Where did our raises go? To health care.
by Robert J. Samuelson - Washington Post - September 3, 2018
It’s wages vs. health benefits. On this Labor Day, just about everything seems to be going right for typical American workers, with the glaring and puzzling exception of wage stagnation. The unemployment rate is 3.9 percent, near its lowest since 2000. The number of new jobs exceeds the peak in 2008 by about 11 million. Then there’s wage stagnation.
Corrected for inflation, wages are up a scant 2 percent since January 2015, according to the Bureau of Labor Statistics. The gain is roughly one-half of 1 percent annually. Little wonder that many workers feel they’re not getting ahead. They aren’t.
A strong and growing economy is, by the textbook, supposed to put upward pressure on wages as companies bid for more workers and employees shop around for higher pay. All sorts of plausible theories have been advanced to explain why this doesn’t seem to be happening.
Demographics are cited. Well-paid baby boom workers are retiring and being replaced by lower-paid millennials; this drags down average wages. Or the Great Recession left workers and employers with psychological scars. Workers are more concerned with job security. They are leery of pressing for big wage increases, just as companies are leery of providing them. Mismeasurement of wages is another theory.
All these explanations may matter, but a major contributor — perhaps the major contributor — may lie elsewhere: health costs. Money once reserved for wage increases is now diverted to pay for employer-provided health insurance. A new study provides stunning estimates: For the bottom 60 percent of U.S. workers, wage gains have been completely wiped out by contributions for employer-provided health insurance.
“For many workers, rising health insurance premiums were eating up every last cent of their pay increases and more,” the study said. This affects how “people buy houses, save for retirement, launch their children into adulthood and otherwise try to get ahead in life.”
The study focused on full-time, year-round workers from 1980 to 2015. It did not cover people who were unemployed or had government insurance (Medicare, Medicaid and the Affordable Care Act).
Using government data and a private survey from Willis Towers Watson, a consulting firm, the study compared wage and salary income to the cost of fringe benefits (mainly retirement and health benefits).
For the bottom 50 percent of workers, employers’ health insurance contributions averaged 30 to 35 percent of companies’ total compensation packages. Companies also increased the premiums that workers themselves must pay to get coverage. From 1999 to 2015, worker premiums for a family plan more than doubled in inflation-adjusted dollars, from about $2,000 annually to almost $5,000.
As this shows, higher health-care costs fall heaviest on lower-paid workers. The reason: Insurance coverage is a bigger part of their total compensation. (In the example, the $5,000 is 10 percent of income for a worker making $50,000 but only 5 percent for a worker making $100,000.)
It has long been known that rapidly rising health-care costs put downward pressure on workers’ wages. But “no one has put the numbers quite like we have . . . [showing] how it affects stagnant pay and the distribution of pay,” said Sylvester Schieber, a retired economist with Willis Towers Watson and the study’s co-author, along with Steven Nyce, the firm’s research director. The study was also co-sponsored by the Council for Affordable Health Coverage, a business group.
Columnist Catherine Rampell analyzes the Trump administration's plan to reduce health care costs. She's not impressed. (Danielle Kunitz, Catherine Rampell/The Washington Post)
The problem is plain: We’d all like both cheaper health insurance and higher wages, but the way the health-care system is operating today, we might get neither. As insurance premiums get more expensive, inflation-adjusted (“real”) wages will continue to stagnate or decline.
This might be acceptable if the medical system were delivering better care for all the extra spending. But, as Nyce and Schieber note, the opposite may be the case. They compare the United States with other advanced societies:
“There is considerable evidence we are receiving less in the way of good health care. . . . We have fewer doctors and fewer doctor visits per capita. We have fewer hospital beds and lower hospital occupancy rates. We undergo more MRI and CT exams, and spend more than twice as much on drugs per capita, on average, than residents of other highly developed countries.”
This is obviously a problem that transcends health care. Let’s grant much excellence in today’s system. Still, its chief flaw is that it is silently determining the nation’s priorities without anyone assigning it that role. Medicare and Medicaid spending is squeezing most other government activities — certainly not what we intend. High private insurance premiums condemn millions of workers to stagnant or falling incomes. We recoil at disciplining health-care spending, because that seems inhumane.
By accident, health care has become labor policy and economic policy. We may all be among the injured.
There’s a genuine solution to our health-care problem
by Robert J. Samuelson - Washington Post - April 29, 2018
No doubt about it: Health care is a vexing political problem.
There’s a contradiction at the core of our thinking. We want the best care when we or our loved ones get sick. It’s a moral issue. There should be no limits on treatment. But the resulting uncontrolled health spending harms the country. It undermines other priorities — higher wages (more labor income gets channeled into health-insurance premiums) and competent government (defense and other programs may be underfunded).
By and large, Americans ignore the contradiction. Presidents and Congresses have wrestled with it for decades without subduing it. The stakes are huge. Collectively, major federal health programs now constitute the budget’s largest spending item, more than $1 trillion in 2017, or 26 percent of outlays. In 1990, the comparable figures were $137 billion and 11 percent of outlays. Meanwhile, insurance premiums— often paid by employers — have jumped, as have deductibles.
What can be done?
Based on experience, it’s tempting to say “not much.” This may ultimately be the case. But a growing number of studies suggest some cause for optimism; health costs can be contained.
The relevant studies compare Medicare reimbursement rates with private insurance payments for the same medical conditions. The finding: Medicare pays less — much less. A 2017 Congressional Budget Office study found that Medicare’s average payment for a standardized hospital admission was $11,354 — 47 percent lower than insurers’ $21,433.
This research has two interpretations. One is that Medicare rates have been cut to artificially low levels. To replace lost revenue, doctors and hospitals must raise their charges on privately insured patients. The increases are passed along in higher premiums. There’s massive cross-subsidization of Medicare recipients by the working-age population.
Not surprisingly, the rival explanation denies Medicare’s role in boosting premiums. Instead, providers — mainly doctors and hospitals — get the blame. Their market power has increased. Hospitals have merged. Doctors’ group practices have grown larger or been sold to hospitals. Providers and insurance companies typically renegotiate premiums once a year. The fewer providers there are, the harder it is for insurance companies to dictate terms to the survivors.
Probably both theories contain some truth. But scholarly opinion seems to favor the market-power explanation. Significantly, the congressionally created Medicare Payment Advisory Commission has endorsed that view.
Many health-care experts believe that high prices — hospital and doctors’ charges — as opposed to more utilization of medical services are the main reason that U.S. health spending outstrips costs in other advanced societies, says Miriam J. Laugesenof Columbia University’s School of Public Health and author of “Fixing Medical Prices: How Physicians Are Paid.”
