Americans Battle Over Coverage and Ignore Real Healthcare Problems – this is pitiful

I ran across two interesting articles on FiveThirtyEight related to health care. It’s good to understand the history of our weird hybrid system and important to know the facts – but depressing.

[A Department of Health and Human Services

Congress argues over a band aid on America's health care

As one of my favorite science fiction franchises says, the answer doesn’t make any sense unless you know precisely what the question is.

report says] health insurance marketplaces set up by Obamacare were relatively stable in 2016. Contrary to the “death-spiral” narrative, the CMS report found that the mix of healthy and sick people buying insurance on the Obamacare marketplaces in 2016 was surprisingly similar to those who enrolled in 2015.

That doesn’t mean the marketplaces are working for everyone. There are millions of people who don’t qualify for subsidies, face high prices in the private market and likely haven’t enrolled in insurance as a result. That’s a problem that needs solving, but it’s a different problem than the marketplaces being in a death spiral.

The agony of repeal and replace is unnecessary – the current political agony and future individuals’ agony if the CBO’s estimate of who loses health care is roughly correct. A bipartisan effort to repair the dysfunctional parts of the Affordable Care Act (drop Obama’s name and maybe the Red Team will feel better) could succeed. Especially if followed by an honest effort to tackle the nation’s real problem – rocketing health care costs.

The two parties agreed only briefly on Medicaid, back when it was first established in 1965. Ever since, Republicans have tried to ratchet back Medicaid, perhaps by imposing per capita spending ceilings or switching the program to block grants. Democrats have gone in the opposite direction, trying to expand coverage.

The back and forth has seen wins and losses on both sides. I’ll pick on Republicans because they’re currently in power: Their claim that a Medicaid card doesn’t get you actual treatment because no one accepts Medicaid leads me to observe – then Medicaid must not actually cost anything so why are you worried about it?

Today Medicaid covers a majority of nursing home patients (after the family has spent down their own savings – I’ve watched that happen), nearly half of all children and births in the nation, and working adults who can’t swing health care.

Medicaid is one of the federal government’s largest expenses, after Social Security, defense and Medicare. It’s the second-largest expense to states, after education.

I can offer one personal story: a lady I know who had surgery for a non-life-threatening condition through Medicaid and thereby went from disability to holding two jobs. They aren’t very good jobs and whatever taxes she pays may never reimburse the government for her treatment – but a measure of independence rather than total dependence on the government is a moral victory for me.

The battle lines are drawn so ferociously that I despair of any real progress in the foreseeable future. Mitch McConnel’s ultimate threat to scare Republicans into following his lead is: he’ll reach out to Democrats otherwise. That’s nauseating.

What bothers me the most is watching all this energy going into a war over coverage when the real problem is cost. Republicans and Democrats keep pushing the same familiar “solutions” without analyzing the problem.

The U.S. leads the world in health care research and cancer treatment… [But we have] fewer physicians per person than in most other OECD* countries… and the average American lives 78.7 years [2010 data], more than one year below the OECD average of 79.8 years…

The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person.

* Organization for Economic Co-operation and Development (OECD) — an international economic group comprised of 34 member nations. pbs.org

Surely we can do as well as the rest of the OECD world.

BTW – the fivethirtyeight article says that the [Lyndon Baynes] “Johnson administration used Medicaid and Medicare to force the integration of segregated Southern hospitals.” Note the word “force.” Fascinating. We continue to suffer from America’s Original Sin.

4 thoughts on “Americans Battle Over Coverage and Ignore Real Healthcare Problems – this is pitiful

  1. There is no shortage of commentary about our healthcare problems, but almost nobody is talking about real, doable solutions. Maybe there aren’t any? As you point out, both political parties are hopelessly mired in their ideologies, so no help from that quarter. I’m a full-blown pessimist when it comes to the Federal government anyway, but this bonbon is a hundred-faceted Rubic’s Cube. Getting costs down is imperative, but how? Extending care to more people in rural areas is imperative, but how? Taking care of the elderly? Gotta do that, but who pays? The list just goes on. And at some point we run out of resources. That’s the real problem with Obamacare – it set the expectations for healthcare at a level that is unsustainable, and now there is no going back. The most piteous examples of whatever segment of the population loses any tidbit of benefit will be paraded across the media while Schumer and Pelosi drone on about how Republicans want to kill everyone except unborn babies. Hard to engage in rational debate with everybody tradiing insults. But some facts are beyond debate. Obamacare cannot continue without either a massive infusion of subsidies or some sort of drastic cost control structure. Cost controls will lead to shortages of care, which will lead to longer wait times for care. This is happening in every country that has tried to provide universal, unconstricted care, and none of those countries has to deal with the population size or diversity that we must. Our Federal budget is straining at the seams and we are 20 trillion in debt. If we returned to the tax structure we had in the 60’s and eviscerated military spending we still could not afford universal care at the use levels we are seeing. We have no clue when the debt tipping point will hit and yes, the United States could go bankrupt.

    There should be a brief history of US healthcare next to the term, Gordian Knot on Google. Whichever string you pull the knot gets tighter. So I fear that debating healthcare is past fruitless at this point, though as I said, I’m all glass-half-empty. My hope for the future is in medical science and the winnowing of the population by the attrition of lousy eating habits and general sloth. My personal health plan is to eat right, exercise and die anyway. We pessimists are almost never disappointed.

    • The problems do feel overwhelming – there are a variety of systems used in various countries that we can study (note that not even all European countires do health care the same way.) But one thing I’ve observed is – no matter what the system, it periodically has problems that become major before anyone “fixes” them. I don’t think we’ll ever set-and-forget healthcare. I read somewhere the cute phrase that America is a vast insurance company that also has an army. Whether you chuckle or groan, it’s a major part ofAmerica today.

      • I was rereading your post today and thought I’d note one of the reasons US per capita healthcare costs are so high compared to other countries. I think it has mostly to do with the size and diversity of population, and a prime example of this is hospitals in smaller communities.

        In rural America, hospitals tend to be around 100 – 200 beds, but many smaller ones are out there, struggling to stay afloat. These clinic-sized establishments are often economic drivers for the communities they support and are rightly seen by locals as being just as vital to their town’s economic health as they are to the physical health of its residents. Leadville is a case in point.

        These small establishments lack economy of scale and are very costly to operate, but most of that money trickles down into the community and helps support other businesses. A town with a hospital is also much more likely to sustain, if not grow, its population. I’ve seen this happen first hand in the town (and hospital) I was born in; Salem, Ohio. Located well inside the borders of Appalachia, Salem was the second largest town in Columbiana County, only about half the size of the largest, East Liverpool. Over the years Salem’s little hospital has grown into a highly-rated regional healthcare center and has allowed the (now) city to actually gain residents despite the loss of several major factories. It is now the largest city in the county, and has both a Walmart and a Home Depot, a sure sign of relative economic health.

        This is just one of many examples of how the economics of healthcare make the politics of healthcare so convoluted. No matter what you try to do to make it more cost efficient you will be pissing in somebody’s porridge.

        • Excellent point. Since the Rural Electrification days, America has been willing to support its rural communities disproportionally. Also – we’re a big country so comparing Americans’ access to big urban hospitals with – say – someone in Europe probably shows up the extra US cost. My small town (12,000 people in a county of 30,000) has a regional hospital that is sinking into financial difficulties and the town is worried. I’ve found it ironic that many of America’s so-called “angry” voters are my fellow rural residents and don’t seem to appreciate receiving more government dollars than they pay in taxes. Hospitals – airports – fiberoptics… Shoot, a lot of the sidwalks in town have WPA 1929 imprinted in the concrete.

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