Eric Ross's Open Salon Blog

Universalizing Medicare Will Help Reduce the Federal Deficit

Wed, 29 Jun 2011 23:06:06 -0400

There is a commonly held view that one of the ways to fight the massive federal deficit is to curb entitlement programs such as Medicare. But, an expansion of Medicare may be what we really need.

According to a 2010 report produced by U.S. Department of Health and Human Services (with the Centers for Disease Control and Prevention and the National Center for Health Statistics), by 2008-9, 19.5 percent of adults --one in five-- between the ages of 18 and 64 had “no usual source of health care.” That kills people, beginning with the very young.

In 2009, among the 34 OECD (Organization for Economic Co-operation and Development) countries, the most developed nations in the world, the five with the highest poverty rates were, in order, (5) Turkey, (4) the United States, (3) Chile, (2) Israel and (1) Mexico. As a result, U.S. Infant mortality was actually the fourth worst in the OECD, after Mexico, Turkey and the Slovak Republic. One of the obvious problems is that the children of the poor, in a country with one of the world’s most productive economies, do not have adequate medical care. According to Columbia University’s National Center for Children in Poverty (NCCP), among all children in the U.S. under 18, 16 percent of those living in low-income families –-5 million—are not covered by any health insurance.

For millions of people in the United States, the situation doesn’t improve as they grow older. In 2008-09, for the 44-64 age group --a group that is particularly prone to a wide range of preventable or treatable diseases, including diabetes, cardiovascular disease, cancer, etc.-- 11.6% had no health insurance. About fifteen percent do not get or delay seeking medical care due to its cost, meaning that conditions become progressively more complicated and costly to treat.

We know, of course, that the new Patient Protection and Affordable Care Act has helped some of these people. But, it will not be until January 2014, that insurers will be prohibited from discriminating against or charging higher rates for adults with pre-existing medical conditions. In the meanwhile, such individuals ostensibly became eligible to join a temporary high-risk pool which would be superseded by a health care exchange in 2014. But, according to the Washington Post this past February, while the Medicaid program's chief actuary forecast that 375,000 Americans would join the new high-risk pools (which operate at the state level) by the end of 2010, as of this past April 30, only 21,454 had. This was not entirely surprising, however. According to an article by Linda J. Blumberg in the New England Journal of Medicine in May, Pre-Existing Condition Insurance Plans (PCIPs) were never meant to be large, so that “Even people whose existing insurance coverage (or coverage held within the past 6 months) excludes the medical condition that would otherwise qualify them for a PCIP cannot enroll.” For many people, premiums are also too high and they remain uninsured.

Millions who are still without insurance do not necessarily suffer from pre-existing conditions, however. One important group is pregnant women. In its 2010 report, Deadly Delivery: the Maternal Healthcare Crisis in the United States, Amnesty International reported that “women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries….the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain.”

Then, there are many people suffering from chronic diseases that, if left untreated, become life threatening and costly to remedy. A good example is diabetes. This is a disease which is increasingly common in the U.S. (and other developed countries) and which compromises the life style and shortens the life-span of millions of people. A recent paper in the journal, Health Affairs (2010), for example, estimates that the median age of diagnosis is 24 for Type 1 diabetes and 57 for Type 2 and that, by age 60, one in five adults in the U.S. has diabetes and two in five has pre-diabetes. The article suggests that the national economic burden of these conditions, in terms of medical costs and productivity losses, was about $218 billion in 2007. Yet, clearly, we cannot reduce that burden when many of the people at risk of diabetes or who suffer from it and will suffer its complications are not being adequately monitored and treated, due to lack of insurance.

Diabetes, of course, is not the only health condition that people are at risk of as a result of low income and insufficient or non-existent insurance. It is estimated that approximately 17.4 percent of individuals aged 18 years and above in the U.S. have hypertension. Among them, another study in Health Affairs indicates that hypertensive adults who have no health insurance are significantly less likely to have their hypertension controlled than those with insurance. They are, therefore, at greater risk of heart disease and stroke.

