We can afford Medicare for All…
… and it could even deliver a huge pay raise to the middle class.
By EMMANUEL SAEZ and GABRIEL ZUCMAN - Politico - November 25, 2019
The current debate over "Medicare for All" anxiously asks “ How are we going to afford paying for health care?” But of course, we’re already paying for health care. The true question should be: “ Who should pay for health care?”
Our research shows that when you look at health care costs as a distribution problem, it becomes clear that not only can we afford Medicare for All, but a properly designed transition to Medicare for All could deliver the biggest pay raise in a generation to middle-class workers.
To understand why, it’s worth reviewing how health care is currently funded in the United States. American workers who don’t qualify for Medicare or Medicaid almost always get their insurance through an employer. The average cost of employer-sponsored health insurance is $13,000 a year per covered worker and this cost is growing fast. That adds up to roughly $1 trillion a year.
Our research shows that when you look at health care costs as a distribution problem, it becomes clear that not only can we afford Medicare for All, but a properly designed transition to Medicare for All could deliver the biggest pay raise in a generation to middle-class workers.
To understand why, it’s worth reviewing how health care is currently funded in the United States. American workers who don’t qualify for Medicare or Medicaid almost always get their insurance through an employer. The average cost of employer-sponsored health insurance is $13,000 a year per covered worker and this cost is growing fast. That adds up to roughly $1 trillion a year.
Since the
passage of the Affordable Care Act, it is mandatory for all employers
with more than 50 full-time workers to provide health insurance to their
full-time employees; employers that don’t provide insurance have to pay
a fine. The government has in effect washed its hands of the
responsibility of providing health insurance to workers, and instead
forces employers to manage this growing cost.
Premiums depress wages
Formally,
employers pay about 70 percent of insurance premiums and workers the
remaining 30 percent. But in practice, workers are paying the whole
thing. The costs might seem invisible to workers, but in fact their
health benefits are reducing their take-home pay every week. Why?
Because for an employer, what matters is the total cost of employing
someone. This cost includes salary but also benefits such as health
insurance. If an employer believes your work is worth $50,000 to the
company but has to pay $13,000 for your health care, your salary is
going to be no more than $37,000.
They
also reduce wages in a particularly unfair way: Because health
insurance premiums are fixed, the wage penalty is the same for a
low-wage secretary as it is for a highly paid executive. This severely
depresses wages for tens of millions of moderate-income workers. When
you hear that average hourly earnings of (nonsupervisory) American
workers have stagnated
since the late 1970s in spite of a growing economy, keep in mind that’s
in part because growing health care costs are devouring an increasing
share of what workers would otherwise be paid. Given the fast growth of
health care costs, this situation is not sustainable.
The
system is opaque enough that workers can’t see such costs clearly, but
they aren’t completely hidden. Health care costs are sometimes visible
on your pay slip as the “employer contribution to medical insurance.”
The full cost of employer and employee premiums is also usually reported
on the W-2 form that you use to file your income taxes. Take a look at
box 12, code DD, and see how staggering the amounts are—typically the
amount exceeds $10,000 in a year, and it can exceed $20,000 if your
insurance covers family members. This is compensation for your work that
you never see in your bank account, and you don’t have much choice, let
alone the option to take the money as wages rather than health
insurance.
Economically, insurance premiums are effectively the same as a tax on
labor—a tax administered by employers. What makes this tax stand out is
that it’s a so-called head tax, unrelated to ability to pay. It’s the
most unfair type of tax: A huge burden for low-wage workers and almost
meaningless for the rich. Head taxes (sometimes called poll taxes) used
to be popular centuries ago but have long fallen out of fashion. (When
Margaret Thatcher tried to impose a head tax in 1988 to replace real
estate property taxes in the United Kingdom, she faced an unprecedented
revolt and was ousted from office in 1990.)
No government would out-of-the-blue impose a head tax to fund health care; it would be a crushing burden on the working and middle classes. And yet in essence that’s what the U.S. government does today by mandating that employers manage a huge head tax to fund health insurance for workers.
When politicians urgently debate the tax burden on the middle class, they rarely point out that the system is already unfairly built on the backs of the middle class — and it’s our health care premiums that make it that way.
No government would out-of-the-blue impose a head tax to fund health care; it would be a crushing burden on the working and middle classes. And yet in essence that’s what the U.S. government does today by mandating that employers manage a huge head tax to fund health insurance for workers.
Middle class bearing the burden
If you see the health system this way, it changes how you understand the entire U.S. tax system. Many people believe that the United States has what’s known as a progressive tax system, in which you pay more, as a fraction of your income, as you earn more. It’s true that income taxes are for the most part designed that way, but when you add all the various tax burdens together, the reality is different. And if you add mandatory private health insurance premiums to the official tax take, the U.S. tax system turns out to be highly regressive. Once private health insurance is factored in, the average tax rate rises from a bit less than 30 percent at the bottom of the income distribution, reaches close to 40 percent for the middle class, and collapses to 23 percent for billionaires.When politicians urgently debate the tax burden on the middle class, they rarely point out that the system is already unfairly built on the backs of the middle class — and it’s our health care premiums that make it that way.
The
solution to this mess is simple: The head tax currently paid by workers
in the form of mandatory premiums should be replaced by actual, normal
taxes based on ability to pay. If employer-sponsored health insurance
premiums were transformed into wages, that’s a $13,000 pay increase that
each covered worker would get on average, the biggest pay raise in a
generation, and one that is long overdue.
Of
course, taxes would then have to increase to fund Medicare for All. But
they could, and should, look very different than the hidden tax they’re
replacing. It would be possible to structure the new taxes so that all
workers below a high wage threshold would pay less in taxes than what
they would get in extra wages once those were returned to their
paychecks – and the government could still raise the same $1 trillion in
revenue. Any form of taxation (be it a payroll tax, an individual
income tax, a corporate tax, a wealth tax, or a mix of these) would do,
since all these taxes are much less regressive than the current health
insurance premiums.
Will employers pocket the savings?
One
crucial aspect of the transition to Medicare for All has not received
enough attention so far: Once employers no longer have to pay for health
benefits, how do we make sure they don’t abuse the system, keeping
wages the same and pocketing the difference?
To
address this problem, the government should legislate the conversion of
employer health care premiums into a permanent wage increase at the
time of the transition to Medicare for All. From the point of view of
employers, this conversion would be neutral: for them, the cost of each
worker would not change. Because health insurance premiums are already
reported on W-2 forms and pay slips, this wage increase would be easy to
enforce and monitor. Firms that try to pocket the premiums instead of
boosting wages could be fined.
The current funding of health care in the U.S., which imposes a mammoth burden on moderate-income workers, is not sustainable. There is broad agreement that everybody should have access to health care—just like all children should have access to education. Given the enormous costs—there’s no cheap way to treat heart attacks, cure cancers, or give birth—low-income families cannot afford health care on their own. The U.S. spends approximately $10,000 on health care per person per year; it is impossible for workers with low salaries to spend $10,000 per family member. Other wealthy countries have understood this basic truth long ago and fund universal health insurance through taxes that are based on ability to pay.
The key question, in the U.S. context, is how to conduct a successful transition to universal public health insurance that redistributes the burden of paying for health care. Do it fast or do it slow, the big picture is this: Fixing the injustice of our current health care funding system is possible and in fact straightforward. And if it came with a law mandating the conversion of premiums into wages, it would deliver the biggest pay raise in a generation to American workers.
https://www.politico.com/news/agenda/2019/11/25/agenda-can-we-afford-medicare-for-all-071560
Warren Has the Remedy for Health Costs
by Simon Johnson - MIT - November, 2019
Her Medicare for All proposal would be a boon to all businesses, and especially to entrepreneurs.
Simon Johnson, The Wall Street Journal, Dec. 1, 2019 2:46 pm ET. https://on.wsj.com/2RiIzge
A millstone hangs around the neck of every company in America, and this dead weight gets heavier each year. Americans currently spend nearly 18% of gross domestic product on health care, with some projections suggesting this will reach 21% by 2027 before continuing to rise. Since the 1970s the U.S. has failed to control the cost of care, and a great deal of this burden falls directly on companies and new entrepreneurs. These costs undermine competitiveness and make it harder to create jobs and pay decent wages.
