Our National Health Care Situation

[Shirley]

I originally wrote this in response to other posts in one of the "non-political" forums. It loses a bit in the transition, but hopefully still makes a point, and starts a constructive discussion.

...And, not to get "partisan", but in 1945, almost 80 years ago, democratic President Harry Truman, only 7 months into his presidency, proposed a "universal national health insurance program". In his remarks to Congress, he declared, “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”

(Isn't that what you (pdub) and Tdub are talking about? Not being able to get the health care you need because it's too expensive?)

Twenty years later, in July of 1965, against massive opposition, when democratic President Lyndon Baines Johnson formally signed the Medicare and Medicaid programs into law in Independence, Missouri, former president Harry S. Truman and his wife, Bess, looked on with pride. As LBJ handed “Give ‘Em Hell Harry” and Bess the pens he used to affix his signature to the document, the President proclaimed Mr. Truman as “the real daddy of Medicare.”

Does anyone recall the demagoguery republicans deployed against President Obama when he proposed the Affordable Care Act? Much like when Johnson created Medicare and Medicaid, there was unrelenting negative catastrophizing by the opponents, republicans, talking about how it will be the end of western civilization, America, as we've known it. Back in the '60s, the opponents warned that all the physicians in America would quit if Medicare/Medicaid passed. "Socialism!" (One of their preferred propaganda terms.)

Republicans have run on repealing the ACA for multiple election cycles, and tried to repeal it in congress more than 60 times. Some republicans still talk about repealing it to this day! (Newsweek "found at least 70 republican-led attempts to repeal, modify, or otherwise curb the ACA, since its inception into law on 3/23/2010".)

A clear majority of Americans like the ACA. As of early 2023, more than 40 million Americans have health insurance coverage under the ACA, the highest total on record. As of early 2022, the national uninsured rate in the US reached an all-time low. 92% of enrollees have access to options from three or more insurance co.s, which they can compare to each other at healthcare.gov.

Affordable Care Act health plans are most popular among people in states where the law is least popular among politicians and ACA enrollments have climbed under Biden, according to new charts from Steve Rattner.
2/2/23 Red states see highest Affordable Care Act enrollment rates

So, with all due respect, please don't give me this generic "rich guys*", "congress", "the government", and/or "lobbyists", i.e., "both sides do it", excuse. Please. Because it's not being real, it's falling for the republican propaganda.

If one of your wishes as an American is to have a more comprehensive national health insurance program like "Medicare for All" available to chose from, do I need to tell you who to vote for?

Pro tip: Americans absolutely love Medicare.

*Which is not to say there aren't rich democrats who oppose it, but still, they aren't the problem. (Dear Joe Manchin, stfu!)

[jfish26]

I have more to say on this (and am very much an outside observer except for limited direct work experience), but for now: I am a free market person. I generally think that a free market will produce efficiency and choice and value and all sorts of other good things.

One of the most common arguments against single-payer is that departing the free market approach to healthcare would, among other bad things, inhibit efficiency and choice and value.

However, it is extremely important to understand that we are not presently dealing with a free market.

We are dealing with a rigged market, where, as I understand it, non-value-producing intermediaries (PBMs are often a good example) suck so much cash out of the system (while also contractually limiting competition and alternatives) that consumers and providers ALIKE are basically suffering the worst of both worlds.

And then you get into the effect of the present system (others can judge for themselves whether this is intentional or not), which is essentially inhibiting socioeconomic upward mobility by saddling lower classes with shitty and expensive healthcare (and attendant crippling healthcare debt).

[zsn]

I have worked for nearly 30 years in the pharmaceutical industry. I have spent a lot of time in Europe and Canada (>20% each year since 2015) and had two Canadian direct reports (from 2007-2014). So, with that set up I’ll give my take on the US healthcare system.

1. Employer-based health insurance is the worst thing that happened to our country.

2. If one were to design a system that would be the worst of all worlds what we have currently is exactly how one would design it.

3. For-profit (“free market”) health insurance is fraudulent by definition. The insurance company makes money for the investors by taking in more money than they pay out. So, if they pay out fairly they are defrauding their investors. If they don’t they are defrauding the customers.

Don’t even get me started on the pharmaceutical companies lobby, and their wholly owned whores known as the Republican Party (and some members of the Democratic Party, such as Manchin).

