The legacy of Obamacare: A five percent increase in heart patient deaths

15 November 2017

When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet  murder it remains. (Friedrich Engels, The Condition of the Working Class in England, 1845)

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A US government program supposedly devised both to improve medical care and cut costs has, predictably, succeeded in the latter while undermining the former. Research published Sunday in JAMA Cardiology (Journal of the American Medical Association) shows that an initiative introduced five years ago under the Affordable Care Act (ACA) to induce hospitals to reduce Medicare readmissions for heart patients has resulted in an increase in mortality rates among those studied.

Under the ACA’s Hospital Readmissions Reduction Program (HRRP), hospitals were penalized financially when heart failure patients were readmitted within a month. While the program has succeeded in reducing the number of 30-day readmissions, the number of patients who died within a year rose by 5 percentage points. According to one of the study’s senior authors, these findings could account for an additional 5,000 to 10,000 deaths annually across the US due directly to the program.

For the American ruling elite, HRRP and other schemes devised by bureaucrats at the Centers for Medicare and Medicaid Services (CMS) are part of an agenda that is as deliberate as it is ruthless: Men and women in the US are living too long into old age and measures must be taken to cut costs associated with their medical care and shorten their life expectancy. This is the deadly price that must be paid to prop up a society that is one of the most socially unequal both in terms of income and the delivery of health care.

The statistics do not lie. Study researchers analyzed 115,245 patients at 416 hospitals in the American Heart Association’s Get With the Guidelines-Heart Failure registry from January 2006 to December 2014. They examined readmission and death rates before and after the program began in 2012.

* Readmission rates within one month fell from 20 percent before HRRP penalties to 18.4 percent after HRRP (down 1.6 percent). Mortality rates, however, rose by almost the same rate, from 7.2 percent before HRRP to 8.6 percent after (up 1.4 percent).

* Statistics for readmission and mortality within one year were even more damning. Readmission within one year fell by only about 1 percent, from 57.2 percent before HRRP to 56.3 percent after. But the mortality rate within one year rose from 31.3 percent before HRRP to 36.3 percent after—a shocking 5 percent increase. These figures show that there is a direct correlation between implementation of the Obamacare policy and preventable deaths.

HRRP penalizes hospitals up to 3 percent of every Medicare dollar for “excessive” repeat hospital stays. That is 15 times more than the 0.2 percent penalty levied against hospitals with high mortality rates. In other words, while hospitals with higher rates of mortality face a minimal fine, hospitals are being substantially penalized for failure to comply with a program that is resulting in increased deaths.

Compounding the misery, financial penalties from HRRP have been shown to fall disproportionately on academic medical centers and “safety-net” hospitals where “higher readmission rates are associated with the higher case-mix complexity and lower socioeconomic status,” according to the study, i.e., those treating poorer and sicker patients. In such settings, hospitals are incentivized to “game” the system by delaying admissions, increasing observation stays or shifting inpatient-type care to emergency departments, to the detriment of patient welfare.

The US mortality rate rose in 2015 in the first year-over-year increase since 2005, with life expectancy falling between 2014 and 2015 from 85.8 years to 85.6 years for men, and from 87.8 years to 87.6 years for women. According to the Centers for Disease Control and Prevention, this decline was due to an increase in eight of the 10 leading causes of death in the US, including heart disease, stroke, Alzheimer’s disease and suicide.

With heart disease rising, there is no other way to interpret the penalties imposed by the ACA for early readmission of heart patients than a deliberate effort to see more men and women die. US corporations are already reaping a grim dividend from this downward trend, with at least 12 major corporations reporting this summer that they have reduced their estimates for how much they could owe in pension and other retirement obligations by a combined $9.7 billion due to shorter life spans.

It is fitting that the health care overhaul known as Obamacare was the instigator of HRRP, an irrefutable demonstration that the ACA was the first major volley in the bipartisan drive to restrict access to affordable health care and sharply reduce the length of workers’ lives.

As the World Socialist Web Site explained as early at 2009, the Obama administration’s health care “reform” established a framework for the insurers, the corporations and the government to drastically reduce the health benefits available to low- and middle-income individuals and families. The aim is to limit the amount that the government must pay out for health care and Social Security payments, as well as what corporations must pay in pensions and other retirement benefits.

Health care in the Obamacare era has nothing in common with quality, near-universal health care, as Obama initially pledged. It is based entirely on the for-profit health care system in America, including the insurance companies, giant hospitals, health care chains and pharmaceutical companies. Any repeal of the ACA—and its replacement with “Trumpcare” or any other legislation—will maintain the class-based delivery of health care and undoubtedly worsen it for the majority of Americans.

The empirical proof provided by research published in JAMA Cardiology that an ACA program has predictably caused increased deaths should serve as a stark warning to the working class. This Obamacare program is of a piece with the bipartisan attack on jobs and living standards, the attack on immigrants and democratic rights, and the drive to war.

