The Ghost of Ronald Reagan

There was a time, long ago, when there were no podcasts. In 1961 there was the vinyl LP that Ronald Reagan made, financed by the American Medical Association, of a speech he often gave, all about how Medicare, if passed, would be the end of America as we know it – “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.”

The American Medical Association sent copies of that LP to everyone they could, but in the 1980 presidential campaign, Jimmy Carter called out Reagan on that notion that a socialist dictatorship was coming. Medicare had been around for sixteen years by then and the political system hadn’t changed. Reagan bumbled about and finally said he never opposed Medicare, really – old folks should be cared for by this sort of program – but he was lying. The evidence was there, on vinyl. And he was who he was. He hated the idea of social insurance, a government safety net for everyone who is foolish enough to get old without being smart enough to get rich. If that happened, well, that was their problem. What about personal responsibility? We all should be free to succeed, or fail, and the consequences of either are ours alone. That’s what freedom is all about, and Medicare was socialized medicine. If it was passed, as it was four years after the release of his impassioned plea, our precious freedom would be gone forever.

Medicare actually was socialized medicine in a way, and our precious freedom wasn’t gone forever. Those over sixty-five ended up with a lot more freedom – they were free from worry about how the hell they’d be able pay for their inevitable increasing medical needs and still manage to live out their sunset years without ending up dead in the gutter next week. Reagan easily defeated Carter in 1980 and then never touched Medicare. By then, he knew better.

Ronald Reagan, however, had warned America about Bernie Sanders. Reagan said that Medicare will bring about a socialist dictatorship, and maybe it will actually do that. Bernie wants “Medicare for All” – but Medicare itself must end, right now, and Social Security too. There is Trump’s proposed budget. He says he will save them both. His budget will phase them out. Which is it? End them both, or freedom ends, or something. Or keep them both. Or just shrug. Trump is who he is. He just says things. Ignore him and move on.

But the ghost of Reagan is a bother. Helaine Olen discusses that:

Osmel Martinez Azcue wanted to do the right thing, for both his own health and the health of the nation. When the Florida resident came down with flu-like symptoms shortly after returning from a trip to China, he immediately went to a local hospital to get tested for coronavirus.

A few weeks later, according to the Miami Herald, Azcue received an invoice for more than $3,000. His insurer claims he’s responsible for $1,400 of the total. He’s expecting even more bills to arrive over the next few weeks.

We’re all fixated on the Trump administration’s day-late-and-billions-of-dollars-short response to the increasing likelihood that coronavirus will cause a public-health crisis in the United States. But the fact remains that even if the government were fully prepared, many Americans will face another barrier to receiving care that will make the crisis worse.

That barrier is their wallet.

That barrier is also a public health issue now:

Medicare-for-all is usually presented as a moral argument: The United States is the richest country ever known; it is not right that we don’t guarantee access to easily affordable and accessible health care like every other First World country.

 But this situation is not simply immoral – it also leaves the United States at a major disadvantage when it comes to combating global pandemics.

We don’t want people to be wondering whether they can afford to visit the doctor if they think they’ve got this contagious and possibly deadly disease. But by happenstance, ideology and shortsighted, penny-wise-pound-foolish thinking, we’ve set up a situation that will force many to do just that.

That’s a good way to make this much worse, but this is built into our healthcare systems in three ways:

According to the Kaiser Family Foundation, more than half of all workers with employer-provided health insurance face an annual individual deductible of more than $1,000. In a survey conducted with the Los Angeles Times, about half of respondents said they or a family member postponed needed care because they were worried they couldn’t afford the bill.

The situation can be even worse for people who purchase their insurance on the individual market. The average individual deductible for a plan purchased on an Affordable Care Act exchange is more than $4,000, and only about half of purchasers receive any help with that sum via cost-sharing subsidies. The Trump administration has compounded this financial quagmire by approving the sale of so-called junk insurance plans that place hard limits on how much the plan will pay out in hospital and pharmaceutical costs in return for a lower monthly premium – frequently leading to high bills that the plans may or may not cover.

There is also the growing problem of surprise medical bills. These occur when someone seeks treatment in an emergency – and I think we can all agree that suspected coronavirus is the definition of an emergency – from a hospital or other medical facility in their network, only to subsequently receive a bill from a doctor or lab affiliated with that institution that wasn’t in network after all.

That third oddity has been covered in the Los Angeles Times quite a bit, story after story of someone with great insurance off to an in-network hospital for this or that, but the hospital has saved money by subcontracting with cheaper independent doctors and staff on the weekends, not their own, whose services aren’t covered at all because, technically, those weekend guys are not in-network, even if the insured patient wasn’t told that at the time. Then there’s the surprise bill for twenty or thirty thousand dollars. The state legislature is working on some sort of law that would stop that. But there are lobbyists. The patient really should ask for the employment status of each person treating them. And so on and so forth.

