Total healthcare spending in the U.S. has risen relentlessly for the last half-century. Obviously, this cannot go on forever. To curb this disastrous increase in healthcare costs, politicians and their advisors must help the public understand which cost-control policies work and which ones fail. A recent STAT News op-ed by Ezekiel Emanuel, MD, a University of Pennsylvania ethicist and former health policy advisor to President Barack Obama, illustrates how wishful thinking can misinform the public about health policy, in this case, the Affordable Care Act (ACA).
Emanuel’s essay correctly notes that Obamacare reduced the ranks of the uninsured, but his claim that it reduced healthcare spending is false. Emanuel concluded that the ACA, which he helped write, “reduced healthcare spending a total of $2.3 trillion” from 2010, the year the ACA was enacted, to 2017. He went on to make an equally astonishing and erroneous claim about health insurance premiums. He alleged they fell by $1,000 per worker, and “about $4,000” for family coverage from 2010 to 2017.
Gun violence has become a public health epidemic. Despite countless deaths in mass shootings over the last 2 decades, the Dickey Amendment—a provision inserted into the 1996 spending bill which blocked federal funding for research on gun violence—remains on the books. While every politician, media pundit, and policy expert “know” the solution, the answers are not that simple.
In reality, the factors which have fueled the rise in gun violence across America are largely unknown. And if the deep-pocketed gun lobby continues pouring millions into politicians’ war chests to stifle critical gun research, we may never know. Science must be part of the mass shooting debate. Congress must “stop dicking around and repeal the Dickey Amendment,” to fund federal research.
What if the premise that more guns cause more mass shootings—a contentious debate that has the left and the right locked in battle—is entirely wrong?
Research shows that income inequality in communities with higher than average household incomes have a statistically significant relationship with the incidence of mass shootings. This association is far stronger than the now-debunked theory that untreated mental health disorders are responsible for mass shooting events. And while more research is necessary, it is highly likely that economic inequality increases the risk of mass shooting to a greater extent than even firearm access.
I attended the Medicare-for-all town hall meeting at Sabathani Community Center in Minneapolis on the evening of July 18. It was convened by Rep. Ilhan Omar, whose congressional district is roughly coterminous with Minneapolis. Rep. Pramila Jayapal (D-WA) the chief sponsor of the Medicare for All Act of 2019, was her guest, along with four local speakers, including Dr. Dave Dvorak, an emergency room physician representing Physicians for a National Health Program (PNHP), and Rose Roach, the executive director of the Minnesota Nurses Association (MNA).
For a small-d and big-d democrat like me, it was a very encouraging event. It was encouraging to see four or five hundred people, almost all of them white, cram themselves into an auditorium on a hot summer night to support a Muslim Congresswoman under vicious attack by our reckless president. It was encouraging to hear Representatives Omar and Jayapal and the other speakers discuss a complex and important topic with so much passion and yet so much civility. And for me, a long-time organizer for single-payer legislation, it was an opportunity to assess firsthand out how prominent leaders of the single-payer movement present the Medicare-for-all solution to the public.
When I drove up to the Sabathani Community Center around 6:40 that Thursday night, the presence of the Minneapolis police was obvious. I saw one squad car parked right next to the only open door (the one on the east side), two others sitting side by side in the parking lot on the east side, and a fourth right in front of the main entrance (which was locked) on the south side.
Ilhan’s online invitation to this event indicated anyone wishing to attend had to pre-register online. The necessity of checking who had registered created a long line that at times extended outside the east door. After about a ten-minute wait, I entered the auditorium. It was already so jammed it was hard to find a seat with a decent view of the stage. I counted ten TV cameras set up in the back, and one more in front. As I headed down the aisle looking for a seat, I asked the camera man near the aisle what station he was with. He said “CBS.”
I was hoping to make contact with someone on Ilhan’s or Pramila’s staff while I was there. I wanted to talk to them about the three hearings on the Medicare for All Act of 2019 (HR 1384) that had been held in the US House of Representatives over the preceding three months. In my view (and in the view of other single-payer supporters who saw all or most of those hearings), they hadn’t gone well. Claims by opponents about whether and how HR 1384 would cut US health care expenditures, including the claim that HR 1384 could only cut costs by slashing doctor and hospital income to the bone, had been left either unanswered by the bill’s proponents, or were simply denied without explanation or documentation. Witnesses supporting Medicare-for-all focused almost exclusively on how bad the US system is. They said almost nothing about how HR 1384 will cut health care costs (it will do so primarily by reducing the extravagant administrative costs generated by our byzantine system), while the opponents of HR 1384 did the reverse – they used up almost none of their time telling legislators how bad our system is and used almost all of their time making false or exaggerated claims related to HR 1384 costs.