Defeated on ObamaCare, Rounds Fights Imaginary Devil of “Government-Run Health Care”

Senator Marion Michael Rounds, like all Trump enablers, had a really bad week. Senator Rounds caps off his really bad week by writing a really bad column. “Government-Run Health Care Does Not Work,” moans Senator Rounds, after seven months in which he and his Republican majority haven’t really worked.

If you read no other response to Senator Rounds’s sniveling horsehockey, read this:

No Democrat I know of is advocating “government-run health care.” No one is saying we should nationalize every hospital, make every doctor a government employee, and submit everyone’s diagnosis and treatment to a vote of Congress.

I’m saying, and Bernie Sanders is saying, and a lot of smart people are saying, we should handle everyone’s health care the way we do with Medicare. Grandma and Grandpa pick their hospitals and doctors and treatments; we just pay for their health care, far more efficiently than private insurance does, with taxpayer dollars. Medicare for Everyone: government-paid health care. 

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Now, if that’s not enough, let’s do the line-by-line.

Comprehensive health care reform is necessary to relieve American families from our current failing health care system [Senator M. Michael Rounds, weekly column, 2017.07.28].

We made the current health care system a whole lot better with the Affordable Care Act, which was basically a Republican reform adopted by Obama and Democrats in 2010 as a compromise measure. The Affordable Care Act individual insurance marketplace is not collapsing. You, Senator Rounds, even worked with Tom Daschle and President Obama to make the ACA work better before you decided your political aspirations depended on kicking and screaming about ObamaCare.

Following recent votes in the Senate, it’s clear that reforming our health care system is no easy task [Rounds, 2017.07.28].

You and your party sure thought health care reform was easy during seven years of shouting, “Repeal ObamaCare!” Only “following recent votes” does the difficulty of the task become clear to you? Unlike you and your Dear Leader, Barack Obama and the Democratic Party knew that health care could be so complicated, and when they took over in 2009, they spent over a year crafting a workable plan that is helping Americans today.

However, I remain committed to working with my colleagues toward a solution.  We believe affordable health care is best achieved through a competitive, market-based system that allows for innovation, competition and optionality [Rounds, 2017.07.28].

“Competitive, market-based system” is at the core of every plan your party has put to a vote this year, and every one of those plans failed to win enough Republican votes to pass. “Competitive, market-based system” was also at the core of the part of the health care system prior to the ACA (and Medicaid, and Medicare) that failed to deliver coverage and care for poor, old, and sick Americans. Your “competitive, market-based system” does not work in health care.

In the quest to address Obamacare’s failures, some have been advocating for a single-payer, government-run health care system in which health care is provided for every single citizen for free and financed by taxes [Rounds, 2017.07.28].

Wrong—see above: government-paid, not government-run. Also, single-payer does not make care free. We all pay, through our taxes, just like we all pay now through insurance. We just pay a lot less.

Care is rationed, and citizens cede their health care decisions to a central government bureaucracy [Rounds, 2017.07.28].

Oops! Senator Rounds, you’re talking about our current multi-payer system in which private insurers and employers ration care and choose our doctors and treatments.

Additionally, the cost makes it unsustainable for future generations. Either taxes – which are already too high – will continue to skyrocket in order to pay for universal care, our debt will spiral even further out of control, or both [Rounds, 2017.07.28].

Wrong—single-payer is cheaper than private insurance, so single-payer is more sustainable than the current system.

Our ability to make decisions for ourselves and our families will suffer. Bureaucrats don’t like taking advice [Rounds, 2017.07.28].

Do Grandma and Grandpa’s ability to make decisions suffer under Medicare? And how much advice do the profit-driven agents at your family insurance agency like to take from patients?

And we have many examples to substantiate this: In the U.S., California and Vermont recently tried to implement universal health care at the state level; both were abandoned as quickly as they were enacted due to its cost [Rounds, 2017.07.28].

