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Monday, January 20, 2020

Health Care Reform Articles - January 20, 2020

Editor's Note -

 I'm posting the following two op-eds by Nicholas Kristof and Yuval Levin because I think they hit the nail on the head by describing what I consider to be one of the underlying pathologies afflicting our healthcare system. - inadequate access to care despite the fact that we are spending more than enough to provide it to everybody due to the role of a misplaced and destructive political ideology - unfettered markeets at any cost - a form of capitalism run amok.

That is is one more argument for getting rid of the estimated 30% of our healthcare spending that is wasted on unnecessary administrative complexity, exessively high prices for all healthcare goods and services, and unnecessary services for which there is inadequate medical justification. If we did that, we could easily afford to cover those Americans who are now left behind.

- SPC

Are My Friends’ Deaths Their Fault or Ours?

We need to move from pointing fingers to offering helping hands.
by Nicholas Kristof - NYT - January 18, 2020

When my wife and I wrote about my  old schoolmates who had died from “deaths of despair,” the reaction was sometimes ugly.
“They killed themselves,” scoffed Jonathan from St. Louis, Mo., in the reader comments. “It was self-inflicted.”
Ajax in Georgia was even harsher: “Natural selection weeding out those less fit for survival.”
Our essay, drawn from our new book, “Tightrope,” explored the disintegration of America’s working class through the kids on my old No. 6 school bus in Yamhill, Ore., particularly my neighbors the Knapps. The five Knapp kids were smart and talented, but Farlan died after years of drug and alcohol abuse, Zealan died in a house fire while passed out drunk, Nathan blew himself up cooking meth, Rogena died of hepatitis after drug use, and Keylan survived partly because he had spent 13 years in the Oregon State Penitentiary.
Working-class men and women like them, of every shade, increasingly are dying of “deaths of despair” — from drugs, alcohol and suicide. That’s why life expectancy in the United States, for the first time in a century, has declined for three years in a row.
Plenty of readers responded with compassion. But there was a prickly scorn from some that deserves a response because it reflects an ideology that underlies so many failed policies. It arises from the myth that we live in a land of limitless opportunity and that those who struggle have simply made “bad choices” and failed to muster “personal responsibility.” Dr. Ben Carson, who grew up poor and black in Detroit and is now the nation’s housing secretary, has described poverty as “more of a choice than anything else.”
This “personal responsibility” narrative animated some reader critics of the Knapps. “This article describes ruined, pitiful people,” one reader commented. “The main problem they have is weakness of character.”
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Over the last half-century, this narrative has gained ground in America; it’s an echo of the “social Darwinism” that circulated a century ago. I’ve come to think that the biggest impediment to strengthening America isn’t a shortage of resources but this personal responsibility obsession.
When we underinvest in our own human capital, when so many Americans are only marginally literate or numerate or suffer from ill health or dependencies, then our entire country suffers. If America wants to compete with China, we should worry less about intellectual property protections and more about investing in the well-being of young Americans.
Yet the personal responsibility narrative leads states to refuse to expand Medicaid. It leads us to lock up drug users instead of providing them help, even though each dollar invested in treatment can save $12 or more in reduced criminal justice and health costs.
When we as a nation are willing to pay extra so that we can lock people up and rip apart their families, that’s gratuitous cruelty posturing as policy.
Of course personal responsibility matters. But imagine if we took the personal responsibility obsession to auto safety. That would look something like this:
Auto crashes often are a result of speeding, drinking or texting. If we coddle drivers with airbags and padded dashboards, and have ambulances ready to rescue them, they’ll never learn to drive responsibly. Better to implant spikes in dashboards so they appreciate consequences!
A newborn in a ZIP code of North Philadelphia with a largely poor and black population has a life expectancy 20 years shorter than a newborn in mostly white central Philadelphia just four miles away; that’s not because one infant has displayed “weak character.”
Britain reduced child poverty by half under Tony Blair. It’s not that British infants suddenly showed more personal responsibility; it’s that the government showed responsibility. Here in the United States, the National Academies of Sciences, Engineering and Medicine laid out a blueprint for reducing America’s child poverty by half, yet Congress and President Trump do nothing.
In that sense, Dr. Carson is right: Poverty is a choice. But it’s our choice.
My friends the Knapps made mistakes. Of course they did. But they weren’t less responsible, less talented or less hard-working than their parents or grandparents who had thrived in the postwar era.
What changed was diminishing access to good jobs, reduced commitment to investment in human capital, a hurricane of addictive drugs (some peddled by the pharmaceutical industry), and the rise of a harsh social narrative that vilified those left behind — a narrative that workers often internalized. Workers lost their dignity and hope, and that exacerbated the spiral of self-medication and self-destruction, of loneliness and despair that swept through my No. 6 bus.
We moved from an inclusive capitalism in the postwar era to a rigged system that hobbles unions, underinvests in children and then punishes those left behind. This is the moral equivalent of spikes on dashboards.
What would a better social narrative look like? It would acknowledge personal responsibility but also our collective social responsibility — especially to help children. It would be infused with empathy and a “morality of grace” that is less about pointing fingers and more about offering helping hands. It would accept that a country cannot reach its potential when so many of its citizens are not achieving theirs.
https://www.nytimes.com/2020/01/18/opinion/sunday/deaths-despair-personal-responsibility.html?


