Remembering King’s fight for health-care equity

Remembering King’s fight for health-care equity

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America celebrates a distortion of Martin Luther King Jr., void of his prophetic call to justice by any nonviolent means necessary. Particularly around the annual remembrance of his life Monday, watch for his words to be repackaged in tasty sound bites and stripped of the so-called extremism that prompted FBI Director J. Edgar Hoover to label him “the most dangerous man in America.”

Chicago was a seminal backdrop for King’s work toward justice and the place where he sounded his call for health care justice. Before a medical conference in 1966 he proclaimed, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” National criticism ensued because this activist, two years after he won the Nobel Peace Prize, dared to articulate a prophetic truism still relevant in 2020.

Researchers at New York University found that Chicago has the largest gap in life expectancy of any city in the United States (followed by Washington, D.C., and New York). Although the national trend in the gap between blacks and non-Hispanic whites continues to improve, ZIP codes can still determine life expectancy with alarming racial disparities. Like real estate, health inequality is about location, location, location.

Dallas is another city with a dubious distinction. The Urban Institute ranked it last out of 274 U.S. cities in racial equity and racial segregation. A study by Parkland Health and Hospital System and the Dallas County Health Department found that geography is deeply linked to health inequity, where a difference of 2 miles has a life expectancy gap of 26 years. Although separated by 1,000 miles, Dallas and Chicago share similar systemic inequities that perpetuate racial disparities in health.

These glaring divides are an enduring legacy of decades of isolating black Americans seeking homeownership by marking mortgage lending maps with red lines. Today, more than 50 years since the passage of the Fair Housing Act, 91% of the communities identified as “best” on the redlined maps remain middle to upper class, with 85% of these communities having majority white populations. Accordingly, 3 out of 4 redlined neighborhoods remain impoverished, and 67% of redlined neighborhoods remain populated by racial minorities. Many were intentionally located in proximity to industrial areas, municipal landfills and toxic waste sites — and the subsequent negative health impacts persist across generations.

This lengthy history of systemic inequality will take time to remedy, as will the legacy of distrust of the medical establishment from the history of experimentation without consent on black Americans. A doctor known as the “Father of Modern Gynecology” performed barbaric vaginal operations on enslaved women. They were denied anesthesia, physically restrained, repeatedly mutilated. The U.S. Public Health Service denied 600 men therapeutic penicillin from 1932 to 1972 to allow the study of the natural progression of latent syphilis in the Tuskegee syphilis experiment. Their health was compromised, as were their partners and children who were predictably exposed to the disease. Black women, many of them teenagers, were the prime target for controlled breeding through forced sterilization. This practice of eugenics did not end until the 1980s. And there was the Pentagon-funded study of nontherapeutic, whole-body irradiation from 1960 to 1971, in which 25% of the subjects died within one month of exposure. All were poor, most were black, and the Radiological Society of North America awarded the lead physician its highest honor.

Nearing his death, King was deemed “unfavorable” by two-thirds of Americans in a 1966 Gallup poll. Decades later in a 1999 Gallup poll, more than 90% of Americans had a favorable opinion and ranked him as the second most admired person of the 20th century (behind Mother Teresa). As we celebrate his legacy, we should embrace his prescient view on health care inequity and further his goal of creating a just society for all.

Perhaps King’s greatest threat was to recognize that, from Chicago to Dallas and to other cities and towns across the land, we are more alike than different. He dared to criticize health inequities embedded in communities from urban ghettos to the mountains of West Virginia. And although his life was ended while he was building bridges across racial and ethnic divides, his dream of proper health care for all should not. Because if raising his voice against persistent health inequality made King a dangerous man, add us to that list.

Health inequality remains among the greatest injustices of our time, and, as King penned in “Letter From Birmingham Jail,” “injustice anywhere is a threat to justice everywhere.” Like King, let us commit ourselves anew to eradicating these death-dealing realities “until justice rolls down like waters, and righteousness like a mighty stream” (Amos 5:24).

 

 

The most expensive health care option of all? Do nothing.

https://www.politico.com/news/2020/01/09/medicare-for-all-health-care-096367?utm_source=The+Fiscal+Times&utm_campaign=b67cf54986-EMAIL_CAMPAIGN_2020_01_09_10_31&utm_medium=email&utm_term=0_714147a9cf-b67cf54986-390702969

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‘Medicare for all’ debate sidesteps cost of current system.

The projected multitrillion-dollar cost of “Medicare for All” has pitted Democratic presidential candidates against each other as they argue about the feasibility of single-payer health care.

But the reality is the current health system may cost trillions more in the long run and be less effective in saving lives.

