Health Policy – The Wrongologist

Implications Of Brian Thompson’s Assassination

The Daily Escape:

Bear Trap Gap, NC – November 2024 photo by Mandy Gallimore

“If you want things to stay as they are, things will have to change”– Il Gattopardo

If you’re on social media, a concerning number of people seem to openly support gunning down a “corporate rich guy” in broad daylight. Brian Thompson, the CEO of United Healthcare was murdered in what appears to be a targeted killing. And the comments about it on the internet underscore there is kind of a depravity circulating in too many Americans.

This, after two attempts to assassinate Trump during the campaign. Which stirred up similar, although more muted reaction on social media.

The killer left anti-insurance messages on the shell casings of the bullets that killed Thompson, using the words: “deny,” “defend” and “depose”. Those words are references to the ways insurance companies avoid paying for care.

An excellent summary by Bob Lefsetz:

“And we thought the revolution would arrive as a result of the red/blue divide. When in truth, it’s all about income inequality. Please don’t criticize me for having sympathy for those screwed by the insurance companies. If I were in charge, there’d be no guns at all, or a law akin to that in Australia. But one would posit that the shooter is pissed because the insurance company didn’t pay.

But that’s what insurance companies do, not pay. That’s their business model. Even assuming you can see the doctor of your choice, which is rare.”

Yes, not pay whenever possible is what insurance companies do.

To be clear, this is why advanced societies have tended to create broad publicly funded social safety net programs. It’s not because their bleeding heart politicians love giving away money. It’s because making sure people have humane standards of living keeps them from becoming desperate and doing stuff like this. During the Great Depression, capitalists agreed—grudgingly—to the New Deal because they were afraid otherwise the country would “go Communist”.

We have no clarity on the actual motive behind the killing, but all signs point to it being linked to dissatisfaction with our health insurance system. And we need to remember that Brian Thompson was a human being with a family. So calling his death justified is despicable.

It’s the health insurance payment system and healthcare pricing for goods and services that is despicable.

From STAT:

“The public’s dissatisfaction has never been higher. Recent polling data show the health care system is as unpopular now as it was before the Affordable Care Act went into effect 15 years ago — a time when insurers could decline to cover people if they had any number of pre-existing health conditions and nearly 49 million people lacked insurance. A survey from Gallup released Friday reveals that “Americans’ positive rating of the quality of health care in the U.S. is now at its lowest point” since 2001.”

“Roughly 25 million Americans remain uninsured. Tens of millions of others have health insurance but can’t afford their deductibles, coinsurance, or copays due to the high prices of tests, surgeries, and prescription drugs….These barriers aren’t just a nuisance — they can have real effects on patients’ health.”

The KFF foundation reports that 100 million Americans have medical debt, and its highly doubtful that they can afford to pay it down. Even people with platinum forms of coverage face long waits coordinating the complex and uncoordinated delivery of their health care, as Wrongo knows firsthand.

After getting care, patients are inundated with medical bills they don’t understand — perplexed why their insurer isn’t advocating on their behalf, and fearful that hospitals and other providers will send them to collections or sue them.

It’s all part of a health care system that is projected to spend $5 trillion this year, eating further into workers’ wages. Those who feel most aggrieved often are the sickest. Most people are generally satisfied with their health insurance. However, people who have more health conditions and therefore need to get care more frequently don’t like their coverage nearly as much as healthier people, according to polling from KFF.

So, the more they know you, the more they dislike you. People are feeling a sense of helplessness in trying to address this mammoth commercial insurance industry that’s putting restraints on people’s ability to get care. When you feel that sense of helplessness is when you end up having situations like this. People don’t really know what else to do.

The murder of the CEO and the public’s reaction reveals that:

Americans are blindingly angry, and not just with the healthcare system.
Due process is no longer trusted. Have enough money and you’re likely to buy your way out of a bad situation. The FTC says Twitter must comply with the consent decree and Elon Musk just doesn’t do it. The government is no match for the rich. Money can insulate you from so much.
Vigilante justice has become a solution in some places because of the lack of due process.

We’re entering a period that is very similar to the Gilded Age of the 1880s and the 1930s.

Our social contract is in free fall. And the Trump administration’s proposed cabinet officers will make it worse.

What will happen in a country with 400 million guns and 320 million people? Things may go downhill quickly. Never forget, most change is fomented by individuals. A fruit vendor in Tunisia ignited the Arab Spring.

Is this the start of change in America? One person gunning down an insurance company executive?

Wrongo doesn’t condone the shooting. At this point we have no motive. But what we do know makes you think about our broken health care system and the overcompensation of the people who run it. They’re getting rich on our illnesses. They take our money and then, don’t pay.

