Editor's Note -
Here is a link to a podcast featuring Peter Arno, my co-author of our March 25 article published in the Health Affairs Blog about the corporate takeover of medical care in the US.
https://retirementrevised.substack.com/p/the-case-for-medicare-for-all-7a2
-SPC
When the Covid-19 pandemic is over, health care must not return to business as usual
I’m a lot of things. I’m honored that patients trust me with their lives. I’m ready to give them the best chance at surviving Covid-19 if they fall critically ill.
I’m scared of contracting the coronavirus and bringing it home to infect my family. And despite donning personal protective equipment, disrobing at my back door, and taking two or more showers a day, I may have done so already. A few nights ago, my 8-year-old daughter developed a fever, headache, and a dry cough.
I am also really, really angry. I hear the phrase “we’ve got this” used to rally doctors and nurses. The words sound like they were focus-group tested by a team of marketers and destined to wind up on a silicone bracelet. They capture a distinctly American blend of overconfidence and naivete. What, exactly, do we have? America has the most confirmed cases of Covid-19 in the world and a health care system that is ill-equipped to care for its citizens and failing to protect its health care workers.
How did it come to this?
The doctor-patient relationship and practicing high-quality medicine were once cherished principles of our health care system. But in recent years, a new guiding principle has been made clear to the doctors, nurses, and others who care for patients: In America, health care is a for-profit enterprise. The practice of medicine has been captured by the men in business suits with MBAs, and they have written the rules. Health care systems spend millions on massive marketing campaigns that sell the public on their commitment to patient care, but their actions make it clear that their priority is the bottom line.
For years the U.S. health care system has strained doctors and nurses with demands that place financial interests above patient care, making the practice of medicine unbearable. Electronic medical records are maximized to capture billable procedures, surgeries, and “patient encounters” rather than communicate meaningful information between providers. The fact that they pull doctors and nurses away from their patients, leading some doctors to spend only 13% of their day face to face with patients is regrettable, but it’s the cost of doing business.
I knew firsthand that staffing in many emergency departments was too thin even before Covid-19 emerged. Too few doctors and nurses were routinely asked to see too many patients. This is a management decision designed to maximize profit. It’s also a decision that makes seeing patients thoughtfully and safely a continual struggle.
Walking the knife’s edge is the business model.
The devotion to profit, marketing, and metrics has supplanted the devotion to quality medical care. Doctors are being taught that the real priorities are door-to-doctor times, patients per hour, patient satisfaction surveys, and generating the most relative value units (a common way of billing). Practicing good medicine and the patient’s well-being were pushed further down the list.
Here’s a small example: Last week, with the Covid-19 pandemic in full swing, a community hospital where I have worked emailed me to let me know it had revoked my privileges. I couldn’t see patients in the ED until I helped the billing department determine if it could boost revenue on the cases I’d seen. Whether the person who wrote this email stopped to consider that this action was sidelining a physician during a pandemic or not serves as a reminder that, in the current framework of American health care, money always comes first.
With a system co-opted to generate revenue first and caring for the sick comes second, the U.S. spends nearly twice what other developed countries do on health care. Although we have our share of some dramatic and expensive victories for individual patients, from a public health perspective America’s patient centered outcomes are mediocre at best. They are even worse for racial and ethnic minorities. That was true before Covid-19, and early data suggest that the pandemic is further widening these health care disparities.
Caught between a health care system built to maximize profit and their devotion to their patients, doctors, nurses, respiratory therapists, physical therapists, and other clinicians are suffering moral injury. A post on a physicians’ private social media forum recently asked, “After we get through the coronavirus pandemic, who else is done with medicine?”
I, like many other health care workers, am sympathetic to the author’s frustration. For decades, doctors and nurses have known of the perverse financial pressures in the American health care system. To get through the day, they either try to ignore these forces or they build elaborate work-arounds to manage them.
As the wave of Covid-19 patients flood the nation’s hospitals, the venality of our system is on full display.
Health care workers are being asked to fight Covid-19 with insufficient personal protective equipment. Pictures of American doctors in flimsy surgical masks and disposable gowns that expose wrists, necks, and hair look shockingly inadequate next to those of Italian and Chinese doctors covered head to toe in layers of personal protective equipment. Not surprisingly, health care workers are being infected with SARS-CoV-2, the virus that causes Covid-19. As I write this, at least 37 nurses and 26 doctors have already lost their lives due to Covid-19 in the U.S. More of us will follow.
There has, of course, been a public outcry by health care workers for hospitals to improve protections for their employees while battling the pandemic. Movements like #GetMePPE have gained national attention.
The responses from hospital administrations range from the pragmatic “we’re doing the best we can with limited supplies,” to the dangerous and threatening. In New York City, nurses were denied coronavirus testing unless their symptoms were severe enough to need admission to the hospital, so that they could continue to work their shifts. That kind of response is not only callous to sick nurses but risks infecting every patient they care for and every staff member they interact with.
Equally troubling, clinicians have been silenced from speaking out about the risks. In Washington state, an emergency department physician was fired by a Bellingham hospital for speaking publicly about its failure to protect its staff and patients from Covid-19.
The observation by the American engineer and management guru W. Edwards Deming that “every system is perfectly designed to get the results it gets,” rings true. Our health care system has perfected the business of medicine: extracting profit from the sick.
But patients and clinicians must ask, “Is this is the health care we want?”
The cataclysm of Covid-19 offers an opportunity to reshape health care in ways that may not have seemed possible just a few months ago. Will we have the collective will to make public health, social justice, equity, workplace safety and the practice of medicine greater priorities than financial success?
