Philip Caper: Paying for universal health care isn’t difficult
by Philip Caper - Lewiston Sun-Journal - February 24, 2019
At Maine AllCare we are often asked “How are we going to pay for health care for all Americans?” The simple answer is: “We will redirect the more than $750 billion per year that we currently waste.”In 2012, The Institute of Medicine (now the Academy of Medicine, part of the National Academy of Science) published a report that estimated the amount and sources of inefficiency (they called it “waste”) in the American health care system. At that time it amounted to $750 billion per year nationwide. That amounts to about $3 billion per year in Maine alone. There is more than enough money in the health care system in the United States to cover everybody, including Maine, and significantly improve the coverage we all deserve in the bargain.
Replacing our fragmented mixed public-private insurance system with improved Medicare for all could effectively address each of these sources of waste:
Second, such a change will eliminate the costs of enforcing compliance with multiple insurance plans, each with its unique benefits and eligibility requirements. The tracking of deductibles, copays and various unique twists by doctors, hospitals and other entities provides no health benefit, and costs are estimated at more than $200 billion. Put another way, each doctor in the U.S. requires more than $80,000 per year in administrative support, but in Canada it is just over $20,000.
Excessively high prices and unnecessary and inefficiently delivered services: By centralizing funding, we will create new tools to restrain overall health care costs. Putting the entire system on a budget will control costs by setting firm (but flexible) limits on the total resources available. By constraining growth in overall spending (currently much higher than any other developed country), we will put downward pressure on the very high prices for medical goods and services. That will include reining in the documented excess of lab tests and procedures currently being done. Why should a test or procedure cost one amount at one hospital and, 100 miles away, cost a third of that figure? The growing practice of traveling to other countries to have a procedure and having the medical vacation cost half of the same procedure here at home shows that the for-profit system simply doesn’t work for patients.
Missed prevention possibilities: We will create a pool of money to invest in primary disease prevention — an activity that is now badly underfunded. We do fund early detection, but not the primary prevention of disease. One reason prevention is so underfunded is that insurance companies have little or no incentive to invest in practices with mostly long-term payoffs, due to short-term churn in insurance coverage. Primary prevention is a public good and should be financed through public sources.
Fraud: Centralizing health care financing, as in Medicare, will create a unitary and universal database to assist in the detection of waste, fraud and abuse. The current system of medical coding is fraught with abuse, but it is often hard to detect because data is so fragmented. From procedures and services never performed to overcharging for drugs and devices, there is significant waste and abuse.
Together, the above factors account for more than $750 billion a year (as of 2012), and rising. Recouping that wasted money in our dysfunctional system will allow us to provide high quality health care for everyone. Of course, we must not penalize the people now in administrative jobs that do not add value. Transition to value-added jobs can be funded with a portion of the existing waste.
By putting everybody in the same system, we will replace the balkanized system that is constantly subject to political attack and bickering and causes the public so much suffering. It would assure extending the broad public support and funding that Medicare currently enjoys.
This is economically sound, common sense, conservative economics. We can save money and have universal coverage providing long-needed peace of mind to all Americans. That sounds to us like a pretty good deal!
Phil Caper is an internist and founding board member of Maine AllCare.
https://www.sunjournal.com/2019/02/24/philip-caper-paying-for-universal-health-care-isnt-difficult/
Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All’
by Robert Pear - NYT - February 23, 2019
WASHINGTON
— Even before Democrats finish drafting bills to create a single-payer
health care system, the health care and insurance industries have
assembled a small army of lobbyists to kill “Medicare for all,” an idea
that is mocked publicly but is being greeted privately with increasing
seriousness.
Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. They have hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts to the left on health care.
They also demonstrate how entrenched the Democrats’ last big health care victory, the Affordable Care Act, has become in the nation’s health care system.
The lobbyists’ message is simple: The Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. More than 155 million Americans have employer-sponsored health coverage. They like it, by and large, and should be allowed to keep it.
Doctors, hospitals, drug companies and insurers are intent on strangling Medicare for all before it advances from an aspirational slogan to a legislative agenda item. They have hired a top lieutenant in Hillary Clinton’s 2016 presidential campaign to spearhead the effort. And their tactics will show Democrats what they are up against as the party drifts to the left on health care.
They also demonstrate how entrenched the Democrats’ last big health care victory, the Affordable Care Act, has become in the nation’s health care system.
The lobbyists’ message is simple: The Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. More than 155 million Americans have employer-sponsored health coverage. They like it, by and large, and should be allowed to keep it.
“We
have a structure that frankly works for most Americans,” said Charles
N. Kahn III, the president of the Federation of American Hospitals,
which represents investor-owned hospitals. “Let’s make it work for all
Americans. We reject the notion that we need to turn the whole apple
cart over and start all over again.”
The Democrats’ proposals could radically change the way health care providers do business and could drastically shrink the role and the revenues of insurers, depending on how a single-payer system is devised.
The hospital federation and two powerful lobbies, America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America, created a coalition last June to pre-empt what they saw as an alarming groundswell of interest in proposals to expand the federal role in health care.
In a daily fusillade of digital advertising, videos and Twitter posts, the coalition, the Partnership for America’s Health Care Future, says that Medicare for all will require tax increases and give politicians and bureaucrats control of medical decisions now made by doctors and patients — arguments that echo those made to stop Medicare in the 1960s, Mrs. Clinton’s health plan in 1993 and the Affordable Care Act a decade ago.
The coalition will step up the tempo in the coming week as Democrats in the House and the Senate plan to introduce bills to establish a single-payer system.
The Democrats’ proposals could radically change the way health care providers do business and could drastically shrink the role and the revenues of insurers, depending on how a single-payer system is devised.
