Is the US ‘the greatest country on the face of this earth?’ Not even close - The Boston Globe
by Michael Cohen - The Boston Globe - January 7, 2019
In the two weeks since President Trump shut down the federal government over his beloved border wall, the White House has offered a host of excuses for why such a construction project is so vital to the United States.Trump and his administration claim that it will stop terrorists, stanch the flow of drugs into America, and keep Americans safe from undocumented immigrants. Never mind that no known terrorist has been stopped at the Southern border, most drugs that enter the United States come through legal ports of entry, and unauthorized immigrants commit disproportionately fewer crimes than native-born Americans.
But on Sunday, White House spokeswoman, Sarah Huckabee Sanders came up with a new one. When asked by Fox News Channel’s Chris Wallace if a border wall was worth the disruption already being caused by the shutdown, she referred to the recent death of a California police officer, Ronil Singh , allegedly at the hands of an unauthorized immigrant. According to Sanders, “This shouldn’t happen in this country, particularly when we have things that we know can help prevent it. Every life — that’s what sets America apart from every other country; we value life. That it’s what makes us unique. And the day that we stop doing that . . . that’s when we stop being the greatest country on the face of this earth.”
This is a lovely sentiment, but it’s not remotely true. Instead, what truly sets America apart from other countries is how little we value the lives of our fellow citizens.
That is particularly true of the administration in which Sanders serves.
I know this might seem harsh, but the evidence of American indifference is overwhelming. Life expectancy in America declined in 2017 for the third year in a row. That hasn’t happened in this country in nearly a century and runs counter to the long-term global trend of increasingly higher life expectancy. Has the Trump administration or Congress mobilized resources and national attention in order to deal with this public health crisis? Not at all.
In 2017, more than 70,000 Americans died of a drug overdose. The federal response was tepid legislation passed last year that doesn’t significantly increase federal spending to deal with this crisis and largely short-changes addiction treatment.
The year 2017 was also the worst for gun violence in America since 1968 — with nearly 40,000 deaths. A country that “values life” would be looking for ways to lessen this carnage, but that hasn’t happened either.
An administration that embodied Sanders exceptionalist belief about saving lives and preventing needless deaths wouldn’t be trying to strip health care or sabotage legislation intended to increase the number of Americans with access to health care coverage. They wouldn’t be approving state efforts to place work requirements on Medicaid recipients, which has already caused tens of thousands of Americans to lose access to care. They certainly wouldn’t be slashing environmental regulations that keep harmful chemicals out of our water supply, our food, and the air we breathe.
If Sanders’ description of the United States were accurate, would America have some of the highest maternal mortality, child poverty, and obesity rates in the developed world? Would a child in a country that made the preservation of life its number one priority be 70 percent more likely to die before reaching adulthood than in other peer nations?
An administration that valued not just American life, but all life, certainly wouldn’t be proposing massive cuts in foreign aid.
All of these might be reasons, even, to shut down the government in order to get Congress’s attention — but of course that’s not what is happening. Rather we are talking about a wall that will do virtually nothing to make America safer.
The sad reality is that while this administration is awful when it comes to prioritizing life, it is consistent with a decades-long tend of lowering taxes (particularly for the wealthiest Americans), slashing the social safety net, and demonstrating studied indifference to the impact these policies have had on the quality of life of all Americans. it also runs counter to the actions of most other countries around the world, the majority of which make a priority out of improving the lives of their fellow citizens. Unfortunately, Sanders is correct that the United States in unique, just not in way that makes us the “greatest country on the face of this earth.”
https://www.bostonglobe.com/opinion/2019/01/07/greatest-country-face-this-earth-not-even-close/BOjGLize9H7OiX33J2c2MO/story.html?
I'm a Brit and America, your health care system is torturing me
by Rob Crilly - CNN - January 4, 2019
Rob Crilly is a British journalist living in New York. He was The Telegraph's Afghanistan and Pakistan correspondent and was the East Africa correspondent for The Times of London. The opinions in this article are those of the author. View more opinion articles on CNN.
(CNN)I am a Brit who lives in the United States. I signed up for medical insurance via the Obamacare marketplace in 2015, and I don't know how you Americans navigate the health care system on a day-to-day basis. To me, the hoops you have to jump through are costly -- and often illogical. And, more importantly, they are in desperate need of a fix.
It's taken me four years, but I am only now coming to grips with my health insurance policy. It is a health maintenance organization, which means that I have to see my primary care physician for a referral for most specialist services.
I know all this because it was explained to me by an exasperated office manager who put on the sort of voice usually reserved for addressing truculent 5-year-olds. She telephoned two weeks ago to upbraid me for getting the wrong type of referral for an appointment. I hadn't known there was a wrong type.
Apparently, my referral needed to make reference to the fact that it was a HIP plan (the Health Insurance Plan of Greater New York is one of the two companies that merged to form EmblemHealth, my current insurer) in order to proceed. I hadn't pointed this out when I supplied my policy number, and somewhere down the line my referral had run into the buffers.
That awkward exchange was followed rapidly by a second call from a different office manager (at a second doctor's office) telephoning me to explain that although I had seen the right doctor last month for my knee, it turned out that I had been at entirely the wrong location.
I hadn't known there could be a wrong location. But it turned out the Brooklyn office situated conveniently near my home was not the right one; the midtown office, a 35-minute subway ride away, was the one covered by my insurance.
When I reached out to EmblemHealth to explain the location discrepancy, a representative emailed me, "Providers, including physician and other practitioners, have the choice about whether they participate with us at some of their locations, or at all of their locations."
The sheer, bewildering complexity of it all
Before arriving in the United States, I was well aware of the inequities of the American health care "system" -- the millions uninsured, the waste of money spent on unnecessary tests or treatments and the people financially ruined after having the misfortune to fall ill. What no one had briefed me on was the sheer bewildering complexity of it all -- particularly Obamacare, which I regularly struggle to navigate. It is only since living here, for example, that I have come to realize that the important thing is not just that Britain's National Health Service is funded by the taxpayer, but that it is "free at the point of delivery" -- without the sort of forms, claims or acronyms that make medical billing an actual degree course.But I welcomed the office managers' phone explanations. During my career as a foreign correspondent, I have generally found it prudent to listen to locals bearing advice and acronyms -- particularly when it comes to navigating issues of Byzantine complexity, such as the tribal structure of North Darfur's nomadic herders or the blood vendettas of MS-13 gangs in San Pedro Sula, Honduras, or even finding my way around the AirTrain at New York's John F. Kennedy Airport.
The only problem was that on this occasion the gist-giving was somewhat redundant, following, as it did, an email a month earlier from my insurance company informing me that it was discontinuing my policy at the end of the year.
A company spokeswoman was very apologetic when I emailed to ask whether this was simply being done to further confuse foreigners. Ongoing legal action by another insurer against New York state and its formulas for calculating rates, she said, was to blame for casting uncertainty on EmblemHealth's offerings. "With the program currently on hold for 2019, it impacted our ability to continue the plan," she wrote.
There is much, much more I still do not know
I spent the end of December struggling to grasp as much as possible about New York's health insurance marketplace -- and I learned there is much, much more I still do not know about US health care policy. Trawling through the different companies' offerings, weighing deductibles versus out-of-pocket maximums, distinguishing between HMOs and EPOs (exclusive provider organizations) is meaningless when you haven't already spent a lifetime in the system.I shudder to think what it was like before Obamacare, when you couldn't even be sure that the basics were covered without an M.D. after your name, a magnifying glass for the small print and a couple of weeks with nothing much in the diary.
Even so, since I've become a freelancer in the United States, I've been jerked around by the New York State of Health marketplace, set up under Obamacare, and its spiraling prices.
The email at the end of that first year came as a rude shock. My insurer told me my premium was going up by 20%. The problem was the Affordable Care Act, according to my then-insurer, and an unforeseen number of people with pre-existing conditions signing up.
Two years later, it was the same thing but different. With Donald Trump ending the "individual mandate," too few healthy people were signing up. "When only sicker people buy health coverage," ran another of the patronizing explanations that I seem to attract, "it costs more." About 30% more in the case of the EmblemHealth HIP plans, according to an email sent to customers during the summer. Or it would have been if New York state hadn't told the company to give consumers a break, limiting increases to single digits, and if my policy wasn't being discontinued anyway, per the email I received in the fall.
Rather like when the British rail system ground to a halt because of the wrong type of snow, the American health care system apparently is beset by the wrong type of patients: ill ones.
Medicare for all sounds like a possibility
So, what is the solution? Medicare for all, which progressives are pushing, sounds like a possibility. Maybe it could work, like it does in Britain. Sure, there's a trade-off in terms of choice, speed and availability of the most expensive drugs, but the upside is a universal system where everyone is treated the same when they turn up at their doctor's office. There's no chance your doctor is "out of network."This bewildered patient is at least grateful that one part of Obamacare remains intact -- the metal ratings that lets one compare easily between gold, silver or bronze policies (but which also reinforce the sure feeling that I am a loser in life as I plunge straight into the cheapest category).
This was perhaps Obama's greatest masterstroke. Could he actually have known his successor would be a precious metal enthusiast, keen to see them on everything from elevator doors to health insurance?
I am, of course, not the first to complain about the system's complexity. And EmblemHealth says it is constantly working to demystify the system. "We want members to be informed about the costs associated with their care, so early next year, we will be introducing a simple, clear and straightforward explanation of what was charged by the clinician, what the plan paid and the costs for which the individual is responsible," the spokeswoman told me.
Anyway, with the clock ticking down to the recent enrollment deadline, I did what I always do when baffled by the wide choice on offer. I went for the easy bronze and picked the second cheapest option.
Then, and only then, did I stop to wonder whether my current doctor was covered.
https://www.cnn.com/2019/01/04/opinions/american-health-care-system-torturing-me-crilly/index.html
Theodore Roosevelt, Health Care Progressive
His
definition of national greatness included a commitment to helping the
sick and the poor. A century after his death, we should follow his lead.
by Patricia O'Toole - NYT - January 6, 2019
Theodore Roosevelt died 100 years ago Sunday, on Jan. 6,
1919, at his home in Oyster Bay, N.Y. A pulmonary embolism, the doctors
said.
