Posted tagged ‘universal healthcare’

When People Think Differently

August 8, 2017

The idea of “universal, single payer” healthcare seems so obvious as both the most efficient and least costly method of delivering a nation’s basic healthcare, it seems incredible that there are so many Americans who do not embrace this notion. Why would that be?

Fewer and fewer Americans remember the time before the wide spread availability of insurance company provided healthcare. Yet the US system of “for profit” healthcare insurers is a relatively recent happening. Following WWII, employers began offering health insurance as an employee benefit designed to retain employees in a period of relatively full employment. Health insurance as a benefit caught on and employers have found it difficult to retain workers without offering health insurance. Hmmm.

Also escaping most Americans knowledge is the cottage industry which is necessary to support the multitudes of healthcare insurers. Healthcare service providers (doctors, hospitals and drug companies for example) must carefully keep track of each patient and how much service that patient has consumers, report those services using each insurers different set of codes on each insurers specific form, and then argue with each of these insurers to insure they receive reimbursement for the services already provided. This entails millions of more healthcare workers who do not themselves provide healthcare. Hmmm.

More than two dozen other modern countries (like Germany, France, England, Japan, and Canada) utilize a single payer, universal healthcare service delivery system. These countries all offer “best in class” healthcare services at about one half the total cost experienced in the US. These countries also report excellent healthcare outcomes and boast longer life expectancies than the US. Oh, and these countries provide this healthcare to all residents. Hmmm.

So, why would anyone not be in favor of universal healthcare?

In the US there are many who decry the idea of universal healthcare. They predict unacceptably long wait times to see a doctor or receive treatments. They ask the question “if healthcare is so good in other countries, why do people from Canada travel to the US for medical care?”, and “Why should we put the government between you and your doctor?”, the ask.

The politics of healthcare is even more fascinating and not easy to understand. Progressives are for a universal system and conservatives are not. Conservatives point to Progressive’s record of entitlements and using taxes to fund the cost. Conservatives see creeping socialism behind the call for universal healthcare and the resulting dependency of Americans to look for government to solve all their problems. And worse, universal healthcare will bloat the government making what is already (in their opinion) too big, even bigger. And even worse, conservatives don’t want their tax dollars going to pay for healthcare for someone else. Hmmm.

Hmmm. What could be simpler. Big government, less choice, poorer quality, and offering out of control cost increases, conservatives claim.

Why do conservatives think that way when there are so many examples around the world that prove otherwise? Why don’t conservatives recognize that some Americans already have “universal healthcare”. These Americans, of course, are over 65 and are enrolled in Medicare.

Is this a subject of “the glass is half empty, or half full”? Do progressives and conservatives see the same problem (basic healthcare available to all Americans) or do they see different solutions to different problems (basic right versus small government with low taxes)?

If Americans see the same problem, conservatives may still view the delivery of basic healthcare too difficult a task for “American thinking” and from their perspective, a universal healthcare system must inevitably end up with poorer healthcare and higher costs. Progressives could, alternatively, see no problem too great for Government to solve and therefore discount totally conservatives’ warnings.

The recent Congressional fight over repeal and replace for Obamacare should make conservatives take notice. The conservative sponsored alternatives largely failed because they offered less coverage for the poor, those with pre-existing conditions, and the elderly.   Voters representing those groups made their views known. Progressives and conservatives would be wise to heed this warning.

Healthcare is not free and does require funding. Most other countries employ a “prevention” oriented healthcare philosophy, inhibitions towards uncontrolled price increases, and utilize a consumption tax (value added tax) to fund healthcare along with modest co-pay requirements.

Obamacare could be a starting point were Republicans to acknowledge that Obamacare was based upon Romneycare (Massachusetts) and that was based on a proposal from the conservative Heritage Foundation think tank.

If conservatives can’t agree with progressives on what the problem really is, voters make make the choice for them. The 2016 Presidential elections was a clear sign that the electorate was dissatisfied with both parties and threw its support to a total outsider.

What will voters do next time?


The Argument For Pension Reforms

July 24, 2014

Across the country many public workers in States, localities, and school districts are experiencing pressure from authorities to renegotiate pensions (and benefits). Why are these previous promises under threat of not being kept?

In most cases authorities cite either demographics (the public sector workers are living too long) or that there is not enough money in the pension fund because the already invested pension money is not earning what it was projected to earn. In either case, the underlying reason is tax payers do not wished to pay more to make up for any short fall.

