Friday, March 1, 2019

New Polls Show Most 'Muricans Don't Want To Pay For A Decent Health Care System

Image result for mri machine
One of the hyper-expensive medical "toys" driving up health care costs - the 3T MRI machine

In his extensive Barbados Advocate column (April 30, 2017, p. 14, ''Addressing the loss of health care professionals') David Jessop shed light on exactly why medical costs are soaring in all the nations of the world. The prime contributing factors he listed as follows:

- A surge in the nature and volume of demand as populations age and birth rates continue to increase

-  The preceding occurring at the same time a desire for low taxes has made it difficult for governments to garner the necessary resources to respond to societal expectations

- Sustained loss of medical professionals causing shortages in many 3rd world nations, because they are picked off by nations such as the U.S.  - which itself is finding it can't cope with the expansion of medical services (e.g. via Medicaid in the ACA) combined with an M.D. shortage.

This combination in addition to overuse of medical resources by certain groups, has led to the condition in which much of the world is in a health care crisis.

The bottom line is this: It is futile to talk about "managing" health care costs when so little money is made available by many nations to support their current medical needs. In effect, medical care today  - from treating cancers to severe disability and chronic disease (e.g. kidney and liver disease) is bloody costly and intensive of medical resources by nature.  
This leads to a Hobson's choice for many governments: either raise taxes to support their local populations' access to medical care to the level needed, or cut access.

Meanwhile, on the home front, William Galston in a recent WSJ piece,  has argued that 'Medicare for all' is a "trap", e.g. › Opinion › Politics & Ideas

As Galston writes:

"The Medicare for All proposal that became popular with Democrats on the stump in 2018 risks pushing Democratic candidates into a trap in 2020. A political party is asking for trouble when it embraces a position on a high-profile issue that most Americans reject. But it’s not easy for a party to avoid this pitfall when a majority of its own members endorse such  a position.

A recent Politico/Morning Consult survey found that endorsing Medicare for All rather than improving the Affordable Care Act did more than any other issue to increase rank-and-file Democratic enthusiasm for a prospective nominee. Fully 57 percent of Democrats said they would be more likely to support such a candidate, compared to just 22 percent who said less likely, and 37 percent said that they would be “much more likely” to do so"

And then we get to the "bugbear" in the proposal (ibid.)

"According to the most recent Kaiser Family Foundation survey, 56 percent of Americans initially favor the idea of Medicare for All, in part because they believe that they would be able to keep their current insurance if they choose. But when they are told that versions of this proposal would eliminate private health insurance options, support dwindles to just 35 percent.

But here’s the dilemma for Democratic presidential candidates: even when voters who identify as Democrats are told about Medicare for All’s impact on private insurance, 57 percent continue to favor it. The same percentage still favor it after they are told that it would “require most Americans to pay more in taxes,” a consequence that only 35 percent of the electorate as a whole is willing to accept."

In other words, the polls militate against Dem success for attracting the larger electorate, which is essential to knocking out Drumpf.

Thus, though health care has long topped the electorate’s list of concerns, including in the 2018 midterms, surveys suggest that most Democrats want their party to focus on fixing the Affordable Care Act rather than on starting a long-shot bid for a single-payer health care system.  The tax depressive factor on the polling is particularly nettlesome and tells me too many Americans are still blinded by Neoliberal propaganda that private insurance or the Affordable Care Act tweaked is the best they can do.  But this is tantamount to batting on a losing wicket- because both systems merely increase the high cost of care while diminishing the benefits of getting it  over time.  Besides, no one in his or her right mind can tell me with a straight face that private insurers will taper off their premium hikes any time soon. Projections from the WSJ Business & Investing pieces consistently predict annual increases from 8- 12%.