The hospital federation and two powerful lobbies, America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America, created a coalition last June to pre-empt what they saw as an alarming groundswell of interest in proposals to expand the federal role in health care.
In a daily fusillade of digital advertising, videos and Twitter posts, the coalition, the Partnership for America’s Health Care Future, says that Medicare for all will require tax increases and give politicians and bureaucrats control of medical decisions now made by doctors and patients — arguments that echo those made to stop Medicare in the 1960s, Mrs. Clinton’s health plan in 1993 and the Affordable Care Act a decade ago.
The coalition will step up the tempo in the coming week as Democrats in the House and the Senate plan to introduce bills to establish a single-payer system.
The name of the coalition is intentionally nondescript, and its executive director, Lauren Crawford Shaver,
who led Mrs. Clinton’s efforts in 2016 to put marginal states into
play, is cagey when asked for details. She says only that the group is
planning “a big nationwide effort” with grass-roots allies.
But its reach is undeniable. The coalition has picked up more than 25 members, including the American Medical Association, the American Hospital Association and the nation’s Blue Cross and Blue Shield plans.
And it has already sprung into action.
When Senator Bernie Sanders, the author of the Medicare for All Act, announced on Tuesday that he was again running for president, the coalition immediately attacked him as “a leading advocate for upending our nation’s health care system in favor of starting from scratch with Medicare for all.”
Mr. Sanders, independent of Vermont, fired back at the insurance and drug companies. “They make tens of billions of dollars a year in profits from this dysfunctional health care system and pay their C.E.O.s outrageous compensation packages,” Mr. Sanders said. “We’ve expected their opposition all along.”
When members of Congress unveiled legislation to let people age 50 to 64 buy into Medicare, the coalition conflated it with proposals to put all Americans into Medicare.
“This is a slippery slope to government-run health care for every American,” said David Merritt, an executive vice president of America’s Health Insurance Plans, a lobby for insurers.
The buy-in proposal for older Americans dates back to Bill Clinton’s presidency, and many of its advocates have put it forward as a moderate alternative to Medicare for all.
But its reach is undeniable. The coalition has picked up more than 25 members, including the American Medical Association, the American Hospital Association and the nation’s Blue Cross and Blue Shield plans.
And it has already sprung into action.
When Senator Bernie Sanders, the author of the Medicare for All Act, announced on Tuesday that he was again running for president, the coalition immediately attacked him as “a leading advocate for upending our nation’s health care system in favor of starting from scratch with Medicare for all.”
Mr. Sanders, independent of Vermont, fired back at the insurance and drug companies. “They make tens of billions of dollars a year in profits from this dysfunctional health care system and pay their C.E.O.s outrageous compensation packages,” Mr. Sanders said. “We’ve expected their opposition all along.”
When members of Congress unveiled legislation to let people age 50 to 64 buy into Medicare, the coalition conflated it with proposals to put all Americans into Medicare.
“This is a slippery slope to government-run health care for every American,” said David Merritt, an executive vice president of America’s Health Insurance Plans, a lobby for insurers.
The buy-in proposal for older Americans dates back to Bill Clinton’s presidency, and many of its advocates have put it forward as a moderate alternative to Medicare for all.
But
the coalition said the proposal was wrong for America, “whether you
call it Medicare for all, Medicare buy-in, single payer or a public
option.”
The chief sponsor of the House buy-in bill, Representative Brian Higgins, Democrat of New York, said: “The critics lump our bill with the bigger Medicare-for-all proposal. That’s strategic, and I think it’s deliberate.”
Mr. Higgins said the option of Medicare at age 50 would create “a countervailing force to private insurance.”
“Insurance companies are fighting it because they are afraid of the prospect of a potent new competitor that will cut into their profits,” Mr. Higgins said. “Medicare has lower administrative costs and lower executive salaries and could use its bargaining power to get better deals from hospitals and other health care providers.”
Senator Debbie Stabenow, Democrat of Michigan and the sponsor of the buy-in bill in the Senate, said she was not surprised at the criticism. “It’s a knee-jerk reaction to anything that expands Medicare,” she said.
But, she said, people 50 to 64 need the option.
“We see the auto industry laying people off, encouraging people to retire early,” Ms. Stabenow said. “Many people are holding their breath until they turn 65. They put off preventive screenings, so they come into Medicare at 65 with more health problems.”
Under the Affordable Care Act, insurers can increase premiums with a person’s age, and older people who do not qualify for subsidies face the highest premiums on the insurance exchange. For a 60-year-old in Charlotte, N.C., the average premium for a midlevel silver plan is more than $1,100 a month; in Phoenix, it is nearly $1,000 a month.
The chief sponsor of the House buy-in bill, Representative Brian Higgins, Democrat of New York, said: “The critics lump our bill with the bigger Medicare-for-all proposal. That’s strategic, and I think it’s deliberate.”
Mr. Higgins said the option of Medicare at age 50 would create “a countervailing force to private insurance.”
“Insurance companies are fighting it because they are afraid of the prospect of a potent new competitor that will cut into their profits,” Mr. Higgins said. “Medicare has lower administrative costs and lower executive salaries and could use its bargaining power to get better deals from hospitals and other health care providers.”
Senator Debbie Stabenow, Democrat of Michigan and the sponsor of the buy-in bill in the Senate, said she was not surprised at the criticism. “It’s a knee-jerk reaction to anything that expands Medicare,” she said.
But, she said, people 50 to 64 need the option.
“We see the auto industry laying people off, encouraging people to retire early,” Ms. Stabenow said. “Many people are holding their breath until they turn 65. They put off preventive screenings, so they come into Medicare at 65 with more health problems.”