Americans found it hard to believe that Roosevelt was dead, much less that he had died in bed. For as long as they could remember, he had lived at full tilt. He was the frontiersman who faced down a grizzly, the Rough Rider who fought in the Spanish-American War, the presidential candidate who made a speech with a fresh bullet wound in his chest.
The heroics thrilled countless American boys of the era — Ernest Hemingway among them — and their elders had cheered in 1899 when Roosevelt exhorted the country to get off its duff and take up “the strenuous life.” Toil, effort, high-minded endeavor — these were the things that made life worth living, in his opinion. If Americans surrendered to “ignoble ease,” he warned, they would never achieve national greatness.
A century later, that is still how most Americans remember him. But a quieter part of his legacy also deserves to be celebrated, especially in an era of incessant discord over health care. Few Americans know that their most physically vigorous president was also the first major American political figure to advocate passionately for national health insurance.
Americans found it hard to believe that Roosevelt was dead, much less that he had died in bed. For as long as they could remember, he had lived at full tilt. He was the frontiersman who faced down a grizzly, the Rough Rider who fought in the Spanish-American War, the presidential candidate who made a speech with a fresh bullet wound in his chest.
The heroics thrilled countless American boys of the era — Ernest Hemingway among them — and their elders had cheered in 1899 when Roosevelt exhorted the country to get off its duff and take up “the strenuous life.” Toil, effort, high-minded endeavor — these were the things that made life worth living, in his opinion. If Americans surrendered to “ignoble ease,” he warned, they would never achieve national greatness.
A century later, that is still how most Americans remember him. But a quieter part of his legacy also deserves to be celebrated, especially in an era of incessant discord over health care. Few Americans know that their most physically vigorous president was also the first major American political figure to advocate passionately for national health insurance.
Theodore Roosevelt may have
inspired he-men later in life, but he began life in delicate health, a
fact he never forgot. Born in 1858, he soon developed asthma. In that
era, asthmatics lived entirely at the mercy of their disease, not
knowing when it would strike or if an attack would prove fatal.
Roosevelt took up bodybuilding in his early teens, and as often happens,
the asthma abated as he reached adulthood. Emerging from the ordeal as a
fine physical specimen, he took pride in his strength, and for the rest
of his life would exalt strength in nations as well as in men.
If Roosevelt’s presidency had to be summed up in a word, “strength” would serve. He strengthened the office of the presidency as well as the regulatory power of the federal government. He refereed the unending contest between capital and labor, arguing that only the national government had enough power to ensure fair play. His foreign policy has been intelligently praised and intelligently damned, but beyond question, it strengthened the United States in world affairs in the opening decade of the 20th century.
So great was Roosevelt’s preoccupation with strength that nearly all of his biographers have felt obliged to explain it. Most have seen it as a response to his childhood illness, and some have suggested that the early delicacy left him with insecurities about his masculinity. One example cited by the prosecution: “Sissy” was a favorite Rooseveltian insult. Another: He would not be photographed on the tennis court, because the game was played by women as well as by men.
Given the vast attention paid to the causes of Roosevelt’s love of strength, there is a surprising lack of discussion about one of its most attractive effects: an exceptional sensitivity to the needs of the sick and others in the grip of circumstances beyond their control. Roosevelt’s efforts on behalf of workers exploited by employers have been well chronicled, but from his earliest days in politics until the last months of his life, he worked equally hard to improve the health of his fellow citizens. Who knew?
The hole in the story is partly Roosevelt’s fault. His concern for public health crops up only a few times in his autobiography, and the stories told are presented as discrete episodes, not illustrations of a long commitment.
If Roosevelt’s presidency had to be summed up in a word, “strength” would serve. He strengthened the office of the presidency as well as the regulatory power of the federal government. He refereed the unending contest between capital and labor, arguing that only the national government had enough power to ensure fair play. His foreign policy has been intelligently praised and intelligently damned, but beyond question, it strengthened the United States in world affairs in the opening decade of the 20th century.
So great was Roosevelt’s preoccupation with strength that nearly all of his biographers have felt obliged to explain it. Most have seen it as a response to his childhood illness, and some have suggested that the early delicacy left him with insecurities about his masculinity. One example cited by the prosecution: “Sissy” was a favorite Rooseveltian insult. Another: He would not be photographed on the tennis court, because the game was played by women as well as by men.
Given the vast attention paid to the causes of Roosevelt’s love of strength, there is a surprising lack of discussion about one of its most attractive effects: an exceptional sensitivity to the needs of the sick and others in the grip of circumstances beyond their control. Roosevelt’s efforts on behalf of workers exploited by employers have been well chronicled, but from his earliest days in politics until the last months of his life, he worked equally hard to improve the health of his fellow citizens. Who knew?
The hole in the story is partly Roosevelt’s fault. His concern for public health crops up only a few times in his autobiography, and the stories told are presented as discrete episodes, not illustrations of a long commitment.
In the first, he is a 23-year-old Republican freshman in the New York State Assembly, fighting for a ban on homemade
cigars. As the representative of Manhattan’s silk stocking district,
Roosevelt was expected to be a laissez-faire man, against government
interference in business. But when he visited cigar makers in their
tenements, he was appalled to find whole families suffering from eye,
skin and lung ailments caused by prolonged exposure to raw tobacco.
Roosevelt decided to champion a proposed ban and persuaded the Legislature to pass the bill. But a judge soon ruled that the new statute violated the sanctity of home. The decision gave Roosevelt his first taste of the opposition in store for politicians who challenged the untrammeled capitalism of the day.
At 39, as Col. Roosevelt of the Rough Riders, he pressed for the speedy departure of American troops from Cuba at the end of the Spanish-American War. The War Department had wanted the troops to stay until a peace treaty was signed, but Washington relented when Roosevelt pointed out that the soldiers were at high risk of dying from disease. He was right: Ninety percent of the American war dead in Cuba had succumbed to yellow fever, malaria and poor sanitation.
Eight years later, President Roosevelt won passage of the Meat Inspection Act and the Pure Food and Drug Act. He succeeded by seizing on public outrage over a best-selling novel, “The Jungle” by Upton Sinclair, which had exposed the stomach-turning conditions in Chicago’s meatpacking plants. Signed on the same day in 1906, the laws were milestones in health and in federal regulation of business for the public good.
Apart from those measures, Roosevelt had little success in persuading Congress to enact more laws to improve health. Though he fought on, he found himself up against a host of entrenched forces: a public suspicious of governmental power, the judiciary’s habit of treating social legislation as an infringement on individual liberties and the South’s alarm at the growing power of the national government.
As president, Roosevelt was aware that the governments of Germany, France and Britain had set up programs to help their citizens stave off the financial catastrophes associated with old age, illness, injury, unemployment and loss of a breadwinner. He was embarrassed that the United States had nothing comparable. The idea of using the government’s strength to assist those unable to fend for themselves seemed to him a mark of national greatness. And there were few things he coveted more than Europe’s recognition of American greatness.
Unable to make any legislative progress on this front, Roosevelt resorted to other tactics. He issued dozens of executive orders creating federal wildlife refuges on public land, a move that protected animals and reduced pollution. He also made liberal use of presidential commissions. The Inland Waterways Commission was established in 1907 to manage the nation’s lakes and rivers and to develop their potential as a transportation network. The ostensible goals were economic, but the plan also called for flood control, soil reclamation and pollution abatement — all boons to public health.
Roosevelt decided to champion a proposed ban and persuaded the Legislature to pass the bill. But a judge soon ruled that the new statute violated the sanctity of home. The decision gave Roosevelt his first taste of the opposition in store for politicians who challenged the untrammeled capitalism of the day.
At 39, as Col. Roosevelt of the Rough Riders, he pressed for the speedy departure of American troops from Cuba at the end of the Spanish-American War. The War Department had wanted the troops to stay until a peace treaty was signed, but Washington relented when Roosevelt pointed out that the soldiers were at high risk of dying from disease. He was right: Ninety percent of the American war dead in Cuba had succumbed to yellow fever, malaria and poor sanitation.
Eight years later, President Roosevelt won passage of the Meat Inspection Act and the Pure Food and Drug Act. He succeeded by seizing on public outrage over a best-selling novel, “The Jungle” by Upton Sinclair, which had exposed the stomach-turning conditions in Chicago’s meatpacking plants. Signed on the same day in 1906, the laws were milestones in health and in federal regulation of business for the public good.
Apart from those measures, Roosevelt had little success in persuading Congress to enact more laws to improve health. Though he fought on, he found himself up against a host of entrenched forces: a public suspicious of governmental power, the judiciary’s habit of treating social legislation as an infringement on individual liberties and the South’s alarm at the growing power of the national government.
As president, Roosevelt was aware that the governments of Germany, France and Britain had set up programs to help their citizens stave off the financial catastrophes associated with old age, illness, injury, unemployment and loss of a breadwinner. He was embarrassed that the United States had nothing comparable. The idea of using the government’s strength to assist those unable to fend for themselves seemed to him a mark of national greatness. And there were few things he coveted more than Europe’s recognition of American greatness.
Unable to make any legislative progress on this front, Roosevelt resorted to other tactics. He issued dozens of executive orders creating federal wildlife refuges on public land, a move that protected animals and reduced pollution. He also made liberal use of presidential commissions. The Inland Waterways Commission was established in 1907 to manage the nation’s lakes and rivers and to develop their potential as a transportation network. The ostensible goals were economic, but the plan also called for flood control, soil reclamation and pollution abatement — all boons to public health.
Toward
the end of his presidency, Roosevelt appointed a White House commission
to study the problems of rural life. Among the chief topics of the
group’s report was the poor state of health in the hinterlands. Farms
ought to be healthy places to live, the commissioners wrote, but doctors
and nurses were scarce, and most rural Americans had not been schooled
in the rudiments of hygiene. While some states had public health
departments, many did not. And because of widespread antipathy to
federal power, officials could not intervene except to address outbreaks
of disease among farm animals. Treading softly, the commission made
only mild recommendations: basic education in hygiene and sanitation,
and a promise of federal help in health matters if a state requested it.
Roosevelt also invented the White House conference, giving himself yet another way to act without Congress. In 1908 he hosted a conference of governors, focused on conservation, and nearly every governor present went home and formed a state conservation commission. The experience was a victory for conservation and public health, and it offered a model for federal-state collaboration on matters affecting the well-being of all Americans.
