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Tuesday, September 17, 2019

Health Care Reform Articles - September 17, 2019

Maine Voices: A public option is not enough – Maine needs universal coverage

by Julie Pease - Portland Press Herald - September 16, 2019

A single state health plan would have greater bargaining power, control costs and improve Mainers' health.

TOPSHAM — In reaction to public support for universal health care coverage, some Maine health care reform advocates promote a public option. From my perspective as a physician who has advocated for universal coverage, a public option is not enough.
First, a public option will never cover everyone, and will do nothing to control health care costs. A relatively small number of people would be enrolled, and the plan would have limited bargaining power. It is likely that many of the sickest of Maine’s uninsured would join a public option plan, essentially making the plan a high-risk pool. This dynamic would drive the public option prices higher. Health insurance plans will always be unaffordable unless a healthy patient pool balances the sickest.
in contrast, universal coverage would put everyone in a single large risk pool, giving the state the bargaining power to achieve cost control. Maine would negotiate global budgets with hospitals, negotiate drug prices and set fair fee schedules for providers. Streamlining payment would offer vast cost savings. With a simplified system, providers would face just one set of billing rules and processes, greatly reducing their operating costs. Having everyone in the system limits opportunities for unscrupulous providers to exploit desperate patients.
Second, a public option will not improve efficiency or reduce waste. At least three major reports estimate that 30 percent to 35 percent of America’s $3 trillion annual health care expenses is not spent on effective care. None of this waste disappears by adding one more insurance “option.” Without transformative change, some hospitals will continue to have 1.5 insurance-related clerical jobs for every bed they operate. Physicians will continue to spend time and money fighting insurance company barriers, negotiating multiple different plan coverage options and pharmacy formulas and restrictions and dealing with duplicative documentation efforts. Patients will continue to negotiate the hassle of annual enrollment with its array of options and guesswork about what plan will meet their future health care needs.
Third, like current health insurance, public option funding will be through premiums and co-pays, least affordable to those in the greatest need. Some Mainers can’t or won’t pay those premiums and will go without coverage. Patients will risk serious illness or financial disaster or both. They will continue to delay seeking providers, to skip dosages or decline prescriptions, or to delay or refuse essential tests or procedures because they can’t afford them.
Fourth, adding a public option maintains Maine’s current employer-based health insurance system. Job changes that many people experience each year mean loss of insurance. (Currently, 1 in 4 Americans goes through an uninsured period annually.) Those who get new insurance often must search for a new doctor, and work with new co-pays and deductibles.
Finally, a “public option” fails to assist Mainers who have insurance. Thousands would still have high deductibles. They would still be restrained by networks that restrict choice of doctors and hospitals. They would still be forced to be on constant guard for surprise medical bills and charges, even when they go to in-network hospitals. Thousands still would not have access to dentistry, eyeglasses and hearing aids.
Each of these problems would be resolved by passing one of the federal “Medicare for All” bills, HR 1384 and S.1129, or by enacting a state-based single-payer type of plan such as L.D. 1611. Each of these plans features tax-funded comprehensive benefits with no premiums, no co-pays, no surprise bills and patient choice of doctors and hospitals.
It remains unlikely that the U.S. Congress will enact “Medicare for All” soon. Maine can lead by enacting a state-based single-payer type of plan that would provide coverage for an estimated 650,000 individuals, and supplemental coverage for those Mainers with Medicare, Medicaid and Veterans Affairs benefits.
Why settle for a public option? Why continue the nightmarish tangle of public and private options, with people constantly moving on and off? Why perpetuate a dysfunctional, wasteful, expensive system that does not meet Mainers’ health care needs? Why not just pay for health care with taxes, cover everyone and make services free at time of use? Why not work for a single state health plan that would control costs, save lives and improve Mainers’ health? We cannot afford to wait. 
https://www.pressherald.com/2019/09/16/maine-voices-public-option-is-not-enough-maine-needs-universal-coverage/