How Did Americans Lose Faith in Everything?

Our institutions lost the capacity to mold character and have become platforms for performance instead.
by Yuval Levin - NYT - January 18, 2020

Americans are living through a social crisis. We can see that in everything from vicious partisan polarization to rampant culture-war resentments to the isolation, alienation and despair that have sent suicide rates climbing and driven an epidemic of opioid abuse. These dysfunctions appear to have common roots, but one symptom of the crisis is that we can’t quite seem to get a handle on just where those roots lie.
When we think about our problems, we tend to imagine our society as a vast open space filled with individuals who are having trouble linking hands. And so we talk about breaking down walls, building bridges, leveling playing fields or casting unifying narratives.
But what we are missing is not simply greater connectedness but a structure of social life: a way to give shape, purpose, concrete meaning and identity to the things we do together. If American life is a big open space, it is not a space filled with individuals. It is a space filled with these structures of social life — with institutions. And if we are too often failing to foster belonging, legitimacy and trust, what we are confronting is a failure of institutions.
This social crisis has followed upon a collapse of our confidence in institutions — public, private, civic and political. But we have not given enough thought to just what that loss of confidence entails and why it’s happening.
Each core institution performs an important task — educating children, enforcing the law, serving the poor, providing some service, meeting some need. And it does that by establishing a structure and process, a form, for combining people’s efforts toward accomplishing that task.
But as it does so, each institution also forms the people within it to carry out that task responsibly and reliably. It shapes behavior and character, fostering an ethic built around some idea of integrity. That’s why we trust the institution and the people who compose it.
We trust political institutions when they undertake a solemn obligation to the public interest and shape the people who populate them to do the same. We trust a business because it promises quality and reliability and rewards its workers when they deliver those. We trust a profession because it imposes standards and rules on its members intended to make them worthy of confidence. We trust the military because it values courage, honor and duty in carrying out the defense of the nation and forms human beings who do, too.
We lose faith in an institution when we no longer believe that it plays this ethical or formative role of teaching the people within it to be trustworthy. This can happen through simple corruption, when an institution’s attempts to be formative fail to overcome the vices of the people within it, and it instead masks their treachery — as when a bank cheats its customers, or a member of the clergy abuses a child.
That kind of gross abuse of power obviously undermines public trust in institutions. It is common in our time as in every time. But for that very reason, it doesn’t really explain the exceptional collapse of trust in American institutions in recent decades.
What stands out about our era in particular is a distinct kind of institutional dereliction — a failure even to attempt to form trustworthy people, and a tendency to think of institutions not as molds of character and behavior but as platforms for performance and prominence.
In one arena after another, we find people who should be insiders formed by institutions acting like outsiders performing on institutions. Many members of Congress now use their positions not to advance legislation but to express and act out the frustrations of their core constituencies. Rather than work through the institution, they use it as a stage to elevate themselves, raise their profiles and perform for the cameras in the reality show of our unceasing culture war.
President Trump clearly does the same thing. Rather than embodying the presidency and acting from within it, he sees it as the latest, highest stage for his lifelong one-man show. And he frequently uses it as he used some of the stages he commanded before he was elected: to complain about the government, as if he were not its chief executive.
The pattern is rampant in the professional world. Check in on Twitter right now, and you’ll find countless journalists, for instance, leveraging the hard-earned reputations of the institutions they work for to build their personal brands outside of those institutions’ structures of editing and verification — leaving the public unsure of just why professional reporters should be trusted. The same too often happens in the sciences, in law and in other professions meant to offer expertise.
Or consider the academy, which is valued for its emphasis on the pursuit of truth through learning and teaching but which now too often serves as a stage for political morality plays enacted precisely by abjuring both. Look at many prominent establishments of American religion and you’ll find institutions intended to change hearts and save souls frequently used instead as yet more stages for livid political theater — not so much forming those within as giving them an outlet.
Artists and athletes often behave this way too, using reputations earned within institutional frameworks as platforms for building a profile outside them. When he was inducted into the National Baseball Hall of Fame, the former Chicago Cubs second baseman Ryne Sandberg implored fellow players to remember “that learning how to bunt and hit-and-run and turning two is more important than knowing where to find the little red light on the dugout camera.” When vital institutions across American life fail to produce people who remember that, they become much harder to trust.
The few exceptions to the pattern of declining confidence in institutions tend to prove this rule. The military is the most conspicuous exception and also the most unabashedly formative of our national institutions — molding men and women who clearly take a standard of behavior and responsibility seriously. And that can help us see what we might do to help alleviate the social crisis we confront.
All of us have roles to play in some institutions we care about, be they familial or communal, educational or professional, civic, political, cultural or economic. Rebuilding trust in those institutions will require the people within them — that is, each of us — to be more trustworthy. And that must mean in part letting the distinct integrities and purposes of these institutions shape us, rather than just using them as stages from which to be seen and heard.
As a practical matter, this can mean forcing ourselves, in little moments of decision, to ask the great unasked question of our time: “Given my role here, how should I behave?” That’s what people who take an institution they’re involved with seriously would ask. “As a president or a member of Congress, a teacher or a scientist, a lawyer or a doctor, a pastor or a member, a parent or a neighbor, what should I do here?”
The people you most respect these days probably seem to ask that kind of question before they make important judgments. And the people who drive you crazy, who you think are part of the problem, are likely those who clearly fail to ask it when they should.
Asking such questions of ourselves would be a first step toward grasping our responsibilities, recovering the great diversity of interlocking purposes that our institutions ought to serve, and constraining elites and people in power so that the larger society can better trust them. It would not be a substitute for institutional reforms but a prerequisite for them.
And asking such questions is one thing we all can do to take on the complicated social crisis we are living through and begin to rebuild the bonds of trust essential for a free society.
Yuval Levin, a scholar at the American Enterprise Institute and the editor of National Affairs and, is the author of the forthcoming “A Time to Build: From Family and Community to Congress and the Campus, How Recommitting to Our Institutions Can Revive the American Dream.”
https://www.nytimes.com/2020/01/18/opinion/sunday/institutions-trust.html 