Fortunately, for those over the age of 65, there is Medicare. But, the sad reality is that, by the time that many people have access to it, medical treatment for conditions such as diabetes and heart disease, among others, is often less straightforward and far more costly than it would have been if everyone were insured from birth to 65. The potential savings from universalizing Medicare, in terms of national economic productivity (including days lost due to illness) and aggregate medical expenditure, and the added value in terms of increased quality of life for those who are currently uninsured, would be immeasurable.

The Sad Truth: Obama is No FDR

Sun, 26 Jun 2011 22:06:01 -0400

This evening, CBS’s 60 Minutes presented an excellent, poignant report on childhood poverty in Central Florida’s Seminole County. According to correspondent Scott Pelley, “We’re told the recession ended in 2009. This is a jobless recovery we’re in. Millions and millions of people are hurting. It grinds on and on and on. We’re raising a generation of kids in hard times. These are formative years for these kids. They know this time as a time of hunger and homelessness.”

What’s happening in Seminole County is just an extreme example of what is happening in varying degrees all across the country. According to the Children’s Defense Fund of Minnesota, a state in which the median income is above average and the rate of families in which all available parents are working is actually one of the highest in the country, the child poverty rate in 2009 was 14 percent. But, as elsewhere, it was highest among Asian- and African-Americans. In the District of Columbia and Mississippi, 32 and 29 percent, respectively, of children were living in poverty in 2009.

According to Columbia University’s National Center for Children in Poverty (NCCP), referring to statistics from 2009, “Nearly 15 million children in the United States –-21% of all children-- live in families with incomes below the federal poverty level–-$22,050 a year for a family of four. Research shows that, on average, families need an income of about twice that level to cover basic expenses. Using this standard, 42% of children live in low-income families." In 2009, among infants and toddlers under the age of three, of whom there are more than 12 million in the United States, 46 percent lived in low-income families, 24 percent in poor families. It is probably even worse today. But, before we blame it all on the economic crisis of 2008, it is notable that child poverty has been on the increase since 2000. There is something deeper and more disturbing at work.

Contrary to common assumptions, moreover, poverty is not because parents do not want to work, or even because they aren’t working. As the NCCP observes, “most of these children have parents who work, but low wages and unstable employment leave their families struggling to make ends meet.” While 88 percent of infants and toddlers with no employed parents –1.4 million– live in low-income families, 29 percent of infants and toddlers with at least one parent who works full-time, year round –2.4 million– live in low-income families and 73 percent of infants and toddlers with at least one parent who works part-time or part year –-2.1 million-– live in low-income families. Many of these children --13 percent of infants and toddlers living in low-income families-- are not covered by any health insurance. Nationwide, among all children under 18, 16 percent of children living in low-income families –-5 million-- have none. That is simply barbaric.

But, contrast this with President Obama’s continual reference to the U.S. “winning the future.” That rousing phrase is meaningless in the face of what is happening, an inadequate rhetorical reaction to the scale of the crisis that American families and children are facing. Millions of hungry, homeless, ill-educated children present a challenge to our society’s moral economy, an affront to our national sense of justice, a collective injury to our country that, to our shame and disquiet, will live with us for many decades. That is our future. Yet, the White House conveys no sense that it appreciates this or that it has the means to express, less alone remedy, the real hopelessness and anguish that its victims feel. Obama is no FDR.

On the Road to Medicare--for Everyone

Thu, 23 Jun 2011 16:06:21 -0400

I’m just five months away from eligibility for Medicare. Aging isn’t the most pleasant of prospects but, as the television ad says, one of the good things about turning 65 is Medicare. Yes, indeed.

I’m comparatively lucky that, a year after I returned to the States from Europe, where I had lived for 27 years, I managed to purchase health insurance. This was a new experience for me, after enjoying the benefits of Britain’s National Health, and it came with all the usual issues. Like almost any one in their sixties, I had “pre-existing conditions.” One of them was hypertension, which is so prevalent --twenty-four percent of the adult, civilian, non-institutionalized population of the United States suffers from hypertension—that to use it as a condition that disqualifies people from securing health insurance is a major threat to public health and the economy. (We’ll discuss that at length in another essay.) In the end, I got my insurance, but it initially wouldn’t cover blood pressure or my glaucoma. But, at $450 a month it was, from everything I heard, comparatively cheap, although there were co-pays and deductibles. Still, when I went into hospital for a week at the end of last year, the insurance company, to my relief, paid for almost everything without hesitation. It might not have.

