Single-Payer Is the Only Answer
By Eldon Katz, LUTU Member
Compared with the dozens of countries that guarantee health care as a right through some publicly funded system, the United States inhumanely and immorally allows a situation to continue in which people are forced into making literal “your money or your life” decisions, needlessly suffering and sometimes dying prematurely because they lack access to needed care. To add insult to injury, in an absurdly ironic twist, our per capita health care spending is roughly double that of the average country with universal health care. Why?
The United States is among the wealthiest nations in the world, yet we still view universal health care as too expensive for us. This view is not only cynically shortsighted, but also inaccurate. Any variation of the current for-profit system (whether it’s the Democrats’ Affordable Care Act [ACA] or the Republicans’ American Health Care Act [AHCA]) will ultimately result in affordable health care becoming inaccessible to more and more people as demand pushes costs higher and higher. The only viable solution is single-payer.
The term “single-payer” can refer to any system under which a majority of health care expenditures are directly paid for by a single government entity. This can range from systems in which the government provides the majority of health care services, as in the United Kingdom, or systems in which private entities provide most services, but the government still pays directly, as in Canada and Australia.
The conventional wisdom among conservatives and neoliberals is that our system provides higher quality through the magic of free-market innovation. They also tell us that other countries “ration” care, offering dubious anecdotes of prohibitively long wait times. The reality is that health care outcomes are actually much better in similarly wealthy countries, where the people are more satisfied with health care and live longer. Out of 36 countries now in the Organization for Economic Cooperation and Development (OECD), 28 have higher life expectancies than the United States. So if the money isn’t going into improved outcomes, where is it going?
The two largest expenses are the administrative costs of billing and the cost of industry price-gouging. Providers, device manufacturers, and pharmaceutical companies routinely charge patients two, three, or up to fifty times what the same treatment, device, or drug costs in countries with single-payer systems. This is due to the basic laws of supply and demand. For most products sold in any economy, rising prices leads to lowered demand, which forces prices to stabilize. When it’s a matter of life and death, demand remains high no matter the cost, incentivizing industries to continue raising prices—unless a single payer has the leverage to negotiate prices.
A 2012 study conducted by economist Gerald Friedman estimated that if the United States switched to a single-payer system, removing the administrative costs around billing and stopping industry price-gouging would save $570 billion annually in health care expenditures nationwide. This same study estimated that the only significant system-wide cost increases—extending coverage to those currently uninsured and increasing utilization among those currently underinsured—would only amount to $320 billion annually. That makes for a net savings of at least $250 billion, not including the elimination of the countless smaller expenses of our for-profit system, such as advertising and legal costs, or the cost to the economy of people holding onto jobs they aren’t suited for because they’re afraid of losing health benefits.
Some of the biggest costs that our system inflicts are less tangible and harder to measure. Our profit-based system encourages providers and patients to ignore problems until they become emergencies. It incentivizes providers to opt for the treatment an insurance company will cover rather than the one that will help the most. It incentivizes the over-prescribing of drugs that may do more harm than good.
Less visible still is the emotional stress this system inflicts, which can lead to even more health problems. Many people in the United States experience the greatest financial stress of their lives as a result of and while dealing with a major illness. This stress inevitably slows recovery times and leads patients to need even more treatment, creating a vicious cycle of illness and financial stress. Finally, the health benefits of a single-payer system will affect the entire country: future epidemics will be less likely to spread if personal financial costs aren’t discouraging sick people from seeing doctors.
Some say the problem with single-payer health care is that it’s politically unfeasible. Folks assume that the lack of enthusiastic public support for the ACA is because people are wary of too much government involvement. In truth, the individual components of the ACA poll very well with a majority of Americans, including all of the parts that amount to government regulation of the industry. The one part with overwhelming disapproval is the individual mandate, which was actually a policy idea born in right-wing think tanks in the twentieth century. The truth is that our most progressive health programs, including Medicare and the Veterans Health Administration, meet with strong approval. Meanwhile, according to a recent Pew Foundation survey, 60% of Americans agree with the statement, “The government should be responsible for ensuring health care coverage for all Americans.” That’s much greater support than we see for either the ACA or the AHCA. In the same poll, 52% of Republican voters with income below $30,000 per year favor government-guaranteed universal coverage! Still think America isn’t ready for single-payer?
All the evidence indicates that single-payer health care systems are the most cost-effective, and their ethical superiority is unquestionable. In a society as wealthy and technologically advanced as the United States, it is inhumane to accept a system in which access to health care is still based on financial success instead of need, and it’s immoral to accept a system that incentivizes people to view illness as a business opportunity. Our current profit-based system is morally and financially unsustainable, and a single-payer replacement is the only answer.
