The Sickness Of American Healthcare

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Above Photo: Images Money/ flickr

Yves here. If nothing else, be sure to look at the chart, which is the second graphic in this article. It presents a factoid that has been remarkably absent from discussions about affordability and access to healthcare.

One of the authors of this post, John Canham-Clyne, gave us a heads up on some news that will be breaking tomorrow. Since Lambert will be traveling, he won’t be able to include it in Water Cooler but interested readers can check the FAIR website in the mid-late afternoon for their take. From Canham-Clyne:

The sidebar on the rise in employer-sponsored premiums is particularly timely. The 2017 Kaiser Family Foundation/Health Research and Education Trust annual employer survey is due out Tuesday at 12:30, and wlll no doubt be accompanied by Democratic promotion of a “historically low” rate of private sector premium increases. A colleague will be looking at the full study when it lands tomorrow, and we’ll have a quick take on the real rate of premium increases.

By Mike Casey, chair of the Healthcare Initiatives Task Force of UNITE HERE, a union of 270,000 North American hospitality workers and John Canham-Clyne, deputy director of research for UNITE HERE. Originally published at FAIR

Media fixation on small fraction of patients distorts system’s real problems 

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Atlantic (2/23/17)

Instead of taking a serious look at the flaws in the ACA, and the deep impact they have on the lives of working-class Americans, reporters covering the healthcare repeal saga spent untold hours and column inches seeking out a tiny slice of the electorate for “reporting” that amounted to little more than mockery. Less than 2 percent of the American people both got new coverage under the ACA and voted for Donald Trump. Yet major media outlets obsessively sought out this sliver of the electorate, to ask, in the words of the Atlantic’s Olga Khazan (2/23/17),

a question that’s baffled health reporters in the months since the election: Why would people who benefit from Obamacare in general—and its Medicaid expansion specifically—vote for a man who vowed to destroy it?

Vox’s Sarah Kliff found these voters in Kentucky, more than once. Abby Goodnough and Reed Abelson did too in North Carolina for a front-page Sunday feature in the New York Times (3/7/17). Jessica Contrera found them in West Virginia for the Washington Post (3/11/17). The LA Times’ Noam Levy (2/24/17) found them in Florida. The Kaiser Family Foundation held monthly focus groups with them in Pennsylvania, Ohio and Michigan, allowing KFF president Drew Altman to opine on the Times’ op-ed page (1/5/17). Like Kliff, ABC (2/27/17) found them in Kentucky, and CNN’s Dr. Sanjay Gupta (1/6/17) went to Florida. Reporting stimulated comment from the Post’s Dana Milbank (12/20/16) to the Times’ Paul Krugman (3/14/17) to influential liberal sites like Daily Kos (1/28/17), Salon (12/15/16) and Digby’s Hullabaloo (3/13/17).

Khazan’s “baffling” question has a simple answer. Trump did not promise to “destroy” Obamacare, he promised to give people better health plans (a promise broken, obviously). Many people can’t afford ACA exchange coverage, made clear in the Kaiser focus groups:

They spoke anxiously about rising premiums, deductibles, co-pays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance—for which they were eligible for subsidies—saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters.

Most People’s Healthcare Left Out of Discussion

        Chart: UNITE HERE

Chart: UNITE HERE

The most damaging effect of singling out this minuscule fraction of the electorate and questioning their motives was the license it gave media to ignore the realities faced by the rest of American working families and to distort the politics of the Affordable Care Act.

Here’s who the media failed to cover: the 177 million Americans who get their insurance through job-based coverage. They are Clinton voters, Sanders voters, Johnson voters, Stein voters and, yes, Trump voters. Media generally overlook the crushing impact the ACA has had on their health insurance. To the extent people with employer-provided insurance are interviewed on healthcare, they are often wrapped in the wrong frame—that their concerns about the ACA are irrational, because the ACA didn’t impact people who were already covered.

This is just a little of what has actually happened across political, racial, economic and gender divisions to the millions of Americans with employer-sponsored health insurance since the ACA was implemented in 2010:

In short, the majority of Americans who get their insurance through work are facing an escalating crisis of underinsurance, brewing under the ACA and not addressed in the GOP’s proposed replacements. With more than a third of workers carrying deductibles of $1,000 or more, and 20 percent now in plans linked to Health Savings Accounts, few Americans’ benefits look much like 2010.

Shifting Costs to Patients

The deepest flaws in the ACA are the fruition of President Obama and congressional Democrats creating a law that counted on controlling costs by forcing employers to make American workers pay more so they would use less healthcare, instead of having millionaires pay their fair share. In particular, the misleadingly named “Cadillac Tax” is putting enormous pressure on workers’ out-of-pocket costs, based on the false notion that Americans use too much healthcare and that giving employers and workers more “skin in the game” will shrink overall costs—as if shifting costs to the least-powerful players in the system weren’t a recipe for boosting rather than curbing healthcare inflation.

In reality, we already pay more out of pocket than almost anyone else, but go to the hospital and see the doctor less often than the average for wealthy nations. American costs aren’t out of control because we use too much healthcare, they’re out of control because our healthcare system allows corporations to charge too much:

Time-Bitter-PillThese trends are covered, but only episodically compared to the avalanche of coverage of the ACA marketplaces and Medicaid expansion. The New York Times(12/15/15) and others covered a groundbreaking study of 3 billion insurance claims that showed that hospital market power and prices, not utilization, are the primary drivers of private-sector costs. Steven Brill (Time3/4/13) has relentlessly exposed extreme hospital prices, and pharmaceutical price-gouging  is a national story (e.g., New York Times4/26/16). But overall, the media allows Washington politicians to frame the “reform” debate as a false choice between a status quo and Republican reaction—in other words, between a system that punishes working-class Americans and even more punitive proposals.

There are plenty of policy tools to combat healthcare corporate monopolies—from Nevada’s first-in-the-nation law curbing Big Pharma’s price-gouging on insulin, to Maryland’s successful hospital rate-setting system, to Hawaii’s employer mandate—or, of course, creating a universal Medicare-for-All (“single-payer”) system. However, all of these require politicians to put working-class Americans before Pharma, hospital and insurance industry profits. Unfortunately, few in Washington, DC, have a taste for any change that isn’t paid for by poor and middle-class families, and corporate media allow politicians to get away with it.

Republicans’ simplistic market nostrums and fixation on tax cuts for millionaires have already run smack into the brick wall of reality. The Democrats’ turn is coming. Standing back and watching GOP infighting may be satisfying, but until Democrats acknowledge the direct harm that their healthcare reforms have inflicted on American families, and the even greater harm that failing to include any restraint on the industry in the original bill has caused, Democrats will continue to suffer apparently mystifying failures at the ballot box.

The media’s myopic focus on a tiny slice of Trump voters, singled out for mockery and disdain, has enabled Democrats’ denial of the true practical and political consequences of a flawed law under whose purview the family fortunes of the majority of Americans have continued to decline.