Uncommon Sense

March 31, 2020

If You Needed a Reason Why a For Profit Healthcare System Doesn’t Cut the Mustard, Here’s One

Filed under: Business,Morality,Politics — Steve Ruis @ 1:00 pm
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From The Guardian:

The frontline in the battle against coronavirus has shifted a couple of hundred yards down the main road through the Kansas city of Wellington.

Two weeks ago, as the virus crept closer and people in other parts of the state started dying, the owners of the city’s only hospital thought it a good time to close down with just a few hours’ notice on the grounds the facility was losing money.

“We lost our hospital abruptly and without warning,” said Dr Lacie Gregory, a family practitioner in Wellington. “Even as the healthcare providers here in town, we did not hear that it was closing until it was a done deal. We received a text message from the director of nursing saying as of now there’s no hospital. So really, really unfortunate timing.”

That has left Gregory and a small group of other doctors and nurse practitioners at the city’s Family Care Center at the forefront of preparing for the coming pandemic with little guidance and not much equipment.

The physicians had assumed the 63-bed Sumner community hospital’s emergency department would deal with people contracting coronavirus while they went on treating more routine conditions of cuts, broken bones and high blood pressure, and that the two would remain safely at a distance. But now the Family Care Center is the first line of defence for the city of 8,000 people.


February 19, 2020

Costing Out Medicare for All

There is still a great debate going on as to whether we can afford Medicare for All. I prefer, rather, to use the term Universal Healthcare (UH) as I do not want to be restrictive in what we can come up with. Maybe Medicare for All is too expensive but a better plan is actually cheaper, etc.

The first stage of this discussion is the one we need now, which can be couched in the form of a single question: Is there enough information to believe we can afford UH to vote politically to have such a thing?

The answer is a clear yes. Other Western countries have better health outcomes or equal health outcomes than we get here and they pay far less for those outcomes.

Therefore we can afford to do UH and we should vote to do so.

The big question is then “Can we do it well?”

Those who believe in American Exceptionalism (U . . . S . . . A . . . U . . . S . . . A . . . !) must believe that not only can we do it, we can do it better than those other countries, especially the shit hole countries.

But, but “God is in the details!” (Not the Devil, people, get it right!) Yes, that is true, but any details being offered up in the current campaign for president are irrelevant because they are non-binding. We can also count on doctors working to protect their earnings. We can count on Big Pharma working to protect their immense profits. We can count on actual costs going down naturally, if for no other reason than Health Insurance company profits will no longer be extracted as rents from the system (see Addendum below).

The attractive thing about Medicare for All is that it has a proven track record of service, of frugality (3% operational overhead), and acceptability. That is political thinking however.

We could either: put health insurance companies out of business or allow them to offer supplemental insurance coverage (true catastrophic insurance) or we could do what Switzerland does. All of the health insurance in Switzerland is offered by private insurance companies (thousands of them). The government, however, limits how much profit those companies be made and dictates what is covered and what is not (no more insurance company death squads). (That this is acceptable to those companies is the fact that over 4000 of them are doing that business, the profits being like they were 50-60 years ago and steady and safe, just like insurance companies used to operate.) The Swiss government also forms and reforms risk pools to make sure that the risks are shared widely. So, UH can include private insurance companies as Switzerland does or it can basically relegate them to the high risk end of the spectrum or even eliminate them.

For example, I don’t think UH should cover rare medical events, e.g. the birth of conjoined twins. If we go down the road of “Oh, we can’t let anything bad happen,” we will soon be broke. Rare, almost untreatable cancers, well, that is sad but not an obligation of the many to the few. So, I think UH should focus on the common ailments that are treatable and allow the insurance companies to sell expensive policies to those who want protection from rare life threatening diseases and accidents, e.g. ‘Every bone in his body was broken but we were able to put him back together.”

But, that’s a detail, too.

Battling out the details in a political process is a vain effort and will not inform us. All we need to know is that other countries can produce health outcomes equivalent to, or better that, ours for much less than we currently pay. This tells us that UH is something we can do. Then it is a matter of political will, and unfortunately, power politics.

