Tag Archives: Health Insurance

Sickcare is the Knife in the Heart of Employment–and the Economy

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By Charles Hugh Smith

Source: Of Two Minds

We need to change the incentives of the entire system, not just healthcare, but if we don’t start with healthcare, that financial cancer will drag us into national insolvency all by itself.

American Healthcare is a growth industry in the same way cancer is a growth industry: both keep growing until they kill the host, which in the case of healthcare is the U.S. economy.

While a great many individuals in the system care about improving the health of their patients, the healthcare system itself only cares about one thing: maximizing profits by any means available, including sending many patients to an early grave via medications which corporations declared “safe” and rigged the political-regulatory-research systems to comply.

I call this maximizing profits by any means available system sickcare, for obvious reasons: this system profits by managing sickness, i.e. chronic diseases, rather than addressing the causes, which in most chronic disorders trace back to lifestyle: SAD (standard American diet), poor fitness and a generally unhealthy lifestyle of convenience (i.e. sedentary), heavy work/financial stress and addictions to meds, drugs, social media, etc.

Sickcare’s single-minded profiteering would be bad enough if we could afford its spiraling ever higher cost, but we cannot: as I noted way back in 2011, Sickcare Will Bankrupt the Nation all by itself. three years ago I noted that U.S. Healthcare Isn’t Broken–It’s Fixed (5/26/18), as generic meds that cost $22.60 for a month’s supply are pushed by Big Pharma as branded meds for $1,120 per month. Such a deal!

I’ve been discussing employment recently, and one of my patrons pointed out the enormously negative impact sickcare costs have on employment. I covered the incredibly negative impact of soaring sickcare insurance costs on small business back in 2011: Here’s Why Small Business Isn’t Hiring, and Won’t be Hiring (7/11/11), but the same soaring-costs dynamic makes Corporate America reluctant to hire anyone in America, too.

You’d have to be insane to pick America as your global base, given the grossly asymmetrical cost of healthcare in the U.S. compared to our developed-world competitors in Europe and East Asia (Japan and South Korea). Sadly, the treatment for your insanity will be so costly in America that your psychiatric problems will soon be exacerbated by financial ruin.

Those with heavily subsidized healthcare insurance may not realize that insurance for a family can cost more than a wage earner’s entire monthly net income. This generates a perverse incentive (from the perspective of a healthy economy, as opposed to a corrupt, rigged economy run for the exclusive benefit of profiteers, fraudsters, speculators and political fixers) for one spouse to quit their jobs or cut their hours to reduce the household income to the point that federal subsidies (ObamaCare) kick in and pay much or most of the insanely overpriced sickcare insurance tab.

The subsidies are of course ultimately paid by the taxpayers; sickcare profiteers thank you.

Needless to say, employers facing monthly healthcare insurance costs of $1,500 for an employee earning $2,500 will be looking for automation or overseas alternatives. How can the employer afford to keep paying healthcare insurance costs that spiral far above the Consumer Price Index (CPI)? Ultimately these higher costs come out of the employee’s paycheck, as employers could have given raises but instead had to fork over all the dough to the sickcare profiteers.

One driver of wages’ ever-declining share of the national income is trillions of dollars have been siphoned off by sickcare. As the comparison chart below shows, the U.S. pays roughly $5,000 more per capita (per person) per year for healthcare than other equally developed nations: the U.S. pays $10,966 per person per year and the average paid by other developed nations pay roughly half: $5,697 per person per year.

330 million Americans X $5,000 is $1.65 trillion a year. No wonder wages have gone nowhere for decades and corporations couldn’t wait to offshore jobs in America. (Not that the Corporate America needed much more of an incentive to offshore U.S. jobs, but let’s recognize that sickcare costs put American companies at a huge global disadvantage.)

Please examine the chart below of healthcare expenses per capita (per person) in the U.S. from 2000 to 2018 (the last year available on the St. Louis Federal Reserve database). I’ve marked up the chart to indicate where healthcare costs per capita would be if healthcare had tracked the Consumer Price Index (CPI) for the past two decades.

Strikingly, the cost had U.S. healthcare risen by the same percentage as everything else–$5,852 per capita per year–is very close to the average costs in comparable developed nations: $5,697 per capita per year. Instead, U.S. healthcare costs per person were $9,000 per year as of 2018.

The third chart shows that the results of this asymmetric expenditure on health hasn’t done much in terms of life expectancy or other broad measures of national health and well-being. America is Number One in costs but far down the list of life expectancy and other measures of well-being.

