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Inequality in the use of health care has increased dramatically in recent years, with wealthier Americans, who tend to be healthier, now consuming the most care, according to a study published today [Wednesday, July 6] in the July issue of Health Affairs.
In 2012, the wealthiest fifth of Americans got 43 percent more health care ($1,743 more per person) than the poorest fifth of Americans, and 23 percent more care ($1,082 per person) than middle-income people. (These figures are adjusted for the higher burden of illness among poor and middle-class people as compared to the wealthy.)
According to the study's authors, who analyzed 22 national surveys conducted over the past five decades, these numbers reflect a striking reversal of a long-term trend toward greater equality in health care use by all income groups. They marshal data showing that the turning point came in the mid-2000s.
Prior to the passage of Medicare and Medicaid in 1965, the wealthy got about twice as much care as the poor. Subsequently, care became more equal, with lower-income Americans using more care than the wealthy (although analyses adjusting for the greater burden of illness among lower-income people showed that the gap was never fully erased.)
But between 2004 and 2012, as the growth in medical spending slowed overall, the use of care by the wealthiest fifth of Americans grew by 19.7 percent, outpacing growth for middle-income groups by 57 percent. Meanwhile, care for the poorest fifth of Americans actually fell by 3.7 percent.
No upswing in health care inequality occurred among the elderly, virtually all of whom are covered by Medicare.
The researchers, who conducted their work at Harvard Medical School, the City University of New York at Hunter College, and Boston University, determined individuals' health care use based on the total costs of their care, whether paid by insurers, the patients themselves, or government programs. Results were similar when they looked at the use of specific services such as the number of doctor visits, which were 40 percent higher for the wealthy than for all other Americans by 2012.
In their study, the income threshold for the wealthiest fifth in 2012 was $101,094 for a family of three, while those in the poorest fifth had family incomes below $22,689. The 60 percent of Americans with incomes between these thresholds were considered middle-income.
The authors attribute their findings to the synergistic impact of widening U.S. income inequality, the 2007-2009 recession and the slow recovery for the poor and middle class, and a sharp rise in health insurance co-payments and deductibles that discourage non-wealthy Americans from seeking care.
According to lead author Dr. Samuel Dickman, who conducted his research at Harvard Medical School and who is now at San Francisco General Hospital: "We spend more on medical care than in any other country, and those dollars are increasingly concentrated on the wealthy, who have good insurance and enough cash to afford skyrocketing deductibles and co-payments. In recent years economists have celebrated a slowdown in health care cost growth. But the slowdown seems to have been achieved by forcing poor and middle-class Americans to choose between paying rent, buying groceries, or going to the doctor when they're sick."
Dr. David Himmelstein, a professor at the City University of New York at Hunter College and lecturer at Harvard Medical School who was the senior author of the study, commented: "While poor and middle-class patients are skipping vital care, the wealthy are getting unnecessary and even harmful care. And the widening inequalities in health care are reflected in rising inequality in death rates. Meanwhile, our overall life expectancy is falling further and further behind nations that distribute care based on need, not wealth. Our findings dramatize the urgent need for national health insurance - a single-payer reform with first-dollar coverage - that would assure that all Americans can get the care they need."
"Health Spending For Low-, Middle-, and High-Income Americans, 1963-2012," by Samuel L. Dickman, Steffie Woolhandler, Jacob Bor, Danny McCormick, David H. Bor, and David U. Himmelstein. Health Affairs, July 2016.
The abstract of the article is available here:
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
"It is clear that a lot of the progress that we have seen on awareness on climate change and positive movement on climate change is due to the fact that people have been demonstrating peacefully throughout the world."
The spokesperson for United Nations Secretary-General António Guterres on Monday commended climate activists in Germany after police raided their homes following months of traffic-disrupting protests against the government's failure to adequately address the climate emergency.
"Climate activists—led by the moral voice of young people—have continued to pursue their goals even in the darkest days," the spokesperson, Stéphane Dujarric told reporters in New York. "They need to be protected and we need them now more than ever."
