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Tuesday, February 6, 2018

Health Care Reform Articles - February 6, 2018

Which Path to National Improved Medicare for All?

by Margaret Flowers - Health Over Profit - February 1, 2018

State-level reforms for universal health care are laudable; they are not single payer.
Two states with a long history of state-based healthcare reform efforts, California and New York, are hard at work organizing for state bills labeled as single payer healthcare plans. Other states are moving in that direction too. This raises questions by single payer advocates: Can states create single payer healthcare systems? Does state-level work help or hinder our goal of National Improved Medicare for All (NIMA)?
The movement for NIMA gained momentum throughout 2017, largely due to rising premiums under the Affordable Care Act (ACA) and Republican efforts to worsen the healthcare crisis. Supporters of NIMA mobilized to build support for single payer legislation in Congress, spoke out at Town Halls and pressured lawmakers. As a result, the House bill, HR 676: The Expanded and Improved Medicare for All Act, grew to 120 co-sponsors, the highest number in its 15-year history, and Senator Sanders was successfully pressured to introduce a bill in the Senate, S 1804: The Medicare for All Act.
As momentum grew, the expected push back materialized. In the spring, Democrats in Congress urged people to focus on fixing the ACA and uttered support for various forms of a public insurance, a ‘public option’ or Medicare buy-in. In August, well-known progressives, claiming to be ‘single payer supporters’, published articles arguing that single payer was too much to ask for and outlining ‘incremental approaches’. Members of Congress, including Speaker Nancy Pelosi, complained about Democratic voters making single payer a litmus test in the next elections. Pelosi said, “So I say to people, if you want [single payer], do it in your States.  States are laboratories.” The message was clear, there was too much pressure for NIMA and Democrats didn’t like it. Sending people to work at the state level would lower the heat on Congress
State Efforts for Universal Health Care
Canada is often pointed to as a model for achieving National Improved Medicare for All in the United States. A universal medical insurance was first created in the province of Saskatchewan in 1962, following decades of increasing socialization of medicine in several provinces and a national law that financed universal hospital coverage at the provincial level. By 1968, a universal publicly-financed Medicare program was adopted nationally. Could the same path occur in the US?
The twenty-first century healthcare system in the United States is much more complex than the Canadian system was in the 1960s. At that time, health care was left up to the provinces. Dr. Don McCanne writes, “We cannot use the example of Saskatchewan and pretend that a state can set up a single payer system that could serve as an example for the nation – a model that could be expanded to all states. No. Saskatchewan began with a tabula rasa. They were able to create a de novo single payer system.”
Rather than socializing medicine, the US has experienced decades of increasing privatization. There are a multitude of payers in the US, which include private insurance through employers, unions and individually, public programs, and national programs for federal employees and the military. A state would have to succeed in obtaining multiple waivers from the federal government and changes to federal laws to enact a state-based program. One federal law, the Employee Retirement and Income Security Act of 1974 (ERISA), which prohibits states from regulating employee benefits, is a major obstacle. States also face the hurdle of being required to balance their budgets, a barrier that doesn’t exist at the national level.
As outlined in Public Citizen’s “Roadmap to Single Payer,” a state can potentially make its healthcare system more efficient, but it cannot achieve a pure single payer system; thus, it can’t attain the bulk of savings that a single payer system would have. Within their budget constraints, states would be forced to raise the costs to individuals and businesses or lower coverage if they are not able to meet their needs for care. This has happened in every past attempt by states to achieve universal coverage, as Drs. Steffie Woolhandler and David Himmelstein document in “State Health Reform Flatlines.”
If a state were able to pass a bill outlining a path toward a universal healthcare system and to be granted a federal waiver from the Affordable Care Act (ACA), which are major feats, the state would still face significant barriers, some of which make it impossible to create a pure single payer program.
Barriers to state single payer
1. Federal health plans – There are numerous federal health plans, such as Medicare for seniors and those who qualify for disability, the Federal Employee Health Benefits Program (FEHBP), which includes over 200 plans, the Veterans Health Administration (VA), the Indian Health Service (IHS) and Tri-Care for members of the military; it is not possible to merge all these programs into a single state system.
