Health Care/Joan Retsinas

Cassandra on the Status Quo

Cassandra predicted disaster. As Democrats debate Medicare for All versus the Public Option versus Expanded Obamacare versus yet-Unnamed Option, the Cassandras are screeching. They predict: soaring taxes, miserly benefits, an exodus of private insurers, rising unemployment, rising costs. Calamity without end.

Enough of the bleating from the dual cadres: people who benefit from the status quo, and people fearful of leaving the status quo, dreading all those Cassandra predictions. Add to that the bleating from people who favor option A over option B over Option C, predicting calamity if we embrace the “wrong” option.

I cannot foresee the future. But since every country in the developed world subsidizes health care to all citizens, at lower per capita costs, showing better mortality and morbidity results, I am willing to follow their lead, stepping outside the status quo. (Their lead follows an array of templates.)

The reason? The sights on that status quo horizon dwarf Cassandra’s predictions of catastrophe. If we continue in Trumpland, we can expect:

1) More people uninsured. Obamacare (which should be co-titled PelosiCare, since Speaker Pelosi’s canny persistence pushed the legislation) insured thousands of Americans. The Trump era cutbacks have moved that needle. If we do nothing, that needle will continue to move. We will be a country with a huge swathe of people without insurance and, consequently, without healthcare, since in pursuit of frugality we have eviscerated our “safety net” clinics and hospitals. We will morph into those “developing world” countries where people die too young, too sick.

2) More people “under insured.” This administration’s pursuit of “skinny plans” that give meager benefits for low premiums will leave more citizens stunned when their insurer says “no” to treatments their physicians prescribed. “Association plans” also give meager benefits. So do religious-based associations of people who pool money to care for each other — not technically insurance, but a poor substitute that will fail when expenses outpass money collected. Obamacare instituted a basic menu of coverage for all insurance plans. This president downgraded that menu. You need dinner; you get a snack.

3) More people flocking to bankruptcy court, holding medical bills in hand. A new study tied 66.5% of all bankruptcies to medical expenses (530,000 families). Once upon a long ago time, people with insurance paid very little. Over time, the bills for premiums, co-pays, deductibles, and non-covered services have risen. Even people with insurance face bills they cannot easily pay. In 2016, the average “traditional” Medicare enrollee spent $5,460 out of pocket for health care expenses, including premiums, cost sharing and costs for services not covered by Medicare. Half of Medicare beneficiaries spent at least 12% of their total per capita income on health care. In Trumpland, we can foresee steeper rises.

4) More people facing environmentally-linked illnesses. Until this president, we were trying to clean up the environment, not so much from a Sierra Club enthusiasm for the great outdoors, but to protect ourselves from the dangers of living in filth. But this president gave a green light to whatever pollutes our air, our land, our water, even our food. Regulations keep a lid on the pollutants that make us sick. His latest thrust: waste products from coal-fired plants. No need to clean them up so quickly. In a nation worried about the safety of its drinking water, expect more worries.

5) More natural disasters from the changing climate. We cannot easily reverse “climate change.” But this president, calling it a hoax, has discounted the warnings of a preponderance of scientists.

Cassandra would urge us to escape Trumpland. The first 100 days of a new administration will focus on reversing the calamitous actions of this administration. Call it the Great Reversal.

As for the steps beyond that Great Reversal, a president with Congress will have to chart a new course for health care. Cassandra is right about the status quo: it will not hold. But no candidate today can dictate what that precise course will be. Indeed, if candidates destroy each other as they battle over the specifics of Plan A versus B versus C, the victor may grasp the Democratic nomination, but lose the Presidency — a Pyrrhic victory that cements us in Trumpland.

Step one: Leave Trumpland, so that these past four years emerge as a sorry footnote in our history.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 15, 2019

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