First, let me state that there are lots of numbers swirling around and it is not always possible to pull out discrete data or disaggregate specific figures from total amounts. Whenever possible I have used official figures and always gone with reputable sources for estimates. Some numbers have been repeated so often in so many different places without contradiction (such as the number uninsured) that I adopt those numbers without attribution. With that explanation, let us proceed.
First, it is accepted that 47 million in this country are uninsured. However, with the increasing numbers of unemployed, that number is probably low and will certainly increase for at least the next year when we may start to see an uptick in employment. When assessing that number, we need to also keep in mind that there are 45 million enrolled in Medicare, most of whom could not find private insurance because of pre-existing conditions. Additionally, even if they could find private insurance, the cost would probably be prohibitive for 90% of them. There are 42 + million receiving Medicaid (42 million as of 2006, the latest figure I could find), people who can't afford private insurance. Some of the people receiving Medicaid also receive Medicare. The number is probably relatively small, but to be conservative, I will estimate that 35 million are receiving Medicaid but not Medicare. The bottom line is that, in addition to the 47 million who don't have health insurance, another 77 million are receiving government insurance because they can't get private insurance. Thus, if we look at the number of uninsured against the number of people who are in the private insurance pool, it is 47 million out of about 223 million, not 47 out of 300 (the US population). This means that 21% of the people in the eligible population are uninsured, not the 16% usually cited. Medicare and Medicaid figures come from cms.hhs.gov/medicare and questionsmedicare.gov. Additionally, the Commonwealth Fund in June, 2007 estimated that 25 million are underinsured. If you add that to the 47 million uninsured, that means that the percentage of people who are uninsured or under insured, as a proportion of the private pool, is 32% (72 million out of 223 million). CONCLUSION--Almost one in three people who are in the private pool are either uninsured or underinsured. I hope these numbers do not confuse you, but they do indicate that the problem is greater than usually supposed.
Next, let's look at the effects of uninsurance and underinsurance. A 2007 Harvard study (see Business Week, 1/4/09) found that 62% of bankruptcies are due to medical expenses. There are approximately 1 million bankruptcies (certain to be higher this year), so that means over 600,000 bankruptcies a year are due to medical expenses. Further, the Harvard study found that 60% of these bankruptcies struck families who had (inadequate) medical insurance. This means that about 360,000 bankruptcies are due to medical expenses which hit people with insurance (the underinsured). Additionally, it is estimated that 1.5 million lose their home to foreclosure due to health costs (National Coalition on Health Care, web site cited below).
In a 2002 study (Institute of Medicine, Care Without Coverage, pp. 161-165), it was estimated that 18,000 people die each year because of lack of medical insurance.
Because the uninsured go to emergency rooms for much of their care and most of the time they can't pay, it has been estimated that this additional cost adds approximately $1100 per year to the average insurance premium.
Even if you are covered with an excellent plan, expect the cost of that plan to continue to rise until it is unaffordable for the average American family. Most of the following information can be found at nchc.org/facts/cost.shtml which has a lot of interesting data. Since 1999, the cost of employment based premiums has increased 120%, compared to a 44% increase in inflation and a 29% increase in average wages. By 2017, the cost of premiums will take from 40 to 50% of the average family's income if nothing is changed. Not surprisingly, the primary reason for non insurance is the high cost of health insurance. The Kaiser Commission study found that 80% of the uninsured are "working poor." Unless you are rich or in Medicare or Medicaid, you, too may join the ranks of the working poor unless something is done. Think your employer will cover the increased cost? Fewer are doing so every year or are passing along increases to their employees. The number of employees getting their insurance through their employers went from 66% in 2000 to 61% in 2004 (Kaiser Commission study). It is certain to be declining more and more rapidly with the recession.
Next, let's look at the overall national picture. Nation-wide, total health care expenses are estimated at $2.5 trillion, which is approximately 17% of Gross Domestic Product. It is projected that that total will reach 20% by 2017 (nchc.org). By way of comparison, the country which is second highest in spending as a percentage of their GDP is Switzerland which spends about 11% of their GDP on health care. If we spent the same percentage in the US as Switzerland does, we would spend about $800 billion less per year on health care. On a per capita basis, we spend approximately twice as much as other developed countries such as Canada, England, Germany, France, etc. Despite spending half as much, the citizens in those countries live longer on average and they cover everybody in their country.
Next, problems and solutions.
Tuesday, August 25, 2009
Friday, August 21, 2009
Sotomayor Silliness
With Sonia Sotomayor having taken her rightful place on the Supreme Court, we can get past, I hope, some of the ridiculous claims and statements made by her opponents. Also, it gives me an opportunity to tell a story I find interesting that is very relevant to the issue.
