Kamala Harris: Everyone Gets Sick. And We Deserve Better.
by Kamala Harris - NYT - December 30, 2018
In 2008, our mother asked my sister, Maya, and me to meet her for lunch. When we arrived, our mother didn’t seem like herself. We wondered what was going on. Then she took a deep breath and reached out to us both across the table.
“I’ve been diagnosed with colon cancer,” she told us.
I know that many can relate to the emotions I felt in that moment. Even just reflecting back on it now fills me with dread. It was one of the worst days of my life.
The hard truth is that every one of us will go through an experience like that sooner or later, whether it is coming to terms with a loved one’s terminal illness or experiencing our own. My mother was a breast cancer researcher. She understood, from a career of looking at cancer cells under a microscope, that no matter who we are or where we are from, our bodies are essentially the same. They work the same way — and they break down the same way, too.
She got sick before the Affordable Care Act became law, back when it was still legal for health insurance companies to deny coverage for pre-existing conditions. I remember thanking God she had Medicare.
That’s something I’ve been thinking a great deal about in the days since a federal district judge in Texas, ruling in a lawsuit filed by a group of Republican governors and state attorneys general, declared the Affordable Care Act unconstitutional. This was not the first attack by Republicans on the law, but if upheld, it will be the most catastrophic.
Without the protections of the A.C.A., Americans with pre-existing conditions could be denied health insurance and insurance companies would once again be allowed to discriminate based on age and gender. According to the Kaiser Family Foundation, more than 50 million Americans could be rejected for coverage by health insurers if the A.C.A. were to disappear.
At the same time, people in their mid-20s would get kicked off their parents’ plans. Lifetime caps could come back. Out-of-pocket costs would no longer be capped. The expansion of Medicaid in dozens of states could be reversed. The human toll would be unthinkable, with some experts estimating that 20,000 to 100,000 people could die each year.
We must fight with everything we have to avert this catastrophe. And as we do so, let’s also accept the truth that even with the Affordable Care Act intact, our health care system still needs fixing. Let’s acknowledge that there are nearly 30 million Americans who still don’t have health insurance. And there are plenty more who have insurance but can’t actually afford the rising cost of health care.
I am so grateful my mother had Medicare, and I will fight for it to be guaranteed to all. I was among the first senators to sign on to the Medicare for All bill when it was introduced last year. There should be nothing partisan about wanting a system where health coverage and care are based not on how much money you have or where you live. We need a system with the goal of good outcomes rather than the goal of high profits. It would save countless lives, and according to recent studies, could trim as much as $5 trillion in health care costs over 10 years.
I believe that health care should be a right, but the reality is that it is still a privilege in this country. We need that to change. When someone gets sick, there is already so much else to deal with: the physical pain for the patient, the emotional pain for the family. There is often a sense of desperation — of helplessness — as we grapple with the fear of the unknown. Medical procedures already have risks. Prescription drugs already have side effects. Financial anxiety should not be one of them.
Logistics, alone, can be overwhelming. I remember that as my mother’s condition worsened, she needed more care than we could provide. I wanted to hire a home health care aide for her. But my mother didn’t want help.
“I’m fine. I don’t need anybody,” she would say, even though she could barely get out of bed. There was a fight to be had, but I didn’t want to have it. Her body was giving out. The medication was making it difficult for her to function, to be herself. I didn’t want to take her dignity away.
So, we muddled through. I cooked elaborate meals for her, filling the house with the smells of childhood, which reminded us both of happier times. When I wasn’t at the office, I was most often with her, telling stories, holding hands, helping her through the misery of chemotherapy. I brought her hats after she lost her hair, and soft clothes to make her as comfortable as I could.
At one point, one of her doctors pulled me aside. “How’s my D.A.?” the doctor asked, referring to my role as the elected prosecutor of San Francisco. The question caught me off guard. I had been so focused on my mother’s well-being, I hadn’t made room for anything else. I started to choke up. I was scared. I was sad. Most of all, I wasn’t ready.
The doctor asked me if I had heard of “anticipatory grief.” I hadn’t, but the term made perfect sense. So much of me was in denial. I couldn’t bring myself to believe that I was going to have to say goodbye. But underneath it, I was aware. And I had started grieving for my mother already.