Ain’t that America.

Political Advertising: How Effective Is It?

The Daily Escape:

Wrongo’s calendar says there’s just 29 days to go until Election Day. The campaigns are in high gear, but what are they saying? And is what they’re saying getting through to both their base voters as well as to those who are “persuadable” enough for them to get out to the polls and vote? Time is running out.

Timing is a point raised in this NBC story, which describes that, after having taken the last 76 days to introduce the Vice President to voters, the campaign now plans to ratchet up negative advertising about how unfit Trump is to be President (emphasis by Wrongo).

“Leaning more heavily into negative campaigning is a strategic shift for Harris. While she has routinely been critical of Trump since becoming a candidate in July….Harris campaign officials said they intend to continue laying out her policy positions, background and plans…But emphasizing what Harris campaign officials view as Trump’s major vulnerabilities is seen as possibly one of the only ways to finally win over some voters who haven’t made up their mind in a static race that Democrats want to push in their direction.”

A recent poll by the Associated Press-NORC Center for Public Affairs suggests that Harris’ attacks on Trump’s brand of hyper-masculinity appear to be working. As the Daily Beast summarized the findings, respondents:

“…chose Harris 59% over Trump’s 57% when it came to which candidate they felt was tough enough to be president…and favored Harris 55 to 46 % on “which candidate would change the country for the better,” and by 54 to 43% on who “was more likely to fight for them.”

Harris also is micro targeting the message of Trump’s weakness. From the WaPo:

“For the millions of football fans who tuned in from home for Saturday night’s much anticipated matchup between the University of Georgia and the University of Alabama, she also ran a new ad nationally on ABC that hammers home her point.”

The ad says:

“’Winners never back down from a challenge. Champions know it’s anytime, anyplace. But losers, they whine and waffle and take their ball home,’ the narrator says at the start of the spot, over images of a football game and washed-out footage of Trump missing a golf putt. The 30-second ad ends with footage of Harris challenging him to another debate, with the words “When we fight, we win” hanging on a sign in the background.”

The money quote:

“Well, Donald, I do hope you’ll reconsider to meet me on the debate stage. If you’ve got something to say, say it to my face,…

Harris also posted the ad on Trump’s Truth Social media platform.

Marcy Wheeler quotes CNN’s David Wright who tracks political spending by the candidates about where the money is headed in this final month as the ad wars intensify:

“You can see how each side is placing bets on their best path to 270 electoral votes. In the first week of October, the Harris campaign is spending the most in the critical trio of “Blue Wall” states – they’ve got more than $5 million booked in Pennsylvania, about $4 million booked in Michigan, plus about $2.7 million booked in Wisconsin. And that makes sense – if Harris wins all three of those states, plus Nebraska’s up-for-grabs electoral vote in the swingy second congressional district (where the campaign also has more than $300,000 in ad time this week), she’s the next president.”

Turning to Trump:

“…he’ s looking to the Sun Belt. This week, Trump’s campaign is spending the most on ads in Pennsylvania, $3.8 million – it’s really the linchpin to both sides’ strategies. But in addition to that, the campaign is also spending $3.4 million in North Carolina and nearly $3 million in Georgia, its other top targets, and if he wins those two states plus Pennsylvania, he’s heading back to the White House.”

The Electoral College will come down to which of the two campaigns potential voters consider more trustable, probably mostly on their personal economic situation and where that’s heading with each potential president. From the WaPo:

“Americans are finally starting to feel better about the economy, invigorating Vice President Kamala Harris’s pitch for the presidency as she narrows her Republican opponent’s longtime lead on an issue that is foremost on voters’ minds.”

“Although voters still favor former president Trump over Harris on handling the economy, his advantage has dropped dramatically in recent weeks. Trump now averages a six-percentage-point edge on the economy…”

But Trump’s only answers for the economy are lower taxes on the rich and more tariffs. Yet, like everything else, Trump has no idea what tariffs actually do.

However, a new survey by Data For Progress’s top line finds Harris leading Trump by 3 points among likely voters nationwide. Nearly half of voters (49%), including a plurality of Independents (46%), choose Harris, while 46% choose Trump.

On the all-important economy, Harris has a trust advantage on most of the economic measures tested, including: supporting small businesses (+10 points), taxes on middle class Americans (+9), increasing wages (+5), lowering housing costs (+5), handling labor union policy (5%), improving our infrastructure (+3), lowering grocery costs (+2), creating jobs (+1), and protecting domestic manufacturing jobs (+1).

That says her campaign messaging is getting through.