One of the arguments made by her opponents is her perceived liberal bias and the statement/belief that justices should be like umpires, calling balls and strikes. In this view, things are unconstitutional or not and there is a clear delineation that should be obviously apparent. Oh, if only it were so. People who make this claim are either being disingenuous or have no knowledge or experience with the courts. By the time something gets to the Supreme Court, it does so because the issues are not clear. I have personal experience with this.
Unfortunately, laws often are written either in a non-specific way, or may be specific but fail to anticipate how they will be used or abused in the future. As an example of the former, let's say that a law is written that says government shall establish regulations to do such and such and reasonable fees established to enforce the provisions of the law. Further, the law will say that fees or provisions shall be examined regularly and updated when warranted. What is a reasonable fee? How often is regular? If laws are written too specifically, then they will fail to deal with many future occurrences. If they are written broadly enough to cover future contingencies, they must be necessarily vague which means they will be open to interpretation.
I was a plaintiff in a case, which was ultimately thrown out because "it fell between the cracks." There was law and court decisions for many different classes of people, but I fell into a small class for which no precedent or specific law applied. The judge could have ruled in my favor by deciding to apply the law in one way, but chose to apply it in another. Later, in a case which I read about in the papers in a similar situation, the same judge ruled in favor of some plaintiffs and allowed the case to go to trial. There was no clear choice in this matter, and this situation occurs frequently.
In another instance, I wrote a law for the State of California. By way of background, there was a petition taken to the City of San Diego for an initiative ballot measure to revise the City's Charter. The petition was not certified because it did not have enough signatures as established by the City's Election Code. However, a judge ruled that the City had to follow the State Elections code for this particular type of initiative. So, I wrote a change to State law so that future petitions would be consistent with our past requirements, which everyone agreed were more sensible than the State requirement. The law was reviewed by the City Attorney's Office, a resolution supporting it passed the City Council. A local assemblyman, a lawyer who was later appointed to a judgeship, agreed to carry the bill for us. We worked closely with the Secretary of Stat's office and the attorneys in their Elections Division and they all reviewed and approved it. It sailed through both houses and was signed by the governor as a non-controversial item. I figured the case was closed. About six months after going into effect, I received phone calls from Oakland from two different people who had found out that I was the original author. They both asked me what my intent was for an election situation which had nothing to do with city charter initiatives. I went back and re-read the new law. Sure enough, the issue they were asking about could be applied to the law which we had so narrowly crafted to apply to another very specific issue. Had I gone to court and been asked how the law should have been applied in the case the people from Oakland were interested in, I would have had no clue as to how to answer. I wouldn't have wanted to be the judge who decided how that law applied.
The point should be obvious. You can't just be an umpire, decisions/solutions are not clear cut and judicial decisions will of necessity be influenced, if not determined, by a judge's past experiences, leanings, and biases. To say otherwise is pure sophistry.
Another attack on Sotomayor was to attack Obama's statement that he wanted a judge with empathy. I guess it is better to have a judge with no empathy? Kudos to L.A. Times columnist Michael Hiltzik (I think I'm spelling his name correctly). He brought to his readers' attention the Supreme Court case of Buck vs. Bell in which the Supreme Court ruled in favor of the State of Virginia for the forced sterilization of a woman who was judged mentally retarded by the State. No proof was ever presented to support that claim by the State. Had there been a woman on the court, might the court have ruled differently? Similarly, the forced relocation/internment of people of Japanese acestry during World War II led to Korematsu vs. U.S. which is arguably one of the worst Supreme Court decisions in history, right up there with Dred Scott and Plessy vs. Ferguson. Had there been a minority on the court, especially one with foreign born parents, might not a more enlightened viewpoint from that kind of justice led to a more just decision? One would hope so. Given the ambiguity one often finds in the law, I much prefer a judge with emnpathy. I know I wish I had had one in my case since I got royally screwed and wasn't even allowed to bring my case to trial despite a clear case of denial of due process.
One of the arguments made by her opponents is her perceived liberal bias and the statement/belief that justices should be like umpires, calling balls and strikes. In this view, things are unconstitutional or not and there is a clear delineation that should be obviously apparent. Oh, if only it were so. People who make this claim are either being disingenuous or have no knowledge or experience with the courts. By the time something gets to the Supreme Court, it does so because the issues are not clear. I have personal experience with this.
Unfortunately, laws often are written either in a non-specific way, or may be specific but fail to anticipate how they will be used or abused in the future. As an example of the former, let's say that a law is written that says government shall establish regulations to do such and such and reasonable fees established to enforce the provisions of the law. Further, the law will say that fees or provisions shall be examined regularly and updated when warranted. What is a reasonable fee? How often is regular? If laws are written too specifically, then they will fail to deal with many future occurrences. If they are written broadly enough to cover future contingencies, they must be necessarily vague which means they will be open to interpretation.