The Center for Medicare and Medicaid Services (CMS) does not have the authority to give federal Medicare dollars to the state as a block grant. Single payer advocates have opposed passing a federal law that would allow this due to concern that it would dismantle the Medicare Program state-by-state and allow some states to use the law to further privatize Medicare through vouchers.
Some state advocates have considered applying for a new state healthcare plan to be considered a Medicare Advantage plan. These are private plans offered under Medicare. If such a waiver were granted, the state still could not force seniors to choose the state plan, so it would only capture some of the Medicare recipients in the state.
There is a similar situation with the health plans for federal employees. It would require a change in federal law to shift the FEHBP to the state. Perhaps a state could apply to be considered a choice for federal employees but even if it succeeded, it could not compel federal employees to choose their plan. Tri-Care is a program run by the Department of Defense that would also continue to operate outside the new state system. And the VA and IHS would operate independently as well.
It is possible, although this has not been tried yet, that a state could become an intermediary between providers in the state and the various federal programs such that claims would be submitted to the state and the state would collect the payment from the federal program to pay the provider. This would add more administrative complexity and cost to the state program, and providers would still have to interact with the individual plans for authorization of care.
2. Medicaid – Medicaid is a federal program for people with low incomes administered at the state level. A state would have to apply for a waiver to incorporate Medicaid into its new state program. There is greater flexibility for a state to do this than there is for Medicare. States would still have to track how many people qualify for Medicaid to be reimbursed for them by the federal government, another administrative task that adds cost, or would need to ask for a block grant. Single payer advocates have opposed turning Medicaid into a block grant program because that would limit funds during periods of recession when more people qualify for Medicaid. A block grant would not expand as the need expanded. Currently, all states except Connecticut use a mix of private insurance Managed Care Organizations (MCO’s) for Medicaid patients. To streamline its Medicaid system, a state would need to get rid of its multiple Medicaid MCO’s.
3. Employer Health Plans – Employee benefits are protected under a federal law, the Employee Retirement Income Security Act of 1974 (ERISA). While states have the authority to regulate health insurers that operate in their state, they do not have authority to regulate plans offered by businesses that self-insure, which is 60 percent of businesses that provide health benefits. Any interference in employee benefits can be challenged under ERISA and would result in a lengthy and expensive court battle.
California and New York are trying to circumvent ERISA by stating explicitly that their state program “does not create any employment benefit, nor does it require, prohibit, or limit the providing of any employment benefit.” However, a state system would be challenged under ERISA, and recent ERISA challenges have not been favorable. A case between the state of Vermont and Liberty Mutual, which operates as an ERISA plan, went to the US Supreme Court in 2016 and was decided against the state. The case involved a law requiring insurers to report claims data. Even though the Vermont law did not specifically target ERISA plans, it was determined to be preempted by ERISA because it had a “connection” to the ERISA plan. Another impermissible “connection” would occur if “economic effects of the state law force an ERISA plan to adopt a certain scheme of substantive coverage or effectively restrict its choice of insurers.” A state law requiring businesses to pay a payroll tax would likely be viewed as restricting choice.
States can strive for universal coverage, but calling plans single payer is incorrect
For many decades, states have introduced and passed laws aimed at achieving universal health care coverage. None has yet succeeded in being universal or sustainable, but these are admirable efforts that have increased access to care, at least temporarily. It is possible for a state, using the roadmap outlined by Public Citizen, to move towards universal coverage. It is not possible to achieve a pure single payer system at the state level and so states forego the significant savings of a single payer system.
