Public Policy 7
One of the most controversial issues in the U.S. today is the debate over healthcare. Should the U.S. adopt some system of public healthcare, like a single payer system, where the government pays for healthcare costs, or maintain a private system of healthcare made up of insurance companies and other industries like pharmaceuticals and hospitals? Honestly, I do not think the debate is as complex as people act like it is, the main challenge is sorting through the disinformation surrounding this issue.
On the other hand, the costs of such a healthcare system need to be properly evaluated as well. The figure that is thrown around is $34 trillion over ten years, that is the figure that Joe Biden quoted in his debate with Bernie Sanders. Of course, conveniently left out is that under the current system, healthcare costs are expected to cost around $50 trillion over ten years.
https://www.politico.com/news/2020/01/09/medicare-for-all-health-care-096367
There is also the recent article published by Yale that argues that single payer would actually save hundreds of billions of dollars a year by reducing costs, and changing behavior patterns to emphasize less expensive preventive care, while saving almost 70,000 lives a year. Again, keep in mind, if this is true, then people standing in the way of this, and that would be all of the Republicans in Congress, pretty much all the Democrats too, and most people in the media and academia, and of course the health insurance, pharmaceutical and private hospital "industries" are in some way responsible for the loss of 70,000 lives a year. Jack the Ripper, Charles Manson, the Son of Sam, and Jeffrey Dahmer combined are not responsible for that many deaths. Obviously, I am not being literal, but I do think that if your actions (or inaction) are in some way responsible for the deaths of 70,000 people every year then I think you are to blame for this to a large extent.
https://www.democracynow.org/2020/2/19/lancet_report_medicare_for_all
To break this down a little more, here are where the savings would come from:
https://www.vox.com/policy-and-politics/2020/2/26/21153775/democratic-debate-bernie-sanders-medicare-for-all-yale-study
I guess we are supposed to assume that people opposed to Medicare are doing so from a completely neutral, impartial perspective? Or they are just technicians looking at the facts of the matter and concluding in their sage-like wisdom that that is simply undoable in the U.S? One of the arguments made are if people pay for healthcare services they will use fewer services, compared to people who do not have to pay. The idea is that if people do not have to pay for healthcare they will raise costs by going to the doctor all the time. First, it ignores the fact that countries that do have single payer healthcare also have much less expensive healthcare costs, so this is already a proven fact. On another level, which I think is even more common sense, you have to ask yourself, do you enjoy going to the doctor or hospitals? Apparently, the only thing preventing people from spending all their free time in waiting rooms is that they have to pay for it, if they were suddenly liberated from making these payments people would all be constantly go to the doctor. What is true is that people would use more preventive care rather than emergency care, but this is an argument for reduced costs, as emergency care is much more expensive than preventive care, in other words, you go for a yearly heart exam, rather than waiting to have a heart attack that requires triple by-pass surgery (much more expensive).
Besides cost, one of the major issues in the debate over healthcare is quality of care, and here again the U.S. does not fare well. Besides having the most expensive healthcare system, we also have one of the lowest quality. One of the best arguments for single payer healthcare is that they produce good results in terms of healthcare and are significantly less expensive. As shown below, the Commonwealth Fund has ranked the U.S. last (11/11) in comparison to ten other industrialized countries.
Simply put, if you are very wealthy then you have access to very good healthcare, but if not, the quality of healthcare is not that good for most people. There are still nearly 30 million that do not have any kind of health insurance. Even those that do are often very limited in terms of access to physicians, while still paying high costs. Even with insurance, the out of pocket expenses for most people in terms of deductibles and co-payments, terms set by insurance companies, is more than most people can bear.
For years, the Commonwealth Fund has done studies on the U.S. healthcare system, both at the national level and state. As seen in the report on states, healthcare costs continue to increase and the disturbing trend of drug related deaths and suicides also continues to increase. Many drug related deaths, from drugs like heroin, actually come after people have been cut off by insurance companies to cover their medications, especially among white men who have seen the highest increase in drug related deaths and suicides. Of course, many people have died from pharmaceutical drugs, which as a number of recent lawsuits have shown, pharmaceutical companies were aware of the abuses of these drugs, but continued to manufacture more, since the profit margins were so large. Lack of access to mental healthcare is linked to the high rate of suicides.