We Deserve a Better Debate Over Medicare For All

by Sarah Jones - Intelligencer - January 17, 2020

In each debate, the healthcare questions are mostly the same, and so, too, are the candidates’ answers. Medicare for All is just so expensive: How would [insert left-wing candidate here] pay for it? Ah but look here, have you considered the fact that some unions oppose it? That a lot of people say they like their private insurance? The questions are no longer urgent. They are almost identical to each other, debate after debate, and no longer uncover any new information. The candidates who say they support Medicare for All have explained repeatedly why they believe it makes fiscal sense, why voters might be open to a future without insurance companies, have pointed out, even, that many unions do support the legislation. Either voters accept their answers about the popularity and technical feasibility of their proposal or they don’t: there is nothing more to be revealed by this line of questioning.
Pundit fixation on these aspects of Medicare for All is predictable. They follow a pattern set years ago, when elected Democrats and columnists alike worried that the Affordable Care Act, a far less radical policy, would bankrupt the nation and knock Obama’s party from power. Years later, everyone still remembers their cues, with a new healthcare proposal as the focus of the performance. The show goes on, and will assault the sanity of all sensible observers until it makes itself irrelevant. The performers may believe they are objective, pontificating from on high like a class of priests. But they help drive public opinion, and will continue to do so until the election finally happens. Voters will either elect someone who supports M4A in spite of its skeptics, or the skeptics will win, and so will a less ambitious vision of progress.
Healthcare reform deserves a more serious public conversation, and it’s possible to start one without ignoring M4A at the debates. Nor should the press abandon its responsibility to question such a radically transformative policy proposal. All that’s needed is a simple redirection, a new line of questioning that accurately grasps the real case for M4A.
The nearly exclusive focus on government spending and on public opinion misses the real rationale for the policy. M4A is a moral argument disguised as a policy proposal. It takes stock of the American healthcare system as it currently exists, and identifies it as a logically and ethically bankrupt structure that exposes people to unnecessary, life-shortening risks. In short, healthcare is a right – a right the status quo violates, and which would be better protected by an entirely different kind of system. So M4A proponents propose a new system, which would cover every person to precisely the same degree, and would in theory rescue them from medical bankruptcy and missing bill payments and crowdfunding campaigns for their insulin pumps. And it assigns to the U.S. government the responsibility of safeguarding the right to healthcare from harm. The policy’s supporters have explained as much, many times. They don’t have much choice: There isn’t a way to explain the proposal, including its financial details, without making certain claims about its moral superiority to both the status quo, and to the alternatives others propose.
A public option would require less government spending. According to most polls, it is somewhat more popular; it would even be a dramatic improvement on the system in place right now. But the public option doesn’t fully address the serious moral crisis that M4A is designed to solve. Individuals would still have to navigate a complicated, frequently counter-intuitive system, in order to exercise the right the public option theoretically expands. M4A, by contrast, argues that there should be no obstacle between a person and the coverage they need. It shifts the cost of healthcare from individuals and employers, where it currently sits, to the government not only because this will save consumers money, but because the policy’s advocates believe this is the most ethical course of action available.
To return briefly to the primary: Ask any candidate in the field if they think Americans have a right to healthcare, and they’d almost certainly agree. But journalists should know better than to take politicians at their word. Instead of rehashing the same three or four criticisms of M4A until we all go numb from the repetition, ponder instead the implications of framing healthcare as an absolute right. If Joe Biden and Pete Buttigieg really believe that right exists, why do both their healthcare plans leave some Americans without coverage? Why is the public option, which doesn’t automatically enroll people in coverage, morally preferable to a universal alternative like M4A? If the only arguments against M4A are that it’s popular, but not as popular as it could be, and that implementing it would take a lot of work, is the problem really the policy itself, or is it a lack of political will? Why should voters settle for moderate versions of healthcare reform that don’t scale to the crisis at hand? And how does it really benefit the public to leave private insurance companies intact?
To engage only with the practical considerations of the policy, and ignore the moral claims that shape it, is to present a lopsided view of its merits to the public. Nobody needs to see journalists re-enact Philosophy 101 on stage with a horde of aspiring presidents; the prospect is more unappealing than Tom Steyer’s tartan ties. But the press can at least stop pretending that policy is an abstract puzzle. All policy preferences have some moral weight attached to them. As American lifespans drop, the media’s decision to ignore the full case for M4A has a moral dimension too.
We Deserve a Better Debate Over Medicare For All