Addendum Check out The American Health Care System Costs Four Times More Than Canada’s Single-Payer System (and the Public Option Won’t Help)

Here’s a taste: “The average American pays a whopping $2,497 per year in administrative costs — which fund insurer overhead and salaries of administrative workers as well as executive pay packages and growing profits — compared to $551 per person per year in Canada, according to a study published in the Annals of Internal Medicine last month. The study estimated that cutting administrative costs to Canadian levels could save more than $600 billion per year.”

“Despite the massive difference in administrative costs, a 2007 study by the Centers for Disease Control and Canada’s health authority found that the overall health of residents in both countries is very similar, though the US actually trails in life expectancy, infant mortality, and fitness.”

October 25, 2019

How to Pay for Medicare for All

Filed under: Economics,Politics — Steve Ruis @ 1:30 pm
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Right wing commentators are whining galore (while wringing their hands greedily) because according to estimates, Medicare for All will cost roughly $28-32 trillion over a decade. Oh my god, oh my god . . . my hair is on fire . . . how will we ever pay for it? OMG!

None of these ordinary potatoes (common taters, get it?) will stop, take a breath and then ask, “Well, what are we paying now?”

“Well, what are we paying now?”

As of 2017 in the U.S. we are paying $3.5 trillion per year for healthcare ($10,739 per person as compared to in Canada where $4974 per person is paid (as of 2018)). According to my very powerful calculator, that means, absent any inflation (Yeah, right, cough, cough . . .) we will spend $35 trillion over the next decade assuming nothing changes. And, of course, no inflation in drug prices, no inflation in hospital costs . . . right, we are going to pay more that $40 trillion over the next decade if the previous decade was any measure.

So, there are the comparisons:

Cost of Medicare for All . . . $28-32 trillion (10 years)
Cost of Status Quo . . . $35-40 trillion (10 years)

And the winner is?
Any idiot can see that universal health care is a winner, which is why so many other countries have it.

But people are whining and crying about how to shuffle around the money we already have committed to pay for something cheaper. (OMG!)

How about these ideas:
1. The money that employers have been paying for employees healthcare goes to the employees. The federal government taxes 80% of this. The employees have more money and guaranteed health care.
2. Now that the corporations are out from under the specter of ever increasing health insurance fringe benefit costs, a flat tax of 5-7% is charged to help pay for the uninsured, etc. (Please no whining about how they can afford it in that corporate profits have been at record levels for decades now.)
3. Health insurance corporations are now free to offer add-on coverage to anyone who wants it.
4. We order our drugs from Canadian pharmacies (by making it “more legal” and easier) until American providers comply and lower their prices. For my right-wing friends, this is called “competition” and “the free market.” (I get my drugs from Canada and they are made by the same corporations that make them here, they just charge less for them in Canada . . . “Ich bin ein Canadienne.”

Any questions?

PS Just in case you weren’t paying attention.
• Will ordinary citizens see their taxes go up? Yes.
• Will ordinary citizens have more disposable income and guaranteed health care? Yes.
• If you are concerned about the quality of care, ask anyone on Medicare if they would rather go back to what they had before Medicare kicked in or ask any real Canadians how they like their system. (Hint: they like it way better than the fictional Canadians in the stories told by the common taters.)

PPS If you want to know why none of the news types on TV aren’t discussing these obvious facts . . . follow the money.

October 11, 2019

Something is seriously wrong with this system.

Filed under: Economics,Politics,The Law — Steve Ruis @ 10:04 am
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Over at the Naked Capitalism site there is a significant post on the costs of healthcare insurance—Wolf Richter: How Employees & Employers Get Bled by Health Insurance.

It is no secret that the healthcare insurers figured out that union-negotiated healthcare insurance was a spigot to tap the wealth of the nation so as to flow into their coffers.

The unions thought that they were negotiating a “fringe benefit,” a non salary-based benefit and that this would make sense for one and all. Everyone needed access to healthcare services, so making it a fringe benefit made sense. It also allowed a larger “purchase” to be made, thereby holding down the costs.