It is interesting to look at U.S. healthcare on a state by state basis because it helps bring out the inequalities in the healthcare system. Among the lowest ranked states are Mississippi, South Carolina, Louisiana, Arkansas, and Alabama. These are also among the poorest states. Negative indicators of healthcare, are things like high infant mortality rates, or maternal mortality rates, something which is alarmingly high among African-Americans:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a6.htm
It is even more shocking to consider how strong Biden, who has literally said that "nothing will fundamentally change" under his Presidency, did in these states, especially among older African-American voters, compared to Sanders, the medicare for all candidate. For example, South Carolina is ranked 37 out of 51 (including the District of Columbia) putting it way down in the bottom half of the country. Even more baffling, is that despite Biden's victory, a strong majority of Democratic voters still prefer medicare for all.
Here is a graph of cancer patients in the state of New Jersey, a state with fairly high incidents of cancer. Notice the highest concentration of cancer is in Southern New Jersey, the poorest region of the state, which includes many rural areas, but also Camden, New Jersey which is one of the poorest cities in the U.S.
Pointing out the connections between poverty and quality of healthcare should seem obvious, but it is conveniently forgotten when people try to defend the current healthcare system.
The most significant healthcare legislation of the past several decades has been the Affordable Care Act, more commonly known as Obamacare. As shown in this article, the ACA increased payments to Medicaid and to CHIP (Children's Health Insurance Program) by close to a trillion dollars over ten years.
https://www.thebalance.com/cost-of-obamacare-3306050
Medicaid was created in 1965 as a program to provide health insurance to low income people, and along with Medicare makes up a large part of the federal budget. The ACA also created insurance exchanges, through healthcare.gov that made it easier to purchase private insurance (although many critics claimed this was funneling money to insurance companies), as well as providing tax credits to businesses to provide insurance and for those who cannot afford insurance. Critics of the bill pointed out it left private insurance companies firmly in control of healthcare, along with other for profit industries, and did not address the central problem of the American healthcare system, namely that it is run by the profit motive. Until the 1980s, the costs of the healthcare system were not as significant, but since then unbearable costs imposed by this system have become more obvious, and yet there has been no significant effort to deal with that core issue.
The ACA was very similar to earlier plans by Republican politicians like Mitt Romney, Bob Dole, the 1996 Presidential candidate, or even Richard Nixon in the 1970s.
https://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/
During the 1970s, Democrats in Congress were actually trying to get a single payer healthcare law passed, and Nixon's plan was seen as a compromise, as shown in this article: https://ihpi.umich.edu/news/nixoncare-vs-obamacare-u-m-team-compares-rhetoric-reality-two-health-plans
The Huffington Post also has an article showing the similarities between Obamacare and Romney's healthcare plan when he was Governor of Massachusetts.
https://www.huffpost.com/entry/did-the-heritage-foundati_b_551804
Romney, now Senator from Utah, was, of course, opposed to Obamacare in the 2012 election.
Many argue that a single payer, or even a fully nationalized system, where the government actually pays doctors, nurses, and other healthcare professionals, is too expensive. Yet, these critics have a hard time explaining why every other rich nation (and some not so rich or middle income nations) in the world has created at least a single payer system, some have gone even further in nationalizing all health care services. Frankly, the burden of proof is on these critics to explain why the U.S. should continue being the only major country in the world not to provide healthcare to everyone free at the point of service (meaning when you use health services). The US has 30 million people without health coverage, and even those who do are increasingly burdened with higher payments in the form of insurance premiums, deductibles, co-payments, etc. and in many cases insurance companies just flat out refuse to cover things by pretending they are not necessary. The leading cause of bankruptcy in the US is from medical bills. Also, as mentioned a strong majority of the public is in favor of some kind of nationalized healthcare system, but politicians from both parties are deaf to these calls. Regrettably, this now even includes Bernie Sanders, AOC, and the rest of the "Squad" who have seemingly abandoned calls for medicare for all, despite Democrats controlling both branches of Congress and the Presidency.
