Polarization in Congress Leaves Questions About How to Solve US Health Problems | DFA 90.7
Over the past eight weeks, The Price We Pay has examined why Americans are poorer than people in other wealthy countries, and why we spend about twice as much on healthcare, according to the Organization for Cooperation and Development. economic.
Today we begin to look at solutions … what the government can do and what it is struggling to do.
Thirty million Americans are uninsured, and many insured people cannot afford care. Among them is Davidson, NC resident Jennifer Fear. She is happiest when she hikes, biking or gardening. But she thought she would lose a whole weekend in 2016.
“I started to feel numbness in my right foot,” says Fear. “It then started in my left foot and it continued to progress upwards as well. I ended up sleeping with a phone in my hand because I just didn’t know how far this numbness and near paralysis was going to continue.
The diagnosis was multiple sclerosis… an incurable degenerative disease that can lead to blindness, paralysis and difficulty thinking.
Fortunately, Fear had good health insurance thanks to his work in St. Louis. She improved and started hiking again within seven months. Last year she moved to Davidson to be near her family. Fear thought that the insurance she had purchased in the personal market would cover her medications. But when she tried to renew her prescription, she was told she was not covered.
“It will be $ 5,600 for a shipment,” he was told. His immediate response: “Is there a way to stop this shipment really quickly before it gets to my door?” “
Fear says she skipped her meds for almost a year and prayed she wouldn’t relapse.
Forty-six million Americans skipped care last year because of the cost, a Gallup investigation find. The problem is both underinsurance and the high cost of care.
Congress began to tackle the problem of underinsurance last year by increasing subsidies under the Affordable Care Act so that no one has to pay more than 8.5% of their income on premiums. But these grants will run out after next year. Many Democrats now want to make them permanent in a $ 3.5 trillion fundraising bill that addresses health care and a host of other social issues.
It’s all part of a battle on Capitol Hill that illustrates the dynamics of how difficult it is for government to resolve complex societal issues. And these include our health problems, says Jonathan Oberlander, professor of health policy at UNC.
“We live in a polarized America,” Oberlander said. “And I think the Affordable Care and Health Care Act got caught up in that polarization.”
Democrats do not expect Republican support for the bill. They are struggling to figure out how to pay for it, and there are ideological differences among Democrats as well. West Virginia Democratic Senator Joe Manchin wants to lower the total cost of the bill, while Senator Bernie Sanders wants to think big.
Last Wednesday, the two men had press conferences on their priorities. Manchin wants the government to pay the new benefits only to the less well off.
“I don’t believe we should turn our society into a rights society,” he announced.
But Sanders wants new visual, dental and hearing benefits for all Medicare beneficiaries.
“Does Senator Manchin think that the elderly have no right to digest their food? He retaliated.
So, as President Joe Biden has taken office with a massive health care agenda, Democrats are lowering their priorities. In addition to extending these grants to Obamacare policies and adding dental and vision benefits to Medicare, they also want to provide coverage for poorer Americans who live in states like North Carolina and South Carolina. who have not extended Medicaid.
There are 3.2 million uninsured people below the poverty line who live in the 12 states that have not extended Medicaid, including more than 600,000 in North Carolina, according to estimates from the Urban Institute and the North Carolina Department of Health and Human Services.
South Carolina’s only Democrat in Congress, Jim Clyburn, said providing them with cover should be paramount.
“My priority is the expansion of Medicaid and I know that Bernie Sanders’ priority is the expansion of Medicare.”
Racial disparities in access to health care have narrowed in states that have extended Medicaid, the Commonwealth Fund reports. Clyburn says covering the poor in the 12 recalcitrant states is important to African Americans.
“It has issues of racial equity,” Clyburn said. “When you tell me 12 states [haven’t expanded Medicaid and] 8 of them in the South. Are these red states? They are black states.
And as the man whose endorsement helped Biden win his first primary, he makes it clear, he carries some weight.
“It’s just everyone trying to get others to understand the sensibilities you’ll have here in this red state that propelled Joe Biden to the presidency.”
Democrats had planned to cover part of the cost of the bill by allowing Medicare to negotiate lower drug prices. The Congress Budget Office projects a measure to achieve this using international prices as a benchmark would save the government $ 456 billion over 10 years. Polls show that allowing Medicare to negotiate a huge popular support and lobbyists from employer groups want the lower prices extended to everyone. But, some lawmakers fear that this could harm innovation.
And as UNC’s Jonathan Oberlander points out, “The most important political dynamic in health care is that a dollar of health care spending is a dollar of someone else’s income and that the pharmacy doesn’t. did not wish to be federally regulated or to have more price regulation. “
The pharmaceutical industry spent more than $171 millionNo on lobbying this year, according to Open Secrets, a group that follows money in politics. He is campaigning to defeat the measure, and when it was put to a vote in congressional committee, several Democrats voted against it.
Thus, the measure to reduce drug prices is also reduced, which means that there is less money to cover other things. And this illustrates why it is often even more difficult for the government to cut spending than to expand coverage. There is always opposition from healthcare providers who want to earn more, says David Cutler, a Harvard health economist who helped draft the Affordable Care Act.
“It’s a lot easier to extend the coverage because you’re kind of giving things away,” says Cutler. “The problem of saving money [is that] every dollar you save is someone’s income they don’t earn.
Politics can make it difficult for Congress to deal with expenses, as well as high prices. But Cutler says there are other things the president can do.
The Trump administration has tried to bring prices down by forcing hospitals to publish their fees online. So far, compliance has been poor, and Cutler says it’s hard to get patients to compare prices.
Biden hopes to reduce price increases by making it harder to consolidate suppliers to encourage competition. Cutler says it’s promising, but it would’ve been more effective years ago
“Most of the horses have already left the stable.” Cutler said. “They’ve already merged and done anything.”
Still Cutler says the Biden administration has other tools at its disposal to reduce overall government spending – like changing the way it pays for health care – to force providers to charge less.
“Part of that will be because the government gets more involved by just saying that I just weren’t going to put up with it anymore.” Cutler said. “Do you want to participate in these programs? You’re gonna do X, Y, and Z and just shut up and do them already. “
Cutler says the government could also cut administrative costs, which are just as much like a third party health care costs. But so far there has been no movement on this.
As for Jennifer Fear, she was able to afford better coverage after getting a new job. This wouldn’t have been possible until Congress passed the Affordable Care Act in 2010, which prohibited insurance companies from refusing coverage for people with pre-existing conditions like multiple sclerosis.
But she still can’t afford the $ 6,637 co-payment for her new drug. As a conservative, she shares Senator Manchin’s concerns about benefit programs, but believes Congress needs to realize that the free market does not work for health care.
“I firmly believe in being responsible and paying your fair share,” says Fear. “But when the costs of some of these basic things make them out of reach, I think something is quite frankly wrong.”
But by now, anyone can guess how much or little the current Congress can accomplish.