The health-care burden hurts American business in three main ways. First, there is the onerous contribution most companies are required to make through employer-sponsored insurance. Every business owner wants employees and their families to have health insurance, but the cost rises inexorably. Mandatory employer coverage is like a tax on businesses, with a major difference that private insurance companies take a cut of the revenue. Under current law, firms with more than 50 employees must either offer employer-sponsored coverage or pay a fine—so in effect the government forces employers to pay private insurers.
Second, companies cannot by themselves easily constrain health-insurance premiums. They need healthy workers who are not ruined financially when a family member is rushed to the emergency room. In most competitive markets across the U.S., if an employer cuts back on health benefits (or raises deductibles, copays or out-of-pocket expenses), it raises the burden on employees and increases the risk that the best will leave.
Third, the unpredictable nature of health-care costs makes it significantly harder to start and run a company. Every year, entrepreneurs and managers hold their breath while insurance companies decide what to charge them. The Affordable Care Act slowed the growth of medical costs—for a while. But under the Trump administration, health-care sector mergers (such as Cigna-Express Scripts, CVS-Aetna and Optum-DaVita) have effectively reduced competition and increased pricing power.
To address this triple threat, Republicans have tried to make the health-care system more “competitive.” But the competition they seek has failed to constrain costs. Rather, it has created an incredibly opaque price system with powerful players grabbing excess profits at every opportunity—the main reason medical care in America costs so much more (relative to income) than it does in any comparable country. The Republican approach is a recipe for human and economic disaster.
Some Democrats propose to restrain the price of health-care to consumers by adjusting the Affordable Care Act in a modest fashion, such as by adding a public option. This has short-term appeal but would not address the deeper long-term problem: the rising underlying cost of care, which private insurance companies have consistently failed to bring under control. None of the proposals for partial reforms—such as those proposed by presidential candidates Joe Biden and Pete Buttigieg—would be likely to lower costs relative to the current law’s baseline.
By contrast, Sen. Elizabeth Warren’s Medicare for All plan would cut costs by reducing inefficiency, eliminating predatory pricing (for example, for prescription drugs) and using the purchasing power of a single-payer system. Her plan would also constrain the growth rate of underlying medical costs. This is exactly what America’s peer countries do to keep costs under control. U.S. companies consequently struggle to stay competitive in international markets. If health-care costs continue to grow unchecked, America’s businesses will be ruined.
Under the Warren plan, national health expenditures over the next 10 years would be about the same as projected under current law. Yet more people would be covered, and with better insurance, improving the health of the nation. Costs would drop immediately and then grow more slowly over the coming decade and beyond.
The Warren plan has other major benefits for businesses. Americans are currently expected, according to the Urban Institute and the Centers for Medicare and Medicaid Services, to pay around $11 trillion out-of-pocket over the next 10 years toward the cost of health care, including premiums, copays, deductibles and other expenses not covered by insurance. Under the Warren plan, that amount would drop nearly to zero, returning those trillions to working families. Much of the savings would be spent on goods and services that Americans would be buying if not for the draining cost of health care.
At the same time, American companies would receive an immediate cut to their cost of hiring workers. Large employers would spend 2% less on coverage with the Warren plan than under current law. New small businesses would pay zero.
How would Sen. Warren finance her plan? The largest and most profitable American companies would finally pay a fair (and internationally competitive) level of taxation, and tax rates would rise for the ultrawealthy—particularly billionaires, but also most people in the top 1%. Tax avoidance by rich people and large multinational corporations has eaten away at the heart of America—metaphorically, and because it undermines our ability to finance a robust health-care system, literally. Avoidance would be lowered toward the level more common in prosperous West European countries.
Sen. Warren’s proposal would help control future costs for all businesses, enabling small and large companies to hire more people and pay higher wages. Lower-income people would have a lot more money to spend, while the rich will hardly notice the difference. The plan would also close tax loopholes to help level the playing field between big businesses and their small and medium-size competitors. Small firms face a straightforward tax process, while large ones too often dodge their burden through complex international strategies.
In short, if you manage to lower health-care costs, you solve the problem. The Warren plan does that.
Mr. Johnson is a professor of entrepreneurship at the MIT Sloan School of Management and an informal adviser to the Warren campaign.
The Army Built to Fight ‘Medicare for All’
The top health industry lobbies
have joined forces to take down socialized medicine — or anything that
looks like it. Will they succeed?
by Adam Cancryn - Politico - November 25, 2109
Chip Kahn took one look at the scene playing out inside
the stately Hart Senate Office Building and knew he needed to do
something about it.
It was mid-September 2017 and Sen. Bernie Sanders had just ascended a stage to the cheers of more than a hundred health care activists, grassroots organizers and political supporters. The packed hearing room had played host to some of the most solemn moments in Washington's modern history: the crafting of a landmark missile treaty with the Soviet Union, the investigation of the 9/11 terror attacks, the consideration of at least five Supreme Court nominees.
On this day, it had been transformed into a staging ground for the first stop in Sanders' latest political crusade. Standing in front of a bright blue HEALTHCARE IS A RIGHT banner tacked to the back wall, Sanders heralded the renewal of a "long and difficult struggle" to fulfill the liberal dream he'd pursued for decades: “Medicare for All.”
It was mid-September 2017 and Sen. Bernie Sanders had just ascended a stage to the cheers of more than a hundred health care activists, grassroots organizers and political supporters. The packed hearing room had played host to some of the most solemn moments in Washington's modern history: the crafting of a landmark missile treaty with the Soviet Union, the investigation of the 9/11 terror attacks, the consideration of at least five Supreme Court nominees.
On this day, it had been transformed into a staging ground for the first stop in Sanders' latest political crusade. Standing in front of a bright blue HEALTHCARE IS A RIGHT banner tacked to the back wall, Sanders heralded the renewal of a "long and difficult struggle" to fulfill the liberal dream he'd pursued for decades: “Medicare for All.”
The speech was classic Bernie, full of grand visions for a
universal health care system at the expense of greedy corporate
executives getting rich off the status quo. For Kahn, the CEO of the
Federation of American Hospitals, which represents more than 1,000
for-profit hospitals, it wasn't so much the rhetoric that bothered him,
despite the fact that he — as head of one of the nation's most powerful
hospital lobbies — was one of the corporate executives in Sanders'
crosshairs. A 67-year-old former GOP operative who'd worked in and
around politics since high school, Kahn was familiar with the Vermont
senator's lengthy, mostly solitary campaign for single-payer health
care.
What he couldn't ignore this time was the group right behind Sanders. Nine Democratic senators, many of them rising stars and likely presidential candidates, stood on stage to pledge their support for Medicare for All — a proposal that would obliterate the private health insurance sector, reorder one-sixth of the nation's economy and jeopardize a system Kahn and his industry allies had worked so hard to construct.
What he couldn't ignore this time was the group right behind Sanders. Nine Democratic senators, many of them rising stars and likely presidential candidates, stood on stage to pledge their support for Medicare for All — a proposal that would obliterate the private health insurance sector, reorder one-sixth of the nation's economy and jeopardize a system Kahn and his industry allies had worked so hard to construct.
Democrats
were less than a decade removed from passage of the Affordable Care Act,
the most significant health care legislation in a half-century. The
fight over how to shape, implement and ultimately rescue it had cost the
industry millions of dollars in time and effort, and exacted a steep
political price. But hospitals across America had now largely adapted to
the new landscape the law had established—and now, Kahn recalled
thinking at the time, politicians wanted to go out and do it all again?
"The Democratic Party had this … amnesia,"
Kahn said in a recent interview, searching for the right word to
express the disbelief he still feels many months later. "That set off
alarm bells."
As recently as a
year earlier, Medicare for All was little more than a progressive pipe
dream, a policy proposal dismissed in most Democratic circles as pure
fantasy. Yet suddenly it had leaped from the fringes into the center of
the conversation, urged on by the party's progressive base and
increasingly embraced by leading Democrats.
With
the images of that Sanders event replaying in his head, Kahn made a
phone call — and then, over the next few weeks, another and another.
Those calls would lead to a series of secretive meetings in downtown
D.C. where officials from every part of the health care industry — from
insurance companies to hospital giants, drugmakers and even, for a time,
doctors — would forge an alliance united to ensure that Sanders’
promises never became reality.