The most notable of Roosevelt’s White House conferences, on dependent children, took place a few weeks before he left office. The idea came from a young lawyer who had grown up in an orphanage and was pressing for governmental subsidies to widowed mothers, whose poverty often forced them to place their children in orphanages. Roosevelt issued the invitations on Dec. 25, 1908, a date surely not chosen at random.
On Jan. 25, 1909, Jane Addams, Booker T. Washington, and some 200 child welfare advocates, juvenile court judges, directors of orphanages and leaders of social service organizations turned out for the White House Conference on the Care of Dependent Children. Considered a landmark in American social policy, the conference led to the establishment of the United States Children’s Bureau, spurred the growth of adoption agencies and inspired the founding the Child Welfare League of America.
When Roosevelt left office, on March 4, his files were thick with correspondence from social activists, urban reformers, physicians and others who shared his belief that the federal government ought to play a larger role in advancing health and well-being. On a two-month tour of Europe in 1910, he made a point of meeting politicians and social reformers who had helped to put up the first government-sponsored social safety nets.
Two years later, disturbed by the Republicans’ drift to the political right, Roosevelt defected from the G.O.P., formed the National Progressive Party, and made a rogue run for an unprecedented third term in the White House (he entered office in 1901, after William McKinley was assassinated). With the insights he gained in Europe and the help of American experts on health and welfare, he and his allies crafted one of the most socially progressive party platforms in American history. It called for universal health insurance; a national public health service; insurance for the elderly, the unemployed and the disabled; the end of child labor; the abolition of the seven-day workweek; and a minimum wage ample enough to support a family of four, provide for recreation and allow savings for a rainy day.
After losing the election, Roosevelt continued to engage in politics through hundreds of newspaper columns and magazine articles. The social agenda of his 1912 platform lived on, inspiring progressives of both parties. And with the Social Security Act of 1935, Franklin Roosevelt secured much of what his distant cousin Theodore had been striving for: old-age insurance, unemployment insurance, aid to families with dependent children, and support for the disabled. Opposition from the medical profession blocked the path to national health insurance, and opposition from the South ensured that Social Security would exclude domestic and agricultural labor, major occupations of African-Americans.
Roosevelt also invented the White House conference, giving himself yet another way to act without Congress. In 1908 he hosted a conference of governors, focused on conservation, and nearly every governor present went home and formed a state conservation commission. The experience was a victory for conservation and public health, and it offered a model for federal-state collaboration on matters affecting the well-being of all Americans.
The most notable of Roosevelt’s White House conferences, on dependent children, took place a few weeks before he left office. The idea came from a young lawyer who had grown up in an orphanage and was pressing for governmental subsidies to widowed mothers, whose poverty often forced them to place their children in orphanages. Roosevelt issued the invitations on Dec. 25, 1908, a date surely not chosen at random.
On Jan. 25, 1909, Jane Addams, Booker T. Washington, and some 200 child welfare advocates, juvenile court judges, directors of orphanages and leaders of social service organizations turned out for the White House Conference on the Care of Dependent Children. Considered a landmark in American social policy, the conference led to the establishment of the United States Children’s Bureau, spurred the growth of adoption agencies and inspired the founding the Child Welfare League of America.
When Roosevelt left office, on March 4, his files were thick with correspondence from social activists, urban reformers, physicians and others who shared his belief that the federal government ought to play a larger role in advancing health and well-being. On a two-month tour of Europe in 1910, he made a point of meeting politicians and social reformers who had helped to put up the first government-sponsored social safety nets.
Two years later, disturbed by the Republicans’ drift to the political right, Roosevelt defected from the G.O.P., formed the National Progressive Party, and made a rogue run for an unprecedented third term in the White House (he entered office in 1901, after William McKinley was assassinated). With the insights he gained in Europe and the help of American experts on health and welfare, he and his allies crafted one of the most socially progressive party platforms in American history. It called for universal health insurance; a national public health service; insurance for the elderly, the unemployed and the disabled; the end of child labor; the abolition of the seven-day workweek; and a minimum wage ample enough to support a family of four, provide for recreation and allow savings for a rainy day.
After losing the election, Roosevelt continued to engage in politics through hundreds of newspaper columns and magazine articles. The social agenda of his 1912 platform lived on, inspiring progressives of both parties. And with the Social Security Act of 1935, Franklin Roosevelt secured much of what his distant cousin Theodore had been striving for: old-age insurance, unemployment insurance, aid to families with dependent children, and support for the disabled. Opposition from the medical profession blocked the path to national health insurance, and opposition from the South ensured that Social Security would exclude domestic and agricultural labor, major occupations of African-Americans.
Roosevelt’s efforts in the field of health yielded more defeats than triumphs. No politician relishes defeat, but as the preacher of the risk-taking strenuous life, he could hardly whine about his losses. Ultimately he decided that the man who mattered most was the man in the arena, taking his lumps and carrying on. Such a man might make mistakes, Roosevelt said, and he might come up short, but he is striving valiantly, spending himself in a worthy cause, and “if he fails, he at least fails while daring greatly.”
If life dealt Theodore Roosevelt the high cards of wealth and privilege, the long suit of his boyhood was a life-threatening illness. The experience might have produced a man who lived on his inheritance and shied away from all things strenuous. This boy, willing and able to make himself strong, entered the political arena and fought against long odds for the health and well-being of his fellow citizens — a worthy cause if ever there was one. There may be no better way for the country to honor his memory than to get off its duff and persevere until all Americans have decent health care.
https://www.nytimes.com/2019/01/06/opinion/theodore-roosevelt-health-care-progressive.html
Hospital visits for some Maine residents could become more complicated, and costly
by Charles Eichhacker - Bangor Daily News - January 7, 2019
Visits to the hospital are never fun, and they’re rarely straightforward.
But for some residents of eastern and central Maine who have
a medical emergency — a broken leg, an allergic reaction, chest pain —
seeking help is about to get more complicated.
It could cost more, too.
Starting early this year, many doctors who staff hospitals
in Blue Hill, Ellsworth, Pittsfield and Waterville will no longer work
for the hospitals themselves or its parent organization, Northern Light
Health. Instead, they’ll work for a company based more than 1,000 miles
away. TeamHealth, a physician staffing firm headquartered in Knoxville,
Tennessee, has signed a contract with Northern Light to employ the
emergency medicine and hospitalist doctors in those four hospitals.
That means patients who see those doctors would get a
separate bill from TeamHealth, in addition to any others from Northern
Light.
It also means patients who have confirmed that their local
hospital accepts their insurance could be in for a shock: It’s not a
given that TeamHealth will accept that insurance, too. If it doesn’t,
patients could be stuck with a hefty bill.
Northern Light administrators say the new partnership will help the system — formerly called Eastern Maine Healthcare Systems
— deliver stronger, more efficient hospital care. It comes as the
organization has struggled to fill open positions at those small,
regional health centers in recent years.
Yet at a time when Americans have grown increasingly wary of
the steep costs and mysterious origins of medical bills, TeamHealth’s
arrival could also put new, upward pressure on the price Mainers pay for
a trip to the hospital.
In particular, if TeamHealth refuses to accept the prices
offered by Maine patients’ health insurers, patients could be exposed to
costly out-of-network bills.
A recent study from Yale University
found that when TeamHealth and one of its competitors entered hospital
emergency rooms between 2011 and 2015, a greater share of patients with
health insurance accepted by the hospital ended up seeing physicians who
were outside their insurance network.
The resulting bill from an unknown, out-of-network
contractor could be more than double what the insurer was willing to
pay, according to the Yale research. When that happens, patients may
then be asked to cover the difference, and the so-called “surprise” or
“balance” bill can reach hundreds or thousands of dollars.
Alternatively, if insurers agree to the steeper bill, they can pass that price on to patients through higher premiums.
While Northern Light administrators say that any insurance
patients have used in the past should still work under the new
partnership, a TeamHealth spokeswoman said the company may send
out-of-network bills to Maine patients.
In 2014, about 20 percent of inpatient admissions and 14
percent of outpatient visits to ERs in the U.S. led to out-of-network
bills, according to a report by the Federal Trade Commission. A recent poll by the Kaiser Family Foundation found four in 10 Americans said they’d received a surprisingly large invoice for medical care in the last year.
Members of Congress, meanwhile, have started considering solutions
to the problem. In Maine, a law that took effect at the start of 2018
aims to protect patients from surprise, out-of-network bills.
TeamHealth’s entrance into the four Northern Light hospitals could test
the strength of the new law.
Some members of the health care industry have said
out-of-network billing isn’t common in Maine, but it has been reported
here. Ann Woloson, executive director of the Augusta-based advocacy
group Consumers for Affordable Health Care, has heard from patients who
thought a hospital and surgeon would take their insurance, for example,
then were billed by an out-of-network anesthesiologist.
Besides the questions about TeamHealth’s billing, it’s
still unclear what specific changes are coming to the staffing of the
four hospitals under the for-profit contractor: Northern Light Blue Hill
Hospital, Northern Light Maine Coast Hospital in Ellsworth, Northern
Light Sebasticook Valley Hospital in Pittsfield and Northern Light
Inland Hospital in Waterville.
The TeamHealth spokeswoman and Northern Light
administrators didn’t respond to specific questions about how many
clinicians will work at those hospitals going forward, but both
emphasized their focus on improving quality outcomes. However, one
doctor who said he was offered a contract to work at one of those
hospitals under TeamHealth questioned whether there will be adequate
emergency room staffing.
Woloson knows little about TeamHealth and hopes the new
arrangement will allow quality physicians to keep working in rural
places like Blue Hill and Pittsfield, where it can be hard to attract
well-trained professionals. Yet she questioned how Maine patients will
be asked to pay for the company’s services.
“I think Northern Light is really trying to manage its
entire system in a way that will not only make it competitive, but also
meet the needs of people living in those rural areas,” Woloson said.
“This might be a way to do that.”
Still, she said, “I do have concerns about this. How are
people going to know whether the TeamHealth person is in-network and
whether they will be billed for services? Maine does have some
protections, but they’re not necessarily foolproof.”
