Tag Archives: health care

Birth Control And Health Care

If the pandemic has taught Americans anything, it is just how inadequate–and let’s be honest, discriminatory and stupid–our healthcare system is. (Actually, every time I write “healthcare system” I am reminded of the student who was studying to be a hospital administrator, who told me the phrase was inaccurate–“We don’t have a healthcare system. We have a healthcare industry.”)

A few days ago, the Supreme Court handed down an indefensible decision that denied women healthcare if they are unlucky enough to have an employer who has “religious qualms” about allowing their health insurance to include birth control.  Gail Collins provided a perfect analogy:

Let’s pretend there was an order of nuns with a particular devotion to the Sacred Heart of Jesus. So much so that the order had, over the years, decided that any human heart was a holy symbol, and it was immoral to mess with it, even if you were a physician doing cardiac surgery.

Following their consciences, these nuns banned heart-related care from their employees’ health policies. That affected thousands of workers, many of whom did not share their religious convictions. Still, the nuns noted, their insurance coverage was generous. Except for that one thing.

The Court affirmed the right of employers to omit birth control coverage from their group health policies. But that “right” is misleading.  The Obama administration had arranged for the federal government to intervene when religious employers had ethical objections. All the employer had to do was file a form, and they’d be off the hook; the government and the health insurance companies would provide the coverage. The employer wouldn’t need to spend a penny on a sinful women’s health measure.

But that wasn’t good enough. Filing a form would make them complicit. Trump, of course, pandered to the “religious” employers who placed their purported moral purity above the actual health and well-being of their female employees, and the Court acquiesced.

An  estimated 70,000 to 126,000 women will lose their current free contraceptive coverage–and contraception isn’t cheap. As the Times Editorial Board wrote, 

It bears reminding that the cost of birth control can be significant, and that many women rely on it not just to prevent pregnancy but to treat medical issues. Sometimes, the contraceptive method that works best — or the only one a person can tolerate — costs many hundreds of dollars without insurance coverage.

As the Editorial Board also noted,

It’s hard to imagine the conservative justices of this court, especially, allowing employers to claim a moral exemption and require their employees to pay out of pocket for, say, a treatment for Covid-19. That sounds absurd. And yet, when it comes to birth control, such state interference with personal health decisions is considered a legitimate matter for public debate.

The health care industry in this country is the real “American Exceptionalism.”

America could solve conflicts like this one–not to mention racial and economic inequities in access to health care–by emulating other advanced, civilized nations and moving to a single-payer system of health insurance. Not only would such a move eliminate the ability of some Americans to impose their religious convictions on others, not only would it ameliorate a number of racial and economic inequities, not only would it vastly reduce personal stress and the country’s high rate of personal bankruptcies, it would introduce cost-controls to a system that costs far more and delivers far poorer results than others.

How much of our stubborn refusal to provide universal health insurance is due to inertia, to misunderstanding of how markets work or don’t, or a false belief in American superiority–and how much of it is due to a shameful reluctance to extend the social safety net to “others”–minorities and women?

What Really Matters?

Assuming the accuracy of recent polling, even people who don’t follow politics or the news with the sort of intensity characteristic of people who comment on this blog have come to recognize that President Trump is insane.

The crazy tweets, the babbling, “word salad” responses to even soft-ball questions from Faux News, the cringe-worthy, extended defense of his wobbly descent down the ramp at West Point, and most astonishing (at least to me) his apparent belief that if we just don’t test people, the Coronavirus will magically go away–are finally taking their toll.

My own response to what I see right now might properly be labeled bipolar: on the one hand, I am terrified of Democratic complacency. This pathetic ignoramus won once–it could happen again. There is still a hard core of voters who respond to his racism and share his overwhelming sense of grievance. On the other hand, polling–both state and national–reflects widespread disapproval; credible media outlets have taken to calling lies, lies (not just “assertions for which there is no evidence”) and previously reliable Republican constituencies are forming pro-Biden PACs. (The Lincoln Group–the first such effort–is producing and airing some of the most devastating–and accurate–political ads.)

So… my thoughts have turned to the massive clean-up job that will await the Democrats if–as I devoutly hope–November delivers both the White House and the Senate.

That cleanup is by no means assured. Universal detestation of Trump has unified a party that is famous for its lack of unity. (Who was it who said “I don’t belong to any organized political party; I’m a Democrat”?) With victory will come the inevitable fractures between the moderates, progressives and leftwing factions of the party.

In the House, I have some confidence that Nancy Pelosi can avoid truly dangerous schisms; the Senate will be dicier, and if Moscow Mitch is re-elected, he can still do enormous damage as Minority Leader.

