FROM THE TPP TO THE ACA: Seventy years after President Truman!

THURSDAY, JULY 16, 2015

Part 4—In fairness, it’s all their fault: It has now been seventy years since President Truman “pitched his idea for national health care.”

Around that time, other developed nations instituted the national health plans which rarely get discussed, whether in our mainstream press corps or at our “liberal” news orgs.

Seventy years later, how is our national health care doing? How well have we liberals done in instituting a “universal” system?

Granted, any shortcoming in our health system is by definition the fault of the others. If the Buddha returned to earth and read Salon and watched Rachel Maddow, he’d be astonished—humbled, even—by the moral enlightenment he found, by our sheer intellectual brilliance.

Granting the point that it’s all their fault, how well does our system function now that the ACA is established law? Consider a question we recently heard from a caller to C-Span’s Washington Journal.

The guest this morning was Dr. Ezekiel Emanuel, who was chyroned thusly: “Former Health Care Special Adviser, Office of Management and Budget, Obama Administration.”

Emanuel appeared in the aftermath of the Supreme Court decision upholding a basic provision of the ACA. About nine minutes in, a caller on the Republican line described a difficult situation:

CALLER FROM ILLINOIS (6/28/15): Listen, doctor—I did some homework for a gal. She’s like 58, I think she’s 58 years old. And you know, she lives on her husband’s death benefit, OK? Because she’s a widow. She needed insurance. I did everything possible. And we got her insurance, which is fine.

But the problem is, her deductible is $6000! And I’m working harder and harder and harder—I think I found one for $4000, but she says even the $4000 is a killer. And is there any way that this thing can be rectified down the road, where these deductibles—because that’s a huge problem for people with limited income...

To watch the whole segment, click here.

The caller was on the Republican line, but he wasn’t especially partisan. As he closed, he only said that he didn’t like the fact that the ACA had ultimately passed the Congress through the legislative procedure called “reconciliation.”

At any rate, the caller said he had helped his friend obtain health insurance. “We got her insurance, which is fine,” he said. But he said the deductible on her plan is “a killer.”

Technically, the caller’s friend is insured. She is part of the upbeat story we frequently we hear at our liberal sites, in which the uninsured rate is coming down, at least within the blue states.

The caller’s friend is listed among insured. But the caller says the deductible on her plan constitutes a significant burden.

In his reply, Emanuel didn’t challenge the caller’s perspective or story. To his credit, this is what he said:

EMANUEL: So let’s talk about the first issue, which is the question of large deductibles and these high deductible plans. There is, I think, a growing sense in the country that we might have gotten too far out ahead of ourselves with these high deductible plans.

One of the advantages of getting insurance is that, if you have a catastrophe, a health catastrophe, a serious stroke, cancer, where the bills are really in the tens and maybe even a hundred thousand dollars, you’re really protected from bankruptcy and you’re protected from losing your house, or whatever, to pay for medical care.

On the other hand, $4000 for most Americans is a lot of money. And if you don’t have serious health problems, you’re probably not going to get to the $4000 deductible. But if you have some serious health problem but not a disaster, it could still be a big pitch.

I think that is one of the issues that’s going to have to be faced over the next three or four years, is how to keep those deductibles down. And also, one of the things we’ve noted is that a lot of employers have been shifting—their premiums actually have not been rising very high. But nonetheless, they have been shifting more costs over to workers with these high deductible plans without putting some money in the bank to help them.

I will tell you, I just recently signed up at my employer, the University of Pennsylvania, for a high deductible, and they put in $500 into an account so I could use to pay off the deductible. Now for many people, those plans are actually a good deal, because it brings your insurance bill down a pretty fair amount of money, in my case over $100. But it does expose you to the chance that you’ll have to pay a fair amount of money if something serious happens and that’s the kind of trade-off.

We do need to protect people and there are a variety of ideas as to how to do that, making sure that the very high deductible doesn’t apply to drugs, so that drug coverage can be reasonable right out of the box, is I think one very important method that we really need to consider.

In our view, some of that answer was so technical that it was essentially incoherent. Beyond that, our analysts shifted in their seats as Emanuel quickly moved to discuss the wonderful plan he receives from his Ivy League employer.

