Posts Tagged ‘healthcare’

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The election of Donald Trump was a nightmare. But we already need to be thinking beyond his administration, imagining another way forward.

The problem is, the past is not so easily overcome. That’s particularly true when it comes to the damage Hillary Clinton’s primary campaign inflicted—in a ruthless, no-holds-barred attempt to defeat Bernie Sanders—on the idea of single-payer healthcare.

I was taken in, too.

Back in February, I criticized the mainstream liberal attacks on Sanders—with their over-the-top language (of “puppies, rainbows, and unicorns”) and their use of the ultimate threat (that choosing Clinton’s opponent would serve to elect Trump). But I did note one exception, the “careful, critical” study of Sanders’s Medicare for All healthcare plan by Kenneth Thorpe.

I thought it strange at the time, that Thorpe, who had lent his support to single-payer programs on the federal and state levels, was so critical of the plan Sanders’s campaign had come up with. But he was the sympathetic “expert” and, I said to myself, perhaps the numbers Sanders was touting didn’t in fact add up.

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Well, as Michael Corcoran [ht: db] explains, based on leaked emails, Thorpe turns out to have been a political mercenary, one more soldier in the liberal battle against Sanders.

In an email dated January 19, 2016, members of the Clinton campaign, along with some outside advisors, were discussing the effectiveness of attacking Sanders on single-payer. Jake Sullivan, a policy advisor for Clinton, wrote: “The idea would be to get someone (Ken Thorpe?) to join Brian Fallon to make the following points … [it hurts many] poor people on Medicaid right now … working seniors … [and] many young people under 26.”

Just eight days later, Thorpe published “An Analysis of Senator Sanders Single Payer Plan,” which, in addition to attacking Sanders on cost, included the three primary points of emphasis the Clinton camp had suggested: the plan’s impact on “working young adults,” (or “people under 26,” to use the Clinton camp’s language), “Medicaid households” (poor people on Medicaid right now) and “Medicare beneficiaries” (seniors). A few days after that, according to another leaked email dated February 3, 2016, which included the line, “here is a round-up thus far”), the staff were monitoring responses to Thorpe’s paper in the media.

The damage was done, as liberal media outlets embraced and disseminated Thorpe’s findings.

While the Clinton-Sanders race and Clinton’s ignominious failure in the presidential campaign are now history, the fallout from the Clinton team’s attacks on the idea of universal healthcare may be with us for a very long time.*

 

*Still, we need to remember that, at least as of May, the majority (58 percent) of Americans favored the idea of replacing Obamacare with a federally funded healthcare system that provides insurance for all Americans. Since I don’t expect the new Republican administration to come up with anything better than the Affordable Care Act (and likely will do even worse), it’s still possible the idea of universal healthcare will survive the damage done by Clinton’s campaign.

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Inequality may be the “defining challenge of our time.” But you wouldn’t know so from Monday evening’s presidential debate, in which neither candidate directly addressed the issue.

But the Obama administration seems to be in full gear—with an op-ed piece by chair of the White House Council of Economic Advisers Jason Furman and an extensive report by the Council of Economic Advisers (pdf)—celebrating its own “historic achievement in reducing inequality.”*

Tax changes enacted since 2009 have boosted the share of after-tax income received by the bottom 99 percent of families by more than the tax changes of any previous Administration since at least 1960. President Obama has also overseen the largest increase in Federal investment to reduce inequality since the Great Society, largely reflecting the coverage provisions of the Affordable Care Act (ACA) and expanded tax credits for working families.

And the results? Together, the changes in tax policy and the ACA provisions will increase the share of after-tax income received by the bottom quintile in 2017 by less than one percentage point and reduce the share received by the top 1 percent by all of 1.2 percentage points.

That’s something, it is true, but it does not reverse the spectacular growth in inequality the United States has witnessed in recent decades (when the share of income captured by the top 1 percent rose from 9 percent in 1971 to 22 percent in 2015), and it doesn’t even touch the even-more-dramatic inequality in the distribution of wealth (such that in 2013, the last year for which data are available, families in the top 10 percent of the wealth distribution held 76 percent of all family wealth, families in the 51st to the 90th percentiles held 23 percent, and those in the bottom half of the distribution held no more than 1 percent).

