Editor's Note:
The February 7 episode of "The Argument", a New York Times podcast, features a discussion about "Medicare For All". Diane Archer, founder of The Medicare Rights Center and JustCare talks with the host, David Leonhardt and NYT columnist Ross Douthat about Medicare for All. It's well worth listening to. The MFA discussion starts at 25 minutes.
https://www.nytimes.com/2019/02/07/opinion/the-argument-abortion-medicare-for-all.html?smtyp=cur&smid=tw-nytopinion
And - you may be entertained by this clip from Lawrence O'Donnell:
https://www.msnbc.com/the-last-word/watch/lawrence-s-last-word-1438576195762
Enjoy!
-SPC
'Everybody In, Nobody Out': What We Know So Far About the Medicare for All Act of 2019
by Ben Day and Mark Dudzic - Common Dreams - February 7, 2019
As the 2019 legislative session in Congress kicks off, the Democratic majority in the House will, in very short order, have to address a national surge of support for Medicare for All (otherwise known as single-payer healthcare). At the close of the last Congress, almost two-thirds of Democratic Representatives had signed onto HR 676, the Expanded & Improved Medicare for All Act. They will be joined by the long list of freshman Democrats who ran and won on this issue."Understandably, the transition to a new lead sponsor and an extensive rewrite process has created some nervousness and confusion in sections of the single-payer advocacy community."
Leading the charge in the House will be Rep. Pramila Jayapal (D-Wash.), who is assuming lead sponsorship of the Medicare for All bill after Keith Ellison stepped down to run for Attorney General of Minnesota. Jayapal got her start in the immigrant rights and civil rights movements, and has extensive ties to the social justice and labor movements in Washington State.
Her willingness to take the lead on the Medicare for All Act will come as no surprise: last year she helped to launch the first Medicare for All Caucus in the history of Congress, and, as Co-Chair of the Congressional Progressive Caucus, is helping to prioritize the CPC's work on single-payer healthcare. She brings an organizing approach and a deep understanding of the power that political momentum brings. She has won commitments from committee chairs to hold actual hearings on the bill and convinced speaker Pelosi to waive the "PayGo" rules as the bill is being marked up.
Rep. Jayapal's office is also in the midst of significantly rewriting the legislation, a move that has become necessary as the social movement for Medicare for All has grown, and the details of how it can be accomplished come under growing scrutiny. Bernie Sanders learned this the hard way when, during the 2016 Presidential primaries, he floated the outline of a plan for single-payer healthcare that received intense criticism from his opponents – most of it dishonest and misleading, but made easier by the lack of some details in the original proposal. The new bill not only will be much more detailed, it will also add additional benefits and correct some major shortcomings in both HR 676 and the Senate Bill (S 1804).
"The new bill not only will be much more detailed, it will also add additional benefits and correct some major shortcomings in both HR 676 and the Senate Bill (S 1804)."
Jayapal’s organizing approach impelled her to engage in extensive deliberations with single-payer advocates and to bring to the table voices that are often marginalized in the healthcare policy world, including advocates from the racial justice and disability rights communities. All of this takes time and the process has also been delayed by the government shutdown, leadership transition and the ongoing disruptions of an out of control Trump Administration. This means that the opportunity has passed to submit the new bill under the old HR 676 number beloved by single-payer diehards. The new bill will have a higher number. But it will be a serious piece of legislation ready to undergo the scrutiny of congressional committees and the Congressional Budget Office. More importantly, we believe the new bill will reflect the values of the healthcare justice movement.
Understandably, the transition to a new lead sponsor and an extensive rewrite process has created some nervousness and confusion in sections of the single-payer advocacy community. This has allowed a range of rumors and misrepresentations to run rampant among activist groups, including some rumors that have started spilling into published articles.
The two of us lead Healthcare-NOW and the Labor Campaign for Single Payer Healthcare, the national organizations representing community members and organized workers fighting to win healthcare as a right. Neither one of us has seen the final bill nor are we authorized to speak on behalf of Congresswoman Jayapal. However, we have been involved in extensive briefings and consultations with Jayapal’s staff and we want to explain what is happening with the bill, and express our confidence that it is shaping up to be a much stronger and more detailed piece of single-payer healthcare legislation than the bills submitted in the last Congress.
Messaging vs. Comprehensive Legislation
HR 676, the Medicare for All bill filed in the House of Representatives for the past fifteen years, was a "messaging" bill. It was intended to outline the key features of what a Medicare for All system would look like and to serve as a rallying point for the growing single payer movement. Many of its laudable features were little more than bullet points describing the essential components of such a system.
"The new bill—which will be filed as the Medicare for All Act of 2019—is more than 120 pages long and tries to flesh out the elements of a Medicare for All system in a comprehensive fashion."
The new bill—which will be filed as the Medicare for All Act of 2019—is more than 120 pages long (HR 676, by contrast, ran 30 pages from start to finish) and tries to flesh out the elements of a Medicare for All system in a comprehensive fashion. This is in expectation that the bill will receive serious consideration and review by the appropriate Congressional committees. It incorporates many new provisions and elaborates on the bullet points in HR 676.
Below are what we believe to be the essential features of a real Medicare for All program, and how we understand the new bill will address them:
Everybody In. Nobody Out.
The new Medicare for All Act will contain the same inclusive language as both HR 676 and Senator Sanders's Medicare for All bill: every resident of the United States would be eligible for coverage under the new health plan. The Secretary of Health and Human Services would define, through regulations, who exactly qualifies as a resident. Because they are younger and healthier than the general population, immigrants have low healthcare costs and pay far more into the system than they use, making full inclusion both the morally and economically right thing to do. The lack of a "citizenship" test is intentional and important, but both of our organizations (Healthcare-NOW and the Labor Campaign) would like to see more explicit language that doesn't provide wiggle-room to the Secretary of HHS.
Full and Comprehensive Medical Coverage
"We are assured that the new bill will follow Senator Sanders' Medicare for All Act and shelter the new national health plan from the Hyde Amendment, ensuring women's access to the full range of reproductive health services."
We expect that the final bill will include the full range of health services covered by the previous House bill (HR 676), as well as additional services that reflect new advances in medical treatment and the needs of the disability community and other vulnerable care recipients. Services covered include primary care, emergency care, mental health coverage, addiction treatment services, prescription drug coverage, medical devices, dental, and vision among others. Freedom to choose providers will be protected.
Long-Term Care
Long-term care (LTC) describes the range of services and supports that help people carry out tasks of everyday living (such as bathing, dressing, eating, taking medications, etc.) for those who need them. HR 676 committed to covering those services but it devoted only one sentence to how this large and life-saving sector would be funded and what benefits would be covered.
"The new House bill's LTC plan is being written after extensive consultation with disability advocacy and senior citizen communities, and incorporates their insights in developing comprehensive coverage that fosters independence and community-based care."
The Senate Medicare for All bill as it was written last session would not expand LTC coverage, and preserves the current system whereby people have to make themselves poor (if they are not poor already) to qualify for LTC under Medicaid. Medicaid LTC coverage varies tremendously from state-to-state, and institutional care (such as at nursing homes) is easier to qualify for than home-based care, even though it is more expensive and typically less beneficial for the recipient.
The new House bill's LTC plan is being written after extensive consultation with disability advocacy and senior citizen communities, and incorporates their insights in developing comprehensive coverage that fosters independence and community-based care.
Reproductive Healthcare
One major shortcoming of the previous House bill was that it remained silent on access to reproductive healthcare and abortion services. This meant that the move to a national healthcare plan coupled with the Hyde Amendment—which prohibits the use of federal funds for abortion and related services—would have denied all women access to insurance coverage for abortion services, even if they currently receive such coverage through their private insurance. We are assured that the new bill will follow Senator Sanders' Medicare for All Act and shelter the new national health plan from the Hyde Amendment, ensuring women's access to the full range of reproductive health services.
No Financial Barriers to Care
"There will be no co-payments, deductibles or other charges at the point of service for any category of care... The bill embraces the principle of a single standard of care for all Americans."
Like HR 676, there will be no co-payments, deductibles or other charges at the point of service for any category of care. And it will not include the Senate Bill's imposition of small drug co-payments to encourage the use of generic pharmaceuticals.
A Single Standard of Care for All
The bill embraces the principle of a single standard of care for all Americans. It will not allow participating institutions and providers to offer private care for covered services to the rich. Allowing the wealthy to "buy out" of the system has led to the erosion of care for everyone else in countries, such as Australia, who have experimented with it. The new House bill will also include substantial new language to begin to remedy healthcare disparities and expand service to underserved communities.
National and Regional Budgeting
Like the previous House bill's authors, Rep. Jayapal supports global budgeting for hospitals and other institutions, and fee-for-service for physicians. Furthermore we expect the bill will prohibit the use of funds for incentives that discourage utilization, increase profits or net revenues for providers, or rely on so-called "value-based payment" models. These are the best policies for minimizing administrative costs and avoiding payment methods that give providers an incentive to undertreat their patients or avoid the sick in favor of the healthy.
