July 1, 2017, from Da Lat, Vietnam

The Conservative arguments that we can’t afford health care for all is rubbish.

Conservatives use the debt and the deficit as their argument for cutting all kinds of programs which are critical to the working class and the poor. “This is unsustainable, we simply cannot afford it, we can’t do this to our grandchildren,” go the arguments. In other words, “We have no choice.” Heard that lately?

Please bear with me in looking at a few numbers: The US federal debt is about $20 Trillion, which is 105% of our GDP. Our 2016 deficit was $587 Billion, about 3.2% of GDP and in line with historical averages.

Five OECD nations have federal debt which is a higher percentage of GDP. None are as strong as the US or have the world’s reserve currency. The US federal government spending as a percentage of GDP is the 4th lowest among 28 OECD countries. It is not a given that our debt is unsustainable, or that it couldn’t safely increase–for the right reasons. Health care for all would strengthen our country.

But for this discussion, let’s stipulate that we can’t increase the deficit or debt. There are many other ways to preserve health care. The Congressional Budget Office originally estimated the Senate bill would reduce the US annual budget deficit by $321 Billion over 10 years. Later estimates reduced the savings to $119 Billion.  But let’s use the earlier CBO number. That’s $32 Billion per year.

Federal spending is about $4 Trillion and when states and municipalities are added in, the total is about $7 Trillion, per year.  $32 Billion is .5% (1/2 of one percent) of $7 Trillion. There are so many ways we can save $32 Billion annually, to continue health care for the 22 Million who will lose it (Congressional Budget Office forecast).

First, we could change to a “single payer” system, something Trump extolled only a few years ago. Economists estimate this could cut our spending on health care from 21% of GDP in 2016 ($3.7 Trillion), to a dramatically lower figure.  There is a clear and indisputable cost advantage to a single payer system. There are many countries demonstrating the cost effectiveness of single payer. California has been developing such a plan. Why can’t the US?

It is a tragedy of our culture that this optimal solution remains indefensible in the the US of today. We are addicted to private sector solutions.

Setting single payer aside for now, there are many other ways to justify retaining health care for all if the cost is only $32 Billion per year, and without increasing the deficit or the debt. We could start by not spending the extra $50 Billion annually that President Trump proposes for the military budget, which is already larger than the next seven nations combined.

Or, could set about to re-engineer the federal government, reduce redundant and out of date regulation, install better management, automate, etc. A 10% savings in the $3.7 Trillion federal budget would generate far more than the projected $32 Billion savings attributed to the Senate bill. Certainly states and cities have similar opportunity.

If only some of the cuts Trump proposes are justified, why not take those savings and keep the military budget at its present level? That’s a lot more than $32 Billion per year.

Finally, Conservatives keep avoiding the obvious–either raising taxes on people like me (a Patriotic Millionaires offer) or cut some of the “entitlements” for those of us who do not really need them. There’s a lot more than another $32 Billion there.

So, the Conservative arguments about our budget deficit and our federal debt do not hold water. There are many ways to save the money necessary to keep 22 Million people in health care, better still, provide health care for everyone, without increasing the deficit or the debt.

It aways seems to come down to who has influence, and who does not. Those 22 million do not have political influence.

It’s not fair. It’s not right.  It’s a shame.