Keith Corl, M.D., practices both emergency and critical care medicine and is an assistant professor of medicine in the Division of Pulmonary Critical Care at the Warren Alpert Medical School of Brown University, in Providence, R.I. The views express here are those of the author. He would like to acknowledge Dr. Wendy Dean for her collaboration and contribution to this article.
https://www.statnews.com/2020/04/23/covid-19-aftermath-no-return-to-business-as-usual/
Medicare for Each of Us in the Age of the Coronavirus
The
U.S. public—and increasingly the business community—are becoming
acutely aware of the rising costs and inadequacies of our current
for-profit system, particularly as the current epidemic unfolds. There
is no other choice but Medicare for All.
by
,
Over the past two weeks, the explosive growth of the coronavirus pandemic has forced nearly 10 million Americans to file for unemployment benefits. Along with their jobs, many have lost their health insurance, if they had any to begin with. Aside from possibly spelling disaster for these newly unemployed workers and their families, this situation puts both the public health and economic wellbeing of our country at great risk. A clearer rationale for universal, affordable, lifetime health coverage as exemplified under a Medicare For All framework would be hard to find.
In this article we outline the need for a universal health plan, its historical context, and the obstacles raised by the medical-industrial complex that must be overcome.
There is a large elephant in the room in the national discussion of Medicare for All: the transformation of the US health care system’s core mission from the prevention, diagnosis, and treatment of illness—and the promotion of healing—to an approach dominated by large, publicly traded corporate entities dedicated to growing profitability and share price, that is, the business of medicine.
The problem is not that these corporate entities are doing something they shouldn’t. They are simply doing too much of what they were created to do—generate wealth for their owners. Unlike any other wealthy country, we let them do it. The dilemma of the US health care system is due not to a failure of capitalism or corporatism per se, but a failure to implement a public policy that adequately constrains their excesses.
"How is it that we spend more on health care than any other nation, yet have arrived at such a sorry state of affairs?"
Since the late 1970s, US public policy regarding health care has
trended toward an increasing dependence on for-pofit corporations and
their accompanying reliance on the tools of the marketplace—such as
competition, consolidation, marketing, and consumer choice—to expand
access and assure quality in the provision of medical care.This commercialized, commodified, and corporatized model is driving the US public’s demand for fundamental reform and has elevated the issue of health care to the top of the political agenda in the current presidential election campaign.
Costs have risen relentlessly, and the quality of and access to care for many Americans has deteriorated. The cultural changes accompanying these trends have affected every segment of the US health care system, including those that remain nominally not-for-profit. Excessive focus on health care as a business has had a destructive effect on both patients and caregivers, leading to increasing difficulties for many patients in accessing care and to anger, frustration, and burnout for many caregivers, especially those attempting to provide critical primary care.
As a result, the ranks of primary care providers have eroded, and that erosion continues. One of the major reasons for burnout in this group is the clash between its members’ professional ethics (put the patient first and “first do no harm”) and the profit-oriented demands of their corporate employers. Applying Band-Aids can’t cure the underlying causes of disease in medicine or public policy. Ignoring the underlying pathology in public policy, as in clinical medicine, is destined to fail.
Many of the symptoms of our dysfunctional health care system are not in dispute:
- We pay more than twice as much per person on total health care spending and on prescription drugs in comparison to other developed countries. This spending totals nearly 18 percent of our economy
- Between 2008 and 2018, premiums for employer-sponsored insurance plans increased 55 percent, twice as fast as workers’ earnings (26 percent). Over the same time period, the average health insurance deductible for covered workers increased by 212 percent
- An average employer-sponsored family health insurance policy now exceeds $28,000 per year, with employers paying about $16,000 and employees paying about $12,000
- Almost half (45 percent) of US adults ages 19 to 64, or more than 88 million people, were inadequately insured over the past year (either they were uninsured, had a gap in coverage, or were underinsured; that is, they had insurance all year but their out-of-pocket costs were so high that they frequently did not receive the care they needed).
- Compared to other developed countries, the US ranks near the bottom on a variety of health indicators including infant mortality, life expectancy, and preventable mortality.
"The theology of the market and the strongly held—but mistaken—belief that the problems of US health care can be solved if only the market could be perfected have effectively obstructed the development of a rational, efficient, and humane national health care policy."The answer is that only in the United States has corporatism engulfed so much of medical care and come so close to dominating the doctor-patient relationship. Publicly traded, profit-driven entities—under constant pressure from Wall Street—control the financing and delivery of medical care in the US to an extent seen nowhere else in the world. For instance, seven investor-owned publicly traded health insurers now control almost a trillion dollars ($913 billion) of total national health care spending and cover half the US population. In 2019, their revenue increased by 31 percent, while their profits grew by 66 percent.
The corporatization of medical care may be the single most distinguishing characteristic of the modern US health care system and the one that has had the most profound impact on it since the early 1980s. The theology of the market and the strongly held—but mistaken—belief that the problems of US health care can be solved if only the market could be perfected have effectively obstructed the development of a rational, efficient, and humane national health care policy.
There are three main reasons to pursue a public policy that embraces genuine health care reform:
- Saving lives: To simplify our complex and confusing health care system while providing universal affordable health care coverage;
- Affordability: To rein in the relentless rise in health care costs that are cannibalizing private and public budgets; and
- Improving quality: To eliminate profitability and share price as the dominant and all-consuming mission of the entities that provide health care services and products when that mission influences clinical decision making. Profitability should be the servant of any health care system’s mission, not its master as seems to be increasingly the case in the US.
What Is The Best Approach To Reform?
