Tom Maertens

Tom Maertens

The World Health Organization said in a September 2014 report that the United States is “currently the only high-income country without nearly universal health-care coverage.”

In fact the Trump administration is trying to cut Medicare and Medicaid and to kill the Affordable Care Act.

Trump said in October, “We have a great Republican plan” to replace the Affordable Care Act.

There has never been a serious Republican plan to replace Obamacare. “Repeal and replace” is an empty slogan designed to snooker the gullible.

In reality, the administration has thrown its full weight behind a lawsuit to kill the ACA. It said in court filings: “The proper course is to strike it down in its entirety.”

Trump recently issued an executive order that purports to save Medicare, but would have the opposite effect, according to Pulitzer-winning L.A. Times columnist Michael Hiltzig. It promotes a false narrative about Medicare competing in the open market, when in fact, its major advantage is that it pays physicians 40% less than commercial plans and pays hospitals only half to two-thirds of what private insurers pay. Trump’s sleight-of-hand would raise the Medicare price structure and bankrupt it.

Consumers are already being subjected to shady dealing and secret negotiations between hospitals and insurance companies, and price gouging by Big Pharma (see My View, April 19, 2019). Hospitals have many different prices depending on who pays: group plans, unions, Medicare, Medicare advantage, worker’s compensation, tort, out of network, and self-pay.

Hospitals and insurers typically treat prices for specific medical services as closely held secrets, which makes it difficult to comparison shop. The WSJ cited the example of a magnetic resonance image of the lower back that costs $141 at an imaging center in Jefferson, La., but $7,646 at a hospital in Torrance, California.

Congress added to the problem. Sen. (R-Utah) Orrin Hatch’s Dietary Supplement Health and Education Act of 1994 all but eliminated government regulation of the (now) $50 billion dollar dietary and herbal supplements industry— for which his son was a lobbyist. As Dr. Peter Lipson has stated, DSHEA, was intended to facilitate the legal marketing of quackery.

Over-the-counter products frequently contain little or none of the active ingredient(s), but unless the manufacturer claims to treat some illness, or people are injured/killed, the FDA cannot intervene.

U.S. health care spending in 2016 totaled 17.2 percent of GDP, compared to just 8.9 percent for the other OECD countries, which for them is sufficient to fund universal health care. Workers on average pay $6,015 toward their coverage, according to a September survey by the Kaiser Family Foundation, plus average deductibles of $1,655 for a single plan. The average premium for family coverage is $19,616 per year, says the Kaiser.

The Center for Medicare and Medicaid Services (CMS) projects that health care costs will climb to $6 trillion, or about $17,000 per person, roughly 19 percent of GDP by 2027.

Universal health care inevitably provokes cries of “socialism” among opponents, who invoke communist countries like North Korea as examples of socialism. For some reason, the multi-trillion dollar Bush bank bailout, the $1 trillion annual subsidy to fossil fuel, the $20 billion annual ag subsidy, and Trump’s $28 billion in handouts to farmers to cover his China tariffs are not socialism. For the record, the VA system is socialized medicine because, well, only the best for our veterans.

In contrast, democratic socialist countries such as Denmark, Finland, the Netherlands, Canada, Sweden, Norway, and Ireland provide universal health care and education for all; they have higher life expectancy, much less poverty and significantly higher overall life satisfaction than in the U.S.

Gallup does a worldwide survey for the U.N. every year of the world’s happiest countries: for 2019, they are, in order: Finland, Denmark, Norway, Iceland, Netherlands, Switzerland, Sweden, New Zealand, Canada, and Austria. The U.S. is #19. Health care is a major factor.

Most universal health care plans would raise taxes on the wealthy, who, largely as a result of Trump’s 2017 tax cut, now pay a lower tax rate than the middle class, according to The New York Times and the Washington Post.

“The Triumph of Injustice,” by economists Emmanuel Saez and Gabriel Zucman, reports that the richest 400 families have more wealth than the bottom 60 percent of households, while the top 0.1 percent own as much as the bottom 80 percent.

CNBC recently reported that the wealthy will avoid/evade $5 trillion in taxes in the next decade.

It’s clear where the money is to pay for universal health care; what’s missing is the willingness to go after it.

Tom Maertens was a naval officer, a Peace Corps Volunteer and a Foreign Service Officer who served around the world, in the White House and in the U.S. Senate.

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