Health Care Reform Articles - March 14, 2019

Maine Voices: We’ve tried everything else – it’s time for universal health care

by Les Fossel - Portland Press Herald - March 11, 2019

ALNA — Interesting things are happening in rural Maine:
• People with software jobs elsewhere are moving to Maine – but only where high-speed internet exists.
• Artists, photographers, actors, musicians from away have created a sophisticated cultural economy.
• A bumper crop of young farmers is moving in – the number of farmers, the acres under cultivation and the value of their product are all increasing. Farmers are now growing, processing and marketing specialty products – 30 Acre Farm and Singing Prairie Farm are good examples. This is part of the foodie revolution – note how craft breweries have gone statewide, as is increasingly true of high-quality restaurants.
• Retirees are attracted to our world-class health care, cultural amenities and low living costs. Our economy benefits since they have middle-class incomes and volunteer in the community but do not strain the tax base.
These four legs can be the economic foundation for rural Maine. However, health care is facing daunting challenges:
Maine’s per capita health care costs are among the nation’s highest, but our per capita income is in the middle range. Maine’s per capita wage income is among the lowest and all the other states with the highest health care costs also have the highest incomes. That’s not us. A large portion of our population cannot afford to use our health care system. This is creating a severe financial crisis in health care.
While we like to think that quality is the same among health care providers in Maine, it is not true. The Leapfrog Group is the organization whose annual ratings are the recognized standard for comparing health care quality across America. Only seven hospitals in Maine got the award – all were small rural hospitals with higher costs. Every one of these same rural hospitals also is either in the red, or close to it.
My hospital, LincolnHealth (I’m on the board), has won the Leapfrog Award almost every year. Three years ago Consumer Reports named our hospital the safest in America. This high quality does nothing for our bottom line. Rural hospitals are merging with larger health care groups because we have no alternative. Medicare and Maine-Care reimbursements (which represent most of our revenues) don’t cover costs. We were not bought out – we joined MaineHealth in order to continue to provide world-class care.
Though most Mainers have health insurance, they don’t use it since they can’t pay the deductibles. This is why LincolnHealth’s uncompensated and charity care is so high. Further, the unaffordability crisis in Maine gets worse every year, since health care cost increases always outstrip economic growth – much like a cancer. Health care is now over 20 percent of our economy, but it should be half that. Imagine if Maine could devote those wasted health care dollars to address our real needs.
I served in the Maine Legislature on the Health and Human Services Committee. I authored some good health care legislation, but I could not address our underlying problems. I have been an employer for over 40 years. I have seen solution after solution attempted – but none has worked.
Now I am treasurer of Maine AllCare – our largest universal health care education group – because it is the only way left to control health care costs. Exporting patients to Portland or Boston just treats the symptoms of the crisis, not the underlying problems. To cut health care costs and live longer, we must root our health care in our local communities – the approach that has worked for all other First World countries.
We must pay attention to what works. Universal health care works. It is less costly and more effective. Winston Churchill once said that Americans always do the right thing – but only after they’ve tried everything else.
Well, we have tried everything else – and it doesn’t work. Isn’t it finally time we do the right thing in health care?
https://www.pressherald.com/2019/03/11/maine-voices-weve-tried-everything-else-its-time-for-universal-health-care/

Medicare-for-all v. Medicare-for-less: Trump’s proposed cuts put health care at center of 2020 race

by Toluse Olorunnipa and Sean Sullivan - Washington Post - March 11, 2019

A new proposal by President Trump to slash Medicare spending puts Republicans in a political bind ahead of the 2020 election as Democrats are pitching an expansion of the popular health-care program for all Americans.

Trump’s 10-year budget unveiled Monday calls for more than $845 billion in reductions for Medicare, aiming to cut “waste, fraud and abuse” in the federal program that gives insurance to older Americans. It’s part of a broader proposed belt-tightening effort after deficits soared during the president’s first two years in office in part due to massive tax cuts for the wealthy.

The move immediately tees up a potential messaging battle between Democratic proposals for Medicare-for-all — castigated by Republicans as a socialist boondoggle — and a kind of Medicare-for-less approach. focused on cutting back on spending, from the GOP.

Democrats, including some seeking to challenge Trump in 2020, seized on the proposed Medicare cuts Monday as an example of the GOP seeking to balance the budget on the backs of the elderly and the poor after giving broad tax breaks to the wealthy.