It is not an exaggeration to say that no reform other than publicly financed, single-payer universal health care will solve the problems of our health care system. This is true whether we are talking about a public option, a Medicare option, Medicare buy-in, Medicare extra, or any other half-measure. The main reason is because of the savings that are inherent only in a truly universal single-payer plan. Specifically, the administrative and bureaucratic savings gained by eliminating private insurers are the largest potential source of savings in a universal single-payer framework, yet all the “option” reforms listed above leave largely intact the tangle of wasteful, inefficient, and costly private commercial health insurers. The second largest source of savings comes through reducing the cost of prescription drugs by using the negotiating leverage of the federal government to bring down prices, as is done in most other developed countries. The ability, will, and policy tools (such as global budgeting) to restrain these and other costs in a single-payer framework are the key to reining in the relentless rise in health care expenditures and providing universal coverage."The real struggle for a universal single-payer system in the US is not technical or economic but almost entirely political."The various “option” reform proposals will not simplify our confusing health care system nor will they lead to universal coverage. None have adequate means to restrain health care costs. So why go down this road? Is it too difficult for the US to guarantee everyone access to affordable care when every other developed country in the world has done so?
The stated reason put forth in favor of these mixed option approaches is that Americans want “choice.” But choice of what? We know with certainty from former insurance company executives such as Wendell Potter that the false “choice” meme polls well with the US public and was used to undermine the Clinton reform efforts more than 25 years ago. It is being widely used today to manipulate public opinion.
But choice in our current system is largely an illusion. In 2019, 67.8 million workers across the country separated from their job at some point during the year—either through layoffs, terminations, or switching jobs. This labor turnover data leaves little doubt that people with employer-sponsored insurance are losing their insurance constantly, as are their spouses and children. And even for those who stay at the same job, insurance coverage often changes. In 2019, more than half of all firms offering health benefits reported shopping for a new health plan and, among those, nearly 20 percent actually changed insurance carriers. Trading off choice of doctors or hospitals for choice of insurance companies is a bad bargain.
The other major objection to a universal single-payer program is cost. Yet, public financing for health care is not a matter of raising new money for health care but of reducing total health care outlays and distributing payments more equitably and efficiently. Nearly every credible study concludes that a single-payer universal framework, with all its increased benefits, would be less costly than the status quo, more effective in restraining future cost increases, and more popular with the public—as 50 years of experience with Medicare has demonstrated.
The status quo generates hundreds of billions of dollars in surplus and profits to private stakeholders, who need only spend a small portion (millions of dollars) to influence legislators, manipulate public opinion, distort the facts, and obfuscate the issues with multiple competing reform efforts.
Conclusion
The real struggle for a universal single-payer system in the US is not technical or economic but almost entirely political. Retaining the status quo (for example, the Affordable Care Act) is the least disruptive course for the existing medical-industrial complex, and therefore the politically easiest route. Unfortunately, the status quo is disruptive to the lives of most Americans and the least effective route in attacking the underlying pathology of the US health care system—corporatism run amok. Following that route will do little more than kick the can down the road, which will require repeatedly revisiting the deficiencies in our health care system outlined above until we get it right.The US public and increasingly the business community are becoming acutely aware of the rising costs and inadequacies of our current system, particularly as the current epidemic unfolds. It is the growing social movement, which rejects the false and misleading narratives, that will lead us to a universal single-payer system—truly the most effective way to reform our health care system for the benefit of the American people.
What Jonas Salk would have said about COVID-19
By Jonathan Salk- The Hill - 04/13/20
There’s a lot of speculation about a COVID-19 vaccine, from false memes that need debunking, to physicians writing about renewed
appreciation and longing for medical victories like the development of
the first effective polio vaccine. Hailed as medical miracle, the
vaccine was announced 65 years ago yesterday [April 12, 1955].
Dr. Jonas Salk, who led the team that developed it, was my father. Today, people often ask me, what he would have thought or done about our current pandemic. My full answer may not be the one they expect.
Yes, he certainly would have supported and participated in developing a COVID-19 vaccine. He would have understood the urgency of seeking a vaccine and the grave responsibility to make it safe and effective. And he would have decried the tragic, sometimes preventable loss of life we are witnessing around the world.
But here’s the surprising part: Even though he’s the historical figure identified with the triumph of medical science, he would have emphasized that there is more to eradicating disease than science alone. It also involves human-to-human social, political and economic relationships.
If he were here now, he would implore us to remember what made it possible to defeat polio: a national effort to develop and test the vaccine and a world-wide effort to make vaccination available to everyone without profit. Millions donated money and volunteered their children for the largest field trial in public health history. International organizations and governments worked to ensure the entire world could get vaccinated.
My father would insist on also making COVID-19 screening, treatment and vaccination available to all of us, regardless of where we live or our social or economic standing. He would argue that doing so is not only morally right, but profoundly in our national and global interest. When it comes to infectious disease, health — unlike wealth — can’t be hoarded by the few. As long as a virus is circulating in an unimmunized population, it’s a threat to all, and it’s in all our interests to contain, prevent and eradicate it.
But he wouldn’t have stopped there. He would have noted what implications the pandemic holds for our long-term future, and he would have connected it to the transformation we need at this juncture in human history if we are to survive.
From the 1970s until his death in 1995, he thought deeply about this transformation and how we as a species might adapt successfully to population pressures and the approach of planetary limits. He examined the evidence and concluded we must evolve socially. In nature, evolutionary pressures and natural selection bear on competing individuals, but in the case of humans, we became evolutionarily successful through cooperation. My father believed that our future survival would depend on the values of collective human and planetary well-being becoming the drivers of our social, economic and political lives.
In his book A New Reality he showed that population growth is slowing and starting to plateau, a unique inflection point in human history that could also prompt a turn in our value system away from competition and independence and towards cooperation and interdependence. In an earlier book, The Survival of the Wisest, he argued that wisdom is the quality that will allow us to adapt and survive in conditions we have never encountered before.
He would have recognized the COVID-19 pandemic not only as something to be feared and fought, but also as a moment to embrace wisdom. He would have seen this crisis as an opportunity to shift from individualism to interdependence. He would have told us that fighting the pandemic demands replacing the “us first,” win/lose mindset with a “we together,” win/win mindset, and he would have advised that, paradoxically, self-interest in this case is best served by generosity. He would have applauded cooperation and knowledge sharing among scientists and the altruism of medical workers and volunteers. He would have seconded New York’s plea for mutual aid: “Help us now and we’ll help you later.” And he would argue we need to implement that mutuality at every level, from individual relationships to global society.