Also the survey finds Trump with just a +1-point trust advantage over Harris on “reducing inflation,” an issue that voters have consistently ranked as their most important when deciding whom to vote for. Here’s their chart:

They also surveyed candidate favorability, which now tilts towards Harris. Harris’ rating is +2, while Trump’s is -12:

Is this poll on the money? Difficult to tell. A shorter election season makes it harder for campaigns to assess where to place their bets. And which of their cohorts in the electorate demand the most attention. We’ve focused on Gen Z and younger voters as being primarily swayed by economics. Messaging to women is another important element. Harris can run ads attacking Trump’s hyper-masculinity, (which will help with women).

From The Economist: (emphasis by Wrongo)

“And Harris needs to focus there. In the Obama years the gap between young men and women identifying as liberals was just five percentage points, during the Trump-Biden years this has tripled to 15 points, according to Gallup. This change has been caused almost entirely by young women moving to the left, rather than young men tacking to the right. The fact that this generation’s formative years were during the #MeToo movement, the Trump years and the decision to overturn Roe v Wade helps explain it.”

In 2020 a majority of white women voted for Trump. He will be in the minority in 2024. Leading among women is a real advantage. Since the 1980s a greater share of women than men has turned out to vote. In 2020 women made up 54% of the electorate. A final indicator that Democrats might be winning this battle of the sexes: in battleground states, according to Target Smart, a data firm, between July and September, twice as many young Democratic women registered to vote than young Republican men.

Trump’s bet is that Harris is the one with the turnout problem. They think their base is more committed to their candidate than is Harris’s. But Marcy Wheeler points to Harris’s investment in the Dem ground game:

“The Harris campaign claimed in late September to have 330 offices and more than 2,400 staff. They completed 25,000 weekend volunteer shifts on the final weekend of last month, contacting over 1 million voters over three days and completed the 100,000th event of the campaign.”

BTW: Ms. Oh So Right got a postcard from Harris to vote early this week.

Cartoons Of The Week – May 26, 2024

The Republican War against women continued as Louisiana became the first state to criminalize abortion pills. The state’s Republican governor Landry signed a bill classifying mifepristone and misoprostol, two drugs used to induce medical abortions as controlled substances.

That puts the abortion pills in same category as anti-anxiety medications Xanax and Valium. The law makes it a crime to possess them without a prescription or outside of a professional medical practice, punishable by one to five years in prison and fines of up to $5,000.

The law will also make it harder for people who need misoprostol for other conditions. The drug is used to induce labor, treat miscarriages, reduce the risk of serious bleeding from ulcers and other indications. This is yet another reason for women everywhere in America to turn Republican legislators out of office.

And we’ve ended another week of decidedly ordinary cartoons, with many about Supreme Court Justice Samuel Alito and his flags. On to cartoons.

What the future is for women in Louisiana:

Then and now, where “then” wasn’t long ago:

The Red Flags are there. What should we do?

Alito is sitting pretty:

In a not-so-unlikely future:

Haley backtracks on Trump:

Why do Republicans always minimize the Trump outrage du jour?

Cartoons Of The Week – April 28, 2024

(The Monday Wake-Up Call will appear on Tuesday)

Many cartoons this week about the Supreme Court’s ridiculous views of presidential immunity. As reader TMcK says:

“They are creating some grand explanation for what is a way to avoid admitting the fruit of the conservative movement is something vile and corrupt.”

On to cartoons. Why is Clarence Thomas allowed to hear this case?

Supremes get behind delaying the Jan. 6 trial:

Supremes seem to agree Trump is above the law:

NY judge seems reluctant to find Trump in contempt:

Are the student protests as bad as the media is portraying them?

The campus demonstrations seem more like Occupy Wall Street than a political movement:

TikTok ban signed by Biden. Politicians once again focus on the wrong thing:

Cartoons Of The Week

Lots of interest in McConnell’s career move this weekend. On to cartoons.

Biden says goodbye to Mitch:

Mitch was a good soldier for the 1%:

Mitch leaves a legacy:

Trump’s delaying tactics are working:

Mike Johnson has no heart or courage:

Embryos get religion:

Michigan voters send a message:

Nikki and Thelma the elephant take a joy ride:

Florida Lets Measles Run Free

The Daily Escape:

Highland Lighthouse, North Truro, Cape Cod, MA – February 2024 photo by Barbra A. Bentley

Let’s take a break this Saturday from a) Russia’s infiltration of the Republican Party and b) the growing realization that unless House Speaker Mike Johnson Johnsonless whips his members into shape before March 1^st, we’ll have a government shutdown. Instead let’s focus today on Measles.

You are a witness the continued collapse in US public health standards since Florida’s Surgeon General has said its ok for unvaccinated kids to attend public school even though there are measles outbreaks. From KFF News:

“With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that’s long kept measles outbreaks under control. On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.”