Anticipating my switch to Medicare in November, I have begun to read all about the way it works and what its limitations are—and they are certainly real. But, whatever else may be said, gaining access to Medicare produces a small revolution in many people’s lives. That is because, as a 2010 report on health in the United States, produced by U.S. Department of Health and Human Services (with the Centers for Disease Control and Prevention and the National Center for Health Statistics), tells us, in 1993-94, 18.9% of U.S. adults between the ages of 18 and 64 had “no usual source of health care.” By 2008-9, this had risen to 19.5—one in five! This is one of the reasons that, among the 34 OECD (Organization for Economic Co-operation and Development) countries, the most developed nations in the world, the five with the highest poverty rates are, in order, (5) Turkey, (4) the United States, (3) Chile, (2) Israel and (1) Mexico.

The particular paradox (or crime, if you will) that confronts and challenges the United States is that, unlike Mexico or Turkey, it is widely regarded as the most prosperous country in the world. Yet, its immense aggregate wealth is apportioned in such an inequitable way that it condemns vast numbers of its citizens to real or near poverty for most of their lives. Such victims, not of their own inadequacy but of the nature of our profit-driven economic system, cannot afford basic health care. Over the years, the U.S. has only managed, by various means, grudgingly, to devise an awkward, costly and largely ineffectual system for dealing with this urgent social problem, one of the most critical of our time. But, it is far from ensuring universal quality care commensurate with our potential as a nation.

As Wendell Potter, the former head of corporate communications for health-insurance giant Cigna and now a leading industry critic, notes, Obama’s Patient Protection and Affordable Care Act undoubtedly remedies some of the worst abuses of the current system (or will, after all its provisions kick in over the next few years). But, it singularly fails to rise above the conventional assumption that the market can should remain the principal mechanism through which people acquire adequate and secure health care—not surprisingly, since it was modeled on the Massachusetts health reform of Republican governor Mitt Romney. As a 2009 report by doctors at the Harvard Medical School concluded, while that state reform “improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.”

According to a study in the American Journal of Medicine (March 2011), the Massachusetts reforms did little to effectively protect people against bankruptcy in the face of medical expenditures. As one of its co-authors, Dr. David Himmelstein, now a professor of public health at City University of New York, has said, “Massachusetts’ health reform, like the national law modeled after it, takes many of the uninsured and makes them underinsured, typically giving them a skimpy, defective private policy that’s like an umbrella that melts in the rain: the protection’s not there when you need it.” As a result, bankruptcies have not significantly declined. As the AJM study observes: “Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts – as in other states – afflicted middle-class families with health insurance. High premium costs and gaps in coverage – co-payments, deductibles and uncovered services – often left insured families liable for substantial out-of-pocket costs. None of that changed. For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services.”

As far as the U.S. in general is concerned, given our reliance on private insurers, too many people get inadequate value for money. While the CEOs of the major insurance companies do very nicely (in 2010, for example, the CEO of Cigna received total compensation –salary, bonuses and stock— of over 15 million dollars), many of their customers get insufficient and unreliable care. Too many others, priced out of the market, get none at all. As a result, if you compare the U.S. to other OECD countries, we are an utter shameful case. In 2009, for example, U.S. Infant mortality was the fourth worst in the OECD, after Mexico, Turkey and the Slovak Republic. (This is closely related to the percentage of U.S. children living in poverty; we are fourth, after Mexico, Turkey and Poland.) In its 2010 report, Deadly Delivery: the Maternal Healthcare Crisis in the United States, Amnesty International reported that “women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries….the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain.