He might point out the folly of placing material and economic value ahead of human life, as many of us are doing amid the pandemic. With an eyebrow arched, he might warn of the consequences of ignoring the workings of nature and continuing to pursue boundless growth, competition and selfishness. He would let us know that if we persist in that way, we will be sowing the seeds of more suffering and, ultimately, our extinction.
But my father was a scientist and an evidence-based thinker. Based on what he knew of evolution, he believed evolutionary pressures would nudge us in the right direction. He would have seen the pandemic as just such a nudge and would have appreciated the irony that a deadly virus, the same thing that prompted the advancement of medical science 65 years ago, might lead us now to advance social evolution toward a healthier, more cooperative, interdependent world where we can not only survive but thrive — if we only listen.
Dr. Jonathan Salk is a practicing psychiatrist and teaches at the UCLA David Geffen School of Medicine. “A New Reality,” the book he co-authored with his father Dr. Jonas Salk, was recently updated and republished.
https://thehill.com/opinion/healthcare/492438-what-jonas-salk-would-have-said-about-covid-19
Dr. Jonas Salk, who led the team that developed it, was my father. Today, people often ask me, what he would have thought or done about our current pandemic. My full answer may not be the one they expect.
Yes, he certainly would have supported and participated in developing a COVID-19 vaccine. He would have understood the urgency of seeking a vaccine and the grave responsibility to make it safe and effective. And he would have decried the tragic, sometimes preventable loss of life we are witnessing around the world.
But here’s the surprising part: Even though he’s the historical figure identified with the triumph of medical science, he would have emphasized that there is more to eradicating disease than science alone. It also involves human-to-human social, political and economic relationships.
If he were here now, he would implore us to remember what made it possible to defeat polio: a national effort to develop and test the vaccine and a world-wide effort to make vaccination available to everyone without profit. Millions donated money and volunteered their children for the largest field trial in public health history. International organizations and governments worked to ensure the entire world could get vaccinated.
My father would insist on also making COVID-19 screening, treatment and vaccination available to all of us, regardless of where we live or our social or economic standing. He would argue that doing so is not only morally right, but profoundly in our national and global interest. When it comes to infectious disease, health — unlike wealth — can’t be hoarded by the few. As long as a virus is circulating in an unimmunized population, it’s a threat to all, and it’s in all our interests to contain, prevent and eradicate it.
But he wouldn’t have stopped there. He would have noted what implications the pandemic holds for our long-term future, and he would have connected it to the transformation we need at this juncture in human history if we are to survive.
From the 1970s until his death in 1995, he thought deeply about this transformation and how we as a species might adapt successfully to population pressures and the approach of planetary limits. He examined the evidence and concluded we must evolve socially. In nature, evolutionary pressures and natural selection bear on competing individuals, but in the case of humans, we became evolutionarily successful through cooperation. My father believed that our future survival would depend on the values of collective human and planetary well-being becoming the drivers of our social, economic and political lives.
In his book A New Reality he showed that population growth is slowing and starting to plateau, a unique inflection point in human history that could also prompt a turn in our value system away from competition and independence and towards cooperation and interdependence. In an earlier book, The Survival of the Wisest, he argued that wisdom is the quality that will allow us to adapt and survive in conditions we have never encountered before.
He would have recognized the COVID-19 pandemic not only as something to be feared and fought, but also as a moment to embrace wisdom. He would have seen this crisis as an opportunity to shift from individualism to interdependence. He would have told us that fighting the pandemic demands replacing the “us first,” win/lose mindset with a “we together,” win/win mindset, and he would have advised that, paradoxically, self-interest in this case is best served by generosity. He would have applauded cooperation and knowledge sharing among scientists and the altruism of medical workers and volunteers. He would have seconded New York’s plea for mutual aid: “Help us now and we’ll help you later.” And he would argue we need to implement that mutuality at every level, from individual relationships to global society.
He might point out the folly of placing material and economic value ahead of human life, as many of us are doing amid the pandemic. With an eyebrow arched, he might warn of the consequences of ignoring the workings of nature and continuing to pursue boundless growth, competition and selfishness. He would let us know that if we persist in that way, we will be sowing the seeds of more suffering and, ultimately, our extinction.
But my father was a scientist and an evidence-based thinker. Based on what he knew of evolution, he believed evolutionary pressures would nudge us in the right direction. He would have seen the pandemic as just such a nudge and would have appreciated the irony that a deadly virus, the same thing that prompted the advancement of medical science 65 years ago, might lead us now to advance social evolution toward a healthier, more cooperative, interdependent world where we can not only survive but thrive — if we only listen.
Dr. Jonathan Salk is a practicing psychiatrist and teaches at the UCLA David Geffen School of Medicine. “A New Reality,” the book he co-authored with his father Dr. Jonas Salk, was recently updated and republished.
https://thehill.com/opinion/healthcare/492438-what-jonas-salk-would-have-said-about-covid-19
First, the coronavirus pandemic took their jobs. Then, it wiped out their health insurance.
by Amy Goldstein - Washington Post - April 18, 202
Easley, out of a job and out of a health plan, and Health Right, swamped with new patients, represent a ripple effect of the novel coronavirus sweeping the United States. In a nation where most health coverage is hinged to employment, the economy’s vanishing jobs are wiping out insurance in the midst of a pandemic.
No one has a count of exactly how many people have lost their health plans, but there are clues. About 22 million workers have filed unemployment claims since mid-March, according to the most recent federal figures, and that includes only the people who have gotten through to clogged state workforce offices. The latest census data show that job-based coverage accounted for 55 percent of Americans’ health insurance, though the kinds of work disappearing the most — restaurant jobs and others in the service industry — have always been less likely to offer health benefits.