How the Health Insurance Industry (and I) Invented the ‘Choice’ Talking Point

It was always misleading. Now Democrats are repeating it.
There’s a dangerous talking point being repeated in the Democratic primary for president that could affect the survival of millions of people, and the finances of even more. This is partly my fault.
When the candidates discuss health care, you’re bound to hear some of them talk about consumer “choice.” If the nation adopts systemic health reform, this idea goes, it would restrict the ability of Americans to choose their plans or doctors, or have a say in their care.
It’s a good little talking point, in that it makes the idea of changing the current system sound scary and limiting. The problem? It’s a P.R. concoction. And right now, somewhere in their plush corporate offices, some health care industry executives are probably beside themselves with glee, drinking a toast to their public relations triumph.
I should know: I was one of them.
To my everlasting regret, I played a hand in devising this deceptive talking point about choice when I worked in various communications roles for a leading health insurer between 1993 and 2008, ultimately serving as vice president for corporate communications. Now I want to come clean by explaining its origin story, and why it’s both factually inaccurate and a political ploy.
Those of us in the insurance industry constantly hustled to prevent significant reforms because changes threatened to eat into our companies’ enormous profits. We were told by our opinion research firms and messaging consultants that when we promoted the purported benefits of the status quo that we should talk about the concept of “choice”: It polled well in focus groups of average Americans (and was encouraged by the work of Frank Luntz, the P.R. guru who literally wrote the book on how the Republican Party should communicate with Americans). As instructed, I used the word “choice” frequently when drafting talking points.
But those of us who held senior positions for the big insurers knew that one of the huge vulnerabilities of the system is its lack of choice. In the current system, Americans cannot, in fact, pick their own doctors, specialists or hospitals — at least, not without incurring huge “out of network” bills.
Not only does the current health care system deny you choice within the details of your plans, it also fails to provide many options for the plan itself. Most working Americans must select from a limited list made by their company’s chosen insurance provider (usually a high-deductible plan or a higher-deductible plan). What’s more, once that choice is made, there are many restrictions around keeping it. You can lose coverage if your company changes its plan, or if you change jobs, or if you turn 26 and leave your parents’ plan, among other scenarios.
This presented a real problem for us in the industry. Well aware that we were losing the “choice” argument, my industry colleagues spent millions on lobbying, advertising and spin doctors — all intended to muddy the issue so Americans might believe that reform would somehow provide “less choice.” Recently, the industry launched a campaign called “My Care, My Choice” aimed in part at convincing Americans that they have choice now — and that government reform would restrict their freedom. That group has been spending large sums on advertising in Iowa during this presidential race.
This isn’t the first time the industry has made “choice” a big talking point as it fights health reform. Soon after the Affordable Care Act was passed a decade ago, insurers formed the Choice and Competition Coalition and pushed states not to create insurance exchanges with better plans.
What’s different now is that it’s the Democrats parroting the misleading “choice” talking point — and even using it as a weapon against one another. Back in my days working in insurance P.R., this would have stunned me. It’s why I believe my former colleagues are celebrating today.
The truth, of course, is that Americans now have little “choice” when it comes to managing their health care. Most can’t choose their own plan or how long they retain it, or even use it to select the doctor or hospital they prefer. But some reforms being discussed this election, such as “Medicare for all,” would provide these basic freedoms to users. In other words, the proposed reforms offer more choice than the status quo, not less.
My advice to voters is that if politicians tell you they oppose reforming the health care system because they want to preserve your “choice” as a consumer, they don’t know what they’re talking about or they’re willfully ignoring the truth. Either way, the insurance industry is delighted.
I would know.
Wendell Potter, a former vice president for corporate communications at Cigna, is president of Business for Medicare for All and Medicare for All NOW!
https://www.blogger.com/blogger.g?blogID=3936036848977011940#editor/target=post;postID=766739002709193292


Overwhelmed by Medical Bills, and Finding Help on TikTok

In a video last month, a North Carolina woman shared a tip about battling “stupid charges.” Thousands responded — some in gratitude, others to commiserate over the baffling costs of health care.
by Jacey Fortin - NYT - January 16, 2020