You can see where this is going. If higher American health spending reflects the growing market power of providers, then why not curb that power with some form of price controls? This is what most affluent societies do, notes Laugesen.
Writing in the liberal Washington Monthly magazine, Paul Hewitt and Phillip Longman recommend just that. Under their proposal, Congress would adopt the Medicare fee and reimbursement system for the entire country. If this were done, employer-paid premiums would drop sharply, and some savings — maybe all — would be passed along to workers. (Hewitt and Longman call their proposal the “single-price system,” as opposed to the “single-payer system,” which is universal coverage.)
Of course, this wouldn’t be done instantly. The sudden loss of so much income would doubtlessly bankrupt scores of hospitals and doctors’ practices, whose costs are tied to present premiums. But phased in over, say, a decade, some sort of new system might achieve significant savings without destroying the health-care infrastructure.
We ought to be grappling with these issues. We aren’t, for understandable if not commendable reasons. The relentless controversy over the Affordable Care Act (“Obamacare”) reminds us how incendiary health-care debates become, raising — as they do — issues of life and death.
There’s also the reality that the self- interest of medical providers is mixed inexorably with their professional opinions. If price controls were proposed, doctors might well lose. They would surely raise legitimate questions about quality of care. Controls would also be denounced as inflexible and un-American, despite the fact that Medicare already has controls: the roughly 750 Diagnosis-Related Groups through which payments are made for various ailments and injuries.
There are few genuine solutions to our health-care problems — only changes that are less bad than the alternatives. We need to slow medical spending and relax the pressures on wages and other government programs. The recognition of the huge gap between Medicare and private reimbursement rates creates the opportunity to do that. We should take it.
A New Lawsuit Threatens Obamacare. Here’s What’s at Stake and What to Expect in Oral Arguments.
by Abby Goodnough and Jan Hoffman - NYT - September 4, 2018
The Affordable Care Act has survived numerous court battles and repeal efforts, but a new case is threatening the law’s future once again. A federal judge in Fort Worth, Tex., will hear arguments Wednesday on whether to grant a preliminary injunction that would suspend the health law until the case is decided. He has also indicated that he might go straight to ruling on the merits of the case.
It focuses on whether the law’s requirement that most Americans have health insurance is unconstitutional, but has much broader implications. The Justice Department made a highly unusual decision this summer: though it disagreed with the plaintiffs that the entire law should be struck down, it decided not to defend the individual mandate or several other central provisions, including protections for people with pre-existing conditions. That prompted a coalition of 16 states and the District of Columbia, led by California, to intervene to defend the law, saying that to pause it or invalidate key components would threaten the health care of millions of people.
Presiding over the case is Judge Reed O’Connor of the Federal District Court for the Northern District of Texas, who was appointed by President George W. Bush. The judge has previously blocked Obama-era efforts to extend medical leave protections to same-sex couples and to include gender-identity discrimination as a form of sex discrimination under the health law.
Who brought this latest case and why?
The case is being brought by a group of 20 Republican state attorneys general and the governors of Maine and Mississippi. They argue that the law is unconstitutional and should be struck down.
The reason, they say, is that in 2012 the Supreme Court upheld the health law based on Congress’s taxation power. Congress, the court said, could impose a tax penalty on people who did not have health insurance.
But Congress enacted a tax bill in December 2017 that zeroed out that tax penalty. The plaintiffs argue that the health law’s requirement that most people have insurance — the so-called individual mandate — no longer functions as a tax, and therefore is unconstitutional.
That leads to a central question in the case: does tugging at the individual mandate unravel the entire health law, including popular provisions like its protections for people with pre-existing medical conditions? The plaintiffs argue that if the mandate is unconstitutional, it cannot be severed from the law’s other requirements. If the mandate falls, they say, so must the entire law.
Who are the defendants?
Technically the federal government is the defendant — the case is called Texas v. United States. But in June, the Trump Administration sided with the plaintiffs on the individual mandate, arguing in a brief that it and the pre-existing conditions protections were unconstitutional. The administration did not challenge certain other parts of the law, however, like the establishment of health insurance marketplaces and premium subsidies for low- and moderate-income people which, it said, could continue without the mandate.
The administration has asked Judge O’Connor for “summary judgment” — in effect to rule immediately on the constitutionality of the individual mandate and other issues, instead of granting a preliminary injunction.
Is anything at stake for people who don’t get insurance through the Affordable Care Act marketplaces?
Yes, there’s a lot on the line for people covered through their employers, as well as those insured through the law. If the court finds that the individual mandate is no longer constitutional and as a result, the entire Affordable Care Act must fall, about 17 million Americans would lose their health insurance, according to the Urban Institute, a left-leaning think tank. That includes millions who gained coverage through the law’s expansion of Medicaid as well as the millions more who get subsidized private insurance through the law’s marketplace. Insurers would also no longer have to cover young adults up to age 26 under their parents’ plans. Annual and lifetime limits on coverage would once again be permitted, and there would be no cap on out-of-pocket costs.
If the court sides with the Justice Department and strikes down only the mandate and the law’s popular protections for people with pre-existing conditions, insurers could return to denying coverage to such people or charging them more. They could also return to charging people more based on their age, gender or profession. The Kaiser Family Foundation, a nonpartisan research organization, estimates that 52 million adults between 18 and 64, or 27 percent of that population, would be rejected for coverage under the practices that were in effect in most states before the Affordable Care Act.
If the judge finds the law unconstitutional, is there any other way to preserve protections for people with pre-existing conditions?
A group of 10 Republican senators preemptively introduced legislation last month, but it would only partially restore the provisions in question. It would prohibit insurance companies from denying coverage or charging more for it based on someone’s health status. But the catch is that insurers could still refuse to cover certain medical conditions. They could also again charge more based on gender or line of work, or raise rates on older Americans.
After the judge rules, what happens next?
The losing side would almost certainly appeal, and that process could take years. Eventually, the case could land before the United States Supreme Court. Confirmation hearings on Judge Brett M. Kavanaugh, the Trump Administration’s nominee for an open seat on that court, began on Tuesday and will continue on Wednesday as the oral arguments in this case get underway.
Insulin's High Cost Leads To Lethal Rationing
by Editor - Maine Public - September 1, 2018
Diabetic ketoacidosis is a terrible way to die. It's what happens when you don't have enough insulin. Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning.
Diabetic ketoacidosis is how Nicole Smith-Holt lost her son. Three days before his payday. Because he couldn't afford his insulin.
