Tag Archives: health care

Solving Two Problems At Once

Thom Hartmann from Independent Media has written a column that is both provocative and persuasive.

If he’s right, it would also explain what I found inexplicable on Thanksgiving–why the GOP is so dead-set against a national system that would expand access to healthcare to all Americans.

Now we know why the GOP is truly terrified of Medicare for All; it will wipe out the Republican Party’s control of the House, Senate, White House, and most state governments. Because it could make it very easy for every citizen over 18 to vote.

Here’s how it works.

In Canada, every citizen has a Canadian government-issued “Health Insurance Card” … It’s largely only available to citizens, as all citizens are eligible for the Canadian Medicare system; everybody else has to work out other insurance options (yes, there are insurance companies in Canada). And in most provinces, the card has your photo and works as an ID card as well as a driver’s license or passport.

In Canada, that health insurance card is also a voter ID card.

As a Canadian explained to Hartmann, the health insurance card is unlike other government issued identifications, such as driver’s licenses, because virtually all Canadian citizens from all socioeconomic backgrounds have them. They can be used as photo IDs for flying domestically, buying alcohol and more importantly voting!

Among other voter suppression tactics, the GOP has spent the last decade fighting a virtually non-existent “voter fraud.” The party has used this largely fabricated concern to pass voter ID laws that make it hard for people who don’t drive –due to old age, lack of ability to afford a car, or in some cities (not mine), convenient public transportation–to cast a vote.

In 2016, Donald Trump won Pennsylvania, Michigan and Wisconsin by razor-thin margins far smaller than the number of voters purged and/or turned away at the polls.

The Brennan Center documentsa 33 percent increase in voters purged during the 2014-1016 election cycle (16 million), compared with the 2006-2008 cycle (12 million purged), as the GOP has made ID and purges (along with fear mongering about brown-skinned people) their main electoral strategy. In just the past year, as many as an additional 14 million votershave been purged from rolls nationwide, while over the past two decades every Republican-controlled state has introduced rigid ID laws.

But with a national ID system in place that’s universally used because it’s the key to getting your health care and medications, there’s no need for “voter registration” and thus no ability for the GOP to purge voters. Voter registration, after all, is a practice we largely got after the Civil War because Southern white politicians warned of “voter fraud” being committed by recently freed black people, and some Northern states used it to prevent poor whites from voting.

In some places in the United States, voter registration just never caught on: North Dakota never bothered to put such a system into place; you just show up at the polls with ID to prove you’re both a citizen and resident, and vote. And with a national Medicare for All ID, every citizen could easily vote, everywhere.

Hartmann insists that the GOP’s adamant  opposition to universal coverage is partly based upon the party’s realization that the universal ID such coverage would require would allow everyone to vote.

True or not, it’s hard to argue with Hartmann when he says that Medicare for All would allow America to join the rest of the developed world, by having both a national health care system and a functioning democracy.

 

This May Explain Some Things….

Not that the explanation is reassuring. Quite the contrary.

Vox recently ran an article about the healthcare perks that members of Congress enjoy while they are working hard to deny poor Americans access to basic health insurance. Here’s the WTF section of that article:

Mike Kim, the reserved pharmacist-turned-owner of the pharmacy, said he has gotten used to knowing the most sensitive details about some of the most famous people in Washington.

“At first it’s cool, and then you realize, I’m filling some drugs that are for some pretty serious health problems as well. And these are the people that are running the country,” Kim said, listing treatments for conditions like diabetes and Alzheimer’s.

“It makes you kind of sit back and say, ‘Wow, they’re making the highest laws of the land and they might not even remember what happened yesterday.’”

The article noted that the current Congress is the oldest in our history. It appears that more than half of the senators who plan to run for reelection in 2018 are over 65. (Dianne Feinstein just announced that she plans to run for another 6 year term; she will be 85 at election time.) The average age in the House of Representatives is a (comparatively) youthful 57, and the average age in the Senate is 61.