“The Department of Health ‘is deferring to parents or guardians to make decisions about school attendance,’ wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo’s in the letterhead.”

With his brief memo, Ladapo has subverted a public health standard that’s long kept measles outbreaks under control. This is where you wind up after decades of indoctrination of libertarianism and neoliberalism, where “freedom” becomes anarchy, a rejection of the ability of the state to impose restrictions, even in the name of public safety.

Everyone in America knows that measles is highly contagious, that it kills, and can do lasting damage. More from KFF:

“Most people who aren’t protected by a vaccine will get measles if they’re exposed to the virus. This vulnerable group includes children whose parents don’t get them vaccinated, infants too young for the vaccine, those who can’t be vaccinated for medical reasons…”

The CDC advises that unvaccinated students stay home from school for three weeks after exposure. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications. They reported that in 2023, childhood immunization rates had hit a 10-year low.

Worse, only about a quarter of Florida’s counties had reached the 95% threshold at which communities are considered protected against measles outbreaks, according to data posted by the Florida Department of Health in 2022.

Rebekah Jones, a data scientist who was removed from her post at Florida’s health department in 2020, over a rift regarding Coronavirus data, said:

“I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,”

A strategy of letting measles spread (which can wipe out your body’s immunity memory) while Covid is still pin-balling its way around the country? Sounds legit.

The way that things are going with public health in the US, it’s only a matter of time until the health departments of other western countries start issuing travel health notices for their citizens wanting to visit the US, advising them of the diseases that are being left to run free, particularly in Florida.

From The Nation:

“In 2022, Georgetown University political scientist Donald Moynihan wrote a piece on how to undermine the administrative state….No country becomes a world power without a capable public service.”

Perhaps the corollary, as stated by The Nation’s Gregg Gonsalves is this:

“No country becomes healthy without a capable public health system.”

That describes America today. More from The Nation:

“We did terribly on Covid…part of the reason was that our fundamentals were weak, but our politics are also set up to undermine public health….This has implications well beyond…the pandemic. It’s about how we expect to survive and thrive in America….This is a disaster in slow motion, and we’re watching it unfold as bystanders.”

There you have it: another thing to lose sleep over, and the election is still 7+ months away. Will there be enough infant deaths to generate sufficient outrage to roll this decision back?

Highly doubtful.

Wrongo is leaving you with that thought and is segueing into our Saturday Soother, where we take a break from doom scrolling and spend a few stolen moments alone with our thoughts. Here on the Fields of Wrong, there is still snow on the ground. So while we hope that spring is just around the corner, there’s little evidence to support it.

To help you relax, grab a seat by a south-facing window and watch and listen to Samuel Barber’s “Adagio for Strings”, played here by the Vienna Philharmonic, and conducted by Gustavo Dudamel. Dudamel is scheduled to become music director of the New York Philharmonic in 2026. This performance was a part of the annual free Vienna Summer Night Concert in 2019.

This is the fourth time Wrongo has featured this composition, although you are seeing this particular version for the first time.

Barber finished the Adagio in 1936. In January 1938, Barber sent an orchestrated version of the Adagio for Strings to Arturo Toscanini. The conductor returned the score without comment, which annoyed Barber. Toscanini later sent word that he was planning to perform the piece and had returned it simply because he had already memorized it!

It was performed for the first time by Toscanini in November, 1938. Here, it is conducted by Gustavo Dudamel in 2019, like Toscanini did, without a score:

Saturday Soother – December 23, 2023

The Daily Escape:

Santa Christmas gondola regatta in Venice – December 2023 photo by Manuel Silvestri

Happy Saturday! Wrongo loves it when the days begin to get longer, if only by a fraction. It’s a hopeful sign of the return to more daylight and eventually, spring and summer. This may (or may not) be the last column until the New Year. If it is, Wrongo wants to end with some positive notes.

First, The Economist is out with its annual “Country of the Year” award. This year, it highlights the move back to moderation from conservative governments in three countries.

First, Brazil which swore in a center-left president, Luiz Inácio Lula da Silva, after four years of mendacious populism under Jair Bolsonaro:

“…who spread divisive conspiracy theories, coddled trigger-happy cops, supported rainforest-torching farmers, refused to accept electoral defeat and encouraged his devotees to attempt an insurrection.”

The new administration quickly restored normality—and reduced the pace of deforestation in the Amazon by nearly 50%. But since Lula likes Putin, Brazil didn’t get the award.

