IT COULD HAPPEN TO YOU

                                                                                  

As I've said many times, the easiest way to get through the corporate media blockade on a lot of issues is to write letters to the editor and guest columns for your local paper. Their editors are not as invested in denying a voice to those who would chip away at corporate control of government.

The following is an editorial I wrote for the Eugene Register-Guard a few years ago making the case for universal health care using an emotional hook. Research has shown this to be most likely to make people think about the issue who would ordinarily be predisposed to dismiss the idea out of hand as "socialist." I was recently reinded of the importance of this idea in a presentation on how to advocate for single payer. I reprint it here as an example of how to hook such people so that they will pay attention long enough to learn how such a system would benefit them, which is ususally the first thing most people think of when they consider public policy.


We’ve all seen it: You walk into a convenience store and there on the counter, taped to a jar, is the photo of a child. Scrawled on the picture is an appeal to leave your change to finance a bone marrow transplant or some other treatment the child’s family cannot afford. Or maybe you can help the victim of a fire or accident by buying a pizza on the night that one dollar per sale goes to her medical expenses.  Do you feel good about being able to help, or are you outraged that these families have to beg for desperately needed assistance?

If you don’t feel guilty passing up such chances to help, perhaps it is because you realize the ultimate futility of such appeals. But if you don’t support doing something about it, you should feel guilty. These are neighbors in need. We can turn away from them now, but what happens when we need medical care we cannot afford?

Chances are, you don’t have enough insurance to keep from going bankrupt if you get an illness or injury requiring expensive treatment. 60% of bankruptcies are due to medical bills, and 75% of those undergoing medical bankruptcy are insured.  In other words, simply having insurance isn’t enough if you can’t afford to use it, or if you use it and go broke anyway.  Medical bankruptcies are unheard of in other developed countries. There, risk sharing through universal health care prevents the unlucky families who most need help from having financial ruin added to their burden. Everyone contributes to the system so that none need go without care when it is needed.

Aside from the humanitarian issue of having nearly 30 million Americans uninsured, most of whom are the working poor, there are many practical advantages to universal health care. When access to care is not tied to employment, it is much easier to change jobs. People are free to work where they want instead of keeping a job with medical benefits that doesn’t otherwise fit their needs. If they want to start their own business, they don’t have to worry about losing it due to unexpected illness or injury. Businesses are more competitive with overseas competitors when they do not have to pay extortionate rates for insurance and instead, have predictable costs.  These costs are significantly less in countries with universal health care than they are in the American system of access through for-profit medical insurance.

The financial benefits of universal health care are well known, but since some continue to claim that we cannot afford it in the US, it bears repeating: Other countries provide universal, comprehensive care for as little as half the amount per person that we pay in the US for care that is full of gaps even for the insured.  While it’s not estimated that we will save that much under the plan recently introduced in Congress by Bernie Sanders, his proposal for an improved system of Medicare for All would provide comprehensive care to every American at less cost than the current system.

Such as system would have built-in cost controls lacking in the Affordable Care Act. Without such constraints, the system will ultimately become unsustainable due to the familiar “death spiral” of medical insurance:  As costs rise, fewer can afford it, leading to premium increases to maintain profits, which leads to fewer being able to afford it, thus causing a new cycle of price increases. Ultimately, most of us will not be able to afford insurance without the subsidies offered under Obamacare. These subsidies amount to a bailout of Wall Street investors in the insurance industry for the sole purpose of maintaining their profits. They add nothing of value to the system to justify their siphoning 30 cents out of every health care dollar, when Medicare overhead is less than a tenth of that.

When you understand the economics of universal health care, it is hard to argue that we cannot afford it. The question then becomes, do we really want to pay more for less care for ourselves and our loved ones, just to deny it to those we think may not be worthy?

WILL DEMOCRATS FALL FOR THE PUBLIC OPTION SCAM AGAIN?

                                                                               

When all the Establishment-backed contenders for the Democratic presidential nomination support some version of a public option, it’s a safe bet that corporate interests that finance the DNC are the ones that are being served. As corporatist candidates like Harris and Biden fail to resonate, new champions of “pragmatic” approaches to reform rise to take their places. Even progressive darling Elizabeth Warren favors an incremental approach that she thinks will lead to single payer, starting with a public option. Only Sanders has consistently indicated his willingness to take the lead in a fight for a Medicare for All now.

The arguments made by the corporatists in the party are having an effect. A substantial proportion of Democrats are buying the false claim that a public option is the only viable way to establish universal access to health care. That’s shown in their growing support for a public option and decreasing support for a single payer system like Medicare for All.  It’s disheartening that so many supporters of a single payer system of health care are falling for the same nonsensical arguments that were used to undermine support for it during the “health care reform” debate in 2009.

Those of us who understood then that the call for a public option was a bait-and-switch strategy to defuse the growing movement for a single payer system must start all over again educating progressives about why it will not lead to single payer. Instead, it will just add one more plan to a multipayer system of access to health care that is inherently inefficient. This inefficiency is the main reason that health care costs per capita in the US are about twice the average in countries with universal health care. Americans will not accept another expensive half-measure that won’t address the root problem or assure access to all.

The reason a public option won’t lead to single payer is that a Congress saturated by lobbyist cash will never create a plan that would compete with private plans. Democrats who are ready to embrace Biden, Buttigieg or any other proponent of a public option have apparently forgotten that Senator Schumer explicitly stated in 2009 that Democrats had no intention of creating such a plan. They also fail to recall that the corporate Democrats who kept single payer off the negotiating table continued to claim that people would like the plan so much that Americans would eventually all want to join it, creating a single payer plan by default. Nothing has changed since then.