Precinct Organizing Project Committee Update
From our discussion in the Strategy Committee last fall, we decided to develop a precinct organizing initiative that could be a model for talking to other Austin communities. The goal of the project is to plan and conduct canvassing of every household to survey residents on issues of concern and develop a plan of action to strengthen civic engagement. LUTU members and allies have completed two block walks in Del Valle ( southeast Austin/Travis County) and are planning more in the coming months. Interested in joining us? Email Organizer Glenn Scott at firstname.lastname@example.org. We have also developed a two-hour training module that we plan to offer in more parts of Austin in cooperation with allies.
The Menace of Texas’s Structural Deficit and Why the Texas Legislature Continues to Fail Texans
The Case of Our Unconstitutional Child Protective Services Program
by Tim Mahoney, LUTU member
The 85th Texas Legislative Session crawled to an end on May 29, 2017, and once again it failed to represent the best interests of Texas. This is no accident: there is a grounded plan to elect people who know very little about policy processes and will use misguided logic to impose their will on the rest of us.
Having observed this session, I have drawn the following conclusions:
The legislature is embarrassingly dysfunctional.
The legislature does not want its logic impeded by data.
The legislature will not improve unless local, decentralized citizen organizations around the state ally with one another.
From the Highway Department to the Health and Human Services Commission, the embedded leadership is the result of a decades-long history of electing to the Texas legislature the people who have access to the most money. To draw an analogy, the most advertised tomato soup is not necessarily the best tomato soup, but it ends up being the most popular and best-selling tomato soup. So too with our representatives: those who have access to the most money win elections. But that can mean electing people who do not care about policy data—a material hindrance to developing good public policy. For example:
For environmental highway studies, state agencies can tailor the bid contract so that the resulting report generates the findings that the agency wants.
Texas has the highest mortality related to pregnancies in the developed world, and we don’t know why, because Texas refuses to keep adequate data.
The need for reform of Child Protective Services (CPS) illustrates the continuing legislative trauma being visited on Texas citizens. A south Texas federal court ruled in 2016 that Texas has an unconstitutional foster care system. Instead of looking for solutions to real problems faced by the living people of Texas, the legislature spent its time passing legislation requiring abortion-related biological materials to be buried or cremated instead of disposed of as medical waste. Meanwhile, their “solution” to the problems in the CPS system is to privatize it.
As the session was coming to a close in April, Rep. James Frank, R-Wichita Falls, in response to a question from a Texas Tribune reporter about whether the CPS “kinship system” in Texas was doing enough to provide necessary resources for families to take in kids, answered, “We are trying to say, ‘Now look, if that is the only thing stopping you, and you are not willing or able to spend that money, then we need to step in.’ … it’s very easy to just say, ’Let’s give you all the money, no matter what, and pay for everything.’”
Before the session started, the Texas Tribune broadcast “A Symposium Previewing the 85th Legislature.” In that session, Sen. Kirk Watson, D-Austin, said, “I do think that this is going to be one of those sessions where we will go . . . one of two ways. One of the ways on the budget . . . is to say ‘We’re broke! We can’t spend any money!’ and the other is ‘Someday we could be broke! We can’t spend any money.’ . . . And part of that is the Legislature’s own doing. … something we have done that has added to what I consider to be a structural deficit with regard to public education.” For most Texans, even the notion of a structural deficit is unknown. It should be a local rallying cry.
Sen. Watson referred to the 2016 federal ruling that the Texas CPS is unconstitutional, saying, “I think we all know . . . there’s things that need to be fixed, management on down, but . . . it’s not going to be a debate between the Senate and the House on some of this stuff, it’s going to be the court telling us what we have to do.“
Rep. Donna Howard, D-Austin, added, “We have been hearing from [CPS] for a long, long time... The fact is that the people who have been running these agencies are people who have been appointed by our governor. If there is a problem with management, talk with the governor.”
The CPS system, by and large, deals with poorer Texans, and just because they are poor does not mean that the state has a right to mistreat and neglect them. There is no data to help us even begin to understand which policies work best for children potentially under CPS control and which policies are most efficient and effective. In all likelihood, the policies the Republican-led legislature is pursuing may be the least effective and efficient and the most expensive and destructive.
Unfortunately, the federal court may have to protect the constitutional rights of Texans, because the collective Texas Legislature and statewide executive officials are the reigning brand of tomato soup, and they do not want to.
