Due to the intricacies of public policy issues and the obvious susceptibility of some of those issues to be subjected to gross distortions, just for the interested purveyors of such distortions to score a political point, it’s imperative at times to proffer some factual narratives in an attempt to remove whatever ambiguity or equivocation that might be surrounding a given policy proposal. In the case of the universal healthcare policy now popularly known as Medicare-for-All (M4A), as initially proposed by Senator Bernie Sanders, which has virtually been embraced and incorporated with some modifications or nuances by almost all of the current and former Democratic presidential candidates, a relevant narrative that readily flashes through my mind involves the unfortunate predicament of Mr. Frederick Christ Trump, III and his wife, Lisa Trump, who in the year 2000, were catering to their infant son—William Trump–with a severe pre-existing condition at the time. In his best-selling book, The Making of Donald Trump, veteran investigative journalist David Cay Johnston narrates an incident involving the current President of the United States, Mr. Donald J. Trump and his nephew, Mr. Fred C. Trump, III.
As recounted by Mr. Johnston, (pages 27-32), when Mr. Fred C. Trump, Sr., the patriarch of the Trumps died in his 93rd year on June 25, 1999, his four surviving children later conservatively estimated their late father’s assets/estate at between $100 million and $300 million at the time, although Mr. Johnston adds, “Its real value was no doubt more.” The elder Trump’s first son, Fred C. Trump, Jr. (born 1938) had predeceased him in 1981, in his prime age of 42 and his surviving son is Fred C. Trump, III. They reportedly decided to give their nephew, Fred C. Trump, III $200,000 out of his grandfather’s staggering assets. Seemingly unsatisfied, Fred, III sought the help of a lawyer who then sued the estate of the late Trump patriarch.
Apparently, the surviving Trump children decided to share their late dad’s assets, even though they were all grown-ups with considerable wealth of their own. Fred III apparently felt that as a direct representative of his late father—Fred C. Trump, Jr.—he deserved a better share of the assets from his two paternal uncles and two paternal aunts. The bad news for Fred, III was that he and his wife had a baby who was suffering from a rare disease and badly needed health insurance coverage, because treatments for the disease ran in thousands.
Johnston notes that the Trumps had a family health insurance from which Fred, III and his family—including the baby, had been benefitting, but because he had sued his late grandfather’s estate for a better share of the pie, the future president abruptly removed the entire Fred C. Trump, III family from the Trump family health insurance. Johnston further emphasizes, “Donald Trump’s reaction was swift and vengeful”, and goes on, “On March 30, 2000, one week after the lawsuit was filed, Fred III received a certified letter stating that all medical benefits would cease on May 1. For little William, that was a potential death sentence” (2016:29). In other words, even though Fred, III was a scion of one of the wealthiest families in the United States, suddenly he and his family—most especially his sickly baby boy–were left without health insurance. This means that he and his wife, Lisa had to pay thousands of dollars out of their pockets, because their continued retention on the Trump family health insurance was based solely on the discretion of his super-rich uncle, Mr. Donald J. Trump, who became president in 2017. What is not clear here is whether Fred III was aware that his uncle’s personal mantra, as recalled by Johnston, is: “Always get even. Hit back harder than you were hit.” (2016:27).
Just imagine if there had been a Federal health insurance here in the United States as it is in neighboring Canada, or in Great Britain, Australia or Sweden, Fred, III’s baby’s life would not have been put at an imminent risk, just because one member of the Trump clan was mad with another member. The unfortunate Fred, III narrative is indicative of how in the absence of a government-guaranteed health insurance, everyone is at the unreliable mercy of private individuals or institutions. Does that drive home the point that every private health insurance, however, abundantly beneficial it might be, is inherently conditional and potentially temporary? It must be noted that since this country came into being 244 years ago, the most enduring and consequently reliable institution has been the Government. Companies, including insurance companies have come and go, but Government remains, whether in times of the Great Depression or the Great Recession, whether during World War I or World War II. It therefore goes without saying that a well-intentioned, people-centric healthcare policy meticulously sculpted and guaranteed by government is better than those primarily designed by predatory capitalists for profit motives.
