Why Are Americans So Unhealthy?

 Financial FAQs

“Americans have just avoided another health care disaster in voting down the Senate’s ‘skinny’ Obamacare Repeal and Replace bill. Even though maintaining most of the taxes to pay for the Medicaid portion, it would have made insurance coverage prohibitively expensive for those older and sicker users with the removal of the private and employer mandate requirements that would cause younger and healthier people to leave the insurance markets.” Harlan Green Huffington Post

Graph: Last Tech Age

I wrote this in 2017 when Republicans had almost succeeded in repealing Obamacare, the Affordable Care Act (ACA) during President Trump’s first term.

And they are at it again by refusing to negotiate their continuing resolution (CR) with Democrats that has caused the latest government shutdown. The Democrats have been asking to keep the Obamacare subsidies in the CR that help to finance the Obamacare premiums for older and sicker folks. It’s 2017 all over again.

Republicans couldn’t repeal Obamacare then but they are about to succeed this time by allowing the Obamacare subsidies that keep premiums affordable for the 30 million users to lapse at the end of this year.

\Americans already have the worst health outcomes in the developed world, precisely because America is the only developed country—in fact, even of undeveloped countries—that doesn’t have universal coverage.

The result is one of the highest birth death rates, as well as diabetes, heart and other infectious disease rates—which are diseases usually associated with poorer, undeveloped countries and regions.

Why have Republicans been able to prevent a universal healthcare system that insures Americans that almost every other country in the world provides for their citizens?

I believe a major reason is because the U.S. has the highest income inequality in the developed world, as measured by the Gini Inequality Index that is accepted by economists. The U.S. is in 34th place of the 149 countries as ranked by the CIA’s World Factbook; with a Gini inequality index (41.8) like Bolivia and Djibouti. Whereas Denmark (29.3) and the European countries are at the top of equality rankings. The higher the index, the greater the gap between wealthy and poorer citizens of a country’s population.

Republicans have made more than 30 attempts to repeal President Obama signature achievement that required private health insurers to cover clients with existing illnesses for the first time.

A 2016 Commonwealth Club study listed Obamacare’s benefits. “…evidence indicates that the ACA has likely acted as an economic stimulus, in part by freeing up private and public resources for investment in jobs and production capacity. Moreover, the law’s payment and other cost-related reforms appear to have contributed to the marked slowdown in health spending growth seen in recent years.” Health care spending growth per person—both public and private—has slowed for five years.

· A number of ACA reforms, particularly related to Medicare, have likely contributed to the slowdown in health care spending growth by tightening provider payment rates and introducing incentives to reduce excess costs.

· Faster-than-expected economic growth and slower-than-expected health care spending have led to multiple downward revisions of the federal deficit and projected deficits.

· These trends have also been a boon to state and local government budgets, as job growth has improved state tax revenues while cost growth in health care programs has slowed. At the same time, expanding insurance to millions of poeople who were previously uninsured has supported local health systems and enhanced families’ ability to pay for necessities, including health care.

The benefits of Obamacare have become blindingly obvious since it was enacted in 2014, which for the first time required private health insurers to cover people with existing illnesses. So why have Republicans continued to oppose it?

Combined with RFK, Jr.’s cuts to the Department of Health and Human Services, Americans’ health outcomes will get even worse, making working Americans less productive.

Why shouldn’t affordable healthcare be a right for the poorest, as well as the wealthiest? Maybe even Republicans might begin to ask why?

Harlan Green © 2025

Follow Harlan Green on Twitter: https://twitter.com/HarlanGreen

No Art of the Deal--Part II

 Answering Kennedy’s Call

“It’s 100 days into the Trump Presidency and looking more and more like President Trump is no more effective at running the country than his business interests. His book, The Art of the Deal was meant to tout his negotiating skills, but the results were never very successful.”

Huffington Post

I wrote this piece for Huffington Post in 2017, after President Trump’s first 100 days as president.

“And neither are his legislative efforts; with no repeal of Obamacare, or tax reform, an immigration ban, new trade policy, and sanctuary city victories in the offing anytime soon because of poorly thought out strategies. Instead, he threatens judges, sanctuary cities, Congress, and even other countries when they don’t support his various executive orders,” I said then.

President Trump’s real intentions are becoming clear on just his second day of his second term in office. He and his Oligarchs want to steal the US Government blind, as the saying goes, by keeping Americans and the media as blind as possible to what he intends.

Will he be more successful in passing his promises in his second term? We should ignore some of his most nonsensical executive orders, such as attempting to amend the 14^th Amendment by decree that guarantees citizenship for anyone born in the U.S. 50 states and territories, which he knows can’t be done by decree or executive order.

But the furor that it and the immediate release of 1500 January 6 Capital attackers from prison, mostly convicted felons, will generate enough attention that it will cloak his real intention; reduce or eliminate as many government programs as possible that make life better for ordinary Americans, such as Medicaid, in order to fund more tax cuts.

He has already rescinded the Biden executive order to cap Medicaid spending on drugs that would save Medicaid $billions in costs.

“In reversing the executive order Biden signed in 2022, Trump halted an effort to cap the copayment for generic medications at $2 for Medicare beneficiaries, along with another program that would see Medicare pay less for drugs that receive accelerated approval from the Food and Drug Administration,” according to MarketWatch’s Jessica Hall.

