Trumpcare is dead, at least for now: But the health care fight will never end

McConnell-Ryan health plan collapses as conservatives bolt — but progressives have no victory to celebrate

It appears that the Republican effort to repeal and replace the Affordable Care Act is dead, at least for now. Donald Trump’s unrealistic, grandiose promise will go unfulfilled.

That didn’t work out. After weeks of prevarication and misdirection on the part of people like Vice President Mike Pence and Health and Human Services Secretary Tom Price, who went on TV last weekend and blatantly lied about the effects of the Senate health care bill, on Monday night two GOP senators, Mike Lee of Utah and Jerry Moran of Kansas, pulled the plug by saying they could not vote for it. Added to the previously announced no votes of Sens. Susan Collins and Rand Paul, Majority Leader Mitch McConnell is now at least two short. He has admitted that this bill will not pass.

We’ve been here before, of course. The first House bill was pulled and they came back and passed an even worse version. This may not end the way everyone seems to assume it will either.

Both Trump and McConnell acknowledged that the Senate’s BCRA is dead and signaled their support for a “full repeal plus two-year delay until they figure out what the hell is going on” plan. It is not impossible that they could put something else together.

After all, the reasons three of the four senators gave for their unwillingness to pass the bill is that it just wasn’t harsh enough. Repeal and replace with nothing would undoubtedly make them quite happy. That would leave the handful of Republican moderates in the Senate having to do something only Collins has so far been willing to do: take a stand for decency. Sens. Dean Heller of Nevada, Shelley Moore Capito of West Virginia, Rob Portman of Ohio, John Hoeven of North Dakota and Lisa Murkowski of Alaska have all said that they won’t vote to deny people health insurance. But there’s always a chance they can be appeased with the two-year delay and a fatuous promise to fix everything before then. Nobody should relax until it’s clear that this is all well and truly dead.

This repeal-and-delay plan was originally proposed back at the beginning of the year but faced a huge uproar, mostly from the health care industry, which cannot run its businesses with this kind of uncertainty about the financing, rules and regulations under which they must operate. A handful of senators balked at the time, including Bob Corker of Tennessee and Tom Cotton of Arkansas, who said, “I don’t think we can repeal Obamacare and say we’re going to get the answer two years from now.” Both Paul and Collins were against it too, as were many of the Republican governors who also have to plan their budgets.

But what really scared them off that time was public opinion. Only 20 percent of Americans were in favor of repeal-and-delay five months ago. It’s hard to imagine that after they’ve seen what kind of horrendous plans the Republicans tried to ram through the Congress they’ll be more favorably disposed today. According to a recent Gallup poll, Americans prefer Democrats to handle health care by 55 to 36 percent.

The Republican leadership exemplified by House Speaker Paul Ryan thought they had come up with a clever way to have their cake and eat it too. If they could repeal the Affordable Care Act and then take their big victory lap, that might satisfy their base that they were getting things done — after which they could pretend they were creating some kind of “new” health care system that would kick in gradually. The simple fact was that they had no idea how to cover the people who are currently covered under the ACA and they knew it. Their best hope was to ease people back into their previous anxiety and despair and blame Obamacare for it.

Donald Trump has said many times that he believes the best political move would be to keep Obamacare in place and help it fail, so he and his party could blame the Democrats. If Republicans can drag this out a couple of years and guilt Democratic lawmakers into signing on to some inadequate Band-aids in order to spare a few lives, that would really be sweet.

It will also be sweet for the Democrats when they run ads against every House Republican who voted for that AHCA atrocity under the assurance that they would “fix it in the Senate.” If the Democrats do manage to eke out a new House majority it will be the health care albatross that brings down the GOP. They can name him Donald.

But whether Republicans manage to push through repeal-and-delay or just drop it altogether, liberals and progressives need to reckon with the fact that this is not the end. There will never be an end.

Republicans have been trying to destroy the American safety net for decades. They’ve been hostile to Medicare and Medicaid since the day they were passed. They’ve been running against Social Security for 82 years. (They just tried to privatize it in 2005!) They will never stop attacking the ACA either.

This isn’t just about profits or ” free markets.” Consider that this Senate bill was opposed by all the so-called stakeholders: the insurance companies, the hospitals, doctors and even big business. It still has 48 out of 52 votes in the Senate. Conservatives simply do not believe that people have a right to health care. They see it as a commodity like any other, something which you should not have if you cannot pay for it.

