By By mikethegunguy – – – – –
THE FIRST IN A SERIES ABOUT U.S. HEALTH CARE
Believe it or not, the first time that a universal (single-payer) medical care system was promoted by a Presidential candidate was not Bernie Sanders, but Harry Truman back in 1948. That’s right, Give ‘Em Hell Harry called for a single-payer system but ended up settling after the election for a very limited plan that provided a bit of coverage for the old folks and ultimately became the greatly-expanded program known today as Medicare.
So we have been arguing over the role of government in health care for nearly 70 years, and while it is estimated that nearly 300 million Americans now have some kind of insurance coverage – private or public – there are still 27 million who are completely uninsured, a number which might rise depending on the outcome of the election which is now less than five weeks away. The degree to which the November 8th outcome will alter the current methods through which Americans pay for health coverage is the subject of three very well-written articles in the October 6th issue of the New England Journal of Medicine, which I am going to summarize here.
If HRC wins but the Congress remains red, chances are that little will change, if only because the Republicans have used opposition to government-mandated health insurance as a stalking-horse for rallying their base for the past twenty years. And Hillary’s aborted attempt in 1993 to generate Congressional support for health-care reform from Republicans, never mind Democrats for that matter, will come back to haunt her again.
Trump, of course, has borrowed the same-old GOP playbook by routinely telling the crowds at his Klan rallies that he will ‘repeal’ the ACA, but even if he were to find himself sitting at 1600 Pennsylvania Avenue with a Republican majority in both houses up on the Hill, he won’t be able to wipe away coverage for millions of people without, at the same time, coming up with a new plan. And the plan he has mentioned, although it’s not clear that he understands it himself, is the usual mixture of ‘free-market’ solutions (purchasing insurance across state lines, expanding health savings accounts) that do not appear to extend the government’s reach.
Neither of these approaches will make any substantial difference in addressing the biggest problem faced by most Americans when it comes to paying for their health care, namely, the fact that the costs keep going up. Between 2006 and 2015 the average annual deductible for individuals with employer-provided health care increased more than 300%, from $303 in 2006 to $1,077 in 2015. And worse, the lower the employee is on the wage scale, the higher the annual deductible, often amountingto more than $1,500 per year.
This is not the place to get into a discussion about the costs or performance of U.S. health care, but the bottom line is that unless there is an electoral tidal wave one way or the other in five weeks, we are probably going to see a continuation of the hyper-partisan and largely ineffectual debate over health care reform that has been going on since the end of World War II. Good health is everyone’s concern, but that doesn’t mean that everyone or anyone can figure out what to do.