But aren’t promises, promises?

Another line of reasoning is that pension (and benefit) reform is based upon comparison with the private sector. There has been a massive shift in the private sector’s approach to pensions (and benefits). For competitive reasons, the private sector has moved to make less rich both the pension and the benefit plans. In short, pensions and benefits as originally promised were becoming prohibitively expensive.  Consequently, companies were losing competitiveness versus companies which produced products overseas.

So the argument became, no change, no job.

Regrettably, many private sector unions did agree to reform and still their jobs were swept away to low cost countries. So much for promises.

The math dealing with pensions or any other benefit (mainly healthcare) is pretty straight forward. The employers and the worker must contribute enough money from current pay that when it is invested, will yield enough to cover actual payout costs for the life of the employee. With Americans living longer, the payout period will be longer than when most of these plans were first instituted.  Investing pension funds is much harder given the practical zero interest policy of the Federal Reserve.

Something has to change if the funds are too meet their obligations.

All aspects of pensions and benefits are negotiable. There are not hard and fast rules binding either employer or employee. The reality, however, is that some agreements will not serve either the employer or the employee well. Too much employer costs risk jobs, too much employee costs makes everyday living more difficult given how Americans have become use to spending their income.

Oh what a mess.

There are other methods for covering workers with retirement or healthcare. European countries have adopted methods where there is a nationwide safety net while individuals can contribute or save for a more generous retirement. These European systems, however, involve all citizens and all companies.

Anyone can save more and any company (or government organization) can provide more generous benefits but nobody can provide less than the standard.  Hmmm.

Can you hear the howl “socialized pensions or socialized medicine” coming?

Maybe, but so what. If Americans slip into the spot where pensions are inadequate for the elderly to live, the public will be asked to subsidize. You can pay me now, or pay me later.

Thinking Backwards

May 8, 2014

Recent polls are showing the tide of support favoring GOP candidates. If the tide continues, President Obama can look working with a GOP controlled Congress.

One of the most quoted reasons is voter disgust with the Affordable Care Act. The two reasons cited are (1) the individual mandate (that is everyone must buy health insurance), and (2) the loss of the coverage, either totally or at least the policy individuals had before ACA.

Both of these reasons are suspect. While the reasons themselves are undoubtably true for some people, but how many? Most Americans still obtain their health insurance through employer administered programs. Everyone should be suspect of those who oppose the individual mandate.

Health insurance avoiders are gaming the system and costing everyone else big bucks through use of emergency room services or outright inability to pay hospital and doctors charges. For those who have had their employer provided coverage taken away, shame on the employer, not shame on ACA.

With respect to those previously elected to purchase less costly policies with less coverage, in a strange way most of them were also gaming the system… unless they were fully prepared to cover all doctors and hospital costs.

Logic suggests that it is unlikely any voters are choosing one party over the other due to healthcare. Rather, there are reacting to impressions developed from negative Super Pac ads. The boat load of conservative negative advertisements very likely has a finger, if not the whole hand, in this.

Super Pac money could have a much greater impact if these donors were really interested in healthcare. Flooding the airwaves with information about how European healthcare works, what its results are, and how much it costs would be an eye opener.

If the GOP said, “that’s what we will bring Americans”, I would say “sign me up”.

The Deficit and Debt Blues

February 4, 2014

Can you hear that tune coming back again?  You know, “the Deficit and Debt Blues”.  It’s a sad song which shows our Congress in a shameful light.  Each time the country approaches the statutory limits on borrowing, we hear this music begin.  Have you ever wondered what our politicians are thinking?

The deficit and debt are in fact important numbers.  Failure to balance the Federal Budget leads to the deficit, and deficits piled on top of other deficits makes our debt.  Just as with our personal household budgets, credit can bridge a period when one spends more than one makes.  Also, as with a personal debt, the more one borrows, sooner or later, the more ones bank will charge more to lend you more.  Lastly, just like with personal debt, banks will continue to loan providing one continues to make payments on the loan interest.

So for either Party to say they do not support increasing the debt limit, either displays a gross misunderstanding of credit markets or a totally reckless approach to life.

The US certainly has a deficit problem.  Congress cannot agree upon the role of Government and therefore cannot agree upon how to properly fund what Government we do have.  Just weeks ago, Congress passed its first budget in several years and said in effect, this is how we will spend our money.