"It is clear that a lot of the progress that we have seen on awareness on climate change and positive movement on climate change is due to the fact that people have been demonstrating peacefully throughout the world," he added.
"The government's approach is intended to intimidate and create fear. But we cannot and will not allow ourselves to remain in this fear."
Last Wednesday, around 170 masked and armed police officers raided the homes of activists from the Germany-based international direct action group Letzte Generation—or Last Generation—in seven German states while shutting down the organization's website and freezing multiple bank accounts.
Among those targeted were Last Generation spokesperson Carla Hinrichs, who said around two dozen armed police broke down the door of her apartment in Berlin's Kreuzberg district while she was in bed at around 7:00 am, with one officer pointing a gun at her.
"I'm afraid that this state is sending its civil servants with weapons drawn to storm my apartment," Hinrichs said in a video posted on Twitter. "But I'm even more afraid that it is letting us speed into this disaster without doing anything."
\u201cBREAKING: German police are staging the world's first nationwide raid on climate activists. The goal: shut down a group called "Last Generation" that engages in peaceful protest to save the planet.\n\nWill they also arrest the fossil fuel executives?\nhttps://t.co/W5RxXfmDmq\u201d— Steven Donziger (@Steven Donziger) 1685012163
No arrests were reported. However, authorities accused seven activists of raising at least $1.5 million to finance "criminal acts."
Police also claimed two Last Generation members are suspected of plotting to sabotage an oil pipeline running from the southern state of Bavaria to the Italian port of Trieste.
Last Generation has become a household name in Germany due to the group's nationwide acts of civil disobedience. Last week, activists blocked 12 streets in the capital Berlin, gluing themselves to the road and to vehicles, and enraging motorists and many other people.
In January, Last Generation was at the center of protests against the expansion of an open-pit coal mine in Lützerath, a depopulated village in the western state of North Rhine-Westphalia.
Members of the group made headlines last year after they threw mashed potatoes on a protected Claude Monet painting in the Museum Barberini in Potsdam.
\u201cClimate protesters from Last Generation threw mashed potato at Claude Monet\u2019s Les Meules (Haystacks) at Potsdam\u2019s Barberini Museum.\u201d— VICE World News (@VICE World News) 1666625542
Last Generation has also held protests in countries including Austria and Italy, where members poured charcoal in Rome's Trevi Fountain to demand an end to government fossil fuel subsidies.
Earlier this month, German Chancellor Olaf Scholz of the center-left Social Democratic Party called Last Generation's protest tactics "completely crazy."
In response, Last Generation asked when police would target "lobby structures and confiscate government fossil funds."
"The government's approach is intended to intimidate and create fear. But we cannot and will not allow ourselves to remain in this fear," the group said on its new website. "The federal government is leading us into climate hell and is stepping on the accelerator."
"What if payments begin and millions—literally millions—of people default on their debt?" the Debt Collective asked. "What if seniors get their Social Security checks garnished en masse?"
House Republicans weren't ultimately able to include a full repeal of President Joe Biden's pending student debt cancellation plan in the new debt ceiling agreement, but they did reach a deal with the Biden White House to insert a provision that campaigners say could be devastating for millions of borrowers across the country.
Tucked in the 99-page legislation that Congress could vote on this week is language prohibiting the education secretary from using "any authority to implement an extension" of the federal student loan repayment pause, which remains in place as the U.S. Supreme Court considers a pair of legal challenges to the Biden administration's debt relief plan.
If passed, the repayment pause enacted early in the Covid-19 pandemic and extended eight times—saving borrowers hundreds of billions of dollars in payments and interest—would be terminated 60 days after June 30, 2023 unless another extension is "expressly authorized" by Congress.
House Speaker Kevin McCarthy (R-Calif.)—who attended California State University, Bakersfield when tuition and fees were an inflation-adjusted $1,982—wasted little time touting the provision as he made the media rounds over the weekend, declaring in a Fox News appearance that the "pause is gone" if the debt ceiling bill passes.