So, what’s the problem? We already know, thanks to a 2015 Brookings Study (pdf), that the effect of changes in top individual tax rates (including a redistribution of all new revenues to household in the bottom 20 percent of the income distribution) are “exceedingly modest.”** And, of course, changes in tax rates on income have little if any effect on the unequal distribution of wealth.

The fact that the current administration can cite its own policies as a “historic achievement” just confirms how little other administrations have done to moderate growing inequality in the United States over the course of the past three decades.

They also confirm the fact that, unless and until the United States decides to tackle the issue of wealth ownership and the resulting unequal market distribution of income— especially the ability of the tiny group at the top to capture and invest for their own sake the enormous surplus created by everyone else—it’s clear that economic inequality will remain the “defining challenge of the next generation, too.”

 

*The same issue has been taken up on the other side of the pond, about whether the last Labor government did anything to reverse “the rise of inequality seen under the previous Conservative administration.” According to the data cited by Simon Wren-Lewis, the best that can be said is Labor did not continue the previous rise in inequality, although it certainly didn’t reverse it.

**Here’s the authors’ conclusion:

In this analysis we have simulated the effects of increasing the top income tax rate under three possible reforms: (a) raise the top individual income tax rate from 39.6 to 45 percent; (2) raise the top individual income tax rate from 39.6 to 50 percent; and (3) raise the top individual income tax rate to 50 percent for income greater than $1 million for joint filers, $750,000 for single filers. We calculate the resulting change in income inequality under these scenarios assuming an explicit redistribution of all new revenue to households in the bottom 20 percent of the income distribution. The resulting effects on overall income inequality are exceedingly modest, with changes in the Gini coefficient of less than 0.01.

That such a sizable increase in the top personal income tax rate leads to a strikingly limited reduction in overall income inequality speaks to the limitations of this particular approach to addressing the broader challenge. It also reflects the fact that the high level of U.S. income inequality is characterized by a wide divergence in income between higher-income households and those at the middle and below.

 

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One of the consequences of the unhealthy healthcare system in the United States (not to mention the obscene level of inequality) is a very high maternal mortality rate—higher than in all other OECD countries except Mexico.

According to the authors of a new study published in Obstetrics & Gynecology (pdf),

Despite the United Nations Millennium Development Goal for a 75% reduction in maternal mortality from 1990 to 2015, the reported (unadjusted) U.S. maternal mortality rate more than doubled from 2000 to 2014. As we have shown, most of the reported increase in maternal mortality rates from 2000 to 2014 was the result of improved ascertainment of maternal deaths. However, combined data for 48 states and the District of Columbia showed an increase in the estimated maternal mortality rate from 18.8 in 2000 to 23.8 in 2014, a 26.6% increase. Notably, the smaller increase seen in the adjusted data appears to be a result of earlier estimates of the U.S. national rate being substantially underreported. Clearly at a time when the World Health Organization reports that 157 of 183 countries studied had decreases in maternal mortality between 2000 and 2013, the U.S. maternal mortality rate is moving in the wrong direction. Among 31 Organization for Economic Cooperation and Development countries reporting maternal mortality data, the United States would rank 30th, ahead of only Mexico. . .

the maternal mortality rate for 48 states and Washington, DC, from 2000 to 2014 was higher than previously reported, is increasing, and places the United States far behind other industrialized nations. There is a need to redouble efforts to prevent maternal deaths and improve maternity care for the 4 million U.S. women giving birth each year.

The U.S. maternal mortality rate is clearly moving in the wrong direction—and it will continue to do so unless and until Americans do something to transform the healthcare system and solve the problem of inequality.

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There are, of course, many aspects of the U.S. healthcare system I have not had the opportunity to discuss over the course of this series on Unhealthy Healthcare. I am thinking of the growth of new, profitable medical centers (e.g., for out-patient surgery), plus biotechnology companies, diagnostic clinics, rehabilitation centers, and nursing homes. There are also all the nurses, orderlies, bookkeepers, and administrative staff, primary-care physicians and therapists in rehabilitation services, the hospital volunteers and the underpaid staff who provide care in nursing homes, the dedicated people who set up clinics for underserved populations, and many others who are forced to work under increasingly difficult conditions to provide decent healthcare to the American people.