When severe pain sent Eva Zavala to an emergency room last March, her treatment involved an ultrasound and some blood work. Her visit left her with a medical bill for more than a thousand dollars, after insurance.
It was an overwhelming cost for Ms. Zavala, 22, a medical assistant in Oregon. She had barely made a dent in the total amount she owed when, several months later, she came across a video on TikTok.
It was a one-minute clip of a woman she didn’t know, presenting a scenario that closely matched Ms. Zavala’s experience: “You go to the emergency room, you get a bill for a thousand dollars,” the woman, Shaunna Burns, said in the Dec. 3 post.
Ms. Burns, 40, of North Carolina, instructed her viewers to call the hospital and ask for “an itemized bill with every single charge,” explaining that the billing department might then remove absurd fees, like a $37 Band-Aid.
“Any of those stupid charges, they’re going to take them right off,” Ms. Burns said in the video.
Ms. Zavala remembered that advice a few days later when she was going over her bills. She decided to give it a shot. “I thought, you know, what could I lose doing it?” she said. “And so I called and I let them know who I was, and I just asked for an itemized bill for that hospital visit.”
About two weeks later, her itemization came in the mail. She opened it and saw that her balance had been reduced to zero.
“I couldn’t believe it, that it was just gone,” she said.
It was unclear whether her phone call was the reason for the reduction. Ms. Zavala’s itemization showed that the hospital had applied “financial assistance” to her debt in September. But Ms. Zavala said she had never asked for assistance and didn’t know it had been applied, even though she had checked her balance in October.
The health care system that administers the hospital Ms. Zavala visited said in a statement that it offers flexible, generous financial assistance programs, and that people who apply for them are typically notified in writing within two weeks of the eligibility determination.
Ms. Zavala shared her experience in a tweet that racked up hundreds of comments, tens of thousands of shares and hundreds of thousands of likes. Many said that a call to the billing department — in some cases to ask for budget assistance — had worked for them or their friends.
Ms. Burns’s advice reached the masses via a social media platform more commonly used to share goofy dance videos, funny skits and other works of art. And something about her description of this particular tactic — a fix that seemed simple but also sort of mysterious, like a magic trick — seemed to hit a nerve.
In an interview, Ms. Burns said her Dec. 3 video was not planned. She had been sick in bed and was dealing with calls from debt collectors when she decided to share a tip in case others were dealing with similar situations.
“I thought, ‘What if people out there don’t know that they have the right to tell those people to screw off?’” she said.
In the replies to her video on TikTok and Twitter, thousands of people commiserated over how baffling the American health care system can be, and how arbitrary the costs.
Asking for an itemized bill won’t always save patients money, since every case is different. But it’s worth trying, said Erin C. Fuse Brown, a health care expert and associate law professor at Georgia State University. It’s not only a way to expose frivolous charges; the process could also reveal human errors or open the door to negotiations.
“It’s a good place to start because it allows the patient to be able to see what they’re being charged for and then push back on particular items,” Professor Fuse Brown said.
Irene Flippo, an advocate for patients dealing with medical bills, said there was a widespread need for education about handling medical costs. “A lot of individuals have this fear about dealing with it: what things should they say and how they should address these issues,” she said.
Ms. Flippo shared several tips for people dealing with medical bills: Request a review of the level of care, along with an itemized bill. Look for errors or duplicate charges. Check resources that can help you compare prices. Appeal. Negotiate. Get an interest-free payment plan, but alert the hospital if you are at risk of missing a payment. See if you qualify for financial assistance. And if billing department workers are not helpful, email top executives at the hospital.
“TikTok, I believe, is younger generations mostly,” Ms. Flippo added. “And so to see the response this woman had gotten, it only reconfirmed to me there’s definitely a lot of concern among that age group’s individuals about their medical costs.”
Ms. Zavala said she understood why people approached health care providers with a sense of powerlessness. “Knowing that it’s so expensive to go, and the fact that your insurance doesn’t cover everything, I think it stops a lot of people from going and getting the care they need,” she said.
She added that she did not fault hospitals entirely for the high medical bills, noting that some of the problems begin with drug companies.
According to the American Hospital Association, in 2018, hospitals provided patients in need with over $41 billion in care for which no payment was received. “As a field, we will always continue to look for new and more effective ways to work with patients who need help understanding their bills or meeting their financial obligations for the care they receive,” the group said in a statement.
Ms. Burns said she learned her way around hospitals after years of caring for three daughters, one of whom was kidnapped for more than a year and now struggles with complex post-traumatic stress disorder.
She described herself as a pushy person — the kind who offers tips, assistance or coupons to strangers without being asked. Her TikTok videos are presented without frills or filters. Her delivery is no-nonsense and peppered with expletives. She often shares detailed journal entries or encouraging messages.
She is not the only one using TikTok to dispense advice. When she gets questions about credit, she sometimes refers them to Alisa Glutz, an Arizona mortgage professional who shares tips on her own TikTok profile. And there are several health care practitioners who share health and wellness tips on social media.
Ms. Burns acknowledged that some of the cost-cutting advice she has given — “Don’t take an ambulance unless you are legit dying!” — could become something of a liability if it did not work out. “I’m not out there as a medical professional,” she said.
But she added that people were still writing to her to ask questions about their medical bills, and that she advised them whenever she could.
“You don’t have to be ashamed to be in debt,” she said. “And you have rights, and you can have confidence and stand up to these people.”
https://www.nytimes.com/2020/01/16/health/tik-tok-medical-bills.html?action=click&module=News&pgtype=Homepage


Forget Medicare for All — Americans are being overcharged for health care

It turns out that, in the United States, while it’s expensive to buy insulin it’s rather cheap to buy a senator.

