A Single Healthcare Choice, Colltalers
The defeat of the Trump-proposed repeal of the Affordable Care Act, last month, was justly celebrated by a majority of Americans. That includes the president’s supporters, who were covered by it, even if unaware Obamacare – a term most despised – was its other name.
But if partying about it may premature – the GOP will certainly come back for more and, after all, this is just one of a couple of wins so far against the regime’s authoritarian streak, along with the ban to the immigrants ban – there’s something to be built upon the momentum.
When Senator Bernie Sanders introduces his Medicare for All bill later this month in Congress, a full turnaround in the way accessible health insurance is perceived may be completed. The issue may be finally wrestled away from its main detractors, big healthcare companies and the politicians they sponsor, who helped sowed unfounded fears about it, and into the embrace of those it’ll benefit the most, the public.
Such was the fallout from the defeat of the so-called Obamacare ‘replacement,’ that it actually led to a positive outcome: more people now understand that it’s a government constitutional role not just to protect its citizens’ health and well being, but also step in on their behalf against for-profit corporate interests. That is, even before moral considerations and the bottom line for such an intervention: to lower costs.
For most estimates of how much nearly-free health care for every taxpayer would cost, come to the same conclusion: according to Physicians for a Health Care Program, just the $400 billion the industry spends in billing, sales and marketing, mostly to deny coverage, or 31% of its total budget, would be enough to fund much of a single-payer system. PHCP, a trade group, is but one of many non-partisan organizations engaged on this issue.
But let’s understand a bit of each of these systems, and why extending Medicare/Medicaid to everyone is the most rational way of making sure the richest country in the world is no longer one of its sickest too. For they’re all complex but not that complicated.
Take Obamacare, the ex-president’s signature issue Republicans spent eight years, and millions of dollars, trying to prevent,
undermine, and ultimately, laden it with industry concessions that hindered its efficacy. It’s funded by two main sources: on everybody’s contribution to it, which creates a Social Security-like foundation, and on higher taxes from the minority that earns several times the income of the lower half.
Without getting too deep into figures, the first thing that cut short its success was giving states the option of not receiving federal funds to subsidize those who couldn’t afford insurance. GOP governors refused the funds, and as a result, claimed their states couldn’t afford it either.
That diminished the pool of contributors, already smaller than needed, because the clause forcing healthy people to sign up for coverage was not being enforced in those states. Then, predictably, insurers began to withdraw from the system, alleging lack of profitable margins.
The other punch designed to knock Obamacare out has just been enforced by the Trump administration: the rollout of tax cuts to the wealthy, which effectively has the potential to defund the plan. Still, despite those efforts, two factors are startling about the law of the land even now.
One: it does provide coverage to 20 million, possibly more, Americans who had no way of being covered before. Another: despite crying foul by the industry during the Obama years, shares of the six biggest managed care companies beat their Standard & Poor’s index. Their stocks gained nearly 300 percent in seven years, against the index’s 135.6% in the same period, according to Bespoke Investment Group.
But in order for Obamacare to pass, and being confirmed by the Supreme Court, two other better options were eviscerated on the floor of Congress: the so-called public option and the single payer, which now is better known by the name Sen. Sanders gave his bill.
The main criticism President Obama’s plan received from consumer advocates and progressives was that big insurers were left in the game, unlike for instance, the socialized Canada’s healthcare system which now, again, may serve as the blueprint for a reformed U.S. system.
But looking back in perspective, it’d have been a non starter then, what with Republicans and most Democrats openly hostile to just such a possibility. If the president hadn’t been pragmatic and pushed through what was possible then, we wouldn’t even be having this conversation now. Essential support to his plan did come from those corporations and now we all know full well why they were behind it.
A quick word about the public option, which many mistakenly think is the same as a single payer plan. While Medicare is a government agency that negotiates lower costs with medical providers, and relay them to consumers, in the public option, the government would have to build from the ground up a whole structure with hospitals and care centers, with their own bureaucratic support, to provide coverage.
Costs would probably soar, management would likely be problematic, and performance would certainly suffer. It was once a better option, at least on paper, but even then, it was riddled with opportunities for sabotage and ultimate failure. By now, we’d be back to ground zero.
Now, how to sell to a corporation-controlled Congress that an entire industry needs to go, specially one generating billions in profits, fat returns to investors and stockholders (hum, one wonders who are these people), and handsome compensation packages to chief executives?
Well, assuming Democrats will drop the ball on this one too, that’s exactly why the current momentum, and renewed public support, are so important. It may take considerable artistry, though, to make consumers aware of the industry’s size and scope, without putting them all to sleep. For its numbers are indeed staggering, and how well they’re presented is crucial too. Does anyone have Beyoncé’s number? We may need it.
Take UnitedHealth, the biggest, and giant Aetna, for instance. Last July, the first posted a quarterly revenue of $46.5 billion, $10 billion more than the same period the previous year. In 2015, Aetna reported an annual operating revenue of over $60 billion, its biggest to date. What these numbers mean may be hairy to explain during an elevator ride. But that’s exactly what every Democrat should be practicing right now.
And a good way is to focus on the CEOs. They’re easy to single out, since they rose to the top of the reap of Wall Street, and they’re usually vain enough to take offense. That’s an opening, and a valid talking point. For example, Stephen J. Hemsley took a pay cut in 2015, but don’t get tear-eyed just yet. He made $20 million in salaries that year. Now, how many people have you had for dinner with that kind of cash?
Heard of Mark Bertolini? Neither did us, and that may be by design. In the great nation of ours, where nevertheless, 20% of the population is way below the poverty level, Aetna’s Mr. Bertolini cleared $27.9 million in 2015. Flushed with generosity with his good fortune, he vowed to donate it all to Doctors Without Borders, since like all CEOs, he doesn’t actually need to spend that money in living expenses. Just kidding.
There are three things the government should and must be in charge of, in the interest of its citizens, three areas that should be granted as a right to all, and where profit margins and short-term solutions shouldn’t even be part of the equation: defense, education, and health care.
Unfortunately, it’s been at least half a century that wars became such a profitable business, that most of them are fought not by soldiers but contractors. We’re now in throes of defining, once and for all, whether health care must remain a right or just a business opportunity. Next to be compromised or not, thanks to a president who actually owns a for-profit ‘educational’ institution, may be the right to free education.
We’ve already lost the war, pun intended or not, and chances for curbing military expansion is limited at best. Accessible healthcare and education are our generation’s fights, ones that define how we want our nation to be and treat its incredibly diverse citizenry. We need to get our stories straight and our front united. We want public education. And we want Medicare for All. Forget T.S. Eliot; April is actually nice. WC