Thanks to Republican Sen. Bill Cassidy, the healthcare policy pronouncements of late night comic Jimmy Kimmel are back in the headlines. This is terrible news, because Kimmel's statements represent everything that is wrong about this nation's healthcare debate.
For those just catching up, Kimmel's entrance into the world of healthcare punditry started earlier this month, when he discussed in emotional terms the birth of a newborn son with a heart condition, and the medical intervention necessary to save him.
Now, it should be said at the outset that I'm sure that what Kimmel and his family went through was incredibly heart-wrenching and stressful and I am happy that his son seems to be doing well. But his experience, while deserving of empathy, does not mean his health policy statements get to go unchallenged.
Let's not pretend he's suddenly an expert on all things health policy, anymore than a stabbing victim automatically becomes an expert in criminal justice policy; or a family whose house caught fire is imbued with knowledge of how to reorganize fire departments.
In reality, Kimmel's statements are a perfect example of how people often act as if there's a simple solution to complex healthcare problems that involve no tradeoffs.
"If your baby is going to die and it doesn't have to, it shouldn't matter how much money you make," he declared in his first monologue on the issue. "I think that's something that, whether you're a Republican or a Democrat or something else, we all agree on that, right?"
Cassidy, a Republican senator opposed to repealing much of Obamacare, subsequently went on television and declared that any changes to the healthcare system should pass what he dubbed the "Kimmel test." The Republican was asked to be a guest on the show, and Kimmel used it as an opening to respond to critics who noted that doctors would do everything they could to save any child who was born with a heart condition, regardless of ability to pay. The comedian noted that beyond the immediate emergency intervention, there were plenty of follow-up visits, and that those require time off from work.
"Since I am Jimmy Kimmel I'd like to make a suggestion as to what the Jimmy Kimmel test should be," he told Cassidy. "I'll keep it simple. The Jimmy Kimmel test I think should be, no family should be denied medical care, emergency or otherwise because they can't afford it."
He added, "I can think of a way to pay for it is don't give a huge tax cut to millionaires like me and instead leave it how it is."
In reality, there is nothing "simple" in what Kimmel is proposing. Leaving things as they are would mean leaving in place Obamacare — a system that does not accomplish what Kimmel has proposed. Expanding the role of government to meet the Kimmel test would require significantly higher levels of taxation – not just maintaining the same level of taxation on millionaires. And even other countries that on paper would claim to meet the "simple" test Kimmel is proposing, fail to do so in practice.
To start, under Obamacare, there are still 26 million people who don't have health insurance, according to the CBO, and that number will rise to 28 million in the next decade. But having access to health insurance isn't the same as having access to care. Under Obamacare, those who gained insurance did so through Medicaid and government-run exchanges. Because Medicaid pays doctors a lot less, fewer than half of doctors in the U.S. accept new Medicaid patients, and about a third don't accept Medicaid at all, according to the Kaiser Family Foundation.
When it comes to Obamacare's exchanges, even before Donald Trump was on the political radar, insurers were struggling to meet the high demand from older and sicker enrollees, and as a result they were raising premiums and narrowing choices of doctors and hospitals. If you aren't as rich as Jimmy Kimmel, but aren't poor enough to qualify for government subsidies, you're forced to purchase much more expensive insurance or go uninsured. I'd implore you to read Mary Katherine Ham's recent account of her experiences a few years ago as "a seven-month-pregnant widow with one toddler who got a letter two weeks after my husband died, informing me I'd lost my third or fourth health insurance plan since the Affordable Care Act passed."
We could also take a look at Los Angeles, where Kimmel's show is filmed, where the cheapest Obamacare plan available to a 35-year-old earning the median income of $56,196 would be a Molina plan that earns two stars out of five. The plan is an HMO that restricts access to in-network caregivers, and carries a $6,300 annual deductible – for $2,301 per year. If that person became part of a married couple without an increase in household income, the couple would qualify for federal subsidies, but that same cheap plan would be $3,847 per year, plus a $12,600 deductible and a separate $1,000 deductible for prescription drugs. That means the couple would have to pay over $17,000 before the full plan benefits start kicking in.
"Why is there such a thing as working uninsured in the United States?" Kimmel asked Cassidy.
Now, it's true that some people support a single-payer system that, in theory, would guarantee coverage for everybody. But that system would require a lot more money than the Kimmel fantasy standard of merely avoiding "a huge tax cut to millionaires."
During the Democratic primaries, Bernie Sanders proposed a single-payer plan that, according to the campaign, would have cost $14 trillion over a decade, but according to the liberal Urban Institute, would have cost $32 trillion more than Obamacare. The taxes Sanders proposed would affect not only millionaires, but also low and middle-income Americans, and even then were deemed inadequate by the Tax Policy Center and the Committee for a Responsible Federal Budget. The plan would also mean that the over 150 million Americans who gain their insurance through their employer would stand to lose their current coverage.
Of course, even if the United States were to migrate to a single-payer system, it wouldn't necessarily meet the Kimmel standard, because any system has to figure out away to divide up scarce resources – there are only so many doctors and hospital beds and waiting rooms and money available – and there is a variation in competence and quality. So in other systems, government plays a central role in deciding what can get covered and in how care is delivered.
When I visited the United Kingdom a few years back, I spoke to Julie Bailey, whose mother died while in the care of the nation's National Health Service. She detailed the deplorable conditions in the supposedly humane system, including patients deprived of water who were forced to drink from vases in the hospital hallways. Her whistleblowing led to a broader investigation, which found 400 to 1,200 estimated deaths had resulted from "appalling" care at the hospital where her mom had died.
In the U.K., people of Kimmel's wealth typically seek private care to avoid having to navigate the NHS. Since Kimmel talked about his wife's experience after childbirth, it's worth noting some recent stories about prenatal and maternity care in the U.K.
In January, a coroner ruled, according to the Telegraph, that a schoolteacher died following giving birth after she "suffered a major hemorrhage and lost four pints of blood after surgeons at Tunbridge Wells Hospital in Kent left a 6-cm piece of placenta in her uterine cavity." One woman who had a traumatic birthing experience took to the Guardian this past week to lament that, "For a system that prides itself on being female-centred, the NHS maternity care system is failing post-natal women." And these aren't isolated issues. In 2015, a government report found failures "at almost every level of the NHS" that led to deaths of mothers and babies.
The point is, no healthcare system is a panacea. All involve tradeoffs. But individuals who interact with the medical system in the United States often act as if there are simple solutions.
People ask: Why can't we just get drug prices under control? Why can't deductibles go down? Why can't everybody be covered with comprehensive health insurance without it costing me more in premiums or taxes or resulting in fewer choices?
Of course, politicians are happy to feed into this, promising a world of tradeoff-free policies. Former President Barack Obama did it, by promising lower premiums and that everybody who liked their plans and doctors would be able to keep them. And President Trump is doing it now, at various times, talking about how he's going to cover everybody, with better insurance, lower premiums, lower deductibles, more choice, and at a lower cost to taxpayers.
Instead of breaking new ground in the healthcare debate, Kimmel has done a tremendous disservice by perpetuating the myth that there are easy solutions to the complex problem of how to finance and deliver healthcare.