The Economic Policy Institute, a nonpartisan think tank, estimates that 9.2 million U.S. residents were at high risk of having lost coverage during the past four weeks. The consulting firm Health Management Associates forecasts that perhaps 12 million to 35 million people will lose job-based insurance because of the pandemic, on top of the 27.5 million who were uninsured before the virus arrived.
In the small state of West Virginia, as many as 30,000 people can be expected to become uninsured, the consulting firm forecast estimates.
“Any safety-net providers, we see it coming down the track like a big locomotive,” said Angie Settle, Health Right’s chief executive. “When you are a free and charitable clinic, everything we have is based on grants and begging, and we already are at capacity.”
The clinic is getting 15 to 20 calls a day from newly uninsured people who want to come for care — many of them middle-class families, unlike its usual clientele of working poor and homeless.
Even with what Settle calls “an absolute lockdown” on visits that are not emergencies, the clinic has accepted 113 new patients over the past 30 days, compared with 72 during the same period a year ago. They are not infected with the coronavirus, though the clinic is doing testing in a tent out back and at a nearby soup kitchen. They just need urgent help.
The greatest pressure is on the pharmacy. Typically, Health Right spends about $10,000 a month on medications, even with pharmaceutical companies donating some drugs. “And now we are spending that a week,” Settle said.
Some existing patients want more pills, fearful medicine will become unavailable. Some drug manufacturers have ratcheted up prices. And some people, such as Easley, are turning to Health Right so that chronic conditions do not flare out of control.
“My battle,” said Jack Whitley, the clinic pharmacist, “is making sure [new patients] qualify, asking for W-2s, pay stubs,” and, often, proof of layoffs.
When Easley still had his job and his hospitality industry health plan, co-pays on his prescriptions cost $140 a month, he said. If he had to buy them on his own, they would cost $2,007 a month, including more than $900 for insulin and syringes alone, according to figures from Health Right, which gave him the medications free, delivered at the curb.
“That’s a blessing,” said Easley, 56.
For a quarter-century, he worked at the hotel across from the Kanawha River, which runs through town. After Sheraton took it over five years ago, he worked seven days a week until he began taking Sundays off.
He was the first to arrive in the kitchen, taking the 4:10 a.m. bus downtown from his apartment building in time to start at 4:30 a.m. Sometimes, he stayed through the lunch shift, getting enough time at $12.40 an hour to make about $18,000 a year.
The morning he and a dishwasher were summoned to the general manager, he already had prepped for lunch and was cleaning up. “I kind of had a feeling something was going on,” Easley recalled.
Even though West Virginia still didn’t have a covid-19 case — Gov. Jim Justice (R) would announce the first, 300 miles northeast in Shepherdstown, that night — the restaurant had few customers. And Easley had been watching the news.
The general manager told him he would be the first rehired, he said. That didn’t help him now.
Two days later, Easley was on the phone with a human resources specialist at Sheraton headquarters going over separation details. She asked whether he was going to pay the $299 to keep his insurance going for April.
“I don’t even have that,” he replied, unsure how he was going to pay $618 in rent and utilities.
In that case, she told him, his health plan’s last day would be March 31.
'Lives are being disrupted'
The largest and oldest free clinic in West Virginia, founded in 1982, West Virginia Health Right is housed in a two-story brick building on Charleston’s east end, not far from the state Capitol.After 23 years as a nurse practitioner, clinical coordinator and now chief executive, Settle has been witness to enough economic trauma in the Kanawha Valley to fear what is coming. “I’m a very optimistic person, but I don’t know how we are going to recover from this,” she said. “I really don’t. I’m scared.”
She has watched the coal industry decay and factories close. She has been thinking lately back to the 2014 water crisis, when a chemical used to wash coal spilled into the Elk River just upstream, forcing 300,000 people not to use contaminated tap water for days or weeks.
“A lot of the restaurants were closed, hair salons,” she said. “And that wasn’t even statewide.” Some small businesses never recovered, and she thinks that now “it’s going to be so far-reaching. . . . In our area, especially, a lot of these stores and different businesses are not ready to sustain something like this.”
The pressure on the clinic so far “is nothing,” she said. “It’s the aftermath I’m worried about.”
She knows that next month will be worse than this one, once more people’s health benefits end April 30.
Among them is Greg Litvin, 53, who moved with his wife and two children to Charleston six years ago for a software sales job. In August, he started working for Thryv, a successor to the Yellow Pages, selling business automation and marketing plans.
By March 25, when his manager in Thryv’s Dallas headquarters and a human resources representative called to say his job was being eliminated, most of the small, local companies that were his customers had shut down.
His wife and 23-year-old son and 19-year-old daughter — both living at home — are covered through her job with a medical supply company. Her earnings have just been cut by 40 percent, and Litvin was expecting to make nearly $80,000 his first year with Thryv. They are uncertain they can afford to add him to her health plan.
The April 30 end to his Cigna insurance policy, with its $300 premium every two weeks, is a problem. A recent MRI showed brain lesions that stumped his doctor, who referred Litvin to a neurosurgeon, who referred him to a neurologist, with whom Litvin had a telehealth appointment days ago.
The neurologist ordered a different MRI. Litvin is trying to get it scheduled before the end of the month but isn’t sure he can. The last MRI required a $391 co-pay. It would have cost more than $1,400 if he’d had to pay on his own, and that test was simpler than the one he needs now.
“This probably sounds really strange, but I’ve been more stoic about it than I thought I would be,” Litvin said. “It’s a worldwide situation. . . . Lives are being disrupted. There’s a strange feeling of, ‘I’m not alone in it.’ It makes me, as a husband and a father, not feel as much of a failure.”
People around town are losing all kinds of work.
Katrina Wright had pleaded with her husband, a union electrician, to come home from Ohio, where he had been on a huge construction site, helping to build a Google data center. He agreed, knowing the International Brotherhood of Electrical Workers was allowing furloughs.