Four Key Things You Should Know About Health Care 

by Ezekial Emmanuel and Victor Fuchs - NYT - September 12, 2019

Health care, so far perhaps the biggest issue in the Democratic primary, is also the most complicated issue facing government and the public. Unfortunately the debate is filled with persistent misconceptions, from the role insurance company profits play in health care costs to who is actually paying for workers’ health coverage.
Clarifying four fundamental health care fallacies could make it easier for voters to square some of the Democratic proposals — and their critiques — with reality:
Employers write checks that cover most health insurance premiums for employees and their dependents. But as the Princeton health economist Uwe Reinhardt once explained, employer-sponsored insurance is like a pickpocket taking money out of your wallet at a bar and buying you a drink. You appreciate the cocktail until you realize you paid for it yourself.
With health coverage, employers write the check to the insurer, but employees bear the cost of the premium — the entire premium, not just the portion listed as their contribution on their pay stub. The premium money that goes to the insurance company is cash that employers would otherwise deposit in employees’ accounts like the rest of their salary.
The fallacy is in thinking an employer’s contribution comes out of profits. In fact, higher health insurance premiums mean lower wages for workers. Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent. But in that time, average wages have hardly moved, increasing just 7 percent. Clearly workers’ wages, not corporate profits, have been paying for higher health insurance premiums.
Health care costs are one — though not the only — reason wages have stagnated over the last few decades. With health insurance costs rising faster than growth in the economy, more labor costs go to benefits like health insurance and less to take-home pay.
Yet the belief that employees don’t pay for their own health insurance is widespread. One reason is that individuals cannot be sure what causes their wages to change or remain stagnant for decades. Another reason is that employers want Americans to believe that they pay for their workers’ health insurance. Still another reason is that there are those who profit from the employment-based system: drug companies, device manufacturers, specialty physicians and high-income individuals. They all want you to believe companies are being magnanimous in giving you insurance.
Who else benefits from the belief in this fallacy? Opponents of national health insurance.
The key to evaluating the cost of Medicare for All is to distinguish between increasing spending on health care and shifting expenditures from private insurance to the federal government.
True, Medicare for All would increase federal health care spending. But that is not the same as increasing total health care spending, which was over $3.5 trillion last year. Instead, Medicare for All would move money from one column (private health insurance spending) to another (federal health spending); it does not automatically increase total costs.
A recent study by the Mercatus Center at George Mason University — a free-market center generally hostile to government programs — estimates that for the 10 years between 2022 and 2031 the total national health costs for Senator Bernie Sanders’s Medicare for All plan would actually be $50.1 trillion. That would be $2 trillion less than if we let the system operate as it currently does. However, Mercatus researchers doubt that the Sanders’s plan would ultimately save trillions because they believe Congress would have to increase Medicare rates paid to hospitals and physicians to get the legislation enacted. They may be right — or wrong. But that is a different argument — a prediction about the politics of enacting laws — than that Medicare for All would inherently increase total health care spending.
We have our doubts about Medicare for All. But unaffordability is not a reason to oppose it. Whether it’s our current arrangement or a future Medicare for All, the per capita cost of our health care system already far exceeds that of any other industrialized country — including those with single-payer systems. When you hear a health care price tag in the trillions, know that the existing system has already brought us there.
In the second Democratic presidential debate, Senator Bernie Sanders declared that the health care industry makes $100 billion in profits. He once railed against the insurance company Anthem for denying a claim while noting that it reported “fourth-quarter profits for 2017 had increased by 234 percent to $1.2 billion.”
Many Americans believe that profits have no place in health care. They see for-profit health insurance, like buying and selling kidneys and livers for transplantation, as what the Nobel Prize winner Alvin Roth termed a “repugnant industry” — something that should not be exchanged in the market.
That is an important moral stand, but it makes no difference to the claim that eliminating for-profit insurers will reduce high health care costs. The fact is, we could eliminate those profits and it would hardly matter to the cost of health care. You would not notice it in your premiums.
For the eight largest for-profit health insurance companies, in 2016, their cumulative revenue amounted to nearly $452.2 billion and profits were $22.1 billion, for a profit margin of about 5 percent. By contrast, technology companies, banks and major drug companies generally make more than 20 percent profit.
True, $22.1 billion is a lot of money — but it is 0.6 percent of health spending. And last year alone health care costs increased over $130 billion — six times insurance company profits. Health care spending would not be significantly cheaper if all insurance companies’ profits were zero.
There are far more savings to be had in other efforts — by cutting unnecessary patient services, for example, or by making physicians and hospitals more efficient — to deliver the same care at a lower cost.
“Hospitals will be required to publish prices that reflect what people pay for services,” said President Trump when he signed his executive order on health care price transparency. “Prices will come down by numbers that you wouldn’t believe. The cost of health care will go way, way down.”
There is no doubt that prices for medical procedures can range widely even within the same city or state. For instance, M.R.I.s of the spine can vary threefold in Massachusetts and mammograms fivefold in San Francisco.
Conservatives argue that informing patients of prices for tests and treatments will induce them to shop for lower-cost services, saving them, insurers and the country money. In theory, the beauty of price transparency is that neither the government nor insurers impose cost controls; the invisible hand of the market does it all.
Yet demonstrations of price transparency have been tried many times in many places, and in reality, it has not reduced the cost of care.
One recent study by Harvard Medical School researchers involved hundreds of thousands of employees and used a website telling them what they would pay out-of-pocket if they chose particular physicians and hospitals. The result: no savings. A follow-up study using another set of employers and another price transparency tool found the same result: no savings.
Since 2007, New Hampshire has had a state website, N.H. Health Cost, that allows patients to select a medical procedure, insurer and ZIP code and then get a list of prices for the procedure from various providers. The most promising study of N.H. Health Cost suggests a few million dollars in savings per year. That works out to be about $5 per New Hampshire resident.
The fact is, price transparency will not make health care costs “go way, way down.” Health insurance insulates the patient from price. Over 80 percent of the cost of medical care is paid by private and public insurance. Patients have little incentive to seek out the cheapest provider. When pricing websites exist, few patients use them. Even in the most favorable studies, when offered a price transparency tool, only 12 percent of patients took advantage of it; usually it’s less than 4 percent of patients.
Furthermore, price considerations are useful for choosing only about 40 percent of procedures — routine services like colonoscopies, M.R.I. scans and laboratory tests. Most of the expensive services — think heart catheterizations, cancer chemotherapy and organ transplants — are not the kind of thing you decide based on price.
Finally, in health care, Americans usually put relationships ahead of money. Once patients find a physician they trust and a hospital they like, they tend to stick with them even if there is a lower-cost alternative nearby.
American health care is complex and any simplistic solution is likely to be based on a fallacy. But that doesn’t mean there is nothing we can do. There are solutions — they just don’t make for bumper sticker phrases like Medicare for All or Eliminate For-Profit Insurers or Price Transparency. 

https://www.nytimes.com/2019/09/12/opinion/health-care-fallacies.html?

Editor's Note:

The next clipping is the tip of the iceberg about what's in store for us, courtesy of the deep-pocketed interests in healthcare, as the debate about further reform of the system heats up.

-SPC 

Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’

Two doctor-staffing companies are pushing back against legislation that could hit their bottom lines.

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Early this summer, Congress appeared on its way to eradicating the large medical bills that have shocked many patients after emergency care. The legislation to end out-of-network charges was popular and had support from both sides of the aisle. President Trump promised his support.
Then, in late July, a mysterious group called Doctor Patient Unity showed up. It poured vast sums of money — now more than $28 million — into ads opposing the legislation, without disclosing its staff or its funders.
Trying to guess who was behind the ads became something of a parlor game in some Beltway circles.
Now, the mystery is solved. The two largest financial backers of Doctor Patient Unity are TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country, according to Greg Blair, a spokesman for the group.
“Doctor Patient Unity represents tens of thousands of doctors across the country who understand the importance of preserving access to lifesaving medical care and support a solution to surprise medical billing that protects patients,” said Mr. Blair, who issued the statement weeks after the group was first contacted about the campaign. “We oppose insurance-industry-backed proposals for government rate setting that will lead to doctor shortages, hospital closures and loss of access to medical care, particularly in rural and underserved communities.”
TeamHealth was acquired in 2016 by the private-equity firm Blackstone Group in a deal valued at $6.1 billion. And last fall, in one of the largest takeovers of the year, the private-equity giant KKR spent $9.9 billion to acquire Envision Healthcare.
The ads generally omit references to surprise bills. Instead, they warn of “government rate setting” that could harm patient care. In one ad, an ambulance crew arrives with a patient, only to find the hospital dark and empty.