TeamHealth
Founded in 1979, TeamHealth has grown into one of the country’s largest physician staffing companies. It has more than 12,000 workers
in a range of medical fields, including hospital and emergency
medicine, primary care and anesthesia. In 2016, the private equity firm
Blackstone acquired it for $6.1 billion, according to Reuters.
Under the new contract, it will become the employer of two
types of providers at the four hospitals in Blue Hill, Ellsworth,
Pittsfield and Waterville: ER clinicians and hospitalists. The latter
are doctors who provide a mix of inpatient services. The new staffing
arrangements will start to take effect around the beginning of February,
according to Northern Light, and TeamHealth is already advertising
physician openings at the Maine hospitals.
TeamHealth will also start working with other hospitals in the $1.7 billion network, including its flagship campus, Northern Light Eastern Maine Medical Center in Bangor. It may submit a proposal to staff three other Northern Light hospitals in Portland, Greenville and Presque Isle in the coming months.
Northern Light says the new arrangement is a win-win.
Administrators think the practices TeamHealth has developed over decades
of operation will help trim costs, improve patient care and give the
hospitals more flexibility to fill staff openings, allowing them to keep
serving the rural residents who depend on them.
“We don’t know all things, in all areas. Nobody does. So
this is an example of a strategic partnership between Northern Light
Health and TeamHealth,” Steven Berkowitz, Northern Light’s senior vice
president and chief physician executive, said. “This is what they do,
and they do it well. They can bring experiences from literally hundreds
of emergency departments across the country: what’s worked, what hasn’t
worked. So I’m very excited about them taking a very comprehensive look
at what we’re doing and what can we do to be even better.”
While Berkowitz said Northern Light providers already
deliver strong care, he said TeamHealth has systems for measuring
performance that will help it find efficiencies and improve a number of
outcomes, such as hospital readmissions and how long patients must wait
to be seen.
Another reason Northern Light is pursuing the new
arrangement is because it’s had to pay for temporary doctors, known as
locum tenens physicians, to fill openings in recent years.
That interim staffing can cost a hospital more than twice
as much as full-time employees, given the travel and other expenses they
require, but TeamHealth has a nationwide network of doctors it can draw
to Maine at less expense and with less hassle, according to Berkowitz.
At least one of the system’s hospitals, Northern Light
Maine Coast Hospital in Ellsworth, has struggled with physician turnover
and staffing costs since joining the system in 2015.
Last year, a group of doctors left after the parent organization made controversial changes to their contracts, according to the Ellsworth American.
The hospital’s reliance on costly locum tenens doctors has contributed
to millions in operating losses over the last few years, its president told the Ellsworth American in December. It projects a $4 million loss this year, after even greater losses in 2016 and 2017.
Out-of-network bills
While the new arrangement may help Northern Light’s bottom
line, it remains to be seen whether patients will feel the same way
about their own wallets.
When TeamHealth and another physician staffing company,
EmCare, entered hospital ERs between 2011 and 2015, their entrances were
associated with a jump in out-of-network billing, though the change was
more dramatic under EmCare, according to the study published in March 2018 by researchers at Yale University.
Using data provided by an unidentified health insurance
company, the researchers found that under EmCare, there was an 81
percent hike in the portion of visits by that insurer’s customers that
led to an out-of-network bill, compared with 33 percent under
TeamHealth.
The study also found that TeamHealth’s arrival raised the
price of emergency care in another way. Several months after the
company’s doctors went out-of-network, many of them negotiated to
re-enter the insurance network and received in-network rates 68 percent
higher than they had received previously, the researchers found.
“This is an example of the firm using a now-credible threat
of out-of-network billing to gain bargaining leverage in their
negotiations over in-network payments,” the authors wrote.
Starting next month, emergency room clinicians at
Northern Light hospitals in Blue Hill, Ellsworth, Pittsfield and
Waterville will no longer work for the hospitals themselves. Their
employer will be TeamHealth, a Tennessee-based physician staffing
company with operations across the country.
Some consumer advocates and academics have assailed the
practice of balance billing, saying it blindsides patients who can’t
control which doctors see them in a hospital or know what those private
doctors have negotiated with insurance providers, according to past reporting by The New York Times.
For U.S. patients who learn they must pay out-of-network medical bills, the damage can be severe.
Those bills range in price from hundreds of dollars to more than $19,000, according to a 2016 study
from Yale University. Using insurance company data, that research found
about one in five emergency room visits nationwide led to an
out-of-network bill, although the practice didn’t appear to be common in
Maine.
“To put it in very, very blunt terms: This is the health
equivalent of a carjacking,” Zack Cooper, an assistant professor of
health policy and economics at Yale, told The New York Times. He
co-authored both the recent study on staffing companies such as TeamHealth and the earlier one on out-of-network billing.
A group representing ER doctors, the American College of
Emergency Physicians, pushed back on some of those findings, saying they
overstate the risk of balance billing. It argued that insurers are the
ones who have failed to offer reasonable in-network rates.
In Maine, patients at the four Northern Light hospitals will soon learn whether it’s a problem here.
A TeamHealth spokeswoman didn’t directly respond to
questions about whether the company plans to enter the insurance
networks accepted at those hospitals, but she left open the possibility
that the company could send out-of-network bills to Maine patients.
TeamHealth works “diligently to negotiate fair market rates
with managed care plans and payers before beginning services at any
client facility,” the spokeswoman, Natalie Bullock, wrote in an email.
“If/when TeamHealth clinicians are out-of-network at a particular
hospital and/or facility, we do everything we can to avoid
out-of-network payment for the physician services portion of a patient’s
bill. When out-of-network payment is unavoidable, we work closely with
patients and families to reach amicable payment solutions.”
At Northern Light, Berkowitz said he doesn’t expect any major insurance changes for patients under the new arrangement.
“When they come to our ER or get admitted to our hospital,
whatever insurance they have with us, the same things would occur, the
same things would” be covered, Berkowitz said. “Now, could there be some
unusual insurance arrangement with some insurance company? I guess it
could, but the intent is to make this seamless.”
“And I want to know if there is an issue like that,” he
added. “Our intent is not to somehow or another pass on more costs to a
patient, or something like that.”
Berkowitz said that he was not aware of any terms in
TeamHealth’s contract that would prevent the contractor from going out
of network, and he doesn’t expect patients to be notified if they’re
seeing a doctor not directly employed by Northern Light. He referred
most questions about future billing to TeamHealth.
Kevin Lewis, president and CEO of one of Maine’s health
insurers, the nonprofit Community Health Options, said in late December
that he wasn’t aware of any negotiations the insurer has had with
TeamHealth. He said he couldn’t comment on how any negotiations with the
company might go.
“We certainly value our partnership with Northern Light and
its system of hospitals,” he said. “These are important access points.
We certainly look to ensure good access to care.”
In Maine, patients have some protections against the costs
that can come from visiting an out-of-network doctor at a facility that
otherwise accepts their insurance.
One law that took
effect at the start of 2018 requires insurers to pay for non-emergency
medical services provided by out-of-network providers if the patient had
reason to believe the provider was in network and covered by the
insurer. It also mandates that insurance companies in the state offer accurate, online directories of providers in each plan that they update monthly.
That law applies to services provided by hospitalists, one
of the types of physicians that will be employed by TeamHealth under its
new deal with Northern Light, Judith Watters, a consumer outreach
specialist at the Maine Bureau of Insurance, wrote in an email.
Another state law requires that health plans
subject to terms in the federal Affordable Care Act pay in-network
rates for emergency medical costs even if an out-of-network provider
provides those services.
Watters said that Mainers can report any concerns about
medical billing or claims to the consumer health care division of the
Maine Bureau of Insurance by calling 800-300-5000.
However, even in states that have passed comprehensive laws
protecting against balance billing, there are gaps that have allowed
the practice to persist, according to a 2017 analysis by the Commonwealth Fund.
Woloson, from Maine Consumers for Affordable Health Care,
questioned whether Maine’s laws would ensure that all services provided
by TeamHealth physicians are covered if the physicians are outside the
accepted insurance networks.
“It’s not clear how expansive the scope of care is that
their doctors will be providing in hospitals,” she said. “If this news
is out, that TeamHeath has providers out working in hospitals, there
could be an argument that if someone is billed by an out-of-network
provider, that it might not be considered surprise billing, especially
if it happens more than once.”
For-profit care?
While roughly two-thirds of U.S. hospitals have outsourced
the staffing of their ERs, according to the recent Yale study, there are
few precedents for it in the Pine Tree State, according to Charles
Pattavina, an emergency physician at St. Joseph Hospital in Bangor who
recently served as that hospital’s medical director and chief of
emergency medicine.
Pattavina — a recent president of the Maine Medical Association
who has been on the national board of the American College of Emergency
Physicians — isn’t aware of any other Maine systems that have
outsourced at the level of Northern Light.
Starting next month, emergency room clinicians at
Northern Light hospitals in Blue Hill, Ellsworth, Pittsfield and
Waterville will no longer work for the hospitals themselves. Their
employer will be TeamHealth, a Tennessee-based physician staffing
company with operations across the country.
The American College of Emergency Physicians has challenged
the view that ER doctors are to blame for out-of-network billing,
arguing that patients would fare better if their insurers offered more
reasonable rates and more comprehensive provider networks.
Speaking for himself, Pattavina said the recent findings on
TeamHealth by the Yale researchers were sound, but he disagreed with
the premise that there was something unseemly about the company’s
reported practice of threatening out-of-network coverage to secure
higher in-network rates.
“That’s just business,” he said. “They can play hard ball
with the insurance company. You would hope they play hard ball
together.”
However, Pattavina raised other concerns about the entry of
a large, outsourcing company into Maine’s ERs. For one thing, he said
that a hospital has less control over the quality of its physicians when
a contractor takes over.
Pattavina knows talented physicians who have worked in
Northern Light hospitals. He also knows good doctors who have worked for
TeamHealth and said that in the best cases, staffing companies can
bring well trained clinicians to hospitals that need them. The danger,
he said, is that existing physicians may refuse to work for the company
and be replaced by less qualified providers.
At Northern Light, Berkowitz disagreed with the notion that
TeamHealth providers could be less qualified and said they all will
have to meet the same standards Northern Light sets for its own staff.