We all age at different rates, and thanks to breakthroughs in medicine and nutrition there are growing numbers of people nearing 100 who remain mentally and physically sharp. It is also true that most of us begin to figure life out as we grow older–there is some validity to the adage that wisdom comes with age. So I would oppose a blanket rule requiring lawmakers to retire at an arbitrary age certain.

That said (since today is my own birthday, and at 76 I am by no means a “spring chicken”), I can personally attest to the indignities the years bring. Memory and recall play tricks on the aging mind; the accelerating rate of technological change is especially disorienting to those of us who grew up with typewriters and rotary phones affixed to walls. Cultural changes embraced by our children and grandchildren can be difficult for us old folks to assimilate and accept.

And all of that is what aging does to healthy seniors, those of us who have retained substantial amounts of our physical vigor and intellectual capacities.

One positive consequence of the 2016 election–assuming we live through the disaster that is Donald Trump–is a new appreciation of the importance of a President’s mental health. It is likely–again, if we survive this–that along with a mandatory disclosure of taxes, a clean bill of physical and mental health will become legal requirements of presidential candidacies.

We need to seriously consider imposing a similar requirement on candidacies for the House and Senate. It’s bad enough that we have only cursory background checks for gun purchases; surely, voters are entitled to similarly cursory physical and psychological checks on people seeking positions where they can do considerably more harm than a deranged shooter.

We may not be able to disqualify the wackos like Roy Moore, but surely we can make Alzheimers a disqualification for public office.

About That Partisan Divide

Over at Talking Points Memo, Josh Marshall makes a point I have often made: partisanship today is different than it used to be, not just in intensity, but in kind.

Marshall’s essay was focused on what he sees as inadequacies in media coverage of the GOP’s “health care” bill, but in the course of that discussion, he made the following observation.

.. coverage of national health care policy is fundamentally distorted by the imperatives of false balance or forced balance coverage. The idea here is that the two parties are so set in their ideological corners that they can’t constructively come together and find points of compromise to address issues of great public concern. But this sentiment only makes sense if you think both parties are trying to accomplish something approaching the same thing, albeit perhaps with very different strategies. That is simply not true….

We talk a lot about how Republicans real focus is getting the ACA money for a big tax cut, which is unquestionably true. You can only get the tax cut if you get back the money that went toward getting people covered. But at a deeper level this is a philosophical dispute, a basic difference in goals. It’s a difference in desired outcomes, not an ideological dispute over the best way to achieve them. (Emphasis mine.)

Perhaps my memory is faulty, but back when I was a Republican, fiscal conservatism meant crafting more cost-effective policies to achieve goals we held in common with Democrats–policies that would help poor people, for example. We favored programs that would help those who needed that help without inadvertently distorting markets in ways that deepened the original problem.

An example would be rent control. The shared goal was affordable housing for low-income renters; opposition to rent control as a means of accomplishing that was based upon the belief that rent control would deter investment in additional, desperately needed units. You could agree or disagree with that analysis (I agreed), but the opposition wasn’t based on a belief that government shouldn’t help low-income people find decent housing.

We were arguing means, not ends.

Today’s Republicans and Democrats do not share a belief in the nature of the common good. Democrats believe that government has a responsibility to ensure access to healthcare. Republicans don’t. As Marshall says,

When you try three times to ‘repeal and replace’ and each time you come up with something that takes away coverage from almost everyone who got it under Obamacare, that’s not an accident or a goof. That is what you’re trying to do. ‘Repeal and replace’ was a slogan that made up for simple ‘repeal’ not being acceptable to a lot of people. But in reality, it’s still repeal. Claw back the taxes, claw back the coverage.

Pretending that both parties just have very different approaches to solving a commonly agreed upon problem is really just a lie. It’s not true. One side is looking for ways to increase the number of people who have real health insurance and thus reasonable access to health care and the other is trying to get the government out of the health care provision business with the inevitable result that the opposite will be the case.