Spending on Medicare, Medicaid, private health insurance and out-of-pocket expenses is projected to hit $6 trillion a year — and $52 trillion over the next decade. At the same time, the number of people with insurance is dropping and Americans are dying younger.

Sen. Bernie Sanders and other single-payer advocates say Medicare for All would cost the government far less — between $20 trillion and $36 trillion over a decade — by slashing overhead, eliminating out-of-pocket costs and empowering federal officials to bargain directly with hospitals and drugmakers. But the streamlined system would have to care for millions of currently uninsured people at a significant cost to taxpayers, and experts disagree whether it would actually save money in the long run.

Centrist Democrats are pushing narrower plans that would, among other things, expand tax credits for people just above the Obamacare subsidy threshold. Virtually no one is arguing for maintaining the status quo, but that’s precisely what could happen given that congressional gridlock has stymied even popular, and bipartisan, causes like halting surprise medical bills.

“It’s really hard to see anything breaking through, especially when the industry interests and the money they’re willing to spend on lobbying and campaign contributions is just mind-boggling,” said Sabrina Corlette, a researcher at Georgetown University’s Center on Health Insurance Reforms. “And, without question, we are on an unsustainable trajectory.”

With Medicare for All and its price tag likely to come up in the next Democratic debate Jan. 14 in Iowa, here are five of the costliest consequences of inaction:

National health spending keeps rising

The Centers for Medicare and Medicaid Services estimates that nationwide health spending will hit $6 trillion a year by 2027 absent any changes in law. That would be nearly a fifth of the economy. In total, the United States is slated to spend about $52 trillion over the coming decade.

The cost drivers include hospitals, physician and clinical services and prescription drugs. Some local health systems have become monopolies that can largely set prices as they please — leading to higher premiums and more out-of-pocket spending for consumers.

“Even the biggest insurance plans are not big enough to bargain down the cost of services, and they don’t have an incentive to,” said Wendell Potter, a former Cigna executive-turned whistleblower and single-payer advocate.

An aging population is driving up Medicare spending, but the rising cost of private insurance is the biggest factor. A recent Kaiser Family Foundation analysis found per capita spending for private insurance grew by nearly 53 percent over the last decade, or more than double the hike in per capita Medicare spending.

More people will be uninsured

The Census Bureau reported in September that the number of Americans without insurance grew by 2 million people since 2017 — the first increase in nearly a decade. Even with a healthy economy and low unemployment, more than 27 million people weren’t covered at any point last year. That could grow to 35 million by 2029, per the Congressional Budget Office, under current law.

The number of people enrolling in the Obamacare marketplace has declined, and more people are dropping employer-sponsored insurance due to cost and other concerns.

Part of this is President Donald Trump’s doing — the administration has slashed efforts to push Obamacare enrollment and rolled back the massive marketing effort that the Obama administration rolled out for years.

There are also more than 400,000 additional uninsured children than just two years ago — and 4 million in all — and states that haven’t expanded Medicaid are seeing the biggest spikes.

“What we also miss in the debate is the number of people temporarily uninsured, who miss open enrollment, who are between jobs, who fall through the cracks,” said Adam Gaffney, a Harvard Medical School researcher and the president of Physicians for a National Health Program. “I see people all the time in my practice in that situation who don’t fill prescriptions and experience serious complications.”

Going without insurance hits patients and health care providers: Average hospital spending on care for the uninsured was $13 million in 2018 up roughly 3 percent annually since 2016.

Coverage will be skimpier

As the cost of health care has skyrocketed, insurance companies have squeezed patients, charging higher premiums, deductibles and co-pays, and creating narrow networks of providers and aggressively billing for out-of-network care.

Since 2009, the amount workers have had to pay for health insurance has increased 71 percent, while wages have only risen 26 percent over that time.

More than 80 percent of workers now have to pay a minimum amount out of pocket before insurance kicks in — and the amount of that deductible has doubled over the last 10 years, now standing at an average of $1,655, though many workers have to pay a lot more.

These costs are putting care out of reach for millions.

new Gallup poll found that a full quarter of adults have put off treatment for a serious medical condition due to the cost — the highest since Gallup began asking the question three decades ago. A full third say they’ve delayed or deferred some kind of health care service over the past year. Another Gallup and West Help survey found that 34 million people know at least one friend or family member who died over the past five years after skipping treatment due to costs.

 

Needed drugs will become more out of reach

U.S. patients pay vastly more for prescription drugs than people in other developed countries and the disparity is set to grow. The United States spent $1,443 per person on prescription drugs in 2018, while other developed countries fell somewhere between $466 and $939.

