Everybody recognizes Uncle Sam as the champion of the poor. All those alphabet programs, all those subsidies, all those tax-dollars going to help people — struggling, people deserving, people maybe not deserving, people here illegally, people abusing the system … Depending on political vantage, a voter will describe the recipients of Uncle Sam’s largesse and vote accordingly. Citizens who want to stanch the flow of tax dollars to help the poor will vote for hard-hearted, fiscally-conservative solons. Softer-hearted, more generous citizens will vote for like-minded solons.
It is time to recognize that Uncle Sam, and his state minions, also buoy the vast middle class.
Here are some below-the-fold examples of Uncle Sam’s hand in our health.
First, Uncle Sam — Medicare — pays far less — up to 50% less — for hospital stays than private insurers. The facile assumption is that a bureaucratic government cannot negotiate good deals, compared to the geniuses in the private sector. The reality is different. As for the impact, those extra dollars paid to hospitals end up in the premiums of employees. The elderly and disabled Americans who opt for “original Medicare” are getting a better deal, for the most part, than their younger private-sector counterparts.
As for Obama Care (a.k.a. the Affordable Care Act), it includes provisions designed to protect enrollees: the 80-20 rule requires insurers to spend at least 80% to reimburse medical expenditures (leaving 20% for administration and profits); the 95% rule requires employers to offer affordable health insurance to 95% of their full-time employees and their children, the Essential Benefits include maternity and emergency care, and the safe harbor affordability (now set at 8.39% of a household’s income, for the least expensive option) seeks to make premiums affordable. Without those rules, what kind of policies would private insurers craft? Do we want to find out?
On to the FDA. The Food and Drug Administration is charged with investigating devices and complaints. Those complaints generally begin when an unhappy customer/patient complains to the manufacturer, who is supposed to send those claims to the FDA. Regardless of how egregious, or trivial, the manufacturer deems the complaints, the manufacturer must send them on. A recent example: Dentists promoted the Anterior Growth Guidance Appliance (AGGA) to expand an adult’s jaw, without surgery. Supposedly the AGGA relieved sleep apnea. No peer-reviewed research backed the claim, and to date 20 patients who complained of harm received a settlement. From a reported 10,000 users, 20 complaints seem trivial; and the company didn’t admit liability.
The complaints never reached the FDA. But at last the FDA has reacted, will investigate. At this point it is easy to fault the FDA’s weak oversight; but without the FDA there would be no oversight. Indeed, without the FDA, there would be no oversight of breast implants, pacemakers, defibrillators, ventilators, cochlear implants, prosthetics. The list goes on. Recent recalls include heating pads: (Blue Electric Heating Pads, with 286 customer complaints and 31 reported injuries), as well as some of the nasal-swab COVIC tests.
The United States Department of Agriculture tries to oversee the safety of food. Recently suspicions of E-coli prompted the recall of walnuts and ground beef. A host of food products have come under the federal radar, including cashews, cherry granola, cream cheese. Log on to recalls.gov for an up-to-date list. Most foods pass muster, but we should be grateful for the oversight that warns us of contaminated food, forces stores to take them off the shelves.
So in this politically charged season of campaigns, when voters decry government as inept, expensive and cumbersome, remember the ways that Uncle Sam props up the health of the middle class.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, June 15, 2024
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