The Affordable Care Act has achieved a dubious distinction: it has brought Americans together. Conservatives are convinced that it is a bolshevik government takeover of private enterprise. Progressives view it as a sell out to big health insurance companies.
Once again, Democrats are selling out their progressive voters. This time, Joe Biden says he’s not going to bother trying for a public option on the Affordable Care Act and there’s no sign of any attempt to increase the minimum wage. What will progressive voters do about it? If history serves, probably nothing.
President Obama had every advantage when he started out his first term yet he disappointed us. Joe Biden, on the other hand, won’t have any advantages at all so he will have every excuse not to do a thing. Hey, that’s great, no disappointment.
One of the more persuasive arguments in favor of supporting Joe Biden is that things would go back to normal after Donald Trump leaves office. For those of us who remember what normal was, and is, that’s not necessarily appealing.
The coronavirus pandemic has laid bare two fundamental flaws in the American healthcare system.
Number one: There’s a reason that other rich countries treat healthcare as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford to buy private healthcare.
The second inherent flaw in the U.S. approach is that it’s for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.
When your insurance company issues a denial, they don’t merely pocket that payment. They also add to future profits. Even if you’re insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. “Visits to primary care providers made by adults under the age of 65…dropped by nearly 25% from 2008 to 2016” due to routine denials by insurers, reports NPR.
Denials also create a societal effect: news stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.
There’s another, third structural problem exposed by the pandemic—but it’s not receiving attention from public policy experts or the media. I’m talking about America’s lack of a centralized healthcare system.
A centralized healthcare system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for-profit. In such a scheme all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you’re on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.
The current system is primitive. Data is not transferable between doctors or medical systems without a patient’s directive, which inexplicably is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that’s it’s not a weekend or national holiday or a Wednesday, when some doctors like to golf.
Unless a patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether an unconscious victim is allergic to a drug, has a chronic illness or that there’s a treatment regimen proven to be more effective for them. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter one-size-fits-all treatment.
A few months ago I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in LA. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. “We do not treat viral infections with antibiotics,” the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.
This would not have been a issue back home in New York, where both my general practitioner and my pulmonologist know my medical history. Either doctor would have prescribed a strong antibiotic and a codeine-based cough syrup.
Because I happened to be in LA, I left CVS empty-handed.
I declined.
It got to the point that I couldn’t walk 100 feet without pausing to catch my breath. I felt like I was going to die.
I called my doctor back in New York. She called in a prescription to the same CVS. It helped arrest my decline. But I wasn’t getting better.
I visited a different walk-in clinic, in West Hollywood. It was a better experience. They tested me for flu (negative), X-rayed me (diagnosis was early stage- pneumonia) and put me on a nebulizer. I began a slow recovery.
A centralized system would have been more efficient. The CVS nurse would have seen my history of non-response to treatment devoid of strong antibiotics. He also might have taken note of my pulmonologist’s effective use of a nebulizer to treat previous bouts of bronchitis and pneumonia. I might have been prescribed the proper medication and treatment as much as a week sooner.
COVID-19 almost certainly would have been detected in the United States sooner if we had a centralized medical system. “One example of a persistent challenge in the early detection of health security threats is the lack of national, web-based databases that link suspected cases of illness with laboratory confirmation. This leaves countries vulnerable, as they cannot accurately and quickly identify the presence of pathogens to minimize the spread of disease,” according to the U.S. Centers for Disease Control. Algorithms can automatically scan massive volumes of information for signs of novel infectious diseases, help identify potential problems and focus responses where they are needed most.
How many people’s lives could have been saved if lockdown procedures had begun earlier? If public health officials had seen the coronavirus coming back in December—or November—they might have been able to protect vulnerable populations and avoid a devastating economic shutdown.
There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized healthcare system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.
We can’t pretend to be a first world country until we join the rest of the world by abolishing corporate for-profit healthcare and decouple insurance benefits from employment. But reform without centralization would be incomplete.
(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie,” updated and expanded for 2020. You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)
The coronavirus crisis is laying bare massive inequities in society. What’s interesting though is that because we are dealing with a contagious virus, even the rich and powerful can no longer hide from the effects of their perfidy and greed.
Moderates who love incrementalism constantly say that is the only way to get things done but the current debate over healthcare shows that the exact opposite is true.
55% of Americans want to keep their current private insurance plan. They should discuss that with a psychologist but you know it wouldn’t be covered under their health plan.