“They have very high credentialing. They have very high
standards, and I see nothing but the top quality ER docs and hospitalist
docs,” he said. “That’s totally unfounded in anything that I’ve
experienced knowing TeamHealth for many years. An organization like
TeamHealth has a very extensive credentialing process, as does Northern
Light Health. They’re both excellent.”
TeamHealth had a similar response. “All clinicians placed
by TeamHealth in the hospital are subject to rigorous screening and
credentialing guidelines established by the hospitals in conjunction
with TeamHealth,” spokeswoman Bullock wrote in an email.
Pattavina was also skeptical that TeamHealth could find
efficiencies across Northern Light without cutting services or raising
prices.
Northern Light is classified as a nonprofit organization.
But Pattavina noted that as a for-profit company owned by the investment
firm Blackstone, TeamHealth is likely trying find a buck somewhere in
the deal. The ways it could do that, he said, include cutting positions,
paying lower wages or increasing billing, either directly from patients
or indirectly from insurers.
“They wouldn’t be in it if they didn’t think they were
going to make money,” Pattavina said. “It’s got to come from somewhere,
because at the end of the day, Blackstone expects to make money.”
Asked how the company’s profit motive could affect Maine
hospital care, Bullock responded, “TeamHealth’s number one priority is
patient safety and delivering high-quality care to patients and
families.” The company didn’t make any representatives available for an
interview.
A chest X-ray of a child
suffering from flu symptoms. Starting next month, emergency room
clinicians and hospitalist doctors at Northern Light hospitals in Blue
Hill, Ellsworth, Pittsfield and Waterville will no longer work for the
hospitals themselves. Their employer will be TeamHealth, a
Tennessee-based physician staffing company with operations across the
country.Staffing levels
Representatives from TeamHealth and Northern Light didn’t
respond to specific questions about how staffing or employment contracts
will change under the new partnership. But Berkowitz said staffing will
be one of the factors TeamHealth considers when it’s looking for
efficiencies.
“Do we have enough doctors, nurses?” he said, as an example
of a question he hopes TeamHealth can answer. “Could we have too many
doctors? What’s the best way to do that? So we want to rely on them for
national models for logistics. … It’s not less care. That’s just not an
option. But efficiencies are made by throughput and the ability to make
time better spent.”
Some physicians who now work for Northern Light declined to speak publicly about TeamHealth’s plans.
But a semi-retired ER doctor who used to work at what’s now
Northern Light Inland Hospital in Waterville said he disagrees with a
staffing change that could be near.
Over a career in family and emergency medicine, John
Garofalo, 64, of Belgrade has worked at several Maine hospitals. From
early 2016 to late 2017, he said he worked full-time in the emergency
department of what was then Inland Hospital, before taking another job
at St. Joseph Hospital in Bangor.
Although Garofalo enjoyed working at Inland and praised his
colleagues there, he couldn’t agree on a new contract with the parent
organization that’s now Northern Light. After tiring of the commute to
Bangor, though, he signed a new contract to return to Inland on a per
diem basis, he said.
Before Garofalo could start, his hiring was put on hold and he was offered a new contract to work for TeamHealth, he said.
However, he refused to sign it because he didn’t agree with
a stipulated change in ER staffing. A physician would still be
stationed there at all hours of the day, but TeamHealth was proposing to
eliminate a second clinical worker — usually a nurse practitioner or
physician assistant — who also staffed the emergency department from
around 10 a.m. to 8 p.m., according to Garofalo.
While Garofalo doesn’t know much about the quality of
TeamHealth’s offerings, he thought the arrangement could prove lacking
if the emergency department was inundated. If a doctor was tied up with
something serious, he said, the lack of a second worker could force
other patients to wait for care.
“The quality of care at Inland is very good. What I’m
saying is, this circumstance could lead to a potential for compromise of
that,” he said, noting that he was just sharing his personal opinion
and hadn’t heard of any actual problems.
“Possibly you may have a patient who is critically ill and
you can’t leave the bedside. Does that happen every day? No, but when it
does happen, it can lead to real problems in terms of providing care in
a timely manner. … I’m not saying I think anything bad has happened,
but the potential for it goes up.”
Asked about Garofalo’s concern, a spokeswoman for Northern
Light, Karen Cashman, wrote in an email that the organization doesn’t
share specific staffing numbers.
Individual “hospitals are staffed based upon historical
data with a back-up plan always in place for unforeseen or emergency
situations,” she wrote. “We remain comfortable that TeamHealth, as a
nationally recognized outcomes-based provider with a demonstrated track
record, has developed an appropriate model that will serve our hospitals
well.”
Bullock, the TeamHealth spokeswoman, wrote in an email that the company couldn’t comment on specific employment contracts.
A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills
I spent a year writing about ER bills. Zuckerberg San Francisco General has the most surprising billing practices I’ve seen.
I spent a year writing about ER bills. Zuckerberg San Francisco General has the most surprising billing practices I’ve seen.
by Sarah Kliff - VOX - January 7, 2019
On April 3, Nina Dang, 24, found herself in a position like so many San Francisco bike riders — on the pavement with a broken arm.
A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.
A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December.
“Eight months after my bike accident, I’m still thinking about [the bill], which is crazy to me,” Dang says.
Dang’s experience with Zuckerberg San Francisco General is not unique. Vox reviewed five patient bills from the hospital’s emergency room, in consultation with medical billing experts, and found that the hospital’s billing can cost privately insured patients tens of thousands of dollars for care that would likely cost them significantly less at other hospitals.
The bills were all submitted by patients to Vox’s Emergency Room Billing Database, which served as the basis for a year-long investigation into ER billing practices.
Zuckerberg San Francisco General (ZSFG), recently renamed for the Facebook founder after he donated $75 million, is the largest public hospital in San Francisco and the city’s only top-tier trauma center. But it doesn’t participate in the networks of any private health insurers — a surprise patients like Dang learn after assuming their coverage includes a trip to a large public ER.
Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in-network.” Zuckerberg San Francisco General has not done that bargaining with private plans, making them “out-of-network.” That leaves many insured patients footing big bills.
The problem is especially acute for patients like Dang: those who are brought to the hospital by ambulance, still recovering from a trauma and with little ability to research or choose an in-network facility.
A spokesperson for the hospital confirmed that ZSFG does not accept any private health insurance, describing this as a normal billing practice. He said the hospital’s focus is on serving those with public health coverage — even if that means offsetting those costs with high bills for the privately insured.
“It’s a pretty common thing,” said Brent Andrew, the hospital spokesperson. “We’re the trauma center for the whole city. Our mission is to serve people who are underserved because of their financial needs. We have to be attuned to that population.”
But most medical billing experts say it is rare for major emergency rooms to be out-of-network with all private health plans.
“According to what I’ve seen, that’s unusual,” says Christopher Garmon, an economist at the University of Missouri Kansas City who studies surprise medical bills. “I’ve heard anecdotes of some hospitals trying a strategy like this but my impression is that it doesn’t last very long.”
The data backs him up: Garmon’s own research finds that just 1 percent of ambulances end up at out-of-network emergency rooms.
Indeed, most other public trauma centers — including those nearby in Sacramento, California or Portland — all advertise a long list of health insurance plans they accept, right on their websites.
Patient advocates who reviewed the San Francisco bills were surprised by the practice, too.
“It’s really unusual for this to be the case. Usually, it’s the doctors who are often out of network. For the ER to be out of network? That’s a bit odd,” says Robert Berman with Systemedic, a medical billing advocacy firm that reviewed Dang’s bills.
Two of the patients I interviewed were able to reverse their bills, both with significant time and effort. Three are still contesting the charges, arguing that they couldn’t have known that the hospital that an ambulance selected for them wasn’t covered by their health insurance.
“It’s terrifying and it’s frustrating,” says Alexa Sulvetta, 31, who has so far spent more than $3,000 in legal fees contesting a $31,000 bill from her emergency room visit. “It could make a huge impact on my credit at the point where we’re thinking about buying a new house.”
An unusual billing practice at San Francisco’s only top-tier trauma center
Founded in 1872, the Zuckerberg San Francisco General Hospital estimates that it currently cares for one in five of the city’s residents. It boasts that it is the city’s “busiest emergency room.” It sees about 80,000 patients annually and receives one-third of the city’s ambulances.
In 2015, the hospital made headlines when it received a $75 million gift from Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, which is believed to be the largest donation ever to a public hospital in the United States. The hospital used the gift to help build a new trauma center, which opened in 2016.
“Priscilla and I believe that everyone deserves access to high quality health care,” Mark Zuckerberg said in a statement released when he and Chan made the donation.
A spokesperson for the Zuckerberg Chan Foundation declined to comment for this story.
The large donation isn’t the only thing that makes the hospital stand out.
Experts say it’s abnormal for such a large hospital to be out-of-network with all private health insurers, as ZSFG is.
When doctors and hospitals join a given health insurance plan’s network, they agree to specific rates for their services, everything from a routine physical to a complex surgery to an ER visit.
Doctors typically end up out-of-network when they can’t come to that agreement. The doctors might think the insurance plan is offering rates that are too low, but the insurer argues that the doctor’s prices are simply too high.
But hospitals themselves, particularly ERs, typically don’t end up in disputes that wind up leaving them out-of-network. I’ve seen this in my own reporting. I’ve read more than a thousand emergency room bills, and in nearly all of them the facility is “in-network” with the patient’s insurance.
Garmon, the health economist, explains that insurers are almost always able to negotiate an “in-network” rate with major hospitals because patients want to use those facilities.
“In general, employer plans tend to be more inclusive in terms of the hospital facilities they have,” says Garmon. “Not having a major hospital in-network is a big deal. It’s the kind of thing that makes the newspapers and that you don’t see often.”
Garmon’s research shows that about one in five emergency room patients ends up with a surprise medical bill from an out-of-network doctor working at their in-network hospital. But only about one in 100 patients ends up with a surprise bill because the hospital itself is out-of-network.
Unless states have laws regulating out-of-network billing — and most don’t — patients often end up stuck in the middle of these contract disputes.
In the case of an emergency room visit, patients brought in by ambulance often have little to no say over where they’re taken.
Andrew, the hospital spokesperson, conceded that the insurance policy can leave patients like Dang in a tough place.