That difference cannot be bridged with pious calls for “bipartisanship.”

We Aren’t Number One…Not Even Close

Donald Trump is accelerating America’s retreat from the world stage, illuminating our national flaws and demonstrating the contradictions between our aspirations and our performance.

Let’s be honest: a nation that could elect this ignorant, unstable man is a nation seriously in decline. If we are really prepared to be honest, we will also concede that America’s social and racial divisions, extremes of inequality and lack of anything approaching an adequate social safety-net aren’t exactly attributes that confer bragging rights, either.

A prime example is our overpriced and underperforming health care system, which our Congressional overlords are eager to make even worse. How long can intellectually dishonest pundits and politicians keep a straight face while peddling the myth that American medical care is “the best in the world”–that “we’re number one”?

The truth is that, if you are very wealthy or have exceptionally good insurance, you can get extremely good care for serious illnesses in the United States. If you don’t fall into one of those categories, not so much. And if you are an average American with a treatable ailment–or an ailment that should be treatable– your prospects are even worse.

Over at Dispatches from the Culture Wars, Ed Brayton reports on yet another in a long line of studies ranking national healthcare systems.

A new study that looks at the effects of highly treatable diseases, ones for which greater access to continual medical care can mean the difference between life and death, finds that the American health care system lags behind much of the developed world.

There are a number of ways to evaluate healthcare systems, but if you are measuring outcomes over a country’s population, rather than touting cutting-edge therapies available only to the privileged few, the U.S. has long lagged other industrialized countries.

Christopher Murray, a researcher at the University of Washington, and his collaborators looked at 32 causes of death in 195 countries from 1990 to 2015 to create a health-care quality index they used for rankings. Murray described the findings as “disturbing.”

“Having a strong economy does not guarantee good health care,” he said. “Having great medical technology doesn’t, either. We know this because people are not getting the care that should be expected for diseases with established treatments.”…

As might be expected, many highly developed nations, such as Norway, Australia and Canada, scored well. Those in more-remote areas in sub-Saharan Africa, South Asia, Latin America and the Caribbean scored poorly…

The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death. These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease and the adverse effects of medical treatment itself.

The United States spends enormously more for medical care than any other country–twice as much per capita has the next most expensive system. We just spend our dollars in the least efficient ways possible: multiple non-standard insurance forms, laws that prohibit government agencies from negotiating drug prices, and private insurers whose high overhead costs include everything from marketing to sky-high management salaries and corporate jets. (Medicare’s overhead runs about 3% in contrast to 24-26% for private insurance companies.)

Obamacare is far from perfect (what we really need is “Medicare for All”), but its passage did represent a move in the right direction–and an acknowledgement that access to healthcare is a human right, not a consumer good to be made available only to those with sufficient disposable income. But rather than working to improve it with “fixes” that are fairly simple and obvious, the White House and  the Congressional GOP consistently sabotage it, most recently by threatening to end crucial Affordable Care Act payments to insurers. Politico has reported on the move, and the fact that it would guarantee huge premium increases, the withdrawal of insurers from the O-Care markets, and generally cause chaos across the individual health insurance marketplace.

It’s enough to make you think American policymakers put a higher priority on the bottom lines of Big Pharma and Big Insurance than they do on the health of average citizens.

But then, what do we expect when we elect people so corrupt and self-serving they don’t even care about the health of the planet their children and grandchildren will inherit?

Taxes and the Common Good

I know “real Amuricans” sneer at the notion that we might learn from the experiences of other countries. Universal healthcare? A commie plot! Decent mass transit? People who can’t afford–or don’t want– cars shouldn’t be coddled! A comprehensive social safety net? You are a commie!

Every so often, however, a “real American” finds living in a country that actually offers these and other subversive services is pretty attractive. Vox recently published an essay by one such person, whose job and that of his wife requires that they split their time between Wisconsin and “high tax” Sweden.