Passage of Anti–Sexual Assault Senate Bills 968 and 969 Brings Hope to Texas
Note: The following article reports issues concerning sexual assault and violence.
by Courtney Szigetvari, LUTU member
This past 2017 Texas legislative session was incredibly horrific (an understatement) for those looking to make progressive change in the state, particularly with the passage of SB4. If there were any victories to be found on our end, one could look at the enactment of Senate bills (SB) 968 and 969, both of which aim to curb and end sexual assault on college campuses. These bills take effect immediately, and it is due to Austin's own Kirk Watson that they saw the light of day.
According to the Texas Observer, Watson formulated these bills in response to the fact that only 9 percent of sexual assaults are reported in Texas and because of the rampant sexual violence that is happening on college campuses throughout the state (especially at the University of Texas at Austin, where 15 percent of undergraduate women have been raped, and Baylor University, where sexual assaults were swept under the rug for far too long). SB 968 and 969 will make those who report sexual violence feel more secure—they will protect survivors and others who report such incidents by allowing them to do so anonymously and without fear of punishment.
The notion of protecting those who report violence may seem like common sense, but until now, it was not on the law books. Left Up To US stands behind Senator Kirk Watson as well as the Texas Association Against Sexual Assault (TAASA), SafePlace, and all other avenues through which survivors of sexual violence are protected.
If you have experienced sexual assault, domestic violence, or human trafficking or are aware of someone who has, you may call the following confidential phone services: SafePlace’s 24/7 hotline at (512) 267-7233, the National Domestic Violence Hotline at (800) 799-7233, or RAINN’s National Sexual Assault Telephone Hotline at (800) 656-4673.
Billionaires vs. Unions
The Battle for Political Power in Texas
by Michael Nachbar, LUTU member
The website of Empower Texans, a Super PAC and conservative think tank, features numerous articles calling for an end to the automatic deduction of union dues from the paychecks of teachers, probation officers, family services workers, and other public servants. One article states that “local government unions wield too much political power” and need to have that power taken away. Teachers unions have this power because they represent the shared interests of hundreds of thousands of hardworking Texans. Empower Texans is able to have a comparable and possibly greater influence on Texas politics, and its power comes from essentially one individual: fracking billionaire Tim Dunn.
It should seem unfair that one man can have as much political influence as all of Texas’s teachers. But to Dunn, it is dangerous that they are able to have as much power as he has. Empower Texans has sponsored the companion bills SB-13 and HB-510, which eliminate the state collection of union dues for public sector employees but make an exception for police officers, firefighters, and EMS workers.
The Empower Texans website claims that the public sector unions hurt by this bill often support Democratic candidates and liberal policies and that this bill will allow more Republicans to win. But two years ago, Empower Texans pushed a version of this bill that affected all unions and did not make any exceptions. Many moderate Republicans balked at a bill that harmed a large number of their voters, and they ended up killing the bill. But the Empower Texans website has publicly attacked House Speaker Joe Straus for taking money from public unions, and if these bills pass, Empower Texans will likely try to eliminate state collection of dues for police and fire unions at some point in the future.
Tim Dunn is right to be worried about unions. In our capitalist society Dunn can amass the wealth of hundreds of thousands of people, but as long as America is a democracy his one vote counts the same as anyone else’s. He can donate money to attempt to influence the political landscape, but results are not guaranteed. Despite more than $100 million in donations, Jeb Bush’s presidential campaign netted only four delegates in the Republican primary. The largest threat to the power of billionaires is an electorate in solidarity, voting for candidates who support populist interests.
And there are trends that suggest voters are looking more to populist candidates. Bernie Sanders, a previously anonymous 74-year-old senator from Vermont, who wasn’t even a member of the Democratic Party until 2015, won 43% of the Democratic primary votes. A large part of his appeal was his populist message that represented the interests of the majority of people, rather than billionaires. Donald Trump defeated Republican primary opponents who had raised far more funds than he did, and a large part of his appeal, especially in the primaries, stemmed from his claims that he was self-funding his campaign and was not beholden to any special interests.
While Trump has not pushed a populist agenda, billionaire donors like Tim Dunn have undoubtedly noticed the rising populist tide. That’s why he is so intent on limiting the power of unions. He wants to curb the populist trend by crippling the avenues for average citizens to fight for their interests.
SB 13, the senate bill, has already passed. It is imperative that Texans fight HB 510, the house bill. In a fair fight, a united and informed citizenry will be able to defeat a few billionaires. That’s why the billionaires are working hard to ensure that it’s not a fair fight and why the citizens must resist their efforts.