10,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: The Case for
- Sprache: Englisch
Largely privately funded with relatively little public regulation, the United States healthcare system is both expensive and inefficient, providing poor care to large parts of the population. For decades, Americans have wrestled with how to fix their broken healthcare system. In this razor-sharp contribution to the healthcare debate, leading economist and former adviser to Bernie Sanders Gerald Friedman recommends that we build on what works: a Medicare system that already efficiently provides healthcare for millions of Americans. Rejecting the discredited idea that healthcare should be treated like any other commodity, Friedman shows that healthcare is distinctive and can be best provided only through universal program of social insurance. Deftly exposing the absurdities of the opponents of reform, Friedman shows in detail how the solution to our health care crisis is staring us in the face: enroll everyone in Medicare to improve the health of all Americans. This bold and brilliantly argued book is essential reading for anyone who wants to see Congress and the White House act to provide America with a 21st century healthcare system.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 125
Veröffentlichungsjahr: 2020
Ähnliche
CONTENTS
Cover
Front Matter
Introduction: The Failure of Free Market Healthcare
Killed By For-Profit Healthcare
Medicare for All?
How Well Does the United States Provide Healthcare?
The Rising Cost of Our Poor-Quality Healthcare
Changing Policy: From Campaigning for Universal Coverage to Medicare
Medicare and Medicaid
The Political Consequences of Expanding Private Healthcare
The Market Turn in Health Policy
Notes
1 Why Markets Cannot Work in Healthcare
Professor Arrow’s Classic
The Problem of Healthcare Market Power
The Problem of Health Insurance
Social Insurance and Health Insurance
The Market Turn in Health Policy: Motivation and Rationales
The Cost of Using the Market to Provide Healthcare
Notes
2 Can We Afford Medicare for All?
“It Costs Too Much, and Would Destroy Everything”
Paying for Medicare for All
The Real Economic Issue
Notes
3 From Here to There Is Politics
Why Is It So Hard?
To Cross a Chasm, Build Bridges
Taking Politics Seriously
Notes
4 Universal Healthcare Is Better Economics Because It Acknowledges Human Rights
Human Rights and the Market for Healthcare
Economists Against Healthcare
The Efficiency of Rights
Values to Live By
Notes
End User License Agreement
List of Illustrations
Introduction
Figure 1
Female life expectancy at birth and per capita healthcare expenditures, 2016, OE…
Figure 2
Female life expectancy and the logarithm of per capita income, OECD, 2016
Figure 3
Lack of access to healthcare and mortality, counties in the United States, 2015
Figure 4
Percentage change in middle-income households’ spending, 2007 to 2014
Chapter 2
Figure 5
Medicare for All savings, 2019, compared with current system
Figure 6
Ten-year savings from Medicare for All
Figure 7
Medicare for All additional costs, 2019, compared with current system
Figure 8
Medicare for All savings as share of taxable payroll
List of Tables
Introduction
Table 1
US healthcare in comparative perspective
Chapter 3
Table 2
Market value, debt, CEO pay, and employees of the nine largest health insurance …
Table 3
CEO compensation, major health insurers, 2016 fiscal year
Guide
Cover
Table of Contents
Begin Reading
Pages
ii
iii
iv
viii
ix
x
xi
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
130
The Case For series
Sam Pizzigati, The Case for a Maximum Wage
Louise Haagh,The Case for Universal Basic Income
James K. Boyce, The Case for Carbon Dividends
Frances Coppola,The Case for People’s Quantitative Easing
Joe Guinan & Martin O’Neill,The Case for Community Wealth Building
Anna Coote & Andrew Percy,The Case for Universal Basic Services
Gerald Friedman, The Case for Medicare for All
Andrew Cumbers, The Case for Economic Democracy
The Case for Medicare for All
Gerald Friedman
polity
Copyright © Gerald Friedman 2020
The right of Gerald Friedman to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
First published in 2020 by Polity Press
Polity Press65 Bridge StreetCambridge CB2 1UR, UK
Polity Press101 Station LandingSuite 300Medford, MA 02155, USA
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN-13: 978-1-5095-3978-9
A catalogue record for this book is available from the British Library.