In the drive towards universal health care, states might consider working to get rid of private Medicaid MCOs as Connecticut did so that more Medicaid dollars are available to cover more people and/or more care. Oklahoma had a similar program that was successful. Part of the success of these programs is providing case management for people with significant health needs to avoid preventable emergency room visits and hospitalizations.
Given that states are not able to achieve pure single payer systems, states take a risk when they label themselves single payer or Medicare for All. While it is understandable that these terms are popular and that most advocates for health reform support single payer, and so are inspired to work for it, it is misleading and could harm national efforts.
For example, Vermont passed a law in 2010 requiring the state to develop a plan for universal healthcare coverage. That law allowed the state to contract Dr. William Hsaio, who assisted in the design of the Taiwanese single payer healthcare system in the 1990s, to design their system. Vermont’s system was not a single payer system, yet it was consistently called single payer by the Governor, advocates and the media. It failed, and its failure was blamed on its high cost.
Similarly, Colorado attempted universal healthcare coverage in 2016 through the creation of a state-wide publicly-financed healthcare cooperative: “ColoradoCare would have replaced most private health insurance and taken over the state’s Medicaid program for the poor and people with disabilities, starting in 2019. The ballot initiative did not seek to replace Medicare benefits or current health coverage for veterans, military personnel and civilian defense employees.”
The Colorado plan was called single payer, even though it wasn’t, and its defeat was marked in the media as a second defeat for single payer health care. Prominent Democrats opposed ColoradoCare. Some progressive groups in Colorado also declined to support it, saying that single payer can only be done at the national level. It is hard to argue with them when they are correct. It undermines our legitimacy if single payer advocates are on the inaccurate side of that argument.
Do state efforts help or hinder national efforts?
Advocates for ‘single payer’ at the state level often say that state efforts will help national efforts. Some advocates work for reform at the state level because they believe the public will be more inspired to fight for change at the local than at the national level.
It is true that it is often easier to engage people around local or state efforts. They feel more winnable. But, what happens when the public is told they are working for state-based single payer and then they find out that they have been misled because the goal is not possible? It may be that public trust is lost or that people experience a deep disappointment because they worked hard for something that will never be realized.
And, what would happen if a state succeeded in passing a health law? First, it would take a tremendous effort focused on influencing state, not national, legislators to pass it. Second, that level of state-based pressure would have to be maintained to implement the law. And third, a state campaign would be so focused on these efforts that it would have little time or resources to advocate for change at the national level. Their national fight would be aimed at applying for waivers and winning changes to the Medicare law and ERISA.
Imagine if a highly-populated progressive state such as California or New York were to drop out of the national effort for NIMA to focus on their state. This would be a huge loss. Dr. Woolhandler reminds us, “Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other ‘red state’ areas for whom national legislation is the only realistic option for health care progress.”
The only way we will achieve National Improved Medicare for All is if we develop a movement of movements and strategic campaigns focused on that goal. It is going to be a fight, but it is a winnable fight, especially now as the ACA becomes unsustainable and Congress threatens the minor safety net currently in existence. To win, we need to continue to build momentum in our states to pressure members of Congress. This election year is a perfect time to do that, particularly during the primaries when candidates are sensitive about their image.
We need to connect our fights to other struggles to protect public insurances such as Medicaid and Medicare. The solution to preserving our social health systems is to make them universal. Then we have the social solidarity, everybody in and nobody out, to protect and strengthen them.
A study of social movements shows us that we are close to winning NIMA. The power holders will predictably work to throw us off track by sending us down false paths of partial reforms and state-based efforts and lure us into working on elections. We must recognize and resist these distractions. We will win when we have built the popular power to shift the political culture so that no politician can be on the wrong side of this issue. We win when there is a loud and clear public demand for National Improved Medicare for All.