Under the Affordable Care Act, insurers can increase premiums with a person’s age, and older people who do not qualify for subsidies face the highest premiums on the insurance exchange. For a 60-year-old in Charlotte, N.C., the average premium for a midlevel silver plan is more than $1,100 a month; in Phoenix, it is nearly $1,000 a month.
The
mission of the industry partnership includes advocacy, advertising,
lobbying and public education, but it has not registered under federal
lobbying laws. Forbes Tate,
a public affairs company that lobbies for many health care and drug
companies, coordinates the work of the partnership, but is not
registered to lobby on its behalf.
“There are no direct lobbyists for the partnership,” Ms. Shaver said. “We work through all of our different groups. They have their own lobbyists who do obviously lobby on Medicare for all. But there are no registered lobbyists for the partnership because we are not doing that directly at this time.”
The coalition, like President Trump, attacks any proposals that smack of socialized medicine. But it also has a positive agenda. It wants to expand Medicaid under the Affordable Care Act in Texas, Florida and other states that have yet to do so. It wants to expand federal subsidies under the health law so insurance will be affordable to more people. And it wants to stabilize premiums by persuading states to set up reinsurance programs, using a combination of federal and state funds to help pay the largest claims.
Beyond their desire to preserve the status quo, coalition members have done well by the Affordable Care Act. Many participants, such as the American Medical Association, the pharmaceuticals lobby and the hospital association, backed the A.C.A. from the start, banking that more insured Americans would mean more customers. The hospitals saw the health law’s Medicaid expansion as a lifeline as they struggled with the uninsured working poor.
Others, like the National Retail Federation, opposed the A.C.A. but have tried to make it work.
The need to bolster the Affordable Care Act will become even more urgent, the coalition says, if Texas and other states succeed in their lawsuit to invalidate the entire law.
Even without legislation to expand Medicare, the program is sure to grow because of the aging of the baby boom generation. The number of Medicare beneficiaries, 60 million today, is expected to top 75 million within a decade. The Congressional Budget Office estimates that Medicare spending will grow under current law to $1.5 trillion in 2029, double the total projected for this year.
E. Neil Trautwein, the vice president for health care policy at the retail federation, which represents companies like Walmart, McDonald’s and Amazon, said his top priority was to protect the stability of the coverage that employers provide to employees.
“There are no direct lobbyists for the partnership,” Ms. Shaver said. “We work through all of our different groups. They have their own lobbyists who do obviously lobby on Medicare for all. But there are no registered lobbyists for the partnership because we are not doing that directly at this time.”
The coalition, like President Trump, attacks any proposals that smack of socialized medicine. But it also has a positive agenda. It wants to expand Medicaid under the Affordable Care Act in Texas, Florida and other states that have yet to do so. It wants to expand federal subsidies under the health law so insurance will be affordable to more people. And it wants to stabilize premiums by persuading states to set up reinsurance programs, using a combination of federal and state funds to help pay the largest claims.
Beyond their desire to preserve the status quo, coalition members have done well by the Affordable Care Act. Many participants, such as the American Medical Association, the pharmaceuticals lobby and the hospital association, backed the A.C.A. from the start, banking that more insured Americans would mean more customers. The hospitals saw the health law’s Medicaid expansion as a lifeline as they struggled with the uninsured working poor.
Others, like the National Retail Federation, opposed the A.C.A. but have tried to make it work.
The need to bolster the Affordable Care Act will become even more urgent, the coalition says, if Texas and other states succeed in their lawsuit to invalidate the entire law.
Even without legislation to expand Medicare, the program is sure to grow because of the aging of the baby boom generation. The number of Medicare beneficiaries, 60 million today, is expected to top 75 million within a decade. The Congressional Budget Office estimates that Medicare spending will grow under current law to $1.5 trillion in 2029, double the total projected for this year.
E. Neil Trautwein, the vice president for health care policy at the retail federation, which represents companies like Walmart, McDonald’s and Amazon, said his top priority was to protect the stability of the coverage that employers provide to employees.
“We are trying to
understand what will be coming at us,” Mr. Trautwein said. “Proposals on
the left and the right, in Congress and on the campaign trail, could
blow up the employer-based health care system that has worked pretty
well for more than 60 years.”
The version of Medicare for all proposed by Mr. Sanders in 2017 could disrupt that coverage. It would expand the list of items and services covered by Medicare and would prohibit employers from duplicating any of those benefits.
When Mr. Sanders introduced that bill, it was endorsed by several Democratic senators who have since become candidates for the party’s presidential nomination: Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.
The more modest Medicare buy-in bill has been endorsed by Mr. Booker, Ms. Gillibrand and Ms. Harris, as well as by another Democratic candidate for president, Senator Amy Klobuchar of Minnesota, and a potential candidate, Senator Sherrod Brown of Ohio.
Yet another Democratic proposal, allowing states to create a Medicaid buy-in program for all their residents, regardless of income, has won support from 23 senators, including Mr. Booker, Mr. Brown, Ms. Gillibrand, Ms. Harris, Ms. Klobuchar and Ms. Warren.
Members of the coalition had different positions in the struggle to pass the Affordable Care Act in 2009 and 2010, but rave about it today. Ten million people have coverage through the exchanges, 14 million have gained Medicaid coverage, and in a strong economy more people have jobs that provide health insurance, they say.
Some members of the coalition have financial as well as philosophical reasons for resisting the push to expand Medicare. Doctors and hospitals say Medicare generally pays less than private insurance, and hospitals say the payments frequently do not cover the costs of providing care to Medicare patients.
The version of Medicare for all proposed by Mr. Sanders in 2017 could disrupt that coverage. It would expand the list of items and services covered by Medicare and would prohibit employers from duplicating any of those benefits.
When Mr. Sanders introduced that bill, it was endorsed by several Democratic senators who have since become candidates for the party’s presidential nomination: Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.