And there is also the question of what Trump will do with regard to the prescription-drug provisions in the Inflation Reduction Act, which would be substantially more consequential. Under the Inflation Reduction Act, Medicare can negotiate the prices of certain prescription drugs with the aim of making drugs more affordable for older adults and people with disabilities.

We can’t blame it just on Trump. Republicans have been trying to deprive Americans of affordable healthcare managed by the government for years. The efforts became serious in the more than 30 unsuccessful attempts to repeal Obamacare since it was passed during President Obama’s first two years in office. It became an obsession in Trump’s first term that I wrote about in Huffington Post at the time.

“What if conservatives succeeded in repealing Obamacare (ACA)? “Republicans' Obamacare repeal bill would leave 17 million more people uninsured next year, and 32 million more in 2026, the Congressional Budget Office said in an estimate Wednesday. It also said premiums would double by 2026. …By 2026, three quarters of the population would live in areas with no insurers participating in the non-group market, due to upward pressure on premiums and downward pressure on enrollment, the report found.”

The accrued savings in health care spending relative to their projected growth prior to the ACA are substantial: Medicare alone is now projected to spend $1 trillion less between 2010 and 2020.

The lobbies behind the Obamacare repeal effort have not succeeded in making more Americans ill. I don’t even want to imagine what the results would be if he and Republicas succeed in downsizing Medicaid benefits as well.

Harlan Green © 2025

Follow Harlan Green on Twitter: https://twitter.com/HarlanGreen

Trumpcare is Killing US!

Financial FAQs

It took 4 hours to coax Patricia Okoumou, a Congolese immigrant, down from the Statue of Liberty while wearing a t-shirt that said, “Trumpcare Makes Us Sick.” It was serendipitous timing. She was part of a group wanting the abolition of ICE, but her t-shirt also brought attention to Republican and Trump administration’s efforts to abolish Obamacare, when a just released HHS report states that  Obamacare is doing better than ever for those in most need of health insurance.

President Trump has to be aware that most Americans want to keep Obamacare, even with the latest Republican tax cut bill that also abolishes the Obamacare mandate in 2019 requiring Americans not covered to pay a penalty if they have no health care coverage. The result has been higher premiums for those above the federal poverty level not subsidized by the federal government.

The reason Obamacare is popular with a majority of Americans is that the alternative Trumpcare bills attempted by Republicans last year wouldn’t just make Americans sicker, they will kill more people. Approximately 17,000 people could have died if a House Republican health proposal endorsed by the Trump administration had become law in 2018, who otherwise would have lived. By 2026, the number of people killed by Trumpcare could have grown to approximately 29,000 in that year alone, according to ThinkProgress, progressive think tank.  It is backed up by a CBO estimate that 24 million more Americans could lose health insurance by 2026 under Trumpcare.

Trump’s assertion that he has “gutted” Obamacare in his attempt to sicken and kill more Americans simply isn’t true. In fact, those in most need of health care coverage, those earning less than the federal poverty line, $48,500 for an individual, and $100,400 for a family of four, are doing quite well, according to the latest assessment from the Centers for Medicare and Medicare Services that administers Obamacare.

 

Overall, according to the figures released by the agency, 10.6 million Americans had signed up for ACA coverage by February and paid their first month’s premium, according to the Los Angeles Times. That was about 3 percent ahead of the 10.3-million enrollment at the same moment in 2017, the agency sai

Unsubsidized customers responded to the challenge of higher premiums by abandoning their health coverage in droves, HHS reported. The trend began in 2017, after Trump’s inauguration. That year, subsidized enrollments fell by about 223,000, or 3 percent. But unsubsidized enrollments fell by 1.3 million, or 20 percent.

This is while subsidized enrollment (those receiving Advanced Premium Tax Credits, or APTC) was 23 percent larger than unsubsidized (non-APTC) in 2014 and 32 percent larger in 2016 — and reached 61 percent in 2017.

Trump’s answer to the premium increases caused by his own policies has been to undercut the law even further by eliminating the consumer protections that make health insurance worth buying. These include requirements that all policies cover essential health benefits such as maternity care, hospitalization and prescription drugs, and opening the marketplace further to short-term junk insurance that carries lower premiums but offers substandard coverage.

We are not even mentioning Trump’s efforts to abolish the exemption for existing illnesses, and take away the federal payments meant to subsidize states’ Medicaid programs, which will result in even higher health insurance premiums for everyone.

Who are President Trump and his Republican synchophants really killing with their heartlessness?  Those now above the poverty line—the increasing number of unsubsidized in the middle class.  And they can and will vote, on what has become the number one issue for voters in November.

A new Pew Research Center survey reports 60 percent of Americans say the government should be responsible for ensuring health care coverage for all Americans, compared with 38 percent who say this should not be the government’s responsibility. The share saying it is the government’s responsibility has increased from 51 percent last year and now stands at its highest point in nearly a decade.

So, Trump and your Republican supporters of big business, please go right ahead and keep up your efforts to repeal and replace Obamacare if you want to become irrelevant.  Voters in November will know what this means.

Harlan Green © 2018

Follow Harlan Green on Twitter: https://twitter.com/HarlanGreen