FacebookTwitterGoogle+RedditEmail

The American Health Care Pyramid

The extraordinary creativity and commitment of the US government has given birth finally to what appears to be a new health care financing scheme which, like everything in Obama’s America, harkens back to the age of pyramids. There are hints in the Obama bio that he knew well of things pyramid –- a post-college stint writing financial briefs on such topics as interest-rate swaps; an embrace of behavioral economics while on the faculty of the University of Chicago Law School. The health care plan takes this president’s commitment to hierarchy to new heights, in effect adding several layers to the bottom of the American Health Care Pyramid. As everyone concerned with the runaway costs, profiteering and huge voids in the health care feared, Obama’s failure ab inicio to call for fundamental change in the health care system simply builds pyramids, shifting more money from working people and the poor to the health care sector.

By the recent reckoning of one forthright New York City radiologist, health care in the US today exists on six tiers. Under the new plan, it will increase to ten. Stratification is the name of the game, not just in health care, but in wages, credit access, education: the Great Marginalization on the march.

The same prescription –greater stratification of health care services – has been decried by a number of US physicians more inclined to truthfulness and, well, public health than most. Adding Medicaid recipients and integrating them by income level will lead to the creation of “high-level” Medicaid facilities in middle-income neighborhoods. At three or four times poverty income, these new Medicaid-qualified families will be a bit less unappealing to urban health care providers, whose antipathy for the poor is well known. And there will be “mid-level” Medicaid clinics for the one-to-two times poverty income crowd – as in crowded – and on down. Don’t count on state-of-the-art medicine at any of these clinics, especially as you bottom out at the pyramid’s base. Afterall, had you saved, and planned, and worked harder in school — been more like the Obamas –you would not be at the bottom rung. Or, good care comes to those who’ve cared for themselves. Education starts at home. Savings are possible no matter the wage. Kill more in Afghanistan now to kill less later. Etc., etc.

At no point has President Obama blasted the awful disparity in existing medical services which, with universality and cost control, is a principal argument for single payer. Notice that there is little talk of “good” jobs, not a word about living wages, nothing about working families, displaced people and others catching up, regaining the ground they’ve lost, via a good income. Off the agenda. And not a peep, no reference whatsoever, to the gross disparities in health care quality in the US today.

All attention now is focused on banks paying back their government aid lest they be forced to limit executive pay and lose the good people. Like the good people of Goldman Sachs – which accessed billions of dollars of government money, a fact it likes to play down. But as Bethany McLean reminds us in January’s Vanity Fair,

“Goldman took $10 billion… of TARP… eventually issued $28 billion of [FDIC] debt, close to the limit. As Goldman acknowledged in its public filings, the firm was ‘unable to raise significant amounts of long-term unsecured debt in the public markets, other than as a result of the issuance of securities guaranteed by the FDIC.’”

No guarantees for working Americans, who receive very little from their government: unemployment insurance and food stamps, which add up to a poverty existence. Poverty wages or poverty assistance. And now new levels of poverty health care.

Which takes us back to the pyramid. Top urologists in New York City and other major urban areas pride themselves on NOT accepting any kind of health insurance whatsoever, as do some general surgeons, neurologists and other specialists whose services are reserved for top-of-the-pyramid patients. And why not? It’s a free market… in virtually everything. Nothing being proposed by our government in the health care sphere changes those rules. What’s next? Free markets in kidneys and other organs?

Under newly proposed measures, the estimated cost of Medicare for individuals 55-64 years old would be $7,600 per year, or $633 per month, per person. That would put a recipient on about tier 4 of the pyramid (ten being the top), a level with mediocre services, at best. Who would’ve thought that $633 a month would provide so little?

Washington, D.C.-based health care expert and Medicare author Max Fine wonders why the new Medicare-eligible should be charged so much given how much they’ve already paid into the system for years. Worst, says Fine, is to have a national health insurance program based upon the Federal Employees Health Benefits Program because of its uncontrolled cost structure. What’s more, the new legislation imbeds the insurance industry further in the system, giving insurers 30 million more customers. “It’s not worth doing,” says Fine.