It’s all very uncertain, and that uncertainty is made worse by the fact that there is considerable ambiguity about what optimum “repairs”–both structural and policy– should look like. Some examples:

  • The federal courts. It’s not just the Supreme Court.  McConnell has managed to put 200 rightwing ideologues on the federal bench, a number of whom have been rated “unqualified” by the ABA. There are a number of proposed “fixes”–from expanding the number of judges to pursuing impeachment against those who engage in the most egregious misconduct. Whatever course of action is taken, returning the courts to the status of impartial arbiters should be a priority.
  • Other structural issues that cry out for attention sooner than later include gerrymandering, the filibuster, money in politics and the Electoral College. (Whether the Electoral College can ever be fixed–either by the Popular Vote Compact or Constitutional Amendment is a “known unknown.”)
  • Repairing the incredible amount of damage done by Trump’s Mafiosa-like cabinet–especially the savage assault on environmental protections by the procession of fossil fuel lobbyists who’ve run the EPA, and Betsy DeVos’ fundamentalist attacks on the very concept of public education–also requires immediate attention.
  • Repairing America’s reputation abroad–restoring our relationships with allies, signaling that yes, America had a psychotic break, but we’re recovering–is critical. We need to rejoin the alliances Trump discarded, reaffirm our commitment to NATO, etc.,etc. Fortunately, foreign policy has been Biden’s strong suit.
  • Attacking our appalling economic inequality by raising both taxes on the rich and the minimum wage.
  • On the policy front, it is long past time for comprehensive immigration reform–not just the immediate cessation of horrendous ICE practices under Trump, but a sweeping revision of immigration policy that discards the racism that has characterized it.
  • It is equally past time to ensure that all Americans have access to healthcare, whether that is via a public option or single payer. (And maybe we should reconstitute that pandemic task force.)
  • Then there’s our crumbling infrastructure. And the elimination of billions of dollars in subsidies for fossil fuel interests. And a long, hard look at farm subsidies (and who’s getting them.) And in the (highly unlikely) world of my dreams, beginning to dismantle and “defund” the military-industrial complex Eisenhower warned us about.

I bet you all can add to this daunting list…..

Unlike culture-war quarrels about who’s using what restroom, or whether women should be able to control their own reproduction, these are the issues that really matter.

These are the issues that define–or defy–assertions of American “greatness.”

 

 

Rich Guys For Higher Taxes, Businesses For Single-Payer

Are more zillionaires joining “renegade” rich guys like Nick Hanauer and Warren Buffett and recognizing the dangers posed by the current gap between the rich and the rest?

A recent article from the Guardian was titled “Patriotic millionaires want to pay more taxes.” Those millionaires didn’t mince words.

If you believe the prevailing philosophy of US conservative ideology, the handful of individuals in the 1% are entitled to every bit of their wealth and power because they deployed their capital wisely.

As businessmen in the 1%, living in a conservative state, we confront this philosophy every day, and frankly, we’re sick of it.

The Republican party’s embrace of the “I’ve-done-it-all-on-my-own” mentality is extraordinarily delusional, harmful, and counterproductive. Collective goods – like a sound infrastructure system, a strong K-12 and higher education systems, and rule of law – are critical ingredients to building both individual and societal economic prosperity.

The article’s authors have joined the Patriotic Millionaires, a group of wealthy Americans “from all walks of life across deep red, deep blue and purple states” who realize that the system that enabled their success, that created opportunity, is fundamentally broken. And they aren’t shy about placing the blame: they write that the system has been ” hijacked by the ultra-wealthy.”

But a substantive and sincere commitment to an evolved form of capitalism requires a few things. It requires us to confront the reality of the climate crisis as the existential threat of our time; and to acknowledge that we are a country founded on the toxic prejudice of white supremacy, which continues to unjustly shape the future of millions of Americans before they’re even born. We must separate money from politics, so that the influence of special interests doesn’t overpower the voices of voters; and shift our financial goals from short-term profits to long-term sustainability.

And it requires economically advantaged folks like us to not only pay our fair share, but also unequivocally commit to and support the policies that will achieve that reality – and to get all of our similarly situated friends and associates to do the same.

It isn’t just the ultra-rich who are (belatedly) recognizing the need for change. Another new group is Businesses for Single Payer.

Activist Wendell Potter has become president of Business for Medicare for All, the only national business organization working for single payer health insurance. This group of the economically pragmatic lends expertise and credibility to the cause of reform at a time when many, including some of those running for the Democratic presidential nomination, question the viability of single payer.

Potter spent twenty years in the health insurance industry, and left to become an outspoken critic of what he calls a broken, dysfunctional and unfair healthcare system. He points to surveys showing that people on Medicare are far more satisfied than people with private insurance, and says one reason is that  private insurance has changed significantly over the years. Premiums have gone up while insurance companies have devised clever strategies to avoid paying for care.

In the linked article, Potter enumerates the reasons single-payer systems are superior to our patchwork approach. Most of us could recite those reasons in our sleep, but until now, the business sector has been noticeably absent from both the conversation and the criticism. Why the change?

About three years ago, I was approached by a business leader in the Lehigh Valley of Pennsylvania, Richard Master, who decided to make a documentary on the US healthcare system….

But he began to pay a lot of attention to healthcare costs. He’s got an MBA from Wharton and a law degree from Columbia so this guy’s really smart, has built a very successful business, but he was questioning the sanity of a system in which he has no control over his healthcare costs from year to year….

 I knew what individuals and families were facing, but I hadn’t paid a lot of attention to what is happening to employers who are trying to stay in the game in our uniquely American, employer-based healthcare system. It’s abundantly clear that the system has run its course and is just not working for increasingly large numbers of employers.

Potter quotes Warren Buffett’s observation that “healthcare is the tapeworm that is destroying American competitiveness,” and goes on to say that more and more businesses are recognizing the need to change.

We’ve got several hundred employers who are part of our organization. Our goal is to have at least one business from every congressional district by this time next year. We’re growing pretty rapidly and we already have a voice in Washington.

Money talks, for good or ill. If people with money support higher tax rates and a more robust social safety net, Congress might actually listen.

 

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.