Protect Workers and Healthcare Professionals
"We expect the bill to include robust 'just transition' benefits for any healthcare and insurance industry workers displaced by the transition to Medicare for All."
We expect the bill to include robust "just transition" benefits for any healthcare and insurance industry workers displaced by the transition to Medicare for All, as well as prohibitions on using any funds intended for medical care towards union busting. There is also a commitment to ensure safe staffing levels, and to allow healthcare professionals to use their judgment to protect the best interests of their patients.
Transition Period
HR 676 had a transition period of between 1 and 2 years (if the bill was passed on January 2, it wouldn't be implemented for 2 full years), with no benefits until full implementation at the end of that period. The new House bill being drafted by Jayapal will likely have a transition period of two years, with significant benefits kicking in at the end of year one to improve Medicare and to extend a single-payer plan to about half the population. This is shorter than the four-year transition plan built into the Senate Medicare for All bill last session. Both the Sanders and the Jayapal bills are also using their transition periods to try to catch people who may lose their insurance if private insurance plans go under or refuse to write coverage after passage of the single-payer bill, which is likely.
What About Investor-Owned Facilities?
The new bill will likely not include one provision previously featured in HR 676 that banned investor-owned providers from participating in the new national health plan (this includes hospitals, nursing homes, dialysis clinics, dental and eye-care providers, etc). This provision would have required tax-payers to reimburse the shareholders of these providers for their lost stock value, and to ostensibly convert the facilities to nonprofit status. Instead, the new bill will seek to minimize profit taking through a series of budgetary and regulatory provisions.
Supporters of the "buy out" model maintain that it will cost $150 billion or so (approx. 5% of the entire federal budget) to reimburse the entire industry, and remind us that studies consistently show that for-profit providers produce abysmal outcomes. But there is considerable disagreement in our movement about whether buying out the for-profits is the best way to deal with the distortions of profit taking. Given the federal courts' propensity to privilege private property over public goods, it is all but certain that this buyout provision would spark a protracted legal battle. It is also difficult to guarantee under this provision that new non-profit providers would be created to replace every single for-profit company that closes its doors, since there is no way to compel a new non-profit to form. And the nonprofit section of the industry itself has gone through extensive consolidation and often embraces a business model that is virtually indistinguishable from that of investor-owned facilities. While we can honestly disagree about the best ways to begin to squeeze profit taking out of our bloated healthcare industry, we believe it is disingenuous for any sincere advocate of Medicare for All to maintain that any bill that fails to require the buyout of investor-owned facilities is fatally flawed and not worthy of support.
Negotiating Lower Prescription Drug Costs
Moreover, Jayapal intends to rein in the 500-pound gorilla in the profiteer room: Big Pharma. While HR 676 empowered the new national health plan to negotiate with drug manufacturers, it contained no backup plan if Pharma refuses to negotiate and holds the country hostage. Rep. Jayapal, taking a page from a bill introduced by Rep. Lloyd Doggett (D-Texas) last year, is in favor of putting real teeth behind that negotiating authority by empowering the federal government to strip drug makers of their patent rights—making them compete with generic producers—if they fail to negotiate reasonable prices in good faith.
Maintaining Our Commitment to Native American and Veterans' Healthcare
Another provision of the previous House bill has been cause for concern: HR 676 was written to phase out the Indian Health Services (IHS) after five years, and to begin a discussion of phasing out the Veterans Administration (VA) after ten years. The thinking was that these populations would be fully covered under the new national health plan, and would have their choice of providers – whether at IHS facilities, VA hospitals, or elsewhere. The language was not written in consultation with the potentially impacted communities, though, and these two healthcare systems are vital for fulfilling our country's historic debt to these two communities. Converting IHS and VA facilities into general providers for anyone in the population could significantly diminish their ability to offer targeted, effective service for Native Americans and veterans. The new Medicare for All Act will keep the IHS and VA systems fully funded and intact, even while their target populations will gain access to broader range of providers and services.
Collaborative Drafting Process
In part because of rumors circulating about the bill and the extended drafting period, there has also been a call for Rep. Jayapal to immediately release the full text of the bill draft to advocates, and to conduct an open revision process. We are not aware of any major piece of legislation—including previous iterations of the bill—that has been drafted in public. There are obvious reasons not to do so: the bill has to undergo legal review before committing to any provisions; you may want to give potential cosponsors the chance to weigh in before they read about it in the press; and you may not want to give your opponents and industry lobbyists the chance to dig in before the full bill is even released.
"We are entering into the fight of our lives... We will need all hands on deck to fight this two-front war."
In truth, Rep. Jayapal has included a number of major single-payer advocacy organizations in the redrafting process and, after reaching a rough draft phase, brought in an even larger range of national grassroots organizations and trade unions. While it is certainly frustrating that it has taken longer than expected to prepare the final draft of a bill that we are all eagerly awaiting, we have to say that Jayapal's office has been extraordinarily open to sharing their views and taking advice from the healthcare justice community.
We are entering into the fight of our lives. Support for Medicare for All has never been stronger and Congress, for the first time in modern history, has been compelled to hold hearings on what an effective Medicare for All bill should look like. As our momentum grows, we will be facing the concentrated power of the Medical Industrial Complex whose tentacles reach into almost one fifth of the U.S. economy. In addition, we will be confronted with a Democratic establishment intent on diluting and undermining our vision in ways that will be very confusing to the American people and will peel off substantial institutional support from labor and other social movement organizations. We will need all hands on deck to fight this two-front war.
As we move from an aspirational phase into dealing with the nuts and bolts of implementing a concrete piece of legislation, the greater the potential will be for tensions within our movement to grow and to be used strategically against us. We are looking forward to the next phase of scaling up our organizing, as well as paying particular attention to building unity within the movement as we do so.
https://www.commondreams.org/views/2019/02/07/everybody-nobody-out-what-we-know-so-far-about-medicare-all-act-2019
How Democrats could lose on health care in 2020
by Ronald A. Klain - Washington Post - February 6, 2019
In 2018, Democrats won the midterm elections
on the issue of health care, specifically protecting the Affordable Care
Act and its guarantee of coverage for pre existing
conditions. It was a hard-earned victory: Passing the ACA was a major
reason Democrats lost the House and seats in the Senate in 2010 , and polls showed
the ACA was not a winner for Democrats in 2012, 2014 or 2016. Now, the
question is: Having won the upper hand on health care, will Democrats
give it back in 2020?
What might squander
that advantage? A primary battle among Democrats who all favor
universal coverage but have differences about how to get there.
Candidates seeking advantage in that contest by questioning the purity
of one another’s views on health care, or conversely, trying to scare
voters with nightmare scenarios about those with more liberal views. And
most important, a focus on internecine differences instead of on the
sharp contrast between the core Democratic position and the Republican
stand on the future of health coverage in our country.
The
first warning sign was the recent false debate over whether any
potential Democratic candidates favor abolishing private health
insurance as part of their support for Medicare-for-all. None do. The
Medicare for All Act explicitly says:
“Nothing in this Act shall be construed as prohibiting the sale of
health insurance coverage for any additional benefits . . . including
additional benefits that an employer may provide to employees . . . or
to former employees.” In fact, many Americans already on Medicare also
have some form of private insurance, whether it is private-company
retiree health benefits or a “Medigap” plan to cover services that
Medicare doesn’t.
But the statements from Sen.
Kamala D. Harris (D-Calif.) at a CNN town hall underscoring the obvious
pain points many encounter when using private insurance were portrayed
as a desire to ban all private coverage. And Sen. Cory Booker’s
(D-N.J.) subsequent acknowledgment that private insurance would remain
in a Medicare-for-all world was painted as a rebuke of Harris . Neither is correct.
Nor is expanding Medicare some radical departure in our system. One in three Americans
already gets coverage from Medicare or Medicaid — far more than are
covered by any private insurer. Expanding that coverage isn’t “un-American ”
(unless one-third of the country is “un-American”); Medicare expansion
should not scare anyone or suggest an end to private coverage as part of
our system.
Yes, there are differences among
the Democrats running for president. Some favor all Americans getting
their basic coverage from a restructured Medicare. Others may back a plan
that would allow all Americans to choose between Medicare or continuing
to get their basic insurance from private carriers. Still others back a more limited growth in Medicare, expanding its reach to those age 55 or older.
The
differences are important, but two critical points are even more
significant. First, overwrought hair-splitting among the primary
contenders’ positions proves little about what any would actually do as
president. In 2008, Hillary Clinton and Barack Obama waged a fierce battle
over whether an “individual mandate” — requiring each person to buy
health-care coverage — should be part of health-care reform. Obama
opposed the mandate during the campaign and then put one in his
health-care plan once in office.