Out
of their pact grew an influence operation known today as the
Partnership for America's Health Care Future, a multimillion-dollar
cooperative designed to overwhelm not just the swelling Medicare for All
movement, but every single Democratic proposal that would significantly
expand the government's role in health care.
Its
core conviction: Right now, things aren't actually that bad. Nine in 10
people have health coverage, insurance premiums are stabilizing and the
system is working better than ever for the vast majority of the
country. What Americans need now is a Washington willing to tinker and
to shore up Obamacare's weak points, not take a sledgehammer to the
entire structure.
"The
reason for the invention of the Partnership was that the Democratic
Party was forgetting what it had done and, in our view, going off on a
tangent that would shake everything up if they ever really got power,"
Kahn said. "In this country, incremental change, and pragmatic change,
has always been the style."
Health care’s warring tribes
Like
most blandly named coalitions in a town bursting with them, the
Partnership is a vehicle for funneling the money and missions of a set
of disparate organizations with just enough in common to make nice with
each other against a common threat.
Though
the health care industry is often seen as a single broad entity, in
Washington it's in fact more like an assortment of warring tribes
competing to secure the biggest slice of the nation's $3.6 trillion in
annual health spending. Hospitals and doctors, for example, spent tens
of millions of dollars this year fighting the insurance industry to a
stalemate over who should pick up the tab for surprise medical bills.
At
the same time, hospitals are playing defense against the pharmaceutical
industry over an obscure-yet-lucrative discount drug program that
allows them to purchase medicines at a steep markdown — ostensibly to
aid low-income and underserved patients, yet with little accountability
for where it directs the billions in annual savings. The pharmaceutical
industry, meanwhile, is at odds with nearly everyone over the rising
cost of drugs, combating separate efforts by Democrats in Congress,
Senate Republicans and the Trump administration to rein in prices — all
while trying to shift blame back onto the insurers and pharmacy benefit
manager middlemen it argues are the real culprits.
Even
in a town with more than 20 lobbyists for every member of Congress, the
corporate health care army is outsized; health care companies spent
nearly $568 million on lobbying in 2018 alone, according
to the Center for Responsive Politics, more than any other industry.
For the past four years, its spending has topped a half-billion dollars.
With so much lobbying power often
aimed in opposite directions, big changes to America's health care
system are already few and far between. But when it came to Medicare for
All — a proposal that would upset the business model of every part of
the health care industry at once — Kahn realized a more unified front
was needed. He would have to broker a ceasefire.
At first glance, the timing was odd. Kahn and his private-sector
colleagues had only weeks earlier received perhaps the best news of
their year: Republicans' bid to dismantle the ACA without any clear plan
for replacing it had suddenly collapsed.
The health care lobby had initially regarded Obamacare with varying levels of disdain and even alarm, yet mostly ended up embracing the law, due largely to the financial incentives President Barack Obama dangled in front of it. Obamacare contained sweeteners for hospitals and insurers by covering more poor patients and expanding the private insurance market, and it mostly left the drug industry alone, declining to impose strict new restraints on the rising price of medicines. Republicans' effort to eliminate Obamacare threatened to hurl that carefully crafted system into chaos, and the health care lobby threw its collective might into saving the law, and prevailed.
Still, as the health care world celebrated its victory over the GOP's repeal attempt in the late summer of 2017, Kahn couldn't help but notice the energy and fury building on the other side of the aisle — the growing sentiment within the Democratic base that Obamacare hadn’t gone nearly far enough, and the only way to secure its gains was with something more radical. And from Kahn's perspective, if repealing Obamacare was bad for business, Medicare for All represented an existential danger.
The health care lobby had initially regarded Obamacare with varying levels of disdain and even alarm, yet mostly ended up embracing the law, due largely to the financial incentives President Barack Obama dangled in front of it. Obamacare contained sweeteners for hospitals and insurers by covering more poor patients and expanding the private insurance market, and it mostly left the drug industry alone, declining to impose strict new restraints on the rising price of medicines. Republicans' effort to eliminate Obamacare threatened to hurl that carefully crafted system into chaos, and the health care lobby threw its collective might into saving the law, and prevailed.
Still, as the health care world celebrated its victory over the GOP's repeal attempt in the late summer of 2017, Kahn couldn't help but notice the energy and fury building on the other side of the aisle — the growing sentiment within the Democratic base that Obamacare hadn’t gone nearly far enough, and the only way to secure its gains was with something more radical. And from Kahn's perspective, if repealing Obamacare was bad for business, Medicare for All represented an existential danger.
"There was
a centrifugal force taking place," Kahn recalled. "Just as the
Republican Party was pushing further and further to the right, that
centrifugal force was pushing the Democratic Party further and further
to the left."
That newfound
liberal momentum needed a counterweight, he added, something that could
forcefully remind Democrats that their alternative to Republican repeal
and replace -- and the best pathway toward universal health coverage --
was staring them right in the face. Better yet, it was already the law
of the land. "You've achieved the framework you wanted to achieve as a
party," Kahn said of Obamacare. "Now let's just make it work."
‘Everybody saw the threat’
Kahn's
broad coalition would be a rare collaboration in Washington lobbying's
ultracompetitive culture, and it took some months to coax his chief
rivals on board. There were negotiations over who would control the
group and set its principles, coalition members present at the time
said, and importantly, how it would remain isolated from the groups'
individual policy agendas.
"One of
the ground rules we agreed upon early on," said David Merritt, a
participant on behalf of insurer lobby AHIP, "was you're not going to
bring your baggage to this coalition."
But
the hypothesis at the group's core — that without organized pushback,
Medicare for All represented a real and imminent threat to survival —
was never in dispute.
Under
Sanders' single-payer plan, private health insurance — a $670 billion
business — would cease to exist. Hospitals, no longer able to strong arm
private insurers into paying far higher rates for care than the federal
government, could lose billions. And drug companies would face fresh
scrutiny and regulation of pricing practices that have allowed the cost
of medicines to skyrocket.
"Everyone
saw the threat," said one lobbyist involved in the early discussions.
"You didn't have to convince anybody that this was a problem."
The
Partnership officially launched in June 2018 with five founding
members: Kahn's Federation of American Hospitals, AHIP and fellow
insurer lobby the Blue Cross Blue Shield Association, drug industry
giant PhRMA and the country's premier association of physicians, the
American Medical Association.
It's
since expanded at breakneck speed, signing up the influential American
Hospital Association and some of the nation's largest individual
hospital systems; biotech trade group BIO; the health care executive
roundtable Healthcare Leadership Council; and a series of trade
associations representing smaller slices of the industry like insurance
brokers and financial advisers, generic medicine manufacturers and
radiologists. Recently, the Partnership branched onto the state level,
adding local Chambers of Commerce, industry groups and private
companies.
In fact, by earlier this year, virtually every part of the health care industry was on board.
The
coalition's ambitions grew with its membership. Initially focused on
beating back the Medicare for All movement, the Partnership has since
expanded its efforts to oppose all major expansions of
government-financed health care.
The
industry still views single payer as the doomsday scenario. But by
early 2019, it'd become far from the only worrying possibility, as
prominent Democrats floated all manner of routes to universal health
care. The problem: each achieved their goal in roughly the same way — by
having the federal government annex broad swaths of the private
insurance market, either by creating a competing public option or
expanding the existing Medicaid or Medicare programs deeper into the
private sector's territory.
Those
plans might sound more palatable to the ordinary American, but to
Partnership members it still meant fewer customers, lower pay rates and a
new, unnecessary regime of profit-pressuring regulations. So as each
2020 presidential contender rolls out their own signature take on an
overhaul, the response from the Partnership has been loud and
unflinching: No.
"The politicians
may call it Medicare for All, Medicare buy-in, or the public option,"
reads an ad run by the Partnership during September's Democratic
presidential debate. "But they mean the same thing."
Defending a lucrative status quo
The
Partnership received $5.1 million in 2018, during its first six months
of existence, according to newly filed disclosures — a period that by
several members' admission was something of a test run for the
coalition. Its current budget remains closely guarded, but members point
to the clear ramp-up in activity nationwide this year, a suggestion its
spending has grown noticeably. Kahn said only that the Partnership is
prepared to spend "many millions."