This assault will inevitably provoke enormous social opposition among workers and young people. This opposition must be channeled into the fight for a progressive overhaul of the health care system that takes as its starting point an end to privately owned health care corporations and medicine-for-profit and the establishment of socialized medicine, democratically administered by a workers’ government, providing free, high-quality health care for all.

Kate Randall

http://www.wsws.org/en/articles/2017/11/15/pers-n15.html

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Will Trump’s sabotage wreck your health care?

Christopher Baum explains what Trump’s executive orders on health care will mean–and why no one should settle for the Democrats’ bipartisan “compromise.”

Donald Trump signs an executive order on health care (Andrea Hanks | WhiteHouse.gov)

Donald Trump signs an executive order on health care (Andrea Hanks | WhiteHouse.gov)

“OBAMACARE IS finished,” Donald Trump told reporters on October 16. “It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”

Just saying the same thing over and over doesn’t make it true. But Trump has certainly been busy trying to turn these words into reality.

This summer, Senate Republicans failed three times to “repeal and replace” the Obama administration’s Affordable Care Act (ACA), thus denying Trump the victory he’s been promising to his right-wing base since last year’s election campaign.

But Trump has the power to do a lot of harm on his own, without any help from Congress. In October, he kicked his sabotage efforts into high gear–first by dismantling the ACA’s contraceptive mandate and then with a pair of orders that threaten to undermine the insurance markets established under the ACA.

A bipartisan pair of senators, Lamar Alexander of Tennessee and Patty Murray of Washington, are proposing a bill that they say will stop the Obamacare system from crashing because of Trump’s unaccountable orders.

But predictably, the bill is tailored to the concerns of the insurance companies threatened with a loss of federal government money to cover premium subsidies for poor and working-class Americans, rather than the problems so many millions of people face because of the ACA–and there’s no guarantee that Trump will support the bipartisan deal, or that the GOP-controlled House will pass it, anyway.

So Trump’s executive actions do represent a further threat to access to health care for millions of people. But even if Trump accepts the bipartisan “compromise” to temporarily prop up one aspect of Obamacare, the ACA status quo is breaking down as a result of a wider crisis, which includes sabotage on the part of the insurance industry itself.

We need to oppose the right-wing assault on our health care in any form–whether the outright “repeal and replace” proposals that would demolish the government’s Medicaid health care system for the poor or Trump’s whittling away at the ACA provisions that help ordinary people.

But the grassroots uprising that helped defeat Trumpcare this summer can’t be diverted by Democrats claiming their bipartisan compromises are enough to solve the worst of the problems.

The health care status quo built on Obamacare won’t do. We need a whole new system: a single-payer system that guarantees free comprehensive health care for all.

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TRUMP’S LATEST wave of attacks came in a one-two punch on October 12.

First, Trump issued an executive order directing his administration to “consider proposing regulations or revising guidance” in some key areas regarding the ACA.

These include association health plans (AHPs), which essentially allow small businesses to band together and thereby obtain more favorable pricing from insurers; and short-term limited duration insurance (STLDI), which provides limited coverage for a defined period for people who are in between jobs or otherwise need “gap” coverage while looking for a more permanent solution.

In both these areas, Trump called for expanded access and availability–which in effect means deregulation.

AHPs, for instance, offer tantalizing prospects to those who find Obamacare’s regulations on what health insurance policies must cover excessive.

The ACA essentially recognizes three types of insurance plans: individual plans, small group plans (covering two to 50 employees), and large group plans (covering 51 or more employees).

Some of the most important protections under Obamacare–such as the requirement that all plans cover a defined list of essential health benefits–apply only to individual and small group plans.

Large group plans can, for example, “avoid covering essential services like mental health care and substance use disorder treatment and, although they technically are not supposed to exclude pre-existing conditions or charge higher rates to people with them, they are in fact less constrained in doing so,” Timothy Jost wrote at the HealthAffairsBlog.com.

Trump’s idea, then, is to find ways to allow small groups–and perhaps even individuals–to band together into AHPs and get the same exemptions as large groups. As Jost goes on to write:

If association health plans could market health coverage claiming to be self-insured large group plans…they could be free from state regulation and could market plans with skimpy benefits and find it easier to cherry pick healthy enrollees and avoid unhealthy ones.

As for the short-term policies known as STLDI, Trump’s order instructs federal agencies to consider lengthening the coverage period and making the policies renewable–meaning that people could choose STLDI, as a more or less permanent option for health care coverage.

This appeals to the Trump administration because, as the executive order notes, STLDI is “exempt from the onerous and expensive insurance mandates and regulations” of Obamacare. Freed from the requirement that such policies be temporary, STLDI could be offered cheaply to young, healthy people who don’t anticipate having significant health care expenses.

Thus, Trump’s objective is clearly to expand the availability of insurance plans that aren’t subject to the full scope of the ACA’s patient protection requirements. As Jonathan Cohn wrote at Huffington Post, the order could allow “a proliferation of cheaper, less comprehensive plans that would undermine rules about who and what insurers must cover.”