To put this into context more, all reforms in the past were met with the same kinds of arguments. As the image below shows, various reforms were made during the twentieth century, and the same arguments have always been made: "it's too expensive," "it will ruin the economy," etc. and they are always wrong. Keep that in mind also when people point out how "humane" American capitalism is. All of the so-called humane elements were only won through a hard fought struggle against business owners. Unless you think it is a good thing to put five year old children to work doing hard labor. Many of these reforms have also been severely undermined over the last several decades. As Frederick Douglass said: "power concedes nothing without a demand."
On the other hand, the costs of such a healthcare system need to be properly evaluated as well. The figure that is thrown around is $34 trillion over ten years, that is the figure that Joe Biden quoted in his debate with Bernie Sanders. Of course, conveniently left out is that under the current system, healthcare costs are expected to cost around $50 trillion over ten years.
https://www.politico.com/news/2020/01/09/medicare-for-all-health-care-096367
There is also the recent article published by Yale that argues that single payer would actually save hundreds of billions of dollars a year by reducing costs, and changing behavior patterns to emphasize less expensive preventive care, while saving almost 70,000 lives a year. Again, keep in mind, if this is true, then people standing in the way of this, and that would be all of the Republicans in Congress, pretty much all the Democrats too, and most people in the media and academia, and of course the health insurance, pharmaceutical and private hospital "industries" are in some way responsible for the loss of 70,000 lives a year. Jack the Ripper, Charles Manson, the Son of Sam, and Jeffrey Dahmer combined are not responsible for that many deaths. Obviously, I am not being literal, but I do think that if your actions (or inaction) are in some way responsible for the deaths of 70,000 people every year then I think you are to blame for this to a large extent.
https://www.democracynow.org/2020/2/19/lancet_report_medicare_for_all
To break this down a little more, here are where the savings would come from:
- $219 billion from administrative savings, because the Medicare program currently spends 2.2 percent on overhead while private insurance spends 12.4 percent
- $188 billion from negotiating lower prices for prescription drugs, based on the rates the Veteran Affairs Department currently pays (which are about 40 percent lower than those paid by Medicare)
- $100 billion from reducing payments to health care providers, by setting rates at Medicare levels (which are about 20 percent lower than private insurance and 20 to 30 percent higher than Medicaid)
- $78 billion from avoiding unnecessary hospitalizations and emergency room visits by improving access to primary care
https://www.vox.com/policy-and-politics/2020/2/26/21153775/democratic-debate-bernie-sanders-medicare-for-all-yale-study
I guess we are supposed to assume that people opposed to Medicare are doing so from a completely neutral, impartial perspective? Or they are just technicians looking at the facts of the matter and concluding in their sage-like wisdom that that is simply undoable in the U.S? One of the arguments made are if people pay for healthcare services they will use fewer services, compared to people who do not have to pay. The idea is that if people do not have to pay for healthcare they will raise costs by going to the doctor all the time. First, it ignores the fact that countries that do have single payer healthcare also have much less expensive healthcare costs, so this is already a proven fact. On another level, which I think is even more common sense, you have to ask yourself, do you enjoy going to the doctor or hospitals? Apparently, the only thing preventing people from spending all their free time in waiting rooms is that they have to pay for it, if they were suddenly liberated from making these payments people would all be constantly go to the doctor. What is true is that people would use more preventive care rather than emergency care, but this is an argument for reduced costs, as emergency care is much more expensive than preventive care, in other words, you go for a yearly heart exam, rather than waiting to have a heart attack that requires triple by-pass surgery (much more expensive).
Besides cost, one of the major issues in the debate over healthcare is quality of care, and here again the U.S. does not fare well. Besides having the most expensive healthcare system, we also have one of the lowest quality. One of the best arguments for single payer healthcare is that they produce good results in terms of healthcare and are significantly less expensive. As shown below, the Commonwealth Fund has ranked the U.S. last (11/11) in comparison to ten other industrialized countries.
Simply put, if you are very wealthy then you have access to very good healthcare, but if not, the quality of healthcare is not that good for most people. There are still nearly 30 million that do not have any kind of health insurance. Even those that do are often very limited in terms of access to physicians, while still paying high costs. Even with insurance, the out of pocket expenses for most people in terms of deductibles and co-payments, terms set by insurance companies, is more than most people can bear.
