Thursday, March 9, 2017

It will affect your healthcare unless you're rich
  The American healthcare funding dispute pits the
  rich against working class employment and wages

Only Americans would piecemeal their implementation of universal healthcare.

Beginning in the 1930's with Franklin Roosevelt, and coincident with the rise of the pharmaceutical industry, the Democrats struggled with how to provide modern healthcare to everyone, finally giving us Medicaid in 1965 and Medicare in 1966 during Lyndon Johnson's administration.

George W. Bush and a Republican Congress got into the mess designing and approving Medicare prescription drug coverage that's weird, isn't adequately funded, and caters to corporate pharmaceutical interests.

Now Donald Trump and another Republican Congress are struggling with what may be impossible - a properly designed and adequately funded revised Patient Protection and Affordable Care Act (ACA) - through a bill in Congress called the American Health Care Act - that doesn't tax the rich and the major corporations but caters to the interests of the U.S. Chamber of Commerce.

We know the ACA, well some know it, as ObamaCare, a nickname which as explained by The Atlantic came from discussion of politics in a healthcare management trade journal in its March 2007 issue talking about probable party primary candidates and their policy proposals described as "Giuliani-care", "Obama-care", "McCain-care," "Edwards-care," and "Hillary-care." For some reason we never can talk about the subject with any sense of emotional detachment and didn't before the 2008 Presidential election.

Blame it all on The Greatest Generation.

Article 25, Paragraph 1 of the Universal Declaration of Human Rights states:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
"The Greatest Generation" did commit to the Universal Declaration of Human Rights which as Wikipedia explains "arose directly from the experience of the Second World War and represents the first global expression of what many people believe to be the rights to which all human beings are inherently entitled."

Now we're not really good at assuring all our people are receiving an adequate standard of living. In this post we're only concerned about health care. So do we believe everyone has the right to adequate medical care in the event of sickness? What exactly is meant by the term "adequate"?

The fact is that the vagaries of healthcare systems everywhere do not assure that someone who has a stroke while in one locations will receive the same treatment that someone 200 miles away may be receiving for a stroke at the same time.

So the first human emotional hurdle to overcome in order to embrace any concept of universal healthcare is that no healthcare system will ever deliver the same level of care to everyone at any particular point in time.

It will always be an unfair system, unless and until we reach a time where robots programmed exactly the same provide human healthcare in facilities equipped and supplied exactly the same. For now we have to depend upon that most unreliable method, the human being.

The second human emotional hurdle to overcome in order to embrace any concept of universal healthcare is how to pay for it so that it can be universal in a more or less non-socialist economic nation.

In 2015 Gross Personal Income for all Americans was about $15.46 trillion. Our Gross Personal Income is all our income before deductions and all the various types of tax credits and other confusing things we do on our tax returns before we calculate our taxes.

In 2015 our National Healthcare Expenditure was about $3.21 trillion. National Healthcare Expenditure means all the money spent on doctors, hospitals, prescription drugs, therapists, etc.

One way of looking at the American healthcare cost problem is that we Americans spend about 20% of all our personal income on healthcare.That is what universal healthcare would cost, 20% of our gross personal income.

Of course, some people - we'll call them "the currently healthy"- aren't currently incurring any costs for healthcare. And some people - we'll call them "the currently ill" - are incurring hundreds of thousands of dollars in costs.

People being people, "the currently healthy" tend to resent paying the healthcare costs for "the currently ill" and this is true everywhere. Thus Canadians might read this article 'Free' Health Care in Canada Costs More Than It's Worth.

In most nations that have universal healthcare it's difficult to determine what taxes support the program. But rest assured, folks are complaining about taxes because before they pay for any other government program, taxes and fees for healthcare in the amount of 20% of all personal gross income will be collected in a myriad of ways. And then the folks have to pay taxes for everything else government does.

So exactly what happened to the American system for providing healthcare when "The Greatest Generation" was responsible for our society? From Wikipedia (emphasis added):
Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs....

In the 1930s, The Roosevelt Administration explored possibilities for creating a national health insurance program, while it was designing the Social Security system. But it abandoned the project because the American Medical Association (AMA) fiercely opposed it, along with all forms of health insurance at that time.

Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II. The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.

President Harry S. Truman proposed a system of public health insurance in his November 19, 1945, address. He envisioned a national system that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury. The proposal was quite popular with the public, but it was fiercely opposed by the Chamber of Commerce, the American Hospital Association, and the AMA, which denounced it as "socialism."

Foreseeing a long and costly political battle, many labor unions chose to campaign for employer-sponsored coverage, which they saw as a less desirable but more achievable goal, and as coverage expanded the national insurance system lost political momentum and ultimately failed to pass. Using health care and other fringe benefits to attract the best employees, private sector, white-collar employers nationwide expanded the U.S. health care system....
Wikipedia also notes:
In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense, which solidified the third-party insurance companies' place as primary providers of access to health care in the United States.
In other words, some of  "The Greatest Generation" benefited from their employers competing for employees and, like "the currently healthy", those that have those benefits tend to resent paying the healthcare costs for "the uninsured currently ill."

Maybe we could start thinking of it as an employment program. The general press will tell you currently about 12.4 million Americans are directly employed in health care. That's about 10% of people employed. In 1957, 60 years ago, 3% of workers were directly employed in health care.

The problem is those numbers are not correct if you consider the health care industry as a whole. The confusion is that the employment data from the Bureau of Labor Statistics under health care does not include anything beyond health care "services" and even there it doesn't include government run hospitals. Here's a more accurate picture comparing 1990 to 2016:

In fact, we need to acknowledge that even the listing for healthcare related above doesn't include those that work in the construction of medical office and care facilities, the sale and management of that real estate, the manufacturing and sale of furnishings to medical care providers, or even the employees of companies involved in providing computers and data services to medical care providers. It is very likely that as much as 20% of American employment is the direct or indirect result of healthcare expenditures.

Using the numbers we have, 21.8% of the job growth during the period of 1990-2016 came from the health care industry. In contrast, the  much overblown publicity of computer/internet related industry notwithstanding, they only accounted for 5.5% of the job growth. The difference is primarily the fact that the jobs in healthcare cannot be outsourced to India or China in order to assure inflated corporate profits to be stored offshore.

But whatever we think, we must start viewing healthcare as our obligation to our fellow humans as we agreed in the Universal Declaration of Human Rights right after WWII. And we must understand that whenever we meddle with the healthcare funding status quo we will be impacting employment and working class wages in one of our largest economic segments.

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