The proposed legislation, which may advance to floor votes this year, is potentially bad for business for TeamHealth and Envision. The two groups have waged many battles against insurers over what they see as low physician payments for emergency room visits. When there is no agreement with an insurer, the physicians work “out of network,” and bill patients for the amount that insurance does not pay.
A recent academic analysis of filings from a large commercial insurance company found that the firms, though Envision more than TeamHealth, have routinely operated outside the insurance networks of hospitals where their doctors practice. This often leads to surprise bills for patients.
Like all so-called dark money political action groups, Doctor Patient Unity is not legally required to reveal the names of its supporters and, in fact, appears to have worked hard to obscure its identity.
The bread crumbs were scant. Filings by the group to the Federal Communications Commission for purposes of advertising listed the name of a treasurer who works for a firm that often fills such roles for Republican political groups. The group’s corporate filing in Virginia lists an agent who is common to more than 150 other political action groups. Neither the treasurer, the named partners in her firm, the advertising firm or the lawyer associated with the corporate entity responded to calls or emails. An email to the address on the group’s bare-bones website went unanswered for weeks until the group’s statement on Friday.
Representatives of both companies confirmed Friday that they had funded the group, offering written statements similar to the one from Mr. Blair. Neither company’s comments explained why they pursued a dark-money advocacy strategy.
Several Washington news outlets had looked into the origin of the ads, as had some local reporters in several states where the ads have run, including Colorado, Texas, Alabama and Minnesota
Doctor Patient Unity has also spent hundreds of thousands of dollars on Facebook and Google advertising, and has been sending direct mail to voters in dozens of congressional districts. In some cases, the group describes the legislation as the “first step toward socialists’ Medicare-for-all dream.”
The group has focused its broadcast ads in areas where senators, mostly Republican, are running for re-election next year. In North Carolina, Doctor Patient Unity has spent more than $4 million on ads to influence Senator Thom Tillis’s vote on the bill. Another target of the ads is Mitch McConnell, the Senate majority leader, who has expressed support for legislation ending surprise billing.


One ad, in heavy rotation in early August, featured a woman standing in front of a blank background urging voters to call their senators to stop a practice she calls “government rate setting.” She warned the policy could affect patients’ access to doctors in an emergency.
Senator Tina Smith, a Democrat from Minnesota, said she found the ads confusing and frustrating. She is a co-sponsor of a bill that would resolve surprise bills using arbitration, the stated preference of the group. But she was still the target of more than $2 million in ads. She said she had heard from constituents at the Minnesota State Fair during the August recess, many asking what the ads were about.
“If they were genuinely interested in engaging in the political process, they at least would have called me,” she said. “I think the ads are designed to intimidate us into backing down about doing something about surprise medical bills, and I refuse to be intimidated.”
The advertisements are not all negative: The group ran one thanking Senator David Perdue, a Republican from Georgia, and Maggie Hassan, a Democrat from New Hampshire. Ms. Hassan, who is the co-sponsor (with Ms. Smith) of a more doctor-friendly surprise billing approach, was not pleased by the endorsement. Aaron Jacobs, her communications director, described the ads as “deeply harmful to our efforts to pass bipartisan legislation to end the outrageous practice of surprise medical billing,” and said the group was acting in “bad faith.”
Legislation that has passed out of the Senate Committee on Health, Education, Labor and Pensions and a similar bill that has passed in the House Energy and Commerce Committee would ban the practice of sending bills to patients when they visit a hospital covered by their insurance. In situations where the doctors fail to negotiate a price with the patient’s insurer, the bills before Congress would mean that the doctors would be paid the median price that other such doctors in the area get.
Most doctor and hospital groups would rather have both sides present their preferred price to an independent arbitrator. Experts say the current legislation would probably lower the pay for doctors in the relevant medical specialties, even those who do not engage in surprise billing.
In the House, the bipartisan leaders of the Energy and Commerce Committee are starting an investigation into the role of private equity firms in surprise billing, according to a committee aide. The committee’s surprise billing legislation passed through the committee with unanimous support. Greg Walden of Oregon, a Republican and the committee’s ranking member, pushed for the bill at the House Republicans’ retreat this week.
“I’m focused on protecting patients from surprise billing, period,” Mr. Walden said in a statement. “If hospitals, doctors and insurers mean what they say — that patients should be held harmless and should not face unexpected, exorbitant medical bills — then we need to act with legislation.”
Together, Envision and TeamHealth employ tens of thousands of physicians, most in the kinds of hospital-based specialties — like emergency medicine, radiology and anesthesiology — that can generate large surprise bills.
After researchers in 2017 pointed to its high share of out-of-network doctors, Envision, then a public company, vowed it would have more of its doctors accept insurance. A spokeswoman said 90 percent of its care is now in-network. Dan Collard, an executive vice president at TeamHealth, said around 85 percent of its care is delivered in-network.
This summer, Fitch Ratings put the debt of both companies at the top of its list of “loans of concern,” noting that the companies have been “pressured by uncertainty over the outcome of political efforts to cut medical bills.”
“Private equity companies have the most to lose from prohibiting surprise billing, so it’s no surprise that they’d be fighting the hardest to blow up the process,” Loren Adler, an associate director of the U.S.C.-Brookings Schaeffer Initiative for Health Policy, said in an email. Mr. Adler, who has studied the issue, endorses the approach Congress is considering.
Doctor Patient Unity is not the only physician group trying to influence the surprise billing legislation in Congress. Physicians for Fair Coverage has also begun a digital ad campaign and has spent an estimated $240,000 on conventional lobbying this year, according to the Center for Responsive Politics. That physicians group lists its members on its website, and its staff speaks with journalists about the group’s perspective. (Some of its members also have private equity ties.)
The American College of Emergency Physicians and the American Society of Anesthesiologists have also sought changes to the surprise billing legislation, but their message is milder than the TV ads, and they say they want the problem resolved.
Leaders in each of those groups denied knowing who funded Doctor Patient Unity or communicating with the group directly.
“I have no idea who they are — I actually tried Google, and when you look at their website, there’s nothing,” said Michele Kimball, the president of Physicians for Fair Coverage.
Laura Wooster, a spokeswoman for the American College of Emergency Physicians, said she found the group’s first ad confusing. After learning about the group’s funders, Ms. Wooster distinguished the dark money group’s strategy from that of the college.
“ACEP does not want our proactive efforts over the past two years to help protect patients from surprise bills to be conflated with more negative messages that are perceived as obstructionist,” she said. The organization’s current president works for TeamHealth; its president elect works for Envision.
Insurance companies, which strongly favor the prevailing legislative approach, are also heavily invested in efforts to influence the surprise billing legislation, although they have been more transparent about their involvement. An industry group, the Coalition Against Surprise Medical Billing, has run digital and television ads worth several million dollars. Its latest, which ran in Washington during the Democratic presidential debate on Thursday, shows men and one woman negotiating in a dark room as a voice-over describes surprise billing as a “private equity business model.”
“Can we get a little privacy in here?” one person asks the camera.
The Doctor Patient Unity campaign is similar to other dark-money efforts in which groups try to influence public policy without disclosing donors. Anna Massoglia, a researcher at the Center for Responsive Politics, which tracks such campaigns, said many of the tactics used by Doctor Patient Unity were familiar. “You do see the same groups and the same operatives popping up time and time again as these new issues emerge,” she said.
Several lawmakers said the mysterious nature of the ad campaign had left them more committed to the issue than they were before.
“This is an example of what happens when voters can’t tell who’s paying for ads because they’re funded by dark money; it causes a lot of confusion,” Senator Jeanne Shaheen, a Democrat from New Hampshire, said in a statement. “But I don’t care how many ads they run, how many mailers they send or how much dark money they spend. I’m not intimidated and am adamant that tackling surprise billing must remain top of Congress’s to-do list.”
https://www.nytimes.com/2019/09/13/upshot/surprise-billing-laws-ad-spending-doctor-patient-unity.html?fallback=0&recId=1QsB3P48bJ1KocJHjWoZMXElZHE&locked=0&geoContinent=NA&geoRegion=ME&recAlloc=control&geoCountry=US&blockId=home-discovery-vi-prg&imp_id=927191846&action=click&module=Discovery&pgtype=Homepage

