By Dave Lindorff
If Democrats want to come out of this economic crisis with a
powerful mandate to continue running the country, they need to bag the
nonsensical talk of “bi-partisanship” and tackle two big lies that have
been stymieing progressives for decades.
The first lie is that the only solution to the nation’s deepening
health care crisis, which now has over 42 million people—roughly one in
seven Americans—living without any health insurance or ready access to
medical care, is a combination of limitations on treatment and
continued reliance on the private health insurance industry.
The second lie is that Social Security, the single most important
economic “safety net” under the lives of America’s elderly, its
disabled, and children who lose a wage-earning parent, is headed for
“bankruptcy” and needs to have its already skimpy benefits cut back.
Let’s start with healthcare. The single biggest problem with health
care in America is that because it is run largely as a profit-making
venture, fully 20 percent of every healthcare dollar has to go towards
paperwork to take care of both the billing, and the monitoring of those
who do the billing, to make sure providers and insurers are not bilking
the system and/or the patients. Another significant percentage of each
healthcare dollar, despite all that paperwork, is wasted by fraud that
goes undetected—either in the form of unnecessary treatments and
medications, or simple billing fraud.
Just one example of this: Most hospitals, built with federal
assistance under the Hill-Burton funding program, are required to
provide a certain amount of free care to indigent patients who do not
qualify for Medicaid or Medicare, but who also have no assets. But as
anyone who has gone to a hospital emergency room without an insurance
card knows, when the bill comes for such treatment, it can easily top
$2000 for just a quick exam by a nurse practitioner and a dose of
aspirin. Why? Because the hospitals want these absurdly inflated
charges to count against their “uncompensated care” obligation. They
know that poor patients are never going to pay these bills, so they
later just shift them into their “free care” column. Insurers like Blue
Cross or state Medicare programs don’t reimburse them at anywhere near
those inflated rates, but that’s not the point.
In any event, where the big lie comes into play is in the
politicians’ refusal to consider simply making Medicare, the healthcare
program for the elderly, universal, which would effectively move the US
to a Canadian-style health system, with a few tweaks. Sure, making the
government the single insurer of all Americans would mean higher taxes,
but any honest accounting of this shift would have to consider how much
we ordinary middle-class and working-class Americans are paying now for
health care. For those who have employer-funded health plans, they are
typically paying anything from 20% to 100% of the premiums, or a
portion for themselves and 100% for other family members. These
payments can run into hundreds of dollars a month or even more. But
really, the sums being paid by the employer have to be added into the
cost too, because that is money that otherwise the employer could be
paying out in wages. For many working families, we could be talking
about as much as $10,000 a year or even more just for insurance
coverage. And of course, these plans don’t cover everything. There are
co-pays and deductibles that come out of the workers’ incomes, and that
can total several thousand dollars a year. The politicians neglect to
point out that by putting everyone on Medicare, all those costs are
eliminated.
Furthermore, by making the government the “single-payer” insurer,
the public’s bargaining power over private doctors and hospitals is
enormously enhanced, allowing us, as the government, to bargain for
lower rates for office visits, exams, and hospital stays and
procedures. Choice of physician is actually expanded, because no doctor
would be allowed to refuse to accept Medicare as payment in full, and
there would be no other option for doctors to receive payment.
There is a reason why the percentage of Gross Domestic Product
devoted to health care in the US is roughly 50% higher (and in some
cases two times higher) than in any of the countries with socialized
medicine, like Canada, Britain, France, Germany or Japan. There is also
a reason why the health statistics—life expectancy, infant mortality,
survival rates from various medical conditions, etc.—are higher in
those countries than in the US.--and are higher even in much poorer
countries that also have public health care systems. (There is also a
reason why socialized medical programs have survived in all those
countries even during periods when governments have been in the hands
of conservatives—the public would rebel if any effort were made to
eliminate them.)
As for Social Security, I always have to laugh when I hear
conservatives intone about the threat that Social Security will be
technically insolvent in 2041. These are, recall, the same people who a
year ago didn’t have a clue that the economy was about to go into a
death spiral. And we’re supposed to believe in their prognostications
about the state of a program whose fortunes are very closely linked to
economic growth models, not five years out or ten years out, but 32
years out. (The 2041 doomsday deadline is based upon a very
conservative estimate for annual average economic growth over the
intervening three decades.)
Just as an exercise, try to think back to 1977 for a minute. If you
are in your 20s or 30s, you are excused, since you cannot think back
that far. Let’s see: Jimmy Carter was president, oil was being
rationed, the Vietnam War had only just ended, songs like the Eagles’
“Hotel California,” Manfred Mann’s “Blinded by the Light,” Bob Seeger’s
“Night Moves” and the Sex Pistols’ “God Save the Queen” were topping
the charts, and the biggest existential threat to mankind was nuclear
war between the US and the USSR, which back then was still a country.
What will America and the world be like in another 32 years? You
can bet that it will be as far removed from anything you can imagine as
today is from what we were imagining back in 1977.
There are many things that should worry us a hell of a lot more
about that distant future a generation hence than the financial
condition of the Social Security Trust Fund. Just take the crisis of
global climate change. In 2041, scientists are pretty certain that
there will be no polar icecap in the summer. Now that is big—it has
never happened in the history of mankind on this planet, and we know it
is a change that will have profound impacts on climate all around the
globe, many of them terrifying. But are any of those people who are all
bent out of shape over the future of Social Security frantically
calling for action to deal with climate change? No. In fact, oddly, the
very people who get so worked up about the imagined crisis 30 years
from now in a government program are the ones most likely to be
unconcerned about climate change.
The big lie here is that Social Security is not some kind of
savings account, where you get back what you put in, with accumulated
interest. Social Security is a promise, by the government, and more
broadly—this being still a democracy of sorts—by the public, to provide
a basic income for retirees and the disabled. And the fulfillment of
that promise at any given time is going to depend upon the political
calculus of who wants to pay for that promise. I would argue that the
system is largely self-correcting. That is, when the demands on the
system are greatest, because of a larger number of retirees collecting
benefits relative to working adults who are paying taxes into the
system, those who are receiving assistance have a relatively greater
political clout, because of their increased numbers. The Baby Boom
population, which is the proximate cause of concerns about Social
Security funds “running out” will also be the most powerful senior
lobby in history when they (we, actually, as I am about to turn 60
myself!) are receiving Social Security benefits. With twice the voting
strength of the already powerful senior lobby today, Baby Boomer
retirees will be in a position to demand, and to get, decent retirement
benefits, even if that means higher taxes on current workers and
employers.
Nor does that imply a “generational war”—another boogeyman raised
by conservatives. The younger working generation, by and large, will be
the children and grandchildren of the Boomer retirees, and many if not
most of them will be enthusiastically supporting their older relatives’
demands for better benefits. Just ask yourself, when have you ever
heard a child complaining about the size of her or his parents’ Social
Security check? And yet even today, current benefits are at least
partially funded by current workers’ payroll deductions.
The point here is that progressives should resist any effort to
lend credence to conservative calls for cutbacks in Social Security and
Medicare. Any calls by Democrats, including President Barack Obama, for
“bi-partisan” commissions to study Medicare and Social Security are
simply cave-ins to ideologically motivated right-wing politicians and
their corporate backers, who want to destroy two of the most important
public-benefit programs run by the federal government. Democrats need
to mount a “Hands Off Social Security and Medicare!” campaign to put
themselves squarely in defense of these programs.
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