“I do understand that situation is a problem for individuals who come in here who are insured,” Andrew said. “She may feel like she didn’t have a choice in coming here, and she might not have.”
Still, he explained the hospital’s out-of-network status in two ways. First, he said that insurers are the ones who get final say over who joins a network. Second, he emphasized that the hospital’s primary mission is to serve vulnerable populations, such as the uninsured and low-income patients with Medicaid.
“For us, the challenge is we don’t want to become just another hospital,” he said. “Our mission is to serve people who are underserved because of their financial needs. We feel like we have to recoup what we’re able to from people who are insured because we’re supporting people who don’t have insurance.”
“I don’t think there is any way to avoid this”
Alicia Rodriquez, 28, ended up at Zuckerberg General with a debilitating migraine last January.
“I couldn’t really move, and could barely hold the phone. I was incapacitated,” says Rodriquez, who has had these migraines since high school. “I was able to call 911 and once they evaluated me, they said they wanted to take me to the emergency room.”
A neurologist came to see Rodriquez in the emergency room, ultimately recommending a CT scan to ensure that she didn’t have a brain tumor. She also received morphine to help treat the pain. The situation was familiar to Rodriquez: Because of her long history of migraines, she has previously received similar treatment at other emergency rooms in Northern California.
But the bill for this visit was quite different than the others because the hospital was out-of-network with her health insurance plan, Cigna. The hospital billed Rodriquez $12,768. Cigna paid only $2,767, leaving her with a bill just over $10,000.
“I don’t think there is any way to avoid this,” she says. “They took me to the closest hospital. I wouldn’t have been able to research the nearest in-network hospital. I couldn’t see.”
Rodriquez is currently appealing the bill to her insurance, asking Cigna to pay a higher price. She is optimistic that her appeal will be successful but, if it’s not, would expect to file a complaint with the hospital and possibly state regulators.
“At this point it’s been ongoing for an entire year,” Rodriquez, who has since moved to Colorado, says. “Since January, I’ve known the bill is going to come. So there’s always this thing that has been in the back of my mind.”
“Not a sustainable solution”: laws leave patients vulnerable to sky-high bills
When Dang first got her $20,243.71 bill, she turned to her health insurance plan, asking it to pay a higher portion of the fees. But the insurance denied that appeal, stating that it had already paid a reasonable fee to cover the services provided.
“You may be held responsible for any charges in excess of the allowable amount when receiving a covered service from a non-network provider,” the letter stated. “This is commonly known as balance billing.”
Premera spokesperson Steve Kipp told me over email that the insurer paid roughly twice what Medicare would pay for the same services. Zuckerberg was billing 12 times the Medicare price. Dang’s employer has since reached out to Premera to see if they can negotiate a lower price directly with the hospital.
Patients like Dang and Rodriquez have little protection under state or federal law. While California actually has some of the most consumer-friendly laws to protect some patients from surprise emergency bills, her health plan doesn’t fall under those rules. Multiple senators have proposed legislation in the Senate to fix this problem, but those bills have so far seen little movement.
For now, most patients end up appealing their bills to the hospital, their insurance plans, or even the court system.
In 2009, emergency room patients filed a class action lawsuit against the hospital. The lead plaintiff in the case wanted relief from the out-of-network bill he received after he had his thumb reattached there.
The judge ruled against the patients, finding that the hospital’s behavior was legal under California insurance regulations.
“The way for patients to solve this is to bring the hospital to court on a small claims action, but at the end of the day, that is just not a sustainable solution,” says Nicholas Carlin, the attorney who brought the suit.
Alexa Sulvetta is still contesting a $31,250 bill she received last spring for treatment of a broken ankle after she fell from a rock climbing wall. As with other patients, the hospital was not in Sulvetta’s insurance network. (I covered Sulvetta’s case previously in a separate story about emergency room trauma fees.)
She received a $113,336 bill for her one-day stay, and her insurance only agreed to pay a portion of that which it deemed reasonable — leaving Sulvetta with the $31,250 bill.
Sulvetta retained a lawyer last December to fight the bill. She has so far gotten the bill reduced by $8,000 — but also paid more than $3,000 in legal fees.
“I’m hoping to get it down to under $5,000 or $10,000,” she says. “It’s frustrating that I have to hire a lawyer, but so far it’s been worth it.”
A+%2420%2C243+bike+crash%3A+Zuckerberg+hospital%92s+aggressive+tactics+leave+patients+with+big+bills
Alexandria Ocasio-Cortez slams critics calling her agenda too radical
Rookie Rep. Alexandria Ocasio-Cortez shot back at critics who
say her progressive agenda is too radical and expensive, saying there’s
nothing revolutionary about providing people with good jobs, health care
and an education.
“When you can’t provide for your kids working a full-time job, working two full-time jobs. When you can’t have health care. That is not dignified,” Ocasio-Cortez told CBS’ “60 Minutes” in an interview that aired Sunday.
The 29-year-old newly minted House member is entering office with an ambitious agenda — including Medicare for all, tuition-free public college, and sweeping environmental protections.
“How are you going to pay for all that?” CBS’ Anderson Cooper asked her.
“No one asks how we’re going to pay for this Space Force. No one asked how we paid for a $2 trillion tax cut,” she said. “We only ask how we pay for it on issues of housing, health care and education. How do we pay for it? With the same exact mechanisms that we pay for military increases for this Space Force.”
Ocasio-Cortez, a self-described Democratic socialist, was asked about a comment from Sen. Chris Coons (D-Del.) that if “unrealistic proposals” are pushed, Democrats who just regained control of the House might look like they’re unable to govern.
“We pay more per capita in health care and education for lower outcomes than many other nations. And so for me, what’s unrealistic is what we’re living in right now,” she said.
Her proposal to increase taxes on the wealthy to fund her Green New Deal, which aims to eliminate carbon emissions in the US within 12 years, was highly criticized.
Ocasio-Cortez, who seemingly came out of nowhere to defeat political power broker Rep. Joe Crowley in June’s Democratic primary, said her brand of Democratic socialism is not the type critics say is associated with economically troubled Cuba and Venezuela.
She said the things she and her colleagues have in mind “resemble what we see in the UK, in Norway, in Finland, in Sweden.”
https://nypost.com/2019/01/06/alexandria-ocasio-cortez-slams-critics-in-60-minutes-interview/
by J. David Goodman - NYT - January 8, 2019
New York City will spend at least $100 million to ensure that undocumented immigrants and others who cannot qualify for insurance can receive medical treatment, Mayor Bill de Blasio announced on Tuesday morning, seeking to insert a city policy into two contentious national debates.
The mayor has styled himself, in his 2017 re-election campaign and during his second term, as a progressive leader on issues like education and health care and as a bulwark against the policies of President Trump, particularly on immigration.
In making the announcement, first on national television, Mr. de Blasio appeared to be trying to heighten that contrast and thrust his efforts on behalf of undocumented New Yorkers into the national debate over immigration, hours before Mr. Trump was to go on television Tuesday night to make his case for a border wall.
“Everyone is guaranteed the right to health care, everyone,” Mr. de Blasio said during a news conference at Lincoln Hospital in the Bronx. “We are saying the word guarantee because we can make it happen.”
“When you can’t provide for your kids working a full-time job, working two full-time jobs. When you can’t have health care. That is not dignified,” Ocasio-Cortez told CBS’ “60 Minutes” in an interview that aired Sunday.
The 29-year-old newly minted House member is entering office with an ambitious agenda — including Medicare for all, tuition-free public college, and sweeping environmental protections.
“How are you going to pay for all that?” CBS’ Anderson Cooper asked her.
“No one asks how we’re going to pay for this Space Force. No one asked how we paid for a $2 trillion tax cut,” she said. “We only ask how we pay for it on issues of housing, health care and education. How do we pay for it? With the same exact mechanisms that we pay for military increases for this Space Force.”
Ocasio-Cortez, a self-described Democratic socialist, was asked about a comment from Sen. Chris Coons (D-Del.) that if “unrealistic proposals” are pushed, Democrats who just regained control of the House might look like they’re unable to govern.
“We pay more per capita in health care and education for lower outcomes than many other nations. And so for me, what’s unrealistic is what we’re living in right now,” she said.
Her proposal to increase taxes on the wealthy to fund her Green New Deal, which aims to eliminate carbon emissions in the US within 12 years, was highly criticized.
Ocasio-Cortez, who seemingly came out of nowhere to defeat political power broker Rep. Joe Crowley in June’s Democratic primary, said her brand of Democratic socialism is not the type critics say is associated with economically troubled Cuba and Venezuela.
She said the things she and her colleagues have in mind “resemble what we see in the UK, in Norway, in Finland, in Sweden.”
https://nypost.com/2019/01/06/alexandria-ocasio-cortez-slams-critics-in-60-minutes-interview/
De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers
by J. David Goodman - NYT - January 8, 2019
New York City will spend at least $100 million to ensure that undocumented immigrants and others who cannot qualify for insurance can receive medical treatment, Mayor Bill de Blasio announced on Tuesday morning, seeking to insert a city policy into two contentious national debates.
The mayor has styled himself, in his 2017 re-election campaign and during his second term, as a progressive leader on issues like education and health care and as a bulwark against the policies of President Trump, particularly on immigration.
In making the announcement, first on national television, Mr. de Blasio appeared to be trying to heighten that contrast and thrust his efforts on behalf of undocumented New Yorkers into the national debate over immigration, hours before Mr. Trump was to go on television Tuesday night to make his case for a border wall.
“Everyone is guaranteed the right to health care, everyone,” Mr. de Blasio said during a news conference at Lincoln Hospital in the Bronx. “We are saying the word guarantee because we can make it happen.”
The
mayor’s office was quick to say that its plan, to be called NYC Care,
would not be a substitute for any universal health care at the state
level or a national single-payer plan. But, aides said, it was something
the city could do immediately and on its own, and not require approval
from the State Legislature, which is weighing some form of universal
health insurance for New York State.
Indeed, NYC Care would be a mix of insurance and direct spending, and Mr. de Blasio said it would take about two years to get up and running. The city already has a kind of public option for health insurance for low-income New Yorkers, through an insurance plan run by city hospitals and known as MetroPlus.