“Make no mistake about it: Trump’s budget is a massive transfer of wealth from the working class to the wealthiest people and most profitable corporations in America,” Sen. Bernie Sanders (I-Vt.), a Democratic presidential candidate, said in a Monday tweet that highlighted Medicare cuts.

During his 2016 campaign, Trump broke from Republican orthodoxy by promising not to cut Medicare, Medicaid or Social Security. His budget, by contrast, calls for scaling back all three programs.

In states with large senior populations, such as Florida, political attacks over Medicare cuts have proved so effective that both parties have used them. Sen. Rick Scott (R-Fla.) won his seat after running ads last year accusing Democrat Bill Nelson of voting to cut Medicare.

Trump probably needs to win Florida, Arizona, Pennsylvania and other states with large numbers of seniors to secure reelection in 2020. Older Americans consistently vote at higher rates than younger Americans.

Since taking office, Trump has largely left untouched Medicare and other programs heavily used by seniors. Republicans have followed his lead, ditching previous proposals to raise the retirement age or impose other restrictions to save costs and reduce the $22 trillion national debt.

While announcing his presidential bid in June 2015, Trump said he would “save Medicare, Medicaid and Social Security without cuts.” He added that it was “not fair” to make cuts to a program that people had been paying into for many years, and that he would save it “by making us rich again” and cutting waste, fraud and abuse.

The White House said Monday that Trump’s budget, which calls for changing hospital reimbursement rates and finding savings on drug prices, does not amount to cuts for Medicare or change the program structurally.

Sen. Kamala Harris (D-Calif.), a 2020 presidential candidate, speaks during an event Saturday in St. George, S.C. She said Monday that President Trump’s proposed Medicare cuts would “hurt seniors.” (Meg Kinnard/AP)

“He’s not cutting Medicare in this budget,” Russell Vought, the acting director of the Office of Management and Budget, told reporters Monday at the White House. “Medicare spending will go up every single year by healthy margins, and there are no structural changes for Medicare beneficiaries.”

But Trump’s proposed Medicare savings are more than three times as large as those in his previous budget, and industry lobbying groups said the reductions would hurt hospitals and seniors.

“The impact on care for seniors would be devastating,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in a statement. “Hospitals are less and less able to cover the cost of care for Medicare patients, it is no time to gut Medicare.”

Many prominent Democratic presidential candidates have embraced some version of a Medicare-for-all system, which would allow most Americans to be covered under the federal program.

Trump and his Republican allies had been on the offensive on health care in recent months, after several Democratic candidates struggled to answer questions about how they would pay for universal coverage and whether they would allow Americans to keep their private insurance.

“Just this week, more than 100 Democrats in Congress signed up for a socialist takeover of American health care,” Trump said earlier this month at the Conservative Political Action Conference, claiming that a Medicare-for-all plan would “take away private coverage from over 180 million Americans.”

Democratic strategists and officials argued Monday that Trump’s budget proposal exposed how little credibility Republicans have in debating health care, and showed signs of confidence that it would sharpen the contrast Democrats are seeking to make in the run-up to the 2020 election.

“It totally eviscerates any integrity to their already pretty flimsy attack,” Sen. Richard Blumenthal (D-Conn.) said. “This assault on Medicare lays bare the real Republican agenda, which is to destroy the health-care safety net. They have no shred of intellectual underpinning or integrity to their attack on Democrats if they make this kind of proposal.”

Republicans and fiscal conservatives offered tepid praise for the president’s proposal, which would not balance the federal budget until 2034. Republicans have long called for more significant changes to Medicare and other mandatory spending programs that are the biggest drivers of the national debt.

“President Trump has the right mind-set regarding his proposed budget,” said Adam Brandon, president of FreedomWorks, a conservative group. “Congress, however, needs to make entitlement reform a priority if we are to address the nation’s burgeoning national debt in the long term.”

In last year’s midterm elections, Democrats campaigned aggressively on health care, attacking Republicans over their failed effort to repeal and replace the Affordable Care Act. The dynamic marked a shift from the two previous midterm elections, during which the GOP was the party mainly going on offense on health care, slamming Democrats over the creation of the ACA, also known as Obamacare.

“On one hand, you don’t like handing the other side a potential campaign message at any point, and Democrats will inevitably try to make this into a ‘Trump wants to cut your Medicare’ argument,” Republican pollster Chris Wilson said. But Wilson argued that the plan probably would not reverberate as the ACA repeal push did. “A proposed cut to entitlements in a budget proposal that has no chance of passing the House just isn’t going to enter the public consciousness in the same way,” he added.