In just five years, national spending on prescription drugs increased 25 percent, according to the Government Accountability Office, and CMS expects that increase to “accelerate” over the next several years.

Increasingly, patients are responding by forgoing their medications. Gallup found in November that nearly 23 percent of adults — roughly 58 million people — said they haven’t been able to “pay for needed medicine or drugs that a doctor prescribed” over the past year.

This widespread inability to take needed medication, a government-funded study found last year, is responsible for as much as 10 percent of hospital admissions. And the Centers for Disease Control and Prevention estimates that medication nonadherence accounts for somewhere between $100 and $300 billion in national health spending every year.

 

Americans will continue to get sicker and die younger

The cost of maintaining the status quo is evident not only in dollars but in human lives.

Life expectancy in the United States has declined over the last three years, even as other developed countries around the world saw improvements.

Though the United States spends nearly twice as much on health care as other high-income countries, there’s been a stark increase in mortality between the ages of 19 and 64, with drug overdoses, alcohol abuse, suicide and organ diseases driving the trend. It’s cut across race and gender with the worst effects felt in rural areas.

The opioid epidemic only accounts for a fraction of the problem. The National Research Council found that the United States has higher mortality rates from most major causes of death than 16 other high-income countries.

Researchers at USC estimate that if these trends continue, it would take the United States more than a century to reach the average life expectancy levels other countries hit in 2016.

 

 

Every American family basically pays an $8,000 ‘poll tax’ under the U.S. health system, top economists say

https://www.washingtonpost.com/business/2020/01/07/every-american-family-basically-pays-an-poll-tax-under-us-health-system-top-economists-say/?utm_campaign=post_most&utm_medium=Email&utm_source=Newsletter&wpisrc=nl_most&wpmm=1

Princeton economist Anne Case speaks about “deaths of despair” in the United States at the American Economic Association's annual meeting in San Diego this past weekend. (Heather Long/The Washington Post)

America’s sky-high health-care costs are so far above what people pay in other countries that they are the equivalent of a hefty tax, Princeton University economists Anne Case and Angus Deaton say. They are surprised Americans aren’t revolting against these taxes.

“A few people are getting very rich at the expense of the rest of us,” Case said at conference in San Diego on Saturday. The U.S. health-care system is “like a tribute to a foreign power, but we’re doing it to ourselves.”

The U.S. health-care system is the most expensive in the world, costing about $1 trillion more per year than the next-most-expensive system — Switzerland’s. That means U.S. households pay an extra $8,000 per year, compared with what Swiss families pay. Case and Deaton view this extra cost as a “poll tax,” meaning it is levied on every individual regardless of their ability to pay. (Most Americans think of a poll tax as money people once had to pay to register to vote, but “polle” was an archaic German word for “head.” The idea behind a poll tax is that it falls on every head.)

Despite paying $8,000 more a year than anyone else, American families do not have better health outcomes, the economists argue. Life expectancy in the United States is lower than in Europe.

“We can brag we have the most expensive health care. We can also now brag that it delivers the worst health of any rich country,” Case said.

Case and Deaton, a Nobel Prize winner in economics, made the critical remarks about U.S. health care during a talk at the American Economic Association’s annual meeting, where thousands of economists gather to discuss the health of the U.S. economy and their latest research on what’s working and what’s not.

The two economists have risen to prominence in recent years for their work on America’s “deaths of despair.” They discovered Americans between the ages of 25 and 64 have been committing suicide, overdosing on opioids or dying from alcohol-related problems like liver disease at skyrocketing rates since 2000. These “deaths of despair” have been especially large among white Americans without college degrees as job options have rapidly declined for them.

Their forthcoming book, Deaths of Despair and the Future of Capitalism,” includes a scathing chapter examining how the U.S. health-care system has played a key role in these deaths. The authors call out pharmaceutical companies, hospitals, device manufacturers and doctors for their roles in driving up costs and creating the opioid epidemic.

In the research looking at the taxing nature of the U.S. health-care system compared with others, Deaton is especially critical of U.S. doctors, pointing out that 16 percent of people in the top 1 percent of income earners are physicians, according to research by Williams College professor Jon Bakija and others.

“We have half as many physicians per head as most European countries, yet they get paid two times as much, on average,” Deaton said in an interview on the sidelines of the AEA conference. “Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us, and yet everybody loves physicians. You can’t touch them.”

As calls grow among the 2020 presidential candidates to overhaul America’s health-care system, Case and Deaton have been careful not to endorse a particular policy.

“It’s the waste that we would really like to see disappear,” Deaton said.