Likewise, most
of 2020’s Democratic contenders — no matter what their apparent
differences on the campaign trail — are likely to work toward
essentially the same policies once in office: strengthening the
Affordable Care Act, expanding Medicaid and creating a path to universal
coverage under Medicare. The devil may be in the details, but Satan
will be wrestled to the ground in the Oval Office, not the Iowa
caucuses.
Second, Democrats cannot let
relatively minor differences between them over how to achieve universal
coverage overshadow the real divide in U.S. politics: the gaping hole
between Democratic plans to expand health-care coverage and the
relentless Republican pursuit of the wish list of the health insurance
industry.
Republicans in Congress spent years
doing everything they could to repeal the ACA. If they had gotten their
way, millions would have lost their coverage, and tens of millions would
have had no protection from insurance company abuses, such as denying
coverage due to preexisting conditions or cutting off coverage after
patients hit a “lifetime cap.” Once in power, and after they were unable
to repeal the law, President Trump pushed forward an agenda to shred
state regulation of insurance companies and allow a single state
regulator captured by insurance interests to greenlight “sham insurance”
plans for sale coast to coast. And on Trump’s watch, the percentage of
Americans lacking coverage has climbed , and the number of families getting covered under the ACA has fallen .
Democrats
should not let 2020 be about their differences on health care. They
need to get sharper at turning the argument around. The question in 2020
should not be why most Democrats want to give more Americans the
opportunity to have Medicare coverage instead of private health
insurance; the question should be why Republicans are so determined to
keep Americans trapped in the world’s most expensive, bureaucratic
health coverage system, which serves so many so poorly, and so many
others not at all.
Nothing Short of Medicare for All in 2020
by Heather Gautney - Jacobin - February 5, 2019
A majority of House Democrats supported single payer in 2016, as did all of the 2020 hopefuls in the Senate. At the opening of this 116th Congress, House Speaker Nancy Pelosi announced her support for hearings on Medicare for All following the launch of the House Medicare for All Caucus last summer. (Though, out of the other side of her mouth that day, Pelosi oversaw the passage of “Paygo” legislation, an austerity measure that requires all new spending to be offset with deficit reduction.)
Recent polls tally support for Medicare for All at 70 percent, with 85 percent of Democrats and more than half (52 percent) of all Republicans. Single payer’s growing popularity, in and outside the Beltway, is a function of US lawmakers’ refusal to legislate an egalitarian health care system and a failure of neoliberalism more generally. Health care is a barometer of how a society values human life and how wealth and political power are distributed in it.
In the context of Democratic Party politics, neoliberal Democrats treat health care as a matter of consumer choice — a commodity distributed according to financial ability and subject to the vagaries of the “free” market. Medicare for All supporters, by contrast, argue that health care is a right that should be equally available to all — regardless of health status, income, employment, gender, immigration status, race, and ethnicity — that’s protected from the whims of business cycles and capitalist exploitation.
The Affordable Care Act (ACA) expanded access to private health insurance and Medicaid for tens of millions of Americans and prohibited insurance companies from denying coverage for preexisting conditions and canceling policies for expensive enrollees. It helped extend coverage to those who needed it most — women, people of color, and poor and working-class people. But the ACA also left some thirty million people uninsured and tens of millions more underinsured due to cost-prohibitive premiums, deductibles, and co-pays.
According to a 2017 Kaiser Family Foundation survey, 43 percent of adults — with health insurance — are struggling to afford their deductibles, and about a third cannot pay their premiums. Millions of people are declaring bankruptcy because of exorbitant medical bills, or are cutting back on food, clothing, or other basic needs to pay for care. Tens of millions are skipping or delaying treatment, and each year, tens of thousands die because they cannot get the care they need.
The fact that people are starving, going bankrupt, and dying because they lack health care has not stopped corporate Democrats from working to sabotage Medicare for All — especially in 2016, when Bernie Sanders’s presidential campaign popularized the idea. Bankrolled by big insurance, big pharma, and hospital systems, Clintonites and the Wall Street wing of the Democratic Party spared no expense to ensure that this highly profitable, multitrillion-dollar industry would not become a public good.
Despite the class antagonisms of 2016, once Trump took office, progressive and corporate Democrats joined forces to stave off the GOP’s multiple attempts to destroy the ACA and cut Medicaid and Medicare to pay for their $1.5 trillion tax cut for the rich. As a senior advisor in the Senate Budget Committee at the time, I accompanied Sanders on of one his “Don’t Take Our Health Care” tours aimed at pressuring Republican senators in Ohio, Pennsylvania, and West Virginia to oppose the legislation. That unified Democratic Party effectively put a stay on the GOP run of anti-ACA bills and marked an incredible victory for “the resistance” in the context of a fully Republican-controlled federal government.
That united front won’t hold in 2020, however.
Already, some of the presidential hopefuls who signed on to Sanders’s bill, namely Cory Booker and Kamala Harris, are waffling on whether Medicare for All should be a public good.
Plus, Obama administration and Hillary Clinton campaign alumni are teaming up with PhRMA, the American Medical Association (AMA), the BlueCross BlueShield Association, and a dozen other hospital and insurance lobbies to undermine Medicare for All in the court of public opinion.
Under the auspices of the Partnership for America’s Health Care Future, they plan to run ads, polls, and white papers to paint single payer as a disruptive, non-pragmatic, “one-size-fits-all, government-controlled system” that would restrict choice and innovation. Tellingly, that same pro-business red-baiting was echoed by Donald Trump in a recent USA Today op-ed, where he lamented the “planned government takeover of American health care.”
In the lead up to the South Carolina primary, for example, where black voters are the Democratic majority, Rep. James Clyburn told voters that Bernie’s free public college legislation would undermine historically black colleges and universities — even though black students would disproportionately benefit from it and despite the fact that Sanders did have targeted funding in his bill to support those historically black institutions. Rep. John Lewis, for his part, insulted Bernie’s civil rights activism and used austerity politics to delegitimize key elements of his agenda, including universal health care:
There’s not anything free in America. We all have to pay for something. Education is not free. Health care is not free. Food is not free. Water is not free. I think it’s very misleading to say to the American people, we’re going to give you something free.The contradictions manifest in Lewis’s remark are instructive. Corporate Democrats know that the failures of Obamacare — thirty million uninsured and tens of millions more underinsured due to exorbitant cost-sharing — have hit Latinx and black Americans the hardest. They also know that the closest thing to single payer in the United States, Medicare, has been effective in mitigating racial disparities among people aged sixty-five and over. Yet many of them still reject the idea that racial, gender, and class-based injustice could be alleviated through universal forms of public investment and an equitable redistribution of wealth.
That rejection was particularly ironic in Lewis’s case, since he, perhaps more than anyone else alive today, is aware that civil rights was about merging movements for black freedom with the general struggle of “the common man.” That fusion of racial and economic justice is embodied in A. Philip Randolph’s 1966 “A Freedom Budget for all Americans,” which offered a concrete policy agenda for universal access to proper medical care, quality housing, full employment, and higher education, in addition to other social goods, like a sound infrastructure and healthy environment.
June Eichner and Bruce C. Vladeck write in Health Affairs, “Because health care access and health status prior to Medicare eligibility are major determinants of beneficiaries’ health, improved access to care for other age groups should reduce health disparities. It could be argued that universal insurance for the entire population would have the largest impact on disparities of any strategy.”
In other words: extending Medicare to all Americans, as Sanders and Rep. Pramila Jayapal have proposed, could be an impactful step in mitigating racial disparities in American health care today.
By far the most successful part of the ACA was Medicaid expansion, which shows that expanding government programs is the cleanest, best way to provide people with health insurance. Studies on the quasi-single-payer system of the Veterans Administration (VA) also bear this out; in multiple measures of health, black patients actually do as well, or better, than their white counterparts.
That said, the Medicare program does have its limits. Racial discrimination is prevalent throughout our entire health care system, from clinical settings to insurance redlining to medical schools. Due to the racial wealth gap in America, many seniors of color cannot afford out-of-pocket costs for deductibles, coinsurance, and uncovered services. Plus, Medicare can only do so much when gross inequalities infect nearly all other social institutions and physical environments, and when the program is only available to people in their elder years.
Nonetheless, poor health outcomes among black Americans, due in large part to lack of access to care, would be significantly mitigated by instituting a universal health care program. That’s especially true if such disparities are addressed in terms of other social inequalities that particularly afflict black Americans — from mass incarceration to food deserts and environmental racism to school segregation and lack of health literacy, and many others.
Like Randolph’s Freedom Budget, for years Sanders has attempted to resolve America’s health care crisis by instituting a universal health care program, but also by legislating major investments in greening our infrastructure and strengthening our social institutions.
