Health Care – Complaining is easy, solutions are hard. Or are they?

When it comes to health care, it’s easy to complain.  All you have to do is find something you don’t like and complain about it.  Bitch about it.  Moan.  Tell the world “There ought to be a better way”.  Now, what that better way should be requires more thought and analysis.

The health care system we have today is a hodge-podge of band-aids grafted on to a model centered around the concept of health insurance.  But it wasn’t always this way.  In fact, over 70 years ago President Harry Truman had a proposal for Universal Health Care.  In the aftermath of World War II, Truman saw under-served populations counting in the millions and wanted to do something about it.  At roughly the same time, the United Kingdom started it’s National Health Service with it’s single-payer system.  So let’s take a look at where we are, 70 years later..

First, a comparison for a sense of proportion:

  • U.K. population: 65 million.
  • U.S. population: 321 million (just under 5x as many)

So let’s use a factor of 5 when we have to compare numbers between our two countries.

What is the UK spending on their National Health Service?  For Fiscal Year (FY) 2015/16 the budget was £116.4 Billion.  At today’s exchange rate (£1 = $1.27), that’s $147B.  Now, multiply that by 5 and you get a little under $740B for a theoretical cost for an “NHS-like” plan scaled up to the size of the United States.  Let’s keep that number in mind.

What are WE spending on health care?  Let’s look at our government expenditures first.

That’s a total of $1,436,200,000,000 or $1.4 TRILLION.  …and that’s just to cover the elderly, the extremely poor and our veterans.  Somehow, the UK manages to cover EVERYONE for just over HALF the cost, adjusted for population.

But that’s not the end of our spending…  In 2016, total US health expenditures were going to top $10,000 for every man woman and child in the country.  …to a total of $3.35 TRILLION.  This would be after you add in what insurers are paying out in benefits and what people are paying out in co-pays, deductibles, fee-for-service, etc.

But what about all the horror stories that we hear from Republicans about Obamacare?  That’s their wallet talking.  Specifically, the wallets filled with insurance company cash.  Insurance companies are trying to have it both ways.  In public, they’re claiming that the ACA causing them losses, but when they have to report to the SEC, by law, they have to admit that they are figuratively swimming in cash.  When you press them they even admit to making money on Obamacare.

But let’s go back to that extrapolated UK number..  $740B.  That covers EVERYONE.  What does our $1,436.2B cover?  The elderly, poorest of the poor and veterans.  What about everyone else?  We’re paying 94% MORE to cover a FRACTION of our people!  Maybe there’s some quality of care issues – like our health care is better than theirs and that is why it’s so expensive!  Let’s look at some numbers:

So..  We pay more, get less, wait longer, die sooner, go broke more often and have to find our passports to get better-priced care..  Why do we put up with this?  (My personal theory is that we’ve been a very parochial country since at least the end of World War Two – anything not invented here isn’t ‘Murican enough for people)

But take a look at those numbers above.  For just over HALF of what our taxes are now paying – we could have an NHS-like system in this country.  FOR OVER $700 BILLION LESS THAN WE PAY NOW TO COVER A MINORITY OF OUR PEOPLE – THAT’S MORE THAN THE ENTIRE FEDERAL BUDGET DEFICIT.  Though, I have to confess, the Medicaid spending numbers DO include spending at the STATE level.

Oh – and after that – we’d have a couple TRILLION dollars in private spending left over – to help make up for the predictable crash in the stock values of the private insurers.  But that’s not so bad.  We could adopt a plan like France or Germany and allow for private, supplemental insurance for people who can’t wait until later in the day or tomorrow to see their GP.  Believe me, the insurance companies will find a market and try to sell to it.

I’m not even including the savings we could get by being able to negotiate drug prices.  How about the savings if we banned drug advertising over the air like we used to?  No more “purple pill” ads telling you to “call your doctor”.  Guess what – your doctor already knows about the drug – and you calling their office only makes them stop what they’re doing for patients they’re seeing.

We can learn from other countries and improve upon their experiences.

Trumpcare. A Post-Mortem.