The latest discussions about Medicare mark a new chapter in the partisan debate. Many Democrats are eager to continue putting health care at the forefront of the national conversation. Democratic presidential candidates “should be raising this issue morning, noon and night,” said Blumenthal, who co-sponsored a Medicare-for-all proposal in the last Congress.

Democratic presidential candidates seized on Trump’s budget framework Monday, singling out the Medicare cuts.

“This budget says a lot about the President’s priorities: cut $845 billion from Medicare, while spending billions on his vanity project, the wall,” Sen. Kamala D. Harris (D-Calif.) tweeted, referring to Trump’s request for border wall funding. “This would hurt our seniors and is yet another piece of evidence for why we need a new president.”

Trump’s proposed Medicare cuts amounted to a “huge gift for Democrats,” said Dan Pfeiffer, who served as White House communications director under President Obama.

“It’s a political fumble on the Republican part in the sense that this budget is going nowhere,” he said. “The argument prior to this was the Democrats’ plan versus the status quo. And now it’s the Democrats’ plan versus the Republican plan to cut Medicare.”

Sen. Brian Schatz (D-Hawaii) said on Twitter: “One party wants to expand Medicare and Medicaid and the other wants to cut them. That’s the end of my tweet.”

https://www.washingtonpost.com/politics/medicare-for-all-v-medicare-for-less-trumps-proposed-cuts-put-health-care-at-center-of-2020-race/2019/03/11/87e9dae2-4424-11e9-8aab-95b8d80a1e4f_story.html?

Why Medicare for some is the wrong idea

by Diane Archer - The Hill - March 11, 2019

If you’re following the health care debate, you’ve already heard quite a bit about “Medicare for all,” the proposal to improve and expand Medicare, the government health insurance program for older adults and people with disabilities, to all Americans. As proposed by Sen. Bernie SandersBernard (Bernie) SandersSenate set to rebuke Trump on support for Saudi Arabia Sanders announces first staff hires in Iowa, New Hampshire Will Washington finally do something about high drug prices? MORE (I-Vt.) and others, Medicare for all provides all Americans the right to use physicians and hospitals of their choice anywhere in the country, eliminates premiums, deductibles and co-payments, and is projected to drive down national health care spending by $2 trillion to $5 trillion over the next 10 years.

For most Americans, this sounds like a pretty good idea. And it looks even better when compared against the failures of our commercial health insurance system. Commercial insurance forces Americans to spend nearly twice as much on health care as our peers in Europe and Japan for significantly worse health care outcomes. Commercial insurance creates an estimated $500 billion a year in administrative waste, enables excessive and irrational provider rates, and forces one in four Americans under 65 to forgo necessary health care because they cannot afford their out-of-pocket costs.
Nonetheless, a number of thoughtful commentators and well-intentioned politicians are telling us that Medicare for All is not a practical approach to health care reform – that it’s just not doable given the political context and the country’s long history with employer-based health insurance. These self-described “pragmatists” would offer Medicare as an additional option alongside commercial insurance, proposing a Medicare buy-in or Medicare for some.
By any measure, Medicare for some would deliver very little for the American people.  At best, it would capture a fraction of the health care savings created under Medicare for all. It would not address the unaffordable premiums, deductibles and coinsurance that keep millions of Americans from getting needed health care. And it would leave tens of millions of Americans uninsured or underinsured.
So, too, Medicare for some does not address the most basic questions about our health care system: Why do we trust health insurers to determine the doctors and hospitals we can see? Why should a knee replacement cost anywhere between $16,000 and $61,000?  Why should Americans pay twice as much for prescription drugs as our peers in Europe and Japan?  And, why should our health coverage depend on where we work?
The “pragmatists” argue that we have to live with this crazy system because Americans want “choices” in health care, and most are not willing to give up their current insurance. As a result, they say, the best we can do today is to support Medicare for some and hope for real reform in the future. However sincere or politically fashionable, this view makes no sense.
Let’s get real: Commercial insurance is the biggest threat to health care choices and our freedom to receive the health care we need. Employers choose our insurers, and the insurers restrict the providers we can use, the treatments we can receive, and the prescription drugs we can take. Every year, we can be forced to change provider networks, benefits, out-of-pocket costs and, often, insurers. If we change jobs, every aspect of our health insurance changes. And, we are left to fend for ourselves if we leave the job market.
No one loves Aetna, Anthem or any other insurance company. What we love – and what we need – is the freedom to get care from the doctors we want to see at a price we can afford. Medicare for all guarantees all Americans access to health care, with freedom to see the doctors we want, throughout our lives, wherever we live, wherever we work and whenever we are out of work. That’s about as pragmatic as it gets.
Maybe the “pragmatists” are concerned that we lack the votes in Congress to pass Medicare for all or that the commercial interests with a stake in maintaining the status quo are too powerful to overcome. That might be right. The health care industry is flush with cash, and insurers use campaign contributions to wield substantial influence in Congress. As we learned in 2009 and 2010, the health insurance industry will fight hard to retain its place in the health care system.
But fixing our broken commercial health insurance system is too important to leave to the politicians or to the insurance industry. The American people deserve a frank conversation about how we can guarantee access to health care as a right in this country. That conversation does not begin with Medicare for some.  It begins – and ends – with Medicare for all.
https://thehill.com/blogs/congress-blog/healthcare/433444-why-medicare-for-some-is-the-wrong-idea

