Tag Archives: single payer

Health Policy Costs Us All

For more years than I can count, opponents of “socialized medicine” (i.e., single-payer, universal health insurance) justified that opposition by assuring us that we were “number One!” American healthcare was the best in the world, thanks to the innovation that was made possible by our refusal to extend that healthcare to everyone who needed it.

As the world got smaller, and more Americans traveled abroad, we began to realize that we really weren’t number one–that in fact, those global indices that ranked us somewhere around 37th or 39th were onto something.

More recently still, medical tourism became a thing (at least, pre-pandemic, when we weren’t shut out of healthier countries.) Americans are traveling to have procedures–and babies!–in places where the care is just as good or better, but much cheaper. 

There’s a reason so many reasonably well-educated, reasonably well-meaning middle-class Americans were so slow to recognize the gargantuan flaws in America’s patchwork approach to medical care–and for that matter, all social services. So long as we remain lucky and privileged, accessing health insurance through our employers, not getting a rare or terribly expensive disease, not having to navigate a system designed to say “not you,”  there’s simply no way we could imagine the experience of those who aren’t so lucky or privileged.

For years, I fell into that “lucky and privileged” category. But many years ago, when a diagnosis meant that my oldest son was unable to work, I encountered the Byzantine world of Social Security disability. At the time, it took two lawyers (me and my youngest son) and a friend who headed a social services agency to navigate the process.

When I asked my oldest’s then-doctor what happened to people without family lawyers and savvy friends, he said simply, “They die.” 

Just over a week ago, we got another lesson. My oldest grandson and his wife had a very premature baby. Born at just over 26 weeks, she is in the NICU, life-lined and hooked up to a tangle of machines and devices. My grandson and his wife take turns being with this much-desired little girl (and when I say “little,” she was one pound five ounces at birth, and about the size of my grandson’s hand.) The stress they are experiencing is etched on their faces.

In addition to the helplessness we feel watching this unfold, the whole family has worried about costs that their insurance won’t cover. If there is anything they don’t need,  especially right now, it’s thousands of dollars in out-of-pocket expenses. My granddaughter-in-law’s sister was so worried she set up a Go Fund Me page, something that wouldn’t be needed–or even comprehensible–in “socialized medicine” countries. (I have a son who lives in the Netherlands and an adult granddaughter who lives in England, and both sing the praises of their healthcare systems.)

We were relieved–and surprised– to learn that there are government programs that  provide at least some measure of secondary insurance in these situations. It’s just that no one in our (reasonably well-educated) family knew they existed until now. And I’d be willing to wager that, unless you are a social services or health insurance worker, those of you reading this haven’t heard of them either.

There is an important public policy lesson here–not to mention a lesson about equity.

This country spends far more than any other country in the world on medical care–twice as much per capita as the next most expensive country. (But hey–“We’re number 37!”)  That includes significant amounts on a patchwork of low-profile programs that help eligible people who manage to find out about them, and still more on the bureaucracy that serves as a “gateway” to those programs.

Think how much we could save if we replaced that haphazard patchwork of complicated and under-inclusive programs with some version of Medicare-for-All. Of course, a simple, single-payer health insurance system with a common and comprehensible “entry point” would serve all citizens, not just empowered ones–maybe that’s why we don’t have one.

There is some evidence that American voters are beginning to catch on.  In a recent column for the Washington Post, E.J. Dionne wrote:

No matter how hard they tried, Republican politicians and their allies could not stop Missouri’s voters from expanding access to Medicaid under the Affordable Care Act.
They tried to rig the timing of the referendum by forcing the vote during a relatively low-turnout primary on Tuesday rather than in November. That failed. They played on racial prejudice and nativism by falsely claiming a yes vote would mean “illegal immigrants flooding Missouri hospitals . . . while we pay for it!” That failed, too.
 
And so did Missouri this week become the sixth state since 2017 — five of them staunchly Republican — where voters took the decision on the expansion of health coverage out of the hands of recalcitrant conservative politicians.

You shouldn’t have to have a social work degree (or a friend with one) in order to access government insurance against calamity.

And Republicans should stop kidding themselves–calamities don’t just happen to “those people.”

 

 

 

 

 

California Dreaming…

Yesterday’s post, and a number of the comments that followed, acknowledged the importance of health insurance to the social safety net, and lamented the resistance of Congressional Republicans to maintenance–let alone extension– of current coverage.

Fortunately, Washington isn’t the only game in town.

With the collapse of anything remotely resembling governance coming from Washington, D.C., California has become the de facto adult in the room. Those of us appalled at Trump’s retreat from environmental protections, for example, take comfort in the fact that California, with its huge and important markets, is insisting upon fuel-efficient cars and other environmentally-sensitive measures.

In healthcare, apparently, California is also proposing to go where Congress won’t.

In the face of the GOP assault on the Affordable Care Act and Medicaid, California is preparing to vote on a statewide single-payer plan. Californians currently spend about $370 billion annually in a typical, insurance-dominated system that leaves 40 percent of the state’s  population uninsured or underinsured. The single-payer measure is working its way through the legislature, and a fiscal analysis was presented to lawmakers and the public last week by the bill’s sponsor and the California Nurses Association.

The analysis was done by a team led by Robert Pollin, the co-director of the Political Economy Research Institute at the University of Massachusetts and a former UC Riverside faculty member. At a Sacramento press conference, he explained how a single-payer system would enable all Californians to be completely covered. That includes 3.7 million currently uninsured residents and another 12 million who are underinsured, meaning they cannot afford their policy’s co-pays and deductibles.

The universal coverage would be paid for by combining all government healthcare subsidies, which accounts for about 70 percent of California’s current spending, and by two proposed tax increases: a 2.3 percent gross receipt taxes on businesses (which kicks in after the first $2 million in earnings and which exempts small businesses); and a 2.3 percent increase in the sales tax, with exemptions for necessities such as food, housing, utilities, and other services.

Those combined revenue streams would raise an estimated $400 billion annually to pay for universal coverage under a single-payer system.

Assuming the law passes, California will actually spend less than it currently does on healthcare, and the average middle-class family will see out-of-pocket costs fall by 9 percent.

Most businesses will also save money, Pollin explained, because they will no longer be paying for their employees’ health care. Even with the proposed gross receipts tax exempting the first $2 million, typical California businesses employing 10 to 19 people would see costs fall by 13.8 percent, he said. Businesses employing 20 to 99 people would see costs fall by 6.8 percent, he said. Businesses employing up to 500 would see costs fall by 5.7 percent, and the 500-plus businesses would see costs fall by 0.6 percent.

The law would establish a system paying hospitals and providers what they are currently paid under the federal Medicare program. That’s about 22 percent less than what private insurers pay. The new system would also negotiate bulk purchases of drugs, and it would achieve the same sort of administrative efficiencies of scale that Medicare has achieved. Medicare’s overhead, as I’ve indicated previously, runs around 3%, while overhead for private insurers (who must market their policies and pay their top management competitive private sector salaries) runs between 22-25%.

As I write this, the measure is not a “done deal.” But a similar bill passed a few years ago, only to be vetoed by then-Governor Schwarzenegger. Assuming passage of the pending measure, it is likely that Governor Jerry Brown will sign it.

California has a bit over 12% of the U.S. population. If it passes single-payer, it will be a game-changer. (Already, New York’s legislature has begun discussing a similar approach.)

This could get very interesting. I’m gaining a new appreciation for federalism.