Measured
by sheer size and the financial resources backing it, that would make
the Partnership the most formidable source of focused resistance to 2020
Democrats' health plans outside of the Trump reelection campaign.
And
they have a lot to protect. The current health care setup is good
business for many of the companies represented by those in the
coalition. Insurance industry profits ballooned to $23.4 billion in
2018, up from $10 billion a year before Obamacare went into full effect
in 2014. The hospital industry has consolidated, vacuuming up physicians
and strengthening the nation's largest systems' abilities to negotiate
higher rates for care, even as enrollment gains mean they're treating
fewer uninsured Americans for free.
Kahn
is a veteran of Washington's health care wars, having spent more than
four decades in and around Capitol Hill; he’s played a role in every
major piece of health legislation during that time.
He
also has experience taking down ambitious plans for health care reform.
As executive vice president of the Health Insurance Association of
America — then the insurance industry's main trade group — he was a
driving force behind the "Harry and Louise" TV ads that played a key
role in tanking Bill Clinton's health care package in 1993 and setting
the standard for a generation of hard-hitting special interest campaigns
that have shaped policy debates ever since.
The
Harry and Louise ads — which featured a middle-aged couple in their
home, agonizing over the rising costs and fewer choices under what the
ads called Clinton's government-driven system — did little to shift
public opinion on their own, studies later showed.
But supplemented by grassroots pressure targeting key lawmakers, the
television spots and publicity surrounding them unnerved Congress and
helped tank support in Washington for Clinton's health plan within a
year.
"They weren't run
nationally, but the reporters covered them and showed them across the
country," Rep. Donna Shalala (D-Fla.), who was Clinton's Health and
Human Services secretary at the time, said of the ads. "It was earned
media."
The
Partnership is now deploying a similar playbook. Run out of a Washington
lobby shop and supported by a phalanx of consultants and political
operatives, it aims to simultaneously influence voters' perception of
Medicare for All and its offshoots, while amplifying doubts about the
plans' political viability for the Washington elite.
Outside
the Beltway, the Partnership pitches itself as a nonpartisan
educational resource on health care. Inside the Beltway, it provides a
constant reminder of the power players Democrats are up against if they
try for yet another health care overhaul.
The
message to both those audiences is simple: Health care reform will take
away Americans' "choice" and "control" and empower government
"bureaucrats" by forcing everyone into a "one-size-fits-all system."
(Medicare for All proponents would counter that few Americans have
choice or control now, since insurance is largely managed by their
employers, and health care decisions are currently made by insurance,
hospital and drug company bureaucrats with little transparency or
accountability.)
The group
bombards policymakers, journalists and voters with its talking points
daily, leaning heavily on digital platforms to reach specific
constituencies. Nearly $300,000 in the last year-and-a-half alone went
toward Twitter and Facebook messages targeting voters in swing states,
the primary battleground of Iowa and the lawmaker-heavy Washington area,
according to metrics made public by the social media companies.
Many of those ads feature a local citizen — Matthew Majestic in Macomb County, Mich., Lisa Smith
in White Stone, Va. — talking to the audience about government-run
insurance systems that will force Americans to "pay more to wait longer
for worse care." It's effectively Harry and Louise, if Harry and Louise
happened to be real people living in your community. Another several
hundred thousand dollars have gone toward similar TV spots, according to
filings with the Federal Communications Commission.
Much
of this messaging is aimed at eroding support for Medicare for All
specifically among Democrats, and the Partnership has leaned on
Democrats to make that case.
"You
can basically get up to 98 percent coverage through our current
structure," said Lauren Crawford Shaver, a former Obama health official
who is now the Partnership's executive director and runs its day-to-day
operations. "If you use the tools of the Affordable Care Act, if it was
fully implemented, you will get more people covered."
The
coalition's messages are built on extensive polling and research, and
produced with help from Bully Pulpit Interactive, a well-known ad firm
that works with the Democratic National Committee and until earlier this
year aided messaging for Sen. Elizabeth Warren's Senate campaign.
They're designed to emphasize that, while the status quo may not be
perfect, it's a safer bet than whatever might come next.
"Building
on what we have today and fixing what's broken, not starting over —
that earns the most support of any policy proposal," said Phillip
Morris, a former Obama field organizer and current partner at public
affairs firm Locust Street Group who runs tracking polls for the
Partnership.
To reinforce the point, the Partnership churns out reams of research
warning of shuttered hospitals, dwindling competition and major shifts
in employer-provided benefits under 2020 Democrats' proposals. Federal
lobbyists with ties to moderate Democrats encourage the party to keep
the focus on pre-existing condition protections and defending Obamacare —
issues that paid dividends during the 2018 midterm elections.
And the Partnership is in reporters' inboxes often multiple times a day, highlighting the latest articles and polls casting doubt on any big health care overhaul -- and offering rapid responses to whichever top Democrat happens to be pushing a universal coverage plan that day.
The overarching goal is to create a kind of anti-Medicare for All feedback loop, where the Partnership's warnings are amplified through so many sources that they become ingrained in the national consciousness and make it feel — in perception, and potentially in reality — like the debate is shifting.
"I don't think it's difficult to get Americans worried about health care," said Paul Starr, a Princeton professor who was a senior adviser on Clinton's health plan. "These groups can take advantage of that anxiety."
Two Washington lobbying powers, meanwhile, defected in the past year. The National Retail Foundation quietly dropped out amid its escalating feud with hospital and doctor groups over surprise billing legislation.
And the Partnership is in reporters' inboxes often multiple times a day, highlighting the latest articles and polls casting doubt on any big health care overhaul -- and offering rapid responses to whichever top Democrat happens to be pushing a universal coverage plan that day.
The overarching goal is to create a kind of anti-Medicare for All feedback loop, where the Partnership's warnings are amplified through so many sources that they become ingrained in the national consciousness and make it feel — in perception, and potentially in reality — like the debate is shifting.
"I don't think it's difficult to get Americans worried about health care," said Paul Starr, a Princeton professor who was a senior adviser on Clinton's health plan. "These groups can take advantage of that anxiety."
The doctors defect
The Partnership — as its critics are eager to point out — makes no claim to being a popular, up-from-the-ground movement. The biggest portion of its funding comes from a minority of its membership, and most of the 92 groups listed as Partnership members don't weigh in on its day-to-day strategy in any substantial way.Two Washington lobbying powers, meanwhile, defected in the past year. The National Retail Foundation quietly dropped out amid its escalating feud with hospital and doctor groups over surprise billing legislation.
Then in
August came the bigger blow: The American Medical Association, the
premier group representing the nation’s physicians and a founding
member, headed for the exits. Partnership members launched a series of
broadsides at the doctor group in the wake of its departure, with
multiple coalition members accusing it of caving to the liberal left.
The AMA
had come under pressure from more progressive factions within its
membership, and months earlier agreed to study the feasibility of a
public option. But it emphasized that the split was driven more by a
desire to focus more on what the industry supports and not just what
it's vehemently against — a contention that Kahn now says is accurate.
"They
wanted more specifics in terms of what the plan would be," he said.
"And I don't think we're in the plan business. I think we're in the
defending the law business."
Still,
it served as a reminder of the fragility of the industry's single-issue
truce. After a recent revamp, the Partnership's website now includes a
carefully worded section titled, "What we're for."
The
critical calculation for Medicare for All proponents and the
Partnership alike is whether, in the years since Harry and Louise,
Americans have grown more frustrated with the health care system's
shortcomings — its expensive premiums, insurance denials, surprise bills
and sky-high drug prices — than they are nervous about changing it.
The
concept of Medicare for All polls well, in general. Senior citizens
already benefiting from the government-run Medicare program
overwhelmingly approve of it, and a majority of Americans support
creating a single-payer system. Even more — about two-thirds of people —
are in favor of trying out a public option. Kaiser Family Foundation polling this month
found that Democrats and Democratic-leaning independents are most
likely to trust Sanders on health care over the other 2020 candidates.
But
in the two years since Sanders and his Democratic colleagues unveiled
his plan, polls suggest that anxiety has also steadily risen. Voter
support for Medicare for All narrowed from a high of 59 percent in March
2018 to 53 percent this month, according to Kaiser. High-profile
Democrats from Harry Reid to Nancy Pelosi to Barack Obama have warned
the party establishment about embracing another health care
transformation.