"It shouldn't have happened," Smith-Holt says looking at her son's death certificate on her dining room table in Richfield, Minn. "That cause of death of diabetic ketoacidosis should have never happened."
The price of insulin in the U.S. has more than doubled since 2012. That has put the life-saving hormone out of reach for some people with diabetes, like Smith-Holt's son Alec Raeshawn Smith. It has left others scrambling for solutions to afford the one thing they need to live. I'm one of those scrambling.
Not enough time
Most people's bodies create insulin, which regulates the amount of sugar in the blood. In the U.S., the roughly 1.25 million of us with Type 1 diabetes have to buy insulin at a pharmacy because our pancreases stopped producing it.
My first vial of insulin cost $24.56 in 2011, after insurance. Seven years later, I pay more than $80. That's nothing compared with what Alec was up against when he turned 26 and aged off his mother's insurance plan.
Smith-Holt says she and Alec started reviewing his options in February 2017, three months before his birthday on May 20. Alec's pharmacist told him his diabetes supplies would cost $1,300 a month without insurance — most of that for insulin. His options with insurance weren't much better.
Alec's yearly salary as a restaurant manager was about $35,000. Too high to qualify for Medicaid and, Smith-Holt says, too high to qualify for subsidies in Minnesota's health insurance marketplace. The plan they found had a $450 premium each month and an annual deductible of $7,600.
"At first, he didn't realize what a deductible was," Smith-Holt says. She says Alec figured he could pick up a part-time job to help cover the $450 per month.
Then Smith-Holt explained it.
"You have to pay the $7,600 out of pocket before your insurance is even going to kick in," she remembers telling him. Alec decided going uninsured would be more manageable. Although there might have been cheaper alternatives for his insulin supply that Alec could have worked out with his doctor, he never made it that far.
He died less than one month after going off of his mother's insurance. His family thinks he was rationing his insulin — using less than he needed — to try to make it last until he could afford to buy more. He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty.
"It's just not even enough time to really test whether [going without insurance] was working or not," Smith-Holt says.
A miracle discovery
Insulin is an unlikely symbol of America's problem with rising prescription costs.
Before the early 1920s, Type 1 diabetes was a death sentence for patients. Then, researchers at the University of Toronto — notably Frederick Banting, Charles Best and J.J.R. Macleod — discovered a method of extracting and purifying insulin that could be used to treat the condition. Banting and Macleod were awarded a Nobel Prize for the discovery in 1923.
For patients, it was nothing short of a miracle. The patent for the discovery was sold to the University of Toronto for only $1 so that live-saving insulin would be available to everyone who needed it.
Today, however, the list price for a single vial of insulin is more than $250. Most patients use two to four vials per month (I personally use two). Without insurance or other forms of medical assistance, those prices can get out of hand quickly, as they did for Alec.
Depending on whom you ask, you'll get a different response for why insulin prices have risen so high. Some blame middlemen — such as pharmacy benefit managers, like Express Scripts and CVS Health — for negotiating lower prices with pharmaceutical companies without passing savings on to customers. Others say patents on incremental changes to insulin have kept cheaper generic versions out of the market.
For Nicole Holt-Smith, as well as a growing number of online activists who tweet under the hashtag #insulin4all, much of the blame should fall on the three main manufacturers of insulin today: Sanofi of France, Novo Nordisk of Denmark and Eli Lilly and Co. in the U.S.
The three companies are being sued in the U.S. federal court by diabetic patients in Massachusetts who allege the prices are rising at the expense of patients' health.
The Eli Lilly did not make anyone available for an interview for this story. But a company spokesman noted in an email that high-deductible health insurance plans — like the one Alec found — are exposing more patients to higher prices. In August, Eli Lilly opened a help line that patients can call for assistance in finding discounted or even free insulin.
A dangerous solution
Rationing insulin, as Nicole Smith-Holt's son Alec did, is a dangerous solution. Still, 1 in 4 people with diabetes admits to having done it. I've done it. Actually, there's a lot of Alec's story that feels familiar to me.
We were both born and raised in the Midwest, just two states apart. We were both diagnosed at age 23 — pretty old to develop a condition that used to be called "juvenile diabetes." I even used to use the same sort of insulin pens that Alec was using when he died. They're more expensive, but they make management a lot easier.
"My story is not so different from what I hear from other families," Smith-Holt recently told a panel of U.S. Senate Democrats in Washington D.C., in a hearing on the high price of prescription drugs.
"Young adults are dropping out of college," she told the lawmakers. "They're getting married just to have insurance or not getting married to the love of their lives because they'll lose their state-funded insurance."
I can relate to that, too. My fiancé moved to a different state recently, and soon I'll be joining her. I'll be freelancing and won't have health benefits, though she will via her job. We're getting married — one year before our actual wedding — so I can get insured, too.
This story is part of NPR's reporting partnership with Side Effects Public Media and Kaiser Health News. A version of this story appears in The Workaround podcast.
What the US can learn from Canada about how to treat moms
by Madeline Somerville - The Guardian - September 3, 2018
When my daughter was 11 months old, we were strolling down a sunny street when she casually reached her hand out of her stroller and made the sign for “airplane”. I looked from her dimpled knuckles to the sky and, sure enough, there in the distance was a plane streaking its way across the horizon. I hadn’t seen it, but she had. And although she hadn’t yet signed “milk” during the thousands of times I’d nursed her over the previous months, she had remembered the one time I showed her the sign for airplane. She’d seen an airplane and then she told me about it. On the scale of milestones in a baby’s life, this was huge.
This monumental moment took place in a small town on the coast of British Columbia, Canada. And it was made possible by Canada’s notably generous maternity leave policy.
After Olive’s birth five and a half years ago, I was fortunate to have a full year of paid maternity leave. These 12 months allowed me to ease myself into this bewildering new role, let my body heal, and learn to function on four hours of broken sleep; to bond with my daughter, take walks in the sun, nap when she napped and, yes, teach her to use sign language before she could speak.
Canada wasn’t always so generous with its new moms. In 1971, Canadian mothers could take just 15 weeks of paid maternity leave (granted, that’s 15 weeks longer than present-day American mothers are given). In 1990, the Canadian government added 10 weeks of parental leave benefits to the initial 15. Whereas the initial 15 weeks were maternity leave exclusively, these next 10 weeks could be used by either parent or even split between the two.
Finally, in 2000, Canada increased the 10 weeks of paid parental leave to 35 weeks, resulting in essentially a full year of benefits for Canadian parents to spend with their newborns. During this time, new parents are paid up to 55% of their salary.