Making Medicaid a pathway out of poverty
by Seema Verma - The Washington Post - February 4, 2018
Americans are among the most generous people in the world. While this nation was founded on the pursuit of a shared dream, the moral pledge of the American people has been to never leave behind our most vulnerable fellow citizens.
When we created Medicaid in 1965 as part of President Lyndon B. Johnson’s War on Poverty, we formalized that commitment and wove a fabric of care that has provided health services for seniors in need, pregnant mothers, low-income children and parents, and people with disabilities. Johnson affirmed the nation’s safety net, saying, “Our aim is not only to relieve the symptoms of poverty, but to cure it and, above all, to prevent it.”

Prior to passage of the Affordable Care Act, the Medicaid program focused on caring for seniors in need, pregnant mothers, children and Americans with disabilities. But in 2010, the ACA fundamentally changed Medicaid by shifting predominantly low-income adults — often without children, healthy and working-age — into a program that wasn’t designed for them.
Our nation should always give our utmost attention and care for Americans most in need. As such, we must allow states, who know the unique needs of their citizens, to design programs that don’t merely provide a Medicaid card but provide care that allows people to rise out of poverty and no longer need public assistance. As Ronald Reagan once put it, the aim of a government program for the poor “should be to eliminate, as far as possible, the need for its own existence.” 
Our aim is to restore a strong state-federal relationship while also modernizing the program to deliver better outcomes for all the populations served. The first step is to recognize that Washington does not know what is best for states. To the contrary, we should empower states to work with their communities, providers and citizens to design innovative programs that meets their diverse needs, while holding them accountable for achieving positive outcomes.
Prior to the Trump administration, many states had been clamoring for the flexibility to add work and community-engagement incentives for able-bodied, working-age Medicaid beneficiaries, a group substantially expanded by the ACA. The compassionate nature of these states encouraged the creativity to design a system to help the new able-bodied, working-age Medicaid population unlock their fullest potential. Despite the evidence demonstrating that work and community engagement can have a major positive impact on health and wellness, the previous administration rejected these requests.
We believe that if Medicaid is going to be used as the vehicle to offer substantial taxpayer benefits to healthy, working-age Americans, then we must allow the program to be more flexible. We recognize that states are closer to the people they serve and can better help recipients rise out of poverty.
Today, 11 states represented by governors of both major political parties have submitted proposals to implement work and community-engagement requirements for their non-disabled, working-age populations. We applaud their efforts to strengthen the Medicaid program and are supportive of testing approaches to end poverty and improve outcomes.
The guidance we released last month intends to help states as they develop and evaluate their programs. It provides for state flexibility but also details the necessary protections states must include for people with disabilities or other health issues that may prevent them from participating in a community-engagement requirement, including those with opioid addiction and other substance-use disorders. Our guidance also requires states to address local economic conditions that may impact an individual’s ability to find work. 
This administration anticipated that this stance would be met with criticism from those who espouse that requiring community engagement as a condition of federal support is a barrier to care. It is unfortunate that some automatically assume that low-income Americans are incapable of contributing to their communities, especially when many of them already do or want to do so. It is even more shameful that they would dress up this unflattering view of their fellow citizens in the guise of compassion.
True compassion is lifting Americans most in need out of difficult circumstances. The new flexibility requested by states will allow them to partner with us to help program beneficiaries live healthy, fulfilling lives as independently as possible. This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens. We owe it to these Americans to try whatever may help them achieve the dignity and self-sufficiency they deserve.