Single payer is not a silver bullet for confronting racial injustice in and beyond health care. We should also be targeting services and placing providers in underserved communities. But giving everyone comprehensive health insurance is absolutely essential to confronting those racial inequalities.
What “access” really means, in Democratic parlance, is that people can buy affordable health insurance — they’re just not guaranteed affordable health care. Sanders and Jayapal excepted, all the proposed plans offer some combination of private and public insurance, which results in a fragmented system that does not contain costs and leaves drug and insurance companies in the driver’s seat.
The high price of deductibles, co-pays, and premiums is part of the reason why so many people remain underinsured under the ACA. The ACA did not break the link between health care and employment, and employer-sponsored insurance (ESI) premiums have been going up for decades as employers shift more and more costs onto their employees. Sanders and Jayapal’s bills are the only ones in the mix that do not involve cost-sharing.
And, by delinking health care from employment, their bills not only address the problem of unaffordable premiums, but also ensure that workers no longer have to stay at jobs they dislike just to keep their health care benefits. Under their plans, no American would have to delay or forego treatment because of an inability to pay, and no one would have to declare bankruptcy due to high medical costs.
Currently, the United States has the highest per-capita health care expenditures in the world, yet our health outcomes lag behind those of most other wealthy nations. Under the Sanders/Jayapal bills, the US health insurance system would be run by one public agency covering all residents equally and would not be treated as a commodity to be exploited by private companies.
The importance of putting health care in the public sector is something that presidential candidates like Cory Booker and Kamala Harris don’t seem to comprehend. By taking health care out of the hands of private insurers and allowing the government to negotiate prices, Medicare for All would lower administrative costs and eliminate waste and profiteering.
Given the clear benefits of single payer, why would any Democrat oppose it?
For those backed by Big Pharma and the insurance industry, it’s an obvious case of political self-interest. For others with less of a financial stake, it’s a matter of political courage. Medicare for All is not just about the institution of health care — it’s about how America distributes its resources. Cost-sharing is politically appealing because it reduces the tax revenue necessary to finance our health care system, and in neoliberals’ crass vernacular, forces patients to put “skin in the game.”
But it unfairly shifts the costs of health care from government and insurance companies onto individuals and families who are already struggling with stagnant wages and soaring costs of living.
In that vein, critical to Sanders’s health care agenda are policies related to jobs and other parts of the social system. For example, single-payer legislation must include robust provisions for transitioning health industry workers to the new system; a federal jobs guarantee such as the one Sanders is developing would offer an additional safety net.
Moreover, a clean environment, affordable housing, a living wage, access to good schools, higher education, and rewarding work all affect our wellness and quality of life. Sanders’s platform involves public sector investment in all of these aspects of the social matrix and physical environment.
If Democrats are genuinely interested in mitigating racial and gender disparities in our social institutions, they must start considering them in terms of the structure of the larger political economy. That means implicating the fundamentals of contemporary capitalism: the primacy of capitalist markets, profit motives, and ruling-class power, and the racial and gender ideologies that help legitimize them.
If Democrats are serious about defeating Donald Trump in 2020, they cannot continue to play footsie with drug and insurance companies and allow them to exploit our sick and our elderly. Sanders, if he runs, would be the only presidential candidate who has taken on corporate health care profiteers in the name of the working class and worked to pass Medicare for All through social movement pressure, not compromise.
As Energy for Medicare for All Soars, Pelosi Aide Reportedly Assured Insurance Industry That Democratic Leaders Remain 'Allies'
by Jake Johnson - Common Dreams - February 5, 2019
Who supports Medicare for All and who doesn't? It's becoming an increasingly complex question.As Medicare for All advocates point to surging grassroots energy behind the bold policy and argue that the key question now "is not if we will win, it is when," a report by The Intercept on Tuesday intensified concerns that the Democratic leadership will continue to resist the rising tide of enthusiasm for single-payer even as it is embraced by a growing number of lawmakers, 2020 presidential candidates, and 70 percent of the public.
"Grassroots supporters of universal healthcare may have reason to be less than trusting of the Democratic leadership."
—David Dayen
According to The Intercept, Wendell Primus—the top healthcare adviser to House Speaker Nancy Pelosi (D-Calif.)—reassured Blue Cross Blue Shield executives during a private meeting shortly after the November midterm elections that the Democratic leadership "had strong reservations about single-payer healthcare and was more focused on lowering drug prices."
"Primus detailed five objections to Medicare for All and said that Democrats would be allies to the insurance industry in the fight against single-payer healthcare," reported The Intercept's Ryan Grim, citing anonymous sources familiar with the meeting. "Primus pitched the insurers on supporting Democrats on efforts to shrink drug prices, specifically by backing a number of measures that the pharmaceutical lobby is opposing."
In a slide presentation obtained by The Intercept, Primus parroted some of the most common and easily debunked objections to Medicare for All pushed by its opponents—such as the policy's supposedly high cost—and argued that improving the Affordable Care Act (ACA) "is the most cost-effective path to universal coverage":
As Grim pointed out, Democratic leaders themselves have publicly adopted a "deeply skeptical" posture toward Medicare for All even as support for the policy has grown rapidly in Congress and at the grassroots.
"In the House, even as [Medicare for All] has picked up momentum with voters and members of the Democratic caucus, Democratic leadership has remained deeply skeptical," Grim notes. "Pelosi's consistent messaging, instead, has been around protecting the Affordable Care Act and lowering prescription drug prices."
Journalist David Dayen argued that The Intercept's reporting provides progressive activists more reason to "be less than trusting of the Democratic leadership" as they work to make the long-standing aspiration of Medicare for All a reality.
"It's no secret that the momentum around single-payer, Medicare for All has been building for months," Justice Democrats noted in an email responding to The Intercept's report. "People are rallying around the notion that no American should die or go bankrupt just because they got sick, and that we can finally end the obscene profiteering of insurance corporations."
"But remember: as long as there are Democrats out there who take money from health insurance corporate PACs, there will be people pandering to the people on top instead of the people on the bottom," the group concluded.
Pointing to overwhelming public support for Medicare for All, Our Revolution added that "Congress should listen to the people, not water down and stifle policy supported by the majority."
This is a prime example of the problem with the corrupting influence of corporate money in our political process.70% of Americans support Medicare for All. Congress should listen to the people, not water down and stifle policy supported by the majority. https://t.co/GXSIWil4hx
— Our Revolution (@OurRevolution) February 5, 2019
Acknowledging that powerful forces like the insurance and pharmaceutical industries will pull out all the stops to prevent Medicare for All from even getting off the ground, NNU declared that only relentless organization and mobilization can overwhelm single-payer opponents on the way to creating a humane and cost-effective healthcare system.
"To build the mass collective action we know we'll need to win, we're asking activists like you across the country to organize a Medicare for All barnstorm in your community as part of a national Medicare for All Week of Action from February 9th-13th," NNU wrote in a petition. "At the barnstorm you'd gather with volunteers near you, talk about the plan to win, and begin organizing to knock doors, make phone calls, and more in your community."
In an interview with the New York Times over the weekend, Sen. Bernie Sanders (I-Vt.)—whose 2016 presidential campaign is credited with pushing Medicare for All into the national conversation—argued that it would be political malpractice to reject Medicare for All in the midst of surging support for an ambitious transformation of the current for-profit system, which leaves tens of millions of Americans completely uninsured.
"Every candidate will make his or her own decisions," the Vermont senator said. "[But] if I look at polling and 70 percent of the people support Medicare for All, if a very significant percentage of people think the rich, the very rich, should start paying their fair share of taxes, I think I'd be pretty dumb not to develop policies that capture what the American people want."
https://www.commondreams.org/news/2019/02/05/energy-medicare-all-soars-pelosi-aide-reportedly-assured-insurance-industry
An Open Letter to Rep. Pramila Jayapal Regarding Medicare for All
, ,
Dear Congresswoman Jayapal,
Thank you for your hard work and leadership as the new lead sponsor of the forthcoming Medicare for All Act of 2019. As health care providers and health justice advocates, we look forward to working with you to grow support for the bill and ensure its future passage.
"There is no place for profit in a humane and efficient national health program."
We applaud your efforts to improve the legislation from previous versions by including guaranteed access to vital services such as reproductive health and long-term care. However, we have identified two key policy provisions that must be addressed in the final bill: 1) the explicit prohibition and buyout of investor-owned, for-profit health facilities, and 2) the explicit inclusion of coverage for every resident of the U.S., regardless of immigration or citizenship status.
1. As part of a transition to a Medicare-for-all system, for-profit health facilities should be converted to nonprofit governance and their owners compensated for past investments.