By David Dodson - Boston Glober - January 15, 2020
If you care about waiting times, the likelihood of a safe pregnancy, or how long you might live, the difference between the US health care system and that of other countries is not whether one pays into a private insurance company or a single-payer government program, but whether their government is focused on controlling costs or padding their donors’ pockets.
In Germany, health insurance is compulsory, and if you lived there, you’d enjoy some of the lowest wait times among developed countries and receive health outcomes in the top 10 in the world. You’d also pay about half as much for health care than in the United States because, after prescription drug prices rose by an annual rate of 4 percent, Germany’s parliament used its national buying power to negotiate consumer discounts.
In sharp contrast to how German legislators behave, despite drug prices in the United States rising 139 percent between 2000 and 2016, Congress continues to forbid the Department of Health and Human Services from negotiating prescription drug prices on behalf of Medicare and Medicaid. These entities are the largest buyers of pharmaceuticals in the world, with massive purchasing power. While DHH is required to shop for the cheapest ballpoint pen, when it comes to chemotherapy medication, it is obligated to pay whatever price drug manufacturers want to charge. Furthermore, because many private and state insurance programs reimburse at a formula based on Medicare and Medicaid pricing, this anticompetitive policy causes a cascade of inflated prices throughout the system.
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Japan has the highest life expectancy in the world and consistently ranks in the top 10 countries for health care quality. But unlike Germany, it has over 3,500 private insurance providers, and health insurance is effectively voluntary, since there is no penalty for being uninsured. But while Japan and Germany differ in how health care is financed, they share an equal commitment to keeping costs down for consumers. Every two years, the Japanese government negotiates prices on behalf of their citizens, which explains why the same hospital services cost 29 percent less in Japan than in the United States.
Congress further protects the pharmaceutical industry from competition by making it illegal to purchase identical prescription medications outside the country. In my 2018 campaign for Wyoming’s US Senate, I won’t easily forget the mother and father from Worland who explained to me that each year they used all their vacation days to travel to Mexico in order to buy a year’s worth of drugs for their son’s cancer therapy. In fact, an estimated 19 million Americans risk prosecution each year in order to buy their drugs illegally, for the simple reason that if they don’t, they can’t afford to take their medicine. Congress’s immoral behavior creates a public health emergency because, despite millions of Americans crossing the border to buy medicine, a staggering 29 percent of us are still unable to afford to take our drugs as prescribed. As a nation we are getting sicker and risking further health problems because, unlike the governments of other developed nations, Congress chooses the profits of their donors over the health of their citizens.
Last year Senators Charles E. Grassley and Ron Wyden introduced modest legislation to cap Medicare drug prices at the rate of inflation — a rather small ask given the other protections Congress provides the industry. But Senate majority leader Mitch McConnell, with the support of my own senator, John Barrasso of Wyoming, who is one of only two physicians in the Senate, refused to allow a vote on the bill. They recognize that a family struggling to buy medication for their daughter to control her epilepsy can hardly afford to also buy a senator. The same politicians who had no reservations about shielding drug companies from foreign competition, and who continue to forbid the DHH from using their buying power to negotiate pricing, declared Grassley’s bill “anti-competitive.”
These shameful market protections that provide billions of dollars in excess profits make it no wonder the health care industry donated close to $500 million to Congress in the last election cycle. It turns out that, in the United States, while it’s expensive to buy insulin it’s rather cheap to buy a Senator.
In terms of quality and outcomes, our health care system ranks number 37, (right above Slovenia) and dead last in the world in terms of cost. Life expectancy here is going down, not up. But the difference is not whether we pay into a private program or a public program. While partisans debate single-payer versus private-pay, the issue is that we have a corrupt political system. Until we address a political system designed to put donors over families, we’ll never solve our health care crisis.
David Dodson is a resident of Wyoming and a former candidate for US Senate.
https://www.bostonglobe.com/2020/01/15/opinion/forget-medicare-all-americans-are-being-overcharged-health-care/

Analysis of 30 Years of Single-Payer Research Shows Medicare for All Would Absolutely Save US Money

