rashida Tlaib (D-Mich.) in response to a post on X that contrasted Hunter Biden's pardon with the fact that tens of thousands of people are in federal custody for drug offenses.
In 2020, Biden pledged to work to abolish the federal death penalty but, according to the Death Penalty Information Center, "there has been little evidence of anything done in furtherance of this promise."
Pressure to issue clemency was building prior to the announcement of Hunter Biden's pardon.
On November 20, over 60 members of Congress sent a letter to Biden, encouraging him to use his "clemency powers to help broad classes of people and cases, including the elderly and chronically ill, those on death row, people with unjustified sentencing disparities, and women who were punished for defending themselves against their abusers."
During a press conference in November that featured House Democrats and anti-death penalty advocates, Rep. Ayanna Pressley (D-Mass.) said that "those on death row who are at risk of barbaric and inhumane murder at the hands of the Trump administration can have their death sentence commuted and be resentenced to a prison term," according to Oklahoma Voice.
"We're here today to ask him to take another step in that direction and to demonstrate, once again, a very positive consequence of his having been elected our 46th president, and to carry out his clemency powers in a very positive way," Rep. James Clyburn (D-S.C.) said.
Meanwhile, the ACLU has also urged Biden to use the lame duck session to commute federal death sentences—pointing out that Trump has vowed to expand the death penalty, including to non-homicide crimes such as drug-related offenses.
"The death penalty is a morally-bankrupt and inescapably racist institution. President Biden came into office committing to abolishing the federal death penalty because of its fundamental flaws. Commuting the federal row is the way he can honor that commitment, and prevent irreversible miscarriages of justice," said Yasmin Cader, ACLU deputy legal director and the director of the Trone Center for Justice and Equality.
While Biden so far has granted far fewer pardon and commutation petitions compared to former President Barack Obama, according to the Department of Justice's Office of the Pardon Attorney, he did in 2022 grant full and unconditional pardons to all U.S. citizens convicted of simple federal marijuana possession—a move that was cheered by advocates.
"President Joe Biden can—and must—act now to finish the death penalty reform work his administration began in 2020," the ACLU said last month. "He must commute the sentences of all people on federal death row to stymie Trump’s plans and to redress the racial injustice inherent to capital punishment."
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US Judge Sets Hearing for 14th Amendment Case on Eve of Debt Limit X-Date
While a DOJ attorney declined to disclose the government's position, one observer said it seems to be: "Stop trying to make us... get rid of the debt ceiling. That sort of thing is for high-level insiders only, not pesky labor unions that are going about it all wrong."
May 23, 2023
With a "significant gap" remaining between what House Republicans and White House negotiators want to resolve the debt limit fight, a federal judge on Tuesday scheduled a hearing next week for a related lawsuit brought by a union for government workers.
Attorneys for the National Association of Government Employees (NAGE)—which represents about 75,000 workers across federal agencies—sued President Joe Biden and Treasury Secretary Yellen in the U.S. District Court for the District of Massachusetts earlier this month. The union's legal team requested emergency action by the court in a filing on Friday.
During a Tuesday videoconference, Judge Richard Stearns gave the U.S. Department of Justice (DOJ) until May 30 to file a response detailing the department's position on presidential authority relating to the public debt and scheduled a hearing for May 31—the eve of the so-called X-date, or when Yellen warns the government could run out of money.
While NAGE wants a decision from the court before the X-date, Stearns, an appointee of former President Bill Clinton, "sounded skeptical of arguments from the union's lawyers that disaster for the nation is impending if he did not put the case on an even faster track," according toPolitico.
"If the emergency is as dire as you think it is, I would think that it's within the power of the president to address it using executive branch authority," the judge said. He added that "I understand there are time constraints, given that events are developing probably even as we're meeting, that probably make a decision prior to June 1st impossible."
Politico also noted that during the conference, DOJ lawyer Alexander Ely declined to disclose the department's position on whether the 14th Amendment's declaration that "the validity of the public debt of the United States... shall not be questioned" means the president can disregard the debt limit on constitutional grounds.
\u201cAs I read this, the government's position in the suit is:\n\n"Stop trying to make us to get rid of the debt ceiling. That sort of thing is for high-level insiders only, not pesky labor unions that are going about it all wrong."\n\nAh, the eternal cry of elites against activists.\u201d— David Rosen (@David Rosen) 1684867753
Thomas Geoghegan, an attorney for NAGE, said that "what we're faced with, I fear, is that the government doesn't really have a position on this, but there is no time to prevent irreparable injury."
As Common Dreams reported Monday, Revolving Door Project executive director Jeff Hauser argued that not only should U.S. Attorney General Merrick Garland "refuse to defend the unconstitutional legal incoherence that is the debt ceiling," but also the DOJ should "file papers supporting the National Association of Government Employees' request, and should do so as soon as possible."
"NAGE's argument is sound," Hauser said. "While President Biden may be willing to keep channels open until the very last minute with nihilistic, bad-faith Republican lawmakers, the Justice Department's obligation is to the Constitution, which is unequivocal."
The American Prospect executive editor David Dayen—who has been closely following the case—noted on Twitter that the DOJ and NAGE's formal request for the Tuesday conference states that "defendants intend to file an opposition to plaintiff's emergency motion for preliminary injunction."
Law Dork's Chris Geidner responded that "it's not necessarily opposition to the underlying arguments. It's possible that their opposition is either to a court ordering this or employees, through litigation, ordering them to do so. I'd think it would be unusual for any executive to argue otherwise."
The Tuesday conference came as the head of another union representing federal workers sent a letter to the White House.
"Many federal agencies that deliver services directly to the public, like the Social Security Administration, are already at the breaking point from years of inadequate funding," American Federation of Government Employees national president Everett Kelley wrote to Biden, warning the House GOP's proposed spending cuts "would be an economic and humanitarian calamity."
"I urge you not to yield to threats but instead to heed the advice of many legal scholars who have concluded that you have the inherent power, and indeed the duty, to avoid a default under the Constitution's 14th Amendment," Kelley added. "You have additional authorities to mint platinum coins under 31 USC § 5112. Please use these authorities now before it is too late."
As Matt Bruenig, president of the think tank People's Policy Project, highlighted in a blog post Tuesday, minting the coin isn't Biden's only option—he could also have the Treasury "issue bonds with a face value of $0 that only paid its holders a set amount of interest each year for a certain number of years. In this scenario, people would still buy the bonds in order to receive the interest, but there would be no principal and thus no face value."
"My current thinking on the best way for Biden to deal with the debt limit is to sell zero-principal bonds," Bruenig wrote. "These would not count as debt under the wording of the debt limit statute because they have a $0 face value. If this was challenged, then the administration has three different defenses to the challenge: that zero-principal bonds do not contribute to the debt limit, that the debt limit is unconstitutional, and that illegally selling bonds is no more unconstitutional than illegally raising taxes, selling assets, or cutting spending.
"But whichever course of action Biden chooses," he concluded, "we should be clear that he has other options than agreeing to crack the whip against America's poor."
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