Category Archives: Health Care

Sep 20 2017

Proposals for Healthcare and Tax Reform

A letter I recently sent to my Democratic Pennsylvania Senator and to Democratic Party leaders:

Dear Senator Casey:

I am growing more and more concerned about the future of our society and the Democratic Party.  We must change course.  I hope these proposals about healthcare and tax reform, top issues for you at this time, will be helpful.

Automation and artificial Intelligence are eliminating more and more jobs.  Making that worse, the profits are going only to the wealthiest of us, and many of our middle and lower income citizens are being impoverished by medical expenses.

We can eliminate that financial ruin with insurance for both the currently healthy and the sick.  Covering every American will also avert a looming Federal debt crisis because that system is much more efficient.

We can best do this is by extending Medicare.  It is an established and popular system that is far less complex and costly than other plans being proposed.

And we must finance it in a way that mitigates our fast growing disparity of wealth.  The very stability of our society is threatened if we allow that trend to continue.

Here’s how we can overcome both huge problems:

Replace Medicare’s 80/20 percent sharing of costs with a progressive Co-Pay amount based on income.  That is the only change for the already retired.

Authorize Medicare to negotiate drug prices with providers to cut costs.

Have working people: (1) continue to pay a progressive payroll tax to cover their Medicare participation when they retire, and (2) also pay a progressive payroll tax for their current medical care, with a progressive Co-Pay amount.

Note:  The tax for current medical care would be less than we pay now for private health insurance because (1) Medicare system costs are lower and (2) costs could be subsidized by other taxes described below.

Allow employers to  pay some or all of this tax to attract employees, but not require them to do so.  They would continue to pay their half of the tax for their employees’ retirement medical care.

Additional funding for this universal health care would come from tax system changes to reduce income and wealth disparity.

Specifically, tax all Personal Income including investment profits in the same way, and return marginal taxes on high incomes closer to where they were in President Eisenhower’s time, perhaps 50% for amounts between $5 million and $10 million, 60% between $10 million and $20 million, and 70% for amounts above that.  The bottom three brackets could be cut by 5% each.

Cut the top Business tax on profits to 25% to encourage re-investment in business instead of taking the money out for personal use where a much higher personal income tax would have to be paid.

Change the Estate tax so distributions are treated as ordinary income with an exclusion of up to $5 million from each person’s share of the estate.  This will reduce wealth disparity over time.

Tax Stock Transactions to reduce High Frequency Trading and increase government revenue.

Eliminate all Tax Expenditures (tax breaks/loopholes) after a five year period during which Congress could individually re-instate any believed to be beneficial with a 2/3 vote from each house.

Drastically cut government expenditures for so-called Regime Change and Nation Building.  We must stop trying to re-invent other nations in our image and destroying them in the process.

Under this Medicare-For-All plan, Medicaid would be eliminated because all citizens would have coverage regardless of their financial situation.  If they were out of work or working a low paid job, they would continue to receive coverage, but their payroll tax and co-pays, based on their income, would be low or possibly zero.

Non-citizens would have to buy their own coverage for the length of their stay, or the companies they work for would have to provide coverage, or there might be reciprocal coverage programs arranged between their country and the U.S.

Does all that sound too radical?  It’s not.  We must take a bold new approach.  Opposition to Trump and the Republicans is simply not enough.  We must win a mandate for sweeping positive change.

We must tell voters what big changes we will make so no American is bankrupted by medical costs.  We must show voters how we will reverse the flow of riches only to the very few.

I hope these ideas can begin to reinvigorate the Democratic Party to be not just a focus for unspecified hope or reflexive opposition, but the agent of great beneficial change.

Sincerely

Jul 25 2017

An Angry Reply to Tom Perez

 

Here’s the reply I just sent to Tom Perez,  Chairman of the Democratic National Committee at  democraticparty@democrats.org:

Tom –

You just made me very angry.  What you wrote is deceptive.

