Tag Archives: health care

Health Care One More Time

Republicans love to accuse government of waste and fraud while pointedly ignoring waste and fraud in the private sector. (I always think of that biblical phrase about ignoring the beam in one’s own eye...if you want to talk about fraud, Senator Scott….).

That disconnect is particularly obvious when it comes to America’s incredibly wasteful insistence on private sector health care. Several years ago, I was on a university research team looking at certain aspects of Indiana’s health care environment. I no longer recall the outlines of our investigation, but I do still remember my shock at learning that–at that time–seventy percent of all American health care costs were being paid by some level of government.

It wasn’t just Medicare and Medicaid, or the CDC, or the numerous federal programs aimed at specific diseases. State and city governments support local hospitals for the indigent, and other local programs; more significantly, the millions of people in the U.S. who work for a government entity–universities, police and firefighters, schoolteachers, etc. etc.–have health insurance paid for by tax dollars.

What really blew my mind was the realization that the money government was already spending would be enough to cover almost all of the costs of a national health care system if we simply reduced the enormous amounts spent–wasted– on duplicative paperwork and insurance company marketing and overhead.

What made me think about that long-ago epiphany was an article from The Fulcrum sharing “shocking statistics” about American healthcare.

The first was the number of people on Medicaid. (Not Medicare–Medicaid.) Most of us think of publicly funded healthcare as something offered by Canada and countries in Europe, not the adamantly “private” U.S.

The shocking truth is that most of the U.S. population will soon be on some form of government-sponsored health insurance. Right now, 158 million Americans (nearly half of the nation’s 330 million population) are covered by a combination of Medicare, Medicaid and subsidized enrollment in the state and federal exchanges. Experts predict that percentage will climb.

Within that population is an even-more shocking statistic: According to the Centers for Medicare & Medicaid Services (CMS), enrollment in Medicaid surpassed 90 million in 2022.

This program, traditionally linked to a small population of Americans in poverty, will serve more than 100 million people in fiscal year 2023 (or 1 in 3 insured Americans). Since 2020, Medicaid enrollment has jumped 30% thanks to expansion programs in several more states under the Affordable Care Act and Covid-19 public health emergency funding.

The article highlighted several problematic consequences of that staggering figure, especially the difficulty experienced by enrollees in finding primary care doctors.

The second statistic concerned individuals who aren’t on either Medicare or Medicaid.

Since 2000, medical costs have risen each year by 4.85%, significantly outpacing the 2.85% annual increase in GDP.

With healthcare premiums rising at a faster rate than revenue, businesses have made up the difference by transferring the financial burden to employees in the form of high-deductible health plans.

In 2022, despite below average healthcare inflation, U.S. employees paid a shocking 10.4% more in out-of-pocket healthcare expenses than the year before.

Already, medical costs are the No. 1 cause of bankruptcies in the United States. If a recession ensues as many economists predict, millions more workers and families will suffer economic hardships.

Number three? Forty-eight percent of those eligible for Medicare choose Medicare Advantage.

“Traditional” Medicare, enacted by Congress in 1965, continues to use a fee-for-service reimbursement model—one that pays doctors and hospitals based on the quantity (rather than quality) of medical services they provide.

In 1997, Congress created an alternative program called Medicare Advantage (MA). Unlike traditional Medicare, this option is “capitated.” That means the federal government pays healthcare providers an annual, up-front fee based on the age and health status of the enrollees.

Supporters of MA say that capitation incentivizes doctors to keep patients healthy without over-treating and over-testing them.

However, there are some downsides. Although seniors enrolled in MA enjoy more predictable annual costs and added benefits such as eyeglass coverage, they have fewer choices when selecting doctors and hospitals.

I found that last observation interesting, since most people who oppose national healthcare insist that Americans value choice more highly than cost. Apparently, we don’t.

The article concludes by reminding readers that healthcare inflation has exceeded GDP growth for half a century. The U.S. spends more than twice as much as the next most expensive nation for health care, and the last time I looked, American healthcare was ranked 37th. Meanwhile, employers and families are increasingly finding the costs out of reach.

These statistics just confirm that ideology can kill. (If you doubt that, look at the disproportionate number of Republicans who died of COVID because they refused to be vaccinated.)

Clinging to the belief that we aren’t already “socialized”–and very inefficiently– costs all of us a lot of money.

 

 

Deprivation And Revenge

Back in the day, we used to feel sorry for the geeky guys who couldn’t get a date to the prom. These days, some of those geeks have gotten together, created a “movement” of sorts, and labeled themselves “Incels,” short for involuntary celibates.

And they’re dangerous.