By way of crude illustration, recall when libertarian godhead Rep. Ron Paul ran for president in 2008. CNN’s Wolf Blitzer asked him during a debate what an uninsured man who  became catastrophically ill and needed intensive care for six months should do. Paul replied, “What he should do is whatever he wants to do and assume responsibility for himself. That’s what freedom is all about, taking your own risk. This whole idea that you have to take care of everybody …” The audience then erupted into cheers, cutting off Paul’s sentence. Blitzer followed up by asking “Congressman, are you saying that society should just let him die?” Members of the audience clapped and shouted “Yeah!”

Or there was this remarkable moment from an Obamacare town hall in 2009:

The sainted Ronald Reagan made his name speaking out against “socialized medicine” for years, memorably warning that if the government passed Medicare, we were all “going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

Nobody who believes that human beings have a right to a government guarantee of health care, security in their old age and society’s support should they be unable to work should ever rest on their laurels. Those who don’t agree will never stop trying to take those things away.

Heather Digby Parton, also known as “Digby,” is a contributing writer to Salon. She was the winner of the 2014 Hillman Prize for Opinion and Analysis Journalism.

Study shows US has poorest health, widest health care gap between rich and poor

As Senate health plan calls for gutting Medicaid

By Kate Randall
15 July 2017

A new study reveals findings that will come as no surprise to most American workers and youth: In the United States, your level of income defines your access to health care, the quality of care you receive, and whether you will meet with an early death because of it. The US also has the poorest health overall among high-income countries.

Using survey data to measure and compare patient and physician experiences across 11 countries, the Commonwealth Fund’s “Mirror, Mirror 2017: International Comparisons Reflect Flaws and Opportunities for Better US Health Care” finds that the US ranks last overall on providing equally accessible and high-quality health care, regardless of income.

The report compares health care system performance in the US with that of 10 other high-income countries, ranking them in five areas: care process, access, administrative efficiency, equity and health care outcomes. The US ranks last overall, and last in all but one area studied, care process, in which it came in fifth.

If the United States were a politically healthy society, the release of this report would sound alarm bells in the White House and on Capitol Hill. Why, in “the greatest country on earth,” is the health of its citizens in such a deplorable state? What can be done to remedy what can only be described as a health care emergency of crisis proportions?

Instead, the study’s release follows the unveiling Thursday of the Senate Republicans’ latest version of their Better Care Reconciliation Act (BCRA), which proposes to slash $772 billion from the Medicaid program for the poor, and the Affordable Care Act’s expansion of Medicaid. The Congressional Budget Office estimated that an earlier version of the bill would leave 22 million more uninsured by 2026 than under current law.

The Commonwealth study points to factors contributing to this appalling US health report card, which will only be worsened under whatever health care “reform” is hatched in Washington. Life expectancy, after improving in recent years, has been aggravated by the opioid crisis. As the baby boom population ages, more people in the US are living with age-related disease, placing increased pressure on the health care system.

These are problems that could be confronted with timely and accessible health care, but these services are woefully inadequate. In particular, poor access to primary care has contributed to inadequate prevention and management of diseases. And in the US, far more than any other country studied, lower-income people are far more likely to lack access to affordable care, and to suffer and die because of it.

Forty-four percent of lower income people reported financial barriers to care, compared to 26 percent of those with higher incomes. By comparison, in the UK only 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting care.

According to the study, in the US population as whole in the past year:

• 33 percent had cost-related access problems to medical care.

• 32 percent skipped dental care or check-ups due to cost.

• 27 percent were denied insurance payment for care or did not receive as much as expected.

• 20 percent had serious problems paying or were unable to pay medical bills.

• 60 percent of doctors reported patients often had difficulty paying for medications or out-of-pocket costs.

• 54 percent of doctors reported time spent on insurance claims is a major problem.

• 54 percent of doctors reported a major problem getting patients needed medications or treatment because of insurance coverage restrictions.

These problems are worse in the low-income segment of the US population. For example, 44 percent of this group had a cost-related access problem to medical care, and 45 percent skipped dental care or a check-up due to cost. There is also a 24 percent gap between those in the above average and below average income groups who skipped dental care due to cost.

The study uses “average” income, which was about $75,000 in 2016, as the dividing line between upper and lower income. However, multimillionaires and billionaires skew this average upwards, and due to the growing income inequality in the US, the health care problems of those living in poverty in the “below average” group are most likely underrepresented.