Trump administration considering lifetime limits on Medicaid benefits

by Tony Pugh - McClatchey News Service - February 5, 2018

WASHINGTON — After allowing states to impose work requirements for Medicaid enrollees, the Trump administration is now pondering lifetime limits on adults’ access to coverage.
Capping health care benefits – like federal welfare benefits – would be a first for Medicaid, the joint state and federal health plan for low-income and disabled Americans.
If approved, the dramatic policy change would recast government-subsidized health coverage as temporary assistance by placing a limit on the number of months adults have access to Medicaid benefits.
The move would continue the Trump administration’s push to inject conservative policies into the Medicaid program through the use of federal waivers, which allow states more flexibility to create policies designed to promote personal and financial responsibility among enrollees.
However, advocates say capping Medicaid benefits would amount to a massive breach of the nation’s social safety net designed to protect children, the elderly and the impoverished.
WAIVER REQUESTS APPROVED
In January, the Trump administration approved waiver requests from Kentucky and Indiana to terminate Medicaid coverage for able-bodied enrollees who do not meet new program work requirements. Ten other states have asked to do the same.
“We must allow states, who know the unique needs of their citizens, to design programs that don’t merely provide a Medicaid card but provide care that allows people to rise out of poverty and no longer need public assistance,” said a statement posted on Twitter on Monday by Medicaid administrator Seema Verma.
At least five states – Arizona, Kansas, Utah, Maine and Wisconsin – are seeking waivers from the Trump administration to impose lifetime Medicaid coverage limits.
The proposals reflect the administration’s belief that Medicaid coverage should be retained for vulnerable populations like children, pregnant women and those with disabilities. Proponents of the change say the program’s coverage for healthy adults, particularly those with no dependent children who received expanded coverage under Obamacare’s Medicaid expansion, should be curbed.
Critics, however, say Medicaid time limits will pose an enormous administrative burden by requiring states to track recipients’ employment, eligibility and disability status. It could also shave valuable coverage months from people with health problems that impede their ability to work.
In addition, low-wage workers who may not get health coverage through their jobs could also reach their Medicaid coverage limit “as if it’s their fault that their job isn’t offering insurance,” said Leonardo Cuello, director of health policy at the National Health Law Center. “And this would happen to thousands upon thousands of people across the country,” if the policy catches on nationwide.
Others argue that attaching time limits and work requirements to Medicaid coverage does not meet a basic requirement of HHS waiver experiments and demonstration projects: to further the objectives of the Medicaid program, such as improving coverage, health outcomes and access to providers.
“All of these policies that we are seeing are inconsistent with the objectives of Medicaid. They don’t seem to have a legal basis and, as such, our stance is that they should not be approved. And we will work very hard with our partners to make that opinion well known,” said Suzanne Wikle, a senior policy analyst at the Center for Law and Social Policy.
But unlike capping cash welfare assistance or food stamp benefits, time-limiting health coverage runs the risk of pushing sick people into costly emergency rooms where they’ll receive indigent care paid for by taxpayers.
“I think you have to be very thoughtful here in a way that’s quite different from cash assistance,” said Gail Wilensky, a senior fellow at Project HOPE who ran the Medicaid program from 1990 to 1992 under President George H.W. Bush. “It depends on what the safeguards and defaults are in a program like this. Otherwise it does not make a lot of sense and seems to be cruel and inappropriate.”
Arizona and Utah both want a five-year lifetime limit on coverage. Utah’s would apply only to childless adults and would come “with the expectation that they do everything they can to help themselves before they lose coverage,” according to the state’s waiver application.
In Arizona, time-limited coverage would only accrue during months when enrollees don’t meet their work requirements, which the state is also seeking in their waiver application. Wisconsin wants to limit lifetime coverage for childless adults to 48 months. Kansas would limit coverage to 36 months.
In Utah, Wisconsin and Kansas, the time-limited coverage would apply even to Medicaid enrollees who meet employment and work requirements.
In Maine, Medicaid enrollees who don’t meet program work requirements could only get up to three months of coverage in a 36-month period. And only in special circumstances could these enrollees get an extra month of coverage.
The Obama administration previously denied Arizona’s request for Medicaid coverage limits and work requirements, saying they didn’t meet the program’s goal of ensuring coverage for vulnerable populations.
Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities, said there’s a “50-50 chance” that the Trump administration approves the time limits.
“I feel like the Trump administration is hell-bent on trying to keep people out of coverage. … So, I don’t know. I hope not, but I’m not holding my breath. And I guess I wouldn’t be too terribly surprised to see it approved,” said Schubel, a former senior policy advisor at HHS’ Center for Medicare and Medicaid Services during the Obama administration.
The Department of Health and Human Services did not respond to a request for comment for this story.


U.S. Pays Billions for ‘Assisted Living,’ but What Does It Get?
by Robert Pear - NYT - February 3, 2018