[Shirley]

I have worked for nearly 30 years in the pharmaceutical industry. I have spent a lot of time in Europe and Canada (>20% each year since 2015) and had two Canadian direct reports (from 2007-2014). So, with that set up I’ll give my take on the US healthcare system.

1. Employer-based health insurance is the worst thing that happened to our country.

2. If one were to design a system that would be the worst of all worlds what we have currently is exactly how one would design it.

3. For-profit (“free market”) health insurance is fraudulent by definition. The insurance company makes money for the investors by taking in more money than they pay out. So, if they pay out fairly they are defrauding their investors. If they don’t they are defrauding the customers.

Don’t even get me started on the pharmaceutical companies lobby, and their wholly owned whores known as the Republican Party (and some members of the Democratic Party, such as Manchin).

^^^^^^^^^^^^^^^^^^^^^^^^^

Thank you for your insight, zsn.

Americans are so thoroughly brainwashed by that one aspect of our health care "system", they're totally oblivious and unaware of the profound compromises and sacrifices they make in their lives in terms of the missed opportunities, choices, and lack of mobility they would have at their disposal otherwise, if they obtained their health care coverage through an alternate means.

To name only one example: Instead of being anchored by a health insurance ball and chain to a job they hate or find unfulfilling because they're afraid they'll lose their health insurance if they leave, they might instead be willing to take a chance and start their own business, work two part-time jobs they like, or even move to a different area of country, instead.

[jfish26]

I have worked for nearly 30 years in the pharmaceutical industry. I have spent a lot of time in Europe and Canada (>20% each year since 2015) and had two Canadian direct reports (from 2007-2014). So, with that set up I’ll give my take on the US healthcare system.

1. Employer-based health insurance is the worst thing that happened to our country.

2. If one were to design a system that would be the worst of all worlds what we have currently is exactly how one would design it.

3. For-profit (“free market”) health insurance is fraudulent by definition. The insurance company makes money for the investors by taking in more money than they pay out. So, if they pay out fairly they are defrauding their investors. If they don’t they are defrauding the customers.

Don’t even get me started on the pharmaceutical companies lobby, and their wholly owned whores known as the Republican Party (and some members of the Democratic Party, such as Manchin).

^^^^^^^^^^^^^^^^^^^^^^^^^

Thank you for your insight, zsn.

Americans are so thoroughly brainwashed by that one aspect of our health care "system", they're totally oblivious and unaware of the profound compromises and sacrifices they make in their lives in terms of the missed opportunities, choices, and lack of mobility they would have at their disposal otherwise, if they obtained their health care coverage through an alternate means.

To name only one example: Instead of being anchored by a health insurance ball and chain to a job they hate or find unfulfilling because they're afraid they'll lose their health insurance if they leave, they might instead be willing to take a chance and start their own business, work two part-time jobs they like, or even move to a different area of country, instead.

And of course it makes no more sense to get health insurance from your employer than it would through any other group; HOAs, kid sports teams, alumni networks, hobby associations.

I’m not, of course, suggesting we DO any of those things. It would just make exactly as much sense as going through employers.

(It’s here where I’d note that, from my perspective anyway, the whole logic behind obtaining insurance in groups so as to smooth out relative costs/needs/attributes…sorta just sounds like centralized healthcare already anyway…)

[Shirley]

...Republicans have run on repealing the ACA for multiple election cycles, and tried to repeal it in congress more than 60 times. Some republicans still talk about repealing it to this day! (Newsweek "found at least 70 republican-led attempts to repeal, modify, or otherwise curb the ACA, since its inception into law on 3/23/2010".)

...As of early 2022, the national uninsured rate in the US reached an all-time low.

Trump posted this yesterday. Rumor is he will propose the republican replacement plan for the ACA during "Infrastructure Week"...

[Shirley]

This is what republicans plan to do nationwide once they get the chance.

The great state of Texas, where poor women are forced to have babies so they can then watch the babies suffer and die for lack of medical care.

All courtesy of the "pro-life" Republican Party.

[ousdahl]

https://apnews.com/article/medicaid-eli ... 6fbea60328

[Shirley]

https://apnews.com/article/medicaid-eli ... 6fbea60328

Yeah, let's blame the federal government for a program that they help fund, but that states administer and have the flexibility to determine what populations and services to cover, how to deliver care, and how much to reimburse providers...

smh

[jfish26]

...Republicans have run on repealing the ACA for multiple election cycles, and tried to repeal it in congress more than 60 times. Some republicans still talk about repealing it to this day! (Newsweek "found at least 70 republican-led attempts to repeal, modify, or otherwise curb the ACA, since its inception into law on 3/23/2010".)