The human and financial costs of this sick system are pervasive. Those trying to provide care within the sickcare system’s perverse incentives are burning out (see last chart), and businesses are crushed by ever-higher costs for everything related to healthcare. The “solution” for employers is to push more of the insane cost increases onto employees, who are already staggering under the weight of stagnant wages and skyrocketing inflation in sectors other than healthcare.

Small business entrepreneurs end up not hiring any workers because they can’t afford to provide the mandated healthcare. Having to do all the work needed to keep the business afloat burns out the owners and they close the business, to the detriment of their community and the local government, which loses the tax revenues generated by the enterprise.

Here’s a real-world example of how healthcare has become unaffordable for employers: in the mid-1980s I could buy comprehensive healthcare insurance for my single employees (mostly young) for 6 hours’ pay for the average employee and 4 hours of my pay. (My partner and I paid all the healthcare insurance costs, the employees paid zero, I’m just using the hours and pay as a means of measuring the cost of healthcare in terms of the purchasing power of wages.)

Can an employer buy equivalent comprehensive healthcare insurance today for 6 hours’ of the employees’ pay? No, not even close. (Note that I’m talking about real insurance, not bogus simulacra of insurance, i.e. catastrophic coverage.)

Sickcare is a win for the sickcare profiteers and a loss for employers, employees, communities, government and the nation. Like cancer, sickcare will keep growing until it kills the host. We’re getting close.

Sickcare is the knife in the heart of employment. Sickcare puts the nation at a tremendous competitive disadvantage, crushes small businesses and generates perverse incentives to automate and offshore jobs just to get out from underneath the dead weight of ever-higher sickcare costs.

We need a whole new approach to healthcare that includes every aspect of American culture, society, education, economics and governance. We need to ditch SAD (standard American diet) and our unhealthy lifestyle, and incentivize improving health from the ground up rather than generating chronic lifestyle diseases such as metabolic disorders and then managing these disorders as a means of maximizing profits. The national goal should not be profiting from an over-medicated populace, it should be eliminating the need for medications. (A healthy person has no need for handfuls of medications.) Rather than profit from 74% of the populace being overweight and 40% being obese, the national goal should be to eliminate lifestyle diseases entirely by changing behaviors and incentives, not costly procedures and medications. That would free healthcare to serve those suffering from non-lifestyle diseases.

As Charlie Munger famously noted, “”Show me the incentive and I will show you the outcome.” That’s how humans operate: we respond to the incentives presented, even if they diminish the health of the populace and bankrupt the nation. We need to change the incentives of the entire system, not just healthcare, but if we don’t start with healthcare, that financial cancer will drag us into national insolvency all by itself.

‘What More Do You Need to Know?’ Health Insurance Stocks Drive Wall Street Rebound on Biden Super Tuesday Wins

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“Biden is the preferred candidate for the financial markets.”

By Eoin Higgins

Source: CommonDreams

Health insurance industry stocks surged Wednesday morning in the wake of former Vice President Joe Biden’s strong showing in the Democratic presidential primary’s Super Tuesday contests, opening up 600 points after traders appeared to bet the candidate’s resurgence would box out any chance of single-payer universal healthcare.

“What more do you need to know,” tweeted journalist Jack Mirkinson of the market’s spike.

Sanders has made Medicare for All a centerpiece of his campaign. The healthcare industry has poured millions in ad buys against Sanders after the Vermont senator won primaries in Iowa, New Hampshire, and Nevada.

“The industry has long seen Biden as their white knight,” said Dr. Adam Gaffney, the president of Physicians for a National Health Program and an outspoken Medicare for All advocate.

Biden on Tuesday won at least nine of the 14 states up for grabs to Sanders’ four. At press time, Maine was yet to be called, with Sanders and Biden locked in a razor-thin contest.

The market surge came after a rough week for the stock market, which at the end of February saw its biggest decline since the 2008 financial crisis after fears of the economic cost of a worldwide coronvirus pandemic increased.

Business commentators also made the connection between Sanders’ victories in the early primary states, particularly in Nevada, and the market’s poor performance last week.

On Fox Business February 28, billionaire Steve Forbes remarked that the weeklong drop was not only about fears of the coronavirus.

“There’s the political side,” Forbes said of the reason for the poor performance. “In the last week, week-and-a-half, the possibility of Bernie Sanders becoming president of the United States has increased, exponentially.”

