Looking Overseas Gives Us Reasons to Be Thankful for Obamacare

U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

This Thanksgiving, a lot of Americans will be giving thanks for Obamacare.

By the end of this month, HealthCare.gov will be able to handle 800,000 users per day, enough to enroll everyone who needs coverage by the end of the year. Meanwhile, the state-run exchanges are reporting “a November enrollment surge,” precisely as the Obama administration predicted. (Massachusetts also experienced a late enrollment surge when they adopted an individual mandate in 2006.) Everyday, we hear new stories about Americans who are saving thousands of dollars on their insurance costs, including House Speaker John Boehner, whose new Obamacare insurance will cost pennies on the dollar of his six-figure income.

And not a moment too soon. Earlier this month, the nonpartisan Commonwealth Fund published the results of their latest survey of eleven industrialized countries, including the United States, where they asked people about their experiences with the health care system in the past year. Their findings are a sad reminder of just how bad the status quo is — and why we demanded health reform in the first place.

Many Americans don’t go to the doctor when they’re sick because they can’t afford it. Many don’t go to the pharmacy or take their medicine. Add it all up, and 37 percent of Americans had some sort of “cost-related access problem” in the past year.

That kind of problem isn’t nearly as common in the Netherlands, where it only affects 22 percent of the population. Or France, where the number drops to 18 percent. Or Canada, where it’s 13 percent. Or the UK, where it’s 4 percent.

Fair enough, you might say. More people have more access, but they also have to wait in line longer, right? Not necessarily.

In fact, in most countries, the majority of the population could see a doctor within a day of their request. The United States placed second-to-last in this category. A quarter of our population had to wait six days or more — a little better than Canada, but far worse than Australia, France, Germany, the Netherlands, New Zealand, and the UK.

But that’s primary care. The United States is known for its specialists, where 76 percent of the population got an appointment in less than four weeks and only 6 percent had to wait two months or more. That’s a heck of a lot better than Australia, where only 51 percent got an appointment in less than four weeks and 18 percent had to wait two months or more. Or Canada, where the numbers are 39 percent and 29 percent, respectively.

But it’s about the same as the Netherlands, where the numbers are 75 percent and 3 percent. And the UK, where they’re 80 percent and 7 percent. And even Germany isn’t far behind, at 72 percent and 10 percent.

So it’s a mixed bag, but we’re certainly not in the lead.

In most countries, it’s a lot easier to get after-hours care than in the United States. Only 35 percent of American doctors have an arrangement to take care of their patients after the office is closed — by far the lowest percentage of all the countries surveyed. In Canada, it’s 46 percent. In France, it’s 76 percent. In Germany, the Netherlands, and the UK, it’s 90 percent or higher.

And the doctors have a lot more problems in the United States, where the paperwork piles up. One in three — 32 percent — reported significant paperwork or payment problems in 2013, compared to 23 percent in France, 17 percent in Germany, 15 percent in Canada, and 4 percent in the UK.

No wonder everyone else is happier with their health care than we are.

Only 25 percent of Americans think their health system works well. In the other countries, that approval rating ranges from 40 percent in France to 63 percent in the UK.

Whereas 27 percent of Americans think the health system needs to be completely rebuilt, that disapproval rating ranges from 12 percent in Norway to 4 percent in the UK.

That’s a lot of numbers, but they all tell the same story: The United States has the most complicated, most expensive, and most frustrating health care system in the industrialized world — and none of that is due to Obamacare, most of which took effect after the survey.

In fact, Obamacare is moving our system closer to our international counterparts. Based on these numbers, I’d say that’s definitely something to be thankful for.

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An abbreviated version of this op-ed was published in Friday’s South Florida Sun-Sentinel. This version was published in the Huffington Post.

How We Stopped Investing in the Future: A Florida Case Study

In June 2009, ten Florida Congressmen sent a letter to the Department of Transportation, requesting over $2 billion from the federal government. They wanted to build a high-speed rail line, shuttling passengers from Tampa to Orlando and eventually Miami in only two hours. The money was supposed to come from the American Recovery and Reinvestment Act, the $787 billion “stimulus” bill that newly-elected President Barack Obama signed in February of that year.

Of the ten Florida Congressmen, three were Republicans, and all three had voted against the stimulus: Lincoln Diaz-Balart, Mario Diaz-Balart, and Adam Putnam.

This kind of about-face wasn’t unusual. Many Republicans were begging for a piece of the stimulus after they had tried to kill it in Congress. Even party leaders like Paul Ryan and Eric Cantor got in on the action.

John Boehner defended this contradiction by saying that the stimulus would fund “shovel-ready projects that will create much-needed jobs.” Only a few months earlier, he had been saying the exact opposite — and relentlessly trashing anyone who dared to disagree with him.