And of the four
2020 candidates who stood shoulder to shoulder with Sanders in 2017,
only one — Warren — is still running on single-payer health care.
The Partnership can't take all the credit. But it's reveling in the results.
"The
fact that Bernie Sanders was bothered about this," Kahn said when asked
how he's measuring the coalition's impact, pointing to a May op-ed
Sanders wrote railing against the group. "That says he's concerned
people are making other arguments out there to his voters that there
might be another way of looking at it."
The
Medicare for All movement's leaders make a similar case about the
Partnership. If the industry is training so much firepower on an effort
still a few years and several dozen votes short of reality, Rep. Pramila
Jayapal (D-Wash.) mused to reporters one October day, it must mean
proponents are doing something right.
A
leader of the Democrats' liberal wing and author of the House companion
to Sanders' Medicare for All bill, Jayapal was on her way to deliver
copies to various Democratic lawmakers' offices of a single-payer
petition backed by 2 million signatures and a number of advocacy groups.
It was one example, she contended, of how progressives are pushing back
on the entrenched health care lobbies in a more organized and powerful
way than ever before.
The Partnership, reform advocates argue, is evidence they've been successful enough to make the industry sweat.
"What's
lost often is the history of Medicare for All — Jimmy Carter ran on
this in 1976," said Rep. Ro Khanna (D-Calif.), the co-chair of Sanders'
campaign. "So why is it that over 50 years later we're still debating
it? Obviously, the special interests have been very effective."
"We're not up against an intellectual argument," he added. "We're up against interests."
Sitting
in his office one night earlier this fall, Kahn acknowledged that
things might be different this time around — that the liberal voices
within the Democratic Party are louder and more insistent, and that
centrism has lost its cachet. Increasingly, there is sentiment on both
sides of the aisle that the health care system no longer works, and the
only solution is to blow it up and start over.
Kahn has a harder time predicting what comes next. He knows that the industry has always wielded outsize influence over Washington's ambitions, whether in quelling the original single-payer effort 50 years ago, stalling Clinton's health plan or giving Obama's ACA a final shove over the finish line. And he believes that now, through the Partnership, industry is ready for the next fight. It has deep pockets and plenty of political sway. It's got a strategy that's time-tested and a simple message that works. And most important, Partnership members believe they can't afford to lose.
"We have threads that hold health care together," Kahn said, intertwining his fingers to represent the enmeshed interests of the health care industry. "If you just want to cut all those threads, I don't know what the outcome will be."
Why the Less Disruptive Health Care Option Could Be Plenty Disruptive
Democrats
like the “optional” part of the so-called public option. But the very
existence of new government insurance could shake up the system.
The single-payer health plans proposed by Senators Bernie
Sanders and Elizabeth Warren are often assailed as being too disruptive.
A government plan for everyone, the argument goes, would mean that tens
of millions of Americans would have to give up health insurance they
like.
Democratic presidential candidates with more moderate brands have their own proposal: a “public option” that would preserve the current private insurance market, while giving people the opportunity to choose government insurance.
Joe Biden, the candidate and former vice president, has gone as far as to say that “if you like your private insurance, you can keep it,” under his public-option proposal. Pete Buttigieg, the South Bend, Ind., mayor, has also embraced such a plan, which he calls “Medicare for all who want it.” His implication is that, if you don’t want it, there will be other choices.
A public option would be less disruptive than a plan that instantly eliminated private insurance. But a public option that is inexpensive and attractive could shake up the private market and also wind up erasing some current insurance arrangements. Conversely, a public option that is expensive and unattractive might not do much good at all.
Democratic presidential candidates with more moderate brands have their own proposal: a “public option” that would preserve the current private insurance market, while giving people the opportunity to choose government insurance.
Joe Biden, the candidate and former vice president, has gone as far as to say that “if you like your private insurance, you can keep it,” under his public-option proposal. Pete Buttigieg, the South Bend, Ind., mayor, has also embraced such a plan, which he calls “Medicare for all who want it.” His implication is that, if you don’t want it, there will be other choices.
A public option would be less disruptive than a plan that instantly eliminated private insurance. But a public option that is inexpensive and attractive could shake up the private market and also wind up erasing some current insurance arrangements. Conversely, a public option that is expensive and unattractive might not do much good at all.
“The
political appeal of the public option is it preserves the choice of
private insurance,” said Larry Levitt, a vice president at the Kaiser
Family Foundation. “But the better it works, then the less likely it is
to actually preserve a private insurance market.”
Most Democratic presidential candidates favor public-option plans, not just Mr. Biden and Mr. Buttigieg. Elizabeth Warren recently released one, too — part of her “transition plan” to single-payer. (Mr. Sanders has long had a public option tucked into his Medicare for All Act, to expand coverage for the four years before a single-payer system kicks in.) Public opinion surveys show that public-option plans command higher support than single-payer plans, even among Democrats.
The basic idea behind a public option is that it would have certain advantages over private insurance. But most of the public-option plans are a little vague about how strong those would be. The government is able to pay doctors and hospitals lower prices for Medicare patients than most private insurance does because it sets the prices and covers so many people.
A public option, by contrast, would cover a smaller population at first, and might have to negotiate with hospitals for good deals, just as other insurance companies do. In those circumstances, several economists said, the public option might look a lot like existing insurance: pretty expensive, and covering a limited set of doctors and hospitals.
“What would happen?” said Sherry Glied, the dean of the N.Y.U. Wagner Graduate School of Public Service, and a former health official in the Obama administration. “Almost nothing.” Ms. Glied said that the public nature of the plan, alone, would not do much to distinguish it from private offerings.
Most Democratic presidential candidates favor public-option plans, not just Mr. Biden and Mr. Buttigieg. Elizabeth Warren recently released one, too — part of her “transition plan” to single-payer. (Mr. Sanders has long had a public option tucked into his Medicare for All Act, to expand coverage for the four years before a single-payer system kicks in.) Public opinion surveys show that public-option plans command higher support than single-payer plans, even among Democrats.
The basic idea behind a public option is that it would have certain advantages over private insurance. But most of the public-option plans are a little vague about how strong those would be. The government is able to pay doctors and hospitals lower prices for Medicare patients than most private insurance does because it sets the prices and covers so many people.
A public option, by contrast, would cover a smaller population at first, and might have to negotiate with hospitals for good deals, just as other insurance companies do. In those circumstances, several economists said, the public option might look a lot like existing insurance: pretty expensive, and covering a limited set of doctors and hospitals.
“What would happen?” said Sherry Glied, the dean of the N.Y.U. Wagner Graduate School of Public Service, and a former health official in the Obama administration. “Almost nothing.” Ms. Glied said that the public nature of the plan, alone, would not do much to distinguish it from private offerings.
If
the public option became explicitly linked to Medicare — requiring all
providers who wanted Medicare patients to accept public-option patients,
too — the public option might be able to negotiate low prices for care
and include a wide range of doctors and hospitals. In most markets of
the country, that might make it far more appealing than the choices that people who buy their own insurance now have.
Insurers would have to adjust. Either they would also have to lower prices, or they would have to offer some sort of special services. Otherwise, they would lose a lot of customers. “It would push them to demonstrate the value of what they are selling,” said Linda Blumberg, a fellow at the Urban Institute. Her research has estimated the effects of several public-option plans, and found that the plans would tend to change remaining private insurance.
There’s also the possibility that linking public-option coverage to Medicare could cause some doctors to stop accepting Medicare patients, Ms. Glied said. That would be another form of politically risky disruption.
Plans from the leading presidential candidates would also change rules around employer health plans, allowing workers to leave their work-based coverage to buy the public option. That change could have effects on employer insurance. Some workers, particularly those whose low incomes would qualify them for financial assistance in buying a public plan, might shift over. Ms. Blumberg said that the transition of individuals out of private plans would most likely be slower there, because employer insurance tends to be “sticky.” But the existence of a public option might also induce some employers to abandon private coverage altogether.
A public-option plan wouldn’t directly affect private insurers. But by changing the rules of the market, it could influence a company’s business decisions. And that could affect consumers who want to buy private coverage. Under Obamacare, new health plans had to follow a set of rules, while many old ones were allowed to stick around under the old rules. Many insurance companies canceled the old plans anyway, setting off a round of recriminations about how the law had caused people to lose coverage that they liked. President Obama had promised Americans they could keep their existing coverage under the Affordable Care Act, a vow that became Politifact’s lie of the year in 2013.