She ended up in the hospital not long after that. That was when I started to see another change. For as long as I could remember, my mother loved to watch the news and read the newspaper. When Maya and I were kids, she’d insist we sit down in front of Walter Cronkite each night before dinner. But suddenly, she had no interest. Her mighty brain decided it had had enough.
She still had room for us, though. I remember that I had just entered the race for California attorney general and she asked me how it was going.
“Mommy, these guys are saying they’re going to kick my ass,” I told her.
She rolled over and looked at me and unveiled the biggest smile. She knew who she’d raised. She knew her fighting spirit was alive and well inside me.
My mother died on Feb. 11, 2009, two months after her 70th birthday. One of the last questions she asked the hospice nurse was, “Are my daughters going to be O.K.?” She was focused on being our mother until the very end.
And though I miss her every day, I carry her with me wherever I go. I think of the battles she fought, the values she taught me, her commitment to improve health care for us all. There is no title or honor on earth I’ll treasure more than to say I am Shyamala Gopalan Harris’s daughter. As I continue the battle for a better health care system, I do so in her name.
Kamala D. Harris is a Democratic senator from California and the author of the forthcoming book “The Truths We Hold: An American Journey,” from which this essay is adapted.
https://www.nytimes.com/2018/12/29/opinion/sunday/kamala-harris-affordable-care-act-medicare.html?
‘Medicare for All’ Gains Favor With Democrats Looking Ahead to 2020
by Robert Pear - NYT - December 29, 2018
WASHINGTON — More and more Democrats, fed up with private health insurance companies, are endorsing the goal of a government-run, single-payer system like Medicare for all Americans. But they have discovered a problem. More than one-third of Medicare beneficiaries are in Medicare Advantage plans, run not by the government but by private insurers.
Whether to allow younger Americans to enroll in such private Medicare plans has become a hotly debated political question as Democrats look to 2020.
When liberal Democrats started advocating “Medicare for all” more than 25 years ago, Medicare was the original fee-for-service program run by the government. Since then, it has changed in big ways. More than 20 million of the 60 million beneficiaries are in comprehensive Medicare Advantage plans sold by private insurers like UnitedHealth, Humana, Kaiser Permanente and Blue Cross and Blue Shield.
Enrollment in private Medicare plans has shot up roughly 80 percent since 2010. Older Americans are attracted by the prospect of extra benefits, a limit on out-of-pocket costs and a doctor or nurse who can coordinate their care.
“Medicare for all” has become a rallying cry for progressive Democrats, though it means different things to different people. Supporters generally agree that it is a way to achieve universal coverage with a system of national health insurance in which a single public program would pay most of the bills, but care would still be delivered by private doctors and hospitals.
One-third of Senate Democrats and more than half of House Democrats who will serve in the new Congress have endorsed proposals to open Medicare to all Americans, regardless of age.
A Medicare-for-all bill drafted by Senator Bernie Sanders, independent of Vermont, has been endorsed by 15 Democratic senators, including several potential presidential candidates: Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.
In the House, Medicare for all is gaining new support with the election of a number of progressive Democrats. They include Sylvia R. Garcia of Texas, Jahana Hayes of Connecticut, Joe Neguse of Colorado, Alexandria Ocasio-Cortez of New York, Ilhan Omar of Minnesota, Katie Porter of California, Ayanna Pressley of Massachusetts and Rashida Tlaib of Michigan.
Although Barack Obama shunned single-payer solutions as president, he praised Medicare for all in a campaign-style speech in September. “Democrats aren’t just running on good old ideas like a higher minimum wage,” he said. “They’re running on good new ideas like Medicare for all.”
Billy Wynne, a health care lobbyist who used to work for Senate Democrats, said: “The literal meaning of ‘Medicare for all’ would include Medicare Advantage. But that is not what most supporters of Medicare for all have in mind.”
The champions of Medicare for all generally see insurance companies as part of the problem, not the solution.
“There are a lot of insurance companies and medical companies that are advocating for their own best interests, and those best interests are usually money, and not people’s health,” Representative-elect Deb Haaland, Democrat of New Mexico and a supporter of Medicare for all, said in an interview. “We need a national public health care system, which would be more affordable in the long run, and the outcomes might be better.”
Wendy Kaplan, 53, of Evanston, Ill., who has found family coverage under the Affordable Care Act rather expensive, said she liked the idea of Medicare for all.