To be fair, it’s theoretically possible that a public option could at least provide universal coverage. However, that’s not the same as universal access to health care. Anyone who has studied the issue understands that premiums, copays and deductibles remain a significant barrier to access to care for the insured. Financial barriers to access have dramatically increased since 1998, according to a recent Harvard study published in the Journal of the AMA. That study also showed that even the much-touted Obamacare expansion, expensive as it was, has not appreciably decreased the proportion of people who experience problems with access to affordable care. That’s why one in four Americans report that they or a family member have put off needed care for a serious condition because of cost. In families earning less than $40,000 per year, that figure rises to one in three.

Insurance is not the same as access to care when financial barriers to using it persist. That even applies to patients on Medicare, who also often have serious difficulty paying for their medications. That’s why single payer advocates generally prefer the term  “Improved Medicare for All” when referring to the plans advocated by most advocacy groups and members of Congress who actually understand these issues and support a single payer solution to the continuing crisis in health care access and affordability.

Improved Medicare for All refers to a system that is more comprehensive than Medicare, with coverage for vision, dental and hearing and medications, no or minimal premiums or copays and no deductibles. Some versions include long term care, as is provided in several European countries such as France and the Netherlands.  It is also a feature of one of the bills currently in Congress. All such bills introduced in the last few Congresses are variations on Improved Medicare for All because that is the type of single payer system that is widely acknowledged to be the most politically palatable in the US due to the generally positive views of Medicare.

I won’t go into the explanations of why single payer systems are less expensive than publicly funded and administered (single payer) systems (the basic reasons are summarized in this bullet-point document, which also points out other economic advantages). There are endless articles written on the subject for the interested reader, but the simple response to those who say we can’t afford such a system is this: countries that provide universal health care to all their residents using a publicly funded and administered system provide care as good or better than the US at the least cost.

If other countries can do it, the only thing stopping the US from doing the same is the lack of political will due to Americans dithering about whether it is politically possible. It will be possible only when we demand it. A single payer plan like Medicare for All is the only affordable way to end the crisis of health care access and affordability in the US. Accept no substitute

MEDICARE FOR ALL-HARD HEADED ECONOMICS, SOFT HEARTED POLICY

                                       


We’ve all seen it: You walk into a convenience store and there on the counter, taped to a jar, is the photo of a child. Scrawled on the picture is an appeal to leave your change to finance a bone marrow transplant or some other treatment the child’s family cannot afford. Or maybe you can help the victim of a fire or accident by buying a pizza on the night that one dollar per sale goes to her medical expenses.  Do you feel good about being able to help, or are you outraged that these families have to beg for desperately needed assistance?

If you don’t feel guilty passing up such chances to help, perhaps it is because you realize the ultimate futility of such appeals. But if you don’t support doing something about it, you should feel guilty. These are neighbors in need. We can turn away from them now, but what happens when we need medical care we cannot afford?

Chances are, you don’t have enough insurance to keep from going bankrupt if you get an illness or injury requiring expensive treatment. 60% of bankruptcies are due to medical bills, and 75% of those undergoing medical bankruptcy are insured.  In other words, simply having insurance isn’t enough if you can’t afford to use it, or if you use it and go broke anyway.  Medical bankruptcies are unheard of in other developed countries. There, risk sharing through universal health care prevents the unlucky families who most need help from having financial ruin added to their burden. Everyone contributes to the system so that none need go without care when it is needed.

Aside from the humanitarian issue of having nearly 30 million Americans uninsured, most of whom are the working poor, there are many practical advantages to universal health care. When access to care is not tied to employment, it is much easier to change jobs. People are free to work where they want instead of keeping a job with medical benefits that doesn’t otherwise fit their needs. If they want to start their own business, they don’t have to worry about losing it due to unexpected illness or injury. Businesses are more competitive with overseas competitors when they do not have to pay extortionate rates for insurance and instead, have predictable costs.  These costs are significantly less in countries with universal health care than they are in the American system of access through for-profit medical insurance.

The financial benefits of universal health care are well known, but since some continue to claim that we cannot afford it in the US, it bears repeating: Other countries provide universal, comprehensive care for as little as half the amount per person that we pay in the US for care that is full of gaps even for the insured.  While it’s not estimated that we will save that much under the plan recently introduced in Congress by Bernie Sanders, his proposal for an improved system of Medicare for All would provide comprehensive care to every American at less cost than the current system.

Such as system would have built-in cost controls lacking in the Affordable Care Act. Without such constraints, the system will ultimately become unsustainable due to the familiar “death spiral” of medical insurance:  As costs rise, fewer can afford it, leading to premium increases to maintain profits, which leads to fewer being able to afford it, thus causing a new cycle of price increases. Ultimately, most of us will not be able to afford insurance without the subsidies offered under Obamacare. These subsidies amount to a bailout of Wall Street investors in the insurance industry for the sole purpose of maintaining their profits. They add nothing of value to the system to justify their siphoning 30 cents out of every health care dollar, when Medicare overhead is less than a tenth of that.

When you understand the economics of universal health care, it is hard to argue that we cannot afford it. The question then becomes, do we really want to pay more for less care for ourselves and our loved ones, just to deny it to those we think may not be worthy?



This article first appeared in the News-Review (Roseburg, OR) on November 17, 2017.