WASHINGTON — Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry.
The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid, the Government Accountability Office, a nonpartisan investigative arm of Congress, says in a report to be issued on Sunday.
Billions of dollars in government spending is flowing to the industry even as it operates under a patchwork of vague standards and limited supervision by federal and state authorities. States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries, an average of more than $30,000 a person, the Government Accountability Office found in a survey of states.
States are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities. But, the report said, more than half of the states were unable to provide information on the number or nature of such cases.
Just 22 states were able to provide data on “critical incidents — cases of potential or actual harm.” In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents.
Many of those people are “particularly vulnerable,” the report said, like older adults and people with physical or intellectual disabilities. More than a third of residents are believed to have Alzheimer’s or other forms of dementia.
The report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a two-year study requested by a bipartisan group of four senators.
Assisted living communities are intended to be a bridge between living at home and living in a nursing home. Residents can live in apartments or houses, with a high degree of independence, but can still receive help managing their medications and performing daily activities like bathing, dressing and eating.
Nothing in the report disputes the fact that some assisted living facilities provide high-quality, compassionate care.
The National Center for Assisted Living, a trade group for providers, said states already had “a robust oversight system” to ensure proper care for residents. In the last two years, it said, several states, including California, Oregon, Rhode Island and Virginia, have adopted laws to enhance licensing requirements and penalties for poor performance.
ut the new report casts a harsh light on federal oversight, concluding that the Centers for Medicare and Medicaid Services has provided “unclear guidance” to states and done little to monitor their use of federal money for assisted living.
As a result, it said, the federal health care agency “cannot ensure states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries receiving assisted living services, potentially jeopardizing their care.”
Congress has not established standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements on homes and specified the services they must provide.
But assisted living facilities have largely escaped such scrutiny even though the Government Accountability Office says the demand for their services is likely to increase because of the aging of the population and increased life expectancy.
That potential has attracted investors. “Don’t miss out on the largest market growth in a generation!” says the website of an Arizona company, which adds that “residential assisted living is the explosive investment opportunity for the next 25 years.”
Carolyn Matthews, a spokeswoman for the company, the Residential Assisted Living Academy, said: “Unfortunately, there has been elderly abuse in this business. We are trying to change the industry so the elderly have better quality care and we are not warehousing them.”
The government report was requested by Senator Susan Collins of Maine, a Republican who is the chairwoman of the Special Committee on Aging; Senator Orrin G. Hatch of Utah, a Republican who is the chairman of the Finance Committee; and two Democratic senators, Claire McCaskill of Missouri and Elizabeth Warren of Massachusetts.
The Trump administration agreed with the auditors’ recommendation that federal officials should clarify the requirement for states to report on the abuse or neglect of people in assisted living facilities. The administration said it was studying whether additional reporting requirements might be needed.
“Although the federal government has comprehensive information on nursing homes providing Medicaid services, not much is known about Medicaid beneficiaries in assisted living facilities,” the report said.
Assisted living was not part of the original Medicaid program, but many states now cover it under waivers intended to encourage “home and community-based services” as an alternative to nursing homes and other institutions.
The report said that assisted living could potentially save money for Medicaid because it generally cost less than nursing home care. Under the most common type of waiver, Medicaid covers assisted living only for people who would be eligible for “an institutional level of care,” in a nursing home or hospital.

Trump: NHS 'going broke and not working'

BBC - February 5, 2018

US President Donald Trump has claimed the NHS is "going broke and not working" as he targeted rival Democrats pushing for a universal health system.
In his tweet he also said "thousands of people are marching" about it.
This was believed to be a reference to a Save the NHS march on Downing Street on Saturday demanding more funding for the health service.
Asked about his remarks, Downing Street said Theresa May was "proud" of the UK's system.
Her spokesman said the NHS had recently been ranked as the world's best healthcare system and that Health Secretary Jeremy Hunt, who has hit back at the US president on Twitter, "speaks for the government".
In the UK the NHS is funded out of general taxation, so people do not have to pay when they get treatment. In the US, when people get treatment they have to pay, most often through health insurance providers.
President Trump's tweet came after ex-UKIP leader Nigel Farage appeared on Fox And Friends, one of the president's favourite shows, talking about the weekend march.
"Dems want to greatly raise taxes for really bad and non-personal medical care," Mr Trump tweeted.
In response, Mr Hunt said that while he "disagreed with claims made on that march", no-one wanted "to live in a system where 28 million people have no cover".
He added: "NHS may have challenges but I'm proud to be from the country that invented universal coverage - where all get care no matter the size of their bank balance."
Labour leader Jeremy Corbyn - the leader of the UK opposition - also hit back, saying: "People were marching because we love our NHS and hate what the Tories are doing to it."
He added: "Healthcare is a human right."
NHS funding has been hotly debated in the UK as hospitals struggle to cope with the pressure on resources.
A panel set up by the Liberal Democrats - the fourth largest party in the Commons - has called for a ring-fenced tax to fund the service, saying an extra £4bn was needed for next year and an additional £2.5bn for both 2019 and 2020.
Lib Dem leader Sir Vince Cable urged the US president to read the study, "to find out how to fund a universal healthcare system".