The best health care reform is already in place

By Laurence Kotlikoff- The Hill September 9, 2019
As with the previous Democratic debates, this week’s debate in Houston will likely start with our country’s forever question: How can we provide health insurance to all without bankrupting the country?
The Republican Party’s answer is to define basic health insurance as no health insurance. The party yearns for, and is suing in the courts, to restore the halcyon pre-ObamaCare days when 50 million Americans were uninsured and insurance companies could deny coverage at will.
This stance isn’t going to fly with the Party’s rank and file, whose own future health care and that of friends and relatives is at stake. But, hey, political self- immolation seems all the rage.
Vision two is Senator Sanders’ traditional Medicare (Parts A, B, and D) for All. Actually, it’s a far more generous version than traditional Medicare, which features co-pays, co-insurance, limits on catastrophic coverage and significant monthly premiums. As a result, millions of participants are forced to purchase Medigap coverage. Under BernieCare, there are no co-pays (except for prescription drugs) and no limits on coverage. Bernie care includes lab work, maternity, vision and dental care, and long-term care for the disabled.
Employers would, to their joy, be banned from the health care business. But their workers will be able to keep their doctors and use the same hospitals, who will simply send their bills to Medicare. Indeed, setting aside requisite tax hikes, BernieCare is far more generous than most employer-provided plans.
BernieCare, which Senator Elizabeth WarrenElizabeth Ann WarrenThe Hill's 12:30 Report: Sights and sounds from Houston debate Huntsman of 'The View' declares Castro campaign dead after Biden moment Infrastructure needed to treat addiction as chronic disease doesn't exist MORE (D-Mass.) and several other Democratic presidential candidates endorse, works great in theory. And it may in practice. The biggest bottom line is the share of GDP spent on health care. Other developed countries are delivering excellent universal health care at well south of 14 percent of GDP. We’re at 18 percent of GDP and growing. And they are all doing it with a healthy dose of central government control.
If it’s a choice between our current system and BernieCare, I’d go with BernieCare in a heartbeat. Yes, there are lots of concerns — people overusing the system, costs that far exceed the senator’s estimates, government price control over what is a fifth of the economy, doctors opting out of medicine because of limits on their reimbursements and long waiting lines.
But 14 percent of U.S. GDP can surely buy a truly first-class health care system for all. Also bear in mind that medicine in our country is already largely government run but done so with maximum inefficiency, leaving 30 million uninsured and far more underinsured.
BernieCare surely beats “Don’tCare” — the Trump-McConnell answer. But is there another reform that makes more sense?
Yes. “Medicare Part C for All.” This is the brain child of John Goodman, the father of Health Saving Accounts. I pushed for this solution in The Healthcare Fix. Goodman recently discussed the plan in the Wall Street Journal.
Medicare Part C is also called the Advantage Plan. Some 22 million Medicare participants – one in three – have opted for Medicare Advantage over traditional Medicare. It works like this. Each year you choose an Advantage Plan from the plans being offered by insurers. The government then sends the plan you choose a check to cover its cost of caring for you for the year. This is like the ObamaCare exchanges except the payment to the insurer doesn’t depend on your income, but rather your health status.
The government figures out based on your pre-existing conditions, recorded in its electronic medical records, what you will cost, on average, and simply pays the insurance company that amount. Hence, if you have diabetes, your Advantage plan gets a much bigger check than if you are perfectly healthy.
The brilliance of this system is that it eliminates the major problem in the health insurance market: cherry picking. If an insurer gets paid the same even though you have diabetes, they’ll do their legal best to keep from insuring you. But if they are fully compensated for the extra cost you represent, they’ll be eager to sign you up. (Note, no insurer can turn anyone down under Medicare Part C.)
Making your premium payment conditional on your health status takes what is now a highly balkanized and dysfunctional health insurance market and transforms it into a hyper competitive one.
Medicare Part C for All gives the government the ability to set a global annual budget for what are, in effect, its aggregate individual-specific voucher payments. To stick to this budget, it simply adjusts what’s covered by the vouchers. The more (fewer) things covered, the higher (lower) the size of each voucher as well as the system’s total cost. So, in adjusting what’s covered, the government can readily keep the system affordable.
Medicare Part C also deals naturally with employer-based health insurance plans. Employers can continue to offer their plans, but they have to offer them as Medicare Advantage plans. I.e., they have to cover what Medicare Part C requires be covered. Furthermore, their coverage needs to be extended to anyone who wants to participate.
Senator Sanders views insurance companies as the problem. I don’t blame him. They have cherry picked the American public literally to death for decades. But individual experience-rated vouchers, which are the essence of Medicare Part C, eliminates this problem, permitting intense competition. This will lower wasteful administrative costs and permit competition in health care to, at long last, flourish and deliver the same benefits it delivers in other markets. Yes, BernieCare beats Don’tCare. But Medicare Part C for All beats them both.
Laurence Kotlikoff is a professor of economics at Boston University (BU), a fellow of the American Academy of Arts and Sciences, a research associate of the National Bureau of Economic Research, a fellow of the Econometric Society, and president of Economic Security Planning, a company that produces MaxiFi.com -- an economics-based personal financial planning tool.https://thehill.com/opinion/healthcare/460455-the-best-health-care-reform-is-already-in-place
  