The Tampa-Orlando rail line really did fit Boehner’s definition. It was shovel-ready because almost all the land and permits were already lined up, and according to the U.S. Conference of Mayors, it would create 27,000 jobs.

Moreover, it was good fiscal policy. According to two separate reports, the project would produce an annual surplus of $31 million to $45 million by 2026 — and that didn’t include the much more profitable connection to Miami that was likely to follow.

And it was good environmental policy. High-speed rail emits far less greenhouse gas than cars, especially in densely populated regions like central and southeastern Florida, which is why overflowing cities in China, Europe, and Japan have surged so far ahead of us in this vehicle of the future. It saves time, money, and pollution. Unsurprisingly, it’s very popular.

Fifty years ago, this would have been a no-brainer. In the 1950s and the 1960s, politicians were dedicated to investing in new technology and staying one step ahead of the Soviet Union. It’s no coincidence that economic growth was faster and more widespread in those days.

Back then, the federal government spent 2.6 percent of the nation’s income on nonmilitary investment. In the last twenty years, it has averaged 1.8 percent per year. That difference of 0.8 percent may not seem like a lot, but it adds up to trillions and trillions of dollars that could have gone into research and development, education, and new infrastructure — and, if previous investments are any indication, would have yielded benefits many times higher than the costs.

As economist Eugene Steuerle put it, “We have a budget for a declining nation.”

On January 28, 2010, the White House granted Florida’s request. By December, the Department of Transportation had allocated $2.4 billion against a cost of $2.65 billion, and they promised to cover any cost overruns. Had Florida accepted the money, its workers would be laying rail for the Sunshine State bullet train at this very moment.

Instead, Governor Rick Scott rejected the deal, citing cost concerns that didn’t make much sense since the feds were on the hook for any losses.

Thus did the dreams of high-speed rail die in Florida. Thus do many dreams of the future die in the modern political arena.

In Tampa, there’s a street called Bayshore Boulevard. It’s the longest continuous sidewalk in the world. It’s a beautiful walk, with a balustrade that overlooks the water below. It was built in the 1930s by the Public Works Administration, part of the federal government’s response to the Great Depression. It’s just one of many breathtaking feats of construction that dot this great land of ours, each a reminder that, as Transportation Secretary Ray LaHood said during the high-speed rail fiasco, “We still know how to do big things in this country.”

I’d like to think that’s true. I’d like to think we still care about the future. I’d like to think we can build a better tomorrow. I only wish Governor Scott and his fellow ideologues felt the same way.

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This op-ed was published in today’s South Florida Sun-Sentinel.

How the Republicans Tried to Kill the Payroll Tax Cut…and Why

With the election year approaching, both parties are going to tell you that they will fight for you, the average American. Both will claim that, in the waning days of 2011, they pushed to lower your taxes, to boost the economy, to save the middle class.

Here’s how it really went down.

As part of the Democrats’ stimulus bill in 2009, the Making Work Pay credit reduced taxes by 6.2 percent, up to $400, on earnings, phased out between $75,000 and $95,000. (The numbers were double for couples.) It expired at the end of 2010.

Instead of renewing the MWP credit, Republicans insisted on replacing it with a two-percentage-point cut in employees’ payroll taxes, which reduced the average tax cut for low-income taxpayers and quadrupled the average tax cut for high-income payers — even though the poor are far more likely to spend those tax cuts and stimulate the economy.

The payroll tax cut cost almost twice as much as the MWP credit, but it didn’t affect the Social Security trust fund because the Treasury filled the hole with general revenues. In other words, they borrowed and increased the deficit. Apparently, Republicans didn’t care as much about the budget deficit as they did about tax cuts for the rich.   Continue reading “How the Republicans Tried to Kill the Payroll Tax Cut…and Why”

Who Am I? (Other Than Cranky)

by Norman Horowitz

The buildings reach up to the sky
The traffic thunders on the busy street
Pavement slips beneath my feet
I walk alone and wonder, who am I?

I close my eyes then I can fly
And I escape from all this worldly strife
Restricted by routine of life
But still I can’t discover, who am I?

I long to wake up in the morning
And find everything has changed
And all the people that I meet don’t wear a frown

But every day is just the same
I’m chasing rainbows in the rain
All the dreams that I believe in let me down

Maybe I’m reaching far too high
For I have something else entirely free
With love of someone close to me
Unfettered by the world that hurries by
Um, to question such good fortune, who am I?

It was more than half a lifetime ago when Petula Clark recorded the song “Who Am I?

Glenn Gould, the Canadian pianist, wrote that the song was a “document of despair which catalogues the symptoms of disenchantment and ennui.” It was said that it embodied the social consciousness of the 1960s, specifically the search for the meaning of life.

I thought about “social consciousness” the other night when the Republicans were threatening to risk so much in shutting down the government in order to defund “Planned Parenthood.” It was a genuine “Good grief!” moment for me.   Continue reading “Who Am I? (Other Than Cranky)”