Debt relief campaigners responded with alarm.
"This has huge and catastrophic financial implications for 50 million+ people," the Debt Collective, the nation's first debtors' union, wrote on Twitter.
The Biden White House had already pledged to end the student loan repayment pause 60 days after the Supreme Court decides the fate of student debt cancellation or 60 days after June 30—whichever comes first.
The debt ceiling agreement codifies that pledge into law, potentially complicating the White House's ability to authorize another pause if the Supreme Court agrees with the right-wing challengers' deeply flawed legal case and strikes down the administration's debt cancellation plan.
The Debt Collective pointed to that possibility late Monday, noting that the Biden administration "was gearing up to resume payments because they were going to simultaneously cancel lots of debt—20 million accounts zeroed out."
"Because of Covid's impact, the Biden admin said returning to repayment needed to be coupled with relief," the group wrote. "If SCOTUS rules student debt relief is legal, Biden can say he took action on student debt—the second-largest household debt in the country. The problem is, WE DON'T KNOW what SCOTUS will rule. We're still waiting. Basically this debt ceiling deal puts the cart before the horse."
"The debt-ceiling bill agreement reached by lawmakers is deeply harmful to millions of American families—the worst thing for borrowers would be a sudden and startling restart of payments."
Education Secretary Miguel Cardona insisted that, under the new agreement, the Biden administration would still retain the "ability to pause student loan payments should that be necessary in future emergencies."
But the Debt Collective warned that it could take the Biden administration weeks or months to implement another pause if it decided one was needed. The administration could also choose not to try to implement another freeze even if millions struggle to make payments.
"What if payments begin and millions—literally millions—of people default on their debt?" the Debt Collective asked. "What if seniors get their Social Security checks garnished en masse?"
\u201cThere's many more reasons to extend the pause, and absolutely no reason to let Republicans push Biden in a corner. Biden will try to tell you this is the fault of Republicans and there was nothing he could do. \n\nThat won't be true. It isn't true. The provision should go.\u201d— The Debt Collective \ud83d\udfe5 (@The Debt Collective \ud83d\udfe5) 1685396895
Due to funding shortfalls, the Education Department doesn't expect to have the capacity to begin collecting student debt payments again until October.
The financial firm Jefferies estimates that once federal student loan repayments begin, they will cost roughly 45 million borrowers a combined $18 billion per month, potentially having a significant impact on the broader U.S. economy in addition to placing major strain on individuals and families.
The average federal student loan payment in the U.S. is around $400 per month—though the Biden administration is working to finalize rules aimed at lessening that financial burden.
Natalia Abrams, president and founder of the Student Debt Crisis Center, said in a statement Monday that "it is imperative that lawmakers prioritize the wellbeing of millions of Americans by keeping payments paused until comprehensive and permanent debt cancellation is delivered."
"The debt-ceiling bill agreement reached by lawmakers is deeply harmful to millions of American families—the worst thing for borrowers would be a sudden and startling restart of payments," said Abrams. "Not only does it unnecessarily codify the end of pandemic relief measures that are still desperately needed, but it also sends a disheartening message that the ongoing efforts to assist borrowers are being rolled back before permanent relief promised by the Biden administration has been delivered."
"Congress must pass a clean debt ceiling bill. This is the only moral and just path forward for lawmakers."
With a vote to raise the U.S. debt limit expected as early as Wednesday, 175 environmental groups on Tuesday demanded Democrats in Congress reject President Joe Biden's deal with Republican lawmakers over "polluter giveaways" and other policies "that have no place in legislation addressing the country’s financial debt obligation."
"We urge Congress to pass a clean debt ceiling bill free of unnecessary poison pill riders that would harm disadvantaged communities, tribal nations and Indigenous Peoples, working families, and the physical environment," says the coalition's letter.