Second, Poland had a remarkable 2023: its economy withstood the shock of the war next door; it continued to host nearly 1 million Ukrainian refugees. It raised its defense spending to above 3% of GDP. The country’s biggest problem has been the dominance of the populist-nationalist Law and Justice (PiS) party, which has run the government for the past eight years, eroding the independence of the courts, stuffing state media with lackeys and nurturing crony capitalism:

“In October voters dumped PiS in favor of an array of opposition parties. It is early days for a new coalition government, led by Donald Tusk, a veteran centrist, but if it does a good job of mending the damage PiS did to democratic institutions, Poland will be a strong candidate for our prize next year.”

Tusk is a former president of the European Council.

But Greece won the prize. We all remember a few years ago when Greece was the economic basket case of Europe. Incomes had plunged, the social contract was fraying and extremist parties on the left and right were popular. The government turned to China and sold its main port, Piraeus, to a Chinese firm:

“But after years of painful restructuring, Greece topped our annual ranking of rich-world economies in 2023. Its center-right government was re-elected in June. Its foreign policy is pro-America, pro-EU and wary of Russia. Greece shows that from the verge of collapse it is possible to enact tough, sensible economic reforms, rebuild the social contract, exhibit restrained patriotism—and still win elections.”

The Economist closes with the thought that nearly half the world is due to vote in new governments in 2024, so democracy isn’t just on the line in America. It’s on the line everywhere.

Second, a piece of good domestic news. Charles Gaba at ACA Signups reports that, according to the Centers for Medicare & Medicaid Services (CMS):

“In 2022, the insured share of the population reached 92% (a historic high). Private health insurance enrollment increased by 2.9 million individuals and Medicaid enrollment increased by 6.1 million individuals.”

Another stunner from CMS: US healthcare spending as a percentage of the GDP was lower last year than it was 6 years earlier. More detail:

“With a lower rate of health care spending growth of 4.1% in 2022, the share of GDP devoted to health care fell to 17.3% in 2022, lower than both the 18.2% share in 2021 and the highest share in the history of the National Health Expenditure Accounts of 19.5% in 2020. During 2016-19 the average share was 17.5%.”

That’s all good news. Around the global headquarters of the Wrongologist, we’re starting to look toward next year. And even if it seems the news can’t get worse, it probably will. Think about Trump on trial, epic Supreme Court decisions, ongoing foreign policy crises and the most important election of at least Wrongo’s life.

2024 will be a long year that’s going to require emotional and intellectual strength to avoid despair when the media continues covering this election as they have been. It will be a lot to handle.

Here’s Wrongo’s wish that you find some comfort and joy over the next week. And please keep showing up around here in the New Year. Wrongo promises to keep trying to give you perspectives that hopefully make some sense of the world.

On to another out of the ordinary Christmas tune. Watch and listen to the Canadian singer-songwriter Loreena McKennitt perform the “Huron Carol”, written in 1642 by a Jesuit missionary, Jean de Brébeuf who lived among the Huron people. It is Canada’s oldest Christmas song. Brébeuf wrote the lyrics in the native language of the Huron/Wendat people. In December 2021, McKennitt sang it together with an ensemble. It’s superb and haunting:

Wake Up To Monday’s Hot Links

The Daily Escape:

Cypress trees, Lake Verritt, LA – November 2023 photo by Rick Berk Photography. Note the egret in the background.

For today’s Wake Up Call, we return to a staple of yesteryear, some hot links that caught Wrongo’s eye over the past few days.

Wrongo isn’t happy with how the Ukraine War has slipped from the consciousness of America’s media and thereby, from our view. Saturday’s WSJ offered an intriguing idea with its column, “Does the West Have a Double Standard for Ukraine and Gaza?” (free link). The article makes two excellent points. First, how these two wars have divided the world. Here’s a view of the division:

From the WSJ: (emphasis by Wrongo)

“Outrage and political mobilization have become subordinated to geopolitical allegiances—a selective empathy that often treats ordinary Ukrainians, Palestinians and Israelis as pawns in a larger ideological battle within Western societies and between the West and rivals such as China and Russia.”

Second, the article concludes by saying that the main difference between the two wars is that the Israeli-Palestinian conflict, with all its complexities, lacks the moral clarity of the Ukrainian resistance to Russia. They quote British lawmaker Alex Sobel:

“There is no moral justification for the Russian invasion. Zero. It’s just about Russian imperialism….But in Israel and Palestine, it’s about the fact that there are two peoples on a very small amount of land, and political and military elites on both sides are unwilling to settle for what’s on offer.”

Yes, America may have the moral high ground in both cases, and views can differ on how both wars are being waged. But as the article says in its second paragraph:

“The Russian invasion of Ukraine in February 2022 was unprovoked, while Israel sent troops into Gaza because of a mass slaughter of Israeli civilians…”.

