Health Care for America

A proposal for guaranteed, affordable health care for all

Americans building on Medicare and

employment-based insurance
b y J a c o b S . H a c k e r

America’s $2.2-trillion-a-year medical complex is enormously wasteful, ill-targeted, inefficient, and unfair. The best medical care is extremely good, but the Rube Goldberg system through which that care is financed is extremely bad—and falling apart. One out of three non-elderly Americans spend some time without health insurance every two years, and the majority of those remain uninsured for more than nine months. Meanwhile, runaway health costs have become an increasingly grave threat, not just to the security of family finances, but also to corporate America’s bottom line. The United States spends much more as a share of its economy on health care than any other nation, and yet all this spending has failed to buy Americans the one thing that health insurance is supposed to provide: health security.

Health insecurity is not confined to one part of the population. It is experienced by all Americans: those without insurance as well as those who risk losing coverage; those who are impoverished as well as those with higher incomes who experience catastrophic costs; those who are sick or injured as well as those who are just one sickness or injury away from financial calamity. As health care costs have skyrocketed and the proportion of Americans with stable benefits has eroded, health insecurity has become a shared American experience, felt by those who thought they had it made as well as those just struggling to get by.

This growing problem is pushing health care reform back onto the agenda of American politics after more than a decade of neglect. And yet, nothing guarantees that this debate will end differently than previous battles. Again and again in the 20th century—most recently, in the early 1990s—efforts to make health insurance an integral piece of the American social fabric were stymied. The stakes are too high to allow reform to be blocked again. America’s economy, the finances of its middle class, the quality of its medical care, and the health of its citizens all hang in the balance.

To avoid the dismal fate of previous reform campaigns, a successful agenda must take seriously the political constraints and organizational realities that have hamstrung reform efforts in the past. Limits on public budgets, resistance to measures that might be seen as taking away what Americans already have, and the embedded realities of the present system all stand squarely in the path of grand policy redesigns—from single-payer national health insurance, to individual mandates requiring that everyone purchase private coverage, to a universe of individualized Health Savings Accounts. Instead, the most promising route forward is to build on the most popular elements of the present structure—Medicare and employment-based health insurance for well-compensated workers—through a series of large-scale changes that are straightforward, politically doable, self-reinforcing, and guaranteed to produce expanded health security.

The full proposal by Jacob Hacker can be viewed at: http://www.sharedprosperity.org/bp180/bp180.pdf

Health Care Insecurity Increases as Employer-Based System Continues to Erode

Health insecurity across education levels

by Heidi Shierholz

It is widely recognized that the employer-based health care system is eroding. The share of workers with employer-provided health insurance has decreased substantially in recent years, even amidst relatively low levels of unemployment and growing productivity. From 2000 to 2006, the share of workers who received health insurance from their own jobs declined 4 percentage points. Perhaps surprisingly, the decline in coverage has taken place across the entire age, education, occupation, industry, race, and ethnicity spectrum. As an example, the chart below shows the decline in employer-provided health insurance between 2000 and 2006 for workers with different levels of education. While workers with more education are more likely to receive health insurance from their employers, workers from all education levels have seen similar declines in coverage. Specifically, workers with no more than a high school education saw a decline of 5.0 percentage points, workers with some college education but no bachelor's degree saw a decline of 4.2 percentage points, and workers with a college degree or more saw a decline of 3.6 percentage points. Overall, 6.4 million fewer workers had employer-provided health insurance in 2006 than in 2000.

These findings, along with others in the Economic Policy Institute paper A Decade of Decline, show that health insecurity is now a broadly shared American experience. The erosion at all levels of the employer-based system, along with the critical need to control skyrocketing health care costs, indicate that the time has come to reform our health care system to guarantee that all Americans have access to affordable, high-quality health insurance. The Health Care for America plan, for example, would ensure that all Americans receive coverage and would do so at a lower total national cost than the current system.

The full report can be viewed at: http://www.epi.org/content.cfm/bp209

INCOME INEQUALITY GREW IN MOST STATES

Low-Income Families Lost Ground Since Late 1990s

The gap between the richest and poorest families, and between the richest and middle-income families, grew significantly in most states over the past two decades, according to a new study by the Center on Budget and Policy Priorities and the Economic Policy Institute. In fact, the nation’s longstanding trend of growing inequality accelerated since the late 1990s as incomes fell
for poor families and stagnated for middle-income families in a number of states.

The study, based on inflation-adjusted Census data, is one of the few to examine income inequality at the state level. It measured and compared income trends among the highest-, middle-, and lowest-income families in three periods – the late 1980s, the late 1990s, and the mid-2000s. (If anything, the study understates inequality because it does not include income from capital gains, which goes overwhelmingly to those at the top.) Low- and middle-income families have reaped few gains since the late 1990s, despite the recent years of economic prosperity. Average incomes actually fell by 2.5% for those in the bottom fifth of the income scale and rose by just 1.3% for those in the middle fifth. Meanwhile, incomes climbed 9% for those in the top fifth.