Compare this with the American Family and Medical Leave Act of 1993, which has remained unchanged since its passage and which requires just 12 weeks of leave – fully unpaid – for mothers of newborns or newly adopted children. Not only is this one of the shortest leave periods in the industrialized world, it is also virtually impossible to pull off. Could you live without your salary for three months? I couldn’t.
This means that a quarter of mothers in the US must go back to work within two weeks of giving birth.
Ten days postpartum I was lying in bed exhausted, encumbered with comically large nursing boobs, crying hysterically and blowing my nose into giant disposable hospital underpants because my hormones were crashing and all I’d had time to do all day was breastfeed and change diapers.
I simply cannot imagine how I could have functioned in my pre-birth role as a youth worker for at-risk teens. I was not capable of managing their crises, providing pregnancy tests and abortion referrals, counseling them out of abusive situations, or arranging rehab stays while my breasts ached and overflowed and fresh C-section stitches stung from holding my abdomen together. But thanks to the US leave policy, millions of new mothers in similar positions are forced to trudge their own weepy, bloody, bruised bodies to jobs they desperately need to stay afloat.
Statistics readily speak to the tangible societal benefits of paid parental leave. Research shows that paid parental leave can reduce infant mortality by as much as 10% and also increase some vaccination rates by almost 25%, probably because these new parents have the time to attend well-baby visits and vaccination clinics.
Mothers who have access to paid maternity leave also consistently experience lower rates of depression – not only during the postpartum period but also when they reach age 50 and older.
When women have a longer maternity leave, they’re able to breastfeed their children for longer. And study after study has linked longer breastfeeding durations to lower infant mortality rates and lower rates of asthma and obesity.
I have never been more grateful to be Canadian than I was during my first year of motherhood. I’ve now come to see that 12-month period as an official, federally mandated recognition of how life-changing it is to become a parent.
This recognition began before I’d even left the hospital. After I underwent a medically necessary C-section, I needed to stay in the hospital for five days – and, thanks to my country’s health insurance coverage, I walked away without paying a cent. When we settled back in at home, along with spending time getting to know my new baby, I had time to spend with other new mothers, our frequent meet-ups bolstering my mental health and reminding me that I existed. I was able to wake up with my daughter one, two, 19 times a night, and give her what she needed without needing to save something for my clients or my employer.
During that year, I didn’t have to function as anything other than a mother – no matter what that looked like. It allowed me to be an exhausted, frustrated, overwhelmed first-time mom who hadn’t showered in three days and lived in leggings and milk-stained T-shirts. I felt lost and in love and invisible and exhausted. I can’t imagine how American mothers feel, being crushed with all of this while also worrying if the daycare they’ve chosen is safe, worrying if their baby will take a bottle, worrying about leaking through their shirts or ripping their vaginal stitches or bleeding through their pants.
I look back at the first year of my daughter’s life, and I was there for all of it. Every cry, every nighttime feed, every scrape and tumble, every milestone. I came to know her better than I knew myself, and that knowledge has served me every day of my parenting life since. I was given the opportunity to watch my daughter become herself, step by step, moment by moment. It feels like a luxury, but it shouldn’t be.
You’ll Never Guess Which Company Is ReinventingHealth Benefits
by Reed Abelson - NYT - September 2, 2018
It’s hard to think of a company that seems less likely to transform health care.
It isn’t headquartered in Silicon Valley, with all the venture-backed start-ups. It’s not among the corporate giants — Amazon, Berkshire Hathaway and JPMorgan Chase — that recently announced, with much fanfare, a plan to overhaul the medical-industrial complex for their employees.
And it is among the most hated companies in the United States, according to many surveys on customer satisfaction.
It’s Comcast. The nation’s largest cable company — the $169 billion Philadelphia-based behemoth that also controls Universal Parks & Resorts, “Sunday Night Football” and MSNBC — is among a handful of employers declaring progress in reaching a much-desired goal. In the last five years, the company says, its health care costs have stayed nearly flat. They are increasing by about 1 percent a year, well under the 3 percent average of other large employers and below general inflation.
“They’re the most interesting and creative employer when it comes to health care benefits,” said Dr. Bob Kocher, a partner at Venrock, a venture capital firm whose portfolio companies have done business with Comcast. (The cable company declined over several months to provide executives for an interview on this topic.)
Comcast, which spends roughly $1.3 billion a year on health care for its 225,000 employees and families, has steered away from some of the traditional methods other companies impose to contain medical expenses. It rejected the popular corporate tack of getting employees to shoulder more of the rising costs — high-deductible plans, a mechanism that is notorious for discouraging people to seek medical help.
Most employers now require their workers to pay a deductible before their insurance kicks in, with individuals on the hook for $1,500, on average, in upfront payouts, according to the Kaiser Family Foundation. Instead, Comcast lowered its deductible to $250 for most of its workers.
“We believe that no one should be required to be an expert in health care,” Shawn Leavitt, the executive overseeing benefits at Comcast, said in a 2015 interview with a consultant. “Our model is based on providing employees support and assistance in making the right decisions for themselves and their families. Employees should not feel alone, confused and overwhelmed when it comes to understanding and selecting their benefits.”
Cable TV subscribers who have felt confused and overwhelmed when dealing with Comcast customer service may be surprised to learn how nimbly the company has upgraded services for its employees. While Comcast continues to work with insurers, it has largely shunned them as a source of innovation. Instead, it has assembled its own portfolio of companies that it contracts with, and invests in some of them through a venture capital arm, Comcast Ventures.
Turning to health start-ups for new benefits
One such company is Accolade, in which Comcast is an investor, and which provides independent guides called navigators to help employees use their health benefits. Another, called Grand Rounds, offers second opinions and help in finding a doctor. Comcast was also among the first major employers to offer workers access to a doctor via cellphone through Doctor on Demand, a telehealth company.
“We see the start-up community as where the real disruption is taking place,” said Brian Marcotte, the chief executive of the National Business Group on Health, which represents large employers. “We weren’t seeing enough innovation.” The group now vets some of these companies for employers, including Comcast.
Comcast “is the tip of the spear,” Mr. Marcotte said.
The corporation, of course, is controlling costs and offering these unusual benefits out of self-interest. And these services are sometimes handed out at the expense of improving wages. In a tight labor market, Comcast also needs to remain competitive for not only highly skilled employees, but also lower-wage workers whose direct contact with customers has generated so much dissatisfaction over the years. “We do these things because it’s great for business,” Mr. Leavitt said.
But much of what sets Comcast apart is its willingness to directly tackle its medical costs rather than relying on others — insurers, consultants or associations. It’s a luxury only the largest companies can afford, and roughly a fifth of big companiescontinue to see annual cost increases of more than 10 percent, according to Mercer, a benefits consultant.