According to the Washington Post:

Stocks of healthcare companies roared in response to Biden’s performance. Cigna was up more than 10 percent in morning trading, while UnitedHealth Group rose nearly 12 percent. Humana jumped 1.25 percent and Anthem soared nearly 14 percent.

Investor Ed Yardeni told the Post that Wednesday’s spike was a correction to earlier fears of what he called “Bernie Sanders’ socialist program.”

“The market’s sell-off last week on Sanders’ primary victories and rebound on Monday after Biden’s big win in South Carolina and this morning after Super Tuesday suggest that domestic U.S. politics may matter as much as the global health crisis on investors,” said Yardeni.

As Common Dreams reported, the results—which saw billionaire Michael Bloomberg and Sen. Elizabeth Warren (D-Mass.) coming in far behind the two frontrunners—transformed a once-crowded primary into a two-man race. Though Biden put up a good showing, exit polls from the contests showed a majority of Democratic voters backing the elimination of private insurance in favor of a government-run system guaranteeing healthcare for all.

National (In)Security In the United States of Inequality

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By Rajan Menon

Source: Unz Review

So effectively has the Beltway establishment captured the concept of national security that, for most of us, it automatically conjures up images of terrorist groups, cyber warriors, or “rogue states.” To ward off such foes, the United States maintains a historically unprecedented constellation of military bases abroad and, since 9/11, has waged wars in Afghanistan, Iraq, Syria, Libya, and elsewhere that have gobbled up nearly $4.8 trillion. The 2018 Pentagon budget already totals $647 billion — four times what China, second in global military spending, shells out and more than the next 12 countries combined, seven of them American allies. For good measure, Donald Trump has added an additional $200 billion to projected defense expenditures through 2019.

Yet to hear the hawks tell it, the United States has never been less secure. So much for bang for the buck.

For millions of Americans, however, the greatest threat to their day-to-day security isn’t terrorism or North Korea, Iran, Russia, or China. It’s internal — and economic. That’s particularly true for the 12.7% of Americans (43.1 million of them) classified as poor by the government’s criteria: an income below $12,140 for a one-person household, $16,460 for a family of two, and so on… until you get to the princely sum of $42,380 for a family of eight.

Savings aren’t much help either: a third of Americans have no savings at all and another third have less than $1,000 in the bank. Little wonder that families struggling to cover the cost of food alone increased from 11% (36 million) in 2007 to 14% (48 million) in 2014.

The Working Poor

Unemployment can certainly contribute to being poor, but millions of Americans endure poverty when they have full-time jobs or even hold down more than one job. The latest figures from the Bureau of Labor Statistics show that there are 8.6 million“working poor,” defined by the government as people who live below the poverty line despite being employed at least 27 weeks a year. Their economic insecurity doesn’t register in our society, partly because working and being poor don’t seem to go together in the minds of many Americans — and unemployment has fallen reasonably steadily. After approaching 10% in 2009, it’s now at only 4%.

Help from the government? Bill Clinton’s 1996 welfare “reform” program , concocted in partnership with congressional Republicans, imposed time limits on government assistance, while tightening eligibility criteria for it. So, as Kathryn Edin and Luke Shaefer show in their disturbing book, $2.00 a Day: Living on Almost Nothing in America, many who desperately need help don’t even bother to apply. And things will only get worse in the age of Trump. His 2019 budget includes deep cuts in a raftof anti-poverty programs.

Anyone seeking a visceral sense of the hardships such Americans endure should read Barbara Ehrenreich’s 2001 book Nickel and Dimed: On (Not) Getting By in America. It’s a gripping account of what she learned when, posing as a “homemaker” with no special skills, she worked for two years in various low-wage jobs, relying solely on her earnings to support herself. The book brims with stories about people who had jobs but, out of necessity, slept in rent-by-the-week fleabag motels, flophouses, or even in their cars, subsisting on vending machine snacks for lunch, hot dogs and instant noodles for dinner , and forgoing basic dental care or health checkups. Those who managed to get permanent housing would choose poor, low-rent neighborhoods close to work because they often couldn’t afford a car. To maintain even such a barebones lifestyle, many worked more than one job.