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TRUMP’S SECOND order would end reimbursements to insurance companies for the cost-saving reductions (CSRs) they are required by law to make for low-income policyholders. These payments are estimated to total $7 billion in 2017.

Trump and Republicans have deceptively characterized these payments as “handouts” to the insurance industry. But CSR payments are the means that the Obama administration came up with to provide help for low-income consumers who have to purchase health insurance under the ACA rules.

Under the ACA, individuals and families with incomes up to 250 percent of the federal poverty line who buy insurance through state or federal markets are eligible for a reduction in premium payments and out-of-pocket costs. The ACA also requires that the federal government pay insurers to offset this reduction.

But because the law doesn’t explicitly require the government to appropriate funds to cover the CSR payments–and Congress didn’t pass a separate measure to fund them–the Republicans claimed that the CSR violated the constitution because the administration was making the payments without the sanction of Congress.

In 2016, a federal judge ruled in favor of the GOP in a lawsuit against the Obama administration, but immediately stayed her order blocking the payments in order to let the appeals process play out.

Ever since Trump took office, his administration has been threatening to use the court decision as a pretext for cutting off CSR payments.

The requirement that insurance companies continue to offer rate reductions to lower-income people remains in effect, whether or not they get CSR payments from the Feds. So the question is how the insurers will respond.

One danger is that more insurance companies will abandon the state and federal marketplaces for selling policies under the ACA–a trend that has been accelerating already over the last several years. Others might use the cutoff as an excuse to stop offering reduced rates as required, and wait to see how the Trump administration responds.

For insurers that remain in the ACA marketplace, another approach would be to raise premiums to offset the lost reimbursement from the federal government.

In August, the Congressional Budget Office (CBO) studied this possible outcome and concluded that most of the negative effects arising from higher premiums would be offset by corresponding increases in the premium tax credit (PTC), another Obamacare subsidy. In other words, the tax credit would increase for people paying higher premiums.

But this conclusion relies on the rather massive assumption that the PTC itself will remain intact.

The CBO estimates that with CSR payments to insurers eliminated, the cost of increased PTCs over the next 10 years in reduced tax revenue to the federal government would be a net of $247 billion.

Republicans in Congress have already demonstrated with every health care proposal they’ve tried to pass this year that they believe too much is being spent on subsidizing health care for the needy. What are they odds they’ll stand for such an increase?

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TO THE extent that a rise in premiums isn’t offset by tax credits or other means, the result will be higher costs, fewer plan options and reduced access to health care. And if enough insurers decide to exit the market, many people may find themselves with no health insurance options whatsoever.

But this–or at least the threat of this–is precisely what Trump wants.

“Now, we’re going to get the health care done,” Trump told reporters on October 16. “In my opinion, what’s happening is, as we meet–Republicans are meeting with Democrats because of what I did with the CSR, because I cut off the gravy train. If I didn’t cut the CSRs, they wouldn’t be meeting.”

As we have seen, the CSR is no “gravy train.” And however much Trump may flatter himself that his destructive behavior is just a clever maneuver, the only thing he’s truly demonstrated is his willingness to destroy anything or anybody to get what he wants.

Whether he is threatening health care subsidies desperately needed by millions of low-income people, or using the possibility of deportation for nearly a million DACA participants as a bargaining chip to get his beloved border wall, Trump’s message is the same: I’m going to get my way, or I’ll blow the whole thing up.

So it’s anybody’s guess whether Trump will support the deal worked out by Sens. Lamar Alexander and Patty Murray, which would fund CSR payments to insurers through 2019.

Although the response from congressional Republicans was lukewarm at best, Democrats were, of course, enthusiastic. Speaking to the press last week, Senate Minority Leader Chuck Schumer spoke of the “growing consensus that in the short term we need stability in the markets,” and praised the Alexander-Murray proposal for providing that–along with “some very significant anti-sabotage provisions,” although he didn’t elaborate on what these might be.

This was in keeping with the Democratic talking points that legislation is needed to “stabilize markets and lower premiums,” as Schumer said last month–and then Obamacare will be just fine.

But insurance markets won’t be “stable” unless they are profitable for insurance companies. If the insurers aren’t happy, they can simply leave.

This is why, for all their talk of serving the health care needs of ordinary people, the Democrats are only willing to pursue this goal to the extent that it is compatible with keeping the insurers happy.

Trump didn’t create this problem. Major insurers were leaving the ACA marketplaces, or threatening to do so, long before he took office. UnitedHealth, for instance, made the decision to exit in mid-2016–not because the insurance giant was losing money, but because profit margins weren’t high enough for its liking.

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THE REAL problem with Obamacare is that it depends on the voluntary participation of for-profit insurance companies–and as a result, it’s at the mercy of those companies.

No “anti-sabotage measures” are going to change this. If insurers decide they aren’t making enough money or if they’re unhappy for any other reason, they can simply take their ball and go home.

