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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Political Strategy Notes – GOP Health Care Follies Edition

You would think that, by now, Republicans would have come up with some sort of “program” that would provide them at least a fig leaf of cover for their real-world indifference to the health care crisis millions of working people face. Yet, Trump and his fellow Republicans in congress have never offered anything resembling a coherent plan to improve health security for Americans. Even The Editorial Board of the Wall St. Journal agrees that Trump has likely set up a disaster for his party in arguing that “the Administration decided this week to elevate a legal fight over health care that it is almost sure to lose.” When pressed, Republicans have to admit that their only ‘alternative’ boils down to a return to the status quo ante the Affordable Care Act. I can’t remember a time when one of the major political parties had so little of substance to say about the leading issue of the day, a stunning admission of  intellectual bankruptsy and political ineptitude.

“Candidate Donald Trump wanted to make sure you have health insurance. President Donald Trump is committed to taking it away,” Sarah Kliff writes at vox.com. “During his presidential campaign, Trump told 60 Minutes, “I am going to take care of everybody.” On the campaign trail in 2018, he sounded similar. “We will always protect Americans with preexisting conditions,” he said at an event in Philadelphia just before the midterm elections…But in office, Trump has attempted to implement an agenda that does the opposite. He’s backed legislation, regulations, and lawsuits that would make it harder for sick people to get health insurance, allow insurance companies to discriminate against patients with preexisting conditions, and kick millions of Americans off the Medicaid program…This week, his Justice Department filed a legal brief arguing that a judge should find Obamacare unconstitutional — a decision that would turn the insurance markets back into the Wild West and eliminate Medicaid coverage for millions of Americans. By at least one estimate, a full repeal could cost 20 million Americans their health care coverage.”

Dylan Scott elaborates, also at Vox: “President Trump just guaranteed health care will remain a dominant issue through the 2020 presidential campaign, opening up a massive vulnerability in his reelection bid…In a legal brief filed this week, the Trump Justice Department argued to a federal court that the entire Affordable Care Act should be found unconstitutional. That would mean an end to the private markets where 15 million Americans buy their coverage, an end to the expansion of Medicaid that covers 15 millions more, and an end to protections for people with preexisting conditions. According to the Urban Institute, if the entire law were eliminated, as the Trump administration is now advocating for, nearly 20 million fewer Americans would have health insurance…The Justice Department’s move is stunning, considering the price House Republicans paid in the 2018 midterms for attempting to repeal the law in Congress. Health care was the top issue for voters, beating out the economy, immigration, and guns. The voters who named health care as their top issue overwhelmingly supported Democratic candidates — helping flip control of the House from Republicans to Democrats…Polling shows Americans strongly disapprove of how Trump has handled health care as president. And now his record on health care heading into his reelection campaign is even more unambiguous: He and his administration have fought to strip health coverage from millions of Americans and to erode protections for people with preexisting conditions — and their new move in the courts shows they are keeping it up.”

At Fortune, Erik Sherman reports that “U.S. Voters Prefer Expanding Medicare Over New Single-Payer Health Care, Says New Poll.” According to the latest national poll from Quinnipiac University, Sherman writes, “People were in favor 55% to 32% of improving the current health care system instead of replacing it with something new. But when asked whether to remove the current system and replace it with single-payer through an expansion of Medicare to cover all citizens, 43% called it a “good idea” while 45% said it was a “bad idea.” By political party, 69% of Democrats and 42% of independents supported it while only 14% of Republicans did…When asked instead whether to keep the current system and then allow any adult who wanted to buy into Medicare, 51% were in favor overall, with 30% opposed. Supporting the concept were 61% of Democrats, 49% of independents, and 43% of Republicans.”

MSNBC’s Katy Tur put it well in her interview of a Trump Administration spokesman: “We are two years into his presidency. We still have not seen a plan from the White House,” she said on “MTP Daily,” repeatedly pressing Marc Short, chief of staff to Vice President Pence and former White House legislative director. “When are we going to see this plan?..”If everything that you say is true and if it goes to the Supreme Court and is not upheld again by Chief Justice [John] Roberts … what is the plan you guys have to replace it?” Tur asked Short…”This law has been in place since 2010,” Tur said. “Republicans have campaigned consistently on repealing and replacing it. They tried again to do it 70 times. The president … talked about repealing and replacing ObamaCare. He’d come up with something beautiful and fantastic and everybody would be covered.”…”We will be coming forward with a plan in the next coming months,” Short said, noting that the Department of Health and Human Services would be working on one.” Don’t hold your breath.