Though politicians prattle on about how times have changed for the better, Ehrenreich’s book still provides a remarkably accurate picture of America’s working poor. Over the past decade the proportion of people who exhausted their monthly paychecks just to pay for life’s essentials actually increased from 31% to 38%. In 2013, 71% of the families that had children and used food pantries run by Feeding America, the largest private organization helping the hungry, included at least one person who had worked during the previous year. And in America’s big cities, chiefly because of a widening gap between rent and wages, thousands of working poor remain homeless, sleeping in shelters, on the streets, or in their vehicles, sometimes along with their families. In New York City, no outlier when it comes to homelessness among the working poor, in a third of the families with children that use homeless shelters at least one adult held a job.

The Wages of Poverty

The working poor cluster in certain occupations. They are salespeople in retail stores, servers or preparers of fast food, custodial staff, hotel workers, and caregivers for children or the elderly. Many make less than $10 an hour and lack any leverage, union or otherwise, to press for raises. In fact, the percentage of unionized workers in such jobs remains in the single digits — and in retail and food preparation, it’s under 4.5%. That’s hardly surprising, given that private sector union membership has fallen by 50% since 1983 to only 6.7% of the workforce.

Low-wage employers like it that way and — Walmart being the poster child for this — work diligently to make it ever harder for employees to join unions. As a result, they rarely find themselves under any real pressure to increase wages, which, adjusted for inflation, have stood still or even decreased since the late 1970s. When employment is “at-will,” workers may be fired or the terms of their work amended on the whim of a company and without the slightest explanation. Walmart announced this year that it would hike its hourly wage to $11 and that’s welcome news. But this had nothing to do with collective bargaining; it was a response to the drop in the unemployment rate, cash flows from the Trump tax cut for corporations (which saved Walmart as much as $2 billion), an increase in minimum wages in a number of states, and pay increases by an arch competitor, Target. It was also accompanied by the shutdown of 63 of Walmart’s Sam’s Club stores, which meant layoffs for 10,000 workers. In short, the balance of power almost always favors the employer, seldom the employee.

As a result, though the United States has a per-capita income of $59,500 and is among the wealthiest countries in the world, 12.7% of Americans (that’s 43.1 million people), officially are impoverished. And that’s generally considered a significant undercount. The Census Bureau establishes the poverty rate by figuring out an annual no-frills family food budget, multiplying it by three, adjusting it for household size, and pegging it to the Consumer Price Index. That, many economists believe, is a woefully inadequate way of estimating poverty. Food prices haven’t risen dramatically over the past 20 years, but the cost of other necessities like medical care (especially if you lack insurance) and housing have: 10.5% and 11.8% respectively between 2013 and 2017 compared to an only 5.5% increase for food.

Include housing and medical expenses in the equation and you get the Supplementary Poverty Measure (SPM), published by the Census Bureau since 2011. It reveals that a larger number of Americans are poor: 14% or 45 million in 2016.

Dismal Data

For a fuller picture of American (in)security, however, it’s necessary to delve deeper into the relevant data, starting with hourly wages, which are the way more than 58%of adult workers are paid. The good news: only 1.8 million, or 2.3% of them, subsist at or below minimum wage. The not-so-good news: one-third of all workers earn less than $12 an hour and 42% earn less than $15. That’s $24,960 and $31,200 a year. Imagine raising a family on such incomes, figuring in the cost of food, rent, childcare, car payments (since a car is often a necessity simply to get to a job in a country with inadequate public transportation), and medical costs.

The problem facing the working poor isn’t just low wages, but the widening gap between wages and rising prices. The government has increased the hourly federal minimum wage more than 20 times since it was set at 25 cents under the 1938 Fair Labor Standards Act. Between 2007 and 2009 it rose to $7.25, but over the past decade that sum lost nearly 10% of its purchasing power to inflation, which means that, in 2018, someone would have to work 41 additional days to make the equivalent of the 2009 minimum wage.

Workers in the lowest 20% have lost the most ground, their inflation-adjusted wages falling by nearly 1% between 1979 and 2016, compared to a 24.7% increase for the top 20%. This can’t be explained by lackluster productivity since, between 1985 and 2015, it outstripped pay raises, often substantially, in every economic sector except mining.

Yes, states can mandate higher minimum wages and 29 have, but 21 have not, leaving many low-wage workers struggling to cover the costs of two essentials in particular: health care and housing.

Even when it comes to jobs that offer health insurance, employers have been shifting ever more of its cost onto their workers through higher deductibles and out-of-pocket expenses, as well as by requiring them to cover more of the premiums. The percentage of workers who paid at least 10% of their earnings to cover such costs — not counting premiums — doubled between 2003 and 2014.