A few mornings later, she laid off the two women who worked with her in her small cleaning business, worried she could be exposing them and their families to the virus and that they might be exposing their customers. Early that evening, she sent her customers a text: “With a heavy heart as a business owner during this life-changing pandemic, we will indefinitely close. . . . At the end of the day, we need to look out for our clients and ourselves. We will do our part in flattening the curve. Please understand our decision and keep us all in our prayers.”
If her husband kept paying into the union health fund, he could still get his family insurance, but it would cost $1,000 a month, and the only money coming into the house now is $1,200 in unemployment benefits from Pennsylvania, where he worked last year. He hasn’t gotten through to West Virginia’s workforce agency.
So they became uninsured April 1, even though everyone needs care. Her 13-year-old son has autism. Her daughter gets migraines with symptoms that mimic a stroke. At 50, her husband has Raynaud’s phenomenon, a disorder in which blood vessels spasm, leading to decreased blood flow in cold or under stress. At 39, she is being treated for high cholesterol and slightly elevated blood pressure.
Wright has always read medical information, not wanting to be a mother who rushes her children to doctors.
Still, she said, “It’s scary. I can only treat so much at home.”
Tears on payroll night
Anthony Paranzino is the only employer he knows still paying for health benefits.He owns Tony the Tailor, a fine menswear shop in an old Masonic Temple building in the center of Charleston’s historical district. His father opened it as a tailor’s shop in 1974, and Paranzino began working there when he was 9, learning the tailor’s craft until they shifted to selling high-end suits, and his father handed over the business in the early 1990s.
In normal times, he has two employees, as well as his wife and a retired woman who still helps out. By early March, the apparel business was already suffering. It was impossible to get fabric from Italy or componentry from China — countries the coronavirus invaded sooner than it did the United States.
The shop’s last day open was March 13. He figured furloughing his workers then would let them apply for unemployment benefits before it got too crowded.
Thursday evenings were always when he wrote out paychecks. That next Thursday, Paranzino said, “I cried like a baby. It was the first time I didn’t have to make payroll on Thursday night in 30-some years. That’s when the reality set in.”
He continues to pay for health insurance. Usually, he pays half of his workers’ premiums, but he is picking up 100 percent for now. “They are great employees, I didn’t want to leave them hanging.”
It is costing him $2,361 a month. “I can’t do it indefinitely,” he said, with his sales volume down 70 percent, even with some online orders still coming in.
Near his shop in the historical district, only the bank drive-through across the street is open. A new branch of West Virginia University’s law school is shuttered. So is a political consulting firm next door and the Art Emporium, a gallery and framing shop behind him. A block away on Capitol Street, the bars are closed, and some restaurants are open for curbside pickup only.
These mostly workless workplaces within sight gave Paranzino the idea for a nonprofit he has just formed with a lawyer friend. Using his empty shop as the headquarters, they are raising money for laid-off service industry workers, to give a little help with rent or food or utilities. Since the effort began a few weeks ago, about 500 people have applied. The project has raised $26,500 and sent out $10,500 in rent aid and $6,000 in $50 Kroger grocery cards.
The high cost of a pandemic
The testing that Health Right is doing in the tent and at the soup kitchen has not detected anyone with the coronavirus, though 111 people in Kanawha County have tested positive, the most in the state. Across the river from the clinic, Charleston Area Medical Center’s Memorial Hospital has taken in the area’s only covid-19 patients sick enough to need such care. The hospital has admitted 27 infected patients. Ten are still there. Sixteen have been discharged. One has died.The hospital has been more fortunate than many. None of the covid-19 patients it has admitted lacked health insurance, according to Dale Witt, the hospital’s spokesman.
Nationwide, an analysis by the Kaiser Family Foundation, a health-policy group, has estimated that, throughout the pandemic, uninsured coronavirus patients will cost hospitals $13.9 billion to $41.8 billion.
On April 3, Vice President Pence announced the Trump administration was planning to pay hospitals for treating uninsured coronavirus patients, relying on part of a $100 billion fund Congress recently designated for hospitals and other providers of health care strained by the pandemic. There are no details yet.
Even if those payments come, they would be less than hospitals are paid for privately insured patients, and uninsured patients would “still be on the hook” for bills from doctors who treat them in the hospital, said Larry Levitt, Kaiser’s executive vice president for health policy.
Under the Affordable Care Act, people who lose a job are allowed a special enrollment period to buy a health plan, if they can afford one, through the federal insurance marketplace created under the law. President Trump, a foe of the ACA, has resisted calls to more broadly open HealthCare.gov, the marketplace’s online enrollment system available for six weeks late in the year.
Eventually, some unemployed workers can join Medicaid, public insurance for the poor, if their incomes fall low enough. The thresholds vary by state.
For now, some laid-off workers qualify for COBRA, transitional coverage when people lose jobs. Thryv offered COBRA to Litvin. When he checked on premiums, he discovered medical and dental coverage would cost him nearly $800 a month.
“It’s astronomical,” he said.
Knowing that government help in regaining insurance is proving piecemeal and iffy, Settle at Health Right is bracing for an intensifying onslaught.
In the past weeks, the clinic has sent out about 10 emergency requests for extra grant aid from the foundations and others that help prop it up in normal times.
As for Easley, he is grateful to an old friend who mentioned to him that Health Right might be able to help him with his medicines.
But he finds his mornings depressing without the hotel kitchen. “Everybody calls me and checks to see how I am doing,” he said, “because I fed all these people.”
In Fine Print, HHS Seems To Have Banned Surprise Medical Bills During The Pandemic
By Emmarie Huetteman - Kaiser Health News -
Apr 18, 2020
U.S. officials offering emergency funding to hospitals, clinics and
doctors' practices during the coronavirus pandemic have included this
stipulation: They are not permitted to foist surprise medical bills on
COVID-19 patients.