The Guardian recently ran an article  about a report from the U.S. Secret Service, detailing the growing threat  posed by these men who are angry over their inability to form what the report delicately terms “intimate relationships” with women. (Although the Secret Service is best known for protecting US presidents, the agency also examines and implements behavioral threat assessment programs designed to “identify and intervene with those who pose a risk of engaging in targeted violence”.)

The report enumerated the troubling and telltale behaviors of the Incels, which included the sending of concerning and threatening communications, and the posting of “concerning” online content.

Characteristics of Incels include a history of interpersonal difficulties, a history of being bullied, financial instability, and failed life aspirations.

As a case study, the Secret Service examined a 2018 shooting at a yoga class in Tallahassee, Florida, in which a man killed two women and wounded six.

“The attacker was motivated to carry out violence by his inability to develop or maintain relationships with women, along with his perception of women’s societal power over men,” the report said.

The gunman, 40-year-old Scott Paul Beierle, exhibited numerous warning signs including a history of inappropriate and criminal behavior toward women and girls.

Steve Driscoll, a lead research specialist at NTAC, said: “During his teen years, the attacker was accused of stalking his classmates and he wrote stories that centered around violent themes.

“One of those stories was 81 pages long and involved the protagonist murdering several girls before committing suicide. The female characters in the story that were killed represented the attacker’s actual classmates from his high school, but he slightly changed the names in his writing.”

Beierle was arrested three times for groping women and was called “Ted Bundy” by his roommates, in reference to a notorious serial killer who targeted women.

On the day of the shooting, Beierle left a note in his hotel room that said: “If I can’t find one decent female to live with, I will find many indecent females to die with. If they are intent on denying me life, I will have no choice, but to deny them life … Their arrogance, indifference and treachery will finally be exposed and punished.”

Other examples cited in the report included the Santa Barbara killings in 2014, in which a 22-year-old  killed six people and injured 14.  (The perpetrator had previously lamented his inability to find a girlfriend and spewed his contempt for women and interracial couples), and the 2020 murder of the son of Esther Salas, a federal District Court judge, by  a man who described himself as an “anti-feminist lawyer” and warned that “manhood is in serious jeopardy in America.” (Senator Josh Hawley evidently agrees with him...)

While research has yet to identify a profile of those among the Incels who are likely to engage in violence, it has pinpointed a set of concerning behaviors that are commonly displayed before violent or deadly assaults. That said, the report emphasized that misogynistic violence isn’t restricted to the sorts of high-profile incidents that make headlines.

Rather, “misogyny frequently appears in more prevalent acts of violence, including stalking and domestic abuse”. As a result, the report said, responses to threats need to be collaborative between law enforcement, courts, mental health providers and domestic violence and hate crime advocacy groups.

Police will often feel that they can’t intervene in a situation until or unless a law has been broken. Research, however–especially research focused on communities that are successfully coping with these behaviors–has found that the presence of a trained professional in threat assessment can avert many of these assaults by identifying warning signs and deploying the proper resources.

In the wake of the COVID pandemic, we’ve been hearing a great deal about the need for additional mental health resources. That need has clearly grown, but groups like the Incels, QAnon believers, Neo-Nazis and the like were part of the American landscape well before the advent of the pandemic, demonstrating that the inadequacy of mental health resources is not new.

Of course, that shouldn’t surprise us. The United States doesn’t even ensure access to physical health care…

 

Birth Control And Health Care

If the pandemic has taught Americans anything, it is just how inadequate–and let’s be honest, discriminatory and stupid–our healthcare system is. (Actually, every time I write “healthcare system” I am reminded of the student who was studying to be a hospital administrator, who told me the phrase was inaccurate–“We don’t have a healthcare system. We have a healthcare industry.”)

A few days ago, the Supreme Court handed down an indefensible decision that denied women healthcare if they are unlucky enough to have an employer who has “religious qualms” about allowing their health insurance to include birth control.  Gail Collins provided a perfect analogy:

Let’s pretend there was an order of nuns with a particular devotion to the Sacred Heart of Jesus. So much so that the order had, over the years, decided that any human heart was a holy symbol, and it was immoral to mess with it, even if you were a physician doing cardiac surgery.

Following their consciences, these nuns banned heart-related care from their employees’ health policies. That affected thousands of workers, many of whom did not share their religious convictions. Still, the nuns noted, their insurance coverage was generous. Except for that one thing.

The Court affirmed the right of employers to omit birth control coverage from their group health policies. But that “right” is misleading.  The Obama administration had arranged for the federal government to intervene when religious employers had ethical objections. All the employer had to do was file a form, and they’d be off the hook; the government and the health insurance companies would provide the coverage. The employer wouldn’t need to spend a penny on a sinful women’s health measure.