There is no place for profit in a humane and efficient national health program. For-profit providers (including hospitals, dialysis centers, nursing homes, home care agencies, and hospices) have been shown to provide inferior care at inflated prices and are more likely to bend care to profitability. For-profit hospitals spend less on nurses and other clinical aspects of care, but more on administration and financial management, compared to nonprofits. For-profit nursing homes are cited for quality deficiencies 28 percent more often than nonprofits, and for deficiencies that place residents in immediate jeopardy 53 percent more frequently. Investor-owned home care agencies cost Medicare $752 more per patient than nonprofit agencies, while providing worse care. In addition, investor-owned chains have often been cited for questionable business practices and have been repeatedly implicated in large-scale fraud.
To achieve a fully nonprofit health system, Medicare for all legislation should include plans for the government to “buy out” investors in for-profit institutions. Researchers estimate the fair market value of investor-owned facilities covered by a buyout to be $150 billion at most. Using Treasury Bill financing over 15 years at the current interest rate of 3 percent would cost the government about $12.75 billion annually, equivalent to about 1 percent of annual hospital costs. Even in the short term, these costs would be offset by eliminating what we currently waste on investor profits. For example, total profits of just three investor-owned firms (HCA, DaVita and Fresenius) totaled more than $6 billion in 2017. For the sake of both patient health and cost savings, we cannot afford to let investor-owned facilities participate in a Medicare for all system.
2. A future Medicare for all program must include everyone living in the U.S., regardless of immigration or citizenship status.
Aside from humanitarian concerns, excluding anyone in the U.S. from a national health plan only adds waste and unnecessary administrative costs. Immigrants are often used as a scapegoat for skyrocketing health costs, but studies show that instead of draining our health care dollars, immigrants subsidize and maintain our health care system.
"Aside from humanitarian concerns, excluding anyone in the U.S. from a national health plan only adds waste and unnecessary administrative costs."
Between 2002 and 2009, immigrants contributed $115 billion more to the Medicare Trust Fund than they used in health care. Because of their lower utilization costs, immigrants also heavily subsidize private insurance for U.S.-born residents. A single-payer bill must explicitly include both documented and undocumented immigrants, and not leave eligibility up to administrative whims.
As medical students and physicians, we strongly believe that a single-payer program is the only solution to our country’s failing health care system. However, to ensure the long-term success of Medicare for All, we must get the policy details right, including a ban on for-profit health facilities with a planned buyout of investors, and the inclusion of every U.S. resident, regardless of immigration status.
Sincerely,
Christopher Cai, Medical Student
Isabel Ostrer, Medical Student
Ana Malinow, MD
https://www.commondreams.org/views/2019/02/06/open-letter-rep-pramila-jayapal-regarding-medicare-all
Are Republicans the Party of No Ideas on Health Care?
The G.O.P. needs to finally figure out, or at least start figuring out, exactly what it stands for on health care policy.
by Peter Suderman - Reason Magazine - February 7, 2019
Judging by exit polls, the single most effective midterm
issue for Democrats was health care — in particular, the argument, made
by Democratic candidates across the country, that Republicans were out
to eliminate the Affordable Care Act’s regulations governing
pre-existing conditions.
So when a Texas judge ruled in December that the entirety of the health law was unconstitutional, he ensured that this issue, and this argument, would remain front and center heading into the 2020 election.
Legally speaking, the ruling is weak, and the case may be tossed in the appeals process. But if it travels all the way to the Supreme Court, it would effectively guarantee that health care remains politically potent throughout the presidential campaign. You can expect the Democrats’ cast-of-thousands presidential field to all swear to protect Obamacare’s pre-existing conditions rules — and President Trump to demonstrate his usual command of the finer points of health care policy in response.
The ruling thus represents a challenge for Republicans — but also an opportunity. At least in theory, it could force the party to finally figure out, or at least start figuring out, exactly what it stands for when it comes to health care policy.
So when a Texas judge ruled in December that the entirety of the health law was unconstitutional, he ensured that this issue, and this argument, would remain front and center heading into the 2020 election.
Legally speaking, the ruling is weak, and the case may be tossed in the appeals process. But if it travels all the way to the Supreme Court, it would effectively guarantee that health care remains politically potent throughout the presidential campaign. You can expect the Democrats’ cast-of-thousands presidential field to all swear to protect Obamacare’s pre-existing conditions rules — and President Trump to demonstrate his usual command of the finer points of health care policy in response.
The ruling thus represents a challenge for Republicans — but also an opportunity. At least in theory, it could force the party to finally figure out, or at least start figuring out, exactly what it stands for when it comes to health care policy.
The empty mantra of
“repeal and replace” — which was all but buried by the midterms — was
never a stand-in for an actual shared vision for the governance of
health care in the United States. At the moment, the party seems
confused about what, exactly, American health care policy should look
like.
That confusion extends beyond Obamacare to Medicare (which President Trump has ruled off limits) and Medicaid (which the repeal bills tried and failed to restructure), as well as to the tax deduction for employer-sponsored insurance around which health care policy has contorted for so many decades.
It’s not that there’s a shortage of ideas: Conservative think tanks have health policy white papers to spare, and have for years. All the way back in 2012, for example, you could find the right-of-center health policy scholars James Capretta and Robert E. Moffit outlining principles for an Obamacare replacement in the journal National Affairs. Their plan called for limiting the tax break employers get for offering health coverage, converting existing public coverage programs to premium support (essentially a subsidy) while promoting competition among private plans, protecting people who maintain continuous coverage from spikes in premiums, and allowing states more flexibility to opt in and out of national health care initiatives.
The Cato Institute’s Michael Cannon has long called for the creation of large Health Savings Accounts that would dramatically increase the amount of money individuals could put into tax-free accounts for medical expenses, including health insurance, potentially giving millions of people an optional exit from employer-sponsored insurance.
What connects these ideas is that they are not merely bullet-pointed lists of policy tweaks; they are frameworks for thinking more broadly about what federal health policy can, and perhaps should, be.
That confusion extends beyond Obamacare to Medicare (which President Trump has ruled off limits) and Medicaid (which the repeal bills tried and failed to restructure), as well as to the tax deduction for employer-sponsored insurance around which health care policy has contorted for so many decades.
It’s not that there’s a shortage of ideas: Conservative think tanks have health policy white papers to spare, and have for years. All the way back in 2012, for example, you could find the right-of-center health policy scholars James Capretta and Robert E. Moffit outlining principles for an Obamacare replacement in the journal National Affairs. Their plan called for limiting the tax break employers get for offering health coverage, converting existing public coverage programs to premium support (essentially a subsidy) while promoting competition among private plans, protecting people who maintain continuous coverage from spikes in premiums, and allowing states more flexibility to opt in and out of national health care initiatives.
The Cato Institute’s Michael Cannon has long called for the creation of large Health Savings Accounts that would dramatically increase the amount of money individuals could put into tax-free accounts for medical expenses, including health insurance, potentially giving millions of people an optional exit from employer-sponsored insurance.
What connects these ideas is that they are not merely bullet-pointed lists of policy tweaks; they are frameworks for thinking more broadly about what federal health policy can, and perhaps should, be.
That sort of
thinking — about both general principles and the specific policy
components necessary to make them a reality — is exactly what the
Republican Party lacks, and what it desperately needs.
It’s true that some Republican lawmakers have cobbled together proposals of varying degrees of specificity over the year: During his 2016 campaign for the Republican presidential nomination, Senator Marco Rubio of Florida sketched out a mostly forgotten health care plan that would have set up a broad-based system of refundable tax credits intended to subsidize the purchase of insurance in hopes of helping people buy coverage. And during the 2017 Obamacare repeal effort, Senators Lindsey Graham and Bill Cassidy offered a plan to give states far more flexibility, eliminating many of Obamacare's provisions at the national level while essentially turning the program into a block grant to the states.
But these efforts have tended to be cursory and short-lived, with tiny or nonexistent constituencies. Few conservative lawmakers talk about them today, and it’s unclear whether many Republicans in Congress today even grasp the basics.
Which is why, for all these ideas, if you ask Republican politicians what they stand for when it comes to health policy, you are likely to hear slogans like “patient centered” and “preserving the doctor-patient relationship” and possibly something about how Democrats want to “socialize Medicare” — as if the nation’s largest government health program is not already an essentially socialist enterprise.
So it’s possible to imagine that at least some in the party will try to resolve, or at least start acknowledging, some of these questions.
More likely, given the state of the G.O.P. under Trump, who is no one’s idea of a wonk, is that Republicans will simply decline to pursue the issue with any force, and the shabbiness of the party’s current non-position will become even more glaring. Indeed, just this month, Mr. Trump continued to predict Obamacare’s demise, saying he believed that “it’s going to be terminated,” possibly as a result of the Texas case, and that in the aftermath, “a deal will be made for good health care in this country.” What sort of deal? I suspect that even (perhaps especially) the president doesn’t know.