What a week it’s been!  How do you pick a topic?  We had the hearings on Supreme Court nominee Neil Gorsuch, a new office in the White House and security clearance for Ivanka Trump (even though Trump denied he was seeking security clearances for his kids), more bombshells about Paul Manafort’s undisclosed ties to Russia (he was being paid $10 million dollars by Putin), Trump’s unbelievable interview with Time magazine on “the truth” where highlights include:

  • He still insists he was wiretapped.
  • He still thinks 3-5 million illegal votes were counted
  • He still think job statistics are phony (until he re-tweeted that they weren’t)
  • He said several times that he got 306 electoral college votes (he got 304)
  • He boasted of his ability to predict terrorist attacks (apparently including the one in Sweden that never happened)
  • And, the strangest of all: “I can’t be doing so badly, because I’m president, and you’re not.”

But I’m going to pick on a topic that hits everyone.  Health care.  Specifically, the now-failed “Trumpcare” bill.

What it was supposed to be:

In 2000, Donald Trump released a book “The America We Deserve“.  In it, he said the following:

We must not allow citizens with medical problems to go untreated because of financial problems or red tape.  It is an unacceptable but accurate fact that the number of uninsured Americans has risen to forty-two million.

Working out detailed plans will take time.  But the goal should be clear: Our people are our greatest asset.  We must take care of our own.  We must have universal healthcare.

Just imagine the improved quality of life for our society as a whole if the issue of access to healthcare were dealt with imaginatively.  With more than forty million Americans living day to day in the fear that an illness or injury will wipe out their savings or drag them into bankruptcy, how can we truly engage in the “pursuit of happiness” as our Founders intended?

Ok, that was a long time ago.  What about more recently?

In 2015, Trump said he would not cut Social Security and Medicare.  However, right after the election , Tom Price (R-GA) said Medicare cuts would come in 2017 – and now he’s the Secretary of the Department of Health and Human Services.

On 60 Minutes, in September 2015, he said “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” – but the CBO report on the bill shows a drastic difference – millions of people to be left behind.

What about after the inauguration?  In February, he said it was going to immediately fix Obamacare.

What it became:

On March 7, we got our look at “Trumpcare”.  What was in it?  The list of broken promises is extensive.

  • 7 of the 66 pages were devoted to keeping lottery winners from getting Medicare
  • $300 BILLION tax cut for the wealthy.
  • $800 BILLION stripped from Medicaid.
  • Medicaid / Medicare expansion rolled back so as to deny over 10 million people coverage.
  • Tax break for corporate executive making over $500,000/year.  (Totalling $2.8 BILLION for the 400 wealthiest families)
  • Tax credit eliminated for million of working families.

Sounds bad, right?  Well, Trump didn’t have the votes to pass it.  There is this group in the House call the “Freedom Caucus” and they didn’t like the things that were still in the bill.  Among the things they wanted to get rid of:

  • The prohibition on annual and lifetime coverage limits.
  • Prohibition on out-of-pocket expenses for preventative care and mammograms.
  • Requirements to standardize documentation (which makes it easier to compare plans)
  • Ratios that require insurance companies to pay out at least 85% of premiums in benefits.

And apparently 80% of the caucus wanted to lift the ban on refusing coverage of pre-existing conditions.  More wanted to eliminate things like maternity procedures, emergency rooms, and the list goes on and on.

What happened:

The response was predictable.  At town halls, they almost came with torches and pitchforks to support Obamacare provisions.  Representative Mike Coffman (R-CO) had to sneak out a back door to avoid angry voters.

So the Republicans caught flak from their constituents, the old “Tea Party” became the “Freedom Caucus” and took enough votes away from the Republicans so as to lose their majority in the House.  The vote on the bill was withdrawn.

So.  Once it was dead.  Who got the blame?  Well, first Trump blamed the Democrats.  Then he blamed House Republicans for not getting the votes and said that he was waiting for Obamacare to ‘explode’.  This is a lot of blaming other people for someone who said that HE *alone* could fix it.  Then, to top it all off, he told his fans on Twitter to watch Jeanine Pirro that night on Fox News where she called for Paul Ryan’s resignation. And when it came to his efforts, well, the White House said Trump did ‘all he could’ to pass the bill.  Apparently, in the Trump White House, a complete effort is 17 days, versus the 13 months of negotiations that went on to pass the ACA (Obamacare).

And now what?  Trump says that, next up on his list is tax reform.  Well, his budget proposal cuts everyone except the Department of Defense and the Department of Homeland Security .  In fact, there are 62 agencies and programs he wants to eliminate entirely.  But his tax plan tries to give money to everyone but especially the rich (I’m guessing he’s trying to give a bone to the poor and middle class so they won’t realize that whole herds of cattle are being given to the rich).  This should add about 5.3 *trillion* dollars to the debt.

This’ll be the next exciting chapter…