Robert Reich on Health Care

Former Secretary of Labor; Democratic Challenger MA Governor


Single-payer healthcare system is inevitable

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells ObamaCare plans. Aetna's decision follows similar moves by UnitedHealth Group and by Humana. All claim they're not making enough money because too many people with serious health problems are using the ObamaCare exchanges, and not enough healthy people are signing up.

The problem isn't ObamaCare per se. It lies in the structure of private markets for health insurance--which creates powerful incentives to avoid sick people and attract healthy ones. ObamaCare is just making this structural problem more obvious. We end up with the most bizarre health-insurance system imaginable: One ever better designed to avoid sick people.

[We can postpone the problem with policy] band aids. Or else a government-run single payer system--we're going to have to choose eventually.

Source: CommonDreams.org column by Robert Reich , Aug 22, 2016

High drug prices result from patents' temporary monopolies

America spends more on medications per person than does any other developed country. Of the $3.1 trillion America spent on health in 2014, drugs accounted for 10 percent of the total.

Drug prices are high in America partly because, while other governments set wholesale drug prices in their countries, the law bars the US government from using its considerable bargaining power to negotiate lower costs. But the bigger reason drug prices are so high in America is that drugs are patented--and those temporary monopolies often last beyond when the patents are supposed to run out (now 20 years); the Patent Office often renews patents on the basis of small changes to the original drugs that technically make them new and therefore patentable.

Many drugs that are available over the counter in other countries can be bought only by prescription in the US. It is illegal for Americans to shop at foreign pharmacies for cheaper versions of the same drugs sold in the US, either branded or generic.

Source: Saving Capitalism, by Robert Reich, p. 22-4 , May 3, 2016

GOP can't beat ObamaCare, so they pretend it's a "disaster"

Having failed to defeat the Affordable Care Act in Congress, to beat it back in the last election, to repeal it despite more than eighty votes in the House, to stop it in the federal courts, to get enough votes in the Supreme Court to overrule it, and to gut it with outright extortion (closing the government and threatening to default on the nation's debts unless it was repealed), Republicans are now down to their last ploy: They are hell-bent on destroying the Affordable Care Act in Americans' minds.

Every Republican in Washington has been programmed to use the word "disaster" whenever mentioning the Act, always refer to it as ObamaCare, and demand its repeal. Republican wordsmiths know they can count on Fox News and right-wing yell radio to amplify & intensify all of this in continuous loops of elaboration & outrage, repeated so often as to infect peoples' minds like purulent pustules. The idea is to make the Act so detestable it becomes the fearsome centerpiece of the next election.

Source: RobertReich.org 2015-16 voting recommendation on ObamaCare , Nov 22, 2013

ObamaCare fixed three big problems of private insurance

The President and other Democrats aren't meeting the Republican barrage [against ObamaCare] with three larger truths:
  1. The wreck of private insurance: Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people--while rejecting people with preexisting conditions, or at high risk.
  2. We could not and cannot continue with this travesty of a healthcare system: The Affordable Care Act is a modest solution. It still relies on private insurers--merely setting minimum standards and "exchanges" where customers can compare policies.
  3. The moral imperative: Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.
Source: RobertReich.org 2015-16 voting recommendation on ObamaCare , Nov 22, 2013

ObamaCare is first step; next is Medicare for all

The passage of the health care legislation in 2010 represents only the first step toward reform. The next stage should be Medicare for all. The most efficient way to provide all Americans with high-quality health care is to allow everyone to sign up for Medicare and to subsidize the costs for middle-class and lower-income families.

It will become apparent that the 2010 reform cannot adequately contain soaring health care costs. The main reason for the soaring costs and poor results is the way our system is organized. We are the only advanced nation whose citizens largely depend on private, for-profit insurers. The result is complicated, expensive, and inequitable.

Source: Aftershock, by Robert Reich, p.137-138 , Apr 5, 2011

2009: Make a racket to get a public option

In 2009, Reich called for a countermarch on Sep. 13, telling advocates of government health care that they had "to be very loud and vocal" if they hope to save their beloved vision of socialized medicine.

"We won't get a public option, or anything close to it, unless people who feel strongly about it make a racket," Reich said. "1. Be very loud & very vocal: Write, phone, & e-mail. 2: Get others to do the same. 3: Get voters and make a hell of a fuss. 4: March on Washington."

Source: Give Us Liberty, by Rep. Dick Armey, p.107 , Aug 17, 2010

Medical savings account are rational but leave vulnerable

As originally conceived, Medicare offered every retiree a certain minimum guaranteed health insurance, financed by the contributions of all workers. Because no individual worker knew for sure how much medical attention he or she would require when reaching retirement age, the system seemed reasonably fair. But now that the wealthier and healthier have a much better idea, many would prefer individual "medical savings accounts," enabling them to get a better deal on their own rather than subsidize the chronically ill. Their preference is perfectly rational. Yet this sorting mechanism, adopted by all, would leave the sickest and poorest elderly behind in their own expensive publicly supported insurance pool, highly vulnerable to budget cuts.
Source: The Future of Success, by Robert Reich, p.207 , Feb 8, 2002

Raise cigarette taxes to make health care more affordable

Massachusetts has one of the best health-care systems in the world but too many of our people can’t afford access to it. More than 360,000 residents of the state have no health insurance. A growing number who have it can barely afford to keep it -- as premiums, co-payments, and deductibles continue to climb. We need to make health care universal and affordable by having employers shoulder more of the cost, raising the cigarette tax to help cover the unemployed and self-employed, and reducing insurers’ administrative and marketing expenses that now drain off 30 to 50 percent of all health-care spending.
Source: Campaign web site, RobertReich.org , Jan 25, 2002

Budget surplus means it’s time for universal health care

Forget a tax cut. Forget paying down the debt. Use the federal surplus for universal health insurance. Working families won’t get much out of any tax cut, and debt elimination is foolish. But working families keenly need affordable health care, now more than ever.

Democrats also shy away from any mention of universal health care because they still believe that Hillary’s ill-fated plan of 1994 was responsible for the Republican takeover of Congress later the same year. Their memories need jogging. Hillary Care sank of its own complex weight--which also made it a perfect foil for right-wing demagoguery. But it didn’t go down without a fight, and not without substantial public support at the start. In 1993, a majority of Americans listed “universal health care” as the most important unmet public need and their highest priority for government action. What better time to revive the idea of universal health care than now, since the federal budget is flush and working families need it more than ever?

Source: The American Prospect, vol.12, no.7, “The Case (once again)” , Apr 23, 2001

Universal coverage helps more than minimum wage increase

Q: Why has the administration so vehemently supported the minimum wage this year?

A: The President proposed a minimum wage increase in 1992 during the campaign, and then when health care reform was on the table, when there was a possibility that employers would be providing health care for all employees, we felt that we didn’t want to add an additional few pennies to payrolls. But the minute health care was no longer viable - and that very ambitious health care plan, as you recall, did not get enacted -- we went back and proposed, in January of 1995, an increase in the minimum wage, and we’ve been fighting for that for the last year and three quarters. Hopefully, we will get it because Americans at the bottom, twelve million of them, deserve at least a livable wage.

Source: Interview on PBS Frontline, WGBH Boston (Clinton Cabinet) , Jul 2, 1998

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