Senate Republicans did not just vote to repeal our health care.  They voted to debate repeal of the Affordable Care Act.

Yes, Congressional and Senate Republicans are trying everything they can to repeal the ACA and yes, they may yet succeed.

But hysteria makes it LESS likely that we can continue to block their cruel program.

Stop using every excuse just to seek donations.

Commit yourself and the Party to a health care system enough of us will vote for.

We will keep losing elections if you keep up this nonsense and I will continue NOT donating to our Party.

Sincerely

— Martin

And here is his email that got me riled up:

Senate Republicans just voted to repeal our health care — so we’re going to vote them out of office. Help us raise $100,000 to elect Democrats today, and get your donation matched.

Martin, the nightmare just became real: Senate Republicans voted to move forward with health care repeal. It’s only a matter of time before a repeal bill lands on Donald Trump’s desk and he eagerly signs it into law.

I’m devastated. Millions of Americans will lose their coverage, millions more will face skyrocketing premiums that put the care they need out of reach, babies born with chronic illnesses could hit lifetime caps on coverage before their first birthday — this is not who we are.

So here’s what we have to do now, Martin: pick ourselves up and get back to work so we can kick every single Republican who votes to take our health care away out of office.

We want to raise $100,000 before the end of the day to start laying the groundwork to win back the House and Senate, and a group of generous Democrats has offered to match it dollar-for-dollar. Chip in $3 or more right now to help us get there and get your donation matched.

Tom

Tom Perez
Chair
Democratic National Committee

The Democratic Party will almost certainly remain ineffective while Tom Perez and others who just want donations are in office.   We must do all we can to motivate them to change while simultaneously working to replace them when they ignore us.

Jul 23 2017

To the Chairman of the DNC

 

Here’s my reply to Tom Perez, Chairman of the Democratic Party, at democraticparty@democrats to help me remember what I wrote, and in the hope that you’ll join me:

I hope this helps, Tom.

What do you mean when you write: “all of us who believe that health care is a right for all Americans”?  The ACA does not provide that.

You write: “Republicans are determined to take away health care from millions” and ask me to give you money to: “throw them out of office.”  The Republican proposals are appalling, but…

What health care system is the DNC committed to instead?

Democrats keep losing elections because many voters want to throw US out of office and others don’t care enough to vote to keep us IN office.  Why?  They don’t know what we stand for.

Every other advanced economy provides universal health care and spends far less than we do.  Decent people can disagree about whether or not health care is a human right but there is no denying that every way other nations provide universal health care costs less than ours.

Is that what you want me to donate for?

Sincerely

— Martin

Here’s what I replied to:

Martin —

Tonight, because of millions of grassroots Democrats like you who banded together and fought against it, Republicans’ attempt to take health care away from millions of Americans failed again.

While this is a victory for basic human decency, for the families who rely on the Affordable Care Act, and for all of us who believe that health care is a right for all Americans, the fight is far from over.

Republicans are determined to take away health care from millions. We saw it when Donald Trump, Mitch McConnell, and Senate Republicans worked in secret, behind closed doors, to write a bill that would have given massive tax cuts to millionaires and billionaires, paid for by cutting working families off from the care they need.

They ignored the overwhelming opposition of their constituents — and now we’re going to make sure their constituents throw them out of office.

Help build the foundation to take on these Republicans in every state, elect Democrats who will protect every American’s access to health care, and take back our majorities in Congress. Chip in $3 or more tonight.

Thank you, sincerely, for everything you’ve done to stop health care repeal. Onward as we continue to fight for the values we believe in.

Tom

Tom Perez
Chair
Democratic National Committee

May 27 2017

Healthcare — the Fundamental Choices

One of our fundamental choices about health care has moral and practical dimensions.  The other is purely practical.

Let’s first address the practical issue.  Our  appruoach to health care puts our businesses at a serious and growing competitive disadvantage.  US corporations currently spend $12,591 on average for coverage of a family of four, up 54% since 2005.