 

In Democrats’ ‘Medicare for All’ battle cry, Republicans see 2020 weapon

by Alan Fram - Portland Press Herald - March 11, 2019

WASHINGTON — “Medicare for All” has become catnip for Democratic presidential candidates and many lawmakers, yet Republicans prepping for next year’s congressional races are also flocking to it – for entirely different reasons.
Republican strategists say they’ll use proposals to expand government-run health insurance to pummel Democrats for plotting to eliminate job-provided coverage, raise taxes and make doctors’ office visits resemble trips to the dreaded Department of Motor Vehicles. If Republicans can define the health care issue on their terms – and they face significant obstacles – that would be a stunning turnabout.
“Democrats have opened the door,” Republican consultant Glen Bolger said.
Democrats made health care their defining 2018 issue as they captured the House and limited losses in a difficult set of Senate races. They denounced Republicans, who tried repealing President Obama’s health care law, for seeking to end coverage for patients with pre-existing conditions. In one monthlong stretch last fall, 6-in-10 ads backing Democratic House candidates focused on health care, according to the nonpartisan Wesleyan Media Project.
Rep. Tom Emmer, R-Minn., chairman of the House Republicans’ campaign committee, says thanks to Medicare for All, times have changed.
“We are going to associate every Democrat running with socialized medicine,” he said. “By the end of this cycle, that is going to be, to them, their pre-existing condition Waterloo.”
Republicans intend to tie the proposal to other currents in Democratic politics, including the Green New Deal for fighting climate change and talk of President Trump’s impeachment and reparations to slaves’ descendants. The goal: A narrative that Democrats are marching toward socialism and beholden to extremists.
Yet it’s unclear that Medicare for All will be the tonic Republican tacticians envision.
Elections are 21 months off and will be dominated by Trump and his Democratic presidential rivals, whatever congressional candidates emphasize. And Republicans start with a disadvantage: A November poll by the Pew Research Center found most people preferred Democrats’ to Trump’s handling of health care.
Looking to woo moderate voters, Democrats led by now-Speaker Nancy Pelosi, D-Calif., campaigned last year on an agenda that included curbing prescription drug and other medical costs. A total health care overhaul wasn’t featured.
“Nobody has to advise Nancy on the political implications of any policy,” said House Budget Committee Chairman John Yarmuth, D-Ky.
While Pelosi said in a brief interview that there will “probably” be votes on some type of Medicare for All, few expect a full-blown version to reach the House floor. Instead, committees will hold hearings while work proceeds on other measures, like curbing prescription drug prices.
“We will deliver on our promise of passing legislation to lower the costs of health care,” said Rep. Cheri Bustos, D-Ill., who heads House Democrats’ campaign organization. Medicare for All is “just one idea,” she said.
Democrats worry that Medicare for All would put candidates on the defensive in suburban swing districts, where moderate voters abound. Those districts were crucial to House Democrats’ 40-seat gain last November and will be 2020 battlegrounds.
“Do what you can to help people now, and don’t get yourself in a box on Medicare for All, which can’t pass Congress” soon anyway, advises Democratic consultant John Anzalone.
There are several Medicare for All variants. The most sweeping would replace today’s blend of private and federal health care like Medicare and Medicaid with a federally run system for everyone, likely financed by higher taxes or astronomical boosts in federal deficits.
One was introduced by Sen. Bernie Sanders, I-Vt., a Democratic presidential candidate, and co-sponsored by fellow presidential contenders Sens. Cory Booker of New Jersey, New York’s Kirsten Gillibrand, Kamala Harris of California and Massachusetts’ Elizabeth Warren. A similar House measure by Reps. Pramila Jayapal, D-Wash., and Debbie Dingell, D-Mich., has over 100 Democratic co-sponsors.
Government coverage would replace private policies and patients would pay no premiums or deductibles. The 10-year cost would be an enormous $25 trillion to $35 trillion, private estimates say, though supporters say it would cost less.
While Medicare for All polls well, the details face skepticism. A January survey by the nonpartisan Kaiser Family Foundation showed that 56 percent back the overall idea, but majorities turned against it when told it could boost taxes and eliminate private health insurance companies.
“Once you get past the bumper sticker, it doesn’t do that well. It’s got a glass jaw” when details are explained, said Jim Kessler, executive vice president of center-left research group Third Way.
Because Medicare for All is deeply popular with Democrats’ presidential contenders and galvanized liberal wing, it should remain a prominent campaign theme. That invites Republicans to wield it against Democrats whether they’re supporters or not.
“It’s hard to imagine that Medicare for All doesn’t become the banner which Democrats have to defend up and down the ticket,” said Steven Law, president of the Senate Leadership Fund, a super political action committee whose purpose is to help Republicans win more Senate seats.
In 2018, Republicans had little success accusing Democrats of backing Medicare for All. Democrats won House seats in Maine, Texas and elsewhere despite such attacks.
But in one open seat in eastern Kansas, Democrat Paul Davis lost by 1 percentage point after ads linked him to Pelosi. One spot accused them of backing “a government takeover of health care” that “could double your income taxes.”
Those ads tried tying him “to national Democrats and policies that were not going to have a great deal of acceptance,” Davis said last week.
The proposals could also fuel Democratic primary challenges, particularly in urban districts loaded with liberal voters. Activist groups like Justice Democrats, which last year backed Rep. Alexandria Ocasio-Cortez’s successful ouster of a longtime Democratic incumbent from New York City, say Medicare for All will be one test as they seek targets.
“We need Democrats fighting for big ideas and big solutions,” said Waleed Shahid, spokesman for the group.
https://www.pressherald.com/2019/03/11/in-democrats-medicare-for-all-battle-cry-republicans-see-2020-weapon/

