Here are 7 big reasons why Americans should worry a lot about health care

debtcomsurvey-300x254Americans have made health care a central concern of the upcoming elections with excellent reasons. Their nightmares about this issue are getting worse, not better:

  • Medical debt, one of the disgraces of the world’s most expensive health care in the planet’s wealthiest nations, has spiked during the Covid-19 pandemic. A consumer finance firm recently found that its 22 million members carry $45 billion in bills owed to providers and  in collections. With the coronavirus also staggering the economy, bankrupting medical debt is only likely to skyrocket as the nation’s 30 million jobless exhaust their finances and lose health insurance from their work.
  • Health insurance offers one of the few widely available means for ordinary folks to try to protect themselves and their loved ones from seeing their finances destroyed by illness or injury. But new U.S. Census data, describing a time before the pandemic, shows that “the first three years of President Trump’s tenure were a period of contracting health insurance coverage,” the Washington Post reported. “The decreases reversed gains that began near the end of the Great Recession and accelerated during early years of expanded access to health plans and Medicaid through the Affordable Care Act — the sprawling law that was a signature domestic achievement of President Barack Obama and has been derided by Republicans, including Trump, ever since.” Just under 30 million Americans were uninsured — 1 in 10 of us, with the numbers rising by several million over the last several years of the Trump term.
  • The fate of Obamacare was complicated further by the death of U.S. Supreme Court Justice Ruth Bader Ginsburg. Republicans in the White House, Congress, and statehouses have filed a lawsuit challenging the ACA and calling for its repeal on dubious legal grounds. The high court is scheduled to take up an appeal of this case, now pending in Texas before an extremist federal judge there. What will be the balance on the highest court of the land, if it is dominated by justices with hard-right views, including the position that the government has no role in Americans’ health care? Popular features of Obamacare that could be at risk include: protections against insurers imposing lifetime limits on benefits and denying coverage based on pre-existing conditions, as well as parents’ ability to keep their young adult children on their coverage. Republicans, to be clear, have fought with zeal for a decade to repeal the ACA without providing either their alternative of details of how they would deal with the tens of millions who would be harmed if it disappeared. This includes explanations of how an estimated 20 million poor, working poor, and middle class Americans would get health insurance if their Obamacare coverage vanished. Fifty million or so Americans have pre-existing conditions, and political partisans have never explained how they would be protected if insurers stripped them of coverage, including in their work-provided policies.
  • Due to job losses, 12 million Americans may have lost their work-related coverage, and many of the 30 million unemployed keep struggling to get some kind of health insurance — either on ACA exchanges, through the Medicaid program for the poor and working poor, or through a pricey benefits-continuation program known as COBRA. The parameters of the health insurance mess caused by unemployment may remain uncertain for a time, as workers and employers see that the pandemic will not be short-lived and furloughs or “temporary” layoffs turn permanent.
  • Even for working Americans, soaring out-of-pocket deductibles and skimpy employer coverages meant that a rising number of the employed were underinsured, struggled with medical bills, and faced lingering financial problems due to health care costs, a recent study found. The results likely will be more severe than reported, as the research focused on a period that ran into early 2020, just when the pandemic struck, throttled the economy, and led to layoffs and other employer cutbacks.
  • Ever-increasing prescription drug costs, contrary to counter factual assertions otherwise, have not declined and, instead, have kept increasing, the Washington Post reported, noting: “For a short period of time, prices did somewhat drop. Consumer prices for prescription drugs fell 0.6% in 2018, according to the Bureau of Labor Statistics. But the trend reversed last year, when prices increased 3% — the sixth-highest category of growth after smoking products, medical care, energy, shelter, and food away from home. This past July, a month in which drug manufacturers traditionally hike prices, 67 drugs increased in cost by an average of 3.1%, according to GoodRx, an online prescription cost service. More than 850 brand-name and generic drugs increased in price by an average of 6.8% in the first six months of the year. In a new analysis … GoodRx found drug prices are surging faster than any other medical service or good, increasing by 33% since 2014.” Trump’s failures to work with his own party members in Congress, or across the aisle, has left him racing as the election nears to pull out hocus-pocus policy steps, notably much-hyped executive orders with little chance of affecting drug prices, particularly because they fail to account for the interests of significant parties — like consumers in Canada.
  • Hospitals, which are among the key drivers in steep rises (along with doctors) in what Americans pay for health care, have been battered by the pandemic. But the institutions, consolidating among themselves, restraining care giver staffing, and expanding into their most profitable operations, also engineered a “runaway train” with their costs for patients and insurers, notably those covering workers with job-based policies. A new study by the independent, nonpartisan RAND Corporation found that “hospitals across the country are charging private insurance companies 2.5 times what they get from Medicare for the same care,” the New York Times reported. Medicare, of course, negotiates aggressively on the cost, quality, and safety of medical services using its size and governmental clout, its advocates say, noting the system also sets tough limits as to what it will pay providers. They long have complained that Medicare reimbursements are too low. At the same time, patients, employers, and insurers have howled that — lacking Medicare’s capacities — doctors and hospitals take advantage of them, charging far more than what they would accept from Uncle Sam. As the newspaper reported: “Employers provide health insurance coverage for more than 153 million Americans. The companies and insurers in the study paid nearly $20 billion more than Medicare would have for the same care from 2016 through 2018, according to the RAND researchers. The findings cast doubt on the ability of private employers and insurers to competitively purchase health care for workers and their families compared to the federal government, said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, which helped fund the study. ‘You have this widening gap,’ she said. Proponents of a so-called public option seize on such price-gouging news to argue that creating a government health plan that could use its clout to demand lower prices would help bring down the cost of care.”