That sort of glibness, in turn, is likely to give already-ascendant Democratic ideas a boost. The party’s enthusiasm for Medicare for All has flourished recently in part because it exists in a vacuum, with little if any substantive competition from the right. There are serious practical and political impediments to making a transition to single payer, from the enormous increase in federal spending and the tax increases it would almost certainly entail to the disruption that would be caused by the elimination of current private health insurance coverage for millions of Americans.
It’s true that some Republican lawmakers have cobbled together proposals of varying degrees of specificity over the year: During his 2016 campaign for the Republican presidential nomination, Senator Marco Rubio of Florida sketched out a mostly forgotten health care plan that would have set up a broad-based system of refundable tax credits intended to subsidize the purchase of insurance in hopes of helping people buy coverage. And during the 2017 Obamacare repeal effort, Senators Lindsey Graham and Bill Cassidy offered a plan to give states far more flexibility, eliminating many of Obamacare's provisions at the national level while essentially turning the program into a block grant to the states.
But these efforts have tended to be cursory and short-lived, with tiny or nonexistent constituencies. Few conservative lawmakers talk about them today, and it’s unclear whether many Republicans in Congress today even grasp the basics.
Which is why, for all these ideas, if you ask Republican politicians what they stand for when it comes to health policy, you are likely to hear slogans like “patient centered” and “preserving the doctor-patient relationship” and possibly something about how Democrats want to “socialize Medicare” — as if the nation’s largest government health program is not already an essentially socialist enterprise.
So it’s possible to imagine that at least some in the party will try to resolve, or at least start acknowledging, some of these questions.
More likely, given the state of the G.O.P. under Trump, who is no one’s idea of a wonk, is that Republicans will simply decline to pursue the issue with any force, and the shabbiness of the party’s current non-position will become even more glaring. Indeed, just this month, Mr. Trump continued to predict Obamacare’s demise, saying he believed that “it’s going to be terminated,” possibly as a result of the Texas case, and that in the aftermath, “a deal will be made for good health care in this country.” What sort of deal? I suspect that even (perhaps especially) the president doesn’t know.
That sort of glibness, in turn, is likely to give already-ascendant Democratic ideas a boost. The party’s enthusiasm for Medicare for All has flourished recently in part because it exists in a vacuum, with little if any substantive competition from the right. There are serious practical and political impediments to making a transition to single payer, from the enormous increase in federal spending and the tax increases it would almost certainly entail to the disruption that would be caused by the elimination of current private health insurance coverage for millions of Americans.
In the meantime, the Texas case will ensure that the G.O.P.’s waffling and uncertainty on policy basics, like legal requirements regarding pre-existing conditions, remain in the spotlight. The red state attorneys general who brought the case may have imagined it was a clever way to highlight Obamacare’s flaws, but instead it shone a spotlight on their own.
https://www.nytimes.com/2019/02/07/opinion/republicans-trump-health-care.html
Trump Versus the Socialist Menace
by Paul Krugman - February 7, 2019
In 1961,
America faced what conservatives considered a mortal threat: calls for a
national health insurance program covering senior citizens. In an
attempt to avert this awful fate, the American Medical Association
launched what it called Operation Coffee Cup, a pioneering attempt at viral marketing.
Here’s how it worked: Doctors’ wives (hey, it was 1961) were asked to invite their friends over and play them a recording in which Ronald Reagan explained that socialized medicine would destroy American freedom. The housewives, in turn, were supposed to write letters to Congress denouncing the menace of Medicare.
Obviously the strategy didn’t work; Medicare not only came into existence, but it became so popular that these days Republicans routinely (and falsely) accuse Democrats of planning to cut the program’s funding. But the strategy — claiming that any attempt to strengthen the social safety net or limit inequality will put us on a slippery slope to totalitarianism — endures.
And so it was that Donald Trump, in his State of the Union address, briefly turned from his usual warnings about scary brown people to warnings about the threat from socialism.
Here’s how it worked: Doctors’ wives (hey, it was 1961) were asked to invite their friends over and play them a recording in which Ronald Reagan explained that socialized medicine would destroy American freedom. The housewives, in turn, were supposed to write letters to Congress denouncing the menace of Medicare.
Obviously the strategy didn’t work; Medicare not only came into existence, but it became so popular that these days Republicans routinely (and falsely) accuse Democrats of planning to cut the program’s funding. But the strategy — claiming that any attempt to strengthen the social safety net or limit inequality will put us on a slippery slope to totalitarianism — endures.
And so it was that Donald Trump, in his State of the Union address, briefly turned from his usual warnings about scary brown people to warnings about the threat from socialism.
What do Trump’s people, or conservatives in general, mean by “socialism”? The answer is, it depends.
Sometimes it means any kind of economic liberalism. Thus after the SOTU, Steven Mnuchin, the Treasury secretary, lauded the Trump economy and declared that “we’re not going back to socialism” — i.e., apparently America itself was a socialist hellhole as recently as 2016. Who knew?
Other times, however, it means Soviet-style central planning, or Venezuela-style nationalization of industry, never mind the reality that there is essentially nobody in American political life who advocates such things.
The trick — and “trick” is the right word — involves shuttling between these utterly different meanings, and hoping that people don’t notice. You say you want free college tuition? Think of all the people who died in the Ukraine famine! And no, this isn’t a caricature: Read the strange, smarmy report on socialism that Trump’s economists released last fall; that’s pretty much how its argument goes.
So let’s talk about what’s really on the table.
Some progressive U.S. politicians now describe themselves as socialists, and a significant number of voters, including a majority of voters under 30, say they approve of socialism. But neither the politicians nor the voters are clamoring for government seizure of the means of production. Instead, they’ve taken on board conservative rhetoric that describes anything that tempers the excesses of a market economy as socialism, and in effect said, “Well, in that case I’m a socialist.”
Sometimes it means any kind of economic liberalism. Thus after the SOTU, Steven Mnuchin, the Treasury secretary, lauded the Trump economy and declared that “we’re not going back to socialism” — i.e., apparently America itself was a socialist hellhole as recently as 2016. Who knew?
Other times, however, it means Soviet-style central planning, or Venezuela-style nationalization of industry, never mind the reality that there is essentially nobody in American political life who advocates such things.
The trick — and “trick” is the right word — involves shuttling between these utterly different meanings, and hoping that people don’t notice. You say you want free college tuition? Think of all the people who died in the Ukraine famine! And no, this isn’t a caricature: Read the strange, smarmy report on socialism that Trump’s economists released last fall; that’s pretty much how its argument goes.
So let’s talk about what’s really on the table.
Some progressive U.S. politicians now describe themselves as socialists, and a significant number of voters, including a majority of voters under 30, say they approve of socialism. But neither the politicians nor the voters are clamoring for government seizure of the means of production. Instead, they’ve taken on board conservative rhetoric that describes anything that tempers the excesses of a market economy as socialism, and in effect said, “Well, in that case I’m a socialist.”
What Americans who
support “socialism” actually want is what the rest of the world calls
social democracy: A market economy, but with extreme hardship limited by
a strong social safety net and extreme inequality limited by
progressive taxation. They want us to look like Denmark or Norway, not
Venezuela.
And in case you haven’t been there, the Nordic countries are not, in fact, hellholes. They have somewhat lower G.D.P. per capita than we do, but that’s largely because they take more vacations. Compared with America, they have higher life expectancy, much less poverty and significantly higher overall life satisfaction. Oh, and they have high levels of entrepreneurship — because people are more willing to take the risk of starting a business when they know that they won’t lose their health care or plunge into abject poverty if they fail.
Trump’s economists clearly had a hard time fitting the reality of Nordic societies into their anti-socialist manifesto. In some places they say that the Nordics aren’t really socialist; in others they try desperately to show that despite appearances, Danes and Swedes are suffering — for example, it’s expensive for them to operate a pickup truck. I am not making this up.
What about the slippery slope from liberalism to totalitarianism? There’s absolutely no evidence that it exists. Medicare didn’t destroy freedom. Stalinist Russia and Maoist China didn’t evolve out of social democracies. Venezuela was a corrupt petrostate long before Hugo Chávez came along. If there’s a road to serfdom, I can’t think of any nation that took it.
So scaremongering over socialism is both silly and dishonest. But will it be politically effective?
Probably not. After all, voters overwhelmingly support most of the policies proposed by American “socialists,” including higher taxes on the wealthy and making Medicare available to everyone (although they don’t support plans that would force people to give up private insurance — a warning to Democrats not to make single-payer purity a litmus test).
On the other hand, we should never discount the power of dishonesty. Right-wing media will portray whomever the Democrats nominate for president as the second coming of Leon Trotsky, and millions of people will believe them. Let’s just hope that the rest of the media report the clean little secret of American socialism, which is that it isn’t radical at all.
https://www.nytimes.com/2019/02/07/opinion/trump-socialism-state-of-the-union.html
Eve and her husband Errol Meikle are two middle-class Americans in just this predicament, forced to prioritize their families’ medical needs, hoping against hope for Medicare for All. Medicare for All is a health care system that builds on Medicare. It allows people to see most doctors and use most hospitals anywhere in the country. It improves on Medicare, eliminating premiums, deductibles and coinsurance and expanding benefits to include vision, hearing, dental and home and community-based care. Medicare for All recognizes health care as a right and guarantees everyone in America access to the care they need.
