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


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


  1. Not one question posed to POTUS Obama about illegal alien Francisco Sanchez murdering Kathryn Steinle in San Francisco. Why has Obama and his administration not bothered to contact Kate's family? Obama even called Sandra Fluke personally to see if she was alright after being called slut by Limberger. Apparently liberals consider words are more harmful than deeds.

    1. Off topic. Put up a relevant comment or go away.

    2. @11:31

      Except after I post a current controversy, B.S. does manage to get around to using it as a topic days or weeks later. Apparently B.S. does read his own blog.

      BTW: In the same time it took you to post your comment you could have actually attempted to defend Obama's curious silence.

    3. Krugman mentioned illegal aliens. Why hasn't Somerby noted the fact that failure to cover illegal aliens is one of the reasons for a high percentage of uninsured low income people and Hispanics. The rate of the uninsured has fallen but Bob seems only to want to focus on the gaps.

    4. cicero, like Somerby the blogger who attracts him daily, can always find an example of things unsaid.

      Obama should call each crime victim personally and all news programs should have no time limit on any story so all issues anyone can imagine can be discussed as thoroughly as any critic might find retroactively possible.

    5. Illegal aliens are not counted in statistics about the percentage of insured. They are mentioned as people the system wasn't intended to cover.

    6. @ 11:45

      Thank you for providing the Josh Earnest talking point. Of course that explanation falls flat considering POTUS Obama reserves his precious time to draw attention to murder victims (or insulted lawyers hawking free contraceptives) when it serves his political agenda.

      Speaking out against the perils of Sanctuary Cities would be anathema to the Obama/HRC agenda.

    7. The only person you are likely to recruit with your trolling here is David in CA.

    8. @12:25

      Dismissing questions about POTUS Obama's selective outrage as "trolling" is indeed the favorite all purpose repose of libs. How about daring to wander off the liberal reservation and attempt to explain why Obama pronounces Bill Cosby as a rapist after claiming his policy is not to speak about on-going criminal cases? At least we know that such an excuse could not be proffered by Obama regarding Kate's murder.

    9. @ 11:47 the rate of insured/uninsured cited here by Somerby are based on a Gallup survey using random phone calls. They are, therefore, included in the figures unless Gallup screens for citizenship.

    10. cicero the Cosby case is not an on-going criminal case. It is a national soap opera entering its third or fourth season.

    11. @ 12:45

      @ 12:45

      Chloe Goins said Cosby assaulted her in 2008. She came forward to Los Angeles police this year. Her attorney said he believes Goins may be the first accuser to have a case that still falls within the statute of limitations.

    12. Observant Howler readers know better than to fall for anything attorneys say. Especially if those claims are filtered through the press. You fall for the trap created in the Trayvon case.

    13. @ 12:58

      Regardless, Obama ain't rescinding Cos's Presidential Medal of Freedom nor is he going to offer condolences to Kate Steinle's parents.

    14. Have you called and offered your condolences?

    15. "...offer condolences to Kate Steinle's parents..."

      Collateral damage in protection of our 2nd Amendment Rights, which give us our freedoms.

    16. @ 2:03

      Thank you for bestowing on me the equivalent title of Commander in Chief and Leader of the Free World.

    17. @2:14

      More like protection of the incompetence of federal authorities. But do let us know about any firearm you have purchased or owned in your entire life?

      "Francisco Sanchez used the stolen firearm in the shooting death of Steinle. The firearm in question was issued to a Bureau of Land Management Law Enforcement Ranger. The Ranger was on official government travel when his vehicle was broken into and the theft occurred. The theft was immediately reported to the San Francisco Police Department."

      "FBI: Breakdown in background check system allowed Dylann Roof to buy gun"

    18. Health care spending, we’re looking at you! Also, TPP!

    19. cicero,
      That kind of incompetence you'd expect from the private sector.

    20. cicero,
      That's nothing. Checkout the Great Iraq Clusterfuck of 2003 to REALLY see government incompetence.
      Which reminds me, that would be a gigantic deal if we had , say, a Tea Party which is against government waste and spending. Unfortunately, there is no such thing.

    21. If Obama had a daughter, she wouldn't look like Kate Steinle. Therein is the reason he has been silent on her murder by an illegal scumbag.

    22. @ 9:37

      But would Obama's grandfather look like Cos?

  2. There seems to be a difference between "insurance" which doesn't pay off unless you have a specific need, and "health care coverage" which pays for all health care required for fee. The latter would presumably include drugs and preventative care and treatment of chronic conditions. The former includes major acute illness such as heart attack or acute cancer treatment. The point of insurance is that you gamble that you won't need such services and pay an affordable amount for services unused unless a rare event happens. The point of health care coverage is that you will regularly use services on an ongoing basis and pay an affordable amount to spread the costs out over time, with use increasing over time as health worsens but costs remaining roughly the same (so there is overpaying at the beginning and underpaying toward the end of the lifespan).

    These situations seem to be a mismatch between what the specific people need and what they can afford to buy. A person who cannot pay for prescriptions needs an HMO, like Kaiser, where prescriptions are included in the monthly fee. A person without much wrong with them but with other demands on income might be able to get by with a large deductible policy. A 58-year old woman approaching a time when she may have increasing health problems due to aging should not be in a large-deductible plan, in my opinion. If she is too unhealthy to work, she should be on SS disability -- then she could be covered by Medicare. If she can work, a larger part of her salary should go toward a more comprehensive plan without the large deductible.

