Could you please deliver this note to Democrat and Republican leaders, doctors, hospitals, insurers, employers, drug and medical technology manufacturers and other people responsible for the future of the U.S. health care system? To make things work better, we need to agree on four goals:
First – and hardest – we must find ways to get health care costs to go down or at least level off. Family coverage costing upward of $20,000 just doesn’t sit well on top of typical household incomes of $60,000 or $40,000, much less wages of $18,000 that a new Brookings study estimates as the midpoint for 53 million low-wage Americans, comprising 44% of all workers.
Health costs are way too high to piggyback on federal minimum wage jobs that bring in about $15,000 a year. MIT economists estimate that paying for the needs of one adult and a child requires a living wage of about $20 an hour in rural Mississippi – $41,600 a year; $26 in Minneapolis/St. Paul – $54,080 annually; $31 in the New York metro area – $64,480; and $37 in San Francisco – $77,000. In New Mexico, they calculate the living wage for an adult and child around $25 an hour – $52,000 a year, despite wide regional variation in household income. Middle- and low-wage workers need a raise, including those in the health-care sector.
Just about everyone in the world, including thousands of Ph.D. economists, knows the U.S. medical-industrial complex has become too expensive. Anesthesiologists and surgeons making $400,000 and health system executives up to $25 million who surprise families with $10,000 bills after treatment in an emergency room need to consider making a bit less. The same goes for hospital conglomerates sitting on billions in liquid assets. Not to mention companies that jack up the price of life-sustaining medicines. They can charge less, do a better job of serving vulnerable people, and still make lots of money. The health care sector really doesn’t have to soak up every dollar of increased national productivity. If budgets need to be adjusted a bit, specialists, health system execs and pharma lobbyists can get to work in a Hyundai. They don’t need another Lexus under the Christmas tree.
Second, our country should make sure that all Americans have coverage – at the beginning of each year if possible, or upon getting sick and going to the hospital.
Third, we need to realize that, if everyone has reliable coverage, it doesn’t have to be through a single-payer system. Any number of payers works if they get the job done. Let the richest 1%, the states, Vlad Putin, the Pope, Ukrainian prosecutors, Mexico, Venezuela and Afghanistan help pay for universal coverage if they can or want to. It doesn’t matter how many payers there are. What matters is getting everyone in our country covered no matter whether they sleep on a sidewalk or in a penthouse.
Just what’s the plan for transitioning people out of Medicaid and employer coverage? Will Congress claw back money from the states like it did with Medicare Part D?
Fourth, we need to invest in infrastructure to take care of people at the fringes of the health care system including the poor and people living in rural areas devoid of providers and in high-cost cities where low- and modest-income families struggle to make ends meet. People in all walks of life need access to mental health providers and drug treatment.
Santa, I’d also like to ask a small personal favor. Please keep me, my family and friends healthy in 2020 and away from most parts of the American health care system. We need enough money to pay our bills and have a little left over for Christmas presents next year.
Thanks Santa. I hope this isn’t asking for too much. And please don’t be too hard on the health care people.
The Center on Capital & Social Equity explores growing economic inequality and advocates for inclusion of the bottom 50%.