This must be kept in mind when considering the other major element that Democratic leaders claim they want to address. It’s fine to talk about lowering premiums, but again, the market must remain profitable for insurers. The usual tradeoff is between premiums and deductibles: the lower the one, the higher the other.

If you truly want to talk about “affordable health care,” both numbers need to be brought down. Otherwise, consumers may have a lower monthly payment–but if they actually need care, they will find themselves paying a ruinously high portion of the bill out of their own pocket before any insurance kicks in.

But the truth is that “affordable health care” is simply the wrong goal. As long as the objective is “affordability,” access to health care will remain a matter not of what people need, but of what they can afford.

The consequences of this are all around us: people who are sick and can’t pay for medication; people who are bankrupted by their medical bills, even though they have insurance; people who don’t get care because the cheap policy they bought doesn’t cover the treatment they need; and on and on.

There is only one way out of this–by providing comprehensive health care to all people, free of charge, without the for-profit insurance companies involved.

What we need, in other words, is a universal single-payer health care system.

As with all the Republicans’ earlier attacks on the ACA, this latest assault must be opposed–but we can’t stop there. No one should be lulled into thinking that all we need to do is tweak Obamacare here and there. Obamacare isn’t just broken; in its reliance on for-profit insurance companies, it is fatally flawed. It can never be the health care solution that every person living in this country needs and deserves.

We must demand single-payer, and fight for it with everything we have. The stakes are too high to settle for anything less.

https://socialistworker.org/2017/10/23/will-trumps-sabotage-wreck-your-health-care

What’s the next step toward Medicare for All?

Sean Petty, a registered nurse in New York City and member of the board of directors of the New York State Nurses Association, makes the case that single-payer health care advocates can advance the struggle politically and organizationally.

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

Taking to the streets for single-payer health care in Los Angeles (Molly Adams | flickr)

THE PRESS conference earlier this month where Bernie Sanders announced his “Medicare for All” legislation shows both the massive opening and the serious challenges facing the struggle for truly universal health care in the U.S.

Sanders’ legislation comes after a summer of successful struggle to stop Trumpcare. The Senate Republicans’ latest attempt to “repeal and replace” Obamacare collapsed this week after a handful of both hard-right and more “moderate” Republican senators came out against it.

Donald Trump tweeted angrily about John McCain, but a very important reason for the defeat of the various Trumpcare proposals was the upsurge of protest organized by liberal organizations, unions and other health care advocates.

The angry demonstrations at events held by Republican lawmakers throughout the year, as well as actions in Washington, helped expose how the GOP plans for “repeal and replace” would have worsened an already ailing system governed by Obamacare–particularly by dismantling Medicaid and Medicare. Beyond the protests, popular opinion ran heavily against Trumpcare.

This opposition went far beyond single-payer advocates, but it helped our movement by reminding millions of people how critical federally funded health care is–and getting them to more seriously consider Medicare for All as an alternative to both Trumpcare and Obamacare.

The effect of this on Sanders’ proposal has been telling. For almost three decades, the mainstream of the Democratic Party has systematically undermined and marginalized proposals for single-payer health care. But this month, 16 Democratic senators, including most of the known hopefuls for the 2020 presidential nomination, lined up in support of Sanders’ legislation.

Of course, it’s easy for liberal Democrats to support Sanders’ bill when it has no chance in becoming law under a majority Republican Congress, with Donald Trump in the White House. The Democrats can appeal to millions of people persuaded by the case for Medicare for All, without having to face the fury of the for-profit health care industry.

But even at the level of purely rhetorical support, Sanders’ legislation is a big deal. It is a crack in the political edifice on the issue of single-payer health care, which opens up opportunities to mobilize greater pressure from outside Washington. Whether the crack gets widened or sealed up is a critical question facing our re-energized movement.

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THIS IS a useful moment to pull the lens back and look at what it will take to make Medicare For All a reality.

The first dynamic to understand is that we haven’t seen anything close to the opposition that will cohere among the health care industry and the ruling class as a whole when a Medicare for All proposal like Sanders’ gets closer to being enacted.

Health care accounts for as much as one-fifth of all economic activity in the U.S., according to estimates. There is a considerable amount of wealth at stake in the profits of the prescription drug industry, from medical supply and equipment sales, and, of course, for private insurance.

Medicare for All would allow the government to bargain with health care companies with an unprecedented leverage and economic scale–and it would be a huge blow to private insurers, even if it doesn’t totally eliminate them. Moreover, Sanders’ bill is filled with taxes on the rich and powerful–higher taxes on business, wealth taxes, a more progressive income tax structure, and even a one-time tax on offshore financial holdings.

The opposition to single-payer will manifest itself in two general ways.

The most blatant will be an extremely well-funded propaganda campaign that claims Medicare For All would produce “death panels” and financial ruin to every household in America.

The resounding defeat last year of a Colorado ballot initiative that would have changed the state constitution to permit universal coverage for every resident gives a taste of how the economic and political powers–including plenty of Democrats who claimed to oppose Trumpcare this year–would line up against single-payer.