There is little doubt that these disparities largely reflect our failure to universalize health care and to depend, instead, on for-profit health insurance which not everyone can afford. Thus, in 2008-09, for the 44-64 age group --a group that is particularly prone to a wide range of preventable or treatable diseases, including diabetes, cardiovascular disease, cancer, etc.-- 11.6% had no health insurance. About fifteen percent did not get or delayed seeking medical care due to its cost, meaning that conditions become progressively more complicated and costly to treat. The impact, for the individuals concerned and for society collectively, is immeasurably destructive.

But, here’s the crucial point: the percentage of people without health insurance drops dramatically to 5.1%, for those 65 and over. The reason is very simple: Medicare. If you are poor and can just hang on until the last decades of your life, you can finally manage to obtain access to the medical care that you always needed.

Of course, as I’ve learned, Medicare is hardly perfect. It was never made to provide complete coverage, so it is essential to top it up with a Medicare Supplement Insurance (Medigap) plan, to cover co-payments, coinsurance and deductibles. What this means is that Medicare, as presently constituted, not surprisingly provides business for the health insurance industry. But, what of the elderly poor-–and 16 percent of people 65-74 years of age and 23 percent of people 75 years or older are poor or near poor-- who lack the financial resources to purchase supplemental insurance? For many, as Diane Rowland and Barbara Lyons, of the Henry J. Kaiser Family Foundation, wrote in 1996 in the Health Care Financing Review, “gaps in the scope of Medicare's benefits and financial obligations for coverage can result in onerous financial burdens.” For several million elderly poor, Medicaid (a federal and state funded means-tested program for people and families on low income) provides their Medigap coverage. But, it does not reach everyone.

Medicare, for all its manifest virtues, is far from being an effective means of providing access to quality health care for all people above 65. As Rowland and Lyons go on to note, “Although Medicare coverage is universal, ability to pay for Medicare's cost-sharing requirements varies for elderly people at different income levels and with different levels of insurance supplementation. Lack of supplementary coverage, through private insurance or Medicaid, to fill gaps in Medicare coverage influences access to health services by elderly people. One-half of the population that relies solely on Medicare is poor or near-poor and likely to experience financial burdens that jeopardize access to care.”

The answer, however, is not, as most Republicans advocate, to alter Medicare in such a way that even more people are unable to meet the costs of necessary health care. Medicare is the closest thing that we have in this country to a model for how we could act like a truly civilized country. So, what we really need to do now is make it work as effectively as possible--not just for me, but for everyone.

Married to the Mob

Fri, 6 Aug 2010 12:08:54 -0400

According to Bloomberg News, “the number of Americans who are receiving food stamps rose to a record 40.8 million in May as the jobless rate hovered near a 27-year high," according to government sources. That means that one eighth of the population of a country that still claims to be the most prosperous on earth depends on federal subsidies to survive.

If that doesn’t startle and anger you, juxtapose it beside the small number of people who have amassed huge fortunes—often through what is called “public service.” At the moment, I’m thinking of the Clintons and, in particular, of Chelsea Clinton’s wedding and wondering why a simple civil ceremony in front of a justice of the peace wouldn’t have been a decent gesture at a time when so many lives are adrift. Instead, we got a real "Let them eat cake" moment!

If there is anything more disturbing than the persistence of poverty in this country, it is the economic and social inequality that threatens any sense that we really have a meaningful “democracy.” And, frankly, Bill Clinton personifies this. As president, he contributed to it and, fatherly pride aside, has now rubbed our faces in it.

It’s become a truism that George W. Bush created a huge budget deficit after Clinton left him a great surplus. But, that surplus was built, among other things, on a Clinton era reduction in government spending on crucial social services. As Michael Meeropol’s 1998 book put it, the Clinton administration completed the “Reagan Revolution,” or counter-revolution to be more precise, if one views such policies as a reversal of the progressive impulses of the New Deal, which is what Meeropol meant.

This is not really surprising. The great sociologist, G. William Domhoff, once described the Republicans and the Democrats as the right-wing and the left-wing of the Property Party. Despite the various ways they seek to characterize one another in their periodic electoral games, the fact is that our system is no less than what Chomsky once said of Colombia: it is an elective dictatorship, in which the two principal parties alternate in how and when they do the bidding of the power elite. So, Clinton’s economic (and, hence, social) policies) were not actually much of a departure from those of his predecessor.

