Guest post: Now is not the time to be nice
Originally a comment by Bruce Gorton on This racially disproportionate rate of death.
One of the most disgusting responses to the virus I saw was – The View accusing Bernie Sanders of politicizing the crisis by pushing medicare for all.
Joe Biden sounding very much like he’d veto medicare for all if it ever actually passed the lower houses.
Biden had previously said medicare for all wouldn’t help – just look at how Italy’s healthcare service was over-run.
Well, if you go to Vox and look at their story from two days ago that included charts of infection rates, what you can see from their linear graph is that Italy has handled the virus significantly better than the US, despite both countries having failed to lock down early enough.
The US is handling this crisis uniquely badly, and a big chunk of that is that the US’ healthcare policy is highly fragmented. Because the US is entirely reliant on private healthcare, some insurers are waiving costs for treatment, others are not.
And it required bringing in new legislation to make the tests free, which meant delays on getting sufficient testing done.
So you’ve got a crisis which requires federal action to deal with. Leaving it up to the states means you get stupid shit like giving religious exemption to lockdowns despite the fact that religious gatherings are pretty good at spreading the disease.
It also means that you have big gaps in who has adequate and inadequate medical infrastructure.
And yes, the virus is in rural America.
There is a real risk of creating reservoirs of the virus that reinfect places that took sensible measures, because the handling of it is so fragmented.
So essentially it is fine to politicize the pandemic in order to prevent any action that might conceivably help solve the crisis and mitigate future pandemics, that’s exactly what Joe Biden did with regards to Italy.
But to suggest letting people get free-at-the-point-of-service healthcare under a unified federal system is bad form. There is a disgusting and frankly odious hypocrisy in that.
Now you’ll note I’m hitting the Democratic Party in this. This is because right now the Democrats need to start showing some spine.
If they cannot argue for a more unified approach on public healthcare now, then when can they?
The argument from high costs is identical to the argument against dealing with climate change, and suffers the same problems. The fact is that you’re already paying for the status quo, and you’ve got no guarantees of treatment under the status quo.
Much like climate change, the cost of doing nothing may well be more than the cost of action.
What medicare for all does is essentially migrate how you pay for healthcare to doing it through your taxes. If healthcare costs are destined to balloon over the next decade, they’ll still do that if you’re doing it through the private sector. Doctors will still need to be paid, medicines will still need to be made, if you get sick, you will still need treatment.
Where the savings predicted in medicare for all come in are through economies of scale, you need less administration for one healthcare system versus a whole load of insurance companies, and through savings on drugs due to the fact that a single payer has more negotiation power.
You also have better preventative care, and earlier detection of health problems, reducing the costs of dealing with those problems as a whole.
The US pays more for medication than any other country in the world, and that medication is developed into a commercial product by drug companies, but are actually often discovered by publicly funded universities.
So the argument that the private sector is the driver for new drug discoveries is in fact dodgy.
This is the case that should be being made by what is supposed to be the leftist party in America, yet they are too timid to make it even as the current sitting president is confiscating medical supplies from hospitals.
When Zimbabwe suffered through its economic collapse, one of the things Zanu-PF did was ensure that their supporters got food aid, while the opposition did not.
The fact that you cannot trust the current president not to do the same thing in this crisis means now is not the time to be nice.
There comes a time in which a party has to be able to fight. To stand up and suggest solutions and not back down for fear of getting criticized.
A politician’s job is to politicize things, to suggest political solutions to problems, to debate what action the body politic should be taking, and for far too long and on far too many issues, this has become taboo because that taboo supports the kind of people who buy patents for diabetic medications and hike the prices.
If you’re hiring somebody for a job, you don’t want somebody who is too cowardly to do the job. The Democratic Party needs to do better here, or risk losing to a man who belongs in jail, not the Oval Office.
I think it’s very important to note that Medicare is not only not a free coverage, it is expensive. And the coverage is less than great. I cringe everytime I hear someone say Medicare for all. I think people are under the illusion that medicare is something great; it isn’t. It has been brutalized in the past couple of decades, and would leave poor people in the same boat they are in now. Unable to afford premiums, unable to afford deductibles (about $400-500 per year currently), unable to afford copays.
The words “single-payer” have become anathema, and NO ONE will say them. We would rather keep on with illusions than find a real way through the snake pit of current public opinion. It’s time to talk turkey about health, and stop saying “costs money”. LAY THE COSTS OF SINGLE-PAYER AGAINST THE COSTS OF CURRENT PLANS. No, BIden prefers to say “It costs this much to insure everyone”, without saying how much it costs now. And Bernie just sort of shrugged and said he’d work that out once he got to the White House. No, Bernie, work it out now. Do the numbers. That’s the only way you’ll convince people.
Yeah, time to stop being nice, but also time to stop sprinkling fairy dust and be realistic. Medicare for all is not the answer. Medicaid for all, maybe. I know much less about that, but I think it comes closer to a free coverage. I am wiling to be corrected on that, though..
This post makes some great points, but while I agree that a single-payer system is better, Bernie’s M4A plan was untenable. I couldn’t support it for that reason. His numbers didn’t add up. But it’s not like it’s impossible, since other countries have done it. Bernie just didn’t do his homework, and I wish that Biden would.