In the second presidential debate of the 2020 cycle, democratic socialist Bernie Sanders made headlines by noting that he had written the “damn bill” on switching Obamacare to Medicare for all.
Amendment XXVIII: No law governing a basic human need shall be passed in a jurisdiction whose government fails to provide citizens with the means to fulfill that need.
Start gathering petition signatures.
If you’ve ever had to work for someone else, you’ve probably been presented with a no-win situation of someone else’s making. “Be promptly at your desk at 9 am,” my boss ordered me. “We can’t have customers calling at the start of business with no answer.” Reasonable. But it was a two-man office — him and me — he had the only key and he was often late. When customers complained, he’d yell at me. “What would you have me do,” I’d ask, “break in?” Unreasonable.
A lot of bosses are stupid little tyrants. But government should know better than to pass a law its citizens can’t obey.
Like most cities, New York prohibits public urination. It’s no longer a criminal offense but public pee-ers still risk a ticket and a fine. The NYPD issues 20,000 to 30,000 such summons a year. Yet, as The New York Times noted in 2016, “New York City…is one of the most public-bathroom-resistant places in the world.”
People pee. People poo. A city that chooses not to provide people to pee and poo knows that some folks won’t find their way to Starbucks or other de facto public restrooms before it’s too late.
The city wants people to pee and poo in public.
Experts estimate that properly equipping Gotham’s streets with the thousands of toilets necessary to serve the city’s inhabitants and visitors would cost tens of millions of dollars. “I gave you a pot to piss in” isn’t the legacy most mayors want to be remembered for (though perhaps they should reconsider). Getting NYC to do the right thing by everyone with a bladder would require ratification of my proposed 28th Amendment.
If nothing else, those who answer nature’s call in the streets and avenues could do so without fear.
Some people charged with a crime have successfully used the “necessity defense” that the harm they committed was necessary in order to avoid a greater wrong or harm. If you’re trying to escape from someone trying to kill you, a judge should dismiss the charge that you trespassed on private property to get away.
Yet, even though it defies common sense, American law still permits government to pass laws that are impossible to follow. In June the California Supreme Court ruled on a law requiring gunmakers to microstamp bullets fired from semi-automatic weapons with unique identifying information.
The court’s ruling was complicated but it included this gem: “impossibility can occasionally excuse noncompliance with a statute, but in such circumstances, the excusal constitutes an interpretation of the statute in accordance with the Legislature’s intent, not an invalidation of the law.” In other words, an impossible-to-follow law can be passed and no court can invalidate it. Each individual who wants to be exempted on the basis of impossibility must hire a lawyer and file a lawsuit.
The Impossible Law Amendment (ILA) would ensure that any law deemed impossible for any citizen to follow would be overturned on constitutional grounds.
Impossible-to-follow laws are more common than you might think.
The Affordable Care Act requires people to purchase health insurance from private for-profit corporations or get slapped with a fine when they file their annual tax returns.
The cheapest healthcare plans in the Obamacare marketplaces run around $1600 to $1800 in many counties. One out of four Americans say they can’t afford healthcare. If the United States insists on spending tax dollars on blowing up brown people in Muslim countries rather than caring for its own sick people, that’s a political priority this nation is free to select. But it’s insane to charge people a fee for not buying something they can’t afford. Punishment is immoral if there was no intent or desire to disobey the law.
The ILA would effectively eliminate an entire class of government fines for things people are mandated to buy but must have in order to live: motor vehicle registration fees, smog inspection fees, parking.
On July 27 The New York Times reported that parents, usually mothers, are routinely arrested and have their children taken away from them by child-welfare authorities, because they can’t afford daycare and so are found guilty of such “abusive” behavior as leaving their kid in the car for a few minutes while running into a store.
Children have died of heatstroke in locked cars, so it reasonable for the police to be concerned when they come across a possible case of neglect. But society should not criminalize the behavior of people who have no other choice. Daycare runs about $200 per week per child. Individual average income runs about $500 a week before taxes, or $350 after taxes. Unless the average American goes without food or shelter — which child-welfare authorities will look down upon at least much as leaving a kid in a car — he or she can’t afford daycare. In many other (civilized) countries, of course, daycare is provided gratis by the government.
If and when the U.S. provides daycare for all, it may prosecute parents for refusing to use it.
A government that passes laws that anyone — much less a significant portion of the population — cannot obey, yet imposes fines and jail terms, deserves nothing but contempt. Ratify the ILA!
(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of “Francis: The People’s Pope.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)