But insurers recognized that the prices they charge were made invisible to the employees and so they used the specter of employee unrest to jack up prices wholesale. Even employers were caught off guard.

Here’s a taste of the article, check out this graphic. It covers only a 20 year span, in which healthcare “costs” increased at a substantially higher rate than, well, anything else. (Why? Because there was no one in charge?)

As a contrast to this consider the school textbook market. All states buy textbooks for their schools. Some states, like Texas and California, are so large that textbook publishers cannot lose sales to those states, so they cater, fawningly over the states with the most buying power. Imagine if there were one giant healthcare insurance customer. Imagine the buying power. Imagine the ability to oversee this entity (as there will be only one customer, with only one suite of paperwork, one set of reports, etc.). Imagine the pressure on drug manufacturers and all of the rest to make sure they get their piece of the pie.

Can’t possibly work, you say? Well it is working . . . in numerous places around the globe . . . and even right here in River City. In the form of Medicare and the Veterans Health Administration.




September 24, 2018

A Failure to Communicate

I read just now the following:

Alexandria Ocasio-Cortez … was on Jake Tapper’s show on CNN the other day, the host grilled her about how she would come up with the forty trillion dollars needed to fund Medicare for all, housing as a federal right, a federal jobs guarantee, tuition-free public college, and canceling all student loan debt.

She apparently could not answer the question … <sigh>.

Let me just address funding “Medicare for All (MFA)” for the nonce. Currently, the average family of four pays in excess of $16,000 per year for their health insurance. Mostly this goes unnoticed because these payments are made by their employers as part of their compensation. How much do you think the actual value of that insurance is? If you compare it with costs in other developed countries and look at how inflated the costs are and consider that the insurance companies providing the “insurance” are quite an unnecessary layer of bureaucracy (Medicare has a 3% overhead. If private insurance companies likewise have a 3% overhead, where do all of the handsome profits those companies make come from?). Basically that $16,000 represents a quite unnecessarily inflated cost. Let’s say, for the sake of argument, the actual cost is $9,000 for that family of four. If MFA is invoked, the employers will be required to pay that $16,000 directly to the family and then that family will pay, say $10,000 in taxes (a bit more than their own costs to be able to cover the unemployed, etc.) and pocket the other $6000! (Note: these are not the actual numbers, but even if $100 ends up in your pocket, you would be making money on the deal.)

Once we have Medicare for All, we also have group buying of pharmaceuticals, something Big Pharma has spent billions to avoid (why they are opposed to such a system is it would squeeze its profits down from the astronomical to merely lavish). This will reduce the cost of medicinals, at least to what other countries are paying (for the same drugs from the same companies … yes, they are gouging the Rich Gringos because they can). Similarly there are a multitude of large cost savings that can be wrung out of the system (e.g. there would be only one billing process, not hundreds, for doctors and hospitals to contend with).

Currently the US spends about double what any other rich nation spends on health care per capita. This means we could spend 10%, 20%, or even 30% less and still be spending more than any other country on health care. If you remove the costs of private health insurance companies, we can save even more.

Conservative pundits always focus on the cost/taxes and never mention the cost savings. Ms. Ocasio-Cortez should be better prepared if she is going to go on camera to defend our ideas.

PS The Federal Reserve “printed” several trillion dollars to bail out the banks and Wall Street firms during the Great Recession and these same pundits didn’t blink. Plus that “forty trillion dollars” is not for just one year and they are careful not to mention that.

January 7, 2018

If the Elites Might Benefit, Then Sure, They are For It

In today’s NY Times an article (Medical Research? Congress Cheers. Medical Care? Congress Brawls by Robert Pear) states that there is some bipartisan support for science in our Congress. Here’s the introduction:

“WASHINGTON — They cannot agree on subsidies for low-income people under the Affordable Care Act or even how to extend funding for the broadly popular Children’s Health Insurance Program — two issues requiring urgent attention as Congress returns to work.