But that wasn’t good enough. Filing a form would make them complicit. Trump, of course, pandered to the “religious” employers who placed their purported moral purity above the actual health and well-being of their female employees, and the Court acquiesced.

An  estimated 70,000 to 126,000 women will lose their current free contraceptive coverage–and contraception isn’t cheap. As the Times Editorial Board wrote, 

It bears reminding that the cost of birth control can be significant, and that many women rely on it not just to prevent pregnancy but to treat medical issues. Sometimes, the contraceptive method that works best — or the only one a person can tolerate — costs many hundreds of dollars without insurance coverage.

As the Editorial Board also noted,

It’s hard to imagine the conservative justices of this court, especially, allowing employers to claim a moral exemption and require their employees to pay out of pocket for, say, a treatment for Covid-19. That sounds absurd. And yet, when it comes to birth control, such state interference with personal health decisions is considered a legitimate matter for public debate.

The health care industry in this country is the real “American Exceptionalism.”

America could solve conflicts like this one–not to mention racial and economic inequities in access to health care–by emulating other advanced, civilized nations and moving to a single-payer system of health insurance. Not only would such a move eliminate the ability of some Americans to impose their religious convictions on others, not only would it ameliorate a number of racial and economic inequities, not only would it vastly reduce personal stress and the country’s high rate of personal bankruptcies, it would introduce cost-controls to a system that costs far more and delivers far poorer results than others.

How much of our stubborn refusal to provide universal health insurance is due to inertia, to misunderstanding of how markets work or don’t, or a false belief in American superiority–and how much of it is due to a shameful reluctance to extend the social safety net to “others”–minorities and women?

What Really Matters?

Assuming the accuracy of recent polling, even people who don’t follow politics or the news with the sort of intensity characteristic of people who comment on this blog have come to recognize that President Trump is insane.

The crazy tweets, the babbling, “word salad” responses to even soft-ball questions from Faux News, the cringe-worthy, extended defense of his wobbly descent down the ramp at West Point, and most astonishing (at least to me) his apparent belief that if we just don’t test people, the Coronavirus will magically go away–are finally taking their toll.

My own response to what I see right now might properly be labeled bipolar: on the one hand, I am terrified of Democratic complacency. This pathetic ignoramus won once–it could happen again. There is still a hard core of voters who respond to his racism and share his overwhelming sense of grievance. On the other hand, polling–both state and national–reflects widespread disapproval; credible media outlets have taken to calling lies, lies (not just “assertions for which there is no evidence”) and previously reliable Republican constituencies are forming pro-Biden PACs. (The Lincoln Group–the first such effort–is producing and airing some of the most devastating–and accurate–political ads.)

So… my thoughts have turned to the massive clean-up job that will await the Democrats if–as I devoutly hope–November delivers both the White House and the Senate.

That cleanup is by no means assured. Universal detestation of Trump has unified a party that is famous for its lack of unity. (Who was it who said “I don’t belong to any organized political party; I’m a Democrat”?) With victory will come the inevitable fractures between the moderates, progressives and leftwing factions of the party.

In the House, I have some confidence that Nancy Pelosi can avoid truly dangerous schisms; the Senate will be dicier, and if Moscow Mitch is re-elected, he can still do enormous damage as Minority Leader.

It’s all very uncertain, and that uncertainty is made worse by the fact that there is considerable ambiguity about what optimum “repairs”–both structural and policy– should look like. Some examples:

  • The federal courts. It’s not just the Supreme Court.  McConnell has managed to put 200 rightwing ideologues on the federal bench, a number of whom have been rated “unqualified” by the ABA. There are a number of proposed “fixes”–from expanding the number of judges to pursuing impeachment against those who engage in the most egregious misconduct. Whatever course of action is taken, returning the courts to the status of impartial arbiters should be a priority.
  • Other structural issues that cry out for attention sooner than later include gerrymandering, the filibuster, money in politics and the Electoral College. (Whether the Electoral College can ever be fixed–either by the Popular Vote Compact or Constitutional Amendment is a “known unknown.”)
  • Repairing the incredible amount of damage done by Trump’s Mafiosa-like cabinet–especially the savage assault on environmental protections by the procession of fossil fuel lobbyists who’ve run the EPA, and Betsy DeVos’ fundamentalist attacks on the very concept of public education–also requires immediate attention.
  • Repairing America’s reputation abroad–restoring our relationships with allies, signaling that yes, America had a psychotic break, but we’re recovering–is critical. We need to rejoin the alliances Trump discarded, reaffirm our commitment to NATO, etc.,etc. Fortunately, foreign policy has been Biden’s strong suit.
  • Attacking our appalling economic inequality by raising both taxes on the rich and the minimum wage.
  • On the policy front, it is long past time for comprehensive immigration reform–not just the immediate cessation of horrendous ICE practices under Trump, but a sweeping revision of immigration policy that discards the racism that has characterized it.
  • It is equally past time to ensure that all Americans have access to healthcare, whether that is via a public option or single payer. (And maybe we should reconstitute that pandemic task force.)
  • Then there’s our crumbling infrastructure. And the elimination of billions of dollars in subsidies for fossil fuel interests. And a long, hard look at farm subsidies (and who’s getting them.) And in the (highly unlikely) world of my dreams, beginning to dismantle and “defund” the military-industrial complex Eisenhower warned us about.