But buried in the Department of Health and Human Services' terms and conditions for eligibility is language that could carry much broader implications. "HHS broadly views every patient as a possible case of COVID-19," the guidance states.
Some health care analysts say that line could disrupt a longtime health care industry practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays. Such charges are a major source of surprise bills, and can be financially devastating for patients. The practice of balance billing is banned in several states, though not federally.
The possibility that HHS might have done with fine print what Congress and the White House could not do — despite bipartisan support and public outrage — caught some who have been immersed in the issue off guard, and raised questions about what exactly HHS meant.
As the first wave of $30 billion in payouts began to hit bank accounts last week, health care providers were asked to sign an online form agreeing to the government's terms. Among those terms is this stipulation: "For all care for a possible or actual case of COVID-19," the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with the patient's insurance company to provide care.
The agreement is posted on the HHS.gov page.
"The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19," an HHS spokesperson said late Friday. "We are clarifying this in the terms and conditions."
Lobbyists, advocates and health policy scholars say the ambiguity could be enough to mandate that providers who accept federal funds not send surprise medical bills to patients — whether or not they test positive for COVID-19.
"If you took the broadest interpretation, any of us could be a potential patient," says Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.
Last week, as HHS released an initial draft of its terms and conditions for the emergency funds allocated by Congress in the CARES Act, the Trump administration startled many in health care by declaring that providers would have to agree not to send surprise bills to COVID-19 patients for treatment. A White House spokesperson declined to comment. HHS did not immediately comment.
But the blanket assertion by health officials that "every patient" is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration's announcement and open the door to lawsuits over whether HHS intended to ban balance billing entirely.
"Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision," says Rodney Whitlock, a health policy consultant and former staffer for Republicans in the Senate.
Some health care providers and others in the industry have fought tooth and nail to safeguard their control over what they can bill patients for care. Certain lobbying groups later revealed to be connected to physician staffing firms owned by profit-driven private equity companies, spent millions last summer to buy political ads that targeted members of Congress who were working on legislation to end surprise billing.
Congress has yet to pass any legislation on surprise billing, but debate over the practice continues behind the scenes. Lawmakers did include modest provisions in relief legislation that prevent people from having to pay out of pocket for COVID-19 tests.
Hoadley of Georgetown says HHS' guidance should have addressed some of the problems that Congress did not explicitly account for in its relief legislation.
"The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients," Hoadley says. "That's going to affect our willingness to" seek testing or treatment.
Frederick Isasi, executive director of Families USA, a nonprofit that advocates for health care consumers, says the group supports the administration's guidance "wholeheartedly" but has urged lawmakers to enshrine broad protections against surprise billing into law.
"It's time to just ban them permanently, not just related to COVID," Isasi says.
https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/
YARMOUTH — We human beings have known about climate change since the
late 1980s, and we have known about the damage it is causing for years.
2019, with its wildfires, storms, melting sea ice, floods in Miami and
elsewhere and famines, has provided a dramatic manifestation of what we
expect in the future. Scientists are telling us that all of these
weather events will increase in intensity.
Yet as we were amazed and frightened by the wildfires that were so close to Sydney, Australia, in 2019, COVID-19 made its appearance in Wuhan, China, and then spread around the world with incredible speed and intensity. There are more than 2.7 million cases and more than 190,000 deaths worldwide. Though the harm caused by the climate crisis is not new, the question hovers: Have the responses to COVID-19 served as a successful dress rehearsal for the human response to the damage that will continue to be caused by the climate crisis?
Let’s look at two countries – Canada and the U.S. – and do two things. First let’s compare the damage done in each of the countries by COVID-19. Then let’s look at the preparations made by both countries to continue to deal with the climate crisis. But we need to make note that the population of the United States is almost 10 times larger than Canada’s. So, to compare any quantity, we need to multiply the Canadian figure by 10 in order to do a comparison.
As of April 10, there were 531 deaths caused by COVID-19 in Canada. Multiplying times 10 gets us 5,310. In the United States, there have been 17,838 deaths caused by COVID-19. When adjusted for population differences, the death rate was more than three times higher in the United States.
Why are there more deaths in the U.S.? Two major reasons seem to be the answer. Canada has a good health care system that is free to all Canadians and seems to have the support of almost all Canadians. So, nobody said I can’t afford to go to the doctor to see if I have COVID. There were testing and hospitalization for those needing it and there were plenty of masks and ventilators and personal protective equipment. In addition, the Trump administration ended the White House’s National Security Council Directorate for Global Health Security and Biodefense, whose mission was to protect Americans from pandemics.
Advertisement
In Canada, there is a belief that government should have the right to make decisions in times of need. Governments are trusted to make decisions based on their understanding of the common good. Because that is true, all of the provincial governments, no matter what their party, agree with the federal government’s strategies on COVID.
The second reason is that the national and provincial governments, in cooperation with Health Canada, enacted action plans together. Most Canadians participated in the strategies of the government from the beginning. As we have seen in other countries, governments that move quickly have a better chance of diminishing the harm caused by the pandemic.
What about the question we started with? Has COVID been a successful dress rehearsal for mitigating the climate crisis? The United States is in process of being the only country in the world that is leaving the Paris agreement, which it is scheduled to do Nov. 4, one day after the U.S. election.
The Canadian government is committed to the Paris agreement’s goal of getting to net-zero greenhouse gas emissions by 2050. That means that they have agreed to reach 30 percent of the 2005 levels of greenhouse-gas emissions by 2030. A terrific goal. There are people in Canada who believe that they need to do much more. Some have stated that they should cut 60 percent of the greenhouse-gas emissions produced in 2005 by 2030.