A very competitive public option could have a similar effect: If it took a lot of market share from private insurers, some might decide to stop selling certain lines of coverage. Private insurance could disappear from some places, or exist largely to fill certain niches, like high-deductible plans.
The health care industry tends not to like public-option plans for this reason. A competitive public option would probably take business away from private insurers. And it would almost guarantee that doctors and hospitals would be paid less for their work. The effects might be less dramatic than under “Medicare for all,” but they would tilt in the same direction.
Insurers would have to adjust. Either they would also have to lower prices, or they would have to offer some sort of special services. Otherwise, they would lose a lot of customers. “It would push them to demonstrate the value of what they are selling,” said Linda Blumberg, a fellow at the Urban Institute. Her research has estimated the effects of several public-option plans, and found that the plans would tend to change remaining private insurance.
There’s also the possibility that linking public-option coverage to Medicare could cause some doctors to stop accepting Medicare patients, Ms. Glied said. That would be another form of politically risky disruption.
Plans from the leading presidential candidates would also change rules around employer health plans, allowing workers to leave their work-based coverage to buy the public option. That change could have effects on employer insurance. Some workers, particularly those whose low incomes would qualify them for financial assistance in buying a public plan, might shift over. Ms. Blumberg said that the transition of individuals out of private plans would most likely be slower there, because employer insurance tends to be “sticky.” But the existence of a public option might also induce some employers to abandon private coverage altogether.
A public-option plan wouldn’t directly affect private insurers. But by changing the rules of the market, it could influence a company’s business decisions. And that could affect consumers who want to buy private coverage. Under Obamacare, new health plans had to follow a set of rules, while many old ones were allowed to stick around under the old rules. Many insurance companies canceled the old plans anyway, setting off a round of recriminations about how the law had caused people to lose coverage that they liked. President Obama had promised Americans they could keep their existing coverage under the Affordable Care Act, a vow that became Politifact’s lie of the year in 2013.
A very competitive public option could have a similar effect: If it took a lot of market share from private insurers, some might decide to stop selling certain lines of coverage. Private insurance could disappear from some places, or exist largely to fill certain niches, like high-deductible plans.
The health care industry tends not to like public-option plans for this reason. A competitive public option would probably take business away from private insurers. And it would almost guarantee that doctors and hospitals would be paid less for their work. The effects might be less dramatic than under “Medicare for all,” but they would tilt in the same direction.
Many of the
candidates have been vague on key details, like whether the
public-option plan would pay health care providers Medicare prices or
some other price. They have also been unclear about whether the
government itself would offer the public option, or whether it would
allow private carriers to operate it.
Just this year Washington State established a public option but, under pressure from doctors, hospitals and insurers, set rates well above what Medicare pays and hired a private plan to run it. A national public-option plan like that would probably be less disruptive than one that’s more like Medicare — but it would also be less popular.
https://www.nytimes.com/2019/12/03/upshot/public-option-medicare-for-all.html
Just this year Washington State established a public option but, under pressure from doctors, hospitals and insurers, set rates well above what Medicare pays and hired a private plan to run it. A national public-option plan like that would probably be less disruptive than one that’s more like Medicare — but it would also be less popular.
https://www.nytimes.com/2019/12/03/upshot/public-option-medicare-for-all.html
Our View: Workers hurt by health care cost shifts
As the government, hospitals and insurance companies pass on costs, employees get stuck with the bill.
by The Editorial Board - Maine Sunday Telegram - December 1, 2019
If a hospital can’t make ends meet on what it gets from the government programs Medicare and Medicaid, it charges people with private insurance more.
If an insurance company pays out more than it takes in from its customers, it raises the premiums.
If an employer that provides an insurance benefit doesn’t want to pay a higher premium, it redesigns the plan it offers so that employees pay more out of pocket.
But that’s where the cost shifting ends. People with insurance have nowhere to dump the bill.
So, they face some grim choices when they get sick. They can pay for their own care until they meet their deductible, sometimes going into debt. Or they can go without care, leaving prescriptions unfilled, skipping diagnostic tests that were ordered by their doctor, hoping that everything will be OK.
Advertisement
Meanwhile, the cost of care keeps going up, faster than incomes, faster than the rate of inflation.
This is particularly true in Maine, where it’s more expensive to get sick than in most other places in the country.
We are the oldest state in the nation, with more than a quarter of our residents over the age of 60. We are also one of the most rural. That adds up to a relatively high number of people who need care living in areas where it’s difficult to deliver.
Not surprisingly, working Mainers have been hit hard by the cost shifting.
According to a recent study by the Commonwealth Fund, the average out-of-pocket costs for Mainers who get health insurance through work surged by 68 percent over the last decade, growing more than twice as fast as personal income. Average out-of-pocket costs in Maine went from $4,670 in 2008 to $7,879 in 2018.
When a family member is seriously ill and their treatment is spread out over several calendar years, these out-of-pocket costs mount, leading to debt and even bankruptcy – something that’s unheard of in any developed nation.
Advertisement
So, it’s frustrating that when Americans debate health care reform, we rarely get past the corporate structure of insurance companies.
There is no political constituency for cost control. But whether we had a Medicare-style system like Canada or a regulated private insurance market like Germany, we would still have to address why hospital stays, physician visits, prescription drugs and tests are more expensive in the United States than in peer nations around the world.
A good way to force this debate would be stopping the cost shifts.
If hospitals can’t provide services at the federal reimbursement rates, they should use their considerable political power to negotiate better rates instead of sticking private payers with high bills.
If insurance companies pay out too much, they should negotiate better rates with providers instead of just hiking premiums.
And there should be stricter limits on how much cost employers can slough off onto employees and still reap the tax benefits that come with providing insurance.
As long as all the major players have the ability to shift costs onto individuals with insurance, there’s nothing to stop the costs from climbing.
https://www.pressherald.com/2019/12/01/our-view-workers-hurt-by-health-care-cost-shifts/
This doctors group is owned by a private equity firm and repeatedly sued the poor until now
by Wendi C. Thomas - ProPublica - November 30, 2019
MEMPHIS, Tenn. — After nine visits to the emergency room at
Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began
receiving bills from an entity she’d never heard of, Southeastern
Emergency Physicians.
Unsure what the bills were for, Brooks, a stay-at-home
mother, said she ignored them until they were sent to collections. She
made payment arrangements, but when she was late, she said the
collection agency demanded $500, which she didn’t have.
In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.
The case against Brooks is one of more than 4,800 lawsuits
Southeastern has filed against patients in Shelby County General
Sessions Court since 2017. In the first six months of this year,
Southeastern filed more lawsuits than local hospitals Methodist Le
Bonheur Healthcare, Baptist and Regional One combined.
Lawsuits against poor patients over unpaid medical debts
have received widespread media attention over the past few years. In
almost all cases, the plaintiff has been a hospital system, often a
nonprofit.
What sets the practices of Southeastern, and its parent, TeamHealth,
apart is that it is a physician staffing firm that contracts with the
doctors who treat patients in four of Baptist’s emergency rooms around
the region. Physicians historically have avoided suing patients en
masse, instead choosing to send unpaid bills to collections or writing
them off as bad debt.
TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.
“There is this tension between being a health care provider
and doing what’s best for their care … and being a profit-maximizing
firm that aggressively goes after patients,” said Brian Shearer, legal
director for Justice Catalyst Law,
a New York-based social justice nonprofit, though he added that he
wasn’t aware of any lawsuits by providers like Southeastern.
TeamHealth initially defended the lawsuits in an interview
with MLK50 and ProPublica, saying they reserved legal action only for
patients who’d made no attempt to pay.
But late last week, faced with additional questions by the
news organizations, the company reversed course, issuing a statement
saying it would no longer sue patients and wouldn’t pursue the lawsuits
it has already filed. “It’s difficult to ensure that only patients with a
strong ability to pay are ultimately impacted, so we’ve decided to
eliminate it,” a TeamHealth spokesman said.
TeamHealth also had policies in place that made it
difficult for patients to access charity care, a form of financial
assistance for low-income patients. Two former TeamHealth employees told
MLK50 and ProPublica that they were instructed not to mention the term
charity care when patients called with questions about their bills.
