Thursday, April 2, 2020

The Covid-19 Election

The Covid-19 Election
      The Democratic base is once again being led to coalesce around the “safe” establishment candidate.  We constantly hear that we must support the establishment candidate or there will be another 4 years of Trump.  This creates the makings of another catastrophic election year unless the two halves of the Democratic base come together.
      There’s an old saw that nobody cares how much you know until they know how much you care.  I have been watching both Bernie groups and establishment Democrat groups on Facebook for the last few years, and there is definitely a lack of understanding.  The Bernie group understands Biden’s positions and what they will mean for them.  They have grown up under and live with the effects of those policies. Unfortunately, I do not see much understanding going the other way.  This gap was recently driven home when the Affordable Care Act was brought up in a conversation.
      The ACA was enacted when I was in graduate school. At the time, I was living on student loans with little disposable income.   That meant the only option was a garbage plan under the ACA that covered nearly nothing.  I used it once for a basic physical, and was still hit with a few hundred dollars in co-pays and lab bills, despite telling the doctor outright that I did not want those excessive, expensive, and unnecessary tests.  A few months later, when I was hit by a car on my bike, I refused to go to the ER because I knew how horrible my insurance plan was.
      I had never really thought much about my ACA experience until that conversation. Looking back, the ACA was worse than nothing for me.  If I had no insurance, then at least I would have saved the premium cost and avoided outrageous medical bills.   Since I had to pay for that out of student loans, I am still paying for that and will be for years to come.  My experience is not unique.
      This is also the experience of millions of Gen X-ers and Millennials.  The Boomer generation has fared better because they were better off financially from the start.  That is our society in a nutshell: if you had it ok before, you're allowed to maintain an average life, but if you had it tough before, it never gets better.  Upward mobility in America has dropped significantly because of the failures in our system. i  Our healthcare system is one of the largest of those failures.  So on it goes, becoming consistently, gradually worse.   If we don't begin to bridge this understanding gap, then there will be 4 more years of Twitler for sure.
      The younger voters that are Bernie's base have been told to accept incremental improvements for decades by the establishment, but those improvements never materialized.   Instead, the incremental change they have experienced has been backwards and consistently makes life worse, not better.  How many more decades do they have to wait for a system with some basic fairness?  Even the ACA, lauded by the likes of Biden, has been an utter failure for younger generations.  Unless and until the Democratic establishment comes to realize this, there will never be unity within the party.
      The Bernie people I know are liberals who are willing to hold their noses and vote for a Democrat only if they fight for positions like Bernie does.  The further away from those positions, the less likely that they will find that person worthy of their vote.  We are taught in America that it is a politician’s duty to not only represent, but to effectively advocate for policies that reflect our values.  If a politician fails to promise to fight for our values, or fails to deliver on their promises, then constituents are under no obligation to continue supporting that failed politician.  The younger generations are not serfs owing a fealty tribute to a manor or party overlord. They are citizens, and, if you want their votes, you must earn them.
      Some Millenials see healthcare as a universal right. Others are more pragmatic and argue that it is simply more economically efficient to get rid of the bloated bureaucracy of insurance companies.  The overwhelming bulk of studies on US healthcare support this argument. ii iii   Whichever path you choose, though, the Coronavirus makes it necessary.
      Now that Coronavirus is a major issue in this election, healthcare is front and center.   I had to refuse healthcare when I was injured, laying on the street, and barely able to move because my Obamacare plan was so awful.  Refusing care was not an option when I was suddenly hit with enteritis on a southbound train from Bangkok somewhere in the rural Thailand; neither is it optional for Covid-19. iv  Now, millions of un- and under-insured are facing the same reality if they become infected with Covid-19.  Do they go to the hospital and risk losing everything, including their homes, or do they tough it out and risk death?  Even worse, there are already some people who were sick with the virus and denied care because they did not have insurance.  At least one teenager has died because he had no insurance and was denied care. v  Yet, Biden is still against universal healthcare. vi
      Biden is heralded as the safe candidate, but the Corona-virus makes us all unsafe. Having uninsured and undiagnosed Americans walking around with a deadly and highly transmissible virus because they cannot afford healthcare is a threat to everyone.  How many of our fellow Americans are we willing to kill off in order to continue this obviously failed system?  How many of our family and friends are we willing to let die just to maintain a system that, by all objective accounts, has been the worldwide worst at containing the disease? vii
      The Democratic party has already broken their own rules by letting an unqualified billionaire on the debate stage, and people in the Bernie camp are rightly infuriated.   Those underhanded maneuvers are what caused the 2016 DemExit, but now it's worse. The people that bolted last time are already on the way out, and I'm afraid even more will follow this time.  The old guard has refused to listen, so the younger generations are refusing to lend their support to a party that has no problem killing them off to maintain corporate profits.  Their shenanigans may have brought them power within the party, but it will not bring them votes in the general election.  Only a true platform of reform will do that. 
       Now is the time to listen.  Yet we hear the establishment say that now is not the time; that they will do an after-action report when the threat has subsided and learn the lessons then. viii  The younger generations have seen that line a million times: you have to change incrementally, slow and steady. But there is no time to wait until after the Coronavirus threat abates.  People are already dying.  Universal healthcare is a deal-breaker because Covid-19 is a death sentence for the uninsured — either immediately because they cannot get treated, or belatedly from a life mired in medical debt and bankruptcy that forecloses opportunities for a better life just because someone got sick once.  Because the younger generations have been misled and told to wait for decades, they will not believe any politician with a history of not forcefully arguing for universal healthcare.  If the candidate will not change his platform, then the party must change the candidate or lose.  Further, they have no obligation to vote for a candidate who is willing to kill them off in support of a failed system.   For them, this is not merely a political issue — it is life or death.  Do not expect them to fall in line behind a candidate that is willing to sacrifice them for corporate profits.