The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.
Every effort has been made to trace all copyright holders, but if any have been overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.
For further information on Polity, visit our website: politybooks.com
Acknowledgements
Over the years, I have benefited from advice and guidance from Leonard Rodberg, Michael Ash, Ben Day, Peter Arno, Michael Dukakis, Erin Georgen, Ida Hellender, Betty Johnson, Lawrence King, Ted Levy, Richard Master, Lee Mercer, Sam Metz, Ivan Miller, Stephanie Nakajima, Eric Naumberg, Chuck Pennacchio, Frank Puig, Katie Robbins, Len Rodberg, Debbie Silverstein, Mark Stelzner, Chris Sturr, Ed Weisbart, and Ralph Whitehead. Len Rodberg, Larry King, and Joe Kane gave an earlier draft a careful reading for which I am most grateful; Debra Jacobson read the penultimate draft and made very helpful edits and suggestions. Students Tiffany Duong, Joe Kane, Joshua Weinstein, and, especially, Tai Spargo-Pasquini, have provided invaluable assistance, as well as advice. I am most grateful to my editors at Polity, George Owers and Julia Davies. Polity’s five anonymous referees were helpful beyond my wildest hopes, for which I am very grateful. They were all thoughtful and constructive; referees one and three even provided a line by line review. All can take a share of whatever is worthwhile here; none are responsible for the opinions expressed or remaining errors.
In my work on behalf of Medicare for All I have spoken in more than a dozen states to over 100 groups. All have provided intellectual stimulation and inspiration. This book is intended to help my many many friends in their work, and I dedicate it to all those good people that I have met along the way. And, of course, it is for Debra, who has been my companion every step, and remains my guiding light.
Preface: We Need Better
This little book reflects the concerns and struggles that have preoccupied my life. When I turned 13, in that explosive year 1968, I imagined that we were on the cusp of a new era of social reform. Liberal Democrats like Hubert Humphrey seemed lame, lacking ambition at a time when social movements were moving far beyond the welfare state towards true economic democracy, a world where we would treat everyone with respect and compassion, “from each according to their ability, to each according to their needs.”
I have not changed my values, but 50 years have taught me political humility. The opposition we face is much stronger and our revolutionary social movements much weaker than had seemed to be the case in that turbulent year. I have learned that we need to be much smarter, and more political. We need to cultivate allies, even among those who may not agree with our ultimate goals. And we need to use those alliances to build institutions that create experiences capable of allaying fears. Already in college at Columbia University and graduate school at Harvard University, I looked for clues from the successful social movements: the bourgeois revolutionaries, the abolitionists, and the labor movements of the twentieth century. My earlier works studied these. That is the background and experience that I bring to bear here.
The campaign for universal healthcare in America is a century old. Reformers have made the case intellectually but have failed because they have not unraveled the politics. That is my task in this book: to go beyond the economic case for Medicare for All to address this political issue. What do we need to do to win? Where might we seek allies? How might we disarm the opposition? How might we build state institutions to prepare for Medicare for All while allaying fears and building public support? Truly, lives depend on our success in answering such questions.
Introduction: The Failure of Free Market Healthcare
Killed By For-Profit Healthcare
Alec Smith died on June 27, 2017, less than a month after turning 26. While his death certificate lists diabetic ketoacidosis as the cause of death, he was killed by the health insurance industry. He developed diabetes three years before his death, and his condition was treated very effectively with insulin, a product developed over a century ago by Frederick Banting and other Canadian scientists who donated the patent to the world so that no one should be denied this life-saving medication.1
For 80 years, insulin was widely available because the lack of patent protection allowed many companies to produce competing generic varieties. In the 1980s, however, new and improved insulin versions were developed, innovations that made insulin a little safer and more effective, while also giving drug companies the opportunity to patent variants and an incentive to stop producing the older, less profitable generic insulin. There are now only three companies producing insulin, and they are ruthlessly exploiting their market power to profit off the 30 million Americans with diabetes. In the last few years, insulin prices have soared, increasing by nearly 300%, from an average price of $4.34 per milliliter in 2002 to $12.92 per milliliter in 2013.2 Prices in the United States are much higher than elsewhere; many Canadians and Europeans pay barely one-sixth of what Americans pay.3 In late 2017, Humalog, a fast-acting insulin, cost $115 in the United States versus $20 in Canada, almost a six-fold markup.4 Unless we are to believe that the manufacturer was selling at a loss in Canada out of a charitable impulse towards Canadian diabetics, then we can only conclude that the manufacturer, Eli Lilly, is making a lot of money off diabetics in the United States.