Sure, the California plan got snarled in a debate about the $400-billion price tag. But let’s clarify the figures:

However, a report by professors at the University of Massachusetts Amherst, commissioned in part by National Nurses United, estimated that after taking in the savings of single-payer, such as lower administrative costs and prices of pharmaceuticals, the actual cost of the plan would end up at around $331 billion. And, because 70 percent of the state’s current health care spending is covered by public programs like Medicare and Medi-Cal, California would only need to come up with $106 billion in new revenue, which researchers proposed could be done through two new taxes (a 2.3 percent gross receipts and sales tax), with exemptions for small businesses and tax credits to offset costs for low-income families. In exchange, nearly all of Californians’ medical expenses would be covered, doing away with premiums, copays, and deductibles [Clio Chang, “What Killed Single-Payer in California?” New Republic, 2017.06.30].

That exchange—taxes go up but premiums, copays, and deductibles go bye-bye—turns out to be a good deal:

But let’s say they’re right and the cost is closer to $400 billion overall, and that $100 billion in new revenues is needed (the high end of their $50b-$100b scale). That would pencil out to a monthly cost to each Californian of $208. ($100 billion / 40 million = $2500, which is the annual sum; divide that by 12 and you’re at $208.)

The average monthly premium for a Californian, as of 2016, was just under $600. For a household, it’s just above $1600.

In other words, even assuming the fiscally conservative analysis of the Senate Appropriations Committee and spreading the cost evenly across every Californian, single-payer would cost a third of what it currently costs Californians – just for health insurance alone. And unlike the present system, this would mean Californians don’t have to pay anything else beyond that $208/mo. No copays. No co-insurance. No out of pocket costs (at least within the Golden State). The ultimate savings would therefore be even greater. Californians could wind up paying just a quarter of what they pay now, if not less [“Single-Payer Would Cost a Third of Current Health Care Costs Per Family,” Health California, 2017.05.26].

Single-payer would have saved money in Vermont, too:

…even [Governor Peter] Shumlin’s projections indicated that the plan would reduce Vermont’s overall health spending and lower costs for the 90% of Vermont families with household incomes under $150,000. Despite differing projections, all three studies showed that single payer was economically feasible [John E. McDonough, “The Demise Of Vermont’s Single-Payer Plan,” New England Journal of Medicine, 2015.04.23].

Now back to Senator Rounds:

In Canada, long wait times in their single-payer system are the norm.According to a Fraser Institute report, British Columbia residents have to wait up to six months just to get an MRI. Ontario’s own Ministry of Health and Long-Term Care states that residents may have to wait up to 11 months for hip replacement surgery [Rounds, 2017.07.28].

Sure, Canada’s wait times exceed the international average, but…

1. Canada doesn’t have to throw out single-payer to fix that problem; they could just use more electronic medical records.
2. The U.S. is also below the international average: 43% of Canadians say they were able to get same-day or next-day appointments last time they were sick; the U.S. figure was 51%; the average in the 11 nations studied by the Commonwealth Fund was 57%.
3. The countries that beat us were Germany, France, Switzerland, United Kingdom, Australia, New Zealand, and Netherlands, all of which have some form of national health insurance system.
4. Canadians report more timely access to mental health care than the international average.
5. A far larger percentage of Americans skip health care due to cost than do Canadians.

Droves of Canadians seek care here in the U.S., at an additional cost to their already-high taxes to pay for government-run health care [Rounds, 2017.07.28].

“Droves” is a fuzzy term. Maybe 45,000 Canadians sought health care in another country in 2015; so did 250,000 Americans:

Overall, then, that’s about 0.13 percent of Canadians and 0.08 percent of Americans who flee their countries for health care. Those are pretty similar numbers. The only real difference is the reason for leaving. Canadians mostly cite wait times for elective surgery. Americans mostly cite the high cost of medical treatment [Kevin Drum, “Americans Flee America for Overseas Health Care Just Like Canadians,” Mother Jones, 2017.02.08].

And overall, Canadians are living longer, losing fewer moms and babies, staying slimmer, and expressing more satisfaction with their health care system than we Americans are.

Thus destroyed on the Canadian comparison, Senator Rounds flees to Europe:

Across Europe, where universal health care is prevalent, the cost to governments for this care is exploding, contributing to rising national debts. But instead of increasing taxes, which oftentimes are already over 50 percent of one’s income, governments are slowing down care to curb the cost, and innovation is stymied [Rounds, 2017.07.28].

Yet most of Europe manages to spend half as much per capita on health care as we do and still provide more health care resources and produce better health outcomes. Evidently slowing down care isn’t killing Europeans or Canadians faster than we Americans kill ourselves.