"Across the political spectrum, there is near consensus among these economists that a single-payer system would save money."
by
A comprehensive new study that reviewed nearly three decades of existing analyses shows implementation of a single-payer healthcare system like Medicare for All could dramatically reduce costs in the United States, with savings likely experienced in the first year and definitely over the longer term.
"At this point, the most expensive health care plan is the status quo."
—Dr. Adam Gaffney, PHNP
The meta-analysis, published Wednesday in the PLOS Medicine journal, reviewed 22 existing studies of state and national single-payer healthcare proposals.
Christopher Cai, a third-year medical student at the University of California at San Francisco and the primary author of the study, explained in a statement that the economic findings were similar regardless of ideological perspective.
"The most important conclusion from our study is that there is near consensus among that single-payer would save money, both in the first year of implementation and in the long term," Cai told Common Dreams. "These findings held true regardless of the political affiliation of study authors."
Of the 22 studies reviewed, 19 of them, or 86%, showed that healthcare costs would be reduced in the first year. All showed savings within a decade.
According to a UCSF press release announcing the study:
The researchers were able to estimate longer-term savings by using cost projections made in 10 of the models, which looked as far as 11 years into the future. These studies assumed that savings would grow over time, as the increases in healthcare utilization by the newly insured leveled off, and the global budgets adopted by single payer systems helped to constrain costs. By the tenth year, all modeled single payer systems would save money, even those that projected costs would initially increase.
The study concludes with a call to implement the systems, saying that "the logical next step is real-world experimentation."
The cost savings benefit of a single payer healthcare system has long been an argument in favor of moving the U.S. away from private insurance. Sen. Bernie Sanders (I-Vt.) has put Medicare for All at the center of his presidential campaign and made the issue a key part of the 2020 Democratic primary. At a primary debate on Tuesday night, moderators continually asked Sanders and other Democrats about the costs of such a policy.
According to the study's researchers, however, cost should be the least concerning aspect of moving towards Medicare for All.
"Even though they start with different single designs and modeling assumptions, the vast majority of these studies all come to the same conclusion," said UCSF Institute for Health Policy Studies professor James G. Kahn. "This suggests that fears that a single-payer system would increase costs are likely misplaced."
In comment to Common Dreams, Cai expressed hope that "public officials will draw on this research to spread accurate information."
"It's natural for the public to be skeptical of change and debate is healthy," said Cai. "Yet as physicians and researchers we want the discussion to be evidence-based, and we want the best for our patients."
Dr. Adam Gaffney, president of Physicians for a National Health Program, which advocates for Medicare for All, told Common Dreams that the costliest system is the current one.
"The numbers speak for themselves," Gaffney said in response to the new study.
"Even studies by conservative and libertarian think takes conclude that Medicare for All will reap enough administrative savings to cover the uninsured and upgrade coverage for everyone else," Gaffney said. "At this point, the most expensive health care plan is the status quo."
Cai said that the way forward involves making a fundamental change to the U.S. healthcare system in order to enjoy the benefits of lower costs.
"Replacing for-profit private insurance with a robust public system is essential to achieving these savings," said Cai.
https://www.commondreams.org/news/2020/01/15/analysis-30-years-single-payer-research-shows-medicare-all-would-absolutely-save-us



Maine needs to create better health care

Contributed • January 15, 2020

To the editor:
I am a “consumer” of health care with a Medicare Advantage plan. I would much rather be a “patient” like I was in the late 1950s when I birthed my three babies in a four-day stay for each at a local hospital.
With insurance then from a nonprofit Blue Cross, Blue Shield, we — a working-class, one-income family — did not worry about how to pay for health care with birthing or when our son suffered a kidney disease at 4 years old and required treatment for four years through several lengthy hospital stays.
Then profit and advertising entered the health care system, and the quality, accessibility and affordability have become increasingly cruel and unsustainable for the vast majority of consumers. I am a mother, grandmother and neighbor of working consumers who must decide with every health-care need to seek care or pay for housing or heating because they can’t afford the co-pays and deductibles of insurance or have no insurance at all.
There is a solution to this unsustainable situation. The Maine Center for Economic Policy conducted “a study of the costs and economic impacts of a health care model that would cover all Maine residents through a state-level public plan, with no fee at point of service. The results of the study show that total yearly healthcare spending could decrease by $1.5 billion under a new public plan, delivering significant benefits to Maine residents, cities, towns, and employers, along with fiscal stability for healthcare providers and hospitals.” 
There are four bills currently in the legislature to create such a model for Maine. I believe the best of these is LD 1611. Health insurers and other big-money stakeholders of the health-care industrial complex are lobbying our legislators hard and contributing big money to political campaigns. The only voice in the legislature more powerful than these stakeholders is the voice of voters. I will write my Senator and Representative and urge them to support LD 1611.  