“In principle,” said Ms. Kaplan, a Democrat, “I feel that health insurance should be available to everyone. Single payer is a great idea in principle. I don’t think health care should be a for-profit endeavor. My biggest reservation is whether our government could be competent at running something like that.”
Large majorities of Medicare beneficiaries say in surveys that they are satisfied with their coverage.
With a Republican president and a Republican-controlled Senate, proposals for a major new health care entitlement have no chance of becoming law in the next two years. But they show how an idea long relegated to the sidelines is edging back into favor with some Democrats and could be embraced by the party’s nominee in the next presidential election.
President Trump and other Republicans have mocked the idea of Medicare for all, saying it could ruin the program for older Americans and generate huge costs for the federal government. It would “come at a staggering cost to taxpayers,” said Alex M. Azar II, the secretary of health and human services.
Christine Vilord, an Idaho schoolteacher who described herself as a moderate Republican, said she could support a Medicare-for-all program of national health insurance even if it meant a small increase in taxes. She said she realized the need for such a program in October when her 25-year-old daughter was in a severe auto accident that left her unable to walk for two months.
Asked if his vision of Medicare for all included private Medicare Advantage plans, Adam Green, a founder of the Progressive Change Campaign Committee, an advocacy group, said: “No, absolutely not. Why would it? Medicare for all, in the end, means fundamental systemic change. People would no longer be at the mercy of for-profit insurers that make money by denying people care.”
Mr. Sanders and Representative Pramila Jayapal, Democrat of Washington and a chairwoman of the Medicare for All Caucus in Congress, see no need for private Medicare Advantage plans.
Vedant Patel, a spokesman for Ms. Jayapal, said her vision of Medicare for all was the traditional Medicare program, not private plans. “The purpose of Medicare for all is defeated if there are other plans people can buy into,” he said.
Josh Miller Lewis, a spokesman for Mr. Sanders, said: “We would get rid of duplicative health insurance. Our version of Medicare would cover most procedures. There would be no need for a Medicare Advantage program.”
Other lawmakers support expanding Medicare, but do not want to disrupt coverage for consumers who like the insurance they have.
“Millions of Americans who rely on employer-sponsored insurance and Medicare Advantage are satisfied with their coverage,” said Representative Rosa DeLauro, Democrat of Connecticut.
She and Representative Jan Schakowsky, Democrat of Illinois, introduced a bill in mid-December to provide comprehensive universal coverage through an enhanced version of traditional Medicare. They would allow people to enroll in Medicare Advantage plans. But, Ms. DeLauro said, “it is my hope that we have designed our new health care program so well that individuals will choose” it over Medicare Advantage.
Under their bill, large employers could continue providing insurance to employees if the coverage and benefits were comparable to those in the government program. By contrast, under Mr. Sanders’s bill, it would be unlawful for an employer to provide coverage that duplicates the benefits in the government’s “universal Medicare program.”
Some health policy experts have suggested building a national health insurance program on Medicare Advantage rather than on the traditional fee-for-service Medicare program.
“Medicare Advantage for all — that would be a much more politically feasible and a uniquely American spin on single payer,” said John K. Gorman, a former Medicare official who is a consultant to many insurers. “It would be Medicare paying all the bills, but it would be privately administered by heavily regulated plans that would effectively serve as utilities.”
25 Ways the Canadian Health Care System Is Better Than Obamacare
by Ralph Nader - Common Dreams - December 26, 2018
Dear America:
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian-style single-payer— full Medicare for all— is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 25 ways the Canadian health care system is better than the chaotic U.S. system.
Replace it with the much more efficient Medicare-for-all: everybody in, nobody out, free choice of doctor and hospital. It will produce far less anxiety, dread, and fear.
Love, Canada
Number 25:
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 28 million Americans (9 percent) are still uninsured and 85 million Americans (26 percent) are underinsured.
Number 24:
In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare has done little to curb insurance industry profits and in fact has increased the concentrated insurance industry’s massive profits.
Number 23:
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
Number 22:
In Canada, health care coverage stays with you for your entire life.
In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your insurance.
Number 21:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”
In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay dearly for it.
Number 20:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in insurance premiums directly and indirectly per employer.
In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
Number 19:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.
In the United States, under Obamacare, hospital and doctor bills are terribly complex, making it very difficult to discover the many costly overcharges or massive billing fraud.