While fate may play a role — a single expensive medical claim can drive up a company’s costs in any given year — employers, like Comcast, that use a variety of strategies tend to have the lowest annual increases. “You attack this thing from different angles,” said Beth Umland, Mercer’s director of research for health and benefits. “The intensity of effort pays off.”
Some companies are shaking up hospitals and doctors
Other employers are focusing more attention on unsatisfying hospitals and doctors. Walmart has been at the forefront of efforts to direct employees to specific providers to get medical care, even if it means paying their travel to places like the Mayo Clinic.
The retailer said it had found, for example, that employees were being told they needed back surgery even when they would not benefit from the procedure. “Walmart isn’t going to stand for this,” said Marcus Osborne, a benefits executive, at a health business conference. “We aren’t going to sit around to try to build another coalition or bureaucracy.”
The majority of working-age Americans — some 155 million — get their health insurance through an employer, and most companies cover their own medical costs. The companies rely on insurers to handle the paperwork and to contract with hospitals and doctors. Insurers may also suggest programs like disease management or wellness to help companies control costs.
But employers, including that Amazon-Berkshire-JPMorgan alliance, are increasingly unhappy with the nation’s health care systems. Companies are paying more than they ever have. And their employees, saddled with escalating out-of-pocket costs and a confusing maze, aren’t well served, either. “The results haven’t been there,” said Jim Winkler, a senior executive at Aon, a benefits consultant. “There’s frustration.”
At Comcast, some workers probably miss out on the new ventures altogether and others don’t have much choice but to go along. The company’s relationship with labor is often strained, and it has largely managed to fend off efforts by groups like the Communications Workers of America to organize its employees. Robert Speer, an official with a local of the International Brotherhood of Electrical Workers in New Jersey that represents about 180 workers, noted the company’s use of independent contractors to do much of its work, none of whom are eligible for benefits and can be paid by the job rather than hourly. “You are making no money,” he said.
And, like many other workers, many employees are being pinched by the rising cost of premiums, Mr. Speer said.
Comcast workers with company coverage are told to go to Accolade first. Its phonenumber appears on the back of their insurance cards and on the benefits website. “The key to Accolade’s success is being the one place to go,” said Tom Spann, a co-founder of the company.
Geoff Girardin, 27, used Accolade when he worked at Comcast a few years ago and he and his wife were expecting. “Our introduction to Accolade was our introduction to our first kid,” Mr. Girardin said. He credits Accolade for telling him his wife was eligible for a free breast pump and helping find a pediatrician when the family moved. “It was a huge, huge help to have somebody who knew the ins and outs” of the system, he said.
For employees like Jerry Kosturko, 63, who survived colon cancer, Accolade was helpful in steering him through complicated medical decisions. When he needed an M.R.I., his navigator recommended a free-standing imaging center to save money. “They will tell me what things will cost ahead of time,” Mr. Kosturko said.
A nurse at Accolade helped him manage symptoms after he had surgery for bladder cancer in 2014. He developed terrible spasms because, he said, he wasn’t warned to avoid caffeine. The Accolade nurse thought to ask him and quickly urged him to call his doctor for medicine to ease his symptoms.
Mr. Kosturko also turned to Grand Rounds when his doctor thought he might need to stay overnight in the hospital to be tested for sleep apnea. The second opinion convinced him he did not.
In complicated cases, Grand Rounds can serve as a check on the network assembled by the insurer. It pointed to the case of Ana Reyes, 39, who does not work for Comcast and had contacted Grand Rounds after treatment for cervical cancer. When she continued to have symptoms, she says, she was told to wait to see if they persisted.
“This is my life at stake,” she recalled in an interview. “I need to know what I’m doing is the best plan.” Grand Rounds asked a specialist at Duke University School of Medicine, Dr. Andrew Berchuck, to review her case.
“Grand Rounds was able to get all my medical records, which is over 1,000 pages,” Ms. Reyes said. Dr. Berchuck reviewed and wrote his opinion in one week, recommending a hysterectomy because she was likely to have some residual cancer. “The same day, my treating physician, she called me to schedule a hysterectomy,” Ms. Reyes said.
Insurers are usually none too pleased with the employers’ use of alternatives: They’re reluctant to share information with an outside company and poised to undercut a potential competitor by offering a cheaper price. They may even refuse to work with some of the companies.
The largest employers push back. Fidelity Investments insists on cooperation between insurers and outsiders, said Jennifer Hanson, an executive at Fidelity Investments. “Those who don’t will be fired,” she said at a health business conference.
For Comcast, the next frontier is the financial well-being of its employees, many of whom live paycheck to paycheck and may not be able to afford even a small co-payment toward a doctor’s visit. Employees who run into financial trouble have no independent source of information, Mr. Spann said.
After talking to hundreds of companies, Comcast Ventures could not find a financial services start-up that would help employees without trying to sell them a product or earning their money on commissions. So Comcast recruited Mr. Spann to serve as chief executive of a new company, Brightside, that it created and invested in.
Employees who are less worried about their finances may be less likely to miss work or suffer from health problems, Mr. Leavitt said. Ultimately, he said, “there is a productivity play for Comcast.”
Letter to the editor: Health care coverage is being slowly undermined
Portland Sunday Telegram - September 2, 2018
Americans with pre-existing conditions are seeing changes to their health insurance coverage.
My father has chronic lymphocytic leukemia, a blood cancer that does not have a cure but is treatable. He will live the rest of his life with this pre-existing condition.
Congress and the Trump administration have repeatedly promised to protect health care coverage for Americans with pre-existing conditions. Unfortunately, actions speak much louder than words. Since late last year, they have taken several steps to slowly eliminate coverage for millions of Americans. In President Trump’s first year in office alone, 3.2 million Americans lost access to health insurance.
Changes to the Affordable Care Act have resulted and will continue to result in skyrocketing premiums and insurance marketplaces with fewer coverage choices. When the individual mandate repeal goes into effect in 2019, the number of Americans without health insurance will go up and so will their premiums. More people with pre-existing conditions will not be able to afford health insurance coverage that meets their medical needs.
My father and all Americans need health care coverage with reasonable premiums, protections for pre-existing conditions and health benefits with an adequate network of providers. Sabotaging the ACA will not achieve those goals.
Kristin Fuhrmann-Simmons
Kennebunkport
Get Sick, Go Bankrupt and Die
by Paul Krugman - NYT - September 4, 2018
Let’s be honest: Despite his reputation as a maverick, John McCain spent most of his last decade being a very orthodox Republican, toeing the party line no matter how irresponsible it became. Think of the way he abandoned his onetime advocacy of action to limit climate change.