Mainers deserve better coverage

Letters to the editor - Mount Desert Islander - January 17, 2020

A recent study by Maine Center for Economic Policy on behalf of Maine AllCare (available at maineallcare.org) showed that a universal, publicly funded health care system covering every Maine resident could save Maine $1.5 billion in total health care spending. This report went to our Governor, legislators and the media and yet they are having the same old conversation about tweaking the existing insurance-based system. This does a disservice to the people of Maine who deserve better. Total healthcare spending with the current system was 25 percent of Maine’s economy in 2018, and is projected to be 27 percent in 2026. That’s $16,000 per person pe Under a plan to cover everyone in Maine with no fee at point of service, 80 percent of families and individuals would see a boost in household income due to savings on insurance and out-of-pocket health costs. Most employers would pay the same or less than they do now, with predictable costs based on number of employees, while eliminating the burden of choosing and managing coverage plans. Workers compensation premiums would be cut in half. Care would continue to be provided by the same private doctors and hospitals that do it now. These providers would be reimbursed at Medicare rates, and elimination of uncompensated charity care and claims processing would ensure that they continue to receive reasonable compensation that covers their costs.
A related statewide healthcare survey by Maine AllCare shows that Mainers overwhelmingly want universal, publicly funded healthcare. It’s time for the media and Legislature to get on board.
Peter Homer
Southwest Harbor
https://www.mdislander.com/opinions/letters-to-the-editor/mainers-deserve-better-coverage


Review Of 22 Studies All Agree Medicare For All Less Expensive Than Insurance-System

By Laura Kurtzman - Popular Resistance - January 18, 2020
 
A single-payer healthcare system would save money over time, likely even during the first year of operation, according to nearly two dozen analyses of national and statewide single payer proposals made over the past 30 years.
The study, published Wednesday, Jan. 15, 2020, in PLOS Medicine, comes as California Gov. Gavin Newsom has created a state commission to find ways to achieve universal coverage, possibly through a single-payer system, and as the Democratic presidential candidates are debating “Medicare for All” proposals on the national stage.
The U.S. spends more on healthcare than any other country, yet is one of only a few developed nations that does not provide universal coverage. Under proposed single payer bills, such as “Medicare for All,” a unified public financing system would replace private insurance, similar to the healthcare system in Canada and many other wealthy nations.
To estimate what would happen if the United States adopted a single-payer system, researchers from UCSF, UCLA and UC Berkeley examined 22 economic analyses by government, business and academic organizations of national and state-level single payer plans, including proposals made in Massachusetts, California, Maryland, Vermont, Minnesota, Pennsylvania, New York and Oregon.
These analyses were used by policymakers to evaluate the proposals, estimating savings the plans would create through simplified billing and lower drug costs while also taking into account increases in health spending that would arise as newly insured people sought healthcare.
The researchers found that 19 of the 22 models predicted net savings in the first year after implementation, averaging 3.5 percent of total healthcare spending.
The researchers were able to estimate longer-term savings by using cost projections made in 10 of the models, which looked as far as 11 years into the future. These studies assumed that savings would grow over time, as the increases in healthcare utilization by the newly insured leveled off, and the global budgets adopted by single-payer systems helped to constrain costs. By the 10th year, all modeled single payer systems would save money, even those that projected costs would initially increase.
“Even though they start with different single designs and modeling assumptions, the vast majority of these studies all come to the same conclusion,” said James G. Kahn, MD, MPH, a professor in the UCSF Department of Epidemiology and Biostatistics, and a member of the Philip R. Lee Health Policy Institute. “This suggests that fears that a single-payer system would increase costs are likely misplaced.”
Savings from simplified payment administration and reductions in drug prices and other efficiencies ranged from 3 to 27 percent, with the largest savings found in plans that lowered drug costs.
Higher initial costs were associated with plans that had low co-pays or none at all, offered rich benefits, or that did not expect savings from lower drug and medical equipment costs.
This means that across the political spectrum, there is near consensus among these economists that a single-payer system would save money.
The models were created by analysts from different political perspectives, and they provided a range of cost estimates in the first year of operation, from 7 percent higher to 15 percent lower.
The researchers found that the economic models that were supported by left-leaning funders or that were done by academics found slightly larger net savings. But analyses supported by more conservative funders or performed outside of academia still predicted single-payer systems would yield savings.
“This means that across the political spectrum, there is near consensus among these economists that a single-payer system would save money,” said Christopher Cai, a third-year medical student at UCSF and the study’s first author. “Replacing private insurance with a public system is essential to achieving these savings.”
Authors: Christopher Cai, Jackson Runte, Isabel Ostrer, Kacey Berry, Justin White, PhD, and James G. Kahn, MD, MPH, of the UCSF School of Medicine; Ninez Ponce, PhD, MPP, of the UCLA Fielding School of Public Health; Michael Rodriguez, MD, MPH, of the David Geffen School of Medicine at UCLA; Stefano Bertozzi, MD, PhD, of the UC Berkley School of Public Health.
Funding: None except as noted in disclosures.
Disclosures: Christopher Cai is an executive board member of Students for a National Health Program. Christopher Cai, Jackson Runte, Isabel Ostrer, Kacey Berry each received a student summer research grant of $750 from Physicians for a National Health Program (PNHP) to support this study. PNHP had no role in study design, data collection, analysis, decision to publish or manuscript preparation.
 https://popularresistance.org/review-of-22-studies-all-agree-medicare-for-all-less-expensive-than-insurance-system/ 
 
 
 

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