I was a plaintiff in a case, which was ultimately thrown out because "it fell between the cracks." There was law and court decisions for many different classes of people, but I fell into a small class for which no precedent or specific law applied. The judge could have ruled in my favor by deciding to apply the law in one way, but chose to apply it in another. Later, in a case which I read about in the papers in a similar situation, the same judge ruled in favor of some plaintiffs and allowed the case to go to trial. There was no clear choice in this matter, and this situation occurs frequently.
In another instance, I wrote a law for the State of California. By way of background, there was a petition taken to the City of San Diego for an initiative ballot measure to revise the City's Charter. The petition was not certified because it did not have enough signatures as established by the City's Election Code. However, a judge ruled that the City had to follow the State Elections code for this particular type of initiative. So, I wrote a change to State law so that future petitions would be consistent with our past requirements, which everyone agreed were more sensible than the State requirement. The law was reviewed by the City Attorney's Office, a resolution supporting it passed the City Council. A local assemblyman, a lawyer who was later appointed to a judgeship, agreed to carry the bill for us. We worked closely with the Secretary of Stat's office and the attorneys in their Elections Division and they all reviewed and approved it. It sailed through both houses and was signed by the governor as a non-controversial item. I figured the case was closed. About six months after going into effect, I received phone calls from Oakland from two different people who had found out that I was the original author. They both asked me what my intent was for an election situation which had nothing to do with city charter initiatives. I went back and re-read the new law. Sure enough, the issue they were asking about could be applied to the law which we had so narrowly crafted to apply to another very specific issue. Had I gone to court and been asked how the law should have been applied in the case the people from Oakland were interested in, I would have had no clue as to how to answer. I wouldn't have wanted to be the judge who decided how that law applied.
The point should be obvious. You can't just be an umpire, decisions/solutions are not clear cut and judicial decisions will of necessity be influenced, if not determined, by a judge's past experiences, leanings, and biases. To say otherwise is pure sophistry.
Another attack on Sotomayor was to attack Obama's statement that he wanted a judge with empathy. I guess it is better to have a judge with no empathy? Kudos to L.A. Times columnist Michael Hiltzik (I think I'm spelling his name correctly). He brought to his readers' attention the Supreme Court case of Buck vs. Bell in which the Supreme Court ruled in favor of the State of Virginia for the forced sterilization of a woman who was judged mentally retarded by the State. No proof was ever presented to support that claim by the State. Had there been a woman on the court, might the court have ruled differently? Similarly, the forced relocation/internment of people of Japanese acestry during World War II led to Korematsu vs. U.S. which is arguably one of the worst Supreme Court decisions in history, right up there with Dred Scott and Plessy vs. Ferguson. Had there been a minority on the court, especially one with foreign born parents, might not a more enlightened viewpoint from that kind of justice led to a more just decision? One would hope so. Given the ambiguity one often finds in the law, I much prefer a judge with emnpathy. I know I wish I had had one in my case since I got royally screwed and wasn't even allowed to bring my case to trial despite a clear case of denial of due process.
The Overriding Importance of Health Care Reform
In all the hullabaloo over health care, there is one thing which I hope progressives, especially those in the Federal government, don't overlook. There has been much talk about the impact this fight has on President Obama's presidency (Senator Jim Demint saying it could be his Waterloo) or on the elctions in 2010 and 2012. However, I think it goes beyond even these future events.
If we look at history and the development of government and party politics, especially in the 20th Century, some trends become clear. Beginning with Teddy Roosevelt, we saw the beginning of an activist government led by a strong executive to bring about change for the benefit of the people. Taft disappointed Roosevelt and the progressives, leading to the divisive 1912 campaign and the election of Wilson who continued the thrust of the Roosevelt presidency. After World War I, the country was ready for a more settled time and, in Coolidge's famous words, the business of government was business. Andrew Mellon, one of the richest and biggest establishment figures in the country was a mainstay of Republican government during this decade. The Republicans believed that government's function was to promote free enterprise and get out of the way. This fell apart with the stock market crash in October, 1929 and the subsequent Depression. Franklin Delano Roosevelt, Teddy's cousin and nephew by marriage, expanded on the first Roosevelt presidency and used government to lead the country out of depression, something that had never been done before.
FDR's presidency was a massive paradigm shift in American politics. Government was now seen as beneficial and even necessary for shepherding the economy and the country to prosperity. Many of the reforms enacted then are still with us today and some lasted until just recently. This also set the stage for the ascendancy of the Democratic Party for the next 36 years. Only the Vietnam War interrupted this ascendancy. Eisenhower, because he was a war hero, was an aberration.
