Thursday, October 17, 2019

Senate health bill waits at the crossroads

Senate Republicans are about to make one of the most fateful decisions of their careers. How far are they willing to go in sacrificing human lives at the altar of the rich?

The sheer madness of the Senate healthcare bill finally hits when you realize $621 million will be cut from Medicaid for the sake of ending a 10% tax on tanning services.

Six hundred and twenty-one million dollars. In a country that spends $3.35 trillion a year on health care, that’s barely a pittance. But in practical terms, that money means babies delivered, bones reset, children inoculated, physicals performed, tumors biopsied, hearts kept beating. With $621 million, tens of thousands of people could receive routine health care, or thousands could live to see a full lifetime of days.

So who sat down at the big Republican conference table and said, “I’ve got it! Let’s trade a life for a cheap tan!”

Surely, no one actually said those words. But someone might as well have. For that’s just how merciless the Republicans’ healthcare bills have turned out to be.

We all know by now that both Paul Ryan’s House bill (the American Health Care Act) and Mitch McConnell’s Senate bill (the Better Care Reconciliation Act) exist because Republicans are fixated on repealing the “imploding” Affordable Care Act. But neither bill accomplishes that. Each simply complicates the existing law and eliminates far-reaching benefits.

Both bills do, however, achieve two overarching goals long pursued by Republicans. First, they give affluent Americans major tax cuts. Second, they place huge caps on Medicaid (“entitlement”) spending. Typically, we call this robbing from the poor to give to the rich. But let’s get specific.

For corporations and the richest families in America, the Senate plan provides tax cuts worth nearly $1 trillion over the next ten years. In addition to the tanning tax, the bill lines the pockets of the rich by repealing these taxes:

•  The extra 0.9% Medicare payroll tax paid by singles and couples making $200,000 or $250,000 or more per year ($220 billion).

•  A 3.8% surcharge on capital gains and investment dividends ($172 billion).

•  A penalty on larger employers not providing health insurance to workers ($171 billion).

•  A new annual fee on health providers, based on market share ($145 billion).

•  A 2.3% tax on companies that make or import medical devices ($19 billion).

This trillion-dollar boon to the rich will be paid for almost entirely by people on Medicaid—low-income, elderly, and disabled Americans, along with children and pregnant women. According to the new Congressional Budget Office (CBO) report, the cuts to Medicaid will yield $772 billion over the coming decade. The net amount saved by all this money-shifting will be $321 billion.

Let’s repeat that: Over the next decade, the country can theoretically cut its debt by $321 billion. But not one single cent of that cut will be paid by the rich. In fact, as the rich get richer, the weak and poor will die.

The most rigid Republicans are hollering on talk shows and Twitter that health insurance coverage doesn’t save lives. And it’s true that many factors—economic, education, societal, etc.—affect health and mortality. But a comprehensive study recently published in the New England Journal of Medicine concludes:

“Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence.”

Estimates of how many people will die are “inherently murky, but the range is from about 28,000 to nearly 100,000 a year,” says a Los Angeles Times story. While those numbers may seem exaggerated, one should keep in mind that the 22 million who will lose insurance under the Senate bill are in addition to the 28 million who would lose coverage under the ACA. That means, by 2026, a total of 50 million people will be uninsured.

One study cited by the Times was performed by the liberal Center for American Progress. It issued a report showing that, over the next decade, the Senate’s repeal would lead to about 217,000 more deaths than would occur under the ACA.

Benjamin Sommers, of the Harvard School of Public Health, has studied Medicaid expansions in New York, Arizona, and Maine dating back to 2001. In a paper due to be published in the American Journal of Health Economics, Sommers estimates that one life is saved for every 239 to 316 adults gaining insurance coverage. At that rate, the CBO’s projected loss of coverage by 22 million under the Senate bill would cost as many as 92,000 lives a year by 2026.

Possibly the most exhaustive study to date is a meta-analysis just published in the Annals of Internal Medicine. The research—performed by two physicians and distinguished professors in the CUNY School of Public Health—sought to determine if a lack of insurance is deadly. As The Atlantic reports,

“They calculated that if the Senate health-care bill passes, an additional 28,600 Americans will die each year due to medical conditions that could have been prevented or treated if the person had health insurance.”

The research is there, and the Republicans know it. They know kicking millions off of Medicaid will cost tens of thousands of lives. Then, why are they so stuck on a healthcare bill that kills?

One explanation is offered by Salon. “In the GOP mythos, most individuals on Medicaid are poor people in big cities who are likely to vote for Democrats. Lowering Medicaid payments, in the minds of these Republicans, is merely taking money away from lazy slackers who don’t deserve public assistance.”

As ugly as that rationale is, there’s a far more repulsive reason Republicans are compelled to charge headlong into their deadly abyss.

Salon reports that, at a recent conference sponsored by the billionaire Koch brothers, “several of the party’s largest benefactors flat-out threatened to close the money spigot if Republican lawmakers don’t pass “major legislation on health care and taxes.”

Possibly the only wise move McConnell has made in his healthcare spree is to postpone the vote on the Senate bill until after summer recess. The Republicans need time to fall on their knees, think, and reflect. For when they return, they’ll be at that most fateful of crossroads. Just how willing are they to make a deal with the devil?

Related: “The devil is in the details of Senate health bill’s waivers”


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Ginger Walters

Perhaps they want people to die. After all, it will help reduce our deficit. Plus, they probably figure they’d killing off mostly people who vote for Democrats. I just can’t think of any other rationale.