Air Ambulances Woo Rural Consumers With Memberships That May Leave Them Hanging

By Sarah Jane Tribble - Kaiser Health News - September 14, 2019

n a hot June day as Fort Scott, Kan.'s Good Ol' Days festival was in full swing, 7-year-old Kaidence Anderson sat in the shade with her family, waiting for a medevac helicopter to land. A crowd had gathered to see the display prearranged by staff at the town's historic fort.
"It's going to show us how it's going to help other people because we don't have the hospital anymore," the redheaded girl explained.
Mercy Hospital Fort Scott closed at the end of 2018, leaving this rural community about 90 miles south of Kansas City, Kan., without a traditional hospital. The community has outpatient clinics run by a regional nonprofit health center and — at least temporarily — an emergency department operated as a satellite of a hospital a county away.
Since the hospital closed, air ambulance advertising has become a more common sight in Fort Scott mailboxes. At least one company's representative has paid visits to a local nursing home and the Chamber of Commerce, offering memberships. A prepaid subscription would guarantee that if an AirMedCare Network helicopter comes to your rescue, you would pay nothing.
Nationwide, though, state insurance leaders, politicians and even one of the nation's largest air ambulance companies have raised concerns about the slickly marketed membership campaigns. The memberships often don't include every ambulance company in an area, and the choice of which medevac service answers a call is out of a consumer's hands.
The air ambulance industry expanded by more than a hundred bases nationwide from 2012 to 2017 and prices increased as well, according to a recent federal report. The median price charged for a medevac helicopter transport was $36,400 in 2017 — a 65% increase compared with the roughly $22,100 charged in 2012, according to the March report from the U.S. Government Accountability Office.
Private insurance frequently does not cover the full cost of the trips and consumers often are surprised to get a bill showing they are responsible for the bulk of the charges. However, both Medicare and Medicaid control the price of the service, so enrollees in those government insurance programs face much lower out-of-pocket costs or have none.
AirMedCare Network, which includes 340 bases across mostly rural America, has more than 3 million people enrolled in memberships, said Seth Myers, president of Air Evac Lifeteam, one of the medevac companies under the AirMedCare Network umbrella.
One brightly colored AirMedCare advertisement mailed in southeastern Kansas promised entry in a summer vacation giveaway as an incentive to sign up. A one-year membership is $85 — unless you are 60 or older, which qualifies you for a discount. Buying multiyear memberships increases the odds of winning that summer trip.
"We're a safety net for people in rural areas," Myers said. "Generally, if I tell you the names of the towns that most of our bases are located in, you wouldn't know them unless you lived in that state."
Increasingly, though, state regulators have a skeptical view.
North Dakota Insurance Commissioner Jon Godfread called the memberships "another loophole" that air ambulance companies use to "essentially exploit our consumers." The state banned the memberships in 2017, noting that the subscription plans don't solve the problem of surprise medical bills as promised.
Too often, the company responding to a patient's call for help is not the one the patient signed up with, Godfread said. North Dakota has nine different air ambulance operators who respond to calls and patients have no control over who will be called, he explained.
Air Evac's Myers said his company, which operates mostly in the Midwest and Texas, said his company just doesn't get complaints from customers about other companies picking them up. He counted three this year.
Texas Rep. Drew Springer, a Republican, introduced a bill passed by the state legislature this year that would require companies to honor the subscriptions or memberships of other air ambulance companies.
But Texas Gov. Greg Abbott, also a Republican, vetoed Springer's reciprocity bill, saying it would unnecessarily intrude on the operations of private businesses.
Myers said that AirMedCare Network was "very careful to educate the legislature and the governor's office" in Texas. A letter signed by Myers and other industry executives noted that the 1978 Airline Deregulation Act — a law created for the commercial airline industry — protects them. The federal law limits states' ability to regulate rates, routes or services. The law is at the core of the industry's defense of its prices.
Like North Dakota, though, Montana used insurance regulations to limit the memberships. A 2017 law requires air ambulance subscriptions to be certified by the state's insurance department. As of August, no company had applied for certification — essentially opting out of the state.
Air Methods, one of the nation's largest private air ambulance companies, decided memberships "aren't right for patients," according to an email from Doug Flanders, the company's director of communications.
While membership programs promise customers will avoid out-of-pocket expenses, in reality the contractual fine print "isn't as cut and dry," she said in an email.
Patients who sign up for memberships and have private insurance would still receive a bill and then must work through their insurance company's claims, denial and appeal processes before the membership benefits take effect.
And while Air Evac's Myers said the AirMedCare Network memberships or subscription fees replace copays and deductibles, Air Method's email highlighted in bold print that "a membership is not necessary" for Medicare patients because federal law prohibits companies from charging more than copays and deductibles.
Myers said having a membership offer peace of mind particularly to those Medicare enrollees who do not have an added supplemental insurance plan that covers transportation.
Also, because the memberships are not officially insurance or a covered benefit, air ambulance companies can end them at any time "without obligation to notify the customer," stated the Air Methods email. This means a patient could believe his or her emergency air transport was taken care of, only to face a rude awakening when the bill came.
Air Methods is the preferred helicopter service for Fort Scott's dispatch service, according to city officials. Yet, Midwest AeroCare operated the helicopter that dropped in during the Good Ol' Days festival.
Midwest AeroCare is part of the AirMedCare Network — not Air Methods. Families like the Andersons were there looking for reassurance that someone would come for them if needed, said Dawn Swisher-Anderson, Kaidence's mom. Her son, Connor, has frequent and severe asthma attacks that require hospitalization.
"It's obviously scary with a young one when he's having breathing complications," Swisher-Anderson said.
Once the helicopter landed, a tall pilot and two crew members stepped out and the onlookers quickly formed a line on the grass. Susan Glossip, who brought her grandchildren to see the helicopter, encouraged them to pose for a picture.
Midwest AeroCare representative Angela Warner stood nearby and asked if she could post the picture on the company's Facebook page.
After Glossip said yes, Warner began talking about the membership program emphasizing that "with Fort Scott losing its hospital ... having a helicopter be able to fly in can mean the difference between living and dying for some people."
Glossip agreed and asked for a membership brochure.
https://www.mainepublic.org/post/air-ambulances-woo-rural-consumers-memberships-may-leave-them-hanging