This brings us to a second narrative. During the February 22, 2020 Nevada caucus of the Democratic Party, the popular sentiment being expressed by some leaders of the seemingly powerful Culinary Union was that Medicare-For-All would take away their union’s private health insurance. Because of the dispute involving the union leadership’s preference and the disconnect with majority of its rank-and-file members, there was no official endorsement of any candidate by the 60,000-strong Culinary Union. Instead, the Secretary-Treasurer of the union hastily convened a press conference during which she heaped praises on one of the candidates, who was clearly not favored by a majority of the members, hence the deadlock in endorsement.
Even though the union said it was not endorsing any candidate, its leaders, however, resorted to using free media time during their press conference to distort and discredit Bernie Sanders’ M4A. That sentiment had been couched months earlier during a townhall in a poignant comment-and-question by one of the union leaders, Elodia Munoz as indicated herein: “We went on strike to protect our healthcare—healthcare I need for my family. We want to keep it. We don’t want to change it. Why would you change it?” The reality is that at such a political gathering, when someone with a vested interest eloquently poses such a loaded question, it is obviously bound to arouse applause from the audience, even if the substance is pale. But beyond the flashy satisfaction of an applause, the stark reality continues to stare.
What that eloquent union leader neglected to articulate is that a typical culinary worker would continue to have that particular private health insurance coverage as long as he, or she remains employed and pays his or her union due. But what happens if such a cherished union member loses his job, or becomes disable? Will that person continue to keep his or her private health insurance? If so, for how long? Will the union continue to pay his or her insurance premiums? In discussing the nitty-gritty of crucial issues that directly affect people’s life, one has to go beyond the ostentatious spectacle of rhetorical flourishing and honestly embrace the underlying substance.
The harsh reality is that private health insurance is strictly contingent on the continued economic viability of the holder. In other words, one can have a private health insurance today and incidentally lose it tomorrow. For example, in December of 2001, when the Houston-based energy giant, Enron collapsed, more than 29,000 of its employees who have hitherto, had a fabulous private health insurance, were suddenly left without health insurance. The Enron scandal was so heart-wrenching that one of its top executives committed suicide on January 25, 2002. Seven years later, thousands of other hardworking employees such as Lehman Brothers and General Motors, among others, experienced such grim reality as their companies collapsed in the wake of the Great Recession.
Usually when the issue of Medicare-for-All is raised in political circles, people with varied vested interests are prone to assail it from all angles, pretending that such policy is impossible. They most often make such claims without rationalizing same. This is understandable though, because the healthcare industry—owners, shareholders and administrators of private hospital and clinic chains, the pharmaceutical companies, health insurance companies and their professional lobbyists, etc—is a very powerful, influential institution. And so, they have every right to fight back, because their profit margins stand to be considerably reduced, in case a bold and virile leader succeeds in instituting M4A as the law of the land. After all, who would want to bite the hand feeds? Because of their mental anguish about the possibility of losing one of the primary sources of their stratospheric wealth, their sugar-coating lobbyists are busy out there, briskly crisscrossing the corridors of powers, coaxing power brokers and ever ready to grease their elbows, in terms of making fabulous contributions to their campaign accounts.
Against the backdrop of such intense lobbying, it’s not surprising when some politicians claim that this country, which more than fifty years ago, sent man to the moon, this country, which has for decades posted annual defense spending consistently exceeding those of 11 other major countries combined; this country, which has robustly led in all other aspects of human endeavor, cannot provide universal healthcare for its citizens, because making healthcare affordable and accessible to everybody would be “expensive.” It must be noted that most of those politicians who make such feeble claims are not experts on the issue at bar, which translates into unreasonable relativism for egregious reasons on their part. Since more than 99.9 percent of the politicians who contend that providing universal healthcare is not possible have little or no expertise on the issue, it is instructive to pay attention to the inputs of healthcare experts.