It seems to me that Canada has had a successful dress rehearsal and should do well at reaching its climate change goals. Its commitment is admirable.
https://www.pressherald.com/2020/04/25/maine-voices-covid-serves-as-dress-rehearsal-for-dealing-with-climate-crisis/
But buried in the Department of Health and Human Services' terms and conditions for eligibility is language that could carry much broader implications. "HHS broadly views every patient as a possible case of COVID-19," the guidance states.
Some health care analysts say that line could disrupt a longtime health care industry practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays. Such charges are a major source of surprise bills, and can be financially devastating for patients. The practice of balance billing is banned in several states, though not federally.
The possibility that HHS might have done with fine print what Congress and the White House could not do — despite bipartisan support and public outrage — caught some who have been immersed in the issue off guard, and raised questions about what exactly HHS meant.
As the first wave of $30 billion in payouts began to hit bank accounts last week, health care providers were asked to sign an online form agreeing to the government's terms. Among those terms is this stipulation: "For all care for a possible or actual case of COVID-19," the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with the patient's insurance company to provide care.
The agreement is posted on the HHS.gov page.
"The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19," an HHS spokesperson said late Friday. "We are clarifying this in the terms and conditions."
Lobbyists, advocates and health policy scholars say the ambiguity could be enough to mandate that providers who accept federal funds not send surprise medical bills to patients — whether or not they test positive for COVID-19.
"If you took the broadest interpretation, any of us could be a potential patient," says Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.
Last week, as HHS released an initial draft of its terms and conditions for the emergency funds allocated by Congress in the CARES Act, the Trump administration startled many in health care by declaring that providers would have to agree not to send surprise bills to COVID-19 patients for treatment. A White House spokesperson declined to comment. HHS did not immediately comment.
But the blanket assertion by health officials that "every patient" is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration's announcement and open the door to lawsuits over whether HHS intended to ban balance billing entirely.
"Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision," says Rodney Whitlock, a health policy consultant and former staffer for Republicans in the Senate.
Some health care providers and others in the industry have fought tooth and nail to safeguard their control over what they can bill patients for care. Certain lobbying groups later revealed to be connected to physician staffing firms owned by profit-driven private equity companies, spent millions last summer to buy political ads that targeted members of Congress who were working on legislation to end surprise billing.
Congress has yet to pass any legislation on surprise billing, but debate over the practice continues behind the scenes. Lawmakers did include modest provisions in relief legislation that prevent people from having to pay out of pocket for COVID-19 tests.
Hoadley of Georgetown says HHS' guidance should have addressed some of the problems that Congress did not explicitly account for in its relief legislation.
"The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients," Hoadley says. "That's going to affect our willingness to" seek testing or treatment.
Frederick Isasi, executive director of Families USA, a nonprofit that advocates for health care consumers, says the group supports the administration's guidance "wholeheartedly" but has urged lawmakers to enshrine broad protections against surprise billing into law.
"It's time to just ban them permanently, not just related to COVID," Isasi says.
https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/
Maine Voices: COVID serves as dress rehearsal for dealing with climate crisis
Comparing the response to the virus by Canada and by the U.S. is illuminating and instructive.
by Reverend Richard Killmer - Portland Press Herald - April 25, 2020
Yet as we were amazed and frightened by the wildfires that were so close to Sydney, Australia, in 2019, COVID-19 made its appearance in Wuhan, China, and then spread around the world with incredible speed and intensity. There are more than 2.7 million cases and more than 190,000 deaths worldwide. Though the harm caused by the climate crisis is not new, the question hovers: Have the responses to COVID-19 served as a successful dress rehearsal for the human response to the damage that will continue to be caused by the climate crisis?
Let’s look at two countries – Canada and the U.S. – and do two things. First let’s compare the damage done in each of the countries by COVID-19. Then let’s look at the preparations made by both countries to continue to deal with the climate crisis. But we need to make note that the population of the United States is almost 10 times larger than Canada’s. So, to compare any quantity, we need to multiply the Canadian figure by 10 in order to do a comparison.
As of April 10, there were 531 deaths caused by COVID-19 in Canada. Multiplying times 10 gets us 5,310. In the United States, there have been 17,838 deaths caused by COVID-19. When adjusted for population differences, the death rate was more than three times higher in the United States.
Why are there more deaths in the U.S.? Two major reasons seem to be the answer. Canada has a good health care system that is free to all Canadians and seems to have the support of almost all Canadians. So, nobody said I can’t afford to go to the doctor to see if I have COVID. There were testing and hospitalization for those needing it and there were plenty of masks and ventilators and personal protective equipment. In addition, the Trump administration ended the White House’s National Security Council Directorate for Global Health Security and Biodefense, whose mission was to protect Americans from pandemics.
Advertisement
In Canada, there is a belief that government should have the right to make decisions in times of need. Governments are trusted to make decisions based on their understanding of the common good. Because that is true, all of the provincial governments, no matter what their party, agree with the federal government’s strategies on COVID.
The second reason is that the national and provincial governments, in cooperation with Health Canada, enacted action plans together. Most Canadians participated in the strategies of the government from the beginning. As we have seen in other countries, governments that move quickly have a better chance of diminishing the harm caused by the pandemic.
What about the question we started with? Has COVID been a successful dress rehearsal for mitigating the climate crisis? The United States is in process of being the only country in the world that is leaving the Paris agreement, which it is scheduled to do Nov. 4, one day after the U.S. election.
The Canadian government is committed to the Paris agreement’s goal of getting to net-zero greenhouse gas emissions by 2050. That means that they have agreed to reach 30 percent of the 2005 levels of greenhouse-gas emissions by 2030. A terrific goal. There are people in Canada who believe that they need to do much more. Some have stated that they should cut 60 percent of the greenhouse-gas emissions produced in 2005 by 2030.
It seems to me that Canada has had a successful dress rehearsal and should do well at reaching its climate change goals. Its commitment is admirable.
https://www.pressherald.com/2020/04/25/maine-voices-covid-serves-as-dress-rehearsal-for-dealing-with-climate-crisis/
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