I’m sure Biden would adopt whatever option polls well and the Democratic party has made their official position…
Unfortunately people need to be convinced that their current insurance (for those that have it or those who aspire to have it through an employer) is utter shite. One would hope that the current and most obvious state of affairs would change that calculation. Unfortunately people are stupid and the right wing propaganda machine has been very effective in convincing people that not only is the status quo good, it is in fact too good and should be bombed into oblivion.
People… are… terrible.
Take that vox chart and multiple Italy’s numbers by 5 (we have more then 5 times their population), and they come out worse than we do.
Biden didn’t say Medicare for All wouldn’t help. Bernie gave an answer suggesting M4A would have made a huge difference, and Biden simply pointed out Italy has universal healthcare and that didn’t automatically solve it for them. You can have a M4A system that provides good overall coverage but doesn’t handle such a pandemic well.
Biden suggested he’d veto M4A if it wasn’t properly funded. He did not suggest he’d veto it if it was.
I’m not a fan of Biden and would like to have Medicare for All in the sense that it’s complete coverage for everyone without premiums. If we’re going to charge everyone the same premium it’s stupid to not just include it in the price of the program.
I have been involved in medical care in this country for about 30 years – both in direct care and public policy. I sat at the airport on Sept 11, 2001 waiting to see if they were going to activate my trauma unit and deploy us to NYC. I gravitated to trauma in large part because it was the one truly egalitarian system of care we had. Everyone got treated. I’ve treated many GSW victims – the youngest was 7. I’ve been through two major pandemics, one in the front lines (the 1980‘s with HIV/AIDS) and one in a support role (COVID-19). In both cases, I have witnessed the devastating effect of political considerations trumping the medical science. I well remember my residency and early practice years when we were confronted with the rise of a totally new and little understood disease that could kill not just our patients but us as well. Of course public and hospital policy was a big help. I remember being forbidden from using the gloves and face shields we used with viral hepatitis patients for PPE even when it was suspected that AIDS was an agent with similar fluid contact transmission. So not that much has changed. I share this to be clear that I know more than the average joe about healthcare.
The problem with most of our public discussion about healthcare is obsessed with the payment system but that’s only part of the equation and arguably not the most important. In the USA we do not have a healthcare system. We have a loose collection of commercial entities competing for your healthcare dollar. For profit or non doesn’t really matter since they all have to make ends meet in a highly competitive industry. To make matters worse, most of our services are skewed toward the American penchant for just in time intervention in lieu of prevention and personal responsibility. Just in time care is expensive.
We worry about how to pay for care when we should first figure out the what. What are we paying for? What are the optimal ways to manage particular patient populations? We already know a lot about this but it isn’t applied universally. What demands need be placed on the patients themselves? How much cheaper and more effective is it in the long run to intervene early in the course of illness? (Trick question – we already know the answer to this one and it’s a huge amount.) But early intervention requires easy, friction free access to primary care services and not just for the well off. We have the models to provide these services to all in ways that we can afford. We just have lacked the political will to do it. Also, like many real world problems it doesn’t fit as easily into a sound bite.
If we want real change we need to shift from arguing about single payer (it will happen anyway if we do this right) and concentrate on a vision for a standard of universal service. A national health system that isn’t just about a panel of providers willing to see some quota of patients but a system of national policies and procedures governing the provision of care. Standards of care not measured by popularity surveys (like we have now) but based on adjusted patient outcomes. Optimal care ends up being the most affordable.
Pliny, I think you’re very correct in this comment, but I can’t begin to imagine how we get from here to there.
There are so many things making this a self-reinforcing system. It costs money every single time I go to the doctor. It’s inconvenient. So I only do it when I can see a clear benefit. People with less money than I have don’t even do it then.
That helps account for the fact that we have a stunningly unhealthy populace. As a simple proxy, just run down the list of countries ranked by obesity; we’re right up there after the Asian island nations and before the Middle Eastern sheikdoms. Most other developed nations are in another part of the list.
Running our national medical system as a just-in-time service like a car mechanic’s garage, but doled out through a maze of paperwork, instead of having a service that takes responsibility for people – that measures outcomes and focuses on prevention, has helped lead a supposedly developed nation to this level of costly metabolic disease.
Not only that, but trying to get a reasonable level of care in certain areas is nigh-impossible through even the best insurance. I really like my primary care physician; I go to the other end of the city to see him. He knows and asks about the whole family; he treats my wife and treated her parents before. If he’s in practice when my kids age out of pediatrics, I expect he’ll see them. When I told him I finally found a good therapist for my son, he knew that meant private pay without me saying it. He already knew that all the good adolescent therapists here don’t take any insurance, because he’d been down the same road with his son. My son’s therapist helped put him back together, but at a cost to us similar to private school tuition. What are the long-term costs to our society of all the kids whose parents can’t afford mental health competence?
I have no doubt this would be true on a national basis, and it could become true on an individual basis. How do we get there, though, in a country that lives and dies by quarterly earnings? Lack of long-term thinking is a national affliction more widespread even than metabolic disease. How, in a country where the practice of withholding prenatal care from undocumented immigrants is seen as a badge of fiscal responsibility, do we seriously contemplate foresight as policy?