“But a more exotic corner of the medical world has drawn rapturous agreement among Republicans and Democrats: the development of new treatments and cures through taxpayer-funded biomedical research.

“For the third straight year, lawmakers are planning to increase the budget of the National Institutes of Health by $2 billion. In the process, they have summarily rejected cuts proposed by President Trump.

“The push for additional funding reflects a fascination among legislators with advances in fields like molecular biology, genetics and regenerative medicine, even as they wage bitter battles over just how large a role the government should play in financing health care and providing coverage.”

When the shade the politicians have thrown is illuminated, it is clear why this support is bipartisan. New medical procedures, even those which prove to be very costly, will help keep the elites alive longer. The elites have told us over and over that “America affords us the finest medical care in the world.” What we didn’t focus on was the use of the word “us.” They were referring to the elites as only they can afford the finest. The fact that our medical care system only ranks somewhere near the middle of first world countries is irrelevant and they know it. Those results are based upon average health outcomes and the elites are paying for treatments and health outcomes that the top 1% get. They do not care much at all about the poor health outcomes that the poor and middle class can afford as those do not affect them directly. But there are many of us and few of them, which means they are more than willing to take our tax dollars to pay for their cures.

Everything you need to see is right in front of your eyes. We only need to believe what they are saying, what they actually are saying and not what we wish to hear.

September 24, 2017

Republican Healthcare Policy Laziness

Once again the GOP has a proposed policy in the U.S. Senate to “Repeal and Replace™” Obamacare. That it would repeal Obamacare is without doubt, the problem comes with the “replace” part. They can’t seem to come up with anything like a coherent plan to do that. Their latest effort seems to be the worst of the recent lot and opposed by even the health insurance lobby along with the other usual suspects.

The GOP seems like the student looking for the minimum effort path through a college course of study. They want a passing grade but they really do not want to have to do any real work. Consider the following alternate scenario: after the passage of Obamacare, the GOP (one of its plutocratic sponsors pays for the effort) sets up a private study group to come up with a better plan. They have access to all kinds of healthcare experts, policy wonks, and expertise in the insurance marketplace. They come up with a water tight plan to pull out of their pocket at a moment’s notice. Ta da!

There are any number of available working models. The Swiss have a model that works, built entirely upon private insurance companies; that should appeal to the small government types. The Medicare, Medicaid, and the VA all have systems that work quite well, with high patient satisfaction levels. (The VA’s much touted problems are administrative and mostly related to computer services and processing of new members, not based on quality of service.) The models they do not favor, like those in the UK and France are well-documented to supply them with evidence against those systems should they need any. This is a piece for cake for consultants willing to accept the generous funding supplied (a few million bucks one way or another).

So, why hasn’t the GOP “done its homework”? Surely something better than the despised Obamacare has to be available. Maybe it has done its homework and failed to come up with something better. I believe there are all kinds of things better than Obamacare, but the genie has been let out of the bottle. All of the better alternatives lead away from GOP cherished ideologies and not toward them. The Swiss system of health insurance, which is intensely driven through private insurance companies, is heavily regulated by the government, for instance.

I guess there is no system that works that includes the GOP preferred “pay as you go,” market-based, non-governmental ideology. Interesting.

Or maybe the GOP’s representatives are just lazy, stupid, and mean. Occam’s razor applies here.

September 17, 2017

Why We Do and They Don’t Want National Health Care System

We are talking here about the healthcare systems such as Canada and France have as examples, you know, all of the other advanced western nations. Names such as Medicare For All have been bandied about for such a system here in the U.S., which is just one such option.

Here in a nutshell is why we want to do this and the conservatives and their paymasters do not:

Per Capita Spending Health Care 2015
United States: $9451
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Miraculous Finland: $3984

When we see this list, we see “Gosh, we could have quality healthcare for only about half of what we are spending now!” and “We could use some of what we save to make sure that all Americans are covered.”

When they see this list, they see “Oh my gosh, look at the profits we will lose under national healthcare.”

