The Uncertainty of Government Run Healthcare

October 22, 2019 by Dan McCue
The White House. (Photo by Dan McCue)

WASHINGTON – Accustomed as they are to believing government can do a great deal of good for a great many, serious Democrats have grown increasingly concerned over the potential long-term ramifications of Medicare for all proposals.

While it’s easy — and perhaps hopeful — to view President Donald Trump as an aberration on the American stage, no one can say for certain that there will never be another administration with a Trump-like figure in Oval Office or a vice president like Mike Pence, two men who are testing boundaries every day.

It’s ironic then that a few Democrats on the far left have reacted to the present by espousing a health care policy that could give such an administration even more power over Americans’ health care choices in the future.

Despite all the evidence to the contrary provided by the Trump White House, proponents of so-called single-payer plans like Medicare for all are intent on putting a national health care policy in place based on the total faith that government and government actors will always implement the law in good faith.

While there are arguably many lessons that can be drawn from the election of President Donald Trump, one that’s often overlooked is that he’s not necessarily a singular occurrence. At some point in the nation’s future, someone similar — or from the Democrats’ perspective, even worse, could again be elected president.

Somewhere down the line there might very well be another president like Trump in charge of the program, gaming the rules, and making Americans’ personal medical decisions for them.

What many find most troublesome is that the mechanism for this situation coming to pass is written into the text of H.R.1384, Medicare for All Act of 2019, introduced by Reps. Pramila Jayapal, D-Wash., and Debbie Dingell, D-Mich., in February.

The bill states that the Secretary of Health and Human Services, a presidential appointee, will be empowered to determine what treatments are “medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition.”

One area that is of particular concern, given the current political environment, is safeguarding a woman’s right to make her own health care decisions.

Proponents of Medicare for all maintain the bill would unwind the Hyde Amendment, the 1976  law that bars the use of taxpayer funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape.

But the bill offers no such assurances for restrictions adopted by a future administration after the enactment of Medicare for all, nor does even explicitly mention abortion, instead, making fleeting reference to coverage of “comprehensive reproductive, maternity, and newborn care.”

And as one moderate Democrat recently noted: “Reproductive care means something totally different to Mike Pence than it does to any Democrat.”

This point was driven home by a recent special report by Reuters that looked at the vice president’s outsized influence over federal health care programs.

As a member of Congress and governor of Indiana, Mike Pence pushed to reshape public health, building his policies from his Christian religious views.

“Now as vice president, Pence has a broader platform to push changes domestically and abroad,” the report says.

It goes on to detail how the Trump administration — “in a sweeping social policy shift” — has sought to remake health care rules for women and gay and transgender people, “restricting access to abortion, curtailing support for contraception and narrowing the scope of civil rights in healthcare.”

While the Trump administration very publicly failed to repeal and replace the Affordable Care Act, Pence has been quietly working behind the scenes to effect changes to health care policy in accordance with his evangelical Christian desire to restrict abortion and prioritize the rights of religious conservatives.

For instance, Reuters noted, under the direction of two secretaries recommended by Pence, the Department of Health and Human Services has moved to slash funds from teen pregnancy-prevention programs, curb abortion both in the United States and abroad and strip civil protections for transgender patients.

The administration has emphasized abstinence programs, led by appointees who believe contraception harms women, and pushed to cut government funds for Planned Parenthood – a longtime cause for Pence while he was in Congress.

More recently, the administration’s new Office of Conscience and Religious Freedom has unveiled a final “conscience rule” to strengthen protections for healthcare workers who object to performing abortions and sterilizations or treating gay and transgender patients.

Emboldened by this activity, the new conservative majority on the Supreme Court, and the large number of Trump nominees the Senate has approved for federal district and appellate court seats,  a number of conservative states, mostly in the Deep South, have passed laws in that nearly outlaw abortion.

The resulting legal challenges are now working their way through the legal system, though their ultimate outcome far from certain. And it’s entirely likely the federal judiciary will move even further to the right before the end of President Trump’s current term.

At present, the Affordable Care Act provides most Americans with protection from these changes. Unfortunately, Medicaid and Medicare recipients do have to comply with the administration’s changes in policy.