Our national health care spending, which was 5% of GDP fifty years ago, is now 17 % of GDP.  It has more than tripled.  Meanwhile, Germany’s spending is two thirds of ours and is growing much less rapidly.

We spend half again as much or more on health care as other advanced economies.  And the gap is growing.  Germany now spends 11% of GDP on health care, only increased from 9% half a century ago.  Japan spends 10%,  Britain 9%.

It’s no coincidence that our health care system is fundamentally different from our competitors’.

Our business leaders say their competitiveness is hobbled by corporate taxes, but while our health care spending has more than tripled in the last half century, corporate taxes that were then 4% of GDP are now half that at about 2%.

It’s true we have industrialized nations’ highest corporate tax rate but many of our great multinational corporations pay little or none.  It’s also true that our high tax rate hurts smaller domestic corporations but that’s much less important than our health care system’s costs.

To remain competitive, we must restructure our health care system.  

The choice with both moral and practical dimensions is whether everyone will have health care, or only those who can pay?  

If only those get health care who can pay, the others will suffer and die.  If we favor this approach we should consider, are we okay with that fact?

If everyone will get health care, there must be some rationing.   If we favor this approach, do we recognize that fact?

It’s misleading to think of health care as a human right.  Nations choose what rights their citizens will have and embody them in laws.  Those laws can and do change.

Our current legal system specifies that, with an exception I’ll get to in a minute, those of us who cannot pay for health care do not get it.  Why is that, and could it change?

It is an article of faith with us that we are rugged individuals who take responsibility for ourselves.  We resist anything we think could make us less responsible.

Another of our articles of faith is that competing organizations motivated by profit always get the best results.

But that could be about to change.  The Medicare for All act has 108 sponsors as of May 13, 2017: https://www.congress.gov/bill/115th-congress/house-bill/676

We would get better results from a unified approach to health care.  We do not, after all, provide for our defense with autonomous, competing armies.  We know that kind of service can only be supplied effectively by our central government.  And we know our government has encouraged, not stifled innovation in that field.

Here are links to what I’ve written before about some important aspects of our approach to health care but if you’re out of time, just skip past them to the conclusion — a single payer system works best.

In http://martinsidwell.com/socially-acceptable-healthcare/ I pointed out that we do currently provide not health care but at least medical treatment to all via the Emergency Medical Treatment and Active Labor Act (EMTALA) passed under President Reagan.  That approach means: “We have in the USA universal access to medical treatment via the most costly system possible.”

Data I posted at:  https://usaturnaround.wordpress.com/2011/09/21/healthcare-from-85000-feet/ show that:  “US health care delivers poorer results at higher cost because it is based on the flawed assumption that market based systems always deliver the best results. While in most cases they do, for health care they do not. The incentives are perverse”.

Exploring our Federal deficit at: https://usaturnaround.wordpress.com/2011/07/11/drivers-of-the-deficit/ I noted that: “more important even than getting rising Federal healthcare spending under control is to get rising health care cost under control.  As noted in previous posts, we spend double what other advanced economies do on healthcare without getting better results.”

Examining national spending and results at: https://usaturnaround.wordpress.com/2011/04/19/overall-us-healthcare/ I pointed out some contributors to our abnormally high costs:  “our obesity rate, the highest of all OECD countries and more than twice as high as the 15% OECD average …  The percentage of our adult population considered obese rose from 13% in 1965 to […] 34% in 2007.  Obesity-related medical spending in the USA doubled […] between 1998 and 2008.”  

Focusing at: https://usaturnaround.wordpress.com/2011/04/17/medicare-and-medicaid/ on Medicare and Medicaid I pointed out that: “The primary cause of increased Medicaid spending is that it now services 16% of all Americans, up from 2% at its inception [while] Medicare now serves 15% of the population, up from 10% in 1966 and the percentage will continue to increase as our population ages … The key fact about Medicare is that an aging population, unhealthy lifestyles and technology advances are driving its costs up 8% annually, much higher than Medicaid.”