This helps explain why, according to the Bureau of Labor Statistics, only 11% of workers in the bottom 10% of wage earners even enrolled in workplace healthcare plans in 2016 (compared to 72% in the top 10%). As a restaurant server who makes $2.13 an hour before tips — and whose husband earns $9 an hour at Walmart — put it, after paying the rent, “it’s either put food in the house or buy insurance.”

The Affordable Care Act, or ACA (aka Obamacare), provided subsidies to help people with low incomes cover the cost of insurance premiums, but workers with employer-supplied healthcare, no matter how low their wages, weren’t covered by it. Now, of course, President Trump, congressional Republicans, and a Supreme Court in which right-wing justices are going to be even more influential will be intent on poleaxing the ACA.

It’s housing, though, that takes the biggest bite out of the paychecks of low-wage workers. The majority of them are renters. Ownership remains for many a pipe dream. According to a Harvard study, between 2001 and 2016, renters who made $30,000-$50,000 a year and paid more than a third of their earnings to landlords (the threshold for qualifying as “rent burdened”) increased from 37% to 50%. For those making only $15,000, that figure rose to 83%.

In other words, in an ever more unequal America, the number of low-income workers struggling to pay their rent has surged. As the Harvard analysis shows, this is, in part, because the number of affluent renters (with incomes of $100,000 or more) has leapt and, in city after city, they’re driving the demand for, and building of, new rental units. As a result, the high-end share of new rental construction soared from a third to nearly two-thirds of all units between 2001 and 2016. Not surprisingly, new low-income rental units dropped from two-fifths to one-fifth of the total and, as the pressure on renters rose, so did rents for even those modest dwellings. On top of that, in places like New York City, where demand from the wealthy shapes the housing market, landlords have found ways — some within the law, others not — to get rid of low-income tenants.

Public housing and housing vouchers are supposed to make housing affordable to low-income households, but the supply of public housing hasn’t remotely matched demand. Consequently, waiting lists are long and people in need languish for years before getting a shot — if they ever do. Only a quarter of those who qualify for such assistance receive it. As for those vouchers, getting them is hard to begin with because of the massive mismatch between available funding for the program and the demand for the help it provides. And then come the other challenges: finding landlords willing to accept vouchers or rentals that are reasonably close to work and not in neighborhoods euphemistically labelled “distressed.”

The bottom line: more than 75% of “at-risk” renters (those for whom the cost of rent exceeds 30% or more of their earnings) do not receive assistance from the government. The real “risk” for them is becoming homeless, which means relying on shelters or family and friends willing to take them in.

President Trump’s proposed budget cuts will make life even harder for low-income workers seeking affordable housing. His 2019 budget proposal slashes $6.8 billion(14.2%) from the resources of the Department of Housing and Urban Development’s (HUD) by, among other things, scrapping housing vouchers and assistance to low-income families struggling to pay heating bills. The president also seeks to slash funds for the upkeep of public housing by nearly 50%. In addition, the deficits that his rich-come-first tax “reform” bill is virtually guaranteed to produce will undoubtedly set the stage for yet more cuts in the future. In other words, in what’s becoming the United States of Inequality, the very phrases “low-income workers” and “affordable housing” have ceased to go together.

None of this seems to have troubled HUD Secretary Ben Carson who happily ordered a $31,000 dining room set for his office suite at the taxpayers’ expense, even as he visited new public housing units to make sure that they weren’t too comfortable (lest the poor settle in for long stays). Carson has declared that it’s time to stop believing the problems of this society can be fixed merely by having the government throw extra money at them — unless, apparently, the dining room accoutrements of superbureaucrats aren’t up to snuff.

Money Talks

The levels of poverty and economic inequality that prevail in America are not intrinsic to either capitalism or globalization. Most other wealthy market economies in the 36-nation Organization for Economic Cooperation and Development (OECD) have done far better than the United States in reducing them without sacrificing innovation or creating government-run economies.

Take the poverty gap, which the OECD defines as the difference between a country’s official poverty line and the average income of those who fall below it. The United States has the second largest poverty gap among wealthy countries; only Italy does worse.

Child poverty? In the World Economic Forum’s ranking of 41 countries — from best to worst — the U.S. placed 35th. Child poverty has declined in the United States since 2010, but a Columbia University report estimates that 19% of American kids (13.7 million) nevertheless lived in families with incomes below the official poverty line in 2016. If you add in the number of kids in low-income households, that number increases to 41%.