Some of the most shocking statistics presented are on population mortality, in which the US ranked last in every category studied compared to the other 10 countries.

• Infant mortality: 6 deaths per 1,000 live births, compared to Sweden, with 2.2 (the lowest)

• Life expectancy at age 60: 23.5 years in the US, compared to 25.7 in France (the highest)

The study also examined “mortality amenable to health care,” or deaths considered preventable by timely and effective medical care. The US had 112 deaths per 100,000 people that could have been prevented with timely and effective care. This is more than twice the rate in Switzerland, at 55 per 100,000.

The US also had a much lower decline in these preventable deaths over 10 years, falling by only 16 percent compared to 34 percent in the Netherlands.

The US spent $9,364 per person on health care in 2016, compared to $4,094 in the UK, which ranked first overall in health care. In other words, while spending far more per person, the US population has poorer health than the other 10 countries studied.

Such figures evoke howls from both big business parties for spending to be slashed. Typical were the recent comments of Trump’s Health and Human Services Secretary Tom Price who said, while claiming to be committed to fighting the opioid epidemic that killed 60,000 people in the US last year, “We don’t need to be throwing money” at the crisis.

What goes unmentioned in such statements is the root cause of the health care crisis in America: a health care system based on capitalist profit. The for-profit insurance companies, pharmaceuticals and giant health care chains are not in business to promote the health of the American people, but to boost their bottom lines.

Whatever health care legislation is passed in Congress—either by the Republicans, or in a bipartisan “compromise” with the Democrats—will be based on this capitalist model. The Republicans’ House and Senate health bills are, in fact, based on Obamacare, incorporating the structures set up under the Democratic legislation.

The central purpose of Obamacare was to shift costs from the government and corporations to the working class, with health care increasingly rationed on a class basis. The Commonwealth Fund’s findings on the state of US health care, particularly those on mortality, are an indication of the preliminary results of this bipartisan strategy.

Behind the BCRA’s proposals to gut Medicaid, and to give the private insurers even more latitude to boost profits through offering shabby, high-cost coverage, lies a calculated effort to reduce life expectancy for working people, and to send many of the old, sick or disabled to an early grave.

http://www.wsws.org/en/articles/2017/07/15/care-j01.html

Ohio politician proposes letting overdose victims die

The policy of “social murder” behind the US health care debate

By Barry Grey
5 July 2017

At a June 20 meeting of the Middletown, Ohio City Council, Dan Picard, a council member, offered a novel proposal to contain surging costs associated with a worsening epidemic of opioid overdoses in the town. Like cities across the United States, this southwestern Ohio town of some 49,000 people is being ravaged by the explosive spread of drug addiction linked to opioid pain killers. This year it has already recorded nearly 600 overdoses, more than in all of 2016.

Picard, who is not planning to run for reelection, proposed that the City Council adopt a “three strikes” policy, under which those who make use of emergency services two times to deal with an overdose will be denied help the third time. As he told the Washington Post, “When we get a call, the [emergency services] dispatcher will ask who is the person who has overdosed. And if it’s someone who has already been provided services twice, we’ll advise them that we’re not going to provide further services—and we will not send out an ambulance.”

Defending his proposal, Picard said, “I want to send a message to the world that you don’t want to come to Middletown to overdose… We need to put a fear about overdosing in Middletown.”

This call for what amounts to state-sanctioned murder evoked an angry response from the public in Middletown and wherever else people became aware of it. Numerous health care organizations and advocacy groups involved in dealing with the drug abuse epidemic denounced Picard and his proposal.

Alexis Pleus, the founder of Truth Pharm, a nonprofit that seeks to raise awareness of the issues surrounding substance abuse, did not mince words in an open letter to Picard: “To suggest that you withhold emergency medical response to overdose patients is manslaughter at best and premeditated murder at worst.”

Most of the American population, however, never learned of the incident. This is because the establishment media, fixated on its campaign against Russia and saber-rattling against North Korea, China, Iran and Syria, along with the political warfare in Washington between the Trump administration and its ruling class opponents, did not widely report the story.

There are other political reasons for the downplaying of the story by the corporate-controlled media. Picard’s brazen suggestion that drug abuse victims be allowed to die comes uncomfortably close to lifting the lid on a basic policy question underlying the current official debate on health care “reform.”