Number 18:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.
In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 17.9 percent of its GDP and still doesn’t cover tens of millions of people.
Number 17:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.
In the United States, health-care-driven bankruptcy will continue to plague Americans.
Number 16:
In Canada, simplicity leads to major savings in administrative costs and overhead.
In the United States, under Obamacare, often staggering complexity leads to ratcheting up huge administrative costs and overhead.
Number 15:
In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”
In the United States, the first thing they ask you is: “What kind of insurance do you have?”
Number 14:
In Canada, the government negotiates drug prices so they are more affordable.
In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable and skyrocketing.
Number 13:
In Canada, the government health care funds are not profitably diverted to the top one percent.
In the United States, under Obamacare, health care funds will continue to flow to the top. In 2017, the CEO of Aetna alone made a whopping $59 million.
Number 12:
In Canada, there are no required co-pays or deductibles in inscrutable contracts.
In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
Number 11:
In Canada, the health care system contributes to social solidarity and national pride.
In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
Number 10:
In Canada, delays in health care are not due to the cost of insurance.
In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
Number 9:
In Canada, nobody dies due to lack of health insurance.
In the United States, tens of thousands of Americans will continue to die every year due to lack of health insurance and much higher prices for drugs, medical devices, and health care itself.
Number 8:
In Canada, health care on average costs half as much, per person, as in the United States. And in Canada, everyone is covered.
In the United States, a majority support Medicare-for-all.
Number 7:
In Canada, the tax payments to fund the health care system are modestly progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.
In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
Number 6:
In Canada, people use GoFundMe to start new businesses.
In the United States, fully one in three GoFundMe fundraisers are now to raise money to pay medical bills. Recently, one American was rejected for a heart transplant because she couldn’t afford the follow-up care. Her insurance company suggested she raise the money through GoFundMe.
Number 5:
In Canada, people avoid prison at all costs.
In the United States, some Americans commit minor crimes so that they can get to prison and get free health care.
Number 4:
In Canada, people look forward to the benefits of early retirement.
In the United States, people delay retirement to 65 to avoid being uninsured.
Number 3:
In Canada, Nobel Prize winners hold on to their medal and pass it down to their children and grandchildren.
In the United States, Nobel Prize winners sell their medals to pay for their medical bills.
Leon Lederman won a Nobel Prize in 1988 for his pioneering physics research. But in 2015, the physicist, who passed away in November 2018, sold his Nobel Prize medal for $765,000 to pay his mounting medical bills. According to a report in Vox, the University of Chicago professor began to suffer from memory loss in 2011, and died in an Idaho nursing home.
Number 2:
In Canada, the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.
In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”
Number 1:
In Canada, the majority of citizens love their health care system.
In the United States, a growing majority of citizens, physicians, and nurses prefer the Canadian type system – Medicare-for-all, free choice of doctor and hospital , everybody in, nobody out and far less expensive.
Democrats who aim to shift health care debate are warming to Medicare for All
It would be a long-term goal, but they hope to get the public accustomed to the thought of a single-payer system in which everyone has coverage.
by Sahil Kapur - Portland Press Herald Tribune News Service - December 27, 2018
WASHINGTON — A clamor to create “Medicare for All” has exploded on the left. Democratic presidential hopefuls are racing to co-sponsor legislation, rising stars in the party are embracing it, and national polls show Americans warming to the concept.
But even the idea’s most fervent backers acknowledge that the goal is far in the distance, beyond the next year or even the 2020 election.
Their aim for now is to shift the health care debate. By making single-payer health care – a model under which all Americans would get their insurance from a single government plan – the progressive position, advocates argue that gives Democrats representing conservative areas of the country political cover to support more modest proposals to expand the government’s role in health insurance.
“Everybody understands we’re not going to get Medicare for All enacted in January. But it’s a marker about where we want to land, which is to say we want everybody to have health care,” Democratic Sen. Brian Schatz of Hawaii said in an interview. “This is about moving the so-called Overton window.”
WIDE RANGE OF PROPOSALS
Moving that Overton window – the spectrum of ideas the public will accept – captures the progressive strategy for making the government’s Medicare program available for everyone, not just those over 65. Schatz, for instance, is a co-sponsor of Sen. Bernie Sanders’ Medicare for All legislation, but has also offered a less comprehensive alternative that would give states the authority to let people who aren’t otherwise eligible buy into the Medicaid program targeted to aiding low-income individuals.