The NYC Care plan would improve that coverage, which already insures some 516,000 people, and aim to reach more of those who are eligible, such as the young and uninsured, and others who qualify but have not applied.
It would also provide direct city spending, about $100 million per year when fully implemented, on those without insurance, including undocumented immigrants, who already can receive care at the emergency rooms of city-run hospitals.
Details of how those seeking care could do so under the new plan were not immediately clear, thought Mr. de Blasio said that eventually New Yorkers will be able to call a dedicated hotline and be connected to a primary care physician who would be their doctor.
Indeed, NYC Care would be a mix of insurance and direct spending, and Mr. de Blasio said it would take about two years to get up and running. The city already has a kind of public option for health insurance for low-income New Yorkers, through an insurance plan run by city hospitals and known as MetroPlus.
The NYC Care plan would improve that coverage, which already insures some 516,000 people, and aim to reach more of those who are eligible, such as the young and uninsured, and others who qualify but have not applied.
It would also provide direct city spending, about $100 million per year when fully implemented, on those without insurance, including undocumented immigrants, who already can receive care at the emergency rooms of city-run hospitals.
Details of how those seeking care could do so under the new plan were not immediately clear, thought Mr. de Blasio said that eventually New Yorkers will be able to call a dedicated hotline and be connected to a primary care physician who would be their doctor.
“They will have a card that will empower them to go to that doctor whenever they need,” he said.
Officials had yet to outline how much the hotline would cost, nor what the number would be, and likened the card to a “membership card” to the city’s hospitals.
Such endeavors can be difficult for the city to implement quickly. Mr. de Blasio oversaw the creation of a municipal identification card for undocumented immigrants in his first term. But last week, he said that an ambitious goal of providing MetroCards to about 800,000 residents whose incomes are below the federal poverty line would fall far short of that goal initially, starting this month with cards for only about 30,000 people, or about four percent of the total.
“This is the city paying for direct comprehensive care (not just E.R.s) for people who can’t afford it, or can’t get comprehensive Medicaid — including 300,000 undocumented New Yorkers,” the mayor’s spokesman, Eric Phillips, wrote on Twitter.
The city’s hospital system has been under severe financial strain and running deficits for years. Part of the idea NYC Care, aides to the mayor said, was to ease that burden while providing better health care to New Yorkers.
The current financial plan for city hospitals projects budget shortfalls of over $156 million in 2018, increasing to $1.8 billion in 2022, according to the city’s Independent Budget Office.
https://www.nytimes.com/2019/01/08/nyregion/de-blasio-health-care-plan.html
Hedda Martin, 60, wrote in a Facebook post Monday that a heart transplant committee with Spectrum Health, the Grand Rapids-based hospital system, could meet as soon as Tuesday and decide whether she is now eligible for a new heart.
The committee previously ruled that she was ineligible, citing her lack of financial wherewithal to afford the drugs, considering the $4,500 annual deductible in her Medicare plan. Martin's 20-percent drug copay would be about $700 per month until she met that deductible.
In an official letter that went viral across social media, a Spectrum Health nurse informed Martin that her transplant was denied for now and that the transplant committee recommended she undertake a $10,000 fundraising campaign for the anti-rejection drugs.
The situation caught the attention of incoming U.S. Rep. Alexandria Ocasio-Cortez, D-New York, an advocate of single-payer health insurance who has gained national prominence as the youngest woman elected to Congress after an upset victory over a longtime Democratic incumbent.
As of late Monday, Martin's GoFundMe campaign had raised nearly $28,300 — including one $10,000 anonymous donation.
Martin, who is suffering from congestive heart failure, was originally scheduled to undergo surgical implantation of a ventricular assist pump as a "bridge" to her eventual heart transplant. But following the hospital's rejection letter, the pump became her Plan B survival option.
She expected to live up to eight more years with the pump, compared with 15 to 20 more years if she received a new heart.
However, the pump implantation surgery — scheduled for Monday — was abruptly postponed in light of how much money her GoFundMe campaign was raising, according to Martin's Facebook post.
She wrote: "No surgery today. I requested for my case to be brought to the transplant board again tomorrow. Wish me luck. I have my $10,000 (funding) request fulfilled."
Martin, whose heart was damaged from 2005 chemotherapy for breast cancer, also expressed gratitude in the Facebook post for all the financial support she received.
"My heart goes out to all of you with the deepest of love and thanks," she wrote. "The outpouring of support, even though it ended up becoming very political, I appreciate so very much."
Spectrum Health has declined Free Press interview requests, referring to a general statement about the situation on its website.
It remains unclear whether the hospital system considered contacting the makers of the anti-rejection drugs before issuing the organ transplant denial. Some drugmakers offer deep discounts or even free medication for poor patients in life-threatening situations.
"The fact is that transplants require lifelong care and immunosuppression drugs, and therefore costs are sometimes a regrettable and unavoidable factor in the decision making process," Spectrum Health's statement says.
Representatives with the American Heart Association and Gift of Life Michigan, an Ann Arbor-based organ and tissue donation organization, said Monday that they were unaware of any similar situations involving patients who were denied heart transplants for lack of ability to afford post-surgery drugs.
Gift of Life CEO Dorrie Dils said it is understandable that organ transplant centers would consider potential transplant recipients' ability to keep themselves and their new organs healthy.
“If this woman were to receive a transplant and not take her medications, not only would the heart be lost, but she would likely die," Dils said. "With so few hearts available for transplant, it is critical that those hearts go to patients who have a solid plan.”
There were 159 people in Michigan waiting for a heart transplant as of Nov. 1, according to United Network for Organ Sharing data. There were 3,102 people in line in Michigan for all organ transplants, most of them waiting for kidneys.
Newsom took office on Monday in a campaign-style inauguration ceremony packed with supporters and media, and featuring nods to California’s multicultural heritage with music from an African-American church choir from the Los Angeles-area city of Compton and a Mexican folk style group dressed in colors of the California flag.
In his executive order, Newsom directed state officials to set up what he said would ultimately be the nation’s largest single-purchaser system for prescription drugs.
It directed California’s massive Medicaid system to negotiate prescription drug prices for all of its 13 million recipients, changing their benefits from a managed-care or HMO approach to one that allows the state to handle all the purchases.
Medicaid is the joint federal-state program that provides health insurance for the low income.
The state would create a list of drugs to be purchased in bulk or targeted for price negotiations.
Newsom has hired numerous health-care advocates as aides and is expected to focus heavily on initiatives related to public health and health care as his administration moves forward.
Under a proposal expected to be released as part of the state’s budget plan later this week, Newsom will ask the legislature to allow all undocumented immigrant young adults under the age of 26 to participate in the state’s Medicaid plan.
The budget proposal will also contain a plan to increase the federal subsidy for participation in Affordable Care Act policies to families of four making as much as $150,000, and reinstate the mandate requiring people to purchase health care.
https://www.reuters.com/article/us-california-governor-newsom-health/new-california-governor-tackles-drug-prices-in-first-act-idUSKCN1P200D
No important health care legislation will come out of this gridlocked Congress. But the run-up to the 2020 presidential campaign will produce at least a Democratic health care plan out of the nominating process.
Yes, House Democrats will hold a number of for-show votes on health care during the next two years—but they know none of them can go anywhere until they can win both the Senate and the White House.
The 2018 elections resulted in a number of Democrats calling for a Canadian-style single-payer plan. Two-thirds of incoming House Democratic freshman supported single-payer in the November elections—26 new members. That is in addition to the 123 House members in the last Congress supporting it, bringing the total to 149—a House majority is 218. Sixteen Democratic Senators also supported the Sanders single-payer plan in the last Congress.
But House Speaker Nancy Pelosi has made it clear she is not going to take Democrats in so controversial a direction—at least during the next two years. She remembers well the electoral damage the Obamacare program did to Democrats following its passage.
Instead she has said the House for now will focus on improving Obamacare.
Pelosi understands that enacting a government-run single-payer health insurance plans is a popular idea among her base. A November Gallup poll found 65% of Democrats favor some sort of government-run plan. But only 40% of overall voters support a government-run plan.
So, the Democratic leadership has to walk a tight rope--please the base who generally favors a government-run plan without alienating the general electorate that does not.
But Democrats can take heart from the same Gallup poll that found 57% of all voters believe that government should take a role in ensuring that people have health insurance coverage.
Pelosi seems to understand that single-payer health care has the potential for becoming political quicksand for Democrats.
In 2016, the left-leaning Urban Institute evaluated Bernie Sanders’ Medicare-For-All proposal, which would sweep all Americans into one government run-plan. They found that his plan would:
The Democratic controlled House may well pass legislation along these lines but it will go nowhere in the Republican controlled Senate. But that is not the House Democrat's reason for focusing on improving Obamacare--they are doing it to keep the health care policy challenged Republicans off balance in the run-up to the 2020 elections.
I also don’t expect to see any of the other really serious Democratic presidential hopefuls embrace the Sanders single-payer plan. Instead I expect most will position themselves to look more moderate than Sanders. From most of the rest, I would look for more incremental proposals taken from a range of choices, which include:
In the wake of their whipping in the 2018 elections--much of that brought on by their ham-handed treatment of repeal and replace--what will be their 2020 health care plan?
I have no idea--and apparently at this point neither do they.
Just how Republicans will be able to coalesce around a cogent health care platform in the wake of their repeal and replace fiasco, with Trump in the lead, is hard for me to see.
I am not even sure where Republicans will begin and who could take the lead.
https://www.forbes.com/sites/robertlaszewski2/2019/01/09/where-does-the-health-insurance-reform-debate-go-from-here/#1ca9a5d66e72
Officials had yet to outline how much the hotline would cost, nor what the number would be, and likened the card to a “membership card” to the city’s hospitals.
Such endeavors can be difficult for the city to implement quickly. Mr. de Blasio oversaw the creation of a municipal identification card for undocumented immigrants in his first term. But last week, he said that an ambitious goal of providing MetroCards to about 800,000 residents whose incomes are below the federal poverty line would fall far short of that goal initially, starting this month with cards for only about 30,000 people, or about four percent of the total.
