Rep. Anna Eshoo,
I am in receipt of your Dec. 18 weekly report, wherein you describe the enormity of the Covid-19 calamity we are confronting.
You note that Covid-19 cases in California alone now surpass caseloads in whole nations like the United Kingdom, Germany and India. You go on to encourage people who don't have insurance for whatever reason to get it through the state-based health care exchange—Covered California—and nonchalantly note that almost 90 percent of those insured through Covered California qualify for a subsidy to help pay for the private health insurance plans sold through the exchange.
The ironic implication here, in case you missed it, is that about 90 percent of people who have no alternatives, and who therefore buy private health insurance through the exchanges, can't fully afford it. This is another way of saying that 10 years after the passage of the Affordable Care Act (ACA) and six years after its rollout, private health insurance affordability for millions of Americans remains dubious, to say the least.
In order to further promote this relatively high-cost insurance option, you have written a letter to the Administrator of the Centers for Medicare and Medicaid, which organize and regulate the ACA insurance exchanges nationally, to request an extension by at least two weeks of the enrollment period for 2021.
That letter states, in part, that “[m]illions of Americans have lost their jobs, upending their ability to access employer-based health insurance. … During this unprecedented health and employment crisis ... enrollment beyond Dec. 15 ... ensures fewer uninsured people will be hit by devastating health care bills.”
So, in the face of seismic disruptions in the lives of your constituents and the country, and in these unprecedented times, you are still incapable or unwilling to put forward solutions as momentous as the crisis you describe in your letter.
You may recall that in April 2019, I was part of a constituent delegation to your office advocating for universal, guaranteed and publicly-financed health care, referred to in the shorthand as “Medicare for All.” In that meeting, you spoke favorably of the predominant employer-based health insurance plans and the ACA, despite their ever-accelerating expense, ever-rising employee shares of costs and their restricted networks of providers.
Despite years of holding key positions in the Health Sub-Committee of the Energy and Commerce Committee, a strategic sub-committee you have chaired since January 2019, you feigned ignorance about the significance, or even the basic definition of, Medicare for All, despite the existence of pending bills in both the House (HR 1384) and the Senate (SB 1129). Indeed, you sounded like an onlooker or a bystander in health care debates, rather than a key policymaker and gatekeeper.
In order to wash your hands of the matter, you even falsely claimed to us that the Energy and Commerce Committee has no jurisdiction over Medicare.
Even after we presented the latest expert research showing that a Medicare for All-type system would lower overall projected health care costs, while covering all presently uninsured Americans, you indicated no interest but did say that the Medicare for All bills should be “scored” by the Congressional Budget Office (CBO) because as you noted “it is our duty as legislators to know.”
Well, the CBO has finally scored those bills and just last week issued its report.
The CBO estimates that, were a system very similar to that proposed in HR 1384 adopted today, total U.S. health care expenditures in 2030 would be about $340 billion below what they would be under current laws and arrangements.
But reduced cost is only half the story: the CBO calculations are for a system that would cover the 30 plus million Americans who currently have no insurance; fully insure the 40 plus millions Americans who currently are under-insured; and include services not currently provided by Medicare such as mental health care, vision care, dental care and, significantly, long term care services.
In other words, the CBO estimates that, as compared to current arrangements, a Medicare for All-type system would give 30 million Americans full coverage for the first time, 40 million others better coverage and give all of them more comprehensive services and still reduce total health care expenditures by several hundreds of billions of dollars per year in the next decade.
This is what your own Congressional research arm is telling you.
Now you know, Rep. Eshoo.
More than 90 percent of U.S. households and businesses would see significant health cost savings under such a rational public plan. The science tells us this is low-hanging fruit, a slam dunk as a public policy prescription. We get more and better while spending less. (You know, like shopping at Costco.)
The establishment Democratic leadership, of which you have been a part for more than a quarter-century, has in the Covid-19 era strongly and relentlessly emphasized the importance of science, especially in their rhetoric directed at the White House.
But, as anyone who has been paying attention can tell you, for more than a half-century, that leadership has consistently put wealthy donor and corporate interests ahead and above good public policy and the public good.
Your own record as the currently sitting all-time, all-star congressional recipient of drug, medical device and health product lobbyists’ money is a case in point. It pits you squarely against the type of health care reform that would so greatly benefit hundreds of thousands of District 18 constituents and tens of millions across the country.
Your affiliations and allegiances to donors first and foremost is why you and House Speaker Nancy Pelosi are alone among the 10-person, all-Democrat Bay Area congressional delegation who have not yet co-sponsored HR 1384. It also places you squarely against science on the matter.
Patriotism is the last refuge of scoundrels and “we can’t afford a single-payer system” is the last hideout of compromised politicians.
As tens and hundreds of millions struggle with inadequate health care coverage and its unbearable human and financial costs, the mounting evidence tells us unambiguously that a universal, guaranteed, publicly-financed health care system, i.e. improved and expanded Medicare, is the least costly and most humane path forward.
The CBO report clearly supports such a conclusion.
Anyone not on the payroll, or under the influence of, insurance companies, for-profit hospitals, drug and medical device companies or ideologically-motivated neoliberals, will tell you the real question is: “how can we afford not to adopt a single-payer system?”
Salem Ajluni, a San Jose resident, is an economist and a member of both the Santa Clara County Single Payer Health Care Coalition and the Silicon Valley Democratic Socialists of America. Opinions are the author’s own and do not necessarily reflect those of San Jose Inside. Send op-ed pitches to [email protected].