That said:

To his credit, Emanuel didn’t dispute the caller’s basic point. The caller was basically non-partisan in his complaint. Emanuel followed suit.

We were intrigued by Emanuel’s statement. Like you, we rarely see such topics discussed. In part, that’s because we watch The One True Liberal Channel, where we’re more likely to see a multimillionaire corporate-paid host playing on her toy xylophone as she endeavors, night after night, to make us massively dumber.

We’re not health care experts here. To our ear, Emanuel was basically telling the caller that his friend has “catastrophic” coverage.

In the event of a health catastrophe, she won’t lose her house, Emanuel said, failing to ask if she owns one. But in the absence of “serious health problems,” she’ll have to pay her monthly fee, and she’ll receive no benefit.

Is that a “good news” story? Is that woman’s situation something to make liberals proud? In his recent column, “Hooray for Obamacare,” Paul Krugman discussed this very issue.

Two days before that C-Span exchange, this is what Krugman said:

KRUGMAN (6/26/15): [Y]ou need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren't eligible, and any system that doesn't enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent—that is, in year two we're already around 80 percent of the way there. Most of the way with the A.C.A.!

But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.

Is Krugman’s statement accurate? Is it true that insurance with a “relatively large deductible” is vastly better than no coverage at all?

In that woman’s case, the answer isn’t clear. At any rate, that woman gets listed as having insurance. She gets listed as one of the beneficiaries of the ACA, as opposed to the 21 percent of lower-income adults who have no insurance at all.

In his response to the C-Span caller, Emanuel said these “high deductible plans” represent “one of the issues that’s going to have to be faced over the next three or four years.” Seventy years after President Truman, a lengthy report in the Washington Post recently presented another such problem—a problem Emanuel specifically cited in his response to that caller.

The 3800-word report was written by Ana Swanson. In hard copy, it topped the front page of the Post’s Business section on Sunday, July 5.

The piece was given a prominent display. In hard copy, headline included, Swanson started like this:

SWANSON (7/5/15): New drugs help Americans live longer—and leave them in debt

Kristin Agar’s symptoms came on in 2008. Her feet swelled. Her joints ached. A rash appeared on her face. And every night a fever that was gone by morning.

Her doctor diagnosed her with lupus, a disease in which the body’s immune system mistakenly attacks healthy tissue, including skin, joints, kidneys or the brain. He prescribed Benlysta, the only treatment on the market specifically for lupus.

The 63-year-old social worker says she cannot afford the medicine. She has a good job and decent health insurance, and yet the math simply doesn’t work. Her insurance cpovers80 percent—or about $2,500 per dose. That leaves Agar $450 to pay one or twice a month—on top of $770 monthly insurance premium, plus her other medical costs.

“I make too much money to qualify for assistance, but I don’t make enough to pay the bills,” she says.

On line, the headline was more direct: “How new drugs helping millions of Americans live longer are also making them go broke.” For that version of Swanson's report, you can just click here.

Swanson goes on, at considerable length, about the high (and rapidly rising) cost of prescription drugs. In hard copy, it isn’t until paragraph 54 that she starts comparing our procedures in this area with those found elsewhere in the developed world.

(“The United States is the only wealthy country that does not negotiate with the pharmaceutical industry over drugs prices,” Swanson writes, then continues from there.)

Kristin Agar, a social worker, has “decent insurance,” we’re told. She too is part of the upbeat story in which our uninsured rate has dropped to 11.4 percent—a rate which leaves the United States the laughingstock of the world.

Will the proposed Trans-Pacific Partnership “kill huge swaths of working-class and middle-class jobs?” If he returned to earth today, the Buddha would be dazzled by our brilliant tribe’s moral enlightenment. But on Our Own Liberal Cable “News” Channel, our xylophone-playing entertainers avoid such topics like the plague.

They also avoid the problems confronting people like Agar and the woman in Illinois. Seventy years after President Truman, we liberals seem disinclined to engage with this giant mess.

Does anyone care about people like Agar? Tomorrow, we’ll venture to the basic key point in this gigantic disgraceful mess.

Seventy years after President Truman, it’s a point which is never allowed to disrupt all the fun on MSNBC.

Tomorrow: Please don’t discuss the truth