Make of the article what you will, but it’s important to think through why you (like Biden) think both wars are morally equivalent.

Link #2 is apropos of the COP28 conference now underway in Dubai. Grist Magazine has an article: “Where could millions of EV batteries retire? Solar farms.” As solar energy expands, it’s becoming more common to use batteries to store the power as it’s generated and transmit it through the grid later. One new idea is to source that battery back up at least in part from used electric vehicle batteries:

“Electric vehicle batteries are typically replaced when they reach 70 to 80% of their capacity, largely because the range they provide at that point begins to dwindle. Almost all of the critical materials inside them, including lithium, nickel, and cobalt, are reusable. A growing domestic recycling industry, supported by billions of dollars in loans from the Energy Department and incentives in the Inflation Reduction Act, is being built to prepare for what will one day be tens of millions of retired EV battery packs.”

“Before they are disassembled…studies show that around three quarters of decommissioned packs are suitable for a second life as stationary storage.”

Apparently there are already at least 3 gigawatt-hours of decommissioned EV battery packs sitting around in the US that could be deployed, and that the volume of them being removed from cars is doubling every two years.

Link #3 also shows the impact of the Inflation Reduction Act. Wolf Richter writes that:

“In October, $18.5 billion were plowed into construction of manufacturing plants in the US ($246 billion annualized), up by 73% from a year ago, by 136% from two years ago, and by 166% from October 2019.”

“The US is the second largest manufacturing country by output, behind China and has a greater share of global production than the next three countries combined, Germany, Japan, and India.”

All of this construction spending will take time to turn into production. When these new plants are up and running and producing at scale, manufacturing’s share of US GDP will rise. And much of the new construction is happening in fly-over America, which can use the help.

Finding factory workers in sufficient numbers to support the new capacity will be a key. America has energy in abundance and has robotic manufacturing. So pulling production from overseas with fewer workers needed will be a giant plus for the US.

Link #4 is a downer. Civic Science says in this week’s 3 things to know column, that “Nearly 3 in 10 Americans say they have had to forgo seeing a doctor in the past year due to costs.” Here’s their chart”:

Civic Science says that 12% of US adults have had to miss or make a late payment on medical bills in the last 90 days, a two percentage point increase over September 2022.

A far larger percentage of Americans – 27% of the general population and about 30% of respondents under 55 years old or with an annual household income under $100,000 – report they could not go to a doctor in the past 12 months because they could not afford the cost. Gen Z adults and households making between $25K-$50K are more likely to have held off seeing a doctor due to cost (34% and 31% respectively).

We all know that medical costs have continued to rise and that medical debt is the leading cause of personal bankruptcy in the US. If Congress was really interested in helping provide for the general welfare, they would deal with this out of control problem.

Time to wake up America! There’s plenty going on that isn’t getting visibility in the mainstream media or on social media. You have to cast your net widely to be on top of the good and bad happening in the US.

To help you wake up, we turn to Shane MacGowan, frontman for the Irish group the Pogues who died last week. He left behind a body of work that merged traditional Irish music and punk rock. He wrote many songs that could easily be mistaken for traditional Irish tunes including this one, which was also used as the music for wakes by the Baltimore Police Department in the great, great HBO series, “The Wire“. Here’s “The Body Of An American” from their 1986 album, “Poguetry in Motion”:

RIP Shane.

Democrats Need New Messaging

The Daily Escape:

Cholla Cactus at sunrise, Joshua Tree NP – November 2023 photo by Michelle Strong

Yesterday’s column described how confusing current polling data is with less than a year to go before the 2024 presidential election. We can easily overdose on polls, but in general, they seem to be pointing toward a very difficult re-election for Biden.

At the risk of contributing to the OD, here’s another example of terrible poll for Biden. It comes from Democratic stalwarts Democracy Corps, run by James Carville and Stanley Greenberg:

“President Biden trails Donald Trump by 5 points in the battleground states and loses at least another point when we include the independent candidates who get 17% of the vote. Biden is trying to win these states where three quarters believe the country is on the wrong track and 48% say, “I will never vote for Biden.”

What to make of all this? Wrongo thinks it’s time to take a different approach to the Democrat’s messaging. Let’s start with a quick look at the NYT’s David Leonhardt’s new book, “Ours Was the Shining Future”. Leonhardt’s most striking contention is based on a study of census and income tax data by the Harvard economist Raj Chetty: Where once the great majority of Americans could hope to earn more than their parents, now only half are likely to. From The Atlantic:

“Of Americans born in 1940, 92% went on to earn more than their parents; among those born in 1980, just 50% did. Over the course of a few decades, the chances of achieving the American dream went from a near-guarantee to a coin flip.”

