Last week, I visited the
Venice Family Clinic in Los Angeles near a public housing project in a poor
neighborhood. Two days later, I drove to a South Los Angeles area where pollution
from the freeway—not to mention mold, rat droppings, dust and
cockroaches—infest crowded apartments, causing asthma that sends children to
the nearby St. John’s Well Child and Family Center.
I visited St. John’s and the
Venice clinic while trying to make sense of the health care debate, which
should be dominating the presidential campaign but has so far failed to do so.
I was angry that Sen. Bernie Sanders’ Medicare-for-all plan, and other
Democratic contenders’ plans for health care reform, are being lost in campaign
news dominated by the ever-present, ever-bombastic Donald Trump. Unbelievably,
this demagogic liar and foe of democratic values, is calling the shots in the
presidential campaign.
To me, the clinics are a ray
of hope in the gloomy political scene. I had first visited them before
President Barack Obama was elected in 2008. Both were strapped for money back
then, with staffs and community supporters spending much of their time drumming
up contributions to support care for their predominantly Latino and African
American patients. Obamacare—the Affordable Care Act—pushed through by
then-President Obama and House Speaker Nancy Pelosi in 2010, changed the lives
of the clinics’ employees and their patients.
In both St. John’s and the
Venice Family Clinic, most of the working poor—defined as a family of four
earning $26,000 a year or less—now receive good medical care thanks to the
Affordable Care Act. At St. John’s, Chief Executive Officer Jim Mangia told me
how Obamacare had permitted expansion of Medi-Cal, the state’s program for
medical help to the poor, expanding it to include those who have jobs but can’t
afford a doctor, a dentist or an optometrist. The number of immigrants enrolled
at St. John’s doubled within two or three years of Obamacare’s passage. In
addition, several thousand more have purchased health insurance policies
through the Covered California exchanges created by Obamacare. “We doubled in
size,” Mangia said.
With $24 million from the
Affordable Care Act, St. John’s grew from nine clinics to 18, plus four new
health centers in public schools. St. John’s added vision care, endocrinology
and podiatry (the latter two fields badly needed for the diabetes that is
prevalent among that hospital’s patients). Mangia said doctors are seeing increased
signs of better health—lower blood sugar counts, lower blood pressure levels,
fewer children with asthma. “Our patients are learning to use the health care
system. People are getting a handle on their health,” he said. Patients are
exercising, eating healthy foods, taking their medicines. Family health habits
are improving, meaning that the children being treated at the clinic now will
likely become healthy adults.
At the Venice Family Clinic, I
met Dr. Rita Evazyan, one of the clinic’s dentists, who sees an average of 20
patients a day. In addition, there are dental hygienists who go to about 20
schools. “You’re busy,” I said. She agreed. Dental services have tripled in
size, said Elizabeth Forer, the clinic’s chief executive officer.
Forer showed me low sinks
where children learn proper tooth-brushing techniques. The result is there are
now 19- and 20-year-olds among their patients who don’t have cavities.
She showed me the kitchen,
where parents and their children learn to cook healthy foods. Fighting obesity
and food education go together. In the clinic’s modern facility, parents and
children learn to cook healthy meals and are educated about how good nutrition
improves all aspects of life. Feeling good, Forer said, encourages exercise and
helps children pay attention at school.
Throughout the nation, the
need for government-financed health care extends beyond the poor into the
middle class. As it stands, more than 27 million Americans are without health
insurance. Another 156 million, almost half of the United States population,
have health insurance from employers, and their combined situations worsen
every year.
In a May 2 article in The Los
Angeles Times, Noam N. Levey reported that “soaring deductibles and medical
bills are pushing millions of American families to the breaking point, fueling
an affordability crisis that is pulling in middle-class households with health
insurance, as well as the poor and uninsured. In the last 12 years, annual
deductibles in job-based health plans have nearly quadrupled and now average
more than $1,300.”
In a survey taken with the
Kaiser Family Foundation, the paper said one of six who get insurance through
work say they have had to make “difficult sacrifices” to pay for health care,
and one in five said health care costs have used up all or most of their
savings. Those losing a job probably lose insurance, too.
These fears resonate among
audiences of Americans following the current presidential campaign.
The Des Moines Register
recently sent reporters to 46 events in Iowa featuring presidential candidates
for the state’s January caucuses, the nation’s first contest of the 2020
campaign. “As it did during the 2018 (midterm) election, health care dominated”
the audience questions, the newspaper reported. In an NBC-Wall Street Journal
poll taken between April 28 and May 1, respondents said health care should be
government’s top priority.
These reactions repeated the
pattern of the 2018 congressional elections when Democrats won the House and
found that the voters were deeply concerned about health care.
It is possible, by looking
closely, to find differences on the health-care issue among the current crop of
candidates.
The most generous plan is that
advanced by Rep. Pramila Jayapal, a Washington Democrat and co-chair of the
Congressional Progressive Caucus. The best known is Sen. Sanders’
Medicare-for-all, a phrase he popularized when he ran for president in 2016. At
the time, it was considered the height of out-of-touch radicalism.
Sanders would put the present
Medicare and Medicaid schemes into a new universal government health plan that
would supplant Obamacare. It would replace most private health insurance,
including plans negotiated by unions, whose members may not want to give them
up. It would cover hospital visits, as well as primary care, medical devices,
laboratory services, maternity care, prescription drugs and vision and dental
care. There would be none of the fast-rising deductibles or out-pocket
expenses. Rep. Jayapal embraces these provisions but would add government
funding for long-term nursing care.
Presidential candidates Sens.
Kamala Harris, Cory Booker and Elizabeth Warren are co-sponsors of the Sanders
bill. Sen. Amy Klobuchar favors the expansion of Medicare and Medicaid, with
government-sponsored insurance plans—the public option—added to Obamacare.
All this would be financed by
higher taxes on the rich and large businesses. Sanders, for example, has
proposed a series of options that would tax offshore profits, impose a special
tax on the very rich, raise the estate tax, limit tax deductions for the
wealthy and impose tax increases that would hit the middle class.
Higher taxes for all might be
enough to sink the Sanders plan, but he argues that the elimination of payments
to insurance companies would more than make up for the higher tax levies.
I talked to Bill Carrick, a
veteran Democratic political consultant who organized focus groups for his
client Sen. Diane Feinstein’s successful reelection campaign in 2018. “These
were middle-class people,” he said. “They were not inclined to all-out opposition
for Medicare-for-all, they just didn’t think it would become law. But they were
very much interested in saving Obamacare.” They wanted provisions assuring
coverage for pre-existing conditions and a chance to buy into Medicare at an
earlier age. And they wanted government-sponsored insurance policies offered on
the Obamacare exchanges—the public option.
That option had been killed
during Obamacare’s rocky road to passage but would offer an alternative to the
increasingly expensive policies, with their high deductibles, available on the
exchanges. “Interestingly,” he said, “nobody wanted the government to take over
health insurance.”
I saw Obamacare at work in the
clinics I visited. It helps a lot but needs fixing. The middle class, oppressed
with increasing deductibles and higher premiums, needs immediate help. Many
more middle-class people should be eligible for subsidies on the Obamacare
exchanges. And the insurance industry, now profiting from Obamacare, requires
tough regulation.
That’s what the Democratic
presidential candidates should be advocating rather than letting the buffoon in
the White House bully them into defeat and low-grade health protection.
