Universal Healthcare: How Do We Get There from Here?

Healthcare should be a right for all Americans. The best way for this to happen will be when we finally provide universal healthcare. Most Americans agree with this. Our problem has always been having the political will to enact it. It’s been a long, winding road.

In remarks to Congress, Harry Truman said, “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.” This was 1945. There had been prior attempts as far back as the 19th century, but none had ever succeeded. Indeed Truman did not succeed. But, he did plant the seed to the next phase of healthcare provision in this country.

The first successful national legislation came in 1965 when Lyndon Johnson signed Medicare and Medicaid into law under the appreciative gaze of Harry and Bess Truman. These programs changed the health trajectory of millions of Americans. Since that time, countless lives have been saved because more people have access to medical care.

But as we know all too well, the journey to a fully implemented national healthcare system has had many stops and starts. The closest we have come is when, in 2010, Barack Obama signed the Affordable Care Act into law, which has allowed millions of people who were either priced out of the market or had pre-existing conditions, to finally get affordable insurance. The poor have greatly benefited from the program as have the sickest persons. Unfortunately, everyone has not.

Many insurance companies have withdrawn from the program based on the uncertainties of funding. They have deemed the risk too high. Some insureds have faced rising premiums due to insurance companies pulling out of counties, even out of entire states. In some places, there is only one option on the exchanges. Much of this can be attributed to a miscalculation of how many young, healthy people would sign up instead of paying the tax penalty and also because all states did not accept the Medicaid expansion. Obamacare opponents in Congress and in state legislatures have hamstrung the program, setting it up for failure.

The Republicans have made a cottage industry out of repealing and replacing Obamacare. The major problem is, they had eight years to come up with a viable alternative and they didn’t. Since the Trump Administration took office they’ve learned the hard way that it is far easier to campaign against something than it is to repeal and replace something. People don’t take kindly to having benefits taken away after they have come to depend on them. If you don’t believe me, ask those Republican legislators who braved town halls. Ask the switchboard operators and congressional staff who have had to field thousands of phone calls, emails and faxes from extremely angry constituents demanding that they keep their hands of their healthcare.

Americans have found themselves pulled in two directions. On the one hand, the Republicans offer a stingy plan that would return pre-existing condition restrictions and allow insurance companies to sell bare-bones insurance plans to healthy persons which would be insurance on paper only. Meanwhile, the sickest people would be shunted into “high-risk pools” where they would receive coverage but at exorbitant prices. By the CBO estimate, at least 22,000,000 people would be without insurance over the next ten years.

On the other hand, you have progressives offering universal and single-payer proposals. Senator Bernie Sanders just rolled out his much-anticipated plan for Medicare for All. Senator Sanders ran on a platform that was built on a foundation of universal healthcare and now he has put some flesh on the bones. His proposal calls for a four-year rollout for full implementation. The proposal has the backing of at least 20 other Democratic senators.

Universal healthcare must happen in this country.  Healthcare is not a privilege. It is a human right. We are at a crossroads where the cost of medical treatment and drugs is completely out of control. Doctors and drug companies control the prices and government programs already in place are not allowed to negotiate pricing with pharmaceutical companies. The major problem that must be addressed is the rising cost of insurance and care. Unless we can come to a place where all Americans have healthcare that won’t bankrupt them, we will continue to see a downward spiral in the health of this nation. We will see the buying power of consumers further decrease. Universal healthcare is a key to prosperity.

But there is the immediate problem of what to do with the hundreds of thousands of people who would lose jobs were the insurance industry to become obsolete and unnecessary. It is estimated that there are over 600,000 persons employed in the health insurance industry according to ThinkProgress. Also, because hospitals and medical practices have built their billing around the high costs they have been able to charge, there is a fear that there would be hospital closures and massive layoffs associated with the government’s ability to negotiate and regulate medical and drug costs.

I believe healthcare is a right for all Americans. But, I also believe we must be careful how we implement any new government single payer options. We need to make universal coverage our goal, but we have to implement steps toward it that will not harm our economy and cause massive job loss.

I believe we should first, shore up the ACA. A good place to start would be to ensure that subsidies for low-income persons will continue. Unless these subsidies continue, up to 7 million people could be priced out of the market. I would increase the subsidy amounts so that people who make up to 60,000 a year may receive the cost-sharing subsidy.

Second, the individual mandate must be continued and strengthened so that insurance providers can offset the cost of paying for their sicker consumers. I would continue the current tax penalty, but increase the amount they will have to pay should they choose not to purchase insurance. I would also withhold any refund that would be available until proof of insurance is provided. Just as you cannot drive your car without insurance, you shouldn’t be able to go without penalty if you don’t have health insurance.

Once the markets are stabilized, I believe we must restore the public option that was in the original version of the Affordable Care Act. This was removed at the insistence of the Republicans as well as former Democrat turned Independent Joe Lieberman. Several proposals have been put forward on how to do this.  Senator Chris Murphy proposes that we allow people to buy into Medicare. This differs from Senator Sanders’ plan because his Medicare for All does not have premiums. You don’t buy in, you are automatically in. Most recipients of Medicare are satisfied with their coverage and enjoy benefits at a lower cost with low deductibles. The thinking is that when enough people are enrolled in Medicare, the private insurance market will gradually diminish and this will pave the way for single-payer, universal coverage.

We must maintain acceptable levels of benefits, including women’s health concerns. While abortion remains controversial, I would seek to put in place adequate funding for contraceptive services which includes safe, legal abortion. We must not continue making women’s lives and the choices they make to control their own bodies a secondary concern when it comes to healthcare. Women deserve to be able to access the full range of services they require to have healthy, happy lives.

While private insurance will decrease, there would still be opportunities for business by selling supplements. Coverage for things like cosmetic surgery or other elective procedures not considered medically necessary should be augmented on the private market and not at the expense of the taxpayers. Many Americans already purchase Medicare supplements to offset costs Medicare doesn’t cover. There will still be a need for these.

Once people have moved to this single payer option, then we move toward free Medicare for all.

Of course, it must be funded. John Conyers, Democrat from Michigan has put forth a bill, H.R. 676, which proposes funding from an array of sources.

The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill

Yes, there will be tax increases but they would be distributed based on income level. This would be taken out of your paycheck. Where you see deductions for Social Security and FICA, you would add a deduction for healthcare. The cost would be modest compared to the current premiums paid for health insurance. Also, the government already has billions of dollars dedicated to healthcare in the budget. Naturally, this would roll over into any new plan. One suggested addition to any legislation passed has been to add a line item to paychecks now that require your employers to show what they’re contributing to your healthcare premiums so when changes are made to the system, it will be harder for employers to keep the premium savings without compensation changes to the worker.

There are various ideas concerning a time table for moving to universal coverage. The Conyers bill sets a deadline of two years, while the Sanders proposal is four years. I recognize the longer we delay in implementing universal coverage, the more lives hang in the balance.

But the healthcare system in this country is both complex and cumbersome. There are trade offs to any change. I believe there needs to be adequate time allotted for the markets to adjust and absorb the new way of providing healthcare for Americans. I tend to believe it will take longer than four years for a complete transition and I believe adequate time should be given. If we fail to get this right, we will end up breaking both the healthcare industry and the economy in the process.

The time has come to move from conversation to action. I believe the American people deserve it. We must do our best to see to it that a parent no longer has to worry about cost when trying to take care of their sick child. The time has come where it doesn’t bankrupt a person when they have to care for an elderly parent. The time has come. The question is, will we have the will to do this? As your Congressman, I will work hard every day to make it so.

Healthcare Bill Defeat

Let me be clear, I am THRILLED the Senate GOP’s latest attempt to “fix the ACA” failed. I’m here in Washington and was with Elizabeth Warren earlier in the day.

I am very thankful for Senators Collins and Murkowski for their long, principled stand for their constituents. I am thankful that Senator McCain followed up on the message of his speech earlier in the week during the motion to proceed vote that if Senate Leadership did not deliver a viable option, he would vote no.

But please understand that despite the people of America winning this current battle, the war is long from over. In order to pass the tax cuts for the wealthy that they want to pass so badly, they need to get the money from somewhere. Cutting this is a big piece required to pass their plan. They will not walk away from this fight. They’re going to come back in some other way, likely with little warning.

Be vigilant, continue to stand together to amplify our voices, and make sure you support those of us working hard to overturn their majorities in Congress so we can stop the assault on the ACA and move towards single-payer or at the very least a strong public option such as Medicare for all.

-DWB

About Healthcare: Healthcare Should Be a Right

Last week, I had a bit of a Twitter rant thread after reading some posts by Senator John Cornyn:

[<a href=”//storify.com/davidwbrown/healthcare-is-a-right” target=”_blank”>View the story “Healthcare is a right” on Storify</a>]

Do you think Healthcare is a right? It is not spelled out as such in our Constitution. Why is that?

We’ve been doing research on doctors during that period of time. First, they clearly had a lot less knowledge then than we do now. In the 240+ years since the American Revolution began, the knowledge that we have discovered is incalculable.

For example, here are just a few of the major medical advancements in the first two hundred years of our nation:

1796 – Experiments with a means to protect against smallpox lead to the discovery of vaccines.

1842-6 – First implementation of anesthesia.

1870 – The establishment of the germ theory of disease.

1895 – Discovery of X-Rays.

1901 – Discovery of blood types.

1953 – Discovery of DNA.

1955 – Development of the Polio Vaccine.

1967 – First successful human heart transplant.

Back in frontier days, “rural settlers often had nothing to pay with except the fruits of their labor. Doctors would commonly be paid in cord wood, produce, meat, eggs, blankets or other items of value.” But treatment was never withheld due to lack of means. A family was just expected to pay what they could.

So a combination of little knowledge, and therefore few options, plus a doctor’s Hippocratic Oath made enumerating the right a moot point. In a sense, we started with universal healthcare if you lived near a doctor.

In the time since then, medical care has become a major money-making segment of our economy. Many people are employed by the industry and there are major profits made by corporations in the medical industry. It will not be an easy process to rework it without risking many jobs and without major lobbying resistance.

We’ve made so many advances in medical science, but much of that innovation has come in the US due to the investment by the capitalist model of medicine. Does that mean that innovation and discovery are stifled in a universal healthcare system? Studies suggest that would not be so, with proper funding of research by the government.

One of the biggest obstacles to universal healthcare in the US is how Republicans have formed the idea that choice equals freedom. If you lose choices, you lose some of your liberty. Just look at the Cruz amendment to the BCRA, being called the “Consumer Freedom Option”. But that is a perspective of privilege. Working class people often have no good choices – either have insurance that is very expensive or don’t and risk potentially suffering from that lack of it.

So the question remains: Is healthcare a right in the US? I believe so, but our current for-profit model will need to be dramatically reworked to achieve what we deserve – universal healthcare, covering every US citizen. As we get to that place, we must shore up the ACA in order to keep the most vulnerable covered as we make the major changes to get to the place where we cover every American, by right.

I plan to follow this article up with one that will address the ACA, including what needs to be done to fix it in the short term, and another about how we can get to our final destination of universal healthcare.