Addressed to Senate Majority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Hakeem Jeffries (D-N.Y.), the letter lays out specific reasons why the coalition opposes the negotiated package. The so-called Fiscal Responsibility Act would:
"Congress must pass a clean debt ceiling bill," argues the letter, signed by groups including the Center for Biological Diversity, People's Justice Council, Zero Hour, and 7 Directions of Service. "This is the only moral and just path forward for lawmakers."
Representatives from the organizations echoed that argument and called out the president for caving to the demands of Republicans who are willing to risk the nation's first-ever economically devastating default to attack crucial programs.
"The fact is that the proposed cuts in the debt ceiling negotiations are a moral failure. Why is it that our most vulnerable communities are always the ones to be sacrificed?" said the Rev. Michael Malcom, founder and executive director of People's Justice Council. "Biden made commitments to our most vulnerable communities. We have yet to see this commitment realized."
Zero Hour policy director Aaditi Lele also stressed that Congress can't pass a bill which "circumvents community demands to appease polluter profits," and asked, "Would a 'climate president' concede our health and safety as a bargaining chip?"
"What is Biden doing? By fast-tracking the Mountain Valley Pipeline in his debt ceiling proposal, he is sacrificing Indigenous and Appalachian communities like mine and fueling global climate catastrophe."
Crystal Cavalier, co-founder of 7 Directions of Service, a local Indigenous-led group opposed to the MVP, similarly said: "What is Biden doing? By fast-tracking the Mountain Valley Pipeline in his debt ceiling proposal, he is sacrificing Indigenous and Appalachian communities like mine and fueling global climate catastrophe."
"Congress needs to reject this dirtier-than-ever deal, pass a clean debt ceiling bill and protect people, not a handful of corrupt fossil fuel profiteers," Cavalier added, nodding to U.S. Sen. Joe Manchin's (D-W.Va.) "dirty deal" on the MVP and permitting reform.
Manchin, a top recipient of fossil fuel industry campaign cash, only supported the Inflation Reduction Act last year in exchange for Schumer promising to push through energy permitting reforms desired by polluters. Despite the senators' backroom agreement, frontline communities and progressives in Congress defeated versions of Manchin's dirty deal three times last year.
Opponents of the partially built-fracked gas pipeline in Virginia and West Virginia warn that completing it would require complex construction involving "incredibly complex and fragile" water crossings, and operating the MVP would threaten "the well-being of people, endangered species, streams, rivers, farms, national forests, and the planet."
On Tuesday, six Virginia Democrats—U.S. Reps. Don Beyer, Gerry Connolly, Jennifer McClellan, Bobby Scott, Abigail Spanberger, and Jennifer Wexton—said they were "incredibly disappointed the Mountain Valley Pipeline was included in the bipartisan budget agreement" and submitted to the House Rules Committee an amendment to remove the permitting provision.
\u201cYES!! There\u2019s now an amendment in the House that would strip the Mountain Valley Pipeline from the #DirtyDeal. \n\nWe can still stop this. Call your members of Congress and tell them to support this amendment now: (202) 224-3121\u201d— Jamie Henn (@Jamie Henn) 1685462195
"This provision is a free pass for the pipeline and sidesteps our nation's environmental laws and judicial review processes," said the lawmakers, highlighting climate and environmental justice concerns. "This project would disproportionately impact the most vulnerable among us, including low-income, elderly, and tribal and Indigenous communities throughout Virginia."
The House proposal is led by McClellan and Sen. Tim Kaine (D-Va.) plans to introduce an identical amendment in the Senate. While some Democrats aim to tweak the Fiscal Responsibility Act, campaigners are urging them to go even further.
"It's outrageous that the country's debt has been co-opted by Sen. Joe Manchin and Republicans so they can ram through fossil fuel projects and gut bedrock environmental laws that give voice to the public," the Center for Biological Diversity's Jean Su said Tuesday. "Any member of Congress who cares about environmental and social justice should reject this dangerous deal and demand a clean bill."