In the particular case of M4A, some expert assessments have been seeping through the surface, in spite of relentless attempts by interested parties to suppress persuasive information about its possibility and affordability. To begin with, let’s do some reality checks with two of the renowned knowledge factories in the country—Yale and Harvard Universities. I chose these two universities because they are among the most prestigious universities that many of those very politicians tend to be alumni of. Besides that, many politicians do whatever within their influence to send their children those very universities. In fact, some of them are fond of bragging about those Ivy League schools and so, in good faith, they must be inclined to accept impartial academic assessments from such schools, unless they have ulterior motives. Moreover, of the 45 men who have so far sat in the presidential chair in the Oval Office since this country was crafted more than 240 years ago, eight had been Harvard alumni, while three have come from Yale. For clarity’s sake, one of them—George Walker Bush—graduated from both universities on the undergraduate level (Yale) and (Harvard) on the graduate level. And so, in actuality, it’s 10 out of 45. Whatever the case might be, the mere fact that there are more than 5,300 universities in the U.S. and of the 45 presidents thus far, 10 or 22 percent of the total have been alumni of the two universities, indicates the premium position Yale and Harvard occupy in the psyche of American society.
Against this backdrop of near impeccable credibility and the sheer prestige that both academic institutions elicit within the larger American society, let’s briefly look at the M4A assessments from the two leading universities. The headline of a study carried out by Harvard medical researchers, as published on the CommonDreams website on January 27, 2020 said it all: “Medicare For All Is What Patients Need.” In their study, which was first published in the Journal of American Medical Association (JAMA), the researchers noted that the current profit-oriented private healthcare system in the country is making it difficult even for those with health insurance coverage to get adequate care, due to the skyrocketing costs in the form of increasing co-pays, noting that the unaffordability in the “so broken” healthcare system, “is leaving a larger number of Americans with unmet medical needs today than there were two decades ago.”
The leading medical science professors who noted, “Our findings call into question the value of private health insurance today”, further emphasized: “When so many people can’t get the care they need even when they have insurance coverage, it says that insurance is not doing what it is supposed to do: ensure that healthcare is affordable when you need it.” As for the Yale study, which was published in the February 19, 2020 edition of The Lancet–said to be one of the oldest, renowned medical journals in the country—it was very blunt in declaring that Medicare-For-All would save a staggering $450 billion per year on the aggregate costs associated healthcare delivery in the country and more importantly, prevent a whopping 68,000 deaths per annual.
Further analyzing the American healthcare landscape, the Yale researchers disclosed that in terms of per capita expenditures, the United States ranks the highest than any other county in the world, that 37 million Americans are currently without health insurance coverage, while “41 million more have inadequate access to care”, even though they actually have health insurance coverage. What is even more ludicrous is that amid such a dismal healthcare delivery situation, since January 23, 2017, the Trump administration has been persistent in its legislative and judicial attempts to scrap the Affordable Care Act (ACA)—Obamacare–which was formulated on March 30, 2010 by the Obama administration. “Efforts are ongoing to repeal the ACA which would exacerbate healthcare inequalities”, the Yale professors further raised such alarm in their study.
Noting that implementing M4A would reduce the country’s overall healthcare delivery costs by 13 percent, the Yale researchers said, “The entire system could be funded with less financial outlay than is currently by employees and households for health care premiums combined with existing government allocations.” For those who might be entertaining a notion that the Harvard and Yale studies are shrouded in academic idealism, the American College of Physicians (ACP), a well-known organization comprising frontline medical doctors providing primary healthcare services for millions of Americans in the country, has also come out in strong support of M4A. As published in the January 11, 2020 edition of The Hill online, the ACP unequivocally said, “The nation’s existing health care system is insufficient, unaffordable, unsustainable and inaccessible to many”, adding, “Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage.”
To be clear, the medical doctors were flexible in their endorsement, noting that both full-scale universal healthcare, or an M4A with a public option would also be acceptable to them than the status quo. The doctors’ position is consistent with the standard paradigm of policy formulation, in that, in such scenario, issues are adequately deliberated on and after finessing the nuances, such issues are then eventually tailored to the fundamental needs of the people. Of course, on a typical debate stage, it is otherwise, because candidates and their supporters are desperately seeking captivating applause lines.