“This is the city paying for direct comprehensive care (not just E.R.s) for people who can’t afford it, or can’t get comprehensive Medicaid — including 300,000 undocumented New Yorkers,” the mayor’s spokesman, Eric Phillips, wrote on Twitter.
The city’s hospital system has been under severe financial strain and running deficits for years. Part of the idea NYC Care, aides to the mayor said, was to ease that burden while providing better health care to New Yorkers.
The current financial plan for city hospitals projects budget shortfalls of over $156 million in 2018, increasing to $1.8 billion in 2022, according to the city’s Independent Budget Office.
https://www.nytimes.com/2019/01/08/nyregion/de-blasio-health-care-plan.html
Grand Rapids woman meets Gofundme goal, now hopes for heart transplant
by JC Reindl - Detroit Free Press - November 26, 2018
A Grand Rapids woman who was turned down for a heart transplant for lack of money says that the hospital may reconsider her case now that a fundraising campaign collected more than $28,000 for the necessary anti-rejection drugs.Hedda Martin, 60, wrote in a Facebook post Monday that a heart transplant committee with Spectrum Health, the Grand Rapids-based hospital system, could meet as soon as Tuesday and decide whether she is now eligible for a new heart.
The committee previously ruled that she was ineligible, citing her lack of financial wherewithal to afford the drugs, considering the $4,500 annual deductible in her Medicare plan. Martin's 20-percent drug copay would be about $700 per month until she met that deductible.
In an official letter that went viral across social media, a Spectrum Health nurse informed Martin that her transplant was denied for now and that the transplant committee recommended she undertake a $10,000 fundraising campaign for the anti-rejection drugs.
The situation caught the attention of incoming U.S. Rep. Alexandria Ocasio-Cortez, D-New York, an advocate of single-payer health insurance who has gained national prominence as the youngest woman elected to Congress after an upset victory over a longtime Democratic incumbent.
As of late Monday, Martin's GoFundMe campaign had raised nearly $28,300 — including one $10,000 anonymous donation.
Martin, who is suffering from congestive heart failure, was originally scheduled to undergo surgical implantation of a ventricular assist pump as a "bridge" to her eventual heart transplant. But following the hospital's rejection letter, the pump became her Plan B survival option.
She expected to live up to eight more years with the pump, compared with 15 to 20 more years if she received a new heart.
However, the pump implantation surgery — scheduled for Monday — was abruptly postponed in light of how much money her GoFundMe campaign was raising, according to Martin's Facebook post.
She wrote: "No surgery today. I requested for my case to be brought to the transplant board again tomorrow. Wish me luck. I have my $10,000 (funding) request fulfilled."
Martin, whose heart was damaged from 2005 chemotherapy for breast cancer, also expressed gratitude in the Facebook post for all the financial support she received.
"My heart goes out to all of you with the deepest of love and thanks," she wrote. "The outpouring of support, even though it ended up becoming very political, I appreciate so very much."
Spectrum Health has declined Free Press interview requests, referring to a general statement about the situation on its website.
It remains unclear whether the hospital system considered contacting the makers of the anti-rejection drugs before issuing the organ transplant denial. Some drugmakers offer deep discounts or even free medication for poor patients in life-threatening situations.
"The fact is that transplants require lifelong care and immunosuppression drugs, and therefore costs are sometimes a regrettable and unavoidable factor in the decision making process," Spectrum Health's statement says.
Representatives with the American Heart Association and Gift of Life Michigan, an Ann Arbor-based organ and tissue donation organization, said Monday that they were unaware of any similar situations involving patients who were denied heart transplants for lack of ability to afford post-surgery drugs.
Gift of Life CEO Dorrie Dils said it is understandable that organ transplant centers would consider potential transplant recipients' ability to keep themselves and their new organs healthy.
“If this woman were to receive a transplant and not take her medications, not only would the heart be lost, but she would likely die," Dils said. "With so few hearts available for transplant, it is critical that those hearts go to patients who have a solid plan.”
There were 159 people in Michigan waiting for a heart transplant as of Nov. 1, according to United Network for Organ Sharing data. There were 3,102 people in line in Michigan for all organ transplants, most of them waiting for kidneys.
New California governor tackles drug prices in first act
by Sharon Bernstein - Reuters - January 7, 2019
Hours into his new job, California Governor Gavin Newsom signed an executive order on Monday that could dramatically reshape the way prescription drugs are paid for and acquired in the most populous U.S. state.
The order, along with another naming the state’s first-ever surgeon general, marks a fast start for a governor who has vowed to combat inequity and position California as a counterweight to the conservative Trump administration in Washington.Newsom took office on Monday in a campaign-style inauguration ceremony packed with supporters and media, and featuring nods to California’s multicultural heritage with music from an African-American church choir from the Los Angeles-area city of Compton and a Mexican folk style group dressed in colors of the California flag.
In his executive order, Newsom directed state officials to set up what he said would ultimately be the nation’s largest single-purchaser system for prescription drugs.
It directed California’s massive Medicaid system to negotiate prescription drug prices for all of its 13 million recipients, changing their benefits from a managed-care or HMO approach to one that allows the state to handle all the purchases.
Medicaid is the joint federal-state program that provides health insurance for the low income.
The state would create a list of drugs to be purchased in bulk or targeted for price negotiations.
Dems to test GOP after Trump's prime-time speech
The
executive order also took the first steps to allow private companies
and other governmental agencies to participate in the process of
negotiating drug prices with pharmaceutical companies. Newsom has hired numerous health-care advocates as aides and is expected to focus heavily on initiatives related to public health and health care as his administration moves forward.
Under a proposal expected to be released as part of the state’s budget plan later this week, Newsom will ask the legislature to allow all undocumented immigrant young adults under the age of 26 to participate in the state’s Medicaid plan.
The budget proposal will also contain a plan to increase the federal subsidy for participation in Affordable Care Act policies to families of four making as much as $150,000, and reinstate the mandate requiring people to purchase health care.
https://www.reuters.com/article/us-california-governor-newsom-health/new-california-governor-tackles-drug-prices-in-first-act-idUSKCN1P200D
Any Chance For A Health Insurance Fix? Where The Debate Goes From Here
by Robert Lazzewski - F0rbes - January 9, 2019
In the wake of Republicans failing to repeal and replace Obamacare and the Democratic takeover of the House, where will the health care debate go from here?No important health care legislation will come out of this gridlocked Congress. But the run-up to the 2020 presidential campaign will produce at least a Democratic health care plan out of the nominating process.
Yes, House Democrats will hold a number of for-show votes on health care during the next two years—but they know none of them can go anywhere until they can win both the Senate and the White House.
The 2018 elections resulted in a number of Democrats calling for a Canadian-style single-payer plan. Two-thirds of incoming House Democratic freshman supported single-payer in the November elections—26 new members. That is in addition to the 123 House members in the last Congress supporting it, bringing the total to 149—a House majority is 218. Sixteen Democratic Senators also supported the Sanders single-payer plan in the last Congress.
But House Speaker Nancy Pelosi has made it clear she is not going to take Democrats in so controversial a direction—at least during the next two years. She remembers well the electoral damage the Obamacare program did to Democrats following its passage.
Instead she has said the House for now will focus on improving Obamacare.
Pelosi understands that enacting a government-run single-payer health insurance plans is a popular idea among her base. A November Gallup poll found 65% of Democrats favor some sort of government-run plan. But only 40% of overall voters support a government-run plan.
So, the Democratic leadership has to walk a tight rope--please the base who generally favors a government-run plan without alienating the general electorate that does not.
But Democrats can take heart from the same Gallup poll that found 57% of all voters believe that government should take a role in ensuring that people have health insurance coverage.
Pelosi seems to understand that single-payer health care has the potential for becoming political quicksand for Democrats.
In 2016, the left-leaning Urban Institute evaluated Bernie Sanders’ Medicare-For-All proposal, which would sweep all Americans into one government run-plan. They found that his plan would:
- Increase national health expenditures by $6.6 trillion between 2016 and 2026.
- Increase federal expenditures by $32 trillion between 2017 and 2026.
- Fall way short of paying for itself—Sanders’ proposal would raise taxes by $15.3 trillion from 2017 to 2026 compared to the estimated federal price tag of $32 trillion during the same period—”thus the proposed taxes are much too low to fully finance his plan.”
- Improving the insurance exchange subsidies for the middle class in the individual market who are struggling with astronomical unsubsidized premiums and deductibles. Forty percent of people in the individual market make too much money for any Obamacare subsidies.
- Making a point of protecting the preexisting condition reforms Republicans were able to bungle their way into looking like they wanted to undermine during their repeal and replace debate.
The Democratic controlled House may well pass legislation along these lines but it will go nowhere in the Republican controlled Senate. But that is not the House Democrat's reason for focusing on improving Obamacare--they are doing it to keep the health care policy challenged Republicans off balance in the run-up to the 2020 elections.
I also don’t expect to see any of the other really serious Democratic presidential hopefuls embrace the Sanders single-payer plan. Instead I expect most will position themselves to look more moderate than Sanders. From most of the rest, I would look for more incremental proposals taken from a range of choices, which include:
- Government directly negotiating drug prices.
- Guaranteed insurability-for-all with Democrats coming out against the alternative individual market the Trump administration is now building around concepts like the short-term plans that don't cover preexisting conditions.
- Improved Obamacare subsidies—particularly for the middle class that have often been forced to drop their individual insurance out of affordability issues.
- The return of the Medicare-like Public Option proposals for the Obamacare insurance exchanges.
- Medicare buy-in for those age-50 and above.
- Medicare Advantage-For-All – Based upon similar proposals offered by the Center for American Progress and the Urban Institute that would generally sweep all but employer-based insurance into one giant federal program offering people the choice of Medicare, or what we now know as private Medicare Advantage plans.
In the wake of their whipping in the 2018 elections--much of that brought on by their ham-handed treatment of repeal and replace--what will be their 2020 health care plan?
I have no idea--and apparently at this point neither do they.
Just how Republicans will be able to coalesce around a cogent health care platform in the wake of their repeal and replace fiasco, with Trump in the lead, is hard for me to see.
I am not even sure where Republicans will begin and who could take the lead.
https://www.forbes.com/sites/robertlaszewski2/2019/01/09/where-does-the-health-insurance-reform-debate-go-from-here/#1ca9a5d66e72
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