Eve, a registered nurse, and Errol, a customer service rep, live in Florida with their three children, ages 18, 14, and 6. With good jobs and an annual income just over $80,000, they can no longer ensure their family gets health care. And, they have insurance!
Eve and her daughter, Kylee, 14, have chronic health conditions requiring attention. Eve has ulcerative colitis. Kylee has scoliosis and gastritis. But, the deductibles and coinsurance required to get all the care they both need have forced the family into medical debt.
To live as much as possible within their budget, Eve and Errol must choose which health conditions get medical attention. Putting aside total out-of-pocket health care costs, upfront costs just to get into the doctor’s office, are often prohibitive. Because of Kylee’s scoliosis and gastritis, today, the Meikle’s owe thousands of dollars to doctors and hospitals.
The big bills started coming in January 2016, soon after Eve got health insurance through her job, and the family started to take care of their health issues. They were not able to do so before then.
When Eve took her daughter, Kylee, for her annual checkup, the doctor said she needed X-rays to determine whether she had scoliosis. The X-rays alone cost several hundred dollars. And, that was only the beginning. Kylee needed to see a specialist.
Shopping for health care was not helpful. Eve contacted several specialists in her network to try to keep costs down. But, none could tell Eve what the visit would cost. There were different levels of service, ranging in cost from $450 to $850. And, this was just for a consult and review of X-rays. Kylee would need treatment as well.
Eve knew she needed to get Kylee to the specialist. Scoliosis can become worse over time and cause problems. But, she didn’t end up doing so because in the six months she was expected to wait for the specialist appointment, Kylee developed a new serious condition. In Eve’s words, Eve “had to let scoliosis go and pray it would not become worse every year.”
In the summer of 2018, Kylee became so sick that she could not go to school. She had nausea every day and needed to stay in bed. So, Eve made the call that this illness trumped the scoliosis and ended up canceling the appointment with the bone specialist. She needed to find out what was wrong with Kylee and get her treatment.
She scheduled appointments for Kylee with two different specialists to figure out what was causing her severe symptoms. While waiting for the appointments, Kylee had to be admitted to the ER. Her symptoms became too severe–nausea, not eating, not sleeping. Eve hoped to get a diagnosis.
The hospital sent Kylee home with a prescription but without a diagnosis. Eve was told that “hopefully” the specialist could figure out what was wrong with Kylee. By then, Eve had paid $275 upfront, her copay, to walk in to the ER. Then, after they left the ER, the physician and ER bills came in at nearly $2,000, which she was expected to pay by “cash, check or credit card.” Eve’s insurance has a $3,000 individual family member deductible and a family deductible of $10,000 before it begins covering 70 percent of the approved rate for covered services. Eve could not pay the ER bill and let the hospital staff know. She was told to call the hospital and set up a payment plan.
Eve then took Kylee to the specialist to get a diagnosis and proper treatment. The upfront doctor’s cost for the visit was $200. The two procedures Kylee needed, the colonoscopy and the EGD, cost $900 more upfront. And, Eve was charged $180 to learn the diagnosis.
The total cost for Kylee’s procedures was more than $17,000. Eve owed over $5,000 for the coinsurance, 30 percent of the cost. That’s when Kylee was diagnosed with gastritis and given a prescription.
Eve was told to schedule a follow-up visit for Kylee, so the doctor could check on how Kylee was doing. But Eve chose not to make that visit. It would have cost $163 upfront. Eve could not imagine what the doctor would say that was worth the cost. “All she’s going to say is how’s it going?” In Eve’s view, there was nothing more the doctor could do. There were no other medications to give. With so much medical debt already, Eve had no choice but to gamble with her daughter’s health. Kylee’s gastritis is still not 100 percent better, and she has yet to see a specialist about her scoliosis.
Meanwhile, Eve has had to put her ulcerative colitis, which she has had for 22 years, on the back burner. After taking Kylee from one specialist to another, she had maxed out her credit card. But, Eve’s ulcerative colitis has caused her tremendous and continual pain and misery. It makes getting through a 13-hour shift very difficult.
Eve explained that one way to treat the ulcerative colitis is to keep your life stress-free. She knows that’s not realistic. She has to go to work, and she has little time to rest. She also needs medications. But, it would be too much to pay for the appointment to get the prescription she needs. Moreover, drugs are expensive. “It’s more on top of more on top of more.”
Eve and her husband are both college educated, with good jobs, and consider themselves to be making good money. Understandably, Eve struggles to understand their financial and health care situation. They don’t live a fancy lifestyle. “No fancy car. No fancy home.” They pay their mortgage and bills. She says, “I’m frugal. I couldn’t be more frugal.” And, she asks “Why am I having to cancel doctors’ appointments for my family and decide which of my illnesses need the most attention and which will be on the back burner until we can afford to take care of them?”
That’s Eve’s story. With expensive commercial health insurance from her hospital, Eve lives in pain everyday, and she and her daughter have not been able to get all the care they need. Eve feels penalized for having health insurance. In her words, “It’s not health insurance when you have to pay so much upfront when you need to see the doctor. It’s a coupon. It’s not insuring me for anything.”
Eve has often talked with her husband about dropping their insurance and paying out of pocket for their care. Without insurance, she says she could get discounted rates. She could pay $200 instead of $800 for a visit. And, she would keep the $550 monthly insurance premium in her pocket. She would have $6,600 a year to pay the discounted fees at the doctor’s office. She also knows that in the event of a catastrophic condition, she would be bankrupt without insurance. So, she keeps it.
Eve’s choice to have health insurance and make tradeoffs with her own and her families’ health care, is not one that should exist in a humane health care system.
Eve has always believed in universal health care. She actively lobbies for Medicare for All, speaks about it and participates in conferences. As she puts it, she is “befuddled” by our current commercial health insurance system. “This isn’t working.” She, and the millions of people like her, must make choices that no one should have to make.
https://justcareusa.org/eves-story-commercial-health-insurance-inhumane-choices/?
And in case you haven’t been there, the Nordic countries are not, in fact, hellholes. They have somewhat lower G.D.P. per capita than we do, but that’s largely because they take more vacations. Compared with America, they have higher life expectancy, much less poverty and significantly higher overall life satisfaction. Oh, and they have high levels of entrepreneurship — because people are more willing to take the risk of starting a business when they know that they won’t lose their health care or plunge into abject poverty if they fail.
Trump’s economists clearly had a hard time fitting the reality of Nordic societies into their anti-socialist manifesto. In some places they say that the Nordics aren’t really socialist; in others they try desperately to show that despite appearances, Danes and Swedes are suffering — for example, it’s expensive for them to operate a pickup truck. I am not making this up.
What about the slippery slope from liberalism to totalitarianism? There’s absolutely no evidence that it exists. Medicare didn’t destroy freedom. Stalinist Russia and Maoist China didn’t evolve out of social democracies. Venezuela was a corrupt petrostate long before Hugo Chávez came along. If there’s a road to serfdom, I can’t think of any nation that took it.
So scaremongering over socialism is both silly and dishonest. But will it be politically effective?
Probably not. After all, voters overwhelmingly support most of the policies proposed by American “socialists,” including higher taxes on the wealthy and making Medicare available to everyone (although they don’t support plans that would force people to give up private insurance — a warning to Democrats not to make single-payer purity a litmus test).
On the other hand, we should never discount the power of dishonesty. Right-wing media will portray whomever the Democrats nominate for president as the second coming of Leon Trotsky, and millions of people will believe them. Let’s just hope that the rest of the media report the clean little secret of American socialism, which is that it isn’t radical at all.
https://www.nytimes.com/2019/02/07/opinion/trump-socialism-state-of-the-union.html
Health Insurance Coverage Eight Years After the ACA
by Sara R. Collins, Herman K. Bhupal,and Michelle M. Doty - The Commonwealth Fund - February 7, 2019
What
does health insurance coverage look like for Americans today, more than
eight years after the Affordable Care Act’s passage? In this brief, we
present findings from the Commonwealth Fund’s latest Biennial Health
Insurance Survey to assess the extent and quality of coverage for U.S.
working-age adults. Conducted since 2001, the survey uses three measures
to gauge the adequacy of people’s coverage:
- whether or not they have insurance
- if they have insurance, whether they have experienced a gap in their coverage in the prior year
- whether high out-of-pocket health care costs and deductibles are causing them to be underinsured, despite having continuous coverage throughout the year.