Another View: When Congress failed, Maine stepped in on drug prices

Sen. Susan Collins and other politicians in Washington talk a lot about taking on Big Pharma – lawmakers in Augusta actually do it. 
by Heather Sanborn - Portland Sunday Telegram - September 15, 2019

Sen. Susan Collins and other politicians in Washington talk a lot about taking on Big Pharma – lawmakers in Augusta actually do it.
Re: “Sen. Collins: Bill takes bipartisan approach to lowering medication costs” (Sept. 10):
There’s no question that the cost of prescription drugs is far too high. As chair of the Legislature’s Health Coverage, Insurance and Financial Services Committee, I hear heartbreaking stories about the stress Mainers face because of these sky-high prices.
One in four Americans struggles to afford their medication, and one in seven Americans doesn’t take their medication as prescribed because it costs too much. Every week, it seems, we hear another story of a young person with diabetes dying after rationing their insulin. That’s unacceptable.
Politicians in Washington, including our own Sen. Susan Collins, talk a lot about prescription drugs, but they’ve avoided doing anything meaningful to address the problem. They take huge amounts of campaign cash from “Big Pharma,” then they ultimately fail to act to lower drug costs, time and time again.
Here in Maine, we were tired of pharmaceutical companies taking advantage of people. It was clear to us that Washington wasn’t going to do anything meaningful, so we stepped up.
In the Legislature, we did what Mainers do best: We got to work. We had difficult but productive conversations with our colleagues across the aisle to reach consensus. In the end, we passed a package of laws, with bipartisan support, that will make a real difference for Mainers.
https://www.pressherald.com/2019/09/15/another-view-when-congress-failed-maine-stepped-in-on-drug-prices/

Is the Profit Motive Hindering Kidney Transplants?

Study compared transplant rate in for-profit vs nonprofit facilities

by Kristen Monaco - Medpage Today - September 10, 2019

The likelihood of a patient receiving a kidney transplant differed according to whether a dialysis center was for-profit or nonprofit, a new study indicated.
With approximately 1,500,000 cases analyzed, patients who were receiving dialysis for end-stage renal disease at a for-profit center had a 64% lower probability of being placed on the deceased kidney donor waiting list compared with patients at a nonprofit dialysis center (HR 0.36, 95% CI 0.35-0.36).
In addition, reported Rachel Patzer, PhD, MPH, of Emory University School of Medicine in Atlanta, and colleagues, the patients at for-profit centers similarly saw a 48% lower likelihood of receiving a living donor kidney transplant (HR 0.52, 95% CI 0.51-0.54) and a 56% lower likelihood of receiving a deceased donor kidney transplant (HR 0.44, 95% CI 0.44-0.45) versus those at nonprofit centers.
As shown in the group's study online in JAMA, the cumulative incidence differences over a 5-year period indicated that patients receiving dialysis at a for-profit center had significantly lower incidence rates of being placed on a donor list or receiving a kidney than did those at nonprofit centers:
  • Placement on deceased donor waiting list: -13.2% (95% CI -13.4% to -13.0%)
  • Receipt of a living donor kidney: -2.3% (95% CI -2.4% to -2.3%)
  • Receipt of a deceased donor kidney: -4.3% (95% CI -4.4% to -4.2%)
"Clinician-level barriers, including clinician perception of the appropriateness of the possible transplantation, poor medical follow-up, time spent with patients, and format of transplant education, may lead to delays in access to transplantation, and could explain some of these findings, but are unmeasured in national data," Patzer and co-authors pointed out.
For the retrospective cohort analysis, the team used data from the U.S. Renal Data System, including records of patients at over 6,500 dialysis facilities from 2000 to 2016. Among the nearly 1.5 million patients with end-stage renal disease included in the analysis, 87% were receiving dialysis at a for-profit facility versus only 13% at a nonprofit facility.
Of the patients receiving care at a for-profit dialysis facility, the majority were at a large chain facility, while only about a quarter of these patients had care at either a small chain or independent facility. The study results also uncovered that the majority of patients do not switch dialysis facilities during the course of their treatment, but if they do, it is often to another facility within the same profit status.
The distribution of patients' insurance coverage was similar between those at nonprofit and for-profit facilities, with the majority of patients having Medicare. The type of dialysis was also similar, with 91% of patients at both types of facilities receiving in-center hemodialysis. Only about 8% of patients at each type of facility received peritoneal dialysis, and only about 1% of patients at for-profit and nonprofit facilities received home hemodialysis.
The distribution of patient comorbidities were also generally comparable between those at for-profit versus nonprofit centers, with about half of patients at each center type having diabetes as the attributed cause of his or her end-stage renal disease. About 84% of all patients at each center also had hypertension at the start of dialysis.
The researchers found that regardless of the type of dialysis center, patients whose end-stage renal disease was caused by glomerulonephritis versus diabetes had a higher chance of being placed on a deceased donor waiting list (HR 3.00, 95% CI 2.96-3.05), receiving a living donor kidney transplant (HR 5.95, 95% CI 5.76-6.15), or receiving a deceased donor kidney (HR 2.17, 95% CI 2.12-2.22).
These findings "paint a bleak and discouraging picture on the function of the dialysis industry in assisting patients' access to kidney transplantation overall," noted the authors of an accompanying editorial. "Assuming the findings of these studies and the report [by Patzer, et al.] are valid and unbiased, it might be reasonable to infer that for-profit dialysis organizations have systematically and disproportionately focused their resource investments to prioritize the delivery of dialysis services while paying less attention to ensuring patients receive transplants," wrote L. Ebony Boulware, MD, MPH, of Duke University School of Medicine in Durham, North Carolina, and co-authors.
"If true, this conclusion should lead to a close examination of market forces (e.g., competition for regional dialysis market share), payment policies (e.g., lack of reimbursement for activities that promote transplantation), or both, that could hinder the alignment of business goals with patient and family-centered treatment options," the editorialists stated.
https://www.medpagetoday.com/nephrology/kidneytransplantation/82071?