But he redeemed much of that record with one action: He cast the crucial vote against G.O.P. attempts to repeal the Affordable Care Act. That single “nay” saved health care for tens of millions of Americans, at least for a while.
But now McCain is gone, and with him, as far as we can tell, the only Republican in Congress with anything resembling a spine. As a result, if Republicans hold Congress in November, they will indeed repeal Obamacare. That’s not a guess: It’s an explicit promise, made by Vice President Mike Pence last week.
But what about the problems that sank the repeal effort in 2017? Surely Republicans have spent the past year rethinking their policy ideas, trying to come up with ways to undo the A.C.A. without inflicting enormous harm on ordinary Americans, especially those with pre-existing medical conditions. Right?
See, I made a joke.
Of course, Republicans haven’t rethought their ideas on health care (or, actually, anything else). Partly that’s because the modern G.O.P. doesn’t do policy analysis. Democrats have a network of think tanks and sympathetic independent experts who look hard at evidence, try to devise solutions to real problems and sometime affect actual legislative proposals. Republicans have nothing comparable; their tame “experts” are basically in the business of saying whatever their political masters want to hear.
In the case of health care, however, there’s an even deeper problem: The G.O.P. can’t come up with an alternative to the Affordable Care Act because no such alternative exists. In particular, if you want to preserve protection for people with pre-existing conditions — the health issue that matters most to voters, including half of Republicans — Obamacare is the most conservative policy that can do that. The only other options are things like Medicare for all that would involve moving significantly to the left, not the right.
Health economists have explained this point many times over the years; but as always, it’s difficult to get a man to understand something when his salary depends on his not understanding it. Still, let’s try one more time.
If you want private insurers to cover people with pre-existing conditions, you have to ban discrimination based on medical history. But that in itself isn’t enough, because if policies cost the same for everyone, those who sign up will be sicker than those who don’t, creating a bad risk pool and forcing high premiums. That was the case in New York, where premiums for individual policies were very high before the A.C.A. — and promptly fell by half when Obamacare went into effect.
For what Obamacare did was provide incentives to get healthy people to sign up, too. On one side there was a penalty for not having insurance (the individual mandate). On the other, there were subsidies designed to limit health expenses as a share of income. Republicans have tried to sabotage health care by doing away with the mandate, and have succeeded in driving premiums higher; but the system is still standing thanks to those subsidies.
The point, again, is that Obamacare is the most conservative option for covering pre-existing conditions, and if Republicans really cared about the scores of millions of Americans with such conditions, they would support and indeed try to strengthen the A.C.A.
Instead, they’re going to kill it if they hold on in two months. But covering pre-existing conditions is popular; therefore, they’re pretending that they’ll do that, while offering proposals that would, in fact, do no such thing.
Why do they imagine they can get away with such brazen fraud, because that’s what it is? Do they imagine that voters are stupid?
Well, yes. In recent rallies Donald Trump has been declaring that Democrats want to “raid Medicare to pay for socialism.”
But the more important target is the news media, many members of which still haven’t learned to cope with the pervasive bad faith of modern conservatism.
When someone like, say, Senator Dean Heller of Nevada co-sponsors a bill that purports to protect pre-existing conditions but actually doesn’t, what he hopes for are headlines that say “Heller Announces Plan to Protect Americans With Pre-existing Conditions,” with the key fact — that his bill wouldn’t do that at all — buried in the 17th paragraph.
Or better yet, from his point of view, that 17th paragraph would state only that “some Democrats” say his bill is a fraud, while Republicans disagree. Both sides, you know.
So if you’re an American who suffers from a pre-existing medical condition, or fear that you might develop such a condition in the future, you need to be clear about the reality: Republicans are coming for your health care. If they hold the line in November, health insurance at an affordable price — maybe at any price — will be gone in a matter of months.
What the Experts Want Us to Know About Public Health
by Austin Frakt and Aaron Carroll - NYT - September 4, 2018
The United States receives tremendous benefits from public health spending — with far more value per dollar than with most other types of health care spending.
We reviewed those benefits in a recent article, suggesting that more such spending should be considered. Then Upshot readers weighed in with their choices of what public health campaigns they’d like to see. Those included more help for mothers and babies (the Nurse-Family Partnership), and a greater focus on diabetes, nutrition, gun deaths (including suicide), loneliness and the harms of sharing hypodermic needles.
We asked some experts — officials who run public health departments, academics and leaders of funding organizations — what they think we should be doing in public health, and a few themes emerged.
Overrating doctors and hospitals
Although we spend huge sums on health care, it’s not always on the right things.
“The key to better health isn’t always to build more hospitals and train more specialists,” said Vivek Murthy, the former surgeon general. “In fact, it usually is not.”
That’s where public health comes in. Consider antismoking commercials late in the last century, for example. Or as Richard Besser, the president and chief executive of the Robert Wood Johnson Foundation, put it, public health has kept us safe “from infectious diseases through immunizations, information, mosquito control and food safety.”
“It ensures that our water is safe to drink and our pools and lakes are safe for swimming,” he added. “It provides screening for cancer and works to prevent injuries.”
Karen DeSalvo, a former New Orleans health commissioner, said: “Of the $1 trillion in federal spending, only 1 percent is on public health — an infrastructure that saves lives” and that can “reduce suffering and improve community well-being and vitality.”
We could do a better job at providing access to the things we know that already work. Ursula Bauer, who manages the nation’s chronic disease prevention portfolio at the Centers for Disease Control and Prevention, said, “Not all adults have access to appropriate cancer screenings, and we don’t do a good job of managing high blood pressure.” She added: “It’s very difficult for most Americans to integrate routine physical activity into our lives. We don’t have destinations within walking distance or sidewalks to get there. We can’t find the stairs to use in most buildings.”
Thomas Farley, the health commissioner for Philadelphia, said, “There’s a lot of money to be made selling products that, over the long term, kill people.” These include tobacco, alcohol, unhealthy food, addictive drugs (legal and illegal) and guns.
Dr. Bauer said policies could do better at using carrots and sticks, including taxes and subsidies, in these cases: “There are more incentives and opportunities for people to consume unhealthy foods and beverages than there are for them to make healthy food and beverage choices.”
‘Deep divides of race and income’
Another theme that emerged was that we could do a lot more in addressing disparities across race and class.