Likewise, in California and New York, it was Democrats who did the dirty work of the insurance industry in blocking legislation to move toward a statewide Medicare for All system.

The second, less obvious way opposition will take shape is the “Trojan Horse” effect.

Right now, powerful mainstream Democrats like Elizabeth Warren, Cory Booker and Kristen Gillibrand have nothing but nice things to say publicly about Sanders’ bill. But there has been and will be intense pressure to water down single-payer legislation.

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NONE OF this means the fight for Medicare for All is unwinnable.

In fact, Sanders’ introduction of this legislation–at this political moment and with support beyond himself, at least for now–shows how easily a government-run system that guarantees universal coverage could be embraced by the majority of people.

Right now, Sanders is probably the most popular politician in the country. Certainly, he is at the federal level, where his favorability rating being higher than his unfavorability is unique. Sanders stands for a progressive political agenda that has partially filled a massive void in mainstream politics.

His Medicare for All bill isn’t perfect. Members of Physicians for a National Health Program are critical of the legislation for allowing co-payments for some medical necessities, including drugs and biologics. There are questions about how far-reaching and systematic its funding mechanisms are, and whether four years is too long of a rollout.

But supporters of Medicare for All have shaped the bill in important ways. It bars deductibles and most co-pays, fully funds abortions and covers undocumented immigrants. The pressure to reverse these important provisions will be relentless. The larger the movement–and the larger the Left within that movement–the more people we will have a bill worth fighting for.

With Medicare for All, Sanders–in stark contrast to Democratic Party leaders–is offering something concrete and popular that would change most everyone’s life for the better.

But Sanders’ popularity obviously isn’t enough. The most important factor that will determine whether we see such a program in our lifetime is whether the widespread popularity and unprecedented momentum is organized so that it becomes an active force, felt in workplaces, communities and the media.

There are many ideas about how to build from the grassroots. Do we need a national march? Do we need to focus on “base-building”? Do we need different forms of coalitions and activist organizations? The answer is all of the above–but the question of strategy and timing will take some time to figure out.

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ACTIVISTS AROUND this issue need to recognize that we won’t win this battle by continuing to do what we currently are doing, just on a grander scale. Whatever organizing we do, we need to be clear on some things.

First, this isn’t an inside game. Medicare for All won’t be won by concentrating on how many members of Congress we persuade, but on how many tens of thousands of people are convinced to take action in various forms for single-payer.

Our organizing needs to be focused on this fact. We need to figure out how to build networks and organizations that can bring in larger numbers of activists, who can then make collective decisions about how to reach the next layer of people.

One step in this direction would be to broaden our approach to the issue–which needs to center both how transformative a future Medicare for All system would be, but to highlight the suffering that goes on in the health care status quo as the price we pay for not having single-payer.

In the public mind, the health insurance industry should be no different than the tobacco industry. We need to create a climate where health insurance industry profits are seen for what they are–blood money–and any politician unwilling to do something about it is treated accordingly.

Second, health care has to become a central issue of a re-inspired labor movement. Many people currently think of health care as related to their job, so there’s a natural connection.

Unions already played a role in mobilizing opposition to Trump’s health care disaster–though not in the numbers they could have. But Medicare for All could become a main issue for labor.

One possibility would be to organize workplace committees in support of Medicare For All. This has already taken shape in National Nurses United and New York State Nurses Association, and could be built on and serve as a model for other unions.

For health care unions, in particular, the question of workplace issues and how to make the health care system accessible come together, creating the basis for a stronger struggle.

We need to think in unprecedented ways about how to use union power to win this struggle. In this context, I could see an argument for a national day of strike action for Medicare For All.

Striking for political reasons–or really striking in general–isn’t something the labor movement is very familiar with in recent decades. But the tradition does exist. Also, the unions that are strongest on Medicare for All are also unions with more experience of going on strike recently.

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THERE ARE many other initiatives being discussed to build wider and active support for Medicare for All.

One that has been discussed this year is a proposal from some members of the Democratic Socialists of America for a national march for single-payer in Washington, D.C.

If such a mobilization gave expression to the wide support for Medicare for All that has developed especially through the course of this year, it would be a major step forward in projecting the importance of this issue. But that also raises the question of organization: What forces would be involved in planning and carrying out such a march?

National initiatives like a march or a day of action in support of Medicare for All can be focus for local organizing to win wider numbers of people to activism on this issue. There will also be more statewide initiatives, as in California and New York. And possibilities for local organizing around health care develop all the time–including workplace action backed by unions, up to the level of strikes.

One opportunity for organizing will arise soon–Sanders is supposed to tour the country to build support for his legislation. Our organizations need to find ways to meet people inspired by Sanders’ proposal and bring them into organizing.