“Before the recent downturn hit, our economy was generating solid income gains. The problem was that high levels of inequality meant these gains failed to reach middle- and low-income families, whose living standards stagnated or even declined,” said Jared Bernstein, senior economist at the Economic Policy Institute and co-author of the report. “As we head into an economic downturn, these families are illprepared to weather the storm.” Elizabeth McNichol, senior fellow at the Center and the other co-author, added, “Rising inequality raises basic issues of fairness, and harms the nation’s economy and political system. It dampens economic
prosperity as incomes stagnate for tens of millions of average Americans and it threatens to widen the nation’s political cleavages, generating more cynicism about political institutions.”
During the longer time period – from the late 1980s to the mid-2000s – in 37 states, incomes grew much more slowly for the bottom fifth of families than for the top fifth. In these states, the incomes of the richest fifth grew by an average of $36,300 (39 percent), while the incomes of the poorest grew by only $1,600 (9 percent). The purchasing power of the poorest families increased by just $93 per year.

The full report can be found at http://www.cbpp.org/4-9-08sfp.htm.

Geography as Destiny

“LIFE AND DEATH” DIFFERENCES IN U.S. CHILD WELL-BEING EXIST BETWEEN TOP AND BOTTOM STATES, YOUTHS UP TO THREE TIMES MORE LIKELY TO DIE BEFORE ADULTHOOD IN SOME PARTS OF U.S.

The Forgotten 2008 Campaign Issue? “Shocking” Disparities Show That “Geography Matters” for U.S. Children

WASHINGTON, D.C., April 2, 2008, The states of Louisiana and Vermont may be part of the same nation, but they are worlds apart when it comes to the well-being of children living within their borders. Across the United States, where a child is born and raised can make a shockingly large difference to their chances of getting and staying healthy and then surviving to adulthood, according to a major new report released today by the nonprofit and nonpartisan Every Child Matters Education Fund (ECMEF). Entitled “Geography Matters: Child Well-Being in the States,” the ECMEF report concludes: “There exists a huge gap among states on a wide variety of child well-being indicators. The state they live in should not adversely influence the life and death of children—but it does. Such inequalities affect all Americans, rich and poor alike, and weaken both our economy and our democracy.

Children in the lowest ranking state are:
• Twice as likely to die in their first year as children in the highest ranking state.
• Three times more likely to die between the ages of one-14.
• Roughly three times more likely to die between the ages of 15-19.
• Three times more likely to be born to a teenage mother.
• Five times more likely to have mothers who received late or no prenatal care.
• Three times more likely to live in poverty.
• Five times more likely to be uninsured.
• Eight times more likely to be incarcerated.
• 13 times more likely to die from abuse and neglect.”

Based on a wide cross-section of 10 major child well-being standards, the 10 bottom states identified in the Every Child Matters Education Fund report are: Arizona (41); South Dakota (42); Nevada (43); Arkansas (44); South Carolina (45); Texas (46); Oklahoma (47); New Mexico (48); Mississippi (49); and Louisiana (50). The 10 top states for children by the same measures are: Maine (10); Washington (9); Minnesota (8); Iowa (7); Hawaii (6); New Hampshire (5); Rhode Island (4); Connecticut (3); Massachusetts (2); Vermont (1).

Michael R. Petit, author of “Geography Matters; Child Well-Being in the States,” and founder of Every Child Matters, said: “Every Presidential candidate and state-office seeker should be asked to speak to these stark findings. Nearly 13 million American children," continued Petit, "live in poverty today. Over eight million U.S. children have no health insurance. Nearly three million children nationwide each year are reported abused and neglected. As Americans, we need to ask ourselves: Does every child in the U.S. deserve an equal opportunity to be healthy and survive to adulthood? Is there a floor below which no American child should fall, regardless of the accident of geography that accounts for where they are born and raised? It should no longer be politically acceptable to permit – or simply ignore -- the vast differences in life chances that exist for children today.”

Elizabeth J. Clark, Ph.D., ACSW, MPH, executive director, National Association of Social Workers, Washington, D.C., said: “As social workers working with the most troubled children and families across the country, we have always known about the disparate treatment of children from state to state. We look forward to a national commitment to protect all children, to create equal opportunities, and to strengthen families and communities. We know that more can be done to ensure that our children have the supports they need to thrive, no matter what state they call home.”