...As of early 2022, the national uninsured rate in the US reached an all-time low.

Trump posted this yesterday. Rumor is he will propose the republican replacement plan for the ACA during "Infrastructure Week"...

As someone interested in not-Trump winning in 2024: please DO continue to make 2024 about healthcare.

Because making elections about women's healthcare is going so well for the Rs, what an idiot.

[zsn]

And of course it makes no more sense to get health insurance from your employer than it would through any other group; HOAs, kid sports teams, alumni networks, hobby associations.

I’m not, of course, suggesting we DO any of those things. It would just make exactly as much sense as going through employers.

(It’s here where I’d note that, from my perspective anyway, the whole logic behind obtaining insurance in groups so as to smooth out relative costs/needs/attributes…sorta just sounds like centralized healthcare already anyway…)

I wonder if anyone has calculated the lost opportunity cost for exactly this reason. When we were laid off from our employer about a decade ago me and my team felt that we were among the best in the industry at doing what we did. The reason for the layoff was that the company needed cash to get the product over the finish line, due to one of the trials not meeting its endpoint. They were doing everything (selling equipment, subleasing space etc). We we discussing starting a contract research firm with the same space and equipment. With our knowledge, experience and connections we would have been extremely successful.

One reason it didn’t happen was because all of us were too scared to take the plunge. At the stage of life we were in (many of our spouses were not employed) reliable health insurance was very important to us and we didn’t know how and where to get affordable insurance coverage.

[jfish26]

And of course it makes no more sense to get health insurance from your employer than it would through any other group; HOAs, kid sports teams, alumni networks, hobby associations.

I’m not, of course, suggesting we DO any of those things. It would just make exactly as much sense as going through employers.

(It’s here where I’d note that, from my perspective anyway, the whole logic behind obtaining insurance in groups so as to smooth out relative costs/needs/attributes…sorta just sounds like centralized healthcare already anyway…)

I wonder if anyone has calculated the lost opportunity cost for exactly this reason. When we were laid off from our employer about a decade ago me and my team felt that we were among the best in the industry at doing what we did. The reason for the layoff was that the company needed cash to get the product over the finish line, due to one of the trials not meeting its endpoint. They were doing everything (selling equipment, subleasing space etc). We we discussing starting a contract research firm with the same space and equipment. With our knowledge, experience and connections we would have been extremely successful.

One reason it didn’t happen was because all of us were too scared to take the plunge. At the stage of life we were in (many of our spouses were not employed) reliable health insurance was very important to us and we didn’t know how and where to get affordable insurance coverage.

Healthcare is not strictly a partisan issue.

However, if the Rs have their way and repeal the ACA, the effect (we can debate the mix of intentional vs. inadvertent) will be to limit upward socioeconomic mobility.

[ousdahl]

https://apnews.com/article/medicaid-eli ... 6fbea60328

Yeah, let's blame the federal government for a program that they help fund, but that states administer and have the flexibility to determine what populations and services to cover, how to deliver care, and how much to reimburse providers...

smh

Well, the federal government DOES help to fund it, right?

But, in the interest of getting along - I don’t disagree!

Just as generally as possible tho, I wish such headlines were less “Biden slow to act” and more something like, “Biden working hard toward any and every angle possible to make US healthcare a little less nightmarish”

And to be fair, I think he HAS at least, like, capped the price of insulin? What else?

[ousdahl]

As someone interested in not-Trump winning in 2024: please DO continue to make 2024 about healthcare.

Yes!

I think healthcare could be one of, if not thee, slam dunk issue for dems to score points with voters.

But, here’s the thing: I think Biden and dems need to offer something to materially improve the healthcare situation.

rather than…

- just this pub boogeymanning - “they gonna try to repeal Obamacare again!”, “they kicking poor folks off Medicaid!”, and so on. Don’t just point fingers, do something to counter!

- still hanging their hat on Obamacare, which has been controversial from the get-go. And for like 14 years in now?, ACA has been the incumbent healthcare policy, which has hardly mitigated the obscene costs and other related horrors of healthcare today.