There’s a long way to go before we’ll have built organization that can express the widespread sentiment for Medicare for All. But activists can use the opportunities as they arise to build in that direction.

https://socialistworker.org/2017/09/28/whats-the-next-step-toward-medicare-for-all

Bernie Sanders brilliantly responds to President Trump’s threat of stripping Congress’ health insurance

The Democratic socialist says all Americans should have the same health care that members of Congress have

Independent Sen. Bernie Sanders turned the table on President Donald Trump in an interview with Jake Tapper Sunday, pointing out that he ironically agreed with the commander in chief on one issue of health care.

To start the interview, Tapper asked Sanders what he thought of Trump’s threat to revoke lawmakers’ health insurance. Members of Congress receive gold-level Obamacare policies that are largely subsidized by the government.

Sanders pushed his universal health-care agenda in his response to the question.

“I would turn that around a little bit and say to the president of Unite States that, yes, every single American, in every state of this country, should be able to get the health care that members of Congress have,” the senator from Vermont said.

Sanders did not mince his words when it came to Trump’s cynical plan to defeat Obamacare by undermining the exchanges and driving insurers out of the markets.

“It’s incomprehensible that we have a president of the United States who wants to sabotage health care in America, make life more difficult for millions of people struggling now to get their health insurance that they need,” Sanders said.

“Maybe the president should stop his tweeting for a while and understand that America today is the only major country on Earth not to guarantee health care to all people and the solution is not to throw tens of millions of people off of health insurance,” he added.

Sanders suggested that Congress returns to regular order, so that they can come up with solutions to make the health care system in America better. He said that there should be a public option available for all Americans.

 

How to sell single payer health care: It’s a great policy, but has a huge political drawback

Workers are not going to want to see employer-provided benefits disappear right as their taxes go up

The very public battle over Trumpcare — which seems like it may, fingers crossed, be collapsing due to the public rejecting the ejection of millions of people from the health care system — seems to have had the side benefit of increasing public interest in the idea of a single payer government-run health insurance system. Polling shows that anywhere from 33 percent to 44 percent to 58 percent of voters back the idea of single payer, and in blue states that theoretically have the tax base to pull off statewide system — such as New York or California — single payer likely could garner more support.

And yet one of the bluest of states, California, has once again failed to get a single payer bill off the ground, in no small part because it was, as David Dayen at the Intercept argued, “a shell bill that cannot become law without a ballot measure approved by voters.”

Dayen blames single payer proponents for not “committing to raising the millions of dollars that would be needed to overcome special interests and pass that initiative”and accuses them of “hiding the realities of California’s woeful political structure in favor of a morality play designed to advance careers and aggrandize power.”

When one looks at the players involved, it’s hard to deny Dayen’s accusation. But it’s also worth pointing out that single payer, as it’s currently constructed, faces a major political obstacle that even a lot of electoral hustle may not be able to overcome: People really do not want to see their taxes raised to pay for it. Proponents of single payer aren’t doing enough to address that objection.

The good news is that there are ways to address these voter concerns. The first step, however, is admitting that tax raises are a real problem.

Polling data shows this. The majority of California residents, 65 percent, say they want a single payer system, but that level of support drops to 42 percent if it will require a tax raise.

Proponents of single payer tend to counter this objection by pointing out that these taxes will replace spending on private health insurance and would reduce health care spending overall. That is true in a macroeconomic sense, but it fails to take into consideration that the majority of people below Medicare eligibility age get their health insurance through their employers.

The perception is going to be, like it or not, that single payer is shifting the responsibility for paying for health insurance off of employers and onto the shoulders of workers. People aren’t going to care about reduced health care costs if they think their bosses reap the bulk of the savings.

Why that gets so frequently overlooked, I have no idea. Otherwise, progressives seem to grasp that squeezing the workers while letting the bosses off the hook tends not to go down well with voters. The problem might be that there’s been a longing for single payer for so long in progressive circles that any objections are written off as neoliberal corporatist nonsense — a theory I suspect much of the response to this article will prove.

But if one accepts that this is a problem, then there’s all sorts of creative ways to address it. One way is to dispense with single payer bills and instead have states offer a Medicaid buy-in that employers can access, with the hopes that the lowered costs will allow Medicaid to eventually conquer the market. Or perhaps payroll taxes are structured so that employers pay a larger chunk, so workers don’t feel the pinch.

I say it’s time to get freaky with it. My proposal: Write the bill so that it requires employers to compensate their employees who lose their health care benefits with a raise in their paycheck. Then the plan could be marketed as “health care for all, plus a raise at work.” Higher taxes go down easier if you’re getting a raise to cover them.

The best part is that this could be a win/win situation. One of the bigger problems facing employers is that insurance premiums are rising while the value of what they get for it is not improving. Giving the money to employees directly in cash would actually be cheaper in the long run because employers would be escaping that inflation pressure. Employees see more money in their paychecks while the per-employee costs for the employer don’t rise as fast.

