How to Make Failure Worse

As the Trump administration implements the GOP-focused evisceration of the Affordable Care Act (ACA), by executive action and chipping away legislation because repeal has never been able to achieve a Congressional majority, American healthcare just becomes less affordable. By removing the healthcare mandate – where people were required to participate in the system (those who cannot afford it were subsidized or simply provided with Medicaid (Medicare for the elderly and qualified disabled) – the GOP has effectively defunded a very significant part of the program. And in a gig economy, where real wages continue to be flat, healthcare is a very, very serious issue. Coverage is “on your own.” You don’t want to pay for it until you need it, and if you are young, you might just think healthcare is just for older folks.

Under the guise of giving consumers “more choice,” the Trump administration has carved exemptions in state programs, openly encouraging such plans of “skinny bundles” that provide minimal coverage, with tons of exclusions for any expensive serious medical conditions. The GOP tells us that people with pre-existing conditions should have appropriately huge deductibles and premiums, even if they know most folks with preexisting conditions (and there are tens of millions of people in this category who do not have employer coverage) could never afford such coverage. ACA healthcare exchanges are still legally banned from negotiating with pharmaceutical companies to reduce the cost of prescription drugs.

Medical costs continue to skyrocket, and the Trump administration is doing everything it can to make sure such costs escalate to show why “Obamacare doesn’t work.” It’s Trump sabotage. A strategy that will hurt his base more than the average rest of the nation. To the GOP, healthcare should be a privilege, not a right, and there is no reason, they believe, for corporate America or the government to provide or pay for it.

You can see that callousness in Trump’s recent focus on our opioid epidemic. After his recent trip to New Hampshire, where the problem is particularly acute, Trump failed to create treatment solutions to those many addicts. Instead, his answer was to fund a new ad campaign to educate against addiction (“just say no” was so effective?) and create legislation to impose the death penalty on dealers, completely ignoring the massive individuals who are already suffering, whose lives are destroyed. Aside from proposing a failed solution, Mr. Trump would expand the most expensive and least effective part of our criminal justice system: capital punishment, which now even many ultra-conservative lawmakers no long believe we can afford.

Meanwhile, the rich are being afforded a deficit-busting tax reduction that is already failing to produce those promise new, high-paying jobs. Stock buyback programs, anyone? The rich just get to keep more money and expand their wealth, creating the most polarized income inequality in the developed world. People do not matter. If we are to measure who we are, as the richest nation on earth, we need to look at how the rest of the developed world fares on healthcare and health statistics.

The March 20^th Los Angeles Times addresses some of the myths behind U.S. healthcare and health standards. Here are a few of their conclusions: “It’s no secret that the United States spends far more on healthcare than the world’s other wealthy nations, yet we get far less bang for our bucks.

By many measures, we Americans are in worse health than our global peers. Infant mortality here (at 5.8 deaths per 1,000 live births) is far above the average for a group of 11 rich countries that includes the U.S. (3.6 deaths per 1,000 live births). More than 70% of Americans are either overweight or obese; among all 11 countries, the average is 56%. And our life expectancy of 78.8 years is the lowest of any of the 11 countries, whose combined average is 81.7 years. How can this be when America spends 17.8% of its GDP on health — nearly 55% more than the group as a whole?

Newly available data from the Organization for Economic Cooperation and Development and the Commonwealth Fund help answer this perennial question. Researchers from Harvard University and the London School of Economics and Political Science combed through the data to see whether common perceptions about the U.S. health system were indeed true. They focused on how well we stacked up against 10 countries with high incomes, high health spending, and “populations with similar demographic characteristics that have similar burdens of illness,” they explained. The countries in this group were Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, Sweden, Switzerland and the United Kingdom.

The results of the analysis were published recently in the Journal of the American Medical Assn. Here’s a look at which items of conventional wisdom appear to be true and which are not supported by the data.

Americans spend more on healthcare because they use more health services.

False.

Americans did rank at or near the top in several categories of healthcare utilization. For instance, they ranked first in coronary artery bypass graft surgeries (79 per 100,000 people; the average for all countries was 54 per 100,000) and total knee replacements (226 per 100,000 people; the average for all countries was 163 per 100,000). They also got the most CT scans (245 per 1,000 people; the average was 151 per 1,000) and the second-most MRIs (118 per 1,000 people; the average was 82 per 1,000).

But overall healthcare use was “relatively similar to other high-income nations,” the researchers found. Even in the areas where the U.S. was at or near the top, “this utilization did not appear to explain a large part of the higher spending in the U.S.”…

Americans spend more on healthcare because they have too many expensive specialists and not enough primary care doctors.

False.

Primary care doctors made up 43% of the physician workforce in the U.S., the same as the average for all 11 countries.

There’s no sign that we have a glut of doctors in the U.S. The researchers tallied 2.6 physicians per 1,000 people here, compared with 3.3 physicians per 1,000 people in the 11 countries overall.

The difference was that American doctors were paid far more than their international counterparts.

For instance, a “generalist” who made $86,607 in Sweden or $108,564 in Australia earned $218,173 in the United States. (The average salary for generalists in all 11 countries was $133,723.)

Likewise, a “specialist” who brought home $140,505 in Denmark or $153,180 in France made $316,000 here. (The average salary for specialists in all 11 countries was $182,657.)

Nurses, too, were paid more in the U.S. ($74,160) than in the countries as a whole ($51,795).

The researchers noted that the ratio of (cheaper) nurses to (more expensive) doctors was higher in the other 10 countries than it is here.

Americans spend too much on healthcare because the fee-for-service system encourages doctors to order too many tests, procedures and checkups.

False.

The OECD and Commonwealth Fund data did not back this up, the researchers said. Nor did they support the idea that defensive medicine — that is, ordering services that are medically unnecessary in order to protect themselves against future lawsuits — added substantially to the country’s overall healthcare bills.

Americans spend too much on healthcare because prescription drugs are more expensive here.

True.

And it’s not even close. Overall, “U.S. spending on pharmaceuticals was almost double the spending in comparison countries,” the study authors wrote.

It’s true that we started with a vastly higher cost basis than many of the developed world for historical reasons. See my January 15^th blog, Could the United States Actually Have the Worst Healthcare System in the Developed World?, which provides specifics. It just means a slower start but is hardly a reason to move backwards. Yet as the Trump administration has attacked as ineffective failures those universal healthcare programs available in every other developed nation in the world, those living with those healthcare programs love them. See my February 11^th blog, Trump-Thought: UK’s National Health Service for a typical example. As a final note, I will repeat that within the developed world, the notion of a medical bankruptcy only exists in the United States.

I’m Peter Dekom, and it’s time to stop accelerating income inequality here in America, cease prioritizing the wealth agenda at the expense of the vast majority of us, and to begin to put people first!