Here in the U.S., the federal government has proved inept at running any large, nationwide program effectively, especially when it comes to health care [Rounds, 2017.07.28].

Sweeping generalization. The federal government runs all sorts of large, nationwide programs effectively—Medicare, military, moonshots….

Look no further than Department of Veterans Affairs (VA) and Indian Health Service (IHS) for proof [Rounds, 2017.07.28].

VA care still scores better on patient satisfaction than the health care industry as a whole. IHS would run a whole lot better if Rounds and colleagues would just give it funding instead of campaign slogans.

While there are good employees in South Dakota at both agencies, nationwide these programs have been plagued with decades of long wait times, bureaucratic mismanagement, corruption and – most importantly – providing inadequate quality of care to Americans. In some cases, patients have even died waiting for care. Meanwhile, administrative costs have skyrocketed, wasting countless taxpayer dollars on paperwork instead of focusing on patient care [Rounds, 2017.07.28].

Comparing VA care to non-VA care is complicated, but older studies found the VA meeting or beating the private sector on cost.

As for IHS care, sure, it’s a mess. But again, that’s because Congress somehow expects IHS to treat remote rural populations with more health problems on less money:

The IHS is chronically underfunded. It receives a set amount of money each year to take care of 2.2 million native people — no matter how much care they may need. On the reservation, IHS facilities often don’t have services that people elsewhere expect, such as emergency departments or MRI machines. And those limited facilities can be hours away by car. In town, reaching care is easier, but clinics also don’t have enough funding to meet all of the health needs of the community. And people can’t get the free medication they are entitled to through the IHS anywhere but an IHS facility.

…In 2013, Indian Health Service spending for patient health services was $2,849 a person, compared with $7,717 for health care spending nationally, according to a report from the National Congress of American Indians. That despite the fact that Native Americans typically have more serious health problems than the general public, including higher rates of diabetes, liver disease and unintentional injuries [Misha Friedman, “For Native Americans Health Care Is a Long, Hard Road Away,” NPR, 2016.04.13].

A set amount of money each year—that’s exactly what Senator Rounds wanted to do to Medicaid. Senator Rounds would have ignored the care the poor actually need, just as he ignores the care American Indians under IHS actually need.

I wholeheartedly believe that everyone should have access to quality health care if they want it. No one should be priced out of health insurance for themselves or their families [Rounds, 2017.07.28].

Yet that’s exactly the effect that the three plans you, Senator Rounds, voted for last week would have had on millions of Americans with pre-existing conditions.

But forcing all Americans onto a costly, ineffective system that will reduce the quality of care and making them surrender all control of their health care decisions to the federal government is not the answer [Rounds, 2017.07.28].

The Republican plans you voted for, Senator Rounds, would have forced millions to pay more for insurance policies that cover less than their current plans. And no one under the ACA, the Canada Health Act, the UK National Health Service, or Australian Medicare has “surrender[ed] all control of their health care decisions to the federal government.” You’re not criticizing a real policy alternative here, Senator Rounds. You’re crying “Dragon!” to distract us from what you’re trying to burn down.

America is home to the best health care providers in the world, due to a free market system that allows for innovation and competition. Replacing Obamacare with a competitive, free-market system that actually controls costs, allows for innovation and focuses on the patient will allow us to continue our proud tradition of being the world’s health leader [Rounds, 2017.07.28].

Again, our best health care providers in the world somehow aren’t providing the best health care outcomes in the world. And even the conservative National Review recognizes that your talk about the “free market” is a sham: the Republican plans still kept all sorts of government intervention in health care. We didn’t have a real free market in health care before the ACA, and nothing Republicans offered would recreate a free market in health care. Moving to single-payer is the truly conservative policy option that would free up more resources for free market innovation in other sectors of the economy.

Nothing in your three votes directly provided for more innovation, cost control, or focus on patients. Your votes just would have made health insurance unaffordable for millions of Americans.

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That’s every word of Senator Rounds’s column on “government-run health care,” and darn near every word is wrong.

Unable to win on the facts, unable to persuade a majority in the Senate away from Barack Obama’s so-far successful Affordable Care Act, Senator Mike Rounds resorts to fiction to win an argument no one is making. We don’t want government-run health care. We just want a more efficient way to pay the bills. Toward that end, Senator Rounds has offered nothing of substance. Nothing.