Now with the ink just dry, some in Congress are saying we will only agree to increasing the debt limit if there are spending concessions.  What?  Why weren’t those concessions already in the budget?

These irrational arguments over the debt simply mask the fundamental legislative shortcomings.  Both parties are only too eager to approve spending (and take credit in their home district) while leaving the funding of that spending to borrowings.  Hence the difficult to contain deficit.

Medicare and Medicaid are the prime culprits.  Combined, the US spends over $ 500 million more than it collects (via wage taxes) on Medicare and Medicaid.  Given rising healthcare costs, the aging population, and the stagnation in average family income, it should be no surprise that Medicare and Medicaid are running deficits.  Isn’t it clear that something must be done if we are to balance the budget?

Regrettably, there is agreement that something must be done, there just isn’t agreement on what.

Some would cut Medicare and Medicaid availability (largely through forcing recipients to pay more).  This seems odd since both programs were specifically established to provide healthcare to fixed income and poor citizens.  Hmmm.

Others would look to other parts of the Federal Budget and make cuts there.  Unfortunately, there are no obvious “one cut” places.  While certainly there are reductions that are possible, these cuts would not stop the pace at which Medicare and Medicaid are outspending their funding.  Hmmm.

Increase taxes is also a favorite.  Some are quick to “tax the rich” (they can afford it).  The rich, of course, will see this differently and suggest consumption taxes if there are to be any taxes at all.  Hmmm.

And a few voice will sing an entirely different song.

Instead of the “Deficit and Debt Blues”, these people propose singing the “Universal Healthcare Rag”.  With Universal Healthcare, there is no need for Medicare or Medicaid.  To be sure there is a funding issue, but with a clean sheet of paper funding can be established on a combination of premiums, and consumption and income taxes.  All other modern countries have adopted a single payer, universal healthcare system and experience about one half the per capita cost than we experience here in the US… and have health outcomes equal to or superior to those we experience.

The “Deficit and Debt Blues” is a troublesome song.  It takes us no place where the sun shines.  The Congressional children (our elected representatives) will huff and puff again.  It is a good bet that no Congress member will speak to root causes.  Therefore, we can expect this crisis to pass without any steps being taken to fix the underlying causes for the deficit.

Hmmm.  I think “ragtime” is far more optimistic than the “blues”.


When No Deal Is The Deal

December 10, 2013

Representative Paul Ryan and Senator Patty Murray have been leading an effort to find a “deal”.  The scope of the deal would include some relief for the sequester and also set spending limits for the next two years.  The objective is to avoid another government shutdown or default on the debt.  Sounds sensible if not heroic, but the substance falls quite short.

Prima facia, the country’s tax code is so convoluted it should be against the law.  Entitlement, especially Medicare and Medicaid are woefully underfunded and should constitute fiscal mismanagement to be allowed to continue as is.    A pinch here or a pinch there on the over all budget without dealing with these two big problems won’t have much impact upon the growth of the debt.

These two elements (tax reform and entitlements) constitute the heart of a political impasse.  Without tax reforms (leading to more tax revenue) Democrats will not support any other changes, especially to entitlements.  Without cuts in entitlements, Republicans won’t budge on any changes in the budget, and as an article of faith, no new taxes will be considered.

The Obama-Boehner “grand bargain” which included tax reform and entitlement cuts, seemed so obvious.  Washington, today, is deafly silent about that possibility.  While it remains an option, it certainly is not one for an election year.

The Murray-Ryan deal is the equivalent of “no deal” even if it can be struck.  Nothing happens versus the systemic problems facing a slow growing nation.  At a time when decisive handling of the nation’s infrastructure could prepare the US for global competition in the 21st century, there is no budget room and sadly, no will to deal with the future.  Just as disturbing is the blind eye both parties are showing towards healthcare.  While the Affordable Care Act promises to reduce the inequality of healthcare delivery and may slow the growth of future healthcare costs, it still leaves the US far short of more than two dozen other modern countries in cost and quality of care.  Not dealing with healthcare also leaves in place the festering sores called Medicare and Medicaid.

If Representative Ryan and Senator Murray cannot lead us to a tiny deal, how can we expect our elected representatives to deal with real game changers?