Olen sees that this way:

Our system is set up to ensure that people prioritize their finances when they are sick. It’s the end result of the concept known as “skin in the game,” the idea – pitched by everyone from health-care wonks to insurance company insiders – that the way to get control of the high cost of American medical care is to turn the patient into a bargain-savvy shopper.

Instead of confronting the medical-industrial complex, the onus is on the sick person to fight the healthcare power. The result? People skip out on seeing the doctor, hoping things will get better. They cut their prescription pills in half because they can’t afford to get a refill. We are a country where people in their 20s die because they can’t afford their insulin bill. “The costs they have to incur are a real barrier to getting the care they need,” longtime Medicare-for-all advocate Wendell Potter explained to me.

Or, as Azcue told the Miami Herald, “How can they expect normal citizens to contribute to eliminating the potential risk of person-to-person spread if hospitals are waiting to charge us $3,270 for a simple blood test and a nasal swab?”

So now things will get worse:

Viruses and infectious diseases don’t check your deductibles, co-pays and network access before they strike. Doubters may claim that our nation can’t afford Medicare-for-all, but it’s increasingly likely that we are about to discover just how costly our current system really is.

But there’s another factor in all this, as Fortune’s Chris Morris explains here:

The Trump administration recently requested $2.5 billion in emergency funds to prepare the U.S. for a possible widespread outbreak of coronavirus. Critics, though, are pointing out that money might not be necessary if the administration hadn’t spent the past two years largely dismantling government units that were designed to protect against pandemics.

And that is exactly what happened:

The cuts started in 2018, as the White House focused on eliminating funding to Obama-era disease security programs. In March of that year, Rear Adm. Timothy Ziemer, whose job it was to lead the U.S. response in the event of a pandemic, abruptly left the administration and his global health security team was disbanded.

That same year, the Centers for Disease Control and Prevention (CDC) was forced to slash its efforts to prevent global disease outbreak by 80% as its funding for the program began to run out. The agency, at the time, opted to focus on 10 priority countries and scale back in others, including China.

Also cut was the Complex Crises Fund, a $30 million emergency response pool that was at the secretary of state’s disposal to deploy disease experts and others in the event of a crisis. (The fund was created by former Secretary of State Hillary Clinton.)

Overall in 2018, Trump called for $15 billion in reduced health spending that had previously been approved, as he looked at increasing budget deficits, cutting the global disease-fighting budgets of the CDC, National Security Council (NSC), Department of Homeland Security (DHS), and Health and Human Services (HHS) in the process.

And one thing leads to another:

While the CDC announced plans to test people with flu-like symptoms for COVID-19, those have been delayed and only three of the country’s 100 public-health labs have been able to test for coronavirus. The administration’s request for additional funding came roughly two weeks after officials said HHS was almost out of funding for its response to the virus.

And the week opened with this:

It’s now looking like coronavirus is threatening a potential public health emergency. And a battle has broken out between the White House and Democrats over how much money to allocate to the crisis, with the White House pushing for less than Democrats think is called for.

But at the core of this dispute is something that’s hasn’t yet gotten public exposure – and is potentially very troubling.

House Democrats are outraged by one aspect of the White House response in particular: The White House appears to have informed Democrats that they want to fund the emergency response in part by taking money from a program that funds low-income home heating assistance.

A document that the Trump administration sent to Congress indicates that the administration is transferring $37 million to emergency funding for the coronavirus response from the Low Income Home Energy Assistance Program, or LIHEAP, which funds heating for poor families.

Democrats see this as provoking budgetary bickering and unnecessary political friction at a time when a clean emergency appropriation could easily avoid both.

Democrats will try to protect those poor people from freezing to death. Their base will love that. Republicans will sneer at those “losers” who whine and always expect the government to save their lazy asses. Their base will love that. Eric Levitz adds this:

There is no rational explanation for the administration’s current position. The coronavirus represents a massive political liability for Trump, not least because of how indefensible his previous bouts of penny-pinching on public health now appear. There is no mass constituency for prioritizing opposition to infinitesimal increases in the national debt over pandemic prevention.

So this worked out this way:

On Wednesday, Senate Majority Leader Chuck Schumer unveiled an $8.5 billion emergency funding proposal, composed entirely of new spending. The Democrats’ counteroffer is not merely superior on the merits, but also a sound election-year messaging device: If the coronavirus creates major disruptions to American life, the Democratic Party will be able to say it demanded more ambitious preparations than the Republican president would allow; if the epidemic somehow peters out, no voters are going to reward Trump for holding the line against a $7 billion increase to the $1 trillion deficit.

Thus, the most plausible explanation for the White House’s stance is the neurosis of budget director Mick Mulvaney and his ideological kin. In the House, Mulvaney was that rare breed of a “small-government” crusader whose zeal for slashing spending didn’t spare the Pentagon. By most accounts, the man is a supply-side, deficit-hawk true believer.