These issues aside, the broader concern is how much the Medicare for all bill leaves open to interpretation.

The bill empowers the HHS Secretary to annually evaluate the program to determine “whether the benefits package should be improved or adjusted” there’s considerable apprehension around the possible that what is deemed medically necessary under the Act by very well change as political power changes in Washington.

A recent analysis by the Kaiser Family Foundation concluded in general, Medicare for all would provide “comprehensive benefits,” accounting for health care needs as “medically necessary or appropriate.”

That means covering hospital and doctor visits, but also, for instance, mental health, maternity services, addiction treatment, pediatrics and medications.

But the foundation noted coverage under Medicare for all gets murky pretty quickly.

Again, because the Department of Health and Human Services would have significant discretion in interpreting what specific services are medically necessary, the politics and even the status of scientific debates over procedures and treatments could play a big role in what’s covered, “even from administration to administration,” the foundation noted.

As Dr. Adam Gaffney, a doctor and president of Physicians for a National Health Program, a single-payer advocacy group that supports the legislation, told the foundation, even “reasonable people could disagree on certain things.”

Which gets back to the larger philosophical question many Democrats are now grappling with — how do you hold on to your belief that government can do good things for American people when you’re living through the worst case scenario right now?

One way, centrist Democrats suggest, is to advance health care policies that don’t give up inherent protections Americans need.

And that means acknowledging that when it comes to something as personal as health care, the government can’t control every aspect; there have to be limits, some form of checks and balances, to ensure health care policy is not subject to political whim.

Health

Trump Rebukes CDC Chief for His Cautions on a Coronavirus Vaccine and Masks
Health
Trump Rebukes CDC Chief for His Cautions on a Coronavirus Vaccine and Masks

WASHINGTON — President Donald Trump contradicted one of his administration’s top scientists and announced Wednesday that widespread distribution of a coronavirus vaccine would begin as early as next month, further rattling the scientific and public health communities and stoking rival Joe Biden’s claim that Trump can’t... Read More

Congress Seeks a Clean Energy Economy While Recovering from Coronavirus Pandemic
Energy
Congress Seeks a Clean Energy Economy While Recovering from Coronavirus Pandemic
September 17, 2020
by Tom Ramstack

WASHINGTON -- Congress discussed proposals Wednesday to switch the United States to 100% clean energy as Western governors confronting out-of-control wildfires demand action on global warming. A House Energy and Commerce subcommittee is trying to figure out a way to recover jobs lost during the coronavirus... Read More

New York Launches COVID Response Team to Monitor City's Schools
Cities
New York Launches COVID Response Team to Monitor City's Schools
September 16, 2020
by Daniel Londono

NEW YORK, N.Y.- The City of New York on Monday implemented a new COVID "Response Team" to monitor the city's schools and hopefully prevent a resurgence of the coronavirus in one of the nation's hardest hit municipalities. The city's new COVID Response Situation Room is a... Read More

Despite Pressure for COVID-19 Relief Deal, Stalemate Continues
Congress
Despite Pressure for COVID-19 Relief Deal, Stalemate Continues

WASHINGTON — Speaker Nancy Pelosi on Tuesday headed a call from her members to commit to keeping the House in session until there’s a coronavirus relief deal, but the vow does little to break the stalemate in bipartisan negotiations that is at the heart of Democrats’... Read More

House Passes Legislation Aimed at Increasing Diversity in Schools
Education
House Passes Legislation Aimed at Increasing Diversity in Schools
September 16, 2020
by Sara Wilkerson

WASHINGTON - Today, the House of Representatives passed the Strength in Diversity Act 2020, legislation that will provide funding for voluntary desegregation initiatives across the country. The Strength in Diversity Act was brought to the House by Rep. Marcia Fudge, D-Ohio, and authored by Rep. Robert... Read More

Preparing for the Worst, Health Agencies Mount Unprecedented Flu Shot Drives
In The News
Preparing for the Worst, Health Agencies Mount Unprecedented Flu Shot Drives

WASHINGTON — If the United States has even a typical flu season that collides with a COVID-19 flare, the resulting public health nightmare could swamp the nation’s already strained health system. This year’s flu season could be milder than usual because of social distancing. And more... Read More

News From The Well
scroll top