Behind the proposals in the Republicans’ bills to cut costs and boost profits by gutting Medicaid, the government insurance program for the poor, and lifting the current requirement that insurance companies cover certain “essential benefits,” lies a deliberate and calculated effort to reduce life expectancy for working people overall and send many of the old, infirm and mentally or socially disabled to an early grave.

The effort, moreover, is bipartisan. The Democrats are pleading for negotiations on a “compromise” bill to “fix” Obamacare, a euphemism for incorporating the demands of the insurance monopolies for even higher premiums, copays and deductibles and fewer restrictions on their ability to gouge the public. Obamacare itself is a mechanism for cutting costs for corporations and the government, weakening the system of employer-provided health insurance and rationing access to health care on a more openly class basis. The Republican plans build on Obamacare to accelerate the health care counterrevolution it initiated.

The corporations, banks and hedge funds that are pushing health care “reform” and the politicians and policy experts who are doing their bidding are well aware that many thousands will die needlessly as a result of the measures being proposed. Medicaid, slated to be cut under the Republican bills by some $800 billion over ten years and terminated as an open-ended entitlement program with guaranteed benefits, provides about 80 percent of funding to treat drug abuse, which overwhelmingly affects working class and poor people.

In 2015, some 1.35 million low-income Americans had an opioid use disorder. As it is, only 25 percent of those people get treated in a year.

Last year some 60,000 people in the US died from drug overdoses, 60 percent of them from opioids. Drug overdoses are now the leading cause of death for Americans under 50. There is no starker barometer of the failure of the capitalist system and the descent of broad masses of the population into conditions of desperate social crisis.

Of the 22 million people who will lose medical coverage under the Senate health care bill, Medicaid cuts will account for 15 million of them. Moreover, both the House and Senate bills allow insurance companies to drop coverage of care for mental health and substance abuse, among other basic services.

Can there be any doubt that many will die as a result of these cuts? Lynn Cooper, director of the Drug and Alcohol Division at Pennsylvania’s Rehabilitation and Community Providers Association, told National Public Radio last month: “It is a death epidemic all over the country. The loss of Medicaid expansion will be like the bottom dropping out for thousands of Pennsylvania citizens and their families.”

The impact is so self-evident, and public opposition so pervasive, that government officials are obliged to resort to the most brazen lying when defending their proposals. Typical was the performance of Health and Human Services Secretary Tom Price, a notorious and longstanding opponent of basic social program such as Medicaid, Medicare and Social Security, in an appearance Sunday on NBC’s “Meet the Press” program. Of the Republican plan to dismantle Medicaid, he said, “We want to make certain that Medicaid is a program that can survive.”

While claiming to be committed to addressing the opioid epidemic, he declared, “We don’t need to be throwing money” at the crisis.

Ruling class strategists speak more frankly on specialized think tank web sites meant for corporate and state officials and their academic advisers. In 2013, the WSWS drew attention to two policy papers published by the Center for Strategic & International Studies (CSIS) on the negative consequences for American imperialism and the national security apparatus of lengthening life spans for ordinary people resulting from advances in medical science and treatment and government health programs.

As the CSIS experts explained, the human and social achievement of better health and longer life for many millions of Americans spells disaster for the American ruling class and the capitalist system. The authors of the studies insisted that action had to be taken to deal with the “crisis,” including increasing the eligibility age for Medicare and Social Security to force the “young elderly,” those aged 60-69, to forgo retirement and keep working.

One of the papers, titled “The Budget Crisis and the Civil-Military Challenge to National Security Spending,” was written by Anthony H. Cordesman, a longtime CSIS strategist who acts as a consultant for the US State and Defense departments. Denouncing the siphoning of money away from the military to pay for medical care for the elderly, Cordesman wrote, “The US does not face any foreign threat as serious as its failure to come to grips with… the rise in the cost of entitlement spending.”

Behind such discussion papers are systematic studies and actuarial tables calculating the likely effectiveness in shortening life expectancy for workers—a process that is already underway—of various proposals to “reform” the health care system.

In his immortal 1845 work The Condition of the Working Class in England, Friedrich Engels accurately characterized as “social murder” the horrific conditions imposed on workers by the capitalist class, which “placed hundreds of proletarians in such as position that they inevitably meet a too early and unnatural death…”

The present crisis-ridden and bankrupt state of American and world capitalism is once again bringing to the fore the incompatibility of the profit system and the rule of a financial aristocracy with the satisfaction of human needs such as health and longevity. The health care counterrevolution in the US is a case of “social murder” at the hands of the capitalist class.