Analysis by Anthony Zurcher, BBC North America reporter

Donald Trump has said that he doesn't watch much television, claiming once he was too busy "reading documents".
Time and again, however, the president has praised and promoted specific Fox News programmes - particularly the cable network's morning offering, Fox and Friends. 
Such was the case on Monday, as the president tweeted about the National Health Service shortly after former UKIP leader Nigel Farage appeared on Fox to criticise the NHS during a segment on a recent London protest march.
Healthcare reform, while a major topic of partisan debate in the US last year, has fallen off the radar recently. Republicans tried, and failed, to roll back government regulation of the insurance industry instituted by Barack Obama. In last week's State of the Union address, Mr Trump barely mentioned of the topic.
When Fox News catches the president's attention, however, that can change with the flick of a Twitter finger.
The UK government says NHS funding "is at a record high" with an extra £2.8bn pledged for the service in the Budget.
Mr Farage said the NHS was "at breaking point due to a population crisis", adding: "We haven't got enough hospitals, doctors or facilities to cope."
The British television presenter Piers Morgan, who calls President Trump a friend and who interviewed him last week, did not agree with the tweet:
Saturday's demonstration, called NHS In Crisis: Fix It Now, was organised by the People's Assembly Against Austerity and Health Campaigns Together.
In a joint response to the US president, they said people had marched "to show their love for the principles of universal and comprehensive care free at the point of use, paid for through general taxation".
They added: "We don't agree with your divisive and incorrect rhetoric."

Editor's Note:

The following short article from the New York Times provides anecdotes about some patients experience with the British National Health Service. What the article fails to mention, however, is that the British NHS spends roughly one-third as much per capita as the United States. It's a classic example of "you get what you pay for". That should be kept in mind when speculating about what the performance of such a system would look like if transplanted to the US.

They also have a private insurance system that functions alongside their public system allowing those who can afford it to "queue-jump" - in other words, to buy out of their public system. That contributes to fragmentation of popular support for adequately funding the NHS.

That is a good illustration of the importance of creating a system where everybody participates, with no queue jumping allowed, as Canada has.

- SPC

What It’s Like to Be a Patient With the N.H.S.

NYT - February 6, 2018

Britain’s National Health Service turns 70 this year, amid warnings of an existential crisis. At the end of last year, we interviewed several staff members to ask them what they hoped and feared for the system’s future. Now, readers tell us about their and their families’ experiences with the N.H.S. 
Here are their stories, edited for length and clarity.

I believe they did all they could

In 2015 my husband died from cancer at 35. It was a short time between realizing something was wrong and him dying, most of which we spent in the hospital. The staff were all caring and professional. I believe they did all they could, and when it became clear that he would die, they were very supportive. I was 20 weeks pregnant at the time, and they went above and beyond to look after us both. One example: We had decided not to know the sex of the baby, but when we realized he wasn’t going to make it to the birth, the midwives in the hospital brought a mobile scanner up to the ward so that my husband could have a last look at the baby, and we could learn the sex together. That meant so much to us. And after he died I had extra appointments and scans (at no extra cost) to reassure me that the stress and emotions hadn’t affected the baby. Again, not everything was perfect, but I just can’t imagine going through all of that, and having to deal with insurance companies and money worries as well. — Kate Trouw, United Kingdom

I would not wish the U.S. medical system on anyone

I am an American living in Britain. I would not wish the U.S. medical system on anyone. When I had a baby in Britain, all was paid for. Suspected meningitis in my baby? Hospital stay and all tests paid for. Sexual health screenings? Free. Dermatologist check-up on my Southern Californian skin? Free. Possible cancerous mole removal? Free. Father-in-law treatment for cancer? Free. End-of-life care for my mother-in-law? Free. Lengthy hospital stay plus live-in rehab unit for an elderly grandparent? Free. If Britain reverts to a U.S.-style system, this country will truly lose what it means to be British: care and compassion for everyone. — Jennie Vian, United Kingdom