The more modest Medicare buy-in bill has been endorsed by Mr. Booker, Ms. Gillibrand and Ms. Harris, as well as by another Democratic candidate for president, Senator Amy Klobuchar of Minnesota, and a potential candidate, Senator Sherrod Brown of Ohio.
Yet another Democratic proposal, allowing states to create a Medicaid buy-in program for all their residents, regardless of income, has won support from 23 senators, including Mr. Booker, Mr. Brown, Ms. Gillibrand, Ms. Harris, Ms. Klobuchar and Ms. Warren.
Members of the coalition had different positions in the struggle to pass the Affordable Care Act in 2009 and 2010, but rave about it today. Ten million people have coverage through the exchanges, 14 million have gained Medicaid coverage, and in a strong economy more people have jobs that provide health insurance, they say.
Some members of the coalition have financial as well as philosophical reasons for resisting the push to expand Medicare. Doctors and hospitals say Medicare generally pays less than private insurance, and hospitals say the payments frequently do not cover the costs of providing care to Medicare patients.
“Chronic underpayment to
providers creates access issues for seniors, particularly with
physicians, who may limit the number of Medicare patients they see,”
said Richard J. Pollack, the president of the American Hospital
Association. Congress, he said, often makes changes in Medicare for
reasons that have nothing to do with sound health policy — to offset the
costs of tax cuts, for example.
Moreover, Mr. Pollack said: “The government can be an unreliable business partner. What happens when the government shuts down? What happens if the health care system is even more dependent on Medicare and the government shuts down again?”
But the coalition does not speak for all health care providers.
The American College of Physicians, the largest medical specialty organization in the country, has supported a Medicare buy-in for people 55 to 64.
And “during the whole debate over the Affordable Care Act, we supported having a public option in the individual insurance market in every state,” said Robert B. Doherty, senior vice president of the college, which represents 154,000 doctors who specialize in internal medicine.
https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html
Members of Congress who support bringing everyone in America under one federally administered health insurance program are proposing Medicare for All. Members of Congress who support opening up Medicare to people as an additional insurance option are proposing a Medicare buy-in or Medicare for Some. Predictably, some members of Congress support both.
Medicare for All is the bill introduced by Sen. Bernie Sanders (I-VT) in the Senate and co-sponsored by several other current and potential 2020 candidates, including Sen. Elizabeth Warren (D-MA), Sen. Kamala Harris (D-CA), Sen. Kirsten Gillibrand (D-NY) and Sen. Cory Booker (D-NJ). (Rep. Pramila Jayapal (D-WA) will introduce a similar bill in the House soon.) It is an improved and expanded version of Medicare, the federal insurance plan for people over 65 and people with disabilities that covers care from most doctors and hospitals anywhere in the country. As proposed, Medicare for All eliminates all of Medicare’s premiums, deductibles and coinsurance, adds new vision, hearing and dental benefits to Medicare, and offers better home- and community-based care.
Medicare for Some comes in many versions. But the concept would allow people to keep their commercial coverage or switch to Medicare. All versions of Medicare for Some keep the premiums, deductibles and coinsurance payments required under commercial insurance and the current Medicare program. Some versions maintain Medicare Advantage plans, a form of commercial insurance, in the Medicare program. One version opens Medicare to people 50 and older. No version of Medicare for Some guarantees affordable care for all Americans.
While Medicare for Some appeals to our instinctive craving for more “choices,” it does not address the unsustainable cost increases keeping our commercial health care system from being as fair and effective as Medicare itself or the health care systems in place in other developed countries.
Only Medicare for All will bring down national health spending and guarantee health care as a human right for every American. It does so by eliminating the profits, administrative waste and inefficiencies of commercial health insurance and using the collective bargaining leverage of all Americans to negotiate fair rates for doctors, hospitals and prescription drugs.
Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system. At the same time, Medicare for All — and only Medicare for All — will provide all Americans their choice of doctors and hospitals anywhere in the United States. (We will no longer have to figure out whether services or providers are “in-network” or “out-of-network.”) And only Medicare for All does away with nearly all out-of-pocket health care costs for individuals.
By eliminating trillions of dollars in excess health care costs, Medicare for All can include all Americans, broaden benefits and reduce out-of-pocket medical expenses for the vast majority of Americans.
It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs.
What will Medicare for All give you in return? Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend — irrespective of where you work. And you will never risk losing your health insurance again.
No health insurance system is perfect. But commercial insurance has created unsustainable health care costs for the nation, with irrational and excessive doctor, hospital and prescription drug costs. As a nation, we pay twice what other countries pay for health care, for medical outcomes that are below average. As individuals, too many Americans lack access to the care they need, cannot afford rising deductibles and copayments, and are one medical crisis away from bankruptcy. And let’s face it. Does anyone really enjoy dealing with Aetna, Anthem, Humana or UnitedHealth?
Now that the facts are straight, the challenge is to overcome the misinformation campaign mounted by those who benefit from the current system. In that debate, the 70 percent of Americans who currently support Medicare for All have on their side the one (and only) point that really matters: Medicare for All is the winning policy solution to our nation’s health care crisis.
https://justcareusa.org/medicare-for-all-does-not-mean-medicare-for-some/?
Moreover, Mr. Pollack said: “The government can be an unreliable business partner. What happens when the government shuts down? What happens if the health care system is even more dependent on Medicare and the government shuts down again?”
But the coalition does not speak for all health care providers.
The American College of Physicians, the largest medical specialty organization in the country, has supported a Medicare buy-in for people 55 to 64.