 

WSWS

Trump nominee reaffirms support for assault on Medicare and Medicaid

ap_17018578526850_wide-6fa132fe2a71949d752c10594b266989175094cd-s900-c85

By Zaida Green
19 January 2017

Republican Representative Tom Price, president-elect Donald Trump’s nominee to head the Department of Health and Human Services (HHS), reiterated his intention to repeal Obamacare and his support for the dismantling of Medicaid and gutting of Medicare, in testimony before the Senate Wednesday.

Over the course of the nearly four-hour confirmation hearing, Price made clear his intent to keep unfettered the right of the healthcare industry to profit from mass suffering, calling for the transformation of Medicaid into a state-run program funded via federal block grants and refusing to commit to maintaining any of the minimal patient protections afforded by the Affordable Care Act, generally referred to as Obamacare.

Speaking before the Senate Health, Education, Labor and Pensions Committee, Price gave few details on the Republicans’ plan to replace Obamacare. While claiming, “Nobody is interested in pulling the rug out from anybody,” Price refused to give a timetable or any other specific details on a substitute health plan, suggesting that any replacement legislation would be implemented piecemeal, leaving open the possibility that the 30 million people who have gained minimal health care coverage through the ACA’s exchanges and Medicaid expansion could be left stranded without health insurance for an indefinite length of time.

Price, who was chairman of the House Budget Committee, refused to commit to Trump’s repeated campaign promise that his administration would not impose any cuts to Medicare and Medicaid, claiming that dollars were “the wrong metric” to measure resources for patient care. The Empowering Patients First Act (EPFA), the legislation which Price proposed in 2015 to replace the ACA last year, would cut $449 billion from Medicare and $1.1 trillion from Medicaid over the next decade.

Price gave vague and non-committal answers to questions about whether replacement legislation would maintain the limited protections afforded by the ACA, such as the prohibition on lifetime caps on most benefits; the requirement that insurance companies not exclude coverage for pre-existing conditions; the requirement that health plans include benefits such as mental health care, emergency services, and prescription drug coverage; and the right of young people to receive coverage from their parents’ insurance plans up to the age of 26.

All of Price’s answers amounted to variations on the themes of “patient choice” and the freedom “for every American to access the type of coverage they want.” In reality, this is the “freedom” to be either sucked dry by insurance companies for minimal coverage, to pay even more for comprehensive coverage, or to gamble on health and go without any coverage at all.

On the other hand, Price spoke sympathetically of the insurance companies preparing the premiums they would levy on patients in 2018, saying that “What they need to hear from all of us, I believe, is a level of support and stability in the market.”

Senate Democrats mounted a cynical assault against Price, citing Trump’s lying promise about not touching Medicare and Medicaid and repeatedly asking Price if he would uphold it, thus presenting the billionaire president-elect as sympathetic to these government-run health insurance programs, and giving themselves a pretext for collaborating with the new administration.

Democratic Senators Elizabeth Warren of Massachusetts and Al Franken of Minnesota referred to the billionaire real estate mogul’s recent comment that his administration would give “insurance for everybody”, and attempting to wring out of Price a commitment to Trump’s supposed promise.

Senator Bernie Sanders, the self-described “democratic socialist” who ran for presidency in the Democratic primary, urged Price, “Will you work with us on this?” as he questioned him on whether he would support the opening up of a market to cheaper imported prescription drugs.

The Democrats also criticized the blatant conflict of interest in Price holding investments of hundreds of thousands of dollars in pharmaceutical and medical device companies as he introduced bills that would boost the profits of these companies.

One senator, Democrat Christopher Murphy from Connecticut, pointing worryingly to the financial backgrounds of the rest of Trump’s cabinet, said, “I raise [these conflict of interests issues] because I think there’s great concern … [among] Americans that this whole administration is starting to look like a get-rich scheme.”

The author also recommends:

Pledging “insurance for everybody,” Trump prepares to escalate attack on health care
[17 January 2017]

US Congress moves to repeal Obamacare in order to impose even deeper health cuts
[14 January 2017]

Trump names Medicare opponent to head health programs: Who is Tom Price?
[01 December 2016]

http://www.wsws.org/en/articles/2017/01/19/pric-j19.html