According to this article from the conservative leaning National Review, the current debate needs to be much broader than health insurance. Who could possibly disagree with that? The article includes a stunning graph tracking middle-age mortality, and a even more stunning video-mapping of the increasing obesity across the US. Here’s a haunting quote by the author, David French:
As Congress debated Obamacare repeal, I had lunch with a local critical-care doctor who seemed oddly indifferent to the outcome. His is a world dominated by addiction. “If it weren’t for addicts,” he says, “I wouldn’t have a job.” The intensive-care unit is overrun with people addicted to drugs, to alcohol, to food, and to tobacco. Insurance matters to the economics of the hospital, but it doesn’t matter so much to the quality of its patients’ immediate care or to their ultimate health outcome. They’re killing themselves, and the best health care and the most luxurious “Cadillac” health plans won’t stop their slide into oblivion.
ObamaCare plays to precisely the opposite of America’s strengths. Instead of being a simple,
straightforward program to hand out insurance coverage — the policy equivalent of a honking great axe — it’s got complex regulations, fiddly quasi-market structures, and mandates everywhere you look — the policy equivalent of the repair box from Toy Story 2. It should be no surprise that many of those regulations do not completely fix the problems they were intended to address, or are effectively ignored. We need simpler, bigger, blunter tools, and single-payer fits the bill.
In Light of the GOP’s new Health Care Proposal, it’s Time to Rename the GOP as the “Social Darwinist Party.”
In light of the GOP’s “solution” to the “problem” of Obamacare, it’s time to simply and clearly declare that the GOP has become (and should be renamed) the “Social Darwinist Party.”
Addressing the cries of the Super Rich (“I want even more money”) is no solution at all to the medical crises many of us face. I realize and recognize the frustration of the GOP that people who are lazy and/or who repeatedly make bad decisions resulting in being poor should not be able to mooch off the rest of us. But what about those who have worked hard and have been laid off by downsizing, and now earn $10/hour? What about people who are doing their best after being raised by dysfunctional families and/or “taught” at dysfunctional schools? Should they really be told that health care is totally out of their reach?
I’m lucky that I am a 60 year old man who can afford to pay the market rate of $900/month for a $6,000 deductible (“Bronze”) health care policy with Anthem for me and my teenage daughter. It was the best deal I could find this year.
But there are good hearted hard-working people who are paid minimum wage, meaning that they gross about $1,500 a month for full time work. After Social Security taxes, if they were to pay $900/month for health insurance (and then all the co-pays and deductible) they would have NOTHING left on which to live. NOTHING.
The GOP solution, I assume, is to have these people (many of whom voted for Trump) begging for health care at hospital doors, with many of them eventually dying in the streets. Is the GOP then going offer block grants to cities to help clean up the bodies of sick and dying people on the sides of streets?
Obamacare was an flawed attempt to balance the many competing interests at play. But it was an attempt. It was far better than the GOP proposal, which is essentially, “If you can’t come up with a LOT more money than minimum wage will pay you, then into society’s scrap heap you go!”
We can do better than Obamacare. We can do a LOT better than the current GOP proposal. It’s time for single payor, a solution used by almost every other industrialized country.
I often wonder about studies showing that Americans are spending less on health care. It seems to me that many of us are now buying cheaper health policies with huge deductibles, then putting off health care because much of it is coming out of pocket. This NYT article was thus interesting to me.
The number of uninsured Americans has fallen by an estimated 15 million since 2013, thanks largely to the Affordable Care Act. But a new survey, the first detailed study of Americans struggling with medical bills, shows that insurance often fails as a safety net. Health plans often require hundreds or thousands of dollars in out-of-pocket payments — sums that can create a cascade of financial troubles for the many households living paycheck to paycheck.
These financial vulnerabilities reflect the high costs of health care in the United States, the most expensive place in the world to get sick. They also highlight a substantial shift in the nature of health insurance. Since the late 1990s, insurance plans have begun asking their customers to pay an increasingly greater share of their bills out of pocket though rising deductibles and co-payments. The Affordable Care Act, signed by President Obama in 2010, protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increases in deductibles.
John Oliver describes Big Pharma marketing to doctors and patients
My family just signed up for an extremely expensive “Bronze” policy with Obamacare. It is shameful that there are only two companies “competing” for our dollars in St. Louis (it’s worse than shopping for a phone company). It’s shameful that none of the policies in the bronze or silver range include Barnes Hospital (St. Louis’ premium teaching hospital) in their network. It shameful that even though we are paying $1,000/month for a family of four, that the annual deductible is in the range of $4,300 for indiv and $8,600 for family, with annual out-of-pocket deductible for our family being $12,700. There is no real competition here, and I have yet to see the any reason to believe that the ACA will pressure providers to lower their costs. In America, we pay many times the amount for basic services (e.g., MRI scan) than people in other countries. Our economic side of our hospitals, including “non-profit” hospitals, are a joke, with their executives getting exorbitant salaries while they are on a shopping spree to buy up the local medical practices so that there is no meaningful competition, even your local doctors. I recognize that the ACA forces insurance companies to provide certain minimum coverages and that they can no longer cherry-pick patients based on pre-existing conditions, which was rampant and immoral. The ACA is certainly better than nothing.