As we said yesterday, the American Dream is fading. Leonhardt says that the Democrats have largely abandoned fighting for basic economic improvements for the working class. Some of the defining progressive triumphs of the 20th century, from labor victories by unions and Social Security under FDR to the Great Society programs of LBJ, were milestones in securing a voting majority. More from The Atlantic:

“Ronald Reagan took office promising to restore growth by paring back government, slashing taxes on the rich and corporations…gutting business regulations and antitrust enforcement. The idea…was that a rising tide would lift all boats. Instead, inequality soared while living standards stagnated and life expectancy fell behind…peer countries.”

Today, a child born in Norway or the UK has a far better chance of out-earning their parents than one born in the US. More context from The Atlantic: (emphasis by Wrongo)

“From the 1930s until the late ’60s, Democrats dominated national politics. They used their power to pass…progressive legislation that transformed the American economy. But their coalition, which included southern Dixiecrats as well as northern liberals, fractured after…Johnson signed the Civil Rights Act of 1964 and the Voting Rights Act of 1965. Richard Nixon’s “southern strategy” exploited that rift and changed the electoral map. Since then, no Democratic presidential candidate has won a majority of the white vote.”

The Atlantic makes another great point: (emphasis by Wrongo)

“The civil-rights revolution also changed white Americans’ economic attitudes. In 1956, 65% of white people said they believed the government ought to guarantee a job to anyone who wanted one and to provide a minimum standard of living. By 1964, that number had sunk to 35%.”

America’s mid-century economy could have created growth and equality, but racial suppression and racial progress led to where we remain today.

Leonhardt argues that what Thomas Piketty called the “Brahmin left” must stop demonizing working-class people who do not share its views on cultural issues such as abortion, immigration, affirmative action and patriotism. From Leonhardt:

“A less self-righteous and more tolerant left could build what successfully increased access to the American Dream in the past: a broad grass-roots movement focused on core economic issues such as strengthening unions, improving wages and working conditions, raising corporate taxes, and decreasing corporate concentration.”

Can the Dems adapt both their priorities and messaging to meet people where they are today?

The priorities must change first. What would it take to establish the right priorities for the future? Stripping away the wedge issues that confuse and divide us, America’s priorities should be Health, Education, Retirement and Environment (“HERE”). It’s an acronym that sells itself: “Vote Here”.

(hat tip to friend of the blog, Rene S. for the HERE concept.)

Wrongo hears from young family members and others that all of the HERE elements are causing very real concerns. Affordable health care coverage still falls short. Regarding education, college costs barely seem to be worth shouldering the huge debt burdens that come with it.

Most young people think that they have no real way to save for retirement early in their careers when there’s the most bang for the buck. They also feel that Social Security won’t be there for them. From the NYT:

“In a Nationwide Retirement Institute survey, 45% of adults younger than 27 said they didn’t believe they would receive any money from the program.”

Today, only about 10% of Americans working in the private sector participate in a defined-benefit pension plan, while roughly 50% contribute to 401(k)-type, defined-contribution plans.

Finally, people today feel that their elders have created an existential environmental threat that will be tossed into their laps. A problem for which there may not be a solution.

As Leonhardt argues, these HERE problems should have always been priorities for Democrats. But for decades, the Party hasn’t been willing to pay today’s political price for a long term gain in voter loyalty. That is, until Biden started working on them in 2020.

But every media outlet continues to harp on inflation and the national debt. Much of what would be helpful in creating a HERE focus as a priority for Democrats depends at least somewhat on government spending. No one can argue that our national debt is high. It is arguable whether it can safely go higher or if it must be reigned in at current levels.

To help you think about that, we collected $4.5 trillion in taxes in 2022, down half a $trillion vs. what we collected in 2021. Estimates are that the Trump tax cuts cost about $350 billion in lost revenue/year.

Looking at tax collections as a percentage of GDP, it’s less than 17% in the US, well below our historical average of 19.5%. There are arguments to keep taxes low, but if you compare the US percentage to other nations, Germany has a ratio of 24%, while the UK’s is 27% and Australia’s is 30%.

If we raised our tax revenue to 24% of GDP, which is where Germany is now, we would eliminate the US deficit.

There’s a great deal of tension in the electorate between perception and reality. And it’s not caused by partisanship: Democrats and independents are also exhibiting a disconnect, too.

Democrats have to return to being the party of FDR and LBJ. They need to adopt the HERE priorities and build programs around them.

How Can America Handle The Costs Of Elder Care?

The Daily Escape:

The start of US Highway 6, outside of Bishop, CA – September 2023 photo by Steve Wolfe

(There will be no Saturday Soother this week. Wrongo is on the road.)