“Public health needs to take a leadership role in confronting and influencing the social, political and economic factors that determine population health,” said Sandro Galea, the Robert A. Knox professor and dean of Boston University’s School of Public Health.
“The patterns of disease and death track along this nation’s deep divides of race and income,” said Mary Travis Bassett, the former New York City health commissioner, who recently took a position at Harvard. She said America needed to divest in prisons and “put that funding toward new systems of justice, better housing or universal child care.”
The opioid crisis is one of America’s most urgent problems. Rhode Island has shown promise in being able to reduce overdose deaths by offering prisoners medications to treat addiction while they’re incarcerated and after they’re released.
Other initiatives can be tailored to meet the needs of various populations. Older and low-income residents of Boston have benefited from the receipt of specially formulated meals — such as those with soft food or with low cholesterol. According to a study in Health Affairs, those receiving such meals had fewer hospital admissions than those who didn’t.
For others, housing assistance may be the most direct way to improve health. That’s why the Boston Medical Center — the city’s principal hospital for low-income and underinsured residents — is investing in affordable housing and referring patients to community housing programs.
Such efforts aren’t unique to Boston. A project in California is providing meals to Medicaid-enrolled cancer patients. In Ohio, a program backed by Nationwide Children’s Hospital, which serves low-income children, is helping finance its affordable housing initiatives, including rehabilitating run-down housing units.
Public health needs better public relations
We could also do a better job addressing things we know that kill. Gun safety and education could decrease accidents and deaths, Monica Bharel, commissioner of the Massachusetts Department of Public Health, told us.
She also pointed out likely problem areas in the future, including e-cigarettes and vaping; the consequences of marijuana legalization; and social isolation.
Dr. Murthy said a shift toward school- and community-based programs to strengthen emotional health would be worthwhile. “Such programs have been shown to reduce violence, smoking, alcohol and drug addiction and mental illness,” he said.
The 2016 Surgeon General’s Report by Dr. Murthy lists several evidence-based school and community programs to address these issues. They include, for example, The Fast Track Program, which identifies children with high rates of aggression and aims to improve their social and educational skills.
Dr. Murthy also argued that “the way the Congressional Budget Office scores health legislation does not recognize much of the cost savings from prevention, which creates a further disincentive for legislators to pursue prevention-oriented legislation.”
Perhaps the biggest change needed is for public health to do a better job at trumpeting its success. Too often, it seems to be the unsung hero. “It can be difficult to maintain support for public health systems when they are so often invisible,” Dr. Besser said.
Few public health initiatives will make anyone wealthy. In the American political environment, that makes it difficult to organize a winning coalition for any specific policy.
But that outlook misses a crucial fact about public health: Many campaigns have achieved a rare double victory: They have lengthened and improved lives, and they have also saved more money than they’ve cost.
https://www.nytimes.com/2018/09/04/upshot/what-the-experts-want-us-to-know-about-public-health.html?
Analysts Predict Health Care Marketplace Premiums Will Stabilize For 2019 Coverage
by Alison Kodjak - NPR - September 3, 2018
Consumers who buy insurance through the Affordable Care Act markets may be pleasantly surprised this fall as average premiums are forecast to rise much less than in recent years.
The price of a 2019 policy sold on the ACA exchanges will increase less than 4 percent, according to an analysis of preliminary filings from insurers in all 50 states by ACASignups.net, a website and blog run by analyst Charles Gaba that tracks ACA enrollment and insurer participation.
And those insurers are expanding their offerings.
"The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation," says Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. (The foundation supports NPR's health care coverage.)
She says premiums overall are rising at about the same rates as medical inflation. That modest rise for insurance is a big change from the last few years when prices rose in the double digits.
For example, the cost of a bronze policy, which is intended to cover about 60 percent of a person's health costs, rose 17 percent from 2017 to 2018. And the cost of the more popular, and more generous, silver plan rose 32 percent in the same time frame.
"We're seeing that double-digit kinds of increases are occurring in a small handful of states, but they're definitely the exceptions," says Hempstead.
For example, premium prices in Kentucky and Connecticut are both forecast to rise an average 12 percent, according to ACASignups.net.
"In quite a few states, we're actually seeing premiums going down," she says.
In New Hampshire, prices are expected to fall about 13 percent, and in Tennessee they could drop 11 percent, according to the analysis.
Insurance companies are also expanding into new markets, says Hempstead, who has been tracking what policies companies plan to offer in various counties.
In Pennsylvania, four companies – Geisinger, UPMC, Capital Blue Cross and Highmark – are expanding their coverage footprints.
The upstart health insurer Oscar, which got into the insurance business specifically to serve ACA markets, is expanding to Florida, Michigan and Arizona.
The insurer Wellmark, which abandoned the ACA market in Iowa last year, is returning.
Hempstead says the increased offerings are a sign that the market is maturing.
"After a very ... tortured birth and infancy, it sort of seems like the market is in some ways at a very stable place right now," she says.
She says insurance companies have figured out how to make a profit from the policies they sell on the ACA exchanges.
But the news could be better, Gaba says.
Premiums would actually be falling next year but for the actions of the Trump administration and Republicans in Congress that have weakened the ACA law itself and its markets, Gaba says.
Those actions include getting rid of the tax penaltyfor people who don't buy health insurance, refusing to reimburse insurance companies for discounts they are required by law to offer to low-income customers, and encouraging insurers to sell stripped-down, short-term insurance. Those moves are draining healthy young people out of the ACA market.
"The reality is that if you didn't have those factors, if you didn't have the expansion of short-term plans, and especially the repeal of the mandate penalty for next year, average premiums would most likely be dropping by a good 4 or 5 percent," he says.
Gaba says some states have managed to lower their premiums by adding a state-level individual mandate requiring people to buy health insurance or implementing a reinsurance program that limits the amount of high-priced medical care an insurer will have to pay for.
Whether premiums go up or down, consumers who qualify for a subsidy will likely pay about the same for their insurance next year as they're paying now. Subsidies are available to people who earn less than 400 percent of the federal poverty level, which is $24,600 for a family of four this year.
Open enrollment for 2019 on the federal exchange and in most states begins on Nov. 1 this year.
Editor's Note:
While many will see this story that health insurance premiums in the ACA exchanges have seemed to stabilize (increasing "only" 4 percent) for 2019 coverage, the real question is why are they rising at all as we pay about twice as much a people in other countries. What is happening to the total cost for healthcare, including out of pocket expenses such as co-pays and deductibles (unheard of in many countries) out of network "surprise" charges, wage suppression and other costs borne by the so-called insured customers.
