Tag Archives: repeal and replace

All Posts, budget, health

CITIZENS MUST LEAD THE HEALTH CARE DEBATE

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Politicians seem weary of hurling half-truths and insults at each other in their years-long shouting match over health care. Nobody won.  All of us lost.  It’s easy to blame them, but conversations with a physician friend helped me realize that lawmakers can’t work well together until voters agree on our values and goals.  My hope is that this column will shed some light on key questions and help readers think through them with family, friends and neighbors.  Let’s open our minds, listen, and look for ideas on which we can agree.

Three important questions are:  1) Which kinds of health care (if any) should be basic rights guaranteed to all Americans?  2)  Who will pay for it? and 3)  What can we do to make health care more affordable?

Hospitals and doctors practicing there are required by law to provide certain emergency services without regard to a patient’s ability (or willingness) to pay.  The cost is built into the prices paid by benefit plans and by individuals who do pay. That is very clearly an undocumented tax on everyone who pays for health care.  Any health care that is promised by government as a right for all Americans will be taxpayer-funded, one way or another.

Our decisions regarding which kinds of health care will be a basic right need not be an “all or nothing” choice.  We could conclude that government (taxpayers) will fund some kinds of health care but not others.  A government-guaranteed plan must have a way to update which services are covered based on our values, goals, scientific advances, and budgets.

By providing wellness services such as vaccinations and screening with no out-of-pocket cost, we might improve our health and reduce our long-term costs. Colonoscopy is an example of a screening that might prevent enough colon cancers to reduce lifetime costs, but it doesn’t make financial sense for short-term, employment based insurance because the savings come later in life when someone else (likely Medicare) is paying the bills.

There are high cost services that are of questionable value.  Suppose that a cancer treatment has a 20 percent chance of extending a patient’s life for not more than three months at a cost of $500,000.  Maybe that treatment wouldn’t be included as a government guaranteed  service.  That wouldn’t mean that you can’t have it.  It simply means that you have to pay for it yourself  through a supplemental insurance plan or out of your own pocket.  Insurance companies and Medicare are already making those coverage decisions today.

The Obamacare individual mandate to purchase insurance is an attempt to answer the “Who pays?” question and (according to the US Supreme Court) it is a tax.  But why do we want to levy special taxes to fund whatever health care we guarantee as a right for all?   Generating government revenue is a budget issue, not a health care issue.   Compare this to the way we pay for public safety.  We’re all guaranteed a good, basic level of protection by law enforcement agencies and we don’t pay a special tax for that or tie eligibility to employment.  If you are wealthy and want more protection you can pay for a gated community or private security.  Why should paying for health care be different from paying for public safety?

The third question, regarding making health care more affordable, deserves serious attention.  American health care spending is roughly double that of other high wealth nations.  All of them guarantee a broad range of health services to all of their citizens.  The astonishing truth is that per person American government (taxpayer) spending exceeds all health spending (including government, individuals and employers) in Australia, Canada, France, Japan, and the U K.2016 PER PERSON HEALTHCARE SPENDING IN DOLLARS

The reasons why our health costs are so much higher than other nations is a subject for another day.  For now, I’ll just point out that citizens of other  nations  are getting more care for far less money.  We would be wise to carefully study how they are doing that before we make up our minds about the future of American health care.

Please engage your friends and family in the discussion.  What health care do they want for you if you fall ill and have limited financial resources?

CLICK HERE for the OECD website where you can explore the cost of health care, who pays and health outcomes in most of the world’s developed nations.

Below are three comparisons that I created as research for this column.  You can see international comparisons and track how US  spending has changed since 2010, when Obamacare was just being created.  Click the chart to expand it.

TOTAL SPENDING BY NATIONOECD total health spending

 

 

 

 

 

GOVERNMENT SPENDING BY NATIONOECD government health spending

 

 

 

 

 

PRIVATE SPENDING BY NATIONOECD out of pocket health spending

All Posts, Congress, economy, health, medicaid, north carolina

Congressional Legislative Malpractice

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The 13 Senators who drafted a bill to replace Obamacare are all Republican, male, white, over age 40, and prosperous.  California, Florida and New York, which together account for one-fourth of our population, were not in the room but there were two Senators from number fifty Wyoming.

Discussing diverse opinions is one way to identify and avoid unintended consequences of new legislation. Do Republicans think that women, middle class, minorities, young, poor, and other Americans left out of the process have no ideas worthy of consideration?

They did their work in secret meetings without input by experts in health policy or economics, out of the sight of the public and the press.  The result is a political bill to satisfy Republican ideology with little regard for facts or alternatives.

Previously, Republicans in the House of Representatives passed a similar bill that was designed behind closed doors without serious public hearings, expert testimony or debate.  They proceeded despite a Congressional Budget Office projection that it would cause 23 million Americans to become uninsured.  The CBO’s estimate of spending reductions from the bill  amount to $43 per month saved for each person who loses health benefits – not a good deal!

There’s no doubt that Obamacare has serious problems in the individual and small employer exchanges.  Republicans try to mislead us into believing that those troubles mean that the law is failing.  It isn’t.   Because of Obamacare 20 million more Americans are now insured and the rate of growth in total health care spending is lower than it was before Obamacare.  It is a successful law that needs improvements.

Bluntly, Republican lawmakers don’t believe that all Americans should receive basic health care regardless of their ability to pay and they’re willing to let other Americans die for that ideology.  Republican leadership intends to pass their bill before Americans understand that it will cause more people to lose health benefits,  more healthcare related family bankruptcies and more individuals suffering death or disability.

Rushing ill-considered bills through a legislature to satisfy an ideology is not limited to the congress.  North Carolina Republicans imagined an “emergency” when Charlotte passed a civil rights ordinance allowing transgender citizens to use restroom facilities consistent with their gender identity (and, in most cases, consistent with their physical appearance).  Rather than holding hearings and carefully considering what (if any) legislation was needed, they packed the infamous HB-2 with unrelated and controversial provisions then passed it as “emergency” legislation.  If standard legislative processes had been followed, a more appropriate response (or no response) to Charlotte’s ordinance might have been made.  HB-2 has been mostly repealed, but the damage to the state’s reputation remains and some economic losses will never be recovered.

Similarly, North Carolina Republicans gerrymandered the state’s congressional and legislative districts through secret processes.  They hired attorneys who hired consultants to design legislative districts that would give massive election advantages to Republicans.  Because the work was done through attorneys, they were able to claim attorney-client privilege as justification for refusing to let the public and the press see exactly how they instructed the consultants.  The US Supreme Court ruled that the result of their work was racial discrimination.  It again seems obvious that an open process with public hearings could have produced a better outcome.

If Republicans were practicing medicine rather than legislating, their negligence would be called malpractice.  They circumvented the rules and procedures  that  assure thoughtful deliberation before laws are passed. That violates American values, undermines trust in government and exposes us all to the negative consequences of ill-considered laws.

Senate Republicans plan to debate, amend and pass a healthcare bill back to the House of Representatives in 10 days, with no public hearings and no expert testimony.  As an example of the unanticipated consequences of doing that, unemployed Republican rural voters in the coal mining areas of the Kentucky mountains will probably lose their Medicaid benefits and see closure of clinics opened to serve them under Obamacare.  Health care has added more jobs than mining lost in the Kentucky mountains.  Similar outcomes are inevitable in other places.  The damage to the credibility of our legislative processes is severe.  Worst of all, Americans will die as a result of Republican legislative malpractice.