As for infant mortality, according to the government’s own Centers for Disease Control, the U.S., with 6.1 deaths per 1,000 live births, has the absolute worst record among wealthy countries. (Finland and Japan do best with 2.3.)

And when it comes to the distribution of wealth, among the OECD countries only Turkey, Chile, and Mexico do worse than the U.S.

It’s time to rethink the American national security state with its annual trillion-dollar budget. For tens of millions of Americans, the source of deep workaday insecurity isn’t the standard roster of foreign enemies, but an ever-more entrenched system of inequality, still growing, that stacks the political deck against the least well-off Americans. They lack the bucks to hire big-time lobbyists. They can’t write lavish checks to candidates running for public office or fund PACs. They have no way of manipulating the myriad influence-generating networks that the elite uses to shape taxation and spending policies. They are up against a system in which money truly does talk — and that’s the voice they don’t have. Welcome to the United States of Inequality.

 

Rajan Menon, a TomDispatch regular, is the Anne and Bernard Spitzer Professor of International Relations at the Powell School, City College of New York, and Senior Research Fellow at Columbia University’s Saltzman Institute of War and Peace Studies. He is the author, most recently, of The Conceit of Humanitarian Intervention 

Financial Tyranny: ‘We the People’ Are the New Permanent Underclass in America

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By John W. Whitehead

Source: The Rutherford Institute

“When plunder becomes a way of life for a group of men in a society, over the course of time they create for themselves a legal system that authorizes it and a moral code that glorifies it.” ― Frédéric Bastiat, French economist

Americans can no longer afford to get sick and there’s a reason why.

That’s because a growing number of Americans are struggling to stretch their dollars far enough to pay their bills, get out of debt and ensure that if and when an illness arises, it doesn’t bankrupt them.

This is a reality that no amount of partisan political bickering can deny.

Many Americans can no longer afford health insurance, drug costs or hospital bills. They can’t afford to pay rising healthcare premiums, out-of-pocket deductibles and prescription drug bills.

They can’t afford to live, and now they can’t afford to get sick or die, either.

To be clear, my definition of “affordable healthcare” is different from the government’s. To the government, you can “afford” to pay for healthcare if your income falls above the poverty line. That takes no account of rising taxes, the cost of living, the cost to clothe and feed a household, the cost of transportation and communication and education, or any of the other line items that add up to a life worth living.

As Helaine Olen points out in The Atlantic:

“Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010.”

For too many Americans, achieving any kind of quality of life has become a choice between putting food on the table and paying one’s bills or health care coverage.

It’s a gamble any way you look at it, and the medical community is not helping.

Healthcare costs are rising, driven by a medical, insurance and pharmaceutical industry that are getting rich off the sick and dying.

Indeed, Americans currently pay $3.4 trillion a year for medical care. We spent more than $10,000 per person on health care in 2016. Those attempting to shop for health insurance coverage right now are understandably experiencing sticker shock with premiums set to rise 34% in 2018. It’s estimated that costs may rise as high as $15,000 by 2023.

As Bloomberg reports, “Rising health-care costs are eating up the wage gains won by American workers, who are being asked by their employers to pick up more of the heftier tab… The cost of buying health coverage at work has increased faster than wages and inflation for years, pressuring household budgets.”

Appallingly, Americans spend more than any developed country on healthcare and have less to show for it. We don’t live as long, we have higher infant mortality rates, we have fewer hospital and physician visits, and the quality of our healthcare is generally worse. We also pay astronomical amounts for prescription drugs, compared to other countries.

Whether or not you’re insured through an employer, the healthcare marketplace, a government-subsidized program such as Medicare or Medicaid, or have no health coverage whatsoever, it’s still “we the consumers” who have to pay to subsidize the bill whenever anyone gets sick in this country. And that bill is a whopper.

While Obamacare (a.k.a. the Affordable Care Act) may have made health insurance more accessible to greater numbers of individuals, it has failed to make healthcare any more affordable.

Why?

As journalist Laurie Meisler concludes, “One big reason U.S. health care costs are so high: pharmaceutical spending. The U.S. spends more per capita on prescription medicines and over-the-counter products than any other country.”

One investigative journalist spent seven months analyzing hundreds of bills from hospitals, doctors, drug companies, and medical equipment manufacturers. His findings confirmed what we’ve known all along: health care in America is just another way of making corporations rich at consumer expense.

