Thursday, March 9, 2017

Death without Death Panels!

We live in a cruel world where empathy is in particularly short supply. You’d think that in a modern, developed world, we would have made great strides to create a kinder world for our own people. That should be the role of government, but when political parties get elected to represent constituents who really do not want obligations for the lower echelons of society, well… Back in 2010, the United States, a rare developed country that does not provide healthcare to all of its citizens, was starting to create a more inclusive medical safety net, but the resistance to it was great.
Ezekiel J. Emanuel, an oncologist and a vice provost at the University of Pennsylvania who advised the Obama administration on the Affordable Care Act, writing in the March 7th New York Times with his senior research fellows, Aaron Glickman and Emily Gudbransonare, explains: “In 2010, Mark Price, a 37-year-old resident of Goodyear, Ariz., was struggling to pay the bills for his leukemia treatment. His house was under foreclosure. He had insurance through Medicaid, and yet he died after the state said it would not pay for a potentially lifesaving bone marrow transplant.
“Facing a $2.6 billion budget deficit, Gov. Jan Brewer and Arizona Republicans had opted to ration care, eliminating state payments for bone marrow, liver, heart, lung and other transplants. Simultaneously, the state changed eligibility rules to cut health care for 47,000 low-income children and 310,000 low-income adults.
“Arizona was not the only state that cut lifesaving health care benefits during the Great Recession. In 2010, Indiana’s Medicaid program denied an infant with a deadly rare disease a tissue transplant, reversing course only after local media coverage led to public outrage.
“If the Republicans replace the Affordable Care Act with the plan released on Monday [March 6th], we should expect more stories like those.
“First, the Medicaid rolls will shrink. The Affordable Care Act extended Medicaid to all Americans earning under 138 percent of the federal poverty line — $16,643 for a single person and $33,948 for a family of four in 2017. Under the Republican plan, enrollment in the Medicaid expansion will freeze starting in 2020. The 11 million Americans who already gained coverage can, in theory, keep it — but only if they never let their enrollment lapse or their incomes rise.
“Then Republicans want to go further, by changing how all of Medicaid is funded: They would replace federal Medicaid payments, which guarantee coverage to anyone who qualifies, with so-called per-person allotments, or per-capita caps. These give states a fixed amount of money for each person on Medicaid, adjusted based on whether the person is blind, disabled, a child, an adult or elderly. The states then decide how to budget the money.
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The problem is that the amount given to the states will not keep up with projected health care costs. Changes in the allotment will be tied to changes in the medical part of the Consumer Price Index, which, for various reasons, is unlikely to increase as quickly as the cost of health care…
“A second hidden kicker is that the grants will not increase in response to changing needs. Currently, federal funding is tied to actual Medicaid costs. So if a state has a natural disaster or an epidemic that unexpectedly increases spending, federal funding automatically increases, too. But the Republicans’ allotments will not respond to real-world changes. Again, this will force states to make more difficult choices — cutting lifesaving treatments or nursing home care for the elderly or support for disabled children.
“The Republicans say they want to give states more flexibility. But that flexibility most likely means they could use the money for non-health-care programs, or to close state budget gaps. When given budgetary flexibility with large sums of money, this is a common state tactic.” Flexibility like not having to cover any form of mental illness? Flexibility to apply money allocated for Medicaid to non-medical state budgetary needs? Flexibility to create a system that de facto excludes rather large categories of people currently covered or make their deductibles so high that they can never use the insurance? Flexibility to increase premiums to older citizens well above current maximum rates? Yup, the new GOP proposal does all of that.
In fact the new proposal drops so many people from coverage and increases costs for many as well, very contrary to Donald Trump’s pledge to his constituents, that there is now a massive backlash from the healthcare community against this proposed legislation: “In a letter to lawmakers, major hospital groups wrote, ‘As organizations that take care of every individual who walks through our doors, both due to our mission and our obligations under federal law, we are committed to ensuring health care coverage is available and affordable for all.’
“The groups, including the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States and the Children’s Hospital Association, said they could not support the bill ‘as currently written.’ … The array of groups taking strong positions against the bill is evidence that its potential consequences extend far beyond health insurance coverage, to much of the nation’s economy…
“For now, the supporters of the House bill seem badly outgunned by opponents. On Wednesday [March 8th], as two congressional committees took up the Republican repeal-and-replace bill, the American Nurses Association and a coalition of hospital groups came out against the proposal.
“The A.M.A., which has nearly 235,000 members and calls itself the voice of the medical profession, sent a letter to leaders of the two committees on Tuesday saying it could not support the Republican bill ‘because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.’
