Wednesday, November 11, 2015

The politics of externalizing the cost of health care in Kentucky and the US

The Maddow Blog has an interesting entry today regarding Kentucky governor elect, Matt Bevin. It seems that many people voted for Bevin because he's not a career politician. But, as has been noted many times before in social media, Republicans have a tendency to vote against their economic interests. In this case, a Kentucky man has voted for Matt Bevin, knowing full well that Bevin ran on a campaign promise to dismantle the Medicaid expansion made possible by Obamacare.

The story about a former coal miner with numerous health problems after a life dedicated to mining coal is sad. The lunacy of that man voting for another man totally dedicated to depriving hundreds of thousands of people of the health care they need is apparent. But the subtext missing from the story is this: where the hell is the coal mining company? Where is the coal mining company that employed this man and why isn't it stepping up to help him and the thousands they employed?

This is the argument missing from single payer plan debate. People sacrifice their health to work for a living. This is particularly true of manual labor industries like construction, mining and manufacturing. All of these industries expose their workers to toxins, so while they're employed, they may or may not get health benefits, but those benefits are not guaranteed.

Sure, we could say that a coal miner knew the dangers going in. Kentucky is known for families that engage in coal mining for generations. The father brings the son along for a career where he'll hardly ever see the sun, but it pays the bills. Like moths to a flame, they keep going back and get burned.

There are many reasons that a single payer health care system is desirable and most have been very well documented. The primary reason, one that seems to be missing from the debate, is to make sure that the employer doesn't escape responsibility.

In most industrialized countries, health care is a right. It's supported by a system of taxation that pays the expenses and tracks the outcomes in one entity, paying millions of service providers. We know that it works in this country by looking at Medicare. As an insurance provider, Medicare has the lowest overhead of any entity engaged in providing health insurance in the United States. It is a model of efficiency unmatched by private industry.

This is probably because the organization is more concerned about the work than meeting demands from the shareholders and executives (also shareholders) that might be present in a private insurance provider. Yet there is signification faction in Congress dead set on the destruction of Medicare, just as we have seen in Kentucky.

So let's connect the dots. It's well established that for at least the last 20 years, Congress hasn't listened to anyone but the top 1% of income earners. I think it's fair to extrapolate that trend to Kentucky and their state legislators. We can fairly say that the Kentucky legislature has only been listening to the top 1% for a long time.

As the Maddow blog points out, the Medicaid expansion in the state was a model for all other states to use, and that was created by a Democrat in the Governor's Mansion. They had a system that worked, and worked well. It proved popular among the people of Kentucky. But given Matt Bevin's election to office, many Kentucky residents now have something to fear in Mr. Bevin. His election is just another example of people not bothering to get out and vote.

If Mr. Bevin's goal is so obviously opposed by the majority of the population, then it must be supported by a small minority, the 1%. In this debate, it is clear that the top 1% wish to escape their responsibility to the people they employed. It would follow that they wish only to extend and entrench the advantages they now enjoy, so that they are not held to account for the health of the workers they employed.

Making health care a right is the first step in the right direction. Providing access to health care with a single payer system will eliminate a massive source of overhead, the confusing practice of medical coding and billing among many insurers. That by itself will save billions. Eliminate the bloated salaries of C-Class executives in the insurance industry that contribute almost nothing positive to the debate will save a few billion more. Imposing a tax to replace the premiums we already pay for health insurance means that an entire industry is replaced by one government provider, managed democratically for the benefit of all, with no visible means of escape for the top 1%.

Our current health care system costs the country about 18% GDP, almost as much as the entire federal government alone. A single payer system is the best way to ensure that everyone gets the care they need and ensures that most of the money paid goes to the people who provide the care. It's been proven to work in numerous countries around the world, including the United States. There is no reason it can't be expanded here, universally, except maybe a fair number of conservative politicians in safe seats supported by gerrymandered districts in Congress.
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