Ideally the raise would be one that’s equivalent to what the employer pays annually to the insurance company to cover that employee’s health care plan, but that could be negotiable depending on how much the employer will be on the hook for in higher payroll taxes. The details are less important here than sending the message to voters that single payer is not about shifting the health care burden away from employers to employees.

This is just one idea, of course. There may be — probably are! — other ways to deal with this political problem that make more sense economically. The main issue here is that the larger economic savings of single payer sound great in the abstract, but will be hard to sell if voters don’t feel that they personally are seeing those savings in their checking accounts. As long as single payer proponents fail to address that political problem, there’s very little chance of getting a single payer bill off the ground.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

New Poll Shows Nation Moving Left on Healthcare, Embracing Medicare for All

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The poll shows that 62 percent of Americans believe it is the federal government’s responsibility to guarantee healthcare for all

“There is a significant increase in people who support universal coverage,” Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. (Photo: Molly Adams/Flickr/cc)

In the face of “cruel” attempts by the Republican Party to strip health insurance from more than 30 million Americans with the goal of providing massive tax breaks to the wealthy, a new poll published on Thursday finds that a growing majority of the public is “shifting toward the political left” on healthcare and expressing support for a system that ensures coverage for all.

“The Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters.”
—Matt Bruenig
The poll, conducted by the Associated Press in partnership with the NORC Center for Public Affairs Research, shows that 62 percent of public believes it is “the federal government’s responsibility to make sure that all Americans have health care coverage.”

As AP‘s Ricardo Alonso-Zaldivar and Laurie Kellman note, this is a dramatic shift in popular attitudes over a very short period of time.

“As recently as March,” they observe, “the AP-NORC poll had found Americans more ambivalent about the federal government’s role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not.”

This most recent poll also found:

  • Only 22 percent of Democrats want to keep Obamacare as it is, and 64 favor changes to the law.
  • 80 percent of Democrats believe it is the federal government’s responsibility to ensure coverage for all.
  • 80 percent of Americans believe Republicans should work with Democrats to improve Obamacare.
  • 13 percent of Americans support the Republican plan to repeal Obamacare without a replacement, a proposal the Congressional Budget Office (CBO) estimates would leave 32 million more Americans uninsured.

These latest survey results are consistent with increasingly vocal grassroots support for a Medicare-for-All style system that “leaves no one out.” Prominent Democrats have joined the groundswell of enthusiasm; former Vice President Al Gore and Sen. Elizabeth Warren(D-Mass.) are two of the more notable figures who have openly advocated a move toward single-payer in recent weeks.

“There is a significant increase in people who support universal coverage,” Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. “The impact of the debate over dropping coverage looks like it has moved [more] people to feel that the government is responsible for making sure that people have coverage.”

This soaring support for Medicare for All at the grassroots has been bolstered by recent analyses showing that a single-payer system would be more affordable than the current for-profit system—a fact that refutes President Donald Trump’s baseless claim on Wednesday that single-payer would “bankrupt our country.”

All of these factors, argues welfare policy analyst Matt Bruenig in a recent piece for Buzzfeed, amount to an irrefutable case in favor of moving beyond Obamacare to a healthcare system that ensures universal coverage.

“Now that the Republicans have failed [in their attempts to repeal Obamacare], the time is ripe for a serious single-payer push,” Bruenig writes. “Policy institutions need to work hard to hammer out the details of a single-payer plan, and the Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters.”

 

Health Care in America: Where is the Socialist Solution?

Photo by Molly Adams | CC BY 2.0

The introduction of the Republican legislation to “repeal and replace” Obamacare is no more than latest scrimmage in the ongoing one-sided war against the poor and working class. The “Affordable Care Act” (ACA, better known as Obamacare) proved to be both unaffordable and unable to provide comprehensive care for millions. Nevertheless, with the ACA being one of the only tangible “victories” Democrats could claim for an administration with a dismal record of noteworthy accomplishments, neoliberal Democrats and the party’s liberal base led by Bernie Sanders are now coalesced around the ACA and have vowed to defend it to the bitter end.

Yet, camouflaged by the hot rhetoric of confrontation and the diversionary struggle of the duopoly, the common agenda and objective interests being protected in this healthcare battle are quite clear. No matter what version of the healthcare bill passes or if the ACA remains in place, it will be a win for the market-based, for-profit beneficiaries of the U.S. system. As long as healthcare remains privatized, the real winners of healthcare reform will continue to be the insurance companies, hospital corporations and pharmaceutical and medical device companies.

That commitment to the interests of the insurance/medical complex ensures that the interests of healthcare consumers, the uninsured, the elderly and the sick will continue to be sacrificed to maintain a healthcare delivery system in which thousands suffer premature deaths from inadequate preventative treatment, millions are unable to afford coverage and millions who have private insurance fear using it because of prohibitive co-pays and deductibles.