Amid the ongoing debates about the imperatives of M4A, with most Republicans cynically labeling it as “socialized medicine”, the Coronavirus pandemic, which the World Health Organization (WHO) later christened as COVID-19, made its dreadful debut into the world, on December 31, 2019 in Wuhan, China. Since its outbreak, COVID-19 has turned out to be one of the rapidly spread viral-diseases known to humankind, assailing victims in every stratum of the global society, with a near supersonic speed. So far, infection data has exceeded one million and counting in more than 160 countries around the world, while more than 70,000 precious souls have succumbed to this merciless pandemic. Considering the fact that there are about 195 member countries of the United Nations, this means that more than 80 percent of the UN membership have been affected by the virus.
As deadly as COVID-19 is, it is also a poignant reminder about the interdependency and interconnectivity of the global community. As many people are vividly aware, since January of 2017, there have been unempathetic echoes of unilateralism bellowing from the corridors of power, but the bitter emerging experience of COVID-19 is a stark reminder that after all, to a large extent, the people of this world—regardless of one’s economic status, skin color, ethnicity, socio-political orientation–are all intertwined, to the extent what affects one corner of the global community has the propensity of directly or indirectly impacting all other parts of the world. From Wuhan to Rome, from London to Washington, DC, the unequivocal message inherent in the heart-wrenching COVID-19 onslaught is an imperative for urgent collaborative efforts by world leaders, aimed at inspiring innovation among technocrats and the global scientific community, to assiduously work in concert and save humanity, rather than brazenly resorting to unnecessary confrontation for political showmanship.
Even though the virus was first discovered in China, it shouldn’t be perceived as a Chinese invention without any irrefutable evidence to the contrary. It will therefore be foolhardy for anyone to ethnically or racially weaponize the name of the virus, or perceive its emergence as another expedient springboard for spewing spasms of racism and xenophobia, in an attempt to score a political point. For those who are fond of downplaying the interconnectivity and interdependency of the world, just reflect on the unprecedented impacts of COVID-19 in so short a time. It turned out that it’s not a locally confined, or racially based virus as some people might have naively thought from the onset, neither was it a hoax as some pliant cheerleaders were made to believe. Thousands of miles away from Wuhan, the dire impacts of the virus are being felt all over the place. For example, the transportation, hospitality and food service industries have nearly been wrecked. Likewise, movement of goods and services have either been shut down, or severely scaled down.
Against such gloomy viral environment, let’s briefly look at the current healthcare landscape here in the United States, in terms of insurance coverage. According to the White House’s State of Homelessness in America, as published by the Council of Economic Advisers, there were 552,000 homeless people in the country as of January 2018. Moreover, the Department of Housing and Urban Development (HUD) notes that “The number of homeless people on a single night increased by 0.3 percent between 2017 and 2018.” The department’s number of homeless persons is put at 553,000 for the same period (2018), slightly above the White House’s stats. Of course, when it comes to housing, HUD is the most competent authority and so, one might be inclined to go with its estimate.
My own layman reasoning is that if someone doesn’t have a home for dwelling purposes, it is most likely that such a person doesn’t have a health insurance. Moreover, the Federal Census Bureau notes that “In 2017, the number of people without health insurance increased to 28.0 million, up from 27.3 million the year before…” In other words, about 700,000 more Americans became uninsured healthcare-wise in 2017 alone; now that we’re three years later in 2020, it is highly likely that the number has significantly increased.
In fact, the 28.0 million seems to be a conservative estimate by the Census Bureau, because the same Yale University study referenced earlier, which estimated a $450 billion annual healthcare costs-saving for the country, if M4A is adopted as a federal healthcare policy, also notes that even though the United States comparatively spends the highest amount of money yearly on healthcare, in terms of per capita, yet 37 million Americans are currently without health insurance, a nine million disparity between the Census Bureau’s estimate and the Yale study. And so, amid this seemingly unprecedented health crisis, the grim reality is that between 28 and 37 million Americans don’t have health insurance, primarily because they can’t afford it.
For those who might be wondering how people without health insurance get medical treatments when they’re sick, one of the well-known ways—at least prior to the eruption of the COVID-19 pandemic—is to call an ambulance, even if one’s symptoms didn’t require an emergency care. Why? It’s because until the ongoing health crisis, hospitals and clinics were not refusing emergency room patients for lack of insurance; once a patient was carried to the ER via an ambulance, it was a slam-dunk treatment. The frequently habitual calls of ambulance by uninsured persons as an easy means of getting medical treatments are some of the key factors in making America’s overall healthcare expenditure astronomical.