- very narrowly prescribed measures (e.g. cap insulin), which, though good in itself, is still the band aid on a bullet wound, and may not be worth much if it’s the only healthcare talking point Biden has to offer

[Shirley]

https://apnews.com/article/medicaid-eli ... 6fbea60328

Yeah, let's blame the federal government for a program that they help fund, but that states administer and have the flexibility to determine what populations and services to cover, how to deliver care, and how much to reimburse providers...

smh

Well, the federal government DOES help to fund it, right?

But, in the interest of getting along - I don’t disagree!

Just as generally as possible tho, I wish such headlines were less “Biden slow to act” and more something like, “Biden working hard toward any and every angle possible to make US healthcare a little less nightmarish”

And to be fair, I think he HAS at least, like, capped the price of insulin? What else?

I guess your reading comprehension skills are right up there with Illy's.

[Shirley]

As someone interested in not-Trump winning in 2024: please DO continue to make 2024 about healthcare.

Yes!

I think healthcare could be one of, if not thee, slam dunk issue for dems to score points with voters.

But, here’s the thing: I think Biden and dems need to offer something to materially improve the healthcare situation.

rather than…

- just this pub boogeymanning - “they gonna try to repeal Obamacare again!”, “they kicking poor folks off Medicaid!”, and so on. Don’t just point fingers, do something to counter!

- still hanging their hat on Obamacare, which has been controversial from the get-go. And for like 14 years in now?, ACA has been the incumbent healthcare policy, which has hardly mitigated the obscene costs and other related horrors of healthcare today.

- very narrowly prescribed measures (e.g. cap insulin), which, though good in itself, is still the band aid on a bullet wound, and may not be worth much if it’s the only healthcare talking point Biden has to offer

Are you aware that Democrats had a one vote majority in the senate from '21 - '23, and that Manchin and Sinema regularly challenged many of the things they tried to do to help the American people?

[Shirley]

In a tweet from May 7, 2015, when Trump was running for the republican nomination he said:

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.”

Of course, being a republican, Trump eventually reverted to the republican mean:

Trump’s 2020 budget proposal was was to spend $1.5 trillion dollars less on Medicaid and instead allocate $1.2 trillion in a block-grant program to states which would have much more discretion on how it was spent, i.e., not necessarily on health care for low-income Americans, $25 billion dollars less on Social Security, and $845 billion dollars less on Medicare.

In 2020 the Trump Admin. also unveiled a major shift in Medicaid, allowing states to be able to cap a portion of the federal money they received, which would likely diminish the number of people in the state receiving health benefits, and spend it on other things.

As of early 2022, the national uninsured rate in the US reached an all-time low.

[zsn]

Healthcare is not strictly a partisan issue.

However, if the Rs have their way and repeal the ACA, the effect (we can debate the mix of intentional vs. inadvertent) will be to limit upward socioeconomic mobility.

While not strictly partisan, there’s a huge partisan component to it. Kathleen Sibelius (someone familiar to many here, if not all) was involved intimately with our company (in a capacity I don’t wish to disclose). She gave us a very interesting talk on the past, present and future of healthcare delivery (this was around 2016). She recollected the goings-on during 2009-10 regarding the negotiations around the passage of the ACA.

One very profound anecdote she related was around getting at least some Republicans on board by incorporating elements that they had originally proposed. However, one prominent Republican told her that they wouldn’t give any support because “there was nothing in it for them” - if it was successful they wouldn’t get any credit and it it wasn’t they would get the blame.

How about that for standing on principles and profiles in courage!!!

[Shirley]

Healthcare is not strictly a partisan issue.

However, if the Rs have their way and repeal the ACA, the effect (we can debate the mix of intentional vs. inadvertent) will be to limit upward socioeconomic mobility.

While not strictly partisan, there’s a huge partisan component to it. Kathleen Sibelius (someone familiar to many here, if not all) was involved intimately with our company (in a capacity I don’t wish to disclose). She gave us a very interesting talk on the past, present and future of healthcare delivery (this was around 2016). She recollected the goings-on during 2009-10 regarding the negotiations around the passage of the ACA.

One very profound anecdote she related was around getting at least some Republicans on board by incorporating elements that they had originally proposed. However, one prominent Republican told her that they wouldn’t give any support because “there was nothing in it for them” - if it was successful they wouldn’t get any credit and it it wasn’t they would get the blame.

How about that for standing on principles and profiles in courage!!!

Thanks for sharing that story.

I only wish it was a surprise.

[Sparko]

I suppose Ewing Kaufman and the Royal Lancers gave us so much more than affordable health care. In retrospect.