Any Democratic candidates looking for fresh health care statistics that reveal the moral bankruptsy of the private health insurance industry could use this excerpt from Roqayah Chamseddine’s article, “A Healthcare Industry Built on Premature Death: On the cruelty of private healthcare corporations” at In These Times: “The industry is an architecture of misery, extracting profits from suffering. According to a report published in 2017 by The Doctor-Patient Rights Project, insurance companies “denied treatment coverage to one-in-four (24 percent) patients with a chronic or persistent illness or condition; 41 percent of the patients denied coverage were denied once, while 59 percent were denied multiple times.” Thirty-four percent of patients who had been denied coverage were forced to put off treatment, despite having a chronic illness. An astounding 70 percent of treatments for a chronic illness denied by insurers were for conditions referred to as “serious.” The grim reaper disguises himself in many forms, in this case that of an insurance agent.”

For some revealing numbers about the cost-effectiveness of Democratic health care, check out Ezekiel J. Emanuel’s “Name the much-criticized federal program that has saved the U.S. $2.3 trillion. Hint: it starts with Affordable” at statnews.com, which notes:  “One month after the ACA had passed, the Office of the Actuary of the Department of Health and Human Services projected its financial impact in a report entitled “Estimated Financial Effects of the ‘Patient Protections and Affordable Care Act’, as Amended.” The government’s official record-keeper estimated that health care costs under the ACA would reach $4.14 trillion per year in 2017 and constitute 20.2 percent of the gross domestic product (GDP)…Fast forward to December 2018, when that same office released the official tabulation of health care spending in 2017. The bottom line: cumulatively from 2010 to 2017 the ACA reduced health care spending a total of $2.3 trillion…In 2017 alone, health expenditures were $650 billion lower than projected, and kept health care spending under 18 percent of GDP — basically a tad over where it was in 2010 when the ACA was passed.

“It did all of this while expanding health coverage to more than 20 million previously uninsured Americans,” Emanuel continues, “Compared to the 2010 projections, the government’s Medicare bill in 2017 was 10 percent ($70 billion) less, and spending for Medicaid and the Children’s Health Insurance Program was a whopping $250 billion below expectations (partially — but only partially — due to the failure of some states to expand the program). The actuary had predicted in 2010 that employer-sponsored insurance would cost $1.21 trillion in 2017, but it came in at $1.04 trillion, a difference of $170 billion for that year…Put another way, health care spending in 2017 was $2,000 less per person than it was projected to be. And for the 176 million Americans who have private employer-sponsored insurance, their lower premiums averaged just under $1,000 per person…Barack Obama pledged on the campaign trail and as president that he would sign a health care bill that lowered family health insurance premiums by $2,500. Conservative politicians and pundits roundly mocked him. Yet the ACA has more than delivered on that promise, saving about $4,000 per family. And these lower health care premiums probably contribute to the recent rise in workers’ wages.” It’s a good article for De,ms to cite. Emanuel also suggests some specific improvements to make the ACA even more cost-effective.”

Some closing notes on health insurance industry economics from Bob Herman’s “The latest on health care executive pay” at Axios: “The CEOs of 23 prominent health care companies earned more than $632 million in 2018, based on the actual value of cashed-out stock, according Axios’ most recent tally of federal securities documents…The highest-paid pharmaceutical executive so far for 2018 was Pfizer’s outgoing CEO, Ian Read, who made $47 million…The two CEOs with the highest overall pay were still HCA Healthcare’s R. Milton Johnson($109 million) and Intuitive Surgical’s Gary Guthart ($99 million)…Flying under the radar as one of the highest-paid health care executives was Ari Bousbib, who heads the pharmaceutical data and consulting company IQVIA. He made $77 million in 2018 and has made $137 million since 2016, when Quintiles and IMS Health merged to form IQVIA…When Express Scripts CEO Tim Wentworth joined Cigna last year, he took home $9 million in retention pay and agreed to “perpetual” agreements to never divulge anything about the company.”

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