     In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care.

by Osborn R¹, Squires D², Doty MM³, Sarnak DO⁴, Schneider EC^{5 - Health Affairs - December 2016}

Abstract

Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination.
 https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1088

California Man Learns He's Dying From Doctor on Robot Video

by Associated Press - NYT - March 8, 2019

Wilharm figured the visit was routine. She was astonished by what the doctor started saying.
"This guy cannot breathe, and he's got this robot trying to talk to him," she said. "Meanwhile, this guy is telling him, 'So we've got your results back, and there's no lung left. There's no lung to work with.'"
Wilharm said she had to repeat what the doctor said to her grandfather, because he was hard of hearing in his right ear and the machine couldn't get to the other side of the bed.
"So he's saying that maybe your next step is going to hospice at home," Wilharm is heard saying in a video she recorded of the visit. "Right?"
"You know, I don't know if he's going to get home," the doctor says.
Steve Pantilat, chief of the palliative medicine division at University of California, San Francisco, said he doesn't know the details in the case but that the robot technology has done wonders for patients and their families, some of whom are too far away for in-person visits.
The video meetings are warm and intimate, he said, adding that not all in-person discussions have empathy and compassion.
"No matter how well we deliver very difficult news, it's sad and it's hard to hear," he said.
Wilharm said her grandfather, a family man who kept every childhood drawing he ever gave her, deserved better. She said that after the visit, he gave her instructions on who should get what and made her promise to look after her grandmother.
"He was such a sweet guy," she said.
https://www.nytimes.com/aponline/2019/03/08/us/ap-us-robot-video-death-news.html

Trump Administration Targets ‘Secretive Nature’ of Health Care Pricing

by Robert Pear - NYT - March 8, 2019

WASHINGTON — Attacking “the secretive nature of pricing in the health care market,” the Trump administration said this week that it wanted to require public disclosure of the rates that doctors and hospitals negotiate with health insurance companies.
“Patients have a right to price information” before they receive care, the administration said.
Disclosure of the wildly different prices paid by insurers for the same services in the same market would probably incite competition and “drive down health care prices,” the administration said in soliciting comment on its idea.
The concept, set forth Monday in the Federal Register and reported by The Wall Street Journal, is not a formal proposal, but rather a first step toward a possible proposal, clearly signaling the direction in which President Trump wants to go.
Price transparency has been a hallmark of health policy under Mr. Trump. In a country that spends more than $3.5 trillion a year on health care, administration officials say, it is absurd that consumers cannot shop for medical goods and services as they shop for airline tickets and electronic gear.