As Gregory Albo, a political scientist at York Universty in Toronto, wrote in his review of Meeropol’s book,

“from the start Clinton’s budgetary policy fixated on the deficit and combined major spending cuts and minor tax increases. His monetary policies did not alter at all the direction that Greenspan had long established of moving to monetary restraint with a relatively high level of unused capacity and unemployment. The first order of business, as Meeropol records Clinton’s advisors as saying, was to ‘satisfy the bond market.’ Indeed, with Greenspan firmly ensconced as an economic tsar in Washington, Clinton left neoliberal monetary policy completely untouched. The second step was the deficit reduction package of the 1993 Budget Reconciliation Act. Here, too, Clintonism made its peace with neoliberalism. When congressional wrangling blocked tax increases, the weight of deficit reduction had to fall on cuts to program spending” to the poor.

We are reaping today what Bill Clinton (and his cronies, such as Larry Summers, still working his magic in the Obama White House, and former Goldman Sachs man, Robert Edward Rubin, Clinton's Secretary of the Treasury) sowed on behalf of the Wall Street mob. Much of what has gone wrong with the U.S. economy in the last two years is directly attributable, for example, to the demise of Glass-Steagall, the famous New Deal banking act of 1933, that Clinton repealed in 1999, an action that Elizabeth Warren, chair of the Congressional Oversight Panel designed to investigate the U.S. banking bailout (TARP), and others hold largely responsible for the financial crisis that is the main reason that so many of our countrymen are now on food stamps and in need of unemployment benefits. Not at Goldman Sachs, though, where the bonuses roll on.

And everything was fine in Rhinebeck the other day, when Chelsea Clinton married former Goldman Sachs banker, now hedge-fund trader, Marc Mezvinsky (whose father, a former Iowa congressman, was convicted of defrauding investors of millions in 2001 and did time in a federal prison). The wedding cake, which reputedly cost between ten and twelve thousand dollars, was a reassuring sign that all is well among the financial elite: it was 4 feet tall and weighed 500 pounds. But, perhaps more impressive is the fact that young Marc purchased the multi-million dollar apartment in Manhattan, where the couple will live, when he was just 30. This was as the economy was going belly-up for millions of his fellow citizens.

This is testimony not just to his personal moxie, but to the vast, excruciating distance that separates those in this troubled country who toil for a pittance and barely survive and the smiling mobsters who rule the economy and enjoy inestimable bounty and have no shame, in these hard times, about flaunting it.

Another "Teachable Moment," Please!

Wed, 21 Jul 2010 11:07:05 -0400

Compared to what has happened to Shirley Sherrod, an honest USDA official who was fired because of a hasty over-reaction by her employer to a deliberate misrepresentation of her remarks on the right-wing blog site of Andrew Breitbart, the mistreatment last year of Harvard professor Henry Louis Gates, Jr., by Cambridge police was certainly no more momentous or disturbing and no more what pundits now like to call a “teachable moment.” Yet, President Obama has not yet stepped up to the microphone to highlight the lesson to be learned—not just by the country as a whole, but by Fox News, of course, by the NAACP, a bit surprisingly, and by the people, above all, who help run his administration (most notably, Agriculture Secretary, Tom Vilsack).

It was Ms. Sherrod who got it exactly right, in her remarks to the NAACP, when she described how she had come to realize that it is not about whether someone is black or white, but whether they are rich or poor. Unfortunately, it is increasingly clear that President Obama does not actually tend to side with the poor. We have seen, time and again, how his ideas of reform inevitably stop far short of what is needed actually to curb the power and influence of the rich, how his language shrinks from the passionate empathy that victims of injustice require from a president committed to real, substantive social transformation. Say what you will, Henry Gates no longer lives on the cutting-edge of that kind of injustice.

So, what will the president do about Ms. Sherrod? Will he personally speak out about her regrettable firing by his Department of Agriculture, as he once did about the Cambridge arrest of Henry Gates? Will he invite her to the White House for a conciliatory drink?

This is clearly a “teachable moment” for our president.