“In particular, the group said it opposed a plan to replace the sliding, income-based premium tax credits provided under the Affordable Care Act with fixed credits based on age. The current system, it said, ‘provides the greatest chance that those of the least means are able to purchase coverage.’
“America’s Health Insurance Plans, the health insurance lobby, released its own lengthy statement on Wednesday [March 8th]. In a letter to the leaders of the House committees that drafted the bill, Marilyn B. Tavenner, the group’s chief executive, warned Republican leaders that their plans to change Medicaid financing, among other things, could harm coverage and care.” New York Times, March 8th. If this legislation passes, an unlikely scenario given the disarray among Republicans and the backlash from those most impacted, it will represent a rather dramatic repudiation of each enumerated Trump election pledge to make healthcare better, cheaper, more easily accessible and cover more people.
It’s funny how the groundswell of red state public opinion, harshly against Barack Obama himself, fought tooth and nail against his Affordable Care Act for years after it had passed. It became the price of admission to orthodox conservative politics, to rail against “socialized” medicine and the very notion that everyone should have access to heathland. Un-American, they called it. Instead of fixing the ACA’s rather obvious defects, the GOP-led Congress only wanted to kill the entire statute. Even as healthcare premium prices began to rise, an increasing number of red state constituents joined their blue brothers and sisters and now simply wanted the same or similar coverage at lower rates. People were growing fond of having health insurance.
Nevertheless, the entire GOP federal ballot, including Donald Trump, were just elected on a platform in  opposition to the ACA, but the desire to repeal most recently became “repeal and replace;” Trump promised cheaper and better, more inclusive. However, the GOP’s latest proposed replacement, the American Health Care Act, will accomplish none of those goals. But even within the GOP, the Republicans were anything but united in whether to pass this new law, even though this statute provided vastly less than Trump promised (the best they could muster). If it does get implemented, a lot of Americans will suffer and die needlessly.
Back in the late 1950s-1960s, when Canada began implementing a universal healthcare system that would eventually include no-cost healthcare to all Canadians, it was called “socialized medicine” and conservatives were furious as it was enacted. All of the politicians who were part of that original effort were quickly voted out of office at the next election. But the people then getting healthcare started electing pro-healthcare politicians, including current Canadian PM Justin Trudeau’s father, Pierre Elliot Trudeau in the 1970s.
The law was continually refined, and by 1984 Parliament unanimously passed the current incarnation of the Canadian Health Act, one that even banned a nascent effort by doctors to extract extra payments from their patients. As you can see, it took time, but once people got some coverage, they soon wanted more… permanently.
Today, according to recent polls, Canadians would rather give up ice hockey before giving up their universal healthcare (a medicare model), however imperfect it is: “Canada’s medicare system provides first-dollar coverage (meaning it covers 100 per cent) of all hospital and physician services. Other health services such as prescription drugs, home care, physiotherapy and dental care are covered to varying degrees by public plans; about two-thirds of Canadians (22 million) have private health insurance to cover these supplementary costs, which, for the most part, is covered by employers. Those legislated distinctions are decades old and out-of-date, yet we have no Obamacare-like shake-up in the works.” The Globe and Mail, 10/6/13.
So much for American critics of the Canadian system. And if history is any judge, we are witnessing a parallel phenomenon here in the United States. People want affordable healthcare.
If the Republicans reduce the existing coverage, favor wealthy people with tax breaks, make healthcare more expensive and cull many of those who get full coverage today, they are probably going to witness a backlash that they will never forget (bigger than what they have already experienced)… unless the Democrats continue to fail to put together a compelling and meaningful counter-platform that addresses the public concerns of a majority of Americans. They missed that boat in 2016 and just might miss it again in 2018. But here’s a sobering thought: Donald Trump – in punishment mode – has pledged to make sure that if a GOP healthcare plan fails to pass, to replace ACA (Obamacare), he will make sure that what’s left of the ACA unravels fast so he can blame the Democrats accordingly.
I’m Peter Dekom, and if our nation does manage to survive intact, expect universal healthcare to become the law of the land, sooner or later.

1 comment:

Anonymous said...

New York Times (March 15th): "House Speaker Paul D. Ryan pressed [the eventual reduction in premium costs] in a series of appearances Monday [3/12] night, suggesting that the budget office had found that the House bill would increase choice and competition and lead to lower prices. The Senate majority leader, Mitch McConnell, issued a statement saying, 'The Congressional Budget Office agrees that the American Health Care Act will ultimately lower premiums and increase access to care.'
"But the way the bill achieves those lower average premiums has little to do with increased choice and competition. It depends, rather, on penalizing older patients and rewarding younger ones. According to the C.B.O. report, the bill would make health insurance so unaffordable for many older Americans that they would simply leave the market and join the ranks of the uninsured."