Survey Highlights
- Today, 45 percent of U.S. adults ages 19 to 64 are inadequately insured — nearly the same as in 2010 — though important shifts have taken place.
- Compared to 2010, many fewer adults are uninsured today, and the duration of coverage gaps people experience has shortened significantly.
- Despite actions by the Trump administration and Congress to weaken the ACA, the adult uninsured rate was 12.4 percent in 2018 in this survey, statistically unchanged from the last time we fielded the survey in 2016.
- More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans.
- People who are underinsured or spend any time uninsured report cost-related problems getting care and difficulty paying medical bills at at higher rates than those with continuous, adequate coverage.
- Federal and state governments could enact policies to extend the ACA’s health coverage gains and improve the cost protection provided by individual-market and employer plans.
Who Is Underinsured?
In this analysis, we use a measure of underinsurance that accounts for an insured adult’s reported out-of-pocket costs over the course of a year, not including insurance premiums, as well as his or her plan deductible. (The measure was first used in the Commonwealth Fund’s 2003 Biennial Health Insurance Survey.*) These actual expenditures and the potential risk of expenditures, as represented by the deductible, are then compared with household income. Specifically, we consider people who are insured all year to be underinsured if:
The out-of-pocket cost component of the measure is only triggered if a person uses his or her plan to obtain health care. The deductible component provides an indicator of the financial protection the plan offers and the risk of incurring costs before someone gets health care. The definition does not include other dimensions of someone’s health plan that might leave them potentially exposed to costs, such as copayments or uncovered services. It therefore provides a conservative measure of underinsurance in the United States.
- their out-of-pocket costs, excluding premiums, over the prior 12 months are equal to 10 percent or more of household income; or
- their out-of-pocket costs, excluding premiums, over the prior 12 months are equal to 5 percent or more of household income for individuals living under 200 percent of the federal poverty level ($24,120 for an individual or $49,200 for a family of four); or
- their deductible constitutes 5 percent or more of household income.
* Cathy Schoen et al., “Insured But Not Protected: How Many Adults Are Underinsured?” Health Affairs Web Exclusive, published online June 14, 2005.https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca?omnicid=EALERT1558577&mid=don@mccanne.org
Eve’s story: Commercial health insurance, inhumane choices
by Diane Archer - Just Care - February 8, 2019
Millions of hard-working Americans with common health conditions struggle every day to stay healthy because they must rely on commercial insurance to cover their care. Deductibles and coinsurance are so high that people must prioritize their families’ health care needs. They are forced to make choices that are inhumane and unconscionable.Eve and her husband Errol Meikle are two middle-class Americans in just this predicament, forced to prioritize their families’ medical needs, hoping against hope for Medicare for All. Medicare for All is a health care system that builds on Medicare. It allows people to see most doctors and use most hospitals anywhere in the country. It improves on Medicare, eliminating premiums, deductibles and coinsurance and expanding benefits to include vision, hearing, dental and home and community-based care. Medicare for All recognizes health care as a right and guarantees everyone in America access to the care they need.
Eve, a registered nurse, and Errol, a customer service rep, live in Florida with their three children, ages 18, 14, and 6. With good jobs and an annual income just over $80,000, they can no longer ensure their family gets health care. And, they have insurance!
Eve and her daughter, Kylee, 14, have chronic health conditions requiring attention. Eve has ulcerative colitis. Kylee has scoliosis and gastritis. But, the deductibles and coinsurance required to get all the care they both need have forced the family into medical debt.
To live as much as possible within their budget, Eve and Errol must choose which health conditions get medical attention. Putting aside total out-of-pocket health care costs, upfront costs just to get into the doctor’s office, are often prohibitive. Because of Kylee’s scoliosis and gastritis, today, the Meikle’s owe thousands of dollars to doctors and hospitals.
The big bills started coming in January 2016, soon after Eve got health insurance through her job, and the family started to take care of their health issues. They were not able to do so before then.
When Eve took her daughter, Kylee, for her annual checkup, the doctor said she needed X-rays to determine whether she had scoliosis. The X-rays alone cost several hundred dollars. And, that was only the beginning. Kylee needed to see a specialist.
Shopping for health care was not helpful. Eve contacted several specialists in her network to try to keep costs down. But, none could tell Eve what the visit would cost. There were different levels of service, ranging in cost from $450 to $850. And, this was just for a consult and review of X-rays. Kylee would need treatment as well.
Eve knew she needed to get Kylee to the specialist. Scoliosis can become worse over time and cause problems. But, she didn’t end up doing so because in the six months she was expected to wait for the specialist appointment, Kylee developed a new serious condition. In Eve’s words, Eve “had to let scoliosis go and pray it would not become worse every year.”
In the summer of 2018, Kylee became so sick that she could not go to school. She had nausea every day and needed to stay in bed. So, Eve made the call that this illness trumped the scoliosis and ended up canceling the appointment with the bone specialist. She needed to find out what was wrong with Kylee and get her treatment.
She scheduled appointments for Kylee with two different specialists to figure out what was causing her severe symptoms. While waiting for the appointments, Kylee had to be admitted to the ER. Her symptoms became too severe–nausea, not eating, not sleeping. Eve hoped to get a diagnosis.
The hospital sent Kylee home with a prescription but without a diagnosis. Eve was told that “hopefully” the specialist could figure out what was wrong with Kylee. By then, Eve had paid $275 upfront, her copay, to walk in to the ER. Then, after they left the ER, the physician and ER bills came in at nearly $2,000, which she was expected to pay by “cash, check or credit card.” Eve’s insurance has a $3,000 individual family member deductible and a family deductible of $10,000 before it begins covering 70 percent of the approved rate for covered services. Eve could not pay the ER bill and let the hospital staff know. She was told to call the hospital and set up a payment plan.
Eve then took Kylee to the specialist to get a diagnosis and proper treatment. The upfront doctor’s cost for the visit was $200. The two procedures Kylee needed, the colonoscopy and the EGD, cost $900 more upfront. And, Eve was charged $180 to learn the diagnosis.
The total cost for Kylee’s procedures was more than $17,000. Eve owed over $5,000 for the coinsurance, 30 percent of the cost. That’s when Kylee was diagnosed with gastritis and given a prescription.
Eve was told to schedule a follow-up visit for Kylee, so the doctor could check on how Kylee was doing. But Eve chose not to make that visit. It would have cost $163 upfront. Eve could not imagine what the doctor would say that was worth the cost. “All she’s going to say is how’s it going?” In Eve’s view, there was nothing more the doctor could do. There were no other medications to give. With so much medical debt already, Eve had no choice but to gamble with her daughter’s health. Kylee’s gastritis is still not 100 percent better, and she has yet to see a specialist about her scoliosis.
Meanwhile, Eve has had to put her ulcerative colitis, which she has had for 22 years, on the back burner. After taking Kylee from one specialist to another, she had maxed out her credit card. But, Eve’s ulcerative colitis has caused her tremendous and continual pain and misery. It makes getting through a 13-hour shift very difficult.
Eve explained that one way to treat the ulcerative colitis is to keep your life stress-free. She knows that’s not realistic. She has to go to work, and she has little time to rest. She also needs medications. But, it would be too much to pay for the appointment to get the prescription she needs. Moreover, drugs are expensive. “It’s more on top of more on top of more.”
Eve and her husband are both college educated, with good jobs, and consider themselves to be making good money. Understandably, Eve struggles to understand their financial and health care situation. They don’t live a fancy lifestyle. “No fancy car. No fancy home.” They pay their mortgage and bills. She says, “I’m frugal. I couldn’t be more frugal.” And, she asks “Why am I having to cancel doctors’ appointments for my family and decide which of my illnesses need the most attention and which will be on the back burner until we can afford to take care of them?”
That’s Eve’s story. With expensive commercial health insurance from her hospital, Eve lives in pain everyday, and she and her daughter have not been able to get all the care they need. Eve feels penalized for having health insurance. In her words, “It’s not health insurance when you have to pay so much upfront when you need to see the doctor. It’s a coupon. It’s not insuring me for anything.”
Eve has often talked with her husband about dropping their insurance and paying out of pocket for their care. Without insurance, she says she could get discounted rates. She could pay $200 instead of $800 for a visit. And, she would keep the $550 monthly insurance premium in her pocket. She would have $6,600 a year to pay the discounted fees at the doctor’s office. She also knows that in the event of a catastrophic condition, she would be bankrupt without insurance. So, she keeps it.
Eve’s choice to have health insurance and make tradeoffs with her own and her families’ health care, is not one that should exist in a humane health care system.
Eve has always believed in universal health care. She actively lobbies for Medicare for All, speaks about it and participates in conferences. As she puts it, she is “befuddled” by our current commercial health insurance system. “This isn’t working.” She, and the millions of people like her, must make choices that no one should have to make.
https://justcareusa.org/eves-story-commercial-health-insurance-inhumane-choices/?
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