The election of Ronald Reagan in 1980 marked the beginning of another paradigm shift. Reagan, through his personal popularity, changed the political dialogue so that government was no longer seen as the solution, but the problem. Even Bill Clinton famously said that the era of big government was over. As with the 20's, the overreach by the Republicans and their corporate allies has led to another economic collapse. The election of President Obama, the promises he made and the challenges he faces have set the stage for another paradigm shift back to that established by FDR. If Obama takes a successful, activist role he can show that government is the solution, not the problem. In so doing, he can control the political dialogue and set the stage for Democratic ascendancy for the next 30 or 40 years.
The two biggest domestic challenges the President and his party face are the economy and fixing the health care system. As readers of this blog know, I firmly believe that his steps in the first area are in the right direction, but do not go far enough. While there needs to be major restructuring of the economy, especially in the financial sector, Obama and his major advisers, Larry Summers and Timothy Geithner, seem content to tweak the system, not truly reform it. Nevertheless, while I agree with Paul Krugman that the stimulus program needs to be larger, it is large enough to stop the recession and begin the turnaround.
Here is where health care reform is crucial. Health care expenditures now total close to 20% of the total GDP. If we can reduce expenditures down to the level found in the next highest expenditure as a percentage of GDP (Switzerland), we could reduce health care expenditures by $800 BILLION PER YEAR, freeing up that money for economic expansion. As Medicare and Social Security did in the past, health care with a strong government option will show the efficacy of government and expose the lies of the Cassandras in the conservative movements. Under FDR's policies, this country has experienced its longest uninterrupted periods of economic growth and expansion. The greatest economic crashes in our history have occurred after periods of Republican laissez-fare policies. It is time to return to the policies that have made this country great. Obama can make this happen if he remains firm and pushes a strong health care reform with a government option.
If we look at history and the development of government and party politics, especially in the 20th Century, some trends become clear. Beginning with Teddy Roosevelt, we saw the beginning of an activist government led by a strong executive to bring about change for the benefit of the people. Taft disappointed Roosevelt and the progressives, leading to the divisive 1912 campaign and the election of Wilson who continued the thrust of the Roosevelt presidency. After World War I, the country was ready for a more settled time and, in Coolidge's famous words, the business of government was business. Andrew Mellon, one of the richest and biggest establishment figures in the country was a mainstay of Republican government during this decade. The Republicans believed that government's function was to promote free enterprise and get out of the way. This fell apart with the stock market crash in October, 1929 and the subsequent Depression. Franklin Delano Roosevelt, Teddy's cousin and nephew by marriage, expanded on the first Roosevelt presidency and used government to lead the country out of depression, something that had never been done before.
FDR's presidency was a massive paradigm shift in American politics. Government was now seen as beneficial and even necessary for shepherding the economy and the country to prosperity. Many of the reforms enacted then are still with us today and some lasted until just recently. This also set the stage for the ascendancy of the Democratic Party for the next 36 years. Only the Vietnam War interrupted this ascendancy. Eisenhower, because he was a war hero, was an aberration.
The election of Ronald Reagan in 1980 marked the beginning of another paradigm shift. Reagan, through his personal popularity, changed the political dialogue so that government was no longer seen as the solution, but the problem. Even Bill Clinton famously said that the era of big government was over. As with the 20's, the overreach by the Republicans and their corporate allies has led to another economic collapse. The election of President Obama, the promises he made and the challenges he faces have set the stage for another paradigm shift back to that established by FDR. If Obama takes a successful, activist role he can show that government is the solution, not the problem. In so doing, he can control the political dialogue and set the stage for Democratic ascendancy for the next 30 or 40 years.
The two biggest domestic challenges the President and his party face are the economy and fixing the health care system. As readers of this blog know, I firmly believe that his steps in the first area are in the right direction, but do not go far enough. While there needs to be major restructuring of the economy, especially in the financial sector, Obama and his major advisers, Larry Summers and Timothy Geithner, seem content to tweak the system, not truly reform it. Nevertheless, while I agree with Paul Krugman that the stimulus program needs to be larger, it is large enough to stop the recession and begin the turnaround.
Here is where health care reform is crucial. Health care expenditures now total close to 20% of the total GDP. If we can reduce expenditures down to the level found in the next highest expenditure as a percentage of GDP (Switzerland), we could reduce health care expenditures by $800 BILLION PER YEAR, freeing up that money for economic expansion. As Medicare and Social Security did in the past, health care with a strong government option will show the efficacy of government and expose the lies of the Cassandras in the conservative movements. Under FDR's policies, this country has experienced its longest uninterrupted periods of economic growth and expansion. The greatest economic crashes in our history have occurred after periods of Republican laissez-fare policies. It is time to return to the policies that have made this country great. Obama can make this happen if he remains firm and pushes a strong health care reform with a government option.
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