Even those top tiers are bound to thin out. Business Week reports that employers’ health care costs have risen 149 percent since 2000, exceeding $10,000 per employee for the first time this year. The Commonwealth Fund estimates that total premiums for employer-based health insurance will go up 94% by 2020, to almost $2,000 per month per family. For small business and freelancers those huge costs are closer, as Blue Cross/Blue Shield in New York raised premiums 22% this year to about $1,500 per family. Watch your step as you descend the pyramid.

CARL GINSBURG is a Medicare lawyer and journalist based in New York. He can be reached at carlginsburg@gmail.com

 

 

 

More articles by:

CARL GINSBURG is a tv producer and journalist based in New York. He can be reached at carlginsburg@gmail.com

January 16, 2019
Patrick Bond
Jim Yong Kim’s Mixed Messages to the World Bank and the World
John Grant
Joe Biden, Crime Fighter from Hell
Alvaro Huerta
Brief History Notes on Mexican Immigration to the U.S.
Kenneth Surin
A Great Speaker of the UK’s House of Commons
Elizabeth Henderson
Why Sustainable Agriculture Should Support a Green New Deal
Binoy Kampmark
Trump, Bolton and the Syrian Confusion
Jeff Mackler
Trump’s Syria Exit Tweet Provokes Washington Panic
Barbara Nimri Aziz
How Long Can Nepal Blame Others for Its Woes?
Glenn Sacks
LA Teachers’ Strike: When Just One Man Says, “No”
Cesar Chelala
Violence Against Women: A Pandemic No Longer Hidden
Kim C. Domenico
To Make a Vineyard of the Curse: Fate, Fatalism and Freedom
Dave Lindorff
Criminalizing BDS Trashes Free Speech & Association
Thomas Knapp
Now More Than Ever, It’s Clear the FBI Must Go
Binoy Kampmark
Dances of Disinformation: The Partisan Politics of the Integrity Initiative
Andrew Stewart
The Green New Deal Must be Centered on African American and Indigenous Workers to Differentiate Itself From the Democratic Party: Part Two
Edward Curtin
A Gentrified Little Town Goes to Pot
January 15, 2019
Patrick Cockburn
Refugees Are in the English Channel Because of Western Interventions in the Middle East
Howard Lisnoff
The Faux Political System by the Numbers
Lawrence Davidson
Amos Oz and the Real Israel
John W. Whitehead
Beware the Emergency State
John Laforge
Loudmouths against Nuclear Lawlessness
Myles Hoenig
Labor in the Age of Trump
Jeff Cohen
Mainstream Media Bias on 2020 Democratic Race Already in High Gear
Dean Baker
Will Paying for Kidneys Reduce the Transplant Wait List?
George Ochenski
Trump’s Wall and the Montana Senate’s Theater of the Absurd
Binoy Kampmark
Dances of Disinformation: the Partisan Politics of the Integrity Initiative
Glenn Sacks
On the Picket Lines: Los Angeles Teachers Go On Strike for First Time in 30 Years
Jonah Raskin
Love in a Cold War Climate
Andrew Stewart
The Green New Deal Must be Centered on African American and Indigenous Workers to Differentiate Itself From the Democratic Party
January 14, 2019
Kenn Orphan
The Tears of Justin Trudeau
Julia Stein
California Needs a 10-Year Green New Deal
Dean Baker
Declining Birth Rates: Is the US in Danger of Running Out of People?
Robert Fisk
The US Media has Lost One of Its Sanest Voices on Military Matters
Vijay Prashad
5.5 Million Women Build Their Wall
Nicky Reid
Lessons From Rojava
Ted Rall
Here is the Progressive Agenda
Robert Koehler
A Green Future is One Without War
Gary Leupp
The Chickens Come Home to Roost….in Northern Syria
Glenn Sacks
LA Teachers’ Strike: “The Country Is Watching”
Sam Gordon
Who Are Northern Ireland’s Democratic Unionists?
Weekend Edition
January 11, 2019
Friday - Sunday
Richard Moser
Neoliberalism: Free Market Fundamentalism or Corporate Power?
Paul Street
Bordering on Fascism: Scholars Reflect on Dangerous Times
Joseph Majerle III – Matthew Stevenson
Who or What Brought Down Dag Hammarskjöld?
Jeffrey St. Clair - Joshua Frank
How Tre Arrow Became America’s Most Wanted Environmental “Terrorist”
Andrew Levine
Dealbreakers: The Democrats, Trump and His Wall
FacebookTwitterGoogle+RedditEmail