Take for example, here in Boston, Massachusetts, the cost for a single ambulance ride per patient ranges from $1,200 to $1,900 (twelve hundred to nineteen hundred dollars), even if the distance is so short. Obviously, costs are most likely to vary from one state to another. The main issue here is that all costs associated with the ambulance transportation and treatments of uninsured persons, most especially homeless persons, are billed to either the state or Federal government. Remember, the $1,200 to $1,900 is just the cost for riding the ambulance, NOT for the treatments.
Against this backdrop, if, for example, 10 percent of the officially known 553,000 homeless persons currently in the United States make at least one urgent care or emergency room visit per year via ambulance, that will be about 5,300 persons at a cost of $1,200 per ride for each person, the total cost would be $6.3 million per year, just for the ride. Now add the treatment costs and then imagine why the U.S. spends a lot more on healthcare than any other developed country, and yet, the Harvard and Yale studies still contend that the country’s healthcare delivery system is still less than desirable. In the same token, if we go by the Federal Census Bureau’s 2018 estimate that 28.0 million Americans had no health insurance, if 10 percent of that number calls at least once in a year, that will be 280,000 persons making such calls. If all of them go to the emergency room through ambulance transportation at a cost of $1,200 per ride for each patient, the cost would be $336 million per year. Remember, as conservative as these estimates are, they are all pre-COVID-19 estimates. Now with the ongoing health crisis, it would certainly be inhumane for any nurse or doctor to ask for a patient’s insurance info before treatment. Besides that, available private healthcare facilities are being overwhelmed and gradually incapacitated by the crisis.
And so, with the eruption of the COVID-19 pandemic, the indisputable reality is that indeed, government does have a pivotal role in ensuring a service-oriented HEALTHCARE FOR ALL its people, regardless of one’s socio-economic status in the society. As the pandemic peaks, nearly all the predatory capitalists, the profit maniacs have shrunk, leaving government at the frontlines; persistent appeals are instead being made to governments around the world to mount an unprecedented rescue mission. Yes, some private institutions might chip in, but that won’t be as herculean or overarching as government’s. It has also become undeniable that making healthcare accessible, sustainable and affordable FOR ALL citizens of a given society IS NOT a “socialized medicine” as some cynics might cunningly claim. Instead, it’s a prudent public policy to ensure societal health, which is an accelerant of sustainable economic growth. As we are now seeing for ourselves, the save-our-souls (SOS) appeals are being persistently made to the Federal Government, rather than individuals or institutions–however super-rich they might be–to expeditiously make ventilators, respirators, masks and other personal protective equipment available, to help save the lives of the American people. And so, with the ongoing dreadful experience, as I see it, the long-term policy implication is that rather than the Federal Government and any other government that actually cares for the wellbeing of its people running helter-skelter, scrambling and scavenging in a panic mood to improvise during a health crisis, amid glaring structural deficits, holistic, comprehensive, service-oriented healthcare delivery policies are imperative to adequately address this inexcusable last frontier of human neglect around the world. That’s the most exigent challenge of humankind.
ABOUT THE AUTHOR: Columnist Joe Bartuah studied English & Professional Writing (BA), Political Science (BA) and Conflict Resolution, Public Policy and International Relations (MSc.) at the University of Massachusetts Boston and its McCormack Graduate School of Public Policy and Global Studies. He’s the author of, AN AGENDA FOR A BETTER LIBERIA–A Common Sense Approach to Nation-Building and Chief Editorial Officer of LIB-Variety, a website published by Consolidated Media, Incorporated, a blogging and free media advocacy non-governmental organization.
Bartuah, a former Director of Media Relations at the Information Ministry in Monrovia, edited The News, a Monrovia-based independent daily between 1995 and 2001. He is accessible on Facebook, Twitter, LinkedIn and other social media platforms. His email: firstname.lastname@example.org or email@example.com.