We spend twice what most other countries spend on healthcare and only the very rich get a commensurate healthcare outcome. Most people spend more and get less than they get in other countries. For those of you who think Canada and France do not have quality healthcare systems, you might want to consider how you learned that … Fox (sic) News, maybe? We have a higher rate of infant mortality than most of those other countries. We have shorter life spans than people in those other countries. The middle class incomes in those other countries often exceed ours, especially when you include the fact that we pay so much for healthcare. We also have millions of people with no health insurance at all, who simply go to a county hospital when they are very, very ill and plead for charity care. In the meantime, those sick people spread diseases and die much younger than they could have.

Whatever your position, do realize that the opposition to “socialized medicine” comes from those making megabucks off the current system: doctors (lead by the AMA, so their faces don’t get shown), Big Pharma (surprise, surprise) and, of course, the health insurance industry.

The insurance companies are playing a game. Through accounting procedures, they are claiming big losses through Obamacare. These losses are being used to argue for large premium increases under the system. But if you look closely, these very same corporations are claiming record profits and their CEO’s are receiving big bonuses. There stocks have soared even higher than the record stock price surges under President Obama. Huge losses, record profits, skyrocketing share prices! Some companies made so much profit that they exceeded the 20% allowed under Obamacare and had to issue refunds! This can be compared to the 3% total overhead for Medicare.

Look at that list again and ask yourself, as Ian Welsh has over and over: why don’t we see those numbers on the news over and over and over again … instead of never. Who controls the news?

September 14, 2017

How Will We Pay for It?

Filed under: Politics — Steve Ruis @ 10:58 am
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Now that healthcare as a right of citizens is becoming viable, there is much public hand wringing along the lines of the question “How will we pay for it?”

Hello? This is a stupid question.

Currently, people’s health insurance is provided by:
Employer  49%
Medicaid  20%
Medicare  20%, and
Other Public  2%.
Add all of those up and you get 91%

The 49% provided by employers (actually almost always a negotiated fringe benefit, so this is part of their employee’s compensation, so it is the employee’s money being spent by the employers) is provided through insurance companies which extract profits from the system. In a national system, the monies currently going to profits, can go to cover the 9% not currently covered. The only political problem is the redistribution of those monies.

The money formerly paid out as a employee fringe benefit to insurance companies, will be paid instead to the employees who will, in turn, pay taxes sufficient for their coverage. Considering the amount of waste, fraud, abuse, and profit taking in the private health insurance business, after their taxes are paid, there will be money left over in their household budgets. The only people who do not benefit in this are the insurance companies currently making too much money for processing too little paper. The people actually delivering the medical services will not change. (It’s called cutting out the middle man, people.)

To those who argue that this gives government too much control over people’s healthcare, tell that to the people getting Medicare and Medicaid, who are all happier with their coverage than other folks. And if you are going to make that argument, then you have to agree that the militaries of this country are socialist and we give too much control over the military to the government, and….

The government is “us,” people, just “us.” It is as good as us, as corrupt as us, as well-meaning as us.

August 3, 2017

Why Are Americans So Afraid?

I was reading an article over at AlterNet with the title above. The subtitle is “Facts Take a Backseat to Deeply Ingrained Fears.” That article takes a fact-based approach in that they point out that violence has been and continues to be on a decline (for a very long time, even including world wars). That is per capita violence, not necessarily total violence as the population is still growing rapidly. That article’s author concludes that the fear people possess is a belief rather than a conclusion from the facts. A bit of discussion of fear mongering and they were done. I am using the same title, but they were asking the question; I will try to answer it, in part.

They didn’t quite go one step farther and they really need to. Why is America so afraid? That is the emphasis they missed. What might be the basis of American fear? We have experienced far less terrorism than much of the rest of the world, yet we seem to be more afraid, for example. The connection that they missed is that the U.S. is also one of the most religious countries in existence. If you compare our church going rates to, say, Great Britain or France, we are way out in front. It may be the case that not even a majority of Britons believe in a god.