My wife and I have been dividing our time between jobs in Sweden and Wisconsin for the past dozen years, and I’m here to tell you that taxes in Sweden are not that high. To my surprise, I found that there are lots of things to love about the Swedish tax system. Swedish taxes are easy to pay, rational, and efficient. Best of all, rather than take away opportunities, Swedish taxes expand them.

The writer goes on to list things he loves about Swedish taxes. No kidding.

It turns out the average Swede pays less than 27 percent of his or her income in direct taxes. As I’ve written elsewhere, my wife and I pay about 22 percent of our US income in taxes. Our Swedish income tax was 31 percent. So, yes, our income taxes in Sweden were higher than in the US, but we still paid less than one-third in tax.

And you get far more for your taxes than you do in the US. In Sweden, college is free and students get a housing stipend. A colleague’s daughter, Kerstin, just completed a five-year dental program. Her family paid nothing for her education.

In Sweden, tax forms are simple, and they come already filled out. The author points out that tax-preparation services cost American taxpayers more than $32 billion per year–not to mention hours of citizens’ time and effort.

And in Sweden, there are no property taxes.

When the conservative government, favoring lower taxes, came to power in Sweden in 2006 one of its first steps was abolish the property tax and replace it with a fixed fee. The real estate fee for services is 7,112 SEK per house ($825 at current exchange rates).

This is the same for everyone no matter what the assessed value of the dwelling. The fee is $12 a month for our co-op apartment in Stockholm. If we owned the same property in Madison, our taxes would be $18,000 a year.

There are sales taxes in Sweden, and they’re high, but even then the author finds mitigating factors:

Sales taxes are high in Sweden, but you don’t see them, and that makes them easier to pay. If something costs 100 kronor, you pay the 100 kronor! Only when you look at the receipt do you see that it costs 80 kronor and 20 kronor for VAT (value-added tax). Many things are taxed at lower rates — 12 percent to have dinner out or buy groceries, 6 percent (only half a percent higher than our sales tax in Madison) for books and tickets to cultural events and in-country travel. Health related items: zero percent.

It is true that sales taxes are regressive; poor people pay a higher proportion of their income in this tax. In the US, a 25 percent sales tax would have to be offset with some kind of subsidies for our many poor. But because Sweden has a narrower income distribution, its sales tax is less regressive than in the US.

A fascinating difference between the U.S. and Sweden is that, in Sweden, if the government wants to encourage an activity, they don’t do it through the tax code.

One of the reasons US income tax preparation is so awful is that we try to reward certain activities by providing a tax deduction. If you do some good deed (like putting in a solar panel) and if you can find the receipt and documentation…, then you can list a number on Form H, line 36, that will lower your taxes.

Does this feel good? Do you feel rewarded for your solar panel?  Or is it just another damn number on a tax form?

If the Swedish government wants you to do something, they give you the money. For example: Having children is good for the society and costs parents money. In the US, you get a deduction on your income tax for dependents. In Sweden, you get a check every month and you can use it to buy shoes. For one child you get $120 a month and up to $620 for four children. Every parent gets a check.

The most persuasive argument for Sweden’s approach (at least, from my perspective) is that the taxes generate income used to provide collective goods that make life better and less costly for citizens.

Not having to pay for college gives the best and the brightest the opportunity to attend any school they choose — equalizing opportunity on merit, not parents’ wealth.

It’s not just college. Public amenities like parks and hiking trails, excellent and frequent public transportation, and–oh yes– universal health care.

Paradoxically it turns out the bloated, heavily lobbied, privatized US system spends more tax money ($4,437) per person than Sweden’s socialized health care ($3,184).

This is due to Swedish efficiency rather than poor service. I do get to choose my doctor, have high-quality care a short walk from my home, same-day appointments and short waits when I walk in unannounced.

Keep chanting “We’re number one! We’re number one.” Maybe we’ll convince someone besides ourselves..