 Americans’ struggles with medical bills are a foreign concept in other countries
By NOAM N. LEVEY - LA Times - September 12, 2019
https://lat.ms/2kJqbPN
GORINCHEM, Netherlands —  In France, a visit to the doctor typically costs the equivalent of $1.12.
A night in a German hospital costs a patient roughly $11.
And in the Netherlands — one of the few wealthy nations other than the U.S. where patients face a deductible — insurers usually must cover all medical care after the first 385 euros, roughly $431.
Healthcare in the U.S. has long been unique. But few things so starkly set the American system apart as how much patients pay out of pocket for medical care, even if they have insurance.
“The U.S. likes to see itself on par with other high-income countries,” said Jonathan Cylus, a former economist at the Department of Health and Human Services who now studies patient costs internationally at the World Health Organization and European Observatory in London. “The truth is, it’s a real outlier.”
Nearly all of America’s global competitors — whether they have government health plans, such as Britain and Canada, or rely on private insurers, such as Germany and the Netherlands — strictly limit out-of-pocket costs.
So while tens of millions of insured Americans must balance medical bills with spending on food and other basic needs, such trade-offs are largely unthinkable for patients in Western Europe, Japan and Australia, a Times examination of international health insurance systems shows.
“We only have to worry about getting well,” said Pieter Piers, a 57-year-old Dutch engineer who was talking with his family doctor earlier this year about work-related stress in Gorinchem, a walled city in the table-flat farmland of southern Netherlands.
“If I had to worry about how to pay for it all, I don’t think that would be very helpful for getting better,” said Piers, one of dozens of patients and physicians worldwide interviewed for this story, including at clinics and hospitals in Germany, Britain and the Netherlands.
The Netherlands, like many wealthy countries, mandates that visits with primary care doctors are free so patients won’t be discouraged from seeking care.
By contrast, as deductibles in job-based health plans in the U.S. have more than tripled in the last decade, half of Americans who have coverage through an employer say they or close family members have put off going to the doctor or filling a prescription because of cost in the last year, according to a nationwide survey conducted for this project by The Times and the nonprofit Kaiser Family Foundation.
One in six covered workers has had to make a difficult sacrifice in the previous year, including taking on extra work or cutting back on food, clothing or other essentials, the poll found.
In the Netherlands, just 1 in 90 households faces catastrophic health spending that competes with necessities such as food and housing, a recent World Health Organization analysis of patient spending in three dozen countries found.
In Ireland, Great Britain, Sweden, France, Germany and Japan, fewer than 1 in 35 households had medical bills that threatened their financial security.
The financial struggles of American patients have prompted renewed calls by some Democrats for a government-run, single-payer system, or “Medicare for all,” as it is sometimes called.
But the experiences of other wealthy nations suggest that strict limits on how much patients must pay and tight regulation of prices are more consequential than whether health coverage is provided directly by the government or through private insurers.
“There isn’t one system that works,” said Thomas Rice, a UCLA health economist who is writing a textbook about health insurance systems around the world. “Lots of different kinds of systems can protect patients from high costs.”
In the United Kingdom, care “free at the point of service” was a founding principle of the National Health Service when it was established after World War II to give Britons affordable healthcare “in place of fear,” as health minister Aneurin Bevan explained at the time.
Patients in the National Health Service usually face no medical bills when they go to the doctor or hospital. Co-pays for prescription drugs are capped at the equivalent of about $12, no matter how expensive the medication.



All hospital care in Australia is similarly covered at no cost for patients, who are protected by a government health plan known there as Medicare. The same is true in Canada.
In Germany, which relies on regulated private health plans, all physician visits are free for patients. Medication co-pays are capped at 10 euros, or about $11.
And Dutch primary care visits have long been cost-free, despite the deductibles for other medical services.
“A very important value in the Netherlands is equity,” said Dr. Jako Burgers, a family physician in Gorinchem who also helps develop clinical guidelines for the Dutch system. “We don’t want a system that benefits the rich more than the poor.”
In the U.S., health insurers can require patients in an individual plan to pay up to $7,900 out of their own pockets before care is covered in full. One in four workers has a deductible of $2,000 or more, according to an annual Kaiser Family Foundation survey.
That kind of cost-sharing would never be tolerated in Germany, said Dr. Markus Frick, a senior official at that country’s leading pharmaceutical industry group, the VfA. “If any German politician proposed high deductibles, he or she would be run out of town,” Frick said.
In Australia, a recent proposal to establish the equivalent of a $5 co-pay for primary care visits fueled such an outcry that the federal government was forced to withdraw the idea.
And in the Netherlands, the government is under mounting pressure to reduce deductibles, which many there believe are too high.
In the U.S., health plans with lower deductibles typically have much higher premiums.
But other wealthy nations, in addition to limiting patients’ out-of-pocket costs, also strictly control the cost of health insurance.
Residents of many countries — including Britain, Australia and Canada — pay no premiums because basic health insurance is financed through taxes, though residents can buy supplemental coverage on their own. In Germany and Japan, a set percentage of workers’ wages is deducted for health insurance, making premiums less expensive for lower-wage workers.
“I don’t think about any costs,” Dorota Langner, a German massage therapist who had pancreatic cancer, said after meeting with her oncologist at a hospital in Berlin earlier this year.
Langner, 41, a single mother, had other worries, including what would happen to her two teenage children. “I don’t know what I’d do if I also had to think about what this would cost me,” she said.
Langner died a few months later.
Keeping insurance premiums and medical bills in check has helped keep overall healthcare spending far lower in most wealthy countries than in the U.S.
Last year, for example, America’s total healthcare tab, including spending on government programs, private health insurance and patients’ out-of-pocket costs, exceeded $10,000 per person, according to government data. That was more than twice what governments, insurers and patients in the Netherlands, Canada, France and the United Kingdom spent and almost twice Germany’s tab.
Controlling costs has sometimes required trade-offs.
Hospitals in Britain, for example, can be overcrowded and in need of renovation. In some, patients must share a room with six or more other patients.
In Canada, patients can face substantial delays for care, with 18% reporting having to wait four months or longer for an elective, nonemergency surgery, compared with just 4% in the U.S., according to a recent international survey conducted by the Commonwealth Fund, a New York-based foundation that studies international health systems.
Evidence suggests that some medical care in the U.S., particularly in hospitals, may be better, as well.
For example, American patients are less likely to die after being hospitalized following a heart attack than are those in most wealthy countries, data show.
However, Australia and Sweden top the U.S. on this measure of cardiac care. Wait times in Germany or France are shorter than in the U.S.
And measures of the overall quality of healthcare place the U.S. near the bottom. Americans are far more likely to die prematurely from diseases that could be treated with timely, high-quality care, such as diabetes, childhood measles and some cancers.
The death rate from these avoidable conditions is more than 30% higher in America than in the United Kingdom and Germany, and nearly twice as high as in Australia, France and Norway, according to an analysis by the European Observatory on Health Systems and Policies, a partnership of international health researchers.
Beyond better health outcomes, residents of most other wealthy countries simply enjoy more peace of mind.
In south London, Chris and Afii Marshall, who had taken their 2-year-old daughter to the emergency room at King’s College Hospital after she cut her lip playing, shuddered at the thought of what they might pay in the U.S.
“I’ve heard stories. It’s terrifying,” said Chris Marshall, noting that he’s had many retail jobs that in America would likely come with high-deductible coverage. “I’d be very, very worried.”
The Marshalls faced no bills for their visit in Britain.
The United Kingdom — like most wealthy nations — keeps patients’ costs in check by tightly regulating the prices that doctors, hospitals and drug companies can charge.
Government regulation of prices has been done for decades in the U.S. by Medicare, which has a fee schedule for most physician and hospital services.
However, this kind of price regulation is rare in commercial health insurance, where most working Americans get coverage.
Instead, individual insurance companies negotiate prices with hospitals and physicians and drug makers. Under this system, prices for medical services and prescription drugs in the U.S. far outpace prices in other countries.
A month’s supply of the popular arthritis drug Humira, for example, tops $2,505 on average in the U.S., according to a 2015 analysis by Bloomberg News and research firms SSR Health and IHS Inc.
In Britain, where the National Health Service sets prices, the drug costs $1,180. In Japan, the monthly price is just $980.
Physicians’ services and hospital care are also far pricier in the U.S., data show.
A knee replacement that costs more than $28,000 on average here costs about $18,000 in Britain and less than $16,000 in Australia, according to 2015 figures collected by the London-based International Federation of Health Plans.
The average price for heart bypass surgery tops $78,000 in the U.S. The same procedure costs less than $29,000 in Australia and $24,000 in Britain.
When medical and pharmaceutical prices are high, insurers pass the costs on to patients. That has fueled higher premiums and, in more recent years, skyrocketing deductibles.
“People may not make the connection, but what’s coming out of their pockets is the result of a failure to control prices,” said Dr. Eric Schneider, senior vice president of the Commonwealth Fund.
“What other countries have learned is that without some form of price regulation, there is no effective check on prices.”
https://www.latimes.com/politics/story/2019-09-11/american-struggle-insurance-deductibles-unique