But no matter how hard those healthcare workers labor, the current system of U.S healthcare is a failure. It provides less healthcare at a higher cost than in other rich countries. And it continues to leave large numbers of Americans, especially workers and the poor, without access to affordable, high-quality healthcare.

The U.S. healthcare system, as it is currently configured, only really works for those who make a profit—selling health insurance, pharmaceuticals, and in-patient and acute-care services in hospitals—and those who have the wherewithal to finance their own healthcare.

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As it turns out, the majority of Americans know this. According to the latest Gallup poll, 54 percent of respondents have a somewhat or very negative view of the healthcare industry. And 60 percent have only some, very little, and no confidence in the current medical system. On top of that, 82 percent worry (either a great deal or a fair amount) about the availability and affordability of healthcare in the United States.

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In fact, the majority of Americans (58 percent) say they would like to see the 2010 health care law, the Affordable Care Act, replaced with care for all—along the lines presented most recently by presidential candidate Bernie Sanders.

Obviously, workers and poor people in the United States need and want a healthier healthcare system. The question then is, what would should a system look like?

Here I’ll admit, I don’t have a detailed plan of what the U.S. healthcare system should be or how exactly it should be transformed. There are plenty of such plans out there (the best known of which is probably the single-payer program developed back in 1989 by the Physicians for a National Health Program). And I’m not about to develop and present a new one.

Instead, I am guided by a lesson I learned from an old friend (a veteran of more than three decades of working in the trade-union movement): formulate and win people over to the general goal and, once they’re committed to it, let policymakers and stakeholders negotiate and work out the details to reach that goal.

In this case, the goal is universal, affordable, high-quality healthcare.

Such a system would provide high-quality healthcare (physical and mental, encompassing prevention, acute-care, substance-abuse, rehabilitation, and late-life) to all Americans (without exception, especially those who at the middle and bottom of the economic ladder) at an affordable price (since, as I see it, Americans are willing to pay for decent healthcare but it should be according to their ability to pay, which it currently is not).

That’s it. We shouldn’t care how they provide it. Just that they do so.* And if the key components of the current healthcare system stand in the way, because they’re making profits on how the system is currently organized and don’t want to see real change, they should be bypassed or nationalized (as the case requires). Then, the other private and public entities, the ones actually committed to the goal, can get on with the task of imagining and implementing the universal, affordable, high-quality healthcare system Americans deserve.

 

*Although, to my view, a healthier healthcare system right now probably involves some combination of single-payer (federal and state) financing and a network of non-profit, community, and cooperative healthcare providers.

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Last Wednesday, as part of my Unhealthy Healthcare series, I showed that the recent slowdown in U.S. healthcare costs has been invisible to American workers, because they have been forced to pay much higher premiums and deductibles in order to obtain access to healthcare for themselves and their families.

That conclusion has been confirmed by a recent Wall Street Journal article about the fact that workers are increasingly feeling the pain of paying for their healthcare.

Middle-class households are finding more of their health-care costs are coming out of their own pockets.

David Cutler, a Harvard health-care economist, said this may be “a story of three Americas.” One group, the rich, can afford health care easily. The poor can access public assistance. But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue,” he said.

A June Brookings Institution study found middle-income households now devote the largest share of their spending to health care, 8.9%, a rise of more than three percentage points from 1984 to 2014.

By 2014, middle-income households’ health-care spending was 25% higher than what they were spending before the recession that began in 2007, even as spending fell for other “basic needs” such as food, housing, clothing and transportation, according to an analysis for The Wall Street Journal by Brookings senior fellow Diane Schanzenbach. These households cut back sharply on more discretionary categories like dining out and clothing.

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While middle-income households are spending 25 percent more on health care, their real incomes actually fell 6.5 percent between 2007 and 2014, from $57,357 to $53,657.

Clearly, American workers are increasingly being squeezed by their employers at both ends—while they’re at work (since they’re working less and less time for themselves and more for their employers) and while they’re away from work (since they’ve been forced to assume a larger and larger share of the costs of their healthcare)