The Wall Street Journal, separately, reported that hospitals’ ravenous pursuit of profits had a significant downside, exposed by the pandemic: Many of the institutions still occupy big, fancy digs, and they have sold themselves as cornerstones of their communities, offering comprehensive services. Their cost-controls, however, emptied the sprawling buildings of staff, with front-line nurses and other direct care givers at “efficient” minimums. When the coronavirus demanded all-hands-on-deck, hospitals had to fork out big sums to pay desperately needed doctors, nurses, and other health workers to provide appropriate care. They also had to shuffle and retrain people. Experts may be studying what all this means to health care economics for a while.

In practical terms, these bullet points may provide important health policy information to voters, if they are undecided about candidates seeking office in November. Facts, experts hope, still matter, and they may help catalyze the answer to a fundamental electoral query, at least in health care: Are we better off than we were four years ago?

In my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, effective, and even excellent medical care. This has become an ordeal to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

The pandemic has added huge challenges to the U.S. health care system, which needs Americans support more than ever before. But the relentless shocks tied to the coronavirus would be less ugly and more helpful if they helped the nation not just return to normal but to a better place, notably in health care.

That cannot occur, if our leaders cannot deal with reality, research, and actual evidence — characteristics President Trump increasingly seems unwilling to muster. In his recent town hall with “ordinary Americans,” he resorted to what one media fact-checker described as a “fire hose” of falsehoods (lies, if you will), including about health care.

His whoppers were so numerous it might even have reprised the cartoon Popeye sidekick J. Wellington Wimpy, as the leader of the free world, for the umpteenth time in at least five years, asserted that he had a comprehensive health care plan and an Obamacare alternative that would be released, um, imminently. (“I’ll gladly pay you Tuesday for a hamburger today,” as Wimpy would say.)

The president boasted about health insurance options available in his term, ignoring a new investigation by the U.S. Government Accountability Office. GAO experts, working under cover, found that brokers were all too willing to deceive consumers about “skinny” health plans pushed by Trump and his allies. They may cost less in monthly premiums, but they also deliver little when patients most need them when sick or injured, especially because many of them exempt pre-existing conditions from coverage.

Trump, by the way, also falsely stated that his magical health care plan would protect patients from insurers denying them coverage based on pre-existing conditions — a beloved element of Obamacare. He tried to talk over the session moderator when asked why his administration and Republicans in the states and Congress have joined in a federal lawsuit demanding the demise of the ACA, without explaining their next steps for tens of millions of Americans who will be affected if this occurs. Really?

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