An examination of an itemized hospital bill (only available upon request) revealed an amazing amount of price gouging. Tylenol, which you can buy for less than $10 for a bottle, was charged to the patient at a rate of $15 per pill, for a total of $345 for a hospital stay. $8 for a plastic bag to hold the patient’s personal items and another $8 for a box of Kleenex. $23 for a single alcohol swab. $53 per pair for non-sterile gloves (adding up to $5,141 for the entire hospital stay). $10 for plastic cup in which to take one’s medicine. $93 for the use of an overhead light during a surgical procedure. $39 each time you want to hold your newborn baby. And $800 for a sterile water IV bag that costs about a dollar to make.

This is clearly not a problem that can be remedied by partisan politics.

The so-called Affordable Care Act pushed through by the Obama administration is proving to be anything but affordable for anyone over the poverty line. And the Trump administration’s “fixes” promise to be no better. Indeed, for too many Americans who live paycheck to paycheck and struggle just to get by, the tax penalty for not having health insurance will actually be cheaper than trying to find affordable coverage that actually pays for care.

This is how the middle classes, who fuel the nation’s economy and fund the government’s programs, get screwed repeatedly.

When almost 60% of Americans are so financially strapped that they don’t have even $500 in savings and nothing whatsoever put away for retirement, and yet they are being forced to pay for government programs that do little to enhance their lives, we’re not living the American dream.

We’re living a financial nightmare.

We have no real say in how the government runs, or how our taxpayer funds are used, but that doesn’t prevent the government from fleecing us at every turn and forcing us to pay for endless wars that do more to fund the military industrial complex than protect us, pork barrel projects that produce little to nothing, and a police state that serves only to imprison us within its walls.

We have no real say, but we’re being forced to pay through the nose, anyhow.

George Harrison, who died 16 years ago this month, summed up this outrageous state of affairs in his song Taxman:

If you drive a car, I’ll tax the street,
If you try to sit, I’ll tax your seat.
If you get too cold I’ll tax the heat,
If you take a walk, I’ll tax your feet.

Don’t ask me what I want it for
If you don’t want to pay some more
‘Cause I’m the taxman, yeah, I’m the taxman

Now my advice for those who die
Declare the pennies on your eyes
‘Cause I’m the taxman, yeah, I’m the taxman
And you’re working for no one but me.

In other words, in the eyes of the government, “we the people, the voters, the consumers, and the taxpayers” are little more than indentured servants and sources of revenue.

If you have no choice, no voice, and no real options when it comes to the government’s claims on your property and your money, you’re not free.

Consider: The government can seize your home and your car (which you’ve bought and paid for) over nonpayment of taxes. Government agents can freeze and seize your bank accounts and other valuables if they merely “suspect” wrongdoing. And the IRS insists on getting the first cut of your salary to pay for government programs over which you have no say.

It wasn’t always this way, of course.

Early Americans went to war over the inalienable rights described by philosopher John Locke as the natural rights of life, liberty and property.

It didn’t take long, however—a hundred years, in fact—before the American government was laying claim to the citizenry’s property by levying taxes to pay for the Civil War. As the New York Times reports, “Widespread resistance led to its repeal in 1872.”

Determined to claim some of the citizenry’s wealth for its own uses, the government reinstituted the income tax in 1894. Charles Pollock challenged the tax as unconstitutional, and the U.S. Supreme Court ruled in his favor. Pollock’s victory was relatively short-lived. Members of Congress—united in their determination to tax the American people’s income—worked together to adopt a constitutional amendment to overrule the Pollock decision.

On the eve of World War I, in 1913, Congress instituted a permanent income tax by way of the 16th Amendment to the Constitution and the Revenue Act of 1913. Under the Revenue Act, individuals with income exceeding $3,000 could be taxed starting at 1% up to 7% for incomes exceeding $500,000.

It’s all gone downhill from there.

Unsurprisingly, the government has used its tax powers to advance its own imperialistic agendas and the courts have repeatedly upheld the government’s power to penalize or jail those who refused to pay their taxes.

Irwin A. Schiff was one of the nation’s most vocal tax protesters. He spent a good portion of his life arguing that the income tax was unconstitutional. He paid the price for his resistance, too: Schiff served three separate prison terms (more than 10 years in all) over his refusal to pay taxes. He died at the age of 87 serving a 14-year prison term. As constitutional activist Robert L. Schulz noted in Schiff’s obituary, “In a society where there is so much fear of government, and in particular of the I.R.S., [Schiff] was probably the most influential educator regarding the illegal and unconstitutional operation and enforcement of the Internal Revenue Code. It’s very hard to speak to power, but he did, and he paid a very heavy price.”