After the company was asked about this, TeamHealth
president and chief executive officer Leif Murphy announced a new
discount policy for patients without insurance.
“Effective December 1, 2019, we are implementing discount
policies for our uninsured population to reduce the cost of care by as
much 90 percent, and up to 100[ percent] when necessary. We will
proactively include eligibility criteria in our invoices to help promote
participation rather than force patients to seek assistance,” Murphy
wrote in a letter to employees.
TeamHealth’s abandonment of its lawsuits, as well as the
implementation of a new financial assistance policy, marks the second
time in five months that a major health care entity in Memphis has
overhauled its practices amid questions
from MLK50 and ProPublica. In July, Methodist, a nonprofit faith-based
hospital system, announced it would curtail its lawsuits over unpaid
debt against poor patients. It has since zeroed out
the balances owed by more than 5,100 patients and reduced bills for
more than 2,200 others, according to a hospital spokesperson.
TeamHealth declined to talk about the suits involving
patients interviewed for this story, even though the patients gave the
company permission to do so.
Mark Rukavina, business development manager at Community Catalyst’s
Center for Consumer Engagement in Health Innovation, a national
advocacy organization, said nonprofit hospitals shouldn’t work with
physicians groups that aggressively pursue patients for medical debts.
“They could say, ‘If you’re going to provide services in
our hospital, you’re going to comply with our financial assistance
policy,’” Rukavina said.
The lawsuit from Southeastern was just a small part of
Brooks’ debt, but learning that TeamHealth won’t pursue her case was
good news, she said. Plus, she now has TennCare, the state’s version of
Medicaid, which she hopes will spare her from other large medical bills.
She and her husband still “go from paycheck to paycheck,”
she said, and with $60,000 in student loans and thousands more in credit
card debt, she thinks bankruptcy – or a winning lottery ticket – is the
most likely path out.
“It definitely helps though, that you’re not having that [doctor’s bill] hanging over your head,” she said.
From a Closet to National Leader
TeamHealth’s roots in Tennessee stretch back 40 years, to when emergency medicine was recognized as a specialty.
In 1979, a small group of ER doctors in Knoxville,
Tennessee, landed contracts to operate two emergency rooms, including at
the University of Tennessee Medical Center in Knoxville, where
administrators allowed them to use a closet
as their office, according to a company video. It was a step up from
their makeshift workspace at Mrs. Winner’s, a fast-food restaurant.
Southeastern’s initial strategy was to focus on hospitals within a two-hour drive of Knoxville, said co-founder Dr. Lynn Massingale
in the video. But his ambition to be the nation’s biggest staffing firm
led him to expand that radius to a two-hour plane ride, he said in an interview posted on TeamHealth’s website, and, gradually, across the country.
Hospitals “needed reliable, 24-7 physician coverage in
their emergency departments, but no one was ultimately responsible for
making sure the shifts were covered,” wrote co-founder Dr. Randal Dabbs
in a 2018 column in an industry publication.
Southeastern would take on that responsibility. “Our goals
have never included conquest, but instead, true collaboration and
servant leadership,” Dabbs wrote.
In 1994, Southeastern merged with three other doctors
groups to become TeamHealth. It had 200 ER physicians at 27 hospitals in
four states, according to a Modern Healthcare article published that year.
TeamHealth now has more than 16,000 physicians and clinicians, according to the company’s website. It provides medical professionals to 3,300 medical facilities and physician groups in 47 states.
“They provided great care in our emergency room, and
because they provided great care, they continued to grow,” said Baptist
Memorial Health Care’s president and chief executive officer Jason
Little, who in 2003 signed the TeamHealth contract for Baptist
Collierville’s emergency department.
Private Equity’s Rise in Health Care
With $554 billion in assets under management, the Blackstone Group is one of the world’s largest private equity firms.
Increasingly, health care is an attractive target for
private equity, thanks to an aging population and a rise in chronic
disease. The growth is highest in specialties where the need
for a long-standing doctor-patient relationship is low, such as
emergency medicine, anesthesia and care provided to patients when they
are hospitalized (a medical specialty known as hospitalists).
The 2017 acquisition was Blackstone’s second investment in
TeamHealth, after buying it in 2005, taking it public in 2009 and then
selling its interest four years later.
Proponents of private equity argue that its profit-driven
mission helps keep afloat sectors that serve the public good. At least
150 public pension funds invest in private equity, including Blackstone,
with higher annual returns than other types of investments, according
to a recent report produced by an industry lobbying firm.
But critics such as Eileen Appelbaum, co-director of the nonprofit Center for Economic and Policy Research, a left-leaning think tank based in Washington, D.C., lament its growing influence in health care.
“Private equity firms buy small competitors to add on to an
initial acquisition, building national powerhouses without any
antitrust supervision,” Appelbaum testified at a congressional committee
hearing last week about private equity. She cited TeamHealth and its competitor Envision Healthcare
as prime examples of how this practice harms consumers. “They use
surprise medical bills, or the threat of such bills, to get much higher
payments than other doctors receive, driving up health care costs.”
A New York Times investigation in 2016 found
that after private equity firms took over ambulance companies, some
response times slowed and billing practices became more aggressive. Soon
after, the companies went bankrupt — leaving gaps in emergency response
across the northeast. Citing that report, Rep. Maxine Waters, D-Calif., the chairwoman of the House Financial Services Committee, raised concerns in the hearing last week about private equity firms managing public services including health care.
In 2017, the year Blackstone acquired TeamHealth, the
disclosed value of private equity health care deals exceeded $42 billion
— the highest level since 2007 — according to a market research report. The following year, the private equity firm KKR acquired Envision, which operates Emcare, another physician staffing firm, for $9.9 billion.
In public filings, Emcare reported that it operated in 45 states in 2017, while TeamHealth said it had a presence in 47 states that year.
TeamHealth estimated that the market for emergency medicine was $12 billion, according to its filing
with the U.S. Securities and Exchange Commission. It claimed a 17
percent share of that market, which in 2016 accounted for 57 percent of
its revenue.
Appelbaum, like other experts interviewed for this story,
had not heard of instances in which private equity-backed doctors groups
sued patients.
In separate interviews before TeamHealth said it would stop
suing patients, officials at TeamHealth and Baptist said Blackstone’s
acquisition had no effect on collection efforts.
“Yes, we were acquired by Blackstone in 2017,” said Joe Carman,
TeamHealth’s chief administrative officer. “But we have not had any
change in practice as it relates to pursuing patients and legal
strategies in that time.”
Baptist’s Little agreed. “We’ve not seen any changes,” he said.
But the lawsuits show something began to change about the same time.
From Zero to Hundreds of Lawsuits
In 2011, Southeastern did not appear as a plaintiff in any
lawsuit filed in Shelby County General Session Court. In 2013, there
were just over 100 suits filed by Southeastern, and the next year, more
than 600.
Both Little and Carman speculated that increased volumes of
patients treated at Baptist’s emergency departments were partially to
blame.
However, such an explanation is not borne out by the data.
Between fiscal 2016 and 2018, the number of visits to three
of the ERs staffed by Southeastern doctors — Baptist Memphis, the
suburban Baptist Collierville and Baptist DeSoto in Southaven,
Mississippi, just over the state line — grew by 12 percent, according to
figures provided by Baptist. But the number of Southeastern lawsuits
grew by 132 percent — from 798 to 1,855 — from calendar year 2016 to
2018, according to Shelby County General Sessions Court records.
One of the defendants is Laurie Kimbrough, 62, who went to Baptist Memphis in March 2017 complaining of flu symptoms.
When the bill arrived, she tried to make payment plans with
Baptist but said the representative she talked to wouldn’t agree to a
payment she could afford.
The bill went to collections and this March, Baptist sued her for nearly $1,300, not including court costs and attorney’s fees.
By that time, she’d lost her job and had started a small
lawn care business. When the weather is good, she manages to make a few
hundred dollars per week, if the lawn mower and blower don’t need
repairs.
Family friends gave her money to pay off the Baptist bill, but three weeks after Baptist sued her, she was sued by Southeastern.
Even though she owed around $400, Kimbrough said she didn’t
have it. When a longtime friend learned she’d have to pay interest on
the relatively small bill, he gave her the money and refused to let her
pay him back.