Mick Mulvaney may be a zombie, one of the living dead, inhabited by the ghost of Ronald Reagan, but it was Donald Trump who settled the matter:

President Trump announced Wednesday that Vice President Pence will lead the administration’s response to the deadly coronavirus in an attempt to reassure the public amid growing concerns of a global health crisis and criticism that the United States has been slow to respond to the fast-moving outbreak.

The move came as a person in Northern California tested positive Wednesday for the virus, the first case in the United States that has no known link to foreign travel or contact with someone known to be infected – a sign the virus may be spreading in at least one location. Officials have begun tracing the contacts of the resident to find out how that person may have been infected and who else might have been exposed.

Trump made no mention of the new case Wednesday as he struck an optimistic tone about the virus.

But that was nonsense:

“We’ve had tremendous success, tremendous success beyond what many people would’ve thought,” the president said during a White House news conference that followed days of mixed messages, tumbling stocks and rising death tolls abroad driven by the coronavirus. “We’re very, very ready for this.”

The president declared that the risk to America was “very low” and predicted a swift end to the outbreak.

Trump’s positive message was at odds with the statements by top members of his administration in recent days who have warned of an unpredictable virus that could spread into communities and upend Americans’ daily lives.

The president was contradicted almost in real time by some of the government experts who flanked him as he stood in the White House press briefing room.

“We could be just one or two people over the next short period of time,” Trump said of the virus’s impact in the United States.

Minutes later, Health and Human Services Secretary Alex Azar and CDC Principal Deputy Director Anne Schuchat warned Americans to prepare for the number of cases to grow.

“We can expect to see more cases in the United States,” Azar said.

“We do expect more cases,” Schuchat said.

Which is it? It doesn’t matter. Trump is who he is. He just says things. Ignore him and move on:

The news conference quickly devolved into campaign-style attacks on Democrats, predictions of a stock market rally and self-congratulatory assessments of his handling of the crisis.

The president said he would be willing to accept more emergency funding than the $2.5 billion requested by his administration after lawmakers pushed for a more robust federal response. He also said he would consider new travel restrictions on other countries struggling to contain the outbreak, including South Korea and Italy.

“At a right time we may do that,” he said. “Right now it’s not the right time.”

He partly blamed Democrats for the drop in the stock market and attacked House Speaker Nancy Pelosi (D-Calif.) as “incompetent” after she had made disparaging comments about his handling of the coronavirus outbreak, dismissing the traditional bipartisan approach leaders take in the midst of natural disasters and public health emergencies while criticizing her for doing the same.

It was the usual angry nonsense:

Trump has made a direct connection between the virus and his political fortunes, accusing Democrats and the media of trying to harm his reelection chances by focusing on the outbreak.

Trump took to Twitter early Wednesday to accuse cable news channels of “doing everything possible to make the Coronavirus look as bad as possible, including panicking markets, if possible.”

This virus was nothing. His enemies made up all the bad stuff, to hurt him. And he said the markets crashed as soon as everyone saw Tuesday evening’s Democratic debate and what dangerous fools they were. The Dow dropped more than a thousand points Monday and almost nine hundred points more by the close of trading Tuesday afternoon. The debate in question started four hours later. But time is a mysterious thing. Or he just says things. Ignore him. Everyone does:

The president’s efforts to downplay the virus have focused on the fact that the United States has seen relatively few cases and, so far, no confirmed deaths. Trump has also contended that the virus was “very much under control” and has indicated it would be gone by April.

Multiple public health officials from the administration have contradicted that prediction. Asked if he agreed that the coronavirus would be gone by April, CDC Director Robert Redfield told Congress he didn’t.

The markets agreed. At that point the Dow futures showed that the market would open the next morning at least four hundred points lower, but that didn’t matter:

Trump, who praised Azar publicly Tuesday, has been skeptical of the secretary’s ability to handle the crisis, a senior administration official said. The president has been reluctant to oust him in part because he did not want to add to the sense of disarray, the official said.

Azar was blindsided by the decision to put Pence in charge of the coronavirus response, according to five people familiar with the situation, who said Azar learned of the decision only moments before the evening news conference…

The White House considered appointing a “czar” to oversee the government-wide response effort, a move that would essentially demote Azar from his role as the head of the coronavirus task force.

“I don’t anticipate one,” Azar told lawmakers earlier Wednesday when asked if a czar would be appointed. “This is working extremely well.”

Trump said his decision to put Pence in charge was not tantamount to appointing a czar, despite him taking a role that serves the same purpose.

“Mike is not a czar, he’s vice president,” the president said. “I’m having them report to Mike. Mike will report to me.”

Still, at the end of the news conference, Azar walked back to the lectern to clarify that he remained the chairman of the coronavirus task force and had not been demoted. He said he was actually “delighted” to have Pence overseeing the effort.

As Azar was speaking, Trump walked out of the room.

He can be a mean bastard. But so could Ronald Reagan. And he’s back.

About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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