After looking at other health systems around the world that deliver better health outcomes, the academics say it’s clear that two things need to happen in the United States: Everyone needs to be in the health system (via insurance or a government-run system like Medicare-for-all), and there must be cost controls, including price caps on drugs and government decisions not to cover some procedures.

The economists say they understand it will be difficult to alter the health-care system, with so many powerful interests lobbying to keep it intact. They pointed to the practice of “surprise billing,” where someone is taken to a hospital — even an “in network” hospital covered by their insurance — but they end up getting a large bill because a doctor or specialist who sees them at the hospital might be considered out of network.

Surprise billing has been widely criticized by people across the political spectrum, yet a bipartisan push in Congress to curb it was killed at the end of last year after lobbying pressure.

“We believe in capitalism, and we think it needs to be put back on the rails,” Case said.

 

 

 

On average, older adults spend over half their waking hours alone

On average, older adults spend over half their waking hours alone

Americans ages 60 and older are alone for more than half of their daily measured time – which includes all waking hours except those spent engaged in personal activities such as grooming. All told, this amounts to about seven hours a day; and among those who live by themselves, alone time rises to over 10 hours a day, according to a new Pew Research Center analysis of Bureau of Labor Statistics data.

In comparison, people in their 40s and 50s spend about 4 hours and 45 minutes alone, and those younger than 40 spend about three and a half hours a day alone, on average. Moreover, 14% of older Americans report spending all their daily measured time alone, compared with 8% of people younger than 60.

While time spent alone is not necessarily associated with adverse effects, it can be used as a measure of social isolation, which in turn is linked with negative health outcomes among older adults. Medical experts suspect that lifestyle factors may explain some of this association – for instance, someone who is socially isolated may have less cognitive stimulation and more difficulty staying active or taking their medications. In some cases, social isolation may mean there is no one on hand to help in case of a medical emergency.

People ages 60 and older currently account for 22% of the U.S. population – 73 million in all. It’s estimated this share will rise to 26% by 2030, fueled by the aging of the Baby Boom generation. The well-being of older adults has become a topic of much interest both in the United States and in other developed nations, particularly as it relates to social connection.

Not surprisingly, time alone is closely associated with living arrangements, for both younger and older Americans. About one-in-four adults ages 60 and older (23%) live alone today – 16.7 million in all. These older adults say they spend, on average, about 10 and a half hours alone each day – almost twice as much time as those who live with a spouse. More than a third (37%) of older adults who live alone report spending all their measured time alone. Among those who live with someone other than a spouse, the average amount of alone time a day is seven and a half hours. (The 3% of older adults who are living in institutionalized settings are not included in this analysis.)

There are significant variations by age, gender and education in time spent alone daily, driven in part by differences in marriage and living arrangements. For instance, people in their 60s report 6 hours and 32 minutes of alone time, compared with 7 hours and 28 minutes for people in their 70s and 7 hours and 47 minutes for people ages 80 and older. These age differences are due in part to the fact that that older people are far less likely to live with a spouse or cohabiting partner – 64% of those in their 60s do, compared with 59% of those in their 70s and 36% of those 80 and older.

Older women spend more time alone, on average, than their male counterparts, and this gap widens markedly at the oldest ages. This is largely due to the fact that women ages 60 and older are more likely than their male counterparts to live alone (28% vs. 18%) given their longer life expectancies and higher rates of widowhood – and this gap in living arrangements also widens with age.

While there aren’t significant gender differences in time spent alone for people in their 60s, for instance, women ages 80 and older spend about eight and a half hours a day alone, compared with 6 hours and 40 minutes for comparable men. When it comes to the share spending all measured time alone, there are no gender differences among all people ages 60 and older, but again a gap emerges at older ages – for people ages 80 and older, 20% of women report spending all measured time alone, compared with 13% of men.

This gender pattern in alone time reverses once gender differences in living arrangements are accounted for, suggesting other factors are also in play. While 43% of men 60 and older who live alone report spending all of their time alone, this share is lower for women who live alone (34%). And among those living with someone other than a spouse, 21% of men report spending all measured time alone, compared with 12% of women. The fact that older women are more likely than men to be involved in activities outside the home such as going to church or volunteering may partly explain this pattern.

Differences in time spent alone also emerge across educational levels. People ages 60 and older who have a high school diploma or less education spend, on average, 7 hours and 18 minutes a day alone – about 45 more minutes than their counterparts with a bachelor’s degree. These patterns reflect in part the fact that less educated people are less likely to be married and living with a spouse than their more educated counterparts. (This is true among younger adults as well.) About half (51%) of adults ages 60 and older with a high school diploma are living with a spouse, compared with 59% of those with some college education or an associate degree and 67% of those with a bachelor’s degree.