Archive for the ‘single payer’ category

Repeal And Replace

November 15, 2016

“Obamacare is a disaster, a jobs killer, and should be repealed at the first opportunity”, we have been told by Republicans. The Affordable Care Act is in the GOP cross hairs and all that is slowing action is January 20th and Donald Trump’s inauguration. Oh, if it were that easy.

There are various estimate for how many Americans owe their healthcare insurance coverage to Obamacare. Most reports come in around 20 million (out of about 300 million insured Americans) and a good piece of that 20 million lies in Medicaid expansions. And amongst these 20 million are those with pre-existing conditions, children under 26 still living at home, and those unable to afford insurance. So, why the great need to throw out the Affordable Care Act?

Consider the following first:

US per capita health care spending is in excess of $9,400 and in first place globally. In comparison, Germany spends about $5,400, France about $4,900, Canada about $5,300, and high cost Japan about $3,700!  Does that make you wonder why healthcare is so expensive in the US compared to the rest of the world?

Could it be with this high cost healthcare that Americans must be the healthiest in the world.   Do they live longer than residents in other countries?

Hmmm, the numbers don’t say that… Germany (81.0 years), France (82.4), Canada (82.2), high cost Japan (83.7) and the winner is US (79.3), in other words, the US spends almost twice as much per person on healthcare and ranks 31 out of 168 countries and well below other modern industrial countries.

And by the way, these comparison countries cover all residents and therefore do not need a separate Obamacare to increase coverage.

The Affordable Care Act is just part of an overall US healthcare delivery system, which includes open enrollment health insurance (individually purchased or provided through an employer), Medicare, Medicaid, Veterans Administration Health System and the Affordable Care Act.  ACA was added with the intent of closing the gap of uninsured Americans and if possible begin reversing the year over year price increases.

The underlying assumptions with ACA are two, cost will decrease and health outcomes will improve with a preventive based healthcare delivery system which would be available and affordable to all Americans, not just who can afford to pay what the market will bear. ACA, unfortunately, is still built upon a free market, for profit model. Accordingly there was no incentive for insurance carriers, hospitals, or drug companies to work at cost control or to insure all Americans. Case in point, of course, is the completely out of control greed associated with increasing drug prices.

So, once again, what is the big deal about Obamacare?

Conservatives and a wide range of special interests believe ACA represents a step along the path to “socialize medicine”. Conservatives would prefer “under” and even “uninsured” Americans in preference to seeing full coverage in a single payer, universal healthcare system as found in Germany, France, Canada, and Japan.

The collateral damage for this ideological strategy is a grossly uneven distribution of healthcare services. Those without health insurance receive the best that emergency rooms can provide and have no protection from potentially massive hospital bills.

Of course there are many questions and concerns with single payer systems. Healthcare is not free and must be paid for in some way. And abuse of any government service is always possible, if not predictable. Never the less, why would it be the case that the US should be proud to be the only modern, developed nation at ease knowing that children of some Americans will grow up without sufficient preventive healthcare when compared to sons and daughters of Wall Street executives?

Healthcare cost is probably one of the most misunderstood realities of American life. Most Americans receive their healthcare coverage through their employer. Even with co-pays, deductibles, and employee sharing of premium costs, these Americans still are hugely insulted from the true healthcare costs. Supporting the repeal of Obamacare is wholesale hypocrisy since the main benefits accrue to those most in need.

A less obvious reason to more seriously study US “cost of healthcare” is income inequality and scarcity of good paying jobs. Healthcare spending which was more in line with Germany and France would reduce insurance premiums for both individuals and businesses thereby freeing up disposable income for individuals and retained earnings for businesses. Accordingly individuals would have more left from the pay check to spend as they please and businesses would have more to invest and grow their businesses.

It appears there will be no such discussion or even interest in a single payer system.  Rather, Republicans will thrash around trying to find ways to keep the ACA benefits and make believe the extra costs do not exist.

Frist Principles

January 6, 2015

Congress begins its 114th session today and GOP leaders have promised to begin governing right away. One of the topics mentioned is changes to the Affordable Care Act. Some Republicans want it repealed outright and others while supportive of repeal favor nibbling at the edges, like changing the requirement for employer supplied health insurance from 30 hours of work to 40. So what is the principle they are working from?

Maybe you have heard about the tremendous burden ACA has put on employers, especially small business owners. Anything the GOP can do to lighten the load of these entrepreneurs, the better American makes out.That doesn’t sound like a “first principle” to me. Hmmm.

On the other hand, saddling small businesses (or any business for that matter) with extra costs doesn’t seem like a robust idea. So are Republicans on to a good idea?

So what are the first principles Republicans (or anyone for that matter) has around healthcare?

Does the GOP believe that everyone (in the world’s wealthiest country) should have access to basic healthcare in a dignified and affordable manner? Or do Republicans subscribe to the idea that everyone is entitled to the best healthcare they can afford? So, if you work harder, save wiser, you can afford the best healthcare America has to offer. If not, you had better change your ways and become more productive.

Please do not misinterpret these thoughts to suggest Democrats have more humane or practical “first principles”. The Affordable Care Act was a political compromise of the first order and is deeply flawed. Its redeeming characteristics are providing broader coverage (more people eligible and far fewer denied coverage), and the seeds for changing medical practices towards greater efficiency (and lower cost).

One would not go too far astray in thinking that the Democrats’ first principle might have been “everyone is entitled to basic healthcare and we will worry about paying for it later (after you have voted for Dems)”. Hmmm.

The most mystifying aspect of the healthcare debate is the wealth of positive health care experience in over 20 modern industrialized nations (not to mention Cuba) where healthcare outcomes are as good or superior to the US, AND at cost levels one half or less that the US spend. Why wouldn’t both political parties be jockeying for ownership of the idea to adopt healthcare models such as in France, Germany, or Japan?

Congress will make great pronouncements about ACA and will point out certain aspects as unnecessary and unjustified. My guess is that many, if not all the Republican examples, ought to be changed (providing the GOP finds alternate means to fund ACA).

The GOP’s real intentions will flow from what they propose as “fixes”. For example, reducing the number of employer who supply healthcare plans will put pressure upon “exchanges” to pick up those left uninsured. Read more government subsidies. Will the GOP raise taxes to cover? The same outcome will follow any attempt to eliminate the individual mandate.

Here’s the surprise. In a world class healthcare system, there would be no discussion of individual mandates or employer required healthcare policies, everyone would be automatically insured for basic coverage.

The first principle involved in these programs is that everyone has a right to basic healthcare coverage and has a responsibility to pay their share of the national cost burden. In addition, the prices for all healthcare services (doctors, hospitals, drugs, and all associated equipment and supplies) are negotiated.

The last six years have demonstrated that neither party is willing to touch the first principle found around the world and provide all Americans with healthcare as good as we have now at half the cost. Good luck 114th.  Hmmm.