I bet you all can add to this daunting list…..

Unlike culture-war quarrels about who’s using what restroom, or whether women should be able to control their own reproduction, these are the issues that really matter.

These are the issues that define–or defy–assertions of American “greatness.”

 

 

Rich Guys For Higher Taxes, Businesses For Single-Payer

Are more zillionaires joining “renegade” rich guys like Nick Hanauer and Warren Buffett and recognizing the dangers posed by the current gap between the rich and the rest?

A recent article from the Guardian was titled “Patriotic millionaires want to pay more taxes.” Those millionaires didn’t mince words.

If you believe the prevailing philosophy of US conservative ideology, the handful of individuals in the 1% are entitled to every bit of their wealth and power because they deployed their capital wisely.

As businessmen in the 1%, living in a conservative state, we confront this philosophy every day, and frankly, we’re sick of it.

The Republican party’s embrace of the “I’ve-done-it-all-on-my-own” mentality is extraordinarily delusional, harmful, and counterproductive. Collective goods – like a sound infrastructure system, a strong K-12 and higher education systems, and rule of law – are critical ingredients to building both individual and societal economic prosperity.

The article’s authors have joined the Patriotic Millionaires, a group of wealthy Americans “from all walks of life across deep red, deep blue and purple states” who realize that the system that enabled their success, that created opportunity, is fundamentally broken. And they aren’t shy about placing the blame: they write that the system has been ” hijacked by the ultra-wealthy.”

But a substantive and sincere commitment to an evolved form of capitalism requires a few things. It requires us to confront the reality of the climate crisis as the existential threat of our time; and to acknowledge that we are a country founded on the toxic prejudice of white supremacy, which continues to unjustly shape the future of millions of Americans before they’re even born. We must separate money from politics, so that the influence of special interests doesn’t overpower the voices of voters; and shift our financial goals from short-term profits to long-term sustainability.

And it requires economically advantaged folks like us to not only pay our fair share, but also unequivocally commit to and support the policies that will achieve that reality – and to get all of our similarly situated friends and associates to do the same.

It isn’t just the ultra-rich who are (belatedly) recognizing the need for change. Another new group is Businesses for Single Payer.

Activist Wendell Potter has become president of Business for Medicare for All, the only national business organization working for single payer health insurance. This group of the economically pragmatic lends expertise and credibility to the cause of reform at a time when many, including some of those running for the Democratic presidential nomination, question the viability of single payer.

Potter spent twenty years in the health insurance industry, and left to become an outspoken critic of what he calls a broken, dysfunctional and unfair healthcare system. He points to surveys showing that people on Medicare are far more satisfied than people with private insurance, and says one reason is that  private insurance has changed significantly over the years. Premiums have gone up while insurance companies have devised clever strategies to avoid paying for care.

In the linked article, Potter enumerates the reasons single-payer systems are superior to our patchwork approach. Most of us could recite those reasons in our sleep, but until now, the business sector has been noticeably absent from both the conversation and the criticism. Why the change?

About three years ago, I was approached by a business leader in the Lehigh Valley of Pennsylvania, Richard Master, who decided to make a documentary on the US healthcare system….

But he began to pay a lot of attention to healthcare costs. He’s got an MBA from Wharton and a law degree from Columbia so this guy’s really smart, has built a very successful business, but he was questioning the sanity of a system in which he has no control over his healthcare costs from year to year….

 I knew what individuals and families were facing, but I hadn’t paid a lot of attention to what is happening to employers who are trying to stay in the game in our uniquely American, employer-based healthcare system. It’s abundantly clear that the system has run its course and is just not working for increasingly large numbers of employers.

Potter quotes Warren Buffett’s observation that “healthcare is the tapeworm that is destroying American competitiveness,” and goes on to say that more and more businesses are recognizing the need to change.

We’ve got several hundred employers who are part of our organization. Our goal is to have at least one business from every congressional district by this time next year. We’re growing pretty rapidly and we already have a voice in Washington.

Money talks, for good or ill. If people with money support higher tax rates and a more robust social safety net, Congress might actually listen.