The most shameful thing of all, however, is that even with the faults of Obamacare, the Republicans want to destroy the modest protection it offers many of us, and the substantial protection it offers low-income families. They propose to replace it with nothing at all. The Republican proposals I have seen would send all of us back to ravages of the dog-eat-dog for-profit health market where cherry-picked customers pay unregulated prices, where premiums have been skyrocketing for decades, where many folks are offered paltry coverage that they have no way of paying for, and where many people are deemed “uninsurable.” If politicians can only convince us to keep watching lots of sports events and movies, maybe we will never force them to enact meaningful reform.
We need single-payor coverage, like most other civilized countries. For more on the dreadful situation we currently have, check out Stephen Brill’s excellent article.
I’ll end with this somber reality from Brill’s article:
The health care industry seems to have the will and means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and healthcare product industries, combined with the organizations representing doctors, hospitals, nursing homes, health services and HMO’s, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.
Hobby Lobby is suing to be exempted from certain provisions of the Affordable Care Act. The Supreme Court has agreed to hear the case . . . The question at the heart of this is, should a company be forced to pay for things with which it has a moral objection? [More . . . ]
I’m reading a lot about the recent problems with Obamacare. For everyone complaining about this new program, however, I would ask “You say Obamacare is bad, but compared to what?”
I’m on COBRA, having left a job a few months ago. I shopped around on the open market PRE-Obamacare. The prices were already high, even for high-deductible coverage. My wife, who walks briskly every day and who is in very good health was deemed uninsurable because of four separate reasons, all of which were total bullshit (one was that she broke her ankle last year, and it had substantially healed by the time we applied for coverage). The for-profit insurance companies have been out there cherry-picking and leaving families in desperate straights. I know of one family that has been paying almost $40,000/ year because two children are fighting depression and the husband has some physical injuries (though he is working). This is all PRE-Obamacare. For all of those people who want to blame Obamacare I would like to remind them that things were terrible before Obamacare. Coverage was shrinking and prices sky-rocketing BEFORE Obamacare.
Not that I’m a big fan of Obamacare–we need Medicare for all–some reasonable level of care for all Americans, combined with many of the strategies offered by “Bitter Pill,” the blockbuster Time Magazine article published a few months ago. We were lucky to get anything at all accomplished in Congress given the abject corruption. There are many aspects of the so-called health care system that need immense rehab, and Congress is not up to the task. Half of Congress wants to destroy Obamacare and replace it with “Fend for yourself, and good luck not getting fleeced by huge profit-driven companies, including all of those huge “non-profit” hospitals who are gobbling up your favorite doctor’s medical practices.”
I fear for many people out there. Too bad ordinary folks can’t afford lobbyists. If they did, we could bring some sanity to the prices charged by many providers and Big Pharma. Finally, as Dylan Ratigan has written, we also need to reconceptualize health care as “Help me, my family and friends live long and prosper” instead of “Don’t let me or anyone I know die.” We need to have courage to face our deaths with dignity in order to reset our priorities in a meaningful way, but there is no sign that this is likely.
Here’s another excellent and succinct analysis by Dylan Ratigan, part of an mass emailing he recently sent out. Allowing conservatives to argue about “death panels” is a big mistake and here’s why — and BTW, the time to make policy is not as we gather around very sick people challenging each other as to who can spend the most to to extending someone’s last breaths by 3 months, bankrupting healthcare in the process. We need to grow up and get our heads out of fantasy-land. Let’s redefine healthcare in terms of sustainable and meaningful goals. Ironically, there is date that those who claim to be most confident in the existence of an afterlife insist on the highest rate of last-minute desperate expenditures. Here’s Dylan’s email:
Generally speaking, there are only two ways to earn money.
1. Charge a fee for goods or services.
2. Charge a mutually agreed upon percentage based on a future outcome based on the newly created value. This percentage can be in the form of equity or commission.
As it stands, healthcare in America is based on the first model. This creates a system with many, high fees generated by acute and traumatic care. The chart above, from this report by the International Federation of Health Plans, shows how much we are paying compared to the rest of the world:
In reality, this care is for only 5 percent of us at a given moment, yet accounts for 50 percent of what each of us spend on the service regardless of whether or not we are using it.
If this unfortunate reality upsets you, please relax…close your eyes….and imagine for a moment a healthcare model that uses the second model of income generation. One that is based on equity or commission based on a future outcome.
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