And “during the whole debate over the Affordable Care Act, we supported having a public option in the individual insurance market in every state,” said Robert B. Doherty, senior vice president of the college, which represents 154,000 doctors who specialize in internal medicine.
https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html
Medicare for All does not mean Medicare for some
by Diane Archer - JustCare - February 20, 2019
As the health care debate heats up, it’s time to be clear about what Medicare for All is and what it is not. Medicare for All does not mean giving people the option to “buy in” to Medicare under our current health insurance system — what might be called Medicare for Some.Members of Congress who support bringing everyone in America under one federally administered health insurance program are proposing Medicare for All. Members of Congress who support opening up Medicare to people as an additional insurance option are proposing a Medicare buy-in or Medicare for Some. Predictably, some members of Congress support both.
Medicare for All is the bill introduced by Sen. Bernie Sanders (I-VT) in the Senate and co-sponsored by several other current and potential 2020 candidates, including Sen. Elizabeth Warren (D-MA), Sen. Kamala Harris (D-CA), Sen. Kirsten Gillibrand (D-NY) and Sen. Cory Booker (D-NJ). (Rep. Pramila Jayapal (D-WA) will introduce a similar bill in the House soon.) It is an improved and expanded version of Medicare, the federal insurance plan for people over 65 and people with disabilities that covers care from most doctors and hospitals anywhere in the country. As proposed, Medicare for All eliminates all of Medicare’s premiums, deductibles and coinsurance, adds new vision, hearing and dental benefits to Medicare, and offers better home- and community-based care.
Medicare for Some comes in many versions. But the concept would allow people to keep their commercial coverage or switch to Medicare. All versions of Medicare for Some keep the premiums, deductibles and coinsurance payments required under commercial insurance and the current Medicare program. Some versions maintain Medicare Advantage plans, a form of commercial insurance, in the Medicare program. One version opens Medicare to people 50 and older. No version of Medicare for Some guarantees affordable care for all Americans.
While Medicare for Some appeals to our instinctive craving for more “choices,” it does not address the unsustainable cost increases keeping our commercial health care system from being as fair and effective as Medicare itself or the health care systems in place in other developed countries.
Only Medicare for All will bring down national health spending and guarantee health care as a human right for every American. It does so by eliminating the profits, administrative waste and inefficiencies of commercial health insurance and using the collective bargaining leverage of all Americans to negotiate fair rates for doctors, hospitals and prescription drugs.
Medicare for All will reduce national health spending by $2 to $5 trillion over ten years when compared to our current fragmented health insurance system. At the same time, Medicare for All — and only Medicare for All — will provide all Americans their choice of doctors and hospitals anywhere in the United States. (We will no longer have to figure out whether services or providers are “in-network” or “out-of-network.”) And only Medicare for All does away with nearly all out-of-pocket health care costs for individuals.
By eliminating trillions of dollars in excess health care costs, Medicare for All can include all Americans, broaden benefits and reduce out-of-pocket medical expenses for the vast majority of Americans.
It is true that Medicare for All will require you to switch to Medicare from the commercial insurance you currently have. Yes, you will have to give up the restricted choice of doctors and hospitals under your existing commercial plan. You will be required to give up paying premiums, deductibles and coinsurance. You no longer will be able to haggle with your insurer about authorizing your care and paying claims. And you will lose the privilege of being forced into a different commercial insurance plan whenever your employer decides to change insurers or you change jobs.
What will Medicare for All give you in return? Medicare for All will ensure that you can see the doctors you want to see and get care in the hospitals your doctors recommend — irrespective of where you work. And you will never risk losing your health insurance again.
No health insurance system is perfect. But commercial insurance has created unsustainable health care costs for the nation, with irrational and excessive doctor, hospital and prescription drug costs. As a nation, we pay twice what other countries pay for health care, for medical outcomes that are below average. As individuals, too many Americans lack access to the care they need, cannot afford rising deductibles and copayments, and are one medical crisis away from bankruptcy. And let’s face it. Does anyone really enjoy dealing with Aetna, Anthem, Humana or UnitedHealth?
Now that the facts are straight, the challenge is to overcome the misinformation campaign mounted by those who benefit from the current system. In that debate, the 70 percent of Americans who currently support Medicare for All have on their side the one (and only) point that really matters: Medicare for All is the winning policy solution to our nation’s health care crisis.
https://justcareusa.org/medicare-for-all-does-not-mean-medicare-for-some/?
UnitedHealth Loses Case to the Health Venture Begun by Amazon, Berkshire-Hathaway and JPMorgan Chase
by Reed Abelson - NYT - February 22, 2019
UnitedHealth Group, the giant health insurance company, on Friday lost its case to prevent a former executive from working at the new health care venture formed by three powerful corporations, Amazon, Berkshire Hathaway and JPMorgan Chase.
A federal judge in Boston denied UnitedHealth’s request to have the executive, David William Smith, immediately stop working. Mr. Smith was an executive at Optum, a unit of UnitedHealth, and it accused him of taking corporate secrets to what it claimed was a competitor. Mr. Smith has denied any wrongdoing.
In its court filings, UnitedHealth argued that Mr. Smith’s role at Optum made him privy to sensitive information about its plans. Among Optum’s businesses is one of the nation’s largest pharmacy benefit managers, which serve as intermediaries between drug makers and employers that purchase medicine for their workers.
The industry has been sharply criticized for a lack of transparency in how pharmacy benefits managers operate, and Optum’s two main rivals recently merged with two large insurers, Aetna and Cigna.
A federal judge in Boston denied UnitedHealth’s request to have the executive, David William Smith, immediately stop working. Mr. Smith was an executive at Optum, a unit of UnitedHealth, and it accused him of taking corporate secrets to what it claimed was a competitor. Mr. Smith has denied any wrongdoing.
In its court filings, UnitedHealth argued that Mr. Smith’s role at Optum made him privy to sensitive information about its plans. Among Optum’s businesses is one of the nation’s largest pharmacy benefit managers, which serve as intermediaries between drug makers and employers that purchase medicine for their workers.
