Health Care as Wealth Care in America
For-Profit, Indeed
It’s not always better to run things for profit and for maximum return on investment. Consider this snippet I saw in my email feed this AM from CNN:
Private equity firms have been taking over hospitals, nursing homes and other health care delivery systems in recent years, and a new study finds the trend is making care riskier for patients. Researchers examined how often patients experienced certain adverse outcomes at hospitals before they were bought by private equity firms and after — and found that rates of hospital-acquired complications for patients increased by 25% at hospitals after they were purchased. The study doesn't answer how exactly private equity ownership diminishes care, but one of its authors said that previous research shows these kinds of acquisitions are often linked to staff cuts and replacing doctors and nurses with lower-paid employees.
Who knew that cutting doctors and nurses and replacing them with lower-paid, less experienced staff might have an impact on health outcomes? Color me shocked.
Meanwhile, roughly 100 million Americans struggle with some form of medical-related debt, and medical debts remain the leading cause of personal bankruptcy in America.
Back in 2013, I wrote the following article on the joys of health care in America. A decade later, matters and outcomes are only getting worse.
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Americans generally, and politicians in particular, proudly proclaim that we live in "the greatest" country. But how should we measure the greatness of a country? I'd suggest that quality of life should be a vitally important measure.
And what is more fundamental to quality of life than ready access to health care? When you're sick or suffering, you should be able to see a medical specialist. And those costs should be -- wait for it -- free to you. Because health care is a fundamental human right that transcends money. Put succinctly, the common health is the commonwealth. And we should use the common wealth to pay for the common health.
Here's the truth: We all face the reality of confiscatory taxation. If you're like me, you pay all sorts of taxes. Federal, state, and local income taxes. Property taxes. School taxes. Social security. State lotteries are a regressive tax aimed at the poor and the gullible. We pay these taxes, and of course some for health care as well (Medicare/Medicaid), amounting to roughly 30 percent of our income (or higher, depending on your tax bracket, unless you're super-rich and your money comes from dividends and capital gains, then you pay 15 percent or lower: see Romney, Mitt).
Yet despite this tax burden, medical care for most of us remains costly and is usually connected somehow to employment (assuming you have a good job that provides health care benefits). Even if you have health care through your job, there's usually a substantial deductible or percentage that you have to pay out-of-pocket.
America, land of the free! But not free health care. Pay up, you moocher! And if you should lose your job or if you're one of the millions of so-called underinsured ... bankruptcy.
Health care is a moral issue, but our leaders see it through a business/free market lens. And this lens leads to enormous moral blind spots. One example: Our colleges and universities are supposed to be enlightened centers of learning. They educate our youth and help to create our future. Higher Ed suggests a higher purpose, one that has a moral center -- somewhere.
But can you guess the response of colleges and universities to Obamacare? They're doing their level best to limit adjunct professors' hours to fewer than thirty per week. Why? So they won't be obligated by law to provide health care benefits to these adjuncts.
Adjuncts are already underpaid; some are lucky to make $3000 for each course they teach. Now colleges and universities are basically telling them, "Tough luck, Adjunct John Galt. If you want medical benefits, pay for health insurance yourself. And we're limiting your hours to ensure that you have to."
So, if Adjunct John Galt teaches 10 courses a year (probably at two or three institutions of "higher" learning) and makes $30,000, he then faces the sobering reality of dedicating one-third of this sum to purchasing private health insurance. If that isn't a sign of American greatness, I don't know what is.
I groan as much as the next guy when I pay my taxes. But I'd groan a lot less if I knew my money was funding free health care for all (including me and mine). Commonwealth for the common health. With no death panels in sight.
As "Dirty Harry" said in a different context, "I know what you're thinking." Free health care for all is simply too expensive. We say this even as we spend a trillion dollars a year on national defense and homeland security, to include the funding of 16 intelligence agencies to watch over us.
A healthy republic that prides itself on "greatness" should place the health of its citizens first. That we don't is a cause for weeping -- and it should be a cause for national soul-searching.
We met an expat here in Ecuador who had maintained a friendship with her ex-husband over the years. He had cancer and was tired of dealing with American health care. They decided to get together again for "one last adventure." They moved here and he lived another three years. The final year of his life, they had a live-in health care nurse who also helped with cooking and laundry--attending to all his needs to the very end. Their (and our) doctora, a Belgian who married an Ecuadorian would make house calls as needed. (She is the best doctor we've had and a plus--fluent in English). He never spent a single night in the hospital though he did visit the emergency room on two occasions. Their total "medical" costs during that last year totaled around $1,000 a month.
When I contrast their experience to my spouse's experience over the years, I marvel at the arrogance of our insistence that the US has such wonderful health care. They are masters of procedures and pill pushing--that's for sure. When private equity firms starting buying things up, you know the already mega rich are about to get richer at the working stiff and retiree's expense. The entire system is a house of cards like the rest of our war economy.
Bingo. The fed gov has money when they want to have money and doesn't have money when it doesn't want to have money. Assume you've heard of or read The Deficit Myth by Stephanie Kelton? Or watched an interview with Michael Hudson? Highly recommend. They are proponents of Modern Monetary Theory- a framework for understanding how a currency-issuing economy really operates.
The same US government that finds nearly one trillion dollars to pay for war (sold as "defense") could also find one trillion dollars to spend on everyday Americans. All the stuff the majority of Americans want - healthcare (that actually promotes health), a living wage, roads without potholes, a retirement without working at Walmart- all this stuff could happen in an instant if the federal government CHOSE TO DO IT.
I was listening to an interview with an MMT proponent named Thomas Fazi who gave a very interesting take on the demise of Liz Truss (on podcast Macro n Cheese, "The Breaking of the World with Thomas Fazi".) Fazi described how Truss had said in public something to the effect of, "deficits don't matter. We can spend whatever we want." In response to airing this secret to the public, the Bank of England tanked its own currency to force Truss out of office. She said something that the US gov and British gov absolutely prohibit expressing out loud: that a government that issues its own currency can spend whatever it wants, on whoever it wants.
Yes, you have to be aware of the inflationary impacts of printing money. But you are 100% spot on that the federal government COULD pay for universal healthcare, etc. It just chooses to pay that money to the Boards of Directors of defense contractors.