The Most Important Questions : Ending healthcare for those who need it will not make them or their problems disappear. On the contrary, the GOP plan will shatter American families and the economy. Nothing magical happens if we stop caring for the elderly, the ones who need vaccinations, the small infections that can be treated for $2 worth of antibiotics, the uncontrolled diabetics, and those with contagious diseases who clean our schools’ offices and homes. They don’t just get healthy.
As George Orwell said in Down and Out in Paris and London, “the more one pays for food, the more sweat and spittle one is obliged to eat with it.” Cutting care only exacerbates illnesses, infection, disability, the effects of age and the costs to society. The burdens continue or increase but the cost is shifted to American families, businesses, and states.
Fifteen years ago, one of the authors showed that lost productivity from workers caring for Alzheimer’s patients cost US businesses over $60 billion a year. Employee-caregivers, usually at the peak of their responsibilities and corporate experience, quit, prematurely retired, were constantly distracted, or engaged in presentism (e.g., at work but focused on mom burning down the house). Business cost were incurred by the need to replace workers, extra training of replacement workers, and increased pressure on other workers to cover for caregivers. The more expensive the employee, the longer and more costly the search and the longer the time to get them up to speed. But that study examined just a miniscule number of patients and workers compared to the tens of millions of people affected by the proposed GOP bill. As noted, it’s not only those needing care, but our society and our families that must deal with the elderly, ill, disabled, under and uninsured, children not receiving even ordinary care, people not being screened for preventable illness, and countless others.
Extrapolating from Koppel’s tiny study to the US population and businesses reveals the GOP bill will cost the nation trillions of dollars in losses and extra costs. It will devastate state budgets, and explains why GOP governors are among those leading the resistance. Consider these facts:
Most every nursing homes (SNF— Skilled Nursing Facilities) depend heavily on Medicaid, the program that will face the largest cuts by all of the GOP plans. What will happen to the millions of our elderly, disabled, and infirm? The lawns and parks of Washington DC and the 50 state capitals could hold only about 5% of them, where, of course, they would die without care.
1.75 million Veterans receive care via Medicaid. In fact, less than half receive care via the VA health system because some don’t qualify for various reasons or live too far from a VA facility to for primary care. Many vets instead rely on Medicaid. Over thirty states and the District of Columbia chose to expand Medicaid to cover more people — especially veterans.
Ironically, while President Trump campaigned on a pledge to force lower drug prices, the GOP plan gives greater freedom to drug companies to set prices. Freeing the FDA to accept less rigorous clinical trials on medications and medical devices is supposed to lower costs. Drug and device companies will be given greater latitude to define “proxy end points,” a term that means they don’t have to really show the drugs’ or devices’ long term effects, e.g., if a drug is shown to shrink cancer tumors after, say, 2 months, the company need not continue the trial for another 9 months—where there’s a good chance it might show the tumors return, or the drug fails, or that the drug or device harms patients through other means. More directly, getting products to market with less testing does not lower the prices of drugs that have been on the market for years and are now being up-priced by a few thousand percent—which is the case with many of the recent pricing scandals. In fact, the GOP committees on drug pricing just cancelled hearings.
Hospitals and medical schools depend on many of the programs cut by the GOP plan. The Association of American Medical Colleges(AAMC) “predicts that the United States will face a shortage of between 40,800-104,900 physicians by 2030.” Cutting training and research dollars will not increase the number of doctors or the good they can accomplish. While about 5,000 doctors offer concierge medical care for fewer than one million family members of multimillionaires, that will leave the remaining 319,000,000 of us scrambling for care. Googling “WebMD” is not a substitute for health professionals.
This GOP bill forged a rare unity among medical societies, addiction physicians, hospital associations, nursing homes, and almost anyone else involved with healthcare. In contrast, big Pharma and the medical device companies win regulatory freedoms and tax cuts. They seem less hostile to the bill.
Not providing birth control will mean millions of more abortions and unwanted babies. Those children born will not disappear, but rather will need care to become productive members of society. This is an additional burden on the American public and taxpayers.
The largest growth area in the US labor force was and is healthcare. There are about 13 million healthcare workers in the USA, of which about 3 million are nurses, 800,000 are physicians, the rest are pharmacists, technicians, respiratory therapists, nurses’ aides, etc. In contrast, there are only about 15,900 miners in the entire USA who are involved with extraction, mining machine operations or earth drillings. Mining jobs have declined for decades because of extraction technology (e.g., mountain top mining and bigger drilling machines), natural gas, pollution concerns, etc. In contrast, even in mining communities, it’s often healthcare jobs that are available. Cutting healthcare jobs is a surefire way to increase unemployment. It will destroy entire communities. Even West Virginia has about 81,000 healthcare workers whereas it has only a few thousand active miners.
Finally, returning to the costs borne by businesses and society: People denied healthcare are more likely to need caregivers. In 2015, the average age for caregivers was about 49 years old, 85% of which provided care for a relative. 60% of caregivers were employed within the last year while they provided care to someone, while 56% of them worked an average of 34.7 hours per work. 43.5 million adults “provided unpaid care to an adult or a child.” Many caregivers are still at an age where they must work, are forced to make accommodation with their jobs, and their extra labor receives no monetary compensation.
The caregiver role is seldom short-term: “three in five care recipients have a long-term physical condition (59%), more than a third have a short-term physical condition (35%), and a quarter have a memory problem (26%).” The unforeseeable end to their role as a caregiver creates a twofold effect on them as their labor remains unaccounted for in the GDP. Unpaid family caregiving costs the nation approximately $470 billion in 2013. For Walmart alone (not exactly the company with the highest paid workforce) the economic value estimate totals more $477 billion.
Offering poorly designed or no health insurance to Americans will not make their problems disappear. Instead, we are left with more costly health problems. Sicker Americans, in addition to paying incomprehensibly large medical bills, will be forced to exit the workforce early–increasing financial burdens on business and families.
Perhaps most important, the GOP plan copies Obamacare in not really confronting healthcare prices. Instead, it only denies insurance, allowing largely unchecked the dizzying array of prices. As Bret Stephens writes, the same blood test in California can vary from $10 to $10,169; a lower back MRI in the USA can range from $199 to $6,221. A more dramatic comparison is the cost of care in the US vs. other nations, where US costs are usually 3 to 5 times higher. In the US, average angioplasty prices are $31,620, whereas in the UK, they are $7,264.
The CBO looked at the loss of insurance and the transfer of wealth to the super rich–both staggering. Yes, there were some deficit reductions from denying healthcare to millions. As we try to show here, however, even those “savings” will backfire horribly for the American government, our citizens and our economy. Neither we nor the CBO address the inhumanity implicit in the proposal health plans. For that there are other metrics.
Ross Koppel is a professor at the University of Pennsylvania. Jasmine Martinez is a senior at Vassar College.