6 To 26

November 21, 2013

Quality experts will often remind executives that if they want their subordinates to remember something, or follow some procedure, they must tell tell their subordinates 6 to 26 times.  President Obama and his Affordable Care Act team ought heed this advice.

Conservative think tanks and PACs are already flooding some airwaves with misleading, fear inducing messages about ACA.  The objective is to influence voters in certain districts to vote against Democrats and support a conservative candidate.  So where does 6 to 26 fit in?

The White House needs to remind voters of what they are getting with ACA and how that compares to what they had before.  If these conservative PACs get their way, voters will lose certain benefits.

Even the 80% of Americans who get their health insurance coverage through their employer are ahead of the game.  Getting a new benefit is a small satisfier, but taking it away is a huge dissatisfier.  Voters need to understand what is involved with Conservative’s efforts to repeal the ACA.

For example, with ACA

  • Insured individuals with family coverage can include children under the age of 26 in their policy.  This provides relief to parents who might otherwise have seen their children purchase expensive low coverage policies or avoided coverage at all.
  • Many seniors will see a drop in their prescription drug costs.  Medicare Part D had a “donut”, a place where drug costs suddenly stopped being covered.  Coverage subsequently began again when drug expenditures reached an even higher level.   Under ACA, Medicare there is no donut hole.
  • Individuals who previously purchased low cost policies often found out that emergency room services were no covered.  Under ACA, emergency room services are covered.
  • Individuals with “pre-existing conditions” and out of work (no employer provided coverage) will be able to get coverage and at a fair price.
  • Women, regardless of their employer, will be able to obtain complete coverage for women health.  Even Notre Dame’s $70 million a year football team will have to provide complete coverage regardless of what its religious affiliate might want to dictate.

The Affordable Care Act is not the ideal plan for medical expense coverage.  ACA may even have some glaring deficiencies that will become clear in the coming months.  ACA, however, does move the ball forward when compared to what preceded it.  ACA may represent the best step forward our complex American healthcare delivery system can tolerate.

If conservatives want to employ fear tactics and take away these benefits in order to achieve their ideological goals, then reminding Americans 6 to 26 times of what they stand to lose listening to these mistruths should help.

Voters have an uncanny way of figuring out these matters giving enough time.  Reminding them 6 to 26 times will remove the chance that slick 30 second commercials might win the day.


What Can They Say Next?

November 8, 2013

The last several weeks has seen the “I told you so” line from Conservatives.  “I told you the Affordable Care Act was a disaster and should have been repealed.  Now with the roll out of the national web site you can see the disaster”.  This was the GOP mantra.

Next came the broken promise. “You, President Obama, promised I could keep my old insurance plan and now I’ve received a cancellation notice.  Even worse, what I can get to replace it costs more.  You lied to us.”  The GOP acted like it was on a roll.

As the dust is settling, the national web site is getting more functional.  There is no reason to believe it will not be 100% functional in a few weeks.  End of that issue.

The “lie” is even more interesting.  In order for the GOP to beat this issue to death, they must continue to engage in a discussion about what exactly these “discontinued” policies actually were.  Comparing them to what is available to replace them, these discontinued policies charged a lot of money for very little coverage.  Buying junk, while every American’s right, is not a good position to argue.

This GOP outrage is again shortsighted.  It does not envelop the entire question of healthcare or address the question of how (or whether) the richest country in the world should deliver healthcare.  The GOP has opted for political sniping instead of issue management.  But that’s their bed they are making.

The Affordable Care Act does have a serious deficiency.  It does not go far enough.

America will still experience uncontrolled Medicare and Medicaid rising costs.  Pre-retirement Americans and those who do not qualify for Medicaid will almost certainly experience greater healthcare expense, either through direct insurance purchase price increases or through greater deductibles or paying larger portions of employer provided plans.

ACA does have some provision aimed at reigning in healthcare cost increases, but when our current healthcare delivery system starts at two times all other countries, it shouldn’t be too long before Americans finally wake up.

The GOP’s non-constructive approach to ACA (ok to oppose but they should offer truly constructive ideas) does not serve anyone well.  When America finally gets angry enough with the excessive cost represented by healthcare, or says enough with the magnitude of Medicare and Medicaid un-funding, the next stop will not be some plan with tax credits or vouchers.  The next step will be universal healthcare just as in two dozen other modern countries.

So at the end of the day, maybe the GOP is actually moving the Country closer to a real solution to the deficit and to affordable healthcare for all.