-SPC
LePage files court-ordered plan to expand Medicaid in Maine – and asks feds to reject it
by Joe Lawlor - Portland Press Herald - September 4, 2018
The LePage administration complied with a court order Tuesday and finally submitted required documents to the federal government to expand Medicaid to 70,000 Mainers – but there’s a catch. Gov. Paul LePage, an expansion opponent, is asking federal officials to deny the application.
“I strongly encourage CMS (U.S. Centers for Medicare and Medicaid Services) to reject the State Plan Amendment that may soon be submitted by the Maine Department of Health and Human Services pursuant to court order,” LePage wrote in a letter sent Friday to Seema Verma, CMS administrator, and U.S. Health and Human Services Secretary Alex Azar. “If accepted, the SPA would commit Maine to expanding the Medicaid program to an additional 70,000 to 90,000 individuals. However, not one dime of the hundreds of millions of dollars that will be needed to pay for the state’s share of the expansion has been appropriated.”
The State Plan Amendment is a required first step toward implementing expansion, and Maine’s highest court on Aug. 23 ordered the LePage administration to file the plan. Maine DHHS filed the plan on Tuesday.
LePage vetoed a $60 million Medicaid expansion funding bill that state lawmakers approved in June, arguing that the funding contained one-time budget gimmicks. Democratic lawmakers countered that $60 million was more than enough to fund the expansion, and that a permanent funding solution should be decided by the next governor and Legislature.
LePage is finishing his final term, and will be out of office in January. Democratic Attorney General Janet Mills, Republican businessman Shawn Moody and independents Terry Hayes, the state treasurer, and businessman Alan Caron are running in the general election to succeed LePage.
Mills said Tuesday night that Medicaid expansion is supported by groups ranging from hospitals to the Maine State Chamber of Commerce and those “fighting the opioid epidemic.”
“Like a lot of Mainers, I’ve had enough of this administration standing in the way,” Mills said in an emailed statement. “The money is there, and, as governor, I’ll implement Medicaid expansion on day one. From the health of our people to the health of our economy, there’s too much at stake not to.”
Moody’s campaign outlined a position that hews closely to the approach LePage has taken.
“Shawn will implement the law and enforce the law with appropriate funding from the Legislature,” Lauren LePage, Moody’s campaign manager and the governor’s daughter, said in an email. “It is the constitutional responsibility of the Legislature to appropriate funds. Shawn has continuously stated that he will not support spending proposals that fund Medicaid expansion by raising taxes, draining the rainy day fund, or using other budget gimmicks.”
Caron questioned the wisdom of LePage’s policy.
“Once again, Gov. LePage is ignoring the will of the public and rejecting common sense,” Caron said. “The federal government is willing to put $9 on the table to our $1 to extend health insurance coverage to as many as 70,000 Mainers. It’s the right thing to do economically, fiscally and morally. It’s incomprehensible why any governor would not want that deal.”
Hayes had not responded to a request for comment Tuesday night.
Voters approved Medicaid expansion by a 59 to 41 percent margin in November 2017, and the law passed at the ballot box required the state to file a State Plan Amendment in April. But the LePage administration has refused to implement it. The expansion, a key component of the Affordable Care Act, would provide health insurance for low-income Mainers earning up to 138 percent of the federal poverty limit, or $34,638 for a family of three and $16,753 for a single person. Expansion has been approved in 34 states.
Robyn Merrill, executive director of Maine Equal Justice Partners, which is suing the state for failing to expand Medicaid, said asking the federal government to reject the expansion plan is unprecedented.
“They submitted a plan, but said, ‘Don’t approve it.’ This is not over,” Merrill said. “The governor is doing everything he can to block the will of Maine voters, trying to stop 70,000 Mainers from having health insurance.”
Merrill said that given the stance of the LePage administration, the legal battle will continue.
Maine Equal Justice Partners has so far won its court fights with the LePage administration, and in August the court ordered Maine DHHS to file the State Plan Amendment.
Merrill has maintained that there is enough funding to start Medicaid expansion, and that the federal government does not get involved in how the state comes up with its share of dollars for the expansion.
The federal government pays for 90 percent of the cost of expansion, so Maine would pay about $50 million per year, according to nonpartisan estimates, and would draw down more than $500 million in federal funds to expand Medicaid.
LePage argued in his three-page letter that an “activist court” forced his administration to file the State Plan Amendment. He said the federal government will likely have to reject the application because of the lack of state funding, and that the “failure of the Legislature to provide any funding for additional staff leaves DHHS in serious jeopardy of being unable to meet its obligations to accurately make eligibility and program integrity determinations.”
LePage wrote that “if the SPA is approved, the state will become obligated under federal law to fund the full range of Medicaid services to tens of thousands of additional individuals. Until the necessary funding is in place, however, the federal government can take no assurance that Maine will be able to pay for its share of costs under the program.”
The Maine Supreme Judicial Court kicked the core issue in the lawsuit, whether the LePage administration could be forced to implement expansion without a specific funding source – back to Superior Court. The Superior Court is still considering constitutional and other questions regarding the case.
Also unresolved, Merrill said, is what happens to people who signed up for Medicaid under expansion starting on July 2. Maine issued denial letters to at least some of the applicants, according to documents provided by Maine Equal Justice, but according to the law voters approved, Mainers could begin applying for coverage in July.
Letter to the Editor - Bangor Daily News - Health care for all
I wholly endorse Phil Caper’s recent call in an Aug. 26 BDN column for universal health care in Maine, and in our nation. The existing patchwork of for-profit insurance in America leaves far too many of our fellow human beings without adequate care throughout their lives. We should follow in the successful and much more highly civilized path that many countries take with an efficient, single-payer, government-administered system that truly serves its people. We know it can work — Medicare has only a small fraction of the administrative costs involved with the bewildering system imposed on us now.
It is time we changed for the better. We are rapidly reaching a tipping point where a majority of Americans realize that healthcare is not only for those who can afford it — it is a human right guaranteed and sustained by a civilized society. And we can only guarantee that right by taking the profit motive out of it. Please make sure that you vote for candidates who endorse Maine Allcare.
Diane Oltarzewski
Belfast
http://bangordailynews.com/2018/09/04/opinion/letters/wednesday-sept-5-2018-speak-up-for-clean-air-health-care-for-all-collins-fooled-again/
Samuelson has been arguing for years that Medicare is an unseemly drain on the economy which serves the elderly by bleeding everybody else. No serious discussion of provider compensation can ignore the enormous administrative overhead which makes it so hard for independent providers to survive without being absorbed by giant corporate entities. If he's concerned about monopolistic pricing by giant provider institutions, he really ought to take this into account.
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