More information, and the full report can be accessed at: http://www.everychildmatters.org/homelandinsecurity/index_geomatters.html

On the Congressional Progressive Caucus Budget for FY 2009

Congressional Progressive Caucus Releases Alternative Budget Proposal

Progressives Release Only Budget to Cut Defense Spending & Cut Poverty in Half in A Decade

Budget Helps Rescue Faltering Economy and Rebuild America’s Infrastructure

(Washington, DC) – Congresswoman Barbara Lee (CA-9), Co-chair of the Progressive Caucus (CPC), released the following statement touting the CPC budget alternative that balances moral and fiscal priorities:
“The CPC’s budget is the only proposal that addresses poverty head on and is also the only alternative to cut even one dime from Pentagon spending. Progressives are very concerned that the Bush administration’s bloated defense budget request is the highest since WWII and propose limiting defense spending to $468.3 billion, which is $68.7 billion under the President’s request and does not compromise national security.
“Because Americans have been hit hard by the Iraq recession, our alternative assumes the redeployment of troops and contractors from Iraq between now and FY 2009, saving tax-payers at least $135 billion over the next 18 months.
“Under the Bush administration, a disproportionate amount of funding has gone to the Pentagon and provided tax cuts for the wealthy, while urgent domestic priorities have gone under-funded, poverty has increased, and the gap between the super wealthy and everybody else grew at an alarming rate. To reverse these trends, CPC’s plan includes a second economic stimulus package, which provides funding increases for unemployment insurance, food stamps, housing assistance and Federal Medical Assistance Percentage payments to states.
“The budget also makes an investment of $73.05 billion in FY 2009, which increases to $129.3 billion in FY 2018, to fund a comprehensive strategy to cut poverty in half in a decade and provide immediate and long-term help for Hurricane Katrina victims.
“It is just common sense to redistribute funding, both domestic and international, to help our nation to become more secure and I urge my colleagues to vote for this sensible and mainstream budget plan that balances in FY 2012.
“Progressives are on the right side of the issues that affect the American people and will garner significant support to be in a position to shift economic priorities this Congressional session.”

Happy Anniversary New Deal

On March 31st, FDR's New Deal celebrates its 75th anniversary.

The impact of the New Deal reforms instituted to combat the Depression, are even more important today as our economy faces many of the same problems that people were faced with in the Great Depression of the 1930's. Much like Herbert Hoover, George W. Bush fiddled while the economy burned, and left his mess for his successor to clean up. In his first 100 days in office, FDR changed the way people looked at the federal government. He firmly established a legitimate role for the federal government to regulate the economy and to provide for the welfare of its citizens. However, for forty of the last seventy-five years, politicians - Democrat and Republican - have been chipping away at New Deal programs and reducing the role of the Federal government in regulating business and the economy, but most importantly reducing the legitimate and necessary role of the federal government in providing for the welfare of its citizens. So today, instead of regulating the investment banking industry, we bail out one of the architects of the sub prime debacle with $30 billion in taxpayer funds, while leaving honest, hardworking Americans who were the victims of this huge pyramid scheme to fend for themselves.

So, it is crucial that we stop, take a step back and celebrate all that the New deal has brought to Americans and then energize ourselves to preserve these programs but most importantly to rededicate ourselves to the belief that government can be the solution and that there is a legitimate role for government to regulate business who when left to its own devices will, like water, find the easiest path to the greatest profit without concern for the impact on the common good.

The following article from Spartacus Education http://www.spartacus.schoolnet.co.uk/ provides a brief overview of the New Deal programs with clickable links to more information.

Roosevelt's first act as president was to deal with the country's banking crisis. Since the beginning of the depression, a fifth of all banks had been forced to close. As a consequence, around 15% of people's life-savings had been lost. By the beginning of 1933 the American people were starting to lose faith in their banking system and a significant proportion were withdrawing their money and keeping it at home. The day after taking office as president, Roosevelt ordered all banks to close. He then asked Congress to pass legislation which would guarantee that savers would not lose their money if there was another financial crisis. On 9th March 1933, Franklin D. Roosevelt called a special session of Congress. He told the members that unemployment could only be solved "by direct recruiting by the Government itself." For the next three months, Roosevelt proposed, and Congress passed, a series of important bills that attempted to deal with the problem of unemployment. The special session of Congress became known as the Hundred Days and provided the basis for Roosevelt's New Deal. The government employed people to carry out a range of different tasks. These projects included the Works Projects Administration (WPA), the Civilian Conservation Corps (CCC), the National Youth Administration (NYA), Farm Security Administration (FSA), the National Recovery Administration (NRA) and the Public Works Administration (PWA). Other schemes adminstered by the Works Projects Administration included the Federal Writers Project (1935-39) Federal Theatre Project (1935-39) and the Federal Art Project (1935-43). As well as trying to reduce unemployment, Roosevelt also attempted to reduce the misery for those who were unable to work. One of the bodies Roosevelt formed was the Federal Emergency Relief Administration which provided federal money to help those in desperate need. Other legislation passed by Roosevelt included the Agricultural Adjustment Act (1933), National Housing Act (1934), the Federal Securities Act (1934). In August 1935 the Social Security Act was passed. This act set up a national system of old age pensions and co-ordinated federal and state action for the relief of the unemployed.

The Nation Magazine's April7th issue is another excellent resource for more information on the New Deal, and a collection of brief essays written by activitst, writers, scholars and artists on a "New New Deal," http://www.thenation.com/