The conclusion?  Our need to remain competitive means we must restructure our health care.  Our competitors did that long ago.  They all established a unified system for all their people, they all have much lower costs than ours, and they all get the same or better results.

Our current approach to health care is not exceptional in a good way.

When the government acts as the one health care buyer it has the market power to negotiate the lowest price that is profitable for suppliers.

A competitive health care market benefits consumers only for procedures like breast enhancement where they have enough time to make an informed choice.

To remain competitive we must change our health care system.  We must either stop providing care to many millions more of those who can’t afford it or establish a single buyer to negotiate the lowest profitable price for providing care to the largest pool of consumers, which is both the currently healthy and the sick.

Jun 25 2012

Socially Acceptable Healthcare

We have in the USA universal access to medical treatment via the most costly system possible.  What we need is a socially acceptable level of healthcare for all with a way for those who can pay more to get more.

Everyone on US soil regardless of citizenship has the right to medical treatment defined by the Emergency Medical Treatment and Active Labor Act (EMTALA) passed under President Reagan.  A frequently quoted court judgment about it says:  “The Emergency Act was passed in 1986 amid growing concern over the availability of emergency health care services to the poor and uninsured. The statute was designed principally to address the problem of “patient dumping,” whereby hospital emergency rooms deny uninsured patients the same treatment provided paying patients, either by refusing care outright or by transferring uninsured patients to other facilities. Reports of patient dumping rose in the 1980s, as hospitals, generally unencumbered by any state law duty to treat, faced new cost containment pressures combined with growing numbers of uninsured and underinsured patients. Congress responded with the Emergency Act, which imposes on Medicare-provider hospitals a duty to afford medical screening and stabilizing treatment to any patient who seeks care in a hospital emergency room.”

Since essentially all hospitals are Medicare providers, EMTALA in effect mandates that anyone who comes to a medical emergency department must be examined and, if suffering from an “emergency medical condition”, provided with treatment.  A pregnant woman in active labor, for example, must be admitted and treated until delivery is completed.  We treat everyone regardless whether they can pay but only after they need the most costly treatment.  Our cockamamie approach means hospitals must recover the cost of treating those who cannot pay via higher prices for those who do.

Medical insurance in the US is a significant burden on US employers who provide it, a burden their competitors do not bear.  In 1986 we decided to no longer accept that many Americans were being denied treatment for a medical emergency, but we have yet to face up to the competitive issue.

We need all Americans to be productive.  Getting everyone to want to be productive must also be addressed but that is outside the scope of this post.  To be productive you must be healthy, which means you must have access to healthcare.  Since some treatments are extremely expensive and everyone is at risk of needing them, insurance is necessary for all.  Because most people will not in fact need the most costly treatments, universal insurance has the lowest per capita cost.  We currently insure only those over 65 years of age and to a lesser extent those with a serious health issue who cannot afford treatment, i.e., only the most costly to insure.

We need our health care costs to be affordable.  We currently have no defined limits on what treatment will be supplied yet ever advancing technology makes what can be attempted to prolong deeply and irreversibly impaired life astronomically costly.  Who should get what level of treatment is a value judgment we avoid discussing.  We should debate openly what judgments about treatment we want in our society.

There is, however, no disagreement that we want the finest possible healthcare.  That means those who can pay for the best should be able to do so, and the best should be affordable by as many as possible so as to maximize its supply in our society.  If great healthcare isn’t available affordably within our system, we will increasingly go to other countries for treatment.

So what in the end does “socially acceptable” mean?  It implies a level of rationing we agree is OK at a cost we agree is OK.  Achieving that balance is among the most difficult of all challenges.  We will get nowhere until we accept that a balance is necessary.