Galston goes on:

In addition, several versions of Medicare expansion enjoy overwhelming support. 77 percent of Americans favor allowing people between the ages of 50 and 64 to buy health insurance through Medicare. 74 percent support a broader plan that could be called “Medicare Open to All,” which would enable everyone to buy into Medicare but would allow people to keep the coverage they have. 49 percent of Americans “strongly” back this approach, and by a margin of 10 percentage points, Democrats prefer it to Harris’s plan. 

So there’s a way for Democratic candidates to square the circle. First, support improvements in the ACA, such as protecting people with health insurance from high out-of-network medical bills without advance warning, along with restraints on prescription drug costs. Second, endorse Medicare Open to All. And third, during the candidate debates, unapologetically explain why you oppose forcing people to give up private insurance and pay higher taxes.

It is true that a single federal payer system — as such proposals envision — may well eliminate the waste, inefficiency and corruption that make the current system so expensive and inaccessible.  In such a system we'd more likely emulate the experience of countries like Canada and Britain that rely heavily on one government payer. But such a system would require dramatic changes from the status quo and would be a tough political sell in a nation conditioned to low taxation.

In order to try to scapegoat single payer systems we see repeated efforts by Neoliberal hacks,  like Scott W. Atlas, trying to paint it as snake oil, i.e.
No automatic alt text available.
 Indeed, I skewered one of Atlas' Hoover Inst. WSJ op -eds back in November.

But like a 'whack-a-mole' they keep popping up and have to be smacked down again and again. So no surprise in his latest propaganda effort ('Single Payer's Misleading Statistics', WSJ December 18, p. A19) Atlas attempts a new tack. This time claiming infant mortality and life expectancy  - by which the U.S. standards are relatively low - are "not valid indicators of health care quality".

Says who? Oh yeah, the Neolibs and their poltroons and propagandists. Well, I'd like Atlas to run that by a poor mother - with four other mouths to feed- who is unable to care for herself with proper nutrition etc. and then miscarries. In 2015, there were 6.5 deaths out of every 1,000 children under 5 years old in the U.S. That puts us behind 35 European countries, including those with median incomes and overall standards of living far below our own, like Bosnia and Macedonia—two Balkan countries that are still recovering from long periods of political instability. Oh, and we’re behind Cuba too.

So  WHO is Atlas fooling?  Maybe himself and the dumbest of right -leaning readers of the WSJ.

 As for the life expectancy trope he peddles, he ignores the dramatic effects on health before people even become eligible for Medicare.  Although Americans are eligible for Medicare at 65, years of many being uninsured or underinsured prior to 65 take a toll on their collective health.

Atlas also argues that "the U.S. has a substantially higher obesity rate than any other nation - a problem - but not one of inferior medical care."

Again, seriously? But I can promise Atlas that if I (or wifey) didn't have a diligent, caring female doc that checked our eating habits, weight, exercise regimen every visit we'd both be in the obese category as opposed to having lost over 18 pounds each.

But aversion to higher taxes and loss of private insurance isn't all on Americans since we've learned Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. 

As The NY Times (Feb. 23rd) points out the medical- PhrMA axis hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts leftward on health care.

They also demonstrate how entrenched the Democrats’ last big health care victory, the Affordable Care Act, has become in the nation’s health care system.

The lobbyists’ message is simple: The Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. More than 155 million Americans have employer-sponsored health coverage. They like it, by and large, and should be allowed to keep it.  Never mind that over time employers have fobbed more and more costs onto workers, as well as company plans with ever higher deductibles.

Naturally  the private insurers are nervous given the Democrats’ proposals could radically change the way health care providers do business and could drastically shrink the role and the revenues of insurers, depending on how a single-payer system is devised.  To give an idea of the level of hysteria, the Times reports a coalition of these capitalist misfits: the Partnership for America’s Health Care Future, claims that 'Medicare for all' will require tax increases and give politicians and bureaucrats control of medical decisions now made by doctors and patients.