For years, the Commonwealth Fund has done studies on the U.S. healthcare system, both at the national level and state. As seen in the report on states, healthcare costs continue to increase and the disturbing trend of drug related deaths and suicides also continues to increase. Many drug related deaths, from drugs like heroin, actually come after people have been cut off by insurance companies to cover their medications, especially among white men who have seen the highest increase in drug related deaths and suicides. Of course, many people have died from pharmaceutical drugs, which as a number of recent lawsuits have shown, pharmaceutical companies were aware of the abuses of these drugs, but continued to manufacture more, since the profit margins were so large. Lack of access to mental healthcare is linked to the high rate of suicides.
It is interesting to look at U.S. healthcare on a state by state basis because it helps bring out the inequalities in the healthcare system. Among the lowest ranked states are Mississippi, South Carolina, Louisiana, Arkansas, and Alabama. These are also among the poorest states. Negative indicators of healthcare, are things like high infant mortality rates, or maternal mortality rates, something which is alarmingly high among African-Americans:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a6.htm
It is even more shocking to consider how strong Biden, who has literally said that "nothing will fundamentally change" under his Presidency, did in these states, especially among older African-American voters, compared to Sanders, the medicare for all candidate. For example, South Carolina is ranked 37 out of 51 (including the District of Columbia) putting it way down in the bottom half of the country. Even more baffling, is that despite Biden's victory, a strong majority of Democratic voters still prefer medicare for all.
Here is a graph of cancer patients in the state of New Jersey, a state with fairly high incidents of cancer. Notice the highest concentration of cancer is in Southern New Jersey, the poorest region of the state, which includes many rural areas, but also Camden, New Jersey which is one of the poorest cities in the U.S.
Pointing out the connections between poverty and quality of healthcare should seem obvious, but it is conveniently forgotten when people try to defend the current healthcare system.
The most significant healthcare legislation of the past several decades has been the Affordable Care Act, more commonly known as Obamacare. As shown in this article, the ACA increased payments to Medicaid and to CHIP (Children's Health Insurance Program) by close to a trillion dollars over ten years.
https://www.thebalance.com/cost-of-obamacare-3306050
Medicaid was created in 1965 as a program to provide health insurance to low income people, and along with Medicare makes up a large part of the federal budget. The ACA also created insurance exchanges, through healthcare.gov that made it easier to purchase private insurance (although many critics claimed this was funneling money to insurance companies), as well as providing tax credits to businesses to provide insurance and for those who cannot afford insurance. Critics of the bill pointed out it left private insurance companies firmly in control of healthcare, along with other for profit industries, and did not address the central problem of the American healthcare system, namely that it is run by the profit motive. Until the 1980s, the costs of the healthcare system were not as significant, but since then unbearable costs imposed by this system have become more obvious, and yet there has been no significant effort to deal with that core issue.
The ACA was very similar to earlier plans by Republican politicians like Mitt Romney, Bob Dole, the 1996 Presidential candidate, or even Richard Nixon in the 1970s.
https://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/
During the 1970s, Democrats in Congress were actually trying to get a single payer healthcare law passed, and Nixon's plan was seen as a compromise, as shown in this article: https://ihpi.umich.edu/news/nixoncare-vs-obamacare-u-m-team-compares-rhetoric-reality-two-health-plans
The Huffington Post also has an article showing the similarities between Obamacare and Romney's healthcare plan when he was Governor of Massachusetts.
https://www.huffpost.com/entry/did-the-heritage-foundati_b_551804
Romney, now Senator from Utah, was, of course, opposed to Obamacare in the 2012 election.
Now, with the current pandemic, even more weaknesses in the American healthcare system are exposed. The U.S. has the most cases and the most deaths of any country in the world. Decades of tax cuts for the wealthy and corporations have eroded the infrastructure and capacity to contain the spread of a virus like this. At the same time, businesses and schools have tried numerous times to re-open prematurely, many times being forced to close again. Cases are currently rising, even with the rollout of the vaccine. Millions of people have lost their employer provided healthcare due to being unemployed with very little in the way of a social safety net.
Next week, we talk more about Social Security, Medicaid, and Medicare.
Next week, we talk more about Social Security, Medicaid, and Medicare.
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