    Inherent in description of these two cases as "atrocities" of ACA is the belief that health care should be free. We haven't made that commitment to our citizens. That means that people must make it more of a priority in their lives if they wish to have their health problems treated. Complaining because they have spent their money on other things and then cannot afford health care isn't the fault of ACA. It is because we have decided as a society that individuals must take care of their own health problems, just as they buy their own housing, food, clothing and other necessities. Criticizing ACA because it has that assumption is unfair. We should address the underlying philosophy of what the bill was intended to do, not the specifics of this particular program. Patching it won't help if the problem is that it envisions catastrophic help, not ongoing care as its goal.

    1. In our view, much of your comment is so sensible that it makes this post essentially incoherent. Beyond that, our imaginary friend's pants puckered as you obviously engaged in an unfair attack on Bob that nobody wants. Go away.

  3. If MSNBC would just replace Rachel Maddow with the C-Span call in show cable TV would be much improved as would our discourse. IMHO. Thanks Bob.

    1. How about replacing the modified Maddow with the original Maddow who had long blonde hair.*

      *See Maddow's graduation photo.

    2. Is there some reason why Maddow cannot intelligently discuss the need for improvements to ACA?

    3. Are you asking cicero, @ 11:37, or just anyone in the audience with an opinion?

    4. @11:37 didn't ask anyone any questions. You seem confused.

    5. I was asking the person who asked the question. You seem not to understand punctuation.

    6. Please moderate this blog.

    7. Moderate with an allowance for stupidity so 12:26/12:35 can stick around.

  4. Bob makes an excellent, rarely stated, point. As a small individual provider (psychologist) I deal with insurance. Ten years ago most clients using insurance had a $25 copay. Today $1000 is a rare "low" deductible. $ 2500 or more is much more typical. It has been moving this way since before the passage of the ACA. The best development I have seen from the ACA is that, for the first time, a self-employed person with a modest income can afford to purchase some form of insurance. That's not nothing. But we have a long way to go.

    1. Most of Bob's excellent points are rarely stated. His points that are not excellent are repeatedly stated.

    2. The best development I have seen from the ACA is that people with preexisting conditions can find coverage. We worked as independent contractors for decades, without any health insurance, because my husband had several chronic conditions (diabetes, heart problems) that prevented him from getting coverage. When I was diagnosed with breast cancer, I realized that I wouldn't be able to find insurance either, so I quit my occupation in order to join a school district that offered health insurance as a benefit. We would have been up a creek if I hadn't been able to do that. Now ACA makes it possible for people without such options to buy coverage regardless of their health problems. That is a BIG deal.

  5. Oh so now it's Maddow's fault that Obama is stupid and lazy. Thanks a lot Bob.

    1. Tribal Corrections OfficerJuly 16, 2015 at 12:47 PM

      It is liberalism's fault that both are lazy. They are not stupid. They are dumb and of dubious morals.

  6. AC/MA's comment yesterday bears repeating:

    "At the risk of exposing myself to scorn as a "Bobfan" my take is that the blogger's point is that the liberal media have failed to explain that in other developed countries everyone is covered by insurance or the equivalent (even for nursing homes I believe); if you lose your job you are not exposed to losing health care; average life spans are longer than in the US; and they pay less than half per capita than in the US. All this should be a major topic of discussion, but it is virtually ignored. Very few Americans are aware of these factors. This should be a major focus of the talking heads at MNBC and in the media in general - yet it gets ignored, probably, one reason, because it's too complicated."

    1. Yes, Except AC/MA seems to have made it within the last hour.

      Wonder why he didn't make it over here himself.

    2. AC/MA should edit for Somerby.

    3. AC/MA's comment should appear as the disclaimer at the top of the comment box every time Somerby writes about health care.

    4. Given that about 3.5% of the population travels overseas each year, Americans may be unaware that the developed world has it better than we do here. Every time I visit Europe I wonder why we cannot have good trains and rapid transit like the have in nearly every city there. You need the comparison with someplace that does things better to recognize that there could be improvement here. But Americans do not travel much outside the US (except for business and some 1% leisure travelers and immigrants going to visit relatives elsewhere).

    5. Huge taxes on gasoline might lead to that.

    6. In California, the refineries are manipulating the gas prices again by withholding supply. Prices jumped nearly a dollar in the past few weeks. The rest of the country doesn't care because prices are still low for them. I wish the government would set the price so that we are not robbed every summer just when people want to put their kids in the car and take a vacation.

    7. Maybe people don't respond to the kinds of questions Somerby asks because we are used to thinking the cost and quality of goods and services are beyond our control. When governments sets prices you can complain to the government (picket, march). When market forces supposedly determine these things, where do you direct your complaints? Everyone passes the buck and the consumer is left having to just suck it up and live with conditions as they are.

      Some of us dream about going to live in Canada or Europe. That seems like a more viable way to accomplish change than anything political we might do.

  7. "Does anyone care about people like Agar?"

    Obviously Ana Swanson and the Washington Post did.

    1. It appeared on a holiday weekend and the jihadists had the day off.

  8. Truman was a total joke


    Locals Fear Literary "R" Bomb Littering
    When the Wind Comes Right Behind the Rain

    1. They never should have broken up that SAE chapter at OU.