 Does Anyone Really ‘Love’ Their Private Health Insurance?

I am alive today not because of insurance companies but despite them.
Twenty minutes after I learned I had Type 1 diabetes — after narrowly avoiding a diabetic coma — a nurse pulled my parents away from my bedside and urged them to call our insurance company immediately. If they didn’t call right away, she warned, insurance would not cover the stay. At that moment — now 10 years ago — my parents had to choose whether to comfort their sick and frightened 14-year-old daughter, or spend hours on the phone with our insurer. Of course, they left me to make those calls, and my nightmarish relationship with the insurance industry began.
Type 1 diabetes is an autoimmune disease that destroys the body’s ability to produce insulin or maintain normal blood-sugar levels. There are no days off from this illness. Without careful monitoring and daily insulin injections, Type 1 diabetics risk blindness, kidney failure and death.
On top of the full-time job of monitoring blood sugar, American diabetics and their families have to work a second shift fighting insurance companies to cover their care. Even though my parents had insurance and both worked multiple jobs, the hospital bills, insulin and supplies drove them into debt, forcing them to forgo insurance, and medical care, for themselves.
When I turned 19, I was kicked off my parents’ plan. I took out thousands of dollars in extra student loans to buy insulin and diabetes supplies. After the Affordable Care Act passed, I was able to regain insurance, a high-deductible plan that cost me hundreds of dollars for each doctor’s visit and insulin refill.
So when I hear politicians talk about how much Americans love their private health insurance, I think: Really?
I am alive today not because of insurance companies but despite them. My insulin refills have been delayed countless times, not because of medical reasons, but because of what seem to be arbitrary insurance limits and requirements to continuously document my condition, which is permanent. Once, my insulin refill was delayed so long that I ran out, just when the insurance office closed for a three-day weekend. I was a student, away from home, with no other way to pay for my prescription. Terrified, I rushed to the pharmacy in tears. The pharmacist took pity on me and slipped me a vial of insulin without charge, saving my life.
The worst part about my story is that it isn’t unique, at least not in this country. Young adults with Type 1 diabetes suffer life-threatening diabetic ketoacidosis — a complication caused by insufficient insulin — at much higher rates in the United States than in Canada. Canada’s single-payer system provides seamless, lifelong coverage. But in the United States, diabetics must wage war with insurance companies to get the care we need, if we have insurance at all.
I’m glad that politicians are finally talking about health care reform. But those who only want to “protect” the Affordable Care Act or add a public option to our already byzantine mix of private and public plans are missing the point. Americans don’t “love” their private insurance, as many of them claim. They’re grateful for any coverage at all. Americans love their doctors, nurses and pharmacists, because those are the people who save our lives.
What diabetics — and all Americans — need is care that is lifelong and portable, covers all medically necessary services and drugs, and is accepted by all doctors and hospitals. Only a single-payer version of “Medicare for all,” in which care is publicly funded by one entity and privately delivered, would guarantee coverage to everyone in the United States, and eliminate the greed and administrative waste of private insurance.
It has been 10 years since my diabetes was diagnosed. I can’t help but think about the doctors and nurses who cared for me with such skill, my parents who sacrificed their needs for mine and the pharmacist who kindly slipped me that vial of insulin. I’m alive today because of them.
Will I have to live the next 10 years holding my breath through every doctor’s visit, praying that insurance will approve my medication, and in time? Will I ever be able to stop my endless fights with insurance middlemen? I know I’ll never live a day without worrying about my health. But maybe one day I, and millions of other diabetics in America, can live without worrying about how to pay for it.
Rachel Madley, a Ph.D. student at Columbia University Medical Center, is a student board member of the New York chapter of Physicians for a National Health Program.
https://www.nytimes.com/2019/09/17/opinion/insulin-prices-diabetics.html?eType=EmailBlastContent&eId=cff05c06-bc52-4df7-9fee-edc87beb983b


 

 

 

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