Two days ago, Senator Claire McCaskill (D-MO) revealed in an NBC interview that she had been diagnosed with breast cancer. On Twitter, she then wrote this:
Sen. McCaskill has my sympathies now and in the trying times ahead for her. Even for those, like her, whose prognosis is good, it’s still going to be a lot of trouble and pain to deal with. And of course, thousands and thousands of women aren’t so fortunate as Sen. McCaskill — to be able to afford treatment which can catch this killer cancer before it’s already spread throughout the body.
In fact, the Kaiser Health Foundation
estimates that, even with the help of Obamacare, 13% of women — about 15
million women — are uninsured. Millions more are underinsured — enrolled in plans that fulfil the bare minimums of the Affordable Care Act, but offer only bare-bones cover, and whose copays for cancer treatment can run into tens or, in particularly bad cases, hundreds of thousands of dollars. Most women cannot afford this, and even many who can are left teetering on the edge of bankruptcy from the vast costs. And even among women, disproportionately the worst-off are Mexican-American women, are African-American women — whether their household is themselves alone or a partner and/or children, it’s almost certainly got far, far fewer resources available than a white household to meet these exorbitant costs.
And these costs are vast not because of some vanishing rarity in the treatments, not because of the high costs of innovation and development — these costs are high because the government takes little or no role in regulating this market at all. Martin Shkreli was only the tip of the iceberg, the most visible sign of the disease in America’s healthcare system — there are thousands of Martin Shkrelis in the hallways of Big Pharma, Big Health, Big Medicine, who silently applaud him but lack the guts or the imagination to so blatantly act the role of villain. The government can and should do so much more than it is, to ensure that treatment is available for women who cannot afford it themselves.
One thing the government could do is take a positive role in bargaining drug prices down to something reasonable.
One example of this is Gleevec, which is used to treat some forms of leukemia. It costs $6,000
per month for this treatment in America — and the insurance company won’t pay one dime more than it has to. But in the United Kingdom, it costs the National Health Service $2,700 for a month’s supply of Gleevec. In the Netherlands, the government has made sure that Dutch insurers only pay $1,100 for a month’s supply. That’s less than one-fifth of the cost Americans pay, and the pharma companies still make a profit from it! Why is America paying five times as much for the same thing? Because in America, the government can’t bargain the prices down — it can’t bring the insurers to heel. Not even Medicare can do this, thanks to a bill the Republicans passed a decade ago — not even Medicare!
Another thing the government could do is offer a government-run health insurance plan to compete with the private insurers, who often abuse their customers in so many ways. They deny treatments on the thinnest of technicalities, they hound and hector the patient nonstop, they act as their own “death panels” simply to cut their costs and inflate their profits. If there were some real competition out there, if there were public insurers who were only required to cover their costs, some real cutting back in healthcare costs would start to happen!
All of this is without even looking at the elephant in the room, and that is single-payer. Right now, the US Government — Federal, State and local —
already spends more healthcare money
per person than many countries spend both privately and publicly! America’s government at all levels spends around $4,000 per person per year on healthcare spending — over a trillion dollars per year, and Americans across the board spend another $4,200 on average — another trillion and a half dollars. In contrast, Australia’s
total healthcare spending is less than $4,000 per person per year, of which the government spends around $2,600. For all of that money, what’s America getting? Not much! And of what
is gotten, all too much is out of reach to poorer people, who are mostly not white.
One effect of this has been the creation (rather, the maintenance) of a significant disparity in life expectancy by race, as you can see to the right:
Consider for a moment what this says. It says that African-Americans, male and female both, can expect to live at least 4-5 years less than white Americans. This is another way that Black Lives Matter, and it’s one which is too often ignored in favour of stories of the latest police atrocity or outrage committed against one or more African-American kids. It tells a story of a quiet killing, of thousands of lives cut short in a boardroom meeting, of unspeakable agony inflicted to shave a few dollars off a corporation’s bottom line.
It tells a story of treatments denied to save money, of doctors’ visits not made to save money, of drugs not purchased due to not having enough money…
Does anyone see the common thread to this? Money. Pharmaceutical companies hoard it. Insurance companies worship it. Patients need it. There are many ways this could be changed — and single-payer isn’t the only possibility. In fact, at least one study has estimated that, given permission to use its buying power to get drug prices down, Medicare could save $16 billion annually. That’s $16,000,000,000 every year — enough money to give each and every public school in America another $160,000 each year to rebuild or update their facilities & equipment. Enough money to build 100,000 homes for low-income people, or resurface over 10,000 miles of four-lane roads each year, build 16,000 miles of high-speed rail, increase public-transportation budgets by one-third or do many, many other things. That’s just one, easy way the government could save money — if it dared to — and it doesn’t even count what would happen to prices paid elsewhere in the market, it doesn’t count the lives saved because costs got cheaper.
But there’s a dimension to this other than money. Senator McCaskill is fortunate enough to be one of the wealthy — she won’t have to choose between the cancer treatments or making her mortgage payments. And because she could afford regular doctors’ visits, she was correctly diagnosed at an early stage, when treatment can still cure it. Many people don’t have that choice. The lives of those people, those who cannot afford to support extravagant profits in American healthcare corporations, are cut short, often well before retirement age. Those people leave holes in the world, all around us, which would be filled if they were here, or if they had lived longer to raise their children, build their businesses, create their legacies or simply live their lives.
This isn’t about Hillary or Bernie. This isn’t about Republicans or Democrats. This is a much more basic issue. It’s about life and death, and the ways people live and the systems they create to prepare themselves for those issues and those emergencies. It’s about justice, about making sure that the colour of your skin doesn’t affect the affordability of your lifesaving treatment. And it’s an issue which every people, every nation, must find a way to address.
To your mind, how should America address this issue? What steps should be taken — and on what principles should they be based?