The industry has been sharply criticized for a lack of transparency in how pharmacy benefits managers operate, and Optum’s two main rivals recently merged with two large insurers, Aetna and Cigna.
While Judge Mark L. Wolf ruled
against it, Optum emphasized that the issues remain unresolved and would
need to be settled in arbitration. “We are committed to protecting our
confidential information and will aggressively do so in arbitration,”
said Matt Stearns, a spokesman for Optum, in an emailed statement.
A spokeswoman for the new venture, referred to as “A.B.C.” or “A.B.J.” in court papers, declined to comment. Unlike court proceedings, the arbitration sessions would not be public.
The case against the nascent venture has highlighted the anxiety of established insurance companies and pharmacy benefit managers over newcomers to their territory. From start-ups to giant technology firms, the new rivals threaten to unseat companies, like UnitedHealth, that have traditionally dominated these markets. Amazon, which has made tentative forays into the pharmacy business, has emerged as a particularly worrisome competitor.
The legal wrangling, which included testimony unsealed by the judge earlier this week, also revealed new details about the powerful triumvirate’s plans. While the companies have said that the new venture was not created to generate profits, they have been cryptic about exactly what changes they could make to lower costs and improve the quality of care for their employees. The company made headlines last summer with its choice of chief executive, Dr. Atul Gawande, a high-profile physician who writes for The New Yorker.
The court proceedings also underscored just how unhappy customers — particularly these three employers — are with the status quo.
A spokeswoman for the new venture, referred to as “A.B.C.” or “A.B.J.” in court papers, declined to comment. Unlike court proceedings, the arbitration sessions would not be public.
The case against the nascent venture has highlighted the anxiety of established insurance companies and pharmacy benefit managers over newcomers to their territory. From start-ups to giant technology firms, the new rivals threaten to unseat companies, like UnitedHealth, that have traditionally dominated these markets. Amazon, which has made tentative forays into the pharmacy business, has emerged as a particularly worrisome competitor.
The legal wrangling, which included testimony unsealed by the judge earlier this week, also revealed new details about the powerful triumvirate’s plans. While the companies have said that the new venture was not created to generate profits, they have been cryptic about exactly what changes they could make to lower costs and improve the quality of care for their employees. The company made headlines last summer with its choice of chief executive, Dr. Atul Gawande, a high-profile physician who writes for The New Yorker.
The court proceedings also underscored just how unhappy customers — particularly these three employers — are with the status quo.
“We’ve
been asked to solve a very big problem, which is to figure out new ways
of health care,” John C. Stoddard, a senior executive for the new
venture, testified.
The three employers combined are spending about $4 billion a year on the roughly one million people they cover. But employees “have a poor experience,” Mr. Stoddard said.
“They’re not getting the care they need, and the costs continue to rise,” he said. “We wouldn’t exist unless there was a need to come up with and find a new solution to the problem.”
The venture, which has no name and fewer than 20 employees, plans to tackle several areas, including how benefits are provided through traditional health insurance plans, Mr. Stoddard said. High deductibles, which force employees to pay for significant amounts of their care before their insurance kicks in, are a hardship for “fulfillment-center workers and call-center workers,” he said.
The companies also want to see if they can lower the cost of drugs for chronic conditions. In his testimony, Mr. Stoddard insisted that the new venture had no plans to enter the pharmacy business but wanted to better understand the process and the actual cost of drugs.
“That doesn’t make us a competitor,” he said. “That makes us a very informed customer.”
The employers also want to make it easier for workers to see a doctor, Mr. Stoddard testified. Because Optum also operates a large network of primary-care doctors, the venture might want to work with Optum to provide employees with easier access to physicians.
“That’s why this is so crazy to me: that they think of us as competitors, when I see us as potential partners,” Mr. Stoddard said.
The three employers combined are spending about $4 billion a year on the roughly one million people they cover. But employees “have a poor experience,” Mr. Stoddard said.
“They’re not getting the care they need, and the costs continue to rise,” he said. “We wouldn’t exist unless there was a need to come up with and find a new solution to the problem.”
The venture, which has no name and fewer than 20 employees, plans to tackle several areas, including how benefits are provided through traditional health insurance plans, Mr. Stoddard said. High deductibles, which force employees to pay for significant amounts of their care before their insurance kicks in, are a hardship for “fulfillment-center workers and call-center workers,” he said.
The companies also want to see if they can lower the cost of drugs for chronic conditions. In his testimony, Mr. Stoddard insisted that the new venture had no plans to enter the pharmacy business but wanted to better understand the process and the actual cost of drugs.
“That doesn’t make us a competitor,” he said. “That makes us a very informed customer.”
The employers also want to make it easier for workers to see a doctor, Mr. Stoddard testified. Because Optum also operates a large network of primary-care doctors, the venture might want to work with Optum to provide employees with easier access to physicians.
“That’s why this is so crazy to me: that they think of us as competitors, when I see us as potential partners,” Mr. Stoddard said.
Like
other large employers, the companies also want to see if they can make
better use of doctor and hospital data and identify where employees can
go for better care at lower prices.
The venture plans to conduct a series of experiments to test new approaches for smaller groups of employees with various partners, including Optum, Mr. Stoddard said.
But while Mr. Stoddard would not rule out the possibility that the venture could be a competitor, he emphasized that it had a different purpose. Unlike Optum, which he described as trying to “maximize profits,” the new organization is “trying to create value for families who are trying to use the health care system,” he said.
https://www.nytimes.com/2019/02/22/health/amazon-berkshire-hathaway-jpmorgan-health.html
LEWISTON — Thanks to new federal rules, Mainers can now find the price of a hospital visit with a click.