And what is the foundational basis of the form of religion we currently espouse? Fear and belief. And what has been happening in the world of religion in the U.S.? Currently there has been a major increase in market share of the “nones,” those who respond to polls, like the Pew Poll on Religion in America, that their religion is “none.” The Nones have doubled as a percentage of the population in the Pew poll for instance. Atheism is spoken about and written about widely. Conservative religion in this country, in response I believe, has upped the drumbeat. The standard message has always been “we are a sinful nation” and “we need to repent our evil ways or God will punish us.” “If we only were to accept Jesus as our Lord, we would be ‘saved’ from eternal torment when we died.” That sounds like a fear-based campaign if I have ever heard one.

And as churches close or they see large reductions in their numbers of parishioners, the pressure gets increased on the standard message. We are more sinful that we were in the past! We are in even more need of belief! The world is descending into a miasma of degradation! Church going rates are decried as being at all-time lows when, in fact, the church-going rates a little over one hundred years ago were a small fraction of what they are now. They mean a “recent low” but that doesn’t have the impact of “all-time low.” Often this message isn’t all that overt, but it is there. And it provides a base for the feeling of fear from the purveyors of violence. There are secular fear mongers, too (Republicans), but I won’t mention their names (Republicans).

This is not accidental. The cadre of very rich people who are trying to subvert democracy in this country, like fear. They also prefer fear that is not based in fact because real fears have real causes that must be addressed. False fears can be “solved” by the same magic that created them in the first place. You may wonder how long we can be kept in a state of fear. To me, the answer is clear: centuries. If you look at how long many in the South have feared the reprisal of Blacks for how they have been treated by the white community, you will see a history of fear management. During the slave period, whites were ever fearful of slave revolts and any hint of such a revolt produced a vicious backlash. After emancipation, vagrancy laws and sundown laws were used to keep Black Americans in a state of near slavery. Jim Crow laws kept Blacks and Whites from interacting and developing any real relationships. It also kept Blacks weak in that in this country money = power and if you don’t have any money, you don’t have any power. The term “poor Black” became almost an oxymoron in the postbellum South.

The latest manifestation of the fear campaign is to make sure that white Americans saw Black Americans, primarily males, as criminals. By jiggering the laws, a large percentage of the Black male population ended up behind bars. Even when they got out, they were ex-cons and had trouble getting jobs and, well, money = power. This stereotyping campaign has been so effective that many police officers are so afraid of Blacks that they shoot 11-year olds with cap guns and even shoot White women because they don’t take the time to really look at the situation. The laws have told them that if they feel fear, they can shoot. And we have made damn sure they feel fear, a lot of fear.

Feeling fear without reason is the tool of the cadre of very rich folks who are trying to capture our democracy. Trying, hell, they basically have captured our democracy. When was the last time Congress passed a bill that the American people supported? Polls showing 60%, 70%, even 80% public support for legislation which then fails to pass. For example, we cannot seem to deny convicted felons, or people with restraining orders, or the mentally deficient the right to bear arms! That would contribute to people feeling safer and where’s the upside in that? People are so in favor of reasonable gun laws that a majority of NRA members support some of them. But … nah, they really don’t want you to feel safer. People want government-supported health care? Too bad, that would contribute to an overall sense of well-being and safety, so, nope, can’t be done.

The politicians are running the show, but it is religion, American religion, that has provided the base for their fear mongering actions, and, interestingly the religious still support them. The minor fact the Evangelical Christians supported Donald Trump in droves tells you all you need to know. And if you think I am exaggerating read the book Democracy in Chains.

The money = power equation works quite simply. By accumulating a large fraction of this nation’s wealth, the people in this category can have a small cadre with enough wealth to exert more power than the rest of the country can. If you wonder why unions have become powerless. If you wonder why wages have been suppressed for so long, start thinking about money = power. It works both ways. Since we do not have it, we have no power. Since they have it, they have the power, enough power to get their money declared a form of “free speech” by the fucking Supreme Court. Now their expenditures to keep democracy in chains is protected by the Constitution!

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