To cope with rising prices, diabetics resort to “self-rationing,” stretching out their supplies, often with toxic results. For Alec Smith, the high cost of insulin was literally deadly. When he aged out of his parents’ health insurance at age 26, he was working in a restaurant job that did not provide health insurance. Because he earned too much to qualify for Medicaid or other public assistance, he looked to buy a health insurance policy on the Minnesota insurance exchange. Even with a government subsidy, a decent health insurance plan cost much more than he could afford on his restaurant salary. The only policy he could find had a $7600 deductible, which he would have to pay before the insurance company would help him pay the $1300 a month for his insulin. Passing on an insurance plan that would not help him for at least six months, Smith planned to pay for his insulin out-of-pocket. Without ready cash to pay for another dose, he tried to stretch out his supply to make it until his next paycheck. He did not make it.
Alec Smith did not have health insurance, but many with insurance fare no better. Health insurance companies refer to the money they pay out in benefits, money spent on healthcare, as “medical losses”—expenses to be minimized whenever possible. Shane Patrick Boyle discovered one way in which insurers limit their losses. Moving from his Texas home to Arkansas to help his ailing mother, he found that his Texas plan did not cover insulin purchased out-of-state. Instead of leaving his mother and driving back to his Texas pharmacy to renew his prescription, Boyle thought he could stretch out his supply while he scrambled for money to buy insulin out-of-pocket. He died $50 short of the $750 he needed.5
Shane Boyle posted an appeal on GoFundMe. com for charitable contributions to help him buy insulin. Millions like him have gone to charity sites for help paying for insulin or other essential medical care. Some have succeeded; most do not.6 Audi, a cute five-year-old, was able to raise over $2000 for a new insulin pump. Makayla Sterner, despite posting a sweet picture of her with her toddler son, was only able to raise half of the $1500 she needed for an insulin pump when, even after multiple blackouts, her insurance company told her it was not medically necessary. Still, she did better than Micaela Archibald. Only 11 people donated to her campaign for a pump, a drive that raised only 10% of what she needed.
GoFundMe.com was started as a crowdfunding site to raise funds for “ideas and dreams,” “wedding donations and honeymoon registry.” Most collection efforts from the first year were “related to such … special occasions.” A category for medical needs existed, but it was further down the list. Now, however, there are nearly 250,000 medical appeals per year, raising a third of the $5 billion collected on the site—a symptom. Rob Solomon, the site’s founder, concludes that “the healthcare system in the United States is really broken.”7
The government is supposed to be there and sometimes they are. The healthcare companies are supposed to be there and sometimes they are. But for literally millions of people they’re not. The only thing you can really do is rely on the kindness of friends and family and community. That’s where GoFundMe comes in. I was not ready for that at all when I started at the company.8
Is this how we want to pay for healthcare?
Medicare for All?
We have been debating healthcare for a century. I have been involved in the debate for nearly half that time, ever since I took a bus from New York to Washington DC in 1977 to lobby for Senator Ted Kennedy’s single-payer proposal. Kennedy’s bill failed, inaugurating a period where reform proposals grew less and less ambitious even while the problems in our healthcare system grew more acute. From the 1980s through the Affordable Care Act of 2010, Democrats began each cycle by accepting the last conservative proposal even while Republicans moved further away from any concept of government-funded universal healthcare.9 When the Democrats finally enacted a serious reform, the Affordable Care Act, it drew on legislation enacted by a Republican governor, Mitt Romney of Massachusetts, based on a 1994 proposal by Republican Senators John Chafee and Robert Dole.