However, experts warn that the new costs posted online amount to sticker prices. Patients’ circumstances vary – including whether they have insurance coverage – so the actual cost may be different from the list price.
The federal Centers for Medicare & Medicaid Services began requiring hospitals to post prices Jan. 1. The postings must be easy to download and read, and they must include current charges for every service and item provided by the hospital, including medications.
Hospitals that do not follow through are at risk of being penalized by CMS, which oversees Medicare and other federal health insurance programs.
Maine hospitals began posting charges on their websites this week.
Some price sheets are easier to find than others. They typically are available by going to the hospital’s website, clicking on “patient information” or “billing information” and finding “billing price estimates” or “pricing transparency” among the options.
Some price sheets are also easier to understand than others. With tens of thousands of items to list, hospitals abbreviate many procedures or medications, leading to listings such as the $1,191 “manip knee jnt w/anes, bilat” – a bilateral manipulation of knee joint with anesthesia – at Northern Light Eastern Maine Medical Center in Bangor.
“In the coming weeks, we plan to refine and simplify this information even further for our patients as we strongly believe health care should be accessible and straightforward,” Northern Light Health spokeswoman Rebecca Parent said of the hospital’s price sheet.
While hospitals must post their charge lists, CMS is encouraging them to add extra data, such as quality information and additional pricing information. Some Maine hospital leaders say they will post more.
“We fully support being transparent and empowering potential patients to make well-informed decisions about their health care,” said Steven Jorgensen, president of St. Mary’s Regional Medical Center in Lewiston. “We’ve posted hospital, procedure and pharmacy prices. In addition, to make this data more comprehensive yet still consumer-friendly, we expect to post bundle prices for a variety of standard procedures soon.”
This is the first time hospitals have been required to publicly post their full charge sheets online. However, Maine hospitals have been required by state law to provide some information to patients on request, and have been required for years to send some cost information to the Maine Health Data Organization for its price comparison website, www.comparemaine.org.
Ann Woloson, executive director of Consumers for Affordable Health Care in Augusta, said she likes pointing patients to the CompareMaine site, but she believes this new comprehensive, hospital-by-hospital listing will be helpful, too.
“Any transparency with health care costs, especially hospital costs, is very important to Maine consumers who are paying more out of pocket for the health care they need,” she said. “Any information they can gain that reflects what their bottom line is going to be is obviously important.”
She cautioned, though, that a hospital’s list price may not reveal the full cost for a procedure. An anesthesiologist’s fee, for example, may be additional.
“It’s probably helpful to do a little bit more work,” she said. “Don’t just think that if you’re going to get a knee operation at some hospital that that price truly reflects all of the costs associated with it.”
At the same time, experts cautioned that hospitals are listing their sticker prices – the amount they charge to people who are uninsured or earn too much to qualify for charity care. The average patient typically pays a lot less after insurer-negotiated discounts and insurance coverage.
“Many patients are interested in their exposure to costs, which generally requires a conversation with their insurance company since that is who sets deductibles and co-pays and can provide patients the most up-to-date info on those cost factors,” said Jeff Austin, spokesman for the Maine Hospital Association. “We encourage patients to speak to their providers and their carriers to get an estimate of costs.”
To make sure potential patients do not get scared by that list price, hospital officials encourage people to call their hospital’s billing department or other patient services department for more information about the listed procedures and their actual costs.
https://www.pressherald.com/2019/01/03/maine-hospitals-now-posting-sticker-prices-for-different-services/
The venture plans to conduct a series of experiments to test new approaches for smaller groups of employees with various partners, including Optum, Mr. Stoddard said.
But while Mr. Stoddard would not rule out the possibility that the venture could be a competitor, he emphasized that it had a different purpose. Unlike Optum, which he described as trying to “maximize profits,” the new organization is “trying to create value for families who are trying to use the health care system,” he said.
https://www.nytimes.com/2019/02/22/health/amazon-berkshire-hathaway-jpmorgan-health.html
Maine hospitals now posting sticker prices for various services
New federal rules require the price lists, which will allow patients to
comparison shop for things like medications and types of surgeries.
by Lindsay Tice - Lewiston Sun-Journal - January 3, 2019
However, experts warn that the new costs posted online amount to sticker prices. Patients’ circumstances vary – including whether they have insurance coverage – so the actual cost may be different from the list price.
The federal Centers for Medicare & Medicaid Services began requiring hospitals to post prices Jan. 1. The postings must be easy to download and read, and they must include current charges for every service and item provided by the hospital, including medications.
Hospitals that do not follow through are at risk of being penalized by CMS, which oversees Medicare and other federal health insurance programs.
Maine hospitals began posting charges on their websites this week.
Some price sheets are easier to find than others. They typically are available by going to the hospital’s website, clicking on “patient information” or “billing information” and finding “billing price estimates” or “pricing transparency” among the options.
Some price sheets are also easier to understand than others. With tens of thousands of items to list, hospitals abbreviate many procedures or medications, leading to listings such as the $1,191 “manip knee jnt w/anes, bilat” – a bilateral manipulation of knee joint with anesthesia – at Northern Light Eastern Maine Medical Center in Bangor.
“In the coming weeks, we plan to refine and simplify this information even further for our patients as we strongly believe health care should be accessible and straightforward,” Northern Light Health spokeswoman Rebecca Parent said of the hospital’s price sheet.
While hospitals must post their charge lists, CMS is encouraging them to add extra data, such as quality information and additional pricing information. Some Maine hospital leaders say they will post more.
“We fully support being transparent and empowering potential patients to make well-informed decisions about their health care,” said Steven Jorgensen, president of St. Mary’s Regional Medical Center in Lewiston. “We’ve posted hospital, procedure and pharmacy prices. In addition, to make this data more comprehensive yet still consumer-friendly, we expect to post bundle prices for a variety of standard procedures soon.”
