March 26, 2012

The nation's health status

Sam Smith - First of all, yes, there are good parts of Obamacare. As the AFL CIO points out: More than 2.5 million young people now have coverage on their parents’ insurance; More than 350 community health centers created by the Affordable Care Act are bringing care to 50 million Americans in underserved areas; More than 50,000 people with pre-existing conditions who couldn’t get insurance before now have coverage; More than 86 million people have received free preventive health care services; Some 5.1 million Medicare recipients (seniors and people with disabilities) have saved $3.2 billion in prescription drug costs; and In 2012, patients will receive up to $323 million in premium rebates from insurance companies.

Second of all, in sum, the bill is a mess, one of the worst supposed reforms of modern times. The major reason for this is that the Obama administration caved over and over to the health insurance industry, one of the most unnecessary segments of the American economic system.

Obama likes to present himself as someone of great reason who can compromise with skill. But the only way you can come up with a good compromise is to have a good long range plan in the first place. Obama starts with the compromise rather than the plan. Thus his compromises lack integrity  and long term value.

The obvious long range plan in this case is single payer but, of course, Obama doesn’t care about that, nor does he have any alternative, so he is a ready target for any special interest that wants to sway him.

The prime example is the individual mandate. These days the slicky, tricky lawyers are coming up with all sorts of justifications for it, but it if you put it in a political and historical context, rather than relying on a downtown law firm’s analysis, you end up with the fact that never before has the government intruded so grossly on private spending decisions. And if it is approved, there will be more to come.

Okay, don’t believe me. Consider the Democratic candidate who told Ellen DeGeneres on her show in February 2008, “If things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t."

That candidate is now sitting in the White House as his plan for a mandate goes before the Supreme Court.

There is one aspect of the mandate debate that I find truly astonishing. Not the president nor any powerful liberals have considered the cost of such a mandate to those facing it. The Democrats, in the midst of a great recession, have come up with a plan that the CBO estimates will cost a single person about $5200 to meet the demands of the mandate. The cost for a family of four would be about $3025 for each member.

And no one’s saying a mumblin’ word
Sam Smith, January 20, 2011 - Ask yourself this question: how many measures purportedly reforming some major problem in American life have been immediately challenged in court by 26 states? Reform is supposed to be more cheerful than that.

Basically our problem is that the law is too hard to understand, too contradictory, too indolent in materializing, and too tempting for both sides to fib about in the meanwhile. Besides it amounts to a contorted way of subsidizing the health insurance industry with significant help from the presently uninsured, many of whom have strong fiscal reasons for being in this state in the first place.

It got so bad last night that I dreamt myself in the hospital for surgery and suddenly Henry Waxman and John Boehner appear on either side of my bed and start a knife fight over proper healthcare policy. I tried to suggest that this helped neither the policy nor my recovery, but they didn't seem to even notice that I was there.

Single Payer Action's Supreme Court brief

Good explanation of why the individual mandate is unconstitutional

Five things Dems got wrong on health care

Nearly 45,000 Americans die each year because of GOP & Democratic refusal to pass single payer

Gallup reports that the percentage of adult Americans without health insurance was higher than in any year the firms started tracking it in 2008. The percentage rose from 14.8% to 17.1%

Businesses jacking up health insurance deductibles

Insurance premiums rising faster than income in every state

Dave Lindorff, Counterpunch – The [healthcare] act, pushed through a Democratic Congress by President Obama in 2010, is a disaster, a cobbled-together set of measures that was fatally corrupted by the insurance lobby and other parts of the nation’s medical-industrial complex, which leaves millions uninsured, continues to tether workers to their employers like indentured servants, and undermines the Medicare program, which should be the cornerstone of a real health reform. . .

There is a reason why the US is the only major modern developed nation in the world (with the exception of Switzerland) that relies on the private insurance industry and employer-based coverage and that it also spends more on health care both per person and as a percentage of GDP of any other nation (20% of $14.6 trillion in 2010) , while being well down on the rankings in terms of health statistics such as life expectancy and infant mortality.

The reality, which both the political leadership and the corporate media have studiously avoided discussing, is that if the US were to shift to a system in which every person was covered by a well-funded Medicare program such as is currently available to every citizen over the age of 65, the total cost of healthcare for the nation — currently about $2.9 trillion per year — would be massively reduced, as would the cost of health care for nearly all individuals. . .

The reason extending Medicare coverage to everyone instead of just those who have reached 65 would be cheaper is quite obvious. The older people are, the more their medical care costs. In fact, even within the Medicare program, 90% of the $475 billion in costs, or about $428 billion, is for medical care for the 10% of the Medicare population who are the oldest. The other younger Medicare recipients require far less medical care. This is even more true for people who are under 65. People in middle age typically have far fewer visits to the doctor, far fewer hospitalizations, and are in general far healthier than those over 65. The only exceptions to this inverse relationship between age and cost of health care are infants and small children, who can require more care, including childbirth itself, than older children, and women who have children, who obviously require more care than younger or older women, or women who choose not to have kids.

Politicians have refused to consider Medicare-for-all as a reform option because of course it would require raising taxes, which in the US has become a political death wish, but that’s simply because no political leaders have had the courage–and no corporate news organization has shown the ethical integrity — to point out that raising the Medicare tax from its current 1.5% on employee and employer, would mean that employees and employers would at the same time be relieved of paying for private insurance coverage, doctor’s bills and hospital co-pays, prescription drugs, etc.

The savings that most people would see in getting rid of the private costs of health care, and the savings employers would see in no longer having to pay for private insurance coverage for their workers, would dwarf any tax increase needed to fund this expansion.

Physicians for a National Health Program - Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work:

(1) it will not achieve universal coverage, as it leaves at least 26 million uninsured,

(2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness.

(3) it will not control costs.

The ACA perpetuates a dominant role for the private insurance industry. Â That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals - truly universal, comprehensive coverage; health security for our patients and their families; and cost control.

1 comment:

Lars said...

The last point in your introduction to the coverage of the individual mandate and the supreme court trial now on is the most important one. This law does nothing to control the costs of health care. Instead it ensures that costs will continue to rise. I live in Massachusetts and I can tell you that our version of the law (largely the same thing) hasn't controlled costs. I have to assume that is when something will change. Either our leaders will leave us less ensured, or the citizens will demand a better deal. The current law, assuming it passes through the court, only delays this time of reckoning.