There’s been no help

We’re meant to lionize the N.H.S., here in the U.K. But it’s not always that great.
My youngest son has been on waiting lists for the Child and Adolescent Mental Health Services for four years. The process is so slow, I had to get my member of Parliament to intervene just to get an initial assessment. We wanted him to get some help for anxiety and autism-related problems before he moved on to senior school. There’s been no help, and he had to start senior school. It went very badly for him. We’ve since had to withdraw him from the school system.
The N.H.S. is full of wonderful clinicians and nursing staff who put patient care first. But to refuse to acknowledge its problems does it a disservice. — Sean Fleming, United Kingdom
I have received mental health services through the N.H.S. I was diagnosed with depression and anxiety, and at a low point I was hospitalized at the mental ward in an N.H.S. hospital. The environment was safe and allowed me to take the first steps to being a calmer, happier person. A few years later I’m able to have a job — something that my intense anxiety wouldn’t have allowed for beforehand. I also received cognitive behavioral therapy which has allowed me to regain control of my life. I am so happy to have this resource as I know my family and I would not have survived without it. — S. Rae, United Kingdom

I wanted to love the N.H.S., but couldn’t

My husband and I (both Americans) worked and lived in London from 2013-17, during which time we were N.H.S. patients for our baby’s birth and my cancer diagnosis. For us, the N.H.S. was great until it was terrible. When we moved to the U.K. for my job, I was offered private insurance by my company and turned it down because the N.H.S. seemed high-quality. I gave birth to our baby there in 2015, and we loved the N.H.S. for so many reasons.
However, in 2017, I found a lump in my breast. It took three visits and two months to convince my N.H.S. doctor that I should go to the hospital. He was certain it was breast-feeding related, which was a misdiagnosis. The N.H.S. hospital revealed stage III breast cancer. It took weeks to get the pathology results, then follow-up tests and results. It took almost a month to get staging, and it would have taken months to get treatment. Delays at every step, and lots of long waits. Fears of operations cancelled or postponed. The delays were so agonizing that we moved to the States. I’m so disappointed because I wanted to love the N.H.S., but I couldn’t. — Laura Bacon, United States

I called up the local hospital and was stunned

I studied abroad at Swansea University in the United Kingdom as an undergraduate. I managed to avoid my usual springtime cold up until the end of my time in Wales — I got pretty sick and figured I needed a check-up just to be sure nothing more serious was going on. I called up the local hospital, and was stunned when I was put straight through to a physician, who calmly walked through my symptoms. He advised that I come into the hospital that evening, to the Accident and Emergency department, for him to have a look.
As any American can understand, my first question on arrival was: Do you know if you accept my insurance? The folks at the front desk had no idea. I assumed I would need to make use of my travel insurance, at the very least. The concept was totally foreign to the staff. Once I saw the doctor, found out I was going to be just fine, and got some good advice, I asked the same question again: Where do I pay? Do you know if my insurance is accepted here? Again, a blank look. “Health care in Britain is free at the point of delivery,” he said proudly. He was incredulous that I had come in worried about who would pay for my simple check-up — and proud to be part of a system in which such a question would be considered absurd. — Chris Collins, United States

If they’d had more time, they’d have seen the D.N.R. note

With my grandma, there were a number of issues that went wrong. First, when my family called the emergency services, the ambulance came, and they checked her over and they said there wasn’t really anything wrong with her. They said she was just playing up to be sickly, which would not have been something my grandma would do. They left her at her house, and then about two hours later, a second ambulance was called. They decided that she did need to go to the hospital, so they took her in. It took quite a while to figure out what was wrong. They wouldn’t listen to my parents, who were describing the symptoms she was presenting with. It was only when she had a heart attack in front of the medical staff that they realized she’d been having multiple heart attacks. She must have been in tremendous pain, and it’s quite frustrating that the underfunding of the N.H.S. meant the priority was “we need a bed for someone who really needs it” rather than providing decent palliative, end-of-life care for someone.
Junior doctors just don’t get given the time to familiarize themselves with patients’ notes. And it’s very unfortunate because if they had had that extra time, they would have seen the do-not-resuscitate note. But unfortunately, they brought my grandma back. She survived the night and then the next day she passed away. — Bryony Jackson, United Kingdom
The N.H.S. is amazing and vital and part of our national identity. One story among many: My son had an infection just after birth. The nurse who suspected something came back after her shift was up as it was on her mind; she’d just caught that his breathing was very slightly fast. She herself was going through a difficult break-up, it was New Year’s, and she must have been exhausted. And yet, but for that sense of something not quite right, my son would be dead. — Owen Hewlett, United Kingdom
https://www.nytimes.com/2018/02/06/opinion/nhs-britain-patient.html?


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