The maneuvering on health policy comes as the Affordable Care Act, which expanded insurance coverage to millions of Americans, is under a Republican-led court challenge. While the law, popularly known as Obamacare, remains in effect, the court case may drag into the 2020 campaigns for the White House and Congress. In the meantime, there’s a wide range of potential proposals between the status quo and a government-run single-payer system that are gaining support among Democrats.
“We will be having a conversation about many ideas on how we can lower the costs of health care,” said Rep. Ben Ray Lujan of New Mexico. The Democratic-led House will discuss the Medicaid buy-in that he co-sponsored with Schatz, as well as Medicare for All and “other initiatives members have, as opposed to Republicans who were only intent on repealing the Affordable Care Act,” he said.
POLITICALLY RISKY GOAL
President Trump and his fellow Republicans are unlikely to give up their opposition to Obamacare, much less embrace an expansion of Medicare. Any hope of movement would rely on Democrats riding the issue to control of the White House and both chambers of Congress in 2020.
Senate Minority Leader Chuck Schumer declined to say if he supports Medicare for All. “There are lots of different routes,” the New York Democrat said Dec. 16 on NBC’s “Meet the Press” program. “Many are for Medicare for All. Some are for Medicare buy-in. Some are Medicare over 55. Some are Medicaid buy-in. Some are public option.”
Schumer said Washington has to “do a lot more on health care,” and that it’ll be “a major issue in 2020.” Rep. Nancy Pelosi, poised to become House speaker in January, has also kept her distance from a federal single-payer program, suggesting states adopt it first.
While Republicans have struggled to coalesce around a health care alternative, they found unity in attacking Medicare for All against Democrats in 2018 House races, calling it a radical and costly government takeover of health care. Democratic candidates running in swing districts generally distanced themselves from the idea.
But the Kaiser Family Foundation found in March that 59 percent of Americans favor “Medicare for All,” a figure that’s grown in recent years, while 38 percent oppose it. Support fell to 53 percent, though, when it was dubbed a “single-payer plan.” Meanwhile, 72 percent favor a “Medicaid buy-in for everyone” and 75 percent favor an optional “Medicare for All” proposal that also lets people who already have coverage keep their plans.
The obstacles are enormous. Major changes to health care are politically treacherous as Americans, about half of whom get insurance from an employer, fear their coverage will be reduced. Opposition from industry and conservatives would make plenty of Democrats wary of such a disruptive change.
“We don’t have the support that we need,” said Rep. Pramila Jayapal of Washington, who will co-chair the Progressive Caucus. She said that she’d favor modest expansions of Medicare or Medicaid eligibility as a step toward Medicare for All.
The Chart That Shows the Price Tag for Trump’s Obamacare Sabotage
by Charles Gaba - NYT - December 27, 2018
The Affordable Care Act is still in effect, and the 2019 open enrollment period just ended for most Americans. The recent ruling by a Texas judge declaring the act invalid doesn’t change that.
But the Trump administration and Republicans are still undermining the health law.
People who earn too much to qualify for financial assistance for policies purchased through the A.C.A.’s health insurance exchanges or directly from insurers — five million now enrolled, including three to four million enrolled off-exchange — will pay for that sabotage in higher premiums. (Another nearly five million are uninsured and priced out of the market.) In the graphic below, I estimate how much more these unsubsidized enrollees will have to lay out in 2019 than they would have if not for the Trump administration’s actions.
Its sabotage efforts in 2018 included cutting off subsidy reimbursement payments for low-income enrollees (the cost of which insurers pass along to unsubsidized consumers), slashing the marketing budget by 90 percent and gouging the outreach-assistance budget by 40 percent. Next year will have those plus the repeal of the individual mandate and the expansion of non-Obamacare-compliant policies that don’t include the law’s patient protections.
These moves siphon off healthy enrollees, damaging the A.C.A. “risk pool,” so that its customers tend to be sicker and more expensive to carriers. In setting their premiums, many insurers specifically point to these actions as reasons for rate increases.
The estimates below are based in part on 2019 rate filings by insurance carriers in each state and modeled in part on estimates by the Urban Institute. Nationally, I estimate an average impact of $49 per month — or nearly $580 per year — for each unsubsidized enrollee.