The tax increases ought not be a startling revelation, nor that we can't just tax the richest to get there. Middle class citizens will also have to bear higher taxes, but look at the payoff! A much superior health care system - analogous to Canada's  - and not having to face ever higher premiums, or becoming impoverished after a medical emergency.

We also know those railing loudest have used similar arguments that echo those made to stop Medicare in the 1960s,  Hillary Clinton’s health plan in 1993 and the Affordable Care Act a decade ago.  It's also clear to me the medical -industrial complex insurance axis sees no difference between the Medicare buy-in option and Medicare for all. Why would they? Both will pile on enormous extra costs and it's not even clear right now there will be enough providers.  The Medicare Buy in will be especially expensive if a lot of over 50s, or over 55s, enter with pre-existing conditions like cancer.

My Medicare costs between the first year eligible -  when I hit 65-  and was cancer free,  and the next when I was diagnosed with prostate cancer, probably spiked by over 150 percent.  Medical encounters that had previously been mainly for PSA tests, general checkups, lipid profiles etc. now expanded with needle biopsies, application of spinal anesthesia,   CT scans, HDR brachytherapy and other subsequent tests, biopsies.  It isn't inconceivable that many entering a Medicare Buy in system could 'break it' if they also enter with cancers, or were subsequently found to have them.

Should we just let all these folks croak? No, absolutely not. But they need to know a Medicare Buy in will be very costly and the tax system has to be adjusted to suit.   No longer can middle class folk expect tax cuts and government- provided health care benefits in whatever guise. Higher premiums alone will not cut the mustard.

The chief sponsor of the House buy-in bill,Representative Brian Higgins, Democrat of New York,  quoted in the Times has said: “The critics lump our bill with the bigger Medicare-for-all proposal. That’s strategic, and I think it’s deliberate.”

Well, it is deliberate, but for good reason.  What we need all the Dems who are championing these new Medicare programs to do is to come clean about the need for new, higher taxes. I suspect at least increased to the 35 % marginal rate. Oh, and no more tax cuts!

Rep. Higgins also said the option of Medicare at age 50 would create “a countervailing force to private insurance.”

Well, doh! Of course it would! Why would a 50-something stick with private insurance, even COBRA, if the Medicare Buy-in option means premiums 20- 30 percent lower, lower drug costs and no "pre-existing condition sword of Damocles" hanging over one's head?   But this is why Higgins must acknowledge the much higher costs of such a program even it it's not an all out Medicare for all.

Personally, I just don't believe the country is ready for Medicare for all (or a Medicare buy in) because  too many aren't ready to pay the higher tax rates needed to support it. (Probably increased to the 40 percent marginal level.)

Higgins goes on to state:

Insurance companies are fighting it because they are afraid of the prospect of a potent new competitor that will cut into their profits. Medicare has lower administrative costs and lower executive salaries and could use its bargaining power to get better deals from hospitals and other health care providers.”

This is all true but these lower costs will still not make up for a much larger sick population, especially one featuring prostate, breast, throat, pancreatic, liver and other cancers - as well as chronic diseases such as Crohn's or diabetes.  (My three now deceased brothers' medical costs soared as their diabetic issues and complications worsened, including diabetic retinopathy for John.) 

Senator Debbie Stabenow, Democrat of Michigan and the sponsor of the buy-in bill in the Senate, said she was not surprised at the criticism. “It’s a knee-jerk reaction to anything that expands Medicare,” 

Again, true, but also understandable because too many Dem politicos have not leveled with their constituents about the real costs and how they must be paid for. Medicare is not a free lunch, whether for the buy -in or 'for all', nor can we believe taxing the wealthy alone can cover those higher costs.  It is time for all the Dem presidential candidates to cease pandering to voters with promises of tax cuts, and level at them the real cost of a more expansive (and generous)  medical system.  And also ask them directly whether they are ready to pay for it!

See also:


Sonali Kolhatkar's picture
Article Tools E-mail | Print Comments (2)

No comments: