Jacob S. Hacker, Yale professor and author of many books and article critiquing the American political system, economy, and the fate of the poor and middle classes, reviewed a new book, AN AMERICAN SICKNESS: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal (NY: Penguin Press, 2017). Most of the review takes up the question of why healthcare is not like other commodities and does not fit into the “let the market solve the problem” ideology of the last 40 years. If you are unpersuaded now, this is useful territory. towards the end of the review Hacker turns to our developed country competitors’ approaches to healthcare.
“The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. ….. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.”
This is a great summary statement. Using a variety of tools and institutional arrangements every other government controls prices and healthcare budgets. They do not allow a one-sided market to focus on delivering as many procedures and prescriptions as possible without any systematic focus on health. My criticism is that Hacker should have provided two further data points to put the outrage of American healthcare in its true global setting: US healthcare spending compared to other developed countries and health outcomes relative to other developed countries. As the chart below demonstrates, the US spends more than 25% more than our closest competitor, Switzerland, and twice as much as most including japan, France, Australia and Canada. The health outcomes are woeful. We rank 42 in the world for longevity and 56th for infant mortality. ((see https://www.cia.gov/library/publications/resources/the-world-factbook/)) These facts need to be front and center in our thinking about healthcare. The developed world is filled with universal healthcare systems with many different structures and approaches, all with several decades of experience at delivering better healthcare at much less expense. The only question is how will poor and middle class people in the united states gain enough political power to end this great rip-off??
Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to other pieces of legislation frequently calling for comprehensive knowledge of the topic to even begin understanding its implications.
The site also spends a lot of time bad-mouthing Obamacare. I get it. Republicans don’t like Obamacare. The question is how will they improve upon it??
The election of Trump and the continued Republican control of both Congress and Senate guarantee that the rich will continue to get richer at the expense of the shrinking middle class and further aggravate conditions for the poor. Trickle down economics and tax subsidies will flow for the rich and corporations. The financial sector will buy its way out of the weak regulations of Dodd/Frank and lurch towards new adventures in gambling; a financial disaster will once again require the socialization of their risk at taxpayer expense. Continue reading →
The rhetoric about our health care system continues to center around market religions of one sort or another. For all of the blathering about “Obamacare” taking us over the edge into the territory of socialized medicine, it remains, like it’s progenitor dreamed up by Romney while governor of Massachusetts, a market focused policy. Even now Massachusetts is struggling to come up with policies to restrain the growth of costs to the rate of inflation plus 1%. At the national level it will be years before Obamacare can begin such considerations in real terms.
What is missing is a willingness by the political system to engage the undeniable truths about our health care system. Continue reading →
It is fairly widely known that income and wealth inequality in the US is as high or higher than at any time except perhaps the Robber Baron period at the end of the 19th century. Lots of articles and books explain how this has come about over the last 30 years. In a recent NYTimes Magazine article, “The Purpose of Spectacular Wealth, According to a Spectacularly Wealthy Guy” by Adam Davidson, we are even offered an affirmative defense of this by a buddy of Mitt Romney from Bain Capital Edward Conrad.
Conrad… “aggressively argues that the enormous and growing income inequality in the United States is not a sign that the system is rigged. On the contrary, Conrad writes, it is a sign that our economy is working. And if we had a little more of it, then everyone, particularly the 99 percent, would be better off.”
But, leaving aside the obvious disconnect between any rational measure of value add by the wealthy and their incomes and holdings, does economic inequality really matter? Is it just that those of us in the not wealthy class, now branded The 99%, are jealous of all the toys of the wealthy? Their four or five houses, countless cars, airplanes, and all the rest?