      Even Trump was smart enough to promise some sort of universal healthcare.  He was lying, as anyone with half a brain knew, but at least he said it.  In 2016, not supporting universal health care was a deal-breaker.  With Covid-19, it’s a no-brainer.  A failure to understand this will ensure the Democratic nominee also fails to capture the White House.   A failure to understand is a plan to fail.
      So, to the Democrat establishment, the choice is yours.  The younger generations see that maintaining the status quo ante will only lead to bankruptcy, misery, and death for them.  Why would they bother voting for that?




iii Some criticize Bernie’s use of the lower of Mercatus’ 2 figures.  For example, they claim that doctors would be forced to accept 40% less in reimbursements.  Maybe so, but that conveniently ignores the cost savings that the doctor’s offices would see by not being forced to keep multiple insurance billing specialists on the payroll.  Private health insurance companies have very complicated payment systems and they frequently change their system with no notice to care providers. This results in lost revenues every time a change is made.

In contrast, the Medicare system is very straight forward.  One insurance billing specialist I used to know estimated that, for her mid-size hospital that serves a metro area of about 100,000 people, the hospital could drop from 3.5 billing specialists to 1 under a Medicare-style billing system.  Not only would that result in substantially fewer denied payments, it would also save the hospital a hundred grand or so every year in unnecessary employee costs. That does not even count how many private practices would be able to reduce their labor costs as well. 

From what I can see, those replies that fail to consider these costs that are littered throughout our system into account smack of being either incompetent or disingenuous. I’ll leave it to the reader to decide which.

If you’d like to see this story written up with better numbers, please leave a comment below. If there’s interest, I will contact the billing specialist and see if I can get better numbers to write it up.

vhttps://www.thesun.co.uk/news/11270647/first-us-child-to-die-of-coronavirus-was-denied-urgent-care-because-he-didnt-have-insurance/
Note: while the health officials are trying to sow doubt and claim he may have had underlying conditions, it is reported that he did test positive for the virus after he died. We reject that spin. This kid was refused the last chance he had for lifesaving treatment because he did not have insurance. Period.


viii Considering how fundamentally incompetently this administration has handled the virus, we all should be outraged, but that’s a rant for another day.
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