That is why during the current debate the insurance companies have been largely silent. There is no need to engage in public debate because having largely written the ACA they are again deeply involved in the construction of the current legislation. Their interests will be protected even if it means forcing Republicans to embrace policies that are at odds with their professed philosophies – like including government subsidies for low-income people to purchase insurance. In fact, the only comments from insurance companies in this debate were related to their supposed concern that the Senate bill might not provide enough assistance to those who need help to pay for healthcare. They want what is being called a “stabilization fund” to reduce the numbers of people who might opt out of coverage because they can’t afford it.

The Senate bill provides those funds, but they are temporary and are scheduled to end after 2019. Which means that people will be forced to make an unpalatable decision after that – purchasing insurance with higher out-of-pocket costs like $10,000 deductibles or electing to go without insurance altogether. If history is a guide, many will opt out. In fact, the Congressional Budget Office predicts that the current bill will push 22 million people back into the ranks of the uninsured with the potential loss of millions of customers and potential profits for healthcare corporations.

But the companies have a plan should those funds prove inadequate to hold substantial numbers in the system: Increase individual premiums by at least 20 percent more than the double-digit increases already under consideration.

Coming to the aid of the Insurance/Medical complex: Ted Cruz and the Consumer Freedom Amendment

Insurers need large numbers of healthy people on the rolls, as their premiums help defray the cost of care for those who are sick. Because insurance companies are for-profit operations they set rates based on the risk pool in a market. With the potential loss of customers if the government does not provide adequate long-term subsidies, middle-class consumers who earn too much to qualify for temporary premium assistance will bear the brunt of any premium increases.

The Cruz amendment to the legislation has a solution to the possible increase in premiums and healthcare costs in general. The so-called “Consumer Freedom Amendment” represents the typical extreme individualism and anti-social sentiments of the right wing. It essentially advocates for reducing the burden on healthy consumers paying into system to help cover higher-risk fellow citizens.

The Washington Post’s analysis of the Cruz amendment suggests:

“Under Senator Cruz’s plan, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.”

And how would the elderly and people with pre-existing conditions pay for the increased premiums that they would face under the current Senate bill and Cruz’s amendment? “The $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under this amendment.”

In an ironic twist that both exposes the class interests of this initiative and its hypocritical approach to the question of the role of the government, Cruz’s amendment affirms that role in the form of subsidies for the sickest citizens and calls for an expansion of government resources to cover them.

The Cruz plan would segment the insurance market into healthier and higher-risk segments. High risk individuals along with the already-sick and the elderly would be pushed out of the market because those premiums would soar even with state subsidies, since insurance companies would still set premium rates to maximize profits.

Given the lose-lose options for consumers now being debated in Congress, the only rational objective for the majority of the people in the U.S. is to move toward the complete elimination of the for-profit healthcare system.

Socialization of Healthcare: The Only Solution

The ideological and political opposition to state-provided healthcare is reflected in the ACA and the various repeal-and-replace scenarios. Through mandates, coercion and the transfer of public funds to the insurance industry, the ACA delivered millions of customers to the private sector in what was probably the biggest insurance shams in the history of private capital. And that gift to the insurance companies is only one part of the story. The public monies transferred to the private sector amounted to subsidies for healthcare providers, hospital chains, group physician practices, drug companies and medical device companies and labs as well.

The Republican alternatives to the ACA variably supplement the corporate handouts with more taxpayer-funded giveaways. And once the private sector gains access to billions of dollars provided by the state, they and their elected water-carriers fiercely resist any efforts to roll those subsidies back.

The subsidies coupled with the mergers and acquisitions of hospital corporations and insurance providers over last few years and a general trend toward consolidation of healthcare services in fewer and fewer hands underscored the iron logic of centralization and concentration of capital represented by the ACA and was a welcome development for the biggest players in the healthcare sector. The movement toward a monopolization of the American health-care market means that rather than the reduction in healthcare costs that is supposed to be the result of repeal and replace, the public can instead expect those costs to escalate.

Many on the left have called for a single-payer system similar to those that work well (if not perfectly) in Britain, the Netherlands, Finland and elsewhere in Europe. But even with an “improved Medicare for all” single-payer system, costs will continue to increase in the U.S. because they cannot be completely controlled when all of the linkages in the healthcare system are still firmly in the hands of private capital.

The only way to control the cost of healthcare and provide universal coverage is to eliminate for-profit, market-based healthcare. Take insurance companies completely out of the mix and bring medical device companies, the pharmaceuticals companies and hospitals chains under public control.

The ideological implications of the Cruz amendment are that it reflects a growing public perception both domestically and internationally that healthcare should be viewed as a human right.

Putting people at the center instead of profit results in healthcare systems that can realize healthcare as a human right. This is the lesson of Cuba where the United Nations World Health Organizationdeclared that Cuba’s health care system was an example for all countries of the world.

That is the socialist option, the only option that makes sense and the one that eventually will prevail when the people are ready to fight for it.

Ajamu Baraka is the national organizer of the Black Alliance for Peace and was the 2016 candidate for vice president on the Green Party ticket. He is an editor and contributing columnist for the Black Agenda Report and contributing columnist for Counterpunch magazine.