It’s still hard to speak to power, and those who do are still paying a very heavy price.

All the while the government continues to do whatever it likes—levy taxes, rack up debt, spend outrageously and irresponsibly—with little thought for the plight of its citizens.

The national debt is $20 trillion and growing. The amount this country owes is now greater than its gross national product (all the products and services produced in one year by labor and property supplied by the citizens). We’re paying more than $270 billion just in interest on that debt annually. And the top two foreign countries who “own” our debt are China and Japan.

To top it all off, all of those wars the U.S. is so eager to fight abroad are being waged with borrowed funds. As The Atlantic reports, “For 15 years now, the United States has been putting these wars on a credit card… U.S. leaders are essentially bankrolling the wars with debt, in the form of purchases of U.S. Treasury bonds by U.S.-based entities like pension funds and state and local governments, and by countries like China and Japan.”

If Americans managed their personal finances the way the government mismanages the nation’s finances, we’d all be in debtors’ prison by now.

Still, the government remains unrepentant, unfazed and undeterred in its money grabs.

While we’re struggling to get by, and making tough decisions about how to spend what little money actually makes it into our pockets after the federal, state and local governments take their share (this doesn’t include the stealth taxes imposed through tolls, fines and other fiscal penalties), the police state is spending our hard-earned tax dollars to further entrench its powers and entrap its citizens.

For instance, American taxpayers have been forced to shell out $5.6 trillion since 9/11 for the military industrial complex’s costly, endless so-called “war on terrorism.” That translates to roughly $23,000 per taxpayer to wage wars abroad, occupy foreign countries, provide financial aid to foreign allies, and fill the pockets of defense contractors and grease the hands of corrupt foreign dignitaries.

Mind you, that staggering $6 trillion is only a portion of what the Pentagon spends on America’s military empire.

That price tag keeps growing, too.

The 16-year war in Afghanistan, which now stands as the longest and one of the most expensive wars in U.S. history, is about to get even longer and more costly, thanks to President Trump’s promise to send more troops over.

In this way, the military industrial complex will get even richer, and the American taxpayer will be forced to shell out even more funds for programs that do little to enhance our lives, ensure our happiness and well-being, or secure our freedoms.

As Dwight D. Eisenhower warned in a 1953 speech:

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter plane with a half million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people. This is, I repeat, the best way of life to be found on the road the world has been taking. This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. […] Is there no other way the world may live?

This is still no way of life.

Yet it’s not just the government’s endless wars that are bleeding us dry.

We’re also being forced to shell out money for surveillance systems to track our movements, money to further militarize our already militarized police, money to allow the government to raid our homes and bank accounts, money to fund schools where our kids learn nothing about freedom and everything about how to comply, and on and on.

Are you getting the picture yet?

The government isn’t taking our money to make our lives better. Just take a look at the nation’s failing infrastructure, and you’ll see how little is being spent on programs that advance the common good.

We’re being robbed blind so the governmental elite can get richer.

This is nothing less than financial tyranny.

“We the people” have become the new, permanent underclass in America.

It’s tempting to say that there’s little we can do about it, except that’s not quite accurate.

There are a few things we can do (demand transparency, reject cronyism and graft, insist on fair pricing and honest accounting methods, call a halt to incentive-driven government programs that prioritize profits over people), but it will require that “we the people” stop playing politics and stand united against the politicians and corporate interests who have turned our government and economy into a pay-to-play exercise in fascism.

We’ve become so invested in identity politics that label us based on our political leanings that we’ve lost sight of the one label that unites us: we’re all Americans.

As I make clear in my book Battlefield America: The War on the American People, the powers-that-be want to pit us against one another. They want us to adopt an “us versus them” mindset that keeps us powerless and divided. Trust me, the only “us versus them” that matters anymore is “we the people” against the police state.

We’re all in the same boat, folks, and there’s only one real life preserver: that’s the Constitution and the Bill of Rights.

The Constitution starts with those three powerful words: “We the people.”

The message is this: there is power in our numbers.

That remains our greatest strength in the face of a governmental elite that continues to ride roughshod over the populace. It remains our greatest defense against a government that has claimed for itself unlimited power over the purse (taxpayer funds) and the sword (military might). As Patrick Henry declared in the last speech before his death, “United we stand, divided we fall. Let us not split into factions … or … exhaust [our strength] in civil commotions and intestine wars.”

This holds true whether you’re talking about health care, war spending, or the American police state.