This is the first time hospitals have been required to publicly post their full charge sheets online. However, Maine hospitals have been required by state law to provide some information to patients on request, and have been required for years to send some cost information to the Maine Health Data Organization for its price comparison website, www.comparemaine.org.
Ann Woloson, executive director of Consumers for Affordable Health Care in Augusta, said she likes pointing patients to the CompareMaine site, but she believes this new comprehensive, hospital-by-hospital listing will be helpful, too.
“Any transparency with health care costs, especially hospital costs, is very important to Maine consumers who are paying more out of pocket for the health care they need,” she said. “Any information they can gain that reflects what their bottom line is going to be is obviously important.”
She cautioned, though, that a hospital’s list price may not reveal the full cost for a procedure. An anesthesiologist’s fee, for example, may be additional.
“It’s probably helpful to do a little bit more work,” she said. “Don’t just think that if you’re going to get a knee operation at some hospital that that price truly reflects all of the costs associated with it.”
At the same time, experts cautioned that hospitals are listing their sticker prices – the amount they charge to people who are uninsured or earn too much to qualify for charity care. The average patient typically pays a lot less after insurer-negotiated discounts and insurance coverage.
“Many patients are interested in their exposure to costs, which generally requires a conversation with their insurance company since that is who sets deductibles and co-pays and can provide patients the most up-to-date info on those cost factors,” said Jeff Austin, spokesman for the Maine Hospital Association. “We encourage patients to speak to their providers and their carriers to get an estimate of costs.”
To make sure potential patients do not get scared by that list price, hospital officials encourage people to call their hospital’s billing department or other patient services department for more information about the listed procedures and their actual costs.
https://www.pressherald.com/2019/01/03/maine-hospitals-now-posting-sticker-prices-for-different-services/
Interactive: Compare the costs in Maine for several medical procedures
Portland Sunday Telegram - February 24, 2019
Prices can vary widely for medical procedures performed in Maine. For a
full list by facility and insurance carrier, go to comparemaine.org.
Here is a sample:
| Hospital | Carpal tunnel release | Gallbladder removal | Hip replacement | Knee replacement | Arthroscopy of knee | Arthroscopy of shoulder |
|---|---|---|---|---|---|---|
| Hospital | Carpal tunnel release | Gallbladder removal | Hip replacement | Knee replacement | Arthroscopy of knee | Arthroscopy of shoulder |
| Average Cost in Maine | 4590 | 14562 | 34205 | 34370 | 6447 | 12983 |
| Average National Prevalent Price | 3215 | 7605 | 22436 | 22360 | 5060 | 9091 |
| Bridgton Hospital | 0 | 0 | 0 | 0 | 7435 | 0 |
| Cary Medical Center | 0 | 16828 | 0 | 0 | 10526 | 0 |
| Central Maine Medical Center | 0 | 11704 | 30024 | 30253 | 0 | 0 |
| Central Maine Orthopaedics | 3238 | 0 | 0 | 0 | 4823 | 8970 |
| Down East Community Hospital | 0 | 13321 | 0 | 0 | 0 | 0 |
| Downeast Surgery Center | 3458 | 0 | 0 | 0 | 5670 | 11301 |
| Eastern Maine Medical Center | 8586 | 16707 | 44853 | 48015 | 11385 | 19763 |
| Franklin Memorial Hospital | 0 | 12642 | 0 | 0 | 10580 | 0 |
| Inland Hospital | 4561 | 17383 | 0 | 0 | 9251 | 14965 |
| InterMed | 0 | 0 | 0 | 0 | 4329 | 0 |
| LincolnHealth | 0 | 18442 | 0 | 0 | 13503 | 0 |
| Maine Coast Memorial Hospital | 5759 | 15831 | 0 | 0 | 11654 | 14645 |
| Maine Medical Center | 5068 | 13070 | 34111 | 35645 | 7034 | 14300 |
| MaineGeneral Medical Center | 6512 | 18592 | 36256 | 31519 | 11459 | 18601 |
| Mayo Regional Hospital | 0 | 13509 | 0 | 0 | 9403 | 0 |
| Mercy Hospital | 2955 | 10763 | 32988 | 33321 | 5300 | 10260 |
| Mid Coast Hospital | 3730 | 11653 | 0 | 0 | 5473 | 12400 |
| Mount Desert Island Hospital | 0 | 17933 | 0 | 0 | 0 | 0 |
| OA Centers for Orthopaedics | 3208 | 0 | 0 | 0 | 5057 | 8708 |
| Pen Bay Medical Center | 7518 | 10257 | 0 | 31320 | 9031 | 20502 |
| Redington-Fairview General Hospital | 0 | 13987 | 0 | 0 | 0 | 0 |
| Rumford Hospital | 0 | 12689 | 0 | 0 | 0 | 0 |
| Southern Maine Health Care | 6128 | 13031 | 26824 | 28006 | 8306 | 14695 |
| St. Joseph Hospital | 0 | 14023 | 35991 | 30953 | 8109 | 12452 |
| St. Mary's Regional Medical Center | 0 | 16928 | 31314 | 42693 | 10790 | 0 |
| Stephens Memorial Hospital | 0 | 16025 | 0 | 0 | 0 | 0 |
| The Aroostook Medical Center | 0 | 20504 | 0 | 0 | 9718 | 0 |
| Waldo County General Hospital | 0 | 15579 | 0 | 0 | 11930 | 25567 |
| York Hospital | 0 | 16357 | 0 | 0 | 8625 | 19948 |
| https://www.pressherald.com/2019/02/24/interactive-compare-the-costs-in-maine-for-several-medical-procedures/ | ||||||||||||
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