Millions of older Americans from the Silent Generation and the Baby Boomers are facing a dilemma as they “age in place.” They must figure out how to pay for increasingly complex medical care. The NYT quotes Richard W. Johnson, director of the program on retirement policy at the Urban Institute:

“People are exposed to the possibility of depleting almost all their wealth….”

The prospect of dying broke is an imminent threat for the Boomers. About 10,000 of them turn 65 every day between now and 2030. They’re expecting to live into their 80s and 90s at the same time as the price tag for long-term care (LTC) is exploding. Currently LTC expense is outpacing inflation and approaching a half-trillion dollars a year, according to federal researchers.

By 2050, the population of Americans 65 and older is projected to increase by more than 50% to 86 million. The number of people 85 or older will nearly triple to 19 million. The Times has a chart of how many of those who need long-term care will die broke:

Some older Americans have prepared for this possible future by purchasing LTC insurance back when it was still affordable. Since then they’ve paid the monthly premiums, even as those premiums continued to rise. But this isn’t the norm. Many adults have no plan at all or assume that Medicare, which kicks in at age 65, will cover their health costs. But Medicare doesn’t cover the kind of long-term daily care, whether in the home or in a full-time nursing facility, that millions of elderly Americans require.

For that, you either pay out-of-pocket or you spend down your assets until you have less than $2,000 in assets in order to qualify for Medicaid. Remember that Medicaid provides health care, including home health care, to more than 80 million low-income Americans.

And even if you qualify, the waiting list for home care assistance for those on Medicaid tops 800,000 people and has an average wait time of more than three years.

Here is a snapshot of how long-term care is paid for in the US:

Governments provide 71.4% of the total. The largest non-government source is people who pay out-of-pocket, and private insurance is becoming increasingly expensive. More from the NYT:

“The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home. But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.”

That has led them to enter assisted-living centers run by for-profit companies and private equity funds. The NYT says that about 850,000 people aged 65 or older now live in these facilities and when in them, they are largely ineligible for federal funds. Some facilities provide only basics like help getting dressed and taking medication while others offer luxury amenities like day trips, gourmet meals, and spas.

In either case, the bills can be staggering. More:

“Half of the nation’s assisted-living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.”

Home care is costly, too. According to Genworth, agencies charge about $27 an hour for a home health aide. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.

It’s worse for people with dementia because they need more services. The number who are developing dementia has soared, as have their needs. Five million to seven million Americans over age 65 have dementia, and that’s expected to grow to nearly 12 million by 2040.

The financial threat posed by dementia also weighs heavily on adult children who in many cases become guardians of aged parents. The Times included this chart:

The reality is that families go broke either caring for, or finding care for their loved ones. The alternative: Women in the family give up their lives and jobs to care for their family members instead, which worsens the gender wage gap.

The NYT article makes it clear that older Americans receive far less government support than their peers in other countries. The “why” question is easily answered: It’s a combination of the concerted effort for any public support to be demonized as “welfare”. It’s also partly the result of our failed experiment with long term care insurance. The politicians’ idea was that “the market” would take care of it, so government help for retirees could be limited to Medicaid-paid nursing homes.

But, the LTC insurance industry has largely imploded. Insurers had little experience with the product and grossly overestimated the lapse rates. If a policyholder stops paying, the insurer gets to keep the money and use it to provide services to everyone remaining in the pool. The surprise was that very few people stopped paying. A second miscalculation was that people who held these policies were living longer than forecasted. Longer life equaled higher and larger payouts (insurers also benefit when customers die before they’ve used up all the policy benefits).

A final factor is the rising levels of dementia described above.

And since demand for support outside of family members exceeds the supply of beds, nursing homes and assisted living facilities that aren’t terrible want residents to join during the independent living phase (which requires very little care, so those fees subsidize intensive nursing home care). Many of these facilities require a $400,000-$500,000 buy-in, which may not be refundable at death, even if the resident is current on their monthly fees.

There’s got to be a better way. Medicaid can’t be the only option to pay for LTC. Congress needs to establish a better system for middle-class Americans to finance LTC.

How we handle the growing costs of long-term care is just another reminder that we get LITTLE for our tax dollars beyond a giant military. Americans are responsible for their own medical care, childcare, college tuition, retirement and nursing home care. Some or all of which are provided in other rich countries.

This is a loudly ticking time bomb, and the demographics of the problem won’t change for decades. And yet, the Republicans seem bent on making it worse. They’re actively trying to bring about their dream of privatizing Social Security and Medicare.

Wake up America! We have real problems to solve.

The Wrongologist

Geopolitics, Power and Political Economy

Category: Health Policy

Cartoons Of The Week

Saturday Soother – December 23, 2023