“There is no more powerful force than an informed consumer,” Alex M. Azar II, the secretary of health and human services, has often said, exhorting health care providers and insurers to “become more transparent about their pricing.”
It was not immediately clear whether the price disclosures contemplated by the White House would directly benefit consumers shopping for a knee replacement operation or the delivery of a baby at a hospital.
“Price transparency is desirable,” Robert Weissman, the president of Public Citizen, a consumer group, said on Friday. But, he said, the disclosure requirement described by the Trump administration “won’t make any difference in the experience of individual patients or for the health care system over all.”
What consumers want to know is what they will have to pay, and that is not the same as the reimbursement rates negotiated by doctors, hospitals and insurers, Mr. Weissman said.
In a similar vein, the administration has proposed requiring pharmaceutical companies to disclose the list prices of prescription drugs they advertise on television, even though consumers often pay less. And the administration has required hospitals to post the list prices for all of their services. Consumers say the data, posted online in spreadsheets for thousands of procedures, is often incomprehensible — a hodgepodge of numbers and technical medical terms.

In its latest proposal, the administration asked if health care providers could be required to disclose the “negotiated rates” for all of the insurance plans with which they do business.
Thomas P. Nickels, an executive vice president of the American Hospital Association, said this was “a radical idea, requiring the disclosure of privately negotiated rates between two parties in a contract.”
Moreover, Mr. Nickels said, it would be impractical because a hospital may have contracts with a dozen insurers, and each insurer may have four or five different health plans with different terms.
The new initiative to require disclosure of price information came in an unusual way, slipped into the preamble to a proposed rule promoting the exchange of information stored in electronic health records. In 2009, Congress provided money to foster the adoption of electronic records, but health care providers cannot always communicate with one another when they use technology made by different vendors.
Economists say health care markets are opaque and frustrate consumers who want to shop for the best value.
Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University in Pittsburgh, said it was possible shining sunlight on the rates paid to doctors and hospitals could put pressure on the industry to lower prices. But in some places, hospitals have market power and can raise prices without losing customers to competitors.
“If you are the only hospital in town, any insurer will have to have you in its network,” Mr. Gaynor said. “The fact that prices are public will not change that.”

The Trump administration said that its plan could reduce huge, inexplicable differences in prices.
In Minnesota, it said, insurers pay as much as $47,000 and as little as $6,200 for a total knee replacement operation. For a total hip replacement, payments have ranged from $6,700 to $44,000.
Reimbursement for a typical vaginal delivery of a baby ranged from $2,900 to $12,300 in one study of Minnesota markets, while C-section deliveries ranged from $4,700 to $22,800.
The American Medical Association and America’s Health Insurance Plans, a lobby for insurers, said they needed more information about the administration’s plan before they could formulate a response.
A research report by securities analysts at Jefferies L.L.C. said the plan faced legal hurdles. “Contract details between managed care organizations and health care providers are covered by confidentiality clauses, so forcing hospitals to post negotiated prices will require hard-to-achieve legislative action,” they wrote.
https://www.nytimes.com/2019/03/08/us/politics/trump-health-care-rates.html?smid=nytcore-ios-share

Drug Costs, in the U.S. and Abroad

A reader points to lower prices in Europe and Mexico.

LTE by Anne Marie O'Connor - NYT - March 13, 2019

To the Editor:
Viewed from abroad, the kind of markup described in “How High Prices Inflate C.E.O.s’ Pay,” by William Lazonick and Oner Tulum (Op-Ed, nytimes.com, Feb. 26), seems like inhumane gouging at the expense of the vulnerable ill.
My generic asthma bronchodilator inhaler, which could save my life, cost me more than $100 at American pharmacies. I moved to Mexico, and the same inhaler cost me $4. In London, it costs me just over $9, and in Spain — where it is manufactured — about $2.60.
What accounts for the American markup? Greed and profit. Who loses? The low-income American children and adults whose asthma could be an easily managed condition, if medication prices did not make it a huge burden.
We are witnessing a large transfer of wealth to already rich Americans, and our inhumane for-profit medical system is playing a shameful role in it. Drug companies still make big profits in Europe, even in countries where prescription drug prices are collectively negotiated by national health systems to benefit their citizens.

Anne-Marie O’Connor
London

 https://www.nytimes.com/2019/03/13/opinion/letters/prescription-drug-prices.html