Health care expenses have an oversized impact in Tennessee,
where 1 in 4 residents has a medical debt on their credit report, the
10th highest rate in the nation, according to a report this year by the Sycamore Institute, a nonpartisan think tank.
Memphis is the second-poorest large metropolitan area in
the United States, so the impact is even more acute here. Inside the
city limits, more than a quarter of residents live below the poverty
line, according to the most recent census figures. More than 40 percent
percent of workers in the city earn less than $15 an hour, according to
one economic development report.
Kimbrough’s current insurance plan covers just three
primary care doctor visits per year, which she’s already used. She
doesn’t have the $60 copay to see a neurologist for her ongoing leg
pain, much less any other diagnostic tests the doctor might order.
In February 2018, Kimbrough went to Baptist’s emergency
room again with flu symptoms. The bill was over $1,300, but she was able
to negotiate the hospital down from the $100 per month payment it
initially demanded.
“I said I’ll come up with the $55 a month, even if it means I have to eat Vienna sausages 7 days a week,” Kimbrough said.
Court records show that on Nov. 4, Southeastern sued Kimbrough again. She has yet to be served with the lawsuit.
Charity Care Elusive by Design?
Baptist, which started in 1912 with a single 150-bed hospital, is a faith-based institution whose mission
is “in keeping with the three-fold ministry of Christ — Healing,
Preaching and Teaching.” It now has 22 hospitals, dotted mostly in rural
communities in eastern Arkansas, West Tennessee and Mississippi.
“If it weren’t for Baptist and our mission,” Little said,
“there wouldn’t be hospitals in a number of communities around the
three-state region that we serve.”
At Baptist, insured patients receive a partial discount for
bills over $5,000 for a single visit, regardless of income. Uninsured
patients with a household income less than 200 percent of the federal poverty guidelines
are eligible for a 100 percent discount on hospital charges. Even
patients making 400 percent of the federal poverty guidelines — or just
over $85,000 for a family of three — would be eligible for an 80 percent
discount.
Baptist prefers that all doctors groups that operate in its
facilities apply the hospital’s financial assistance policy to
patients, but Little said he couldn’t discuss whether the hospital’s
contract with TeamHealth requires it to do so. TeamHealth did not
respond to a request from Baptist to provide the system permission to
discuss the contract, Little said.
In an interview before TeamHealth changed its policy,
Carman said the company’s internal policy is to match Baptist’s charity
care discount if a patient submits written proof of the financial
assistance Baptist provided.
However, TeamHealth’s billing statements haven’t mentioned charity care. And the firm is not on Baptist’s list of providers that participate in the hospital’s financial assistance program.
In interviews, two former TeamHealth call center agents
said they were instructed not to mention charity care unless patients
did so first.
Between 2017 and 2018, Sharon Lovingood was one of about
100 employees fielding patients’ calls from a single-story TeamHealth
office in Knoxville. “We were the first person they talked to for any
issues,” she said. When she worked in the U.S. Department of Education’s
student loan division between 2012 and 2017, managers encouraged her
and her colleagues to find solutions for those who called in.
But not at TeamHealth.
“A lot of times, a patient would call in and say, ‘Hey, can
you give us a discount?’ But we had to say, ‘No, I can’t do that,’
because we weren’t allowed to say, ‘Well, did you apply for charity care
at the hospital?’” Lovingood said. “They didn’t want us doing that.”
She asked her supervisors why and said she was told that
the hospitals and billing groups TeamHealth had contracts with didn’t
want call center workers bringing it up. Lovingood said she left the job
in February 2018 because she could not stomach the restrictions that
stopped her from helping people. “I was miserable working there.”
Sherry Breitung, who worked as a national patient service
representative in Knoxville from 2014 to 2018, also said she asked for
an explanation about the policy but didn’t get one. One thing was clear,
though: “We weren’t allowed to mention charity care to the patients.”
Since all of their calls were monitored and reviewed by
supervisors, Breitung and Lovingood, who don’t know each other, each
said they devised their own work arounds — such as asking patients, “Did
the hospital help you?” But the four minutes allotted per phone call
wasn’t enough to help patients understand their options, they said.
Carman, on the other hand, said he thought call center
agents were instructed to bring up charity care. “We are attempting
always to try to understand their circumstance, and we’re trying to
understand charity care.”
After additional questions, TeamHealth CEO Murphy said in
his letter to employees that effective Dec. 1, the company would begin
including eligibility criteria for charity care in patients’ invoices to
make it easier to find.
After a reporter asked Kimbrough if the ER doctors had offered her charity care, she called TeamHealth to inquire.
“I said, ‘I need to talk to someone in your charity division,’” Kimbrough recalled, “and they said ‘What?’”
She said she was put on hold and then transferred to
another call center agent, who asked her if she wanted to set up a
payment plan.
“I said, ‘I want to know if I can’t pay, if you have a charity division,’” Kimbrough said.
The representative then told her that if she’d gotten a
charity care discount from Baptist, she could send proof to TeamHealth
and they’d consider her for the same discount.
But Kimbrough is uneasy with the idea of getting financial
assistance. “I feel like if I pursue charity, there’s somebody who won’t
get it who needs it worse than me.”
“Some way it’ll all work out,” Kimbrough said. “If it
doesn’t, I’m lucky that if I lost everything I could go and live with my
mom.”
Hospitals are abdicating their responsibility to protect
patients from financial harm when they hide behind firms to which
they’ve outsourced services, said Michele Johnson, executive director of
the Tennessee Justice Center, which advocates for expanded health care
access.
“Particularly with hospitals that have a mission that is
aligned with treating low-income folks with fairness … it’s unfortunate
that they’re not having people who intersect with their patients follow
that same charitable mission,” Johnson said.
Health care is a necessary and often unavoidable expense,
Johnson said. “These are not designer jeans. These are not video games.
This is a whole different thing.”
Questions Remain for Hospital, Patients
TeamHealth declined to answer questions about its timeline
for dropping existing lawsuits or whether its decision will apply to
lawsuits that have already resulted in judgments, saying in a statement,
“TeamHealth will not file additional cases naming patients as
defendants and will not appear in any pending case.”
After MLK50-ProPublica’s investigation into Methodist Le Bonheur Healthcare’s debt collection practices, the nonprofit hospital dropped hundreds of lawsuits
for unpaid medical bills and expanded its financial assistance policy
to cover families making up to 250 percent of the federal poverty
guideline, which will cover more than half of Memphis-area households.
It has not filed any lawsuits since July 3.
It’s unclear whether TeamHealth’s change will shift the responsibility of unpaid bills from patients to Baptist.
In his letter to employees, TeamHealth’s CEO pointed the
finger at insurance companies, noting that the share of insured patients
with deductibles of more than $1,000 has risen sharply over the last
five years. (In most cases, patients must pay deductibles out of pocket
before their insurance coverage kicks in.)
The typical contract with a physician staffing firm calls
for the hospital to guarantee enough business to at least break even,
Little said.
“If they can’t do that on their own billing and collection,
then they, generally speaking, look to the hospital for a subsidy to
make them whole,” Little said.
He said he hasn’t spoken with TeamHealth since its
statement was issued but doesn’t anticipate any changes. “We have a
contract and it’s in place.”
Little was cautiously optimistic about the end of
TeamHealth’s lawsuits for unpaid ER doctors’ bills. “It sounds like it’s
going to be a benefit for patients, so I’m anxious to study it,” he
said.
Through a spokesperson, Blackstone said it was not involved
in “these specific practices at the company, which we understand are
quite common in the broader industry. However, we fully agreed with and support TeamHealth’s determination to discontinue it.”
TeamHealth’s decision comes just in time for Loretta
Baxter, who went to court Friday to keep Southeastern from garnishing
her paycheck.
Baxter, 33, didn’t have insurance when she visited a
Baptist ER in 2017 for stomach pain and couldn’t afford the $1,111
doctor’s bill.
In April, Southeastern sued her, and on Thursday, her
employer told her that it had received a garnishment attempt that could
take up to 25 percent of her paycheck.
That would leave her with $250 less to cover her rent, car
note, insurance and expenses for her three children. She makes about $11
an hour as a caregiver at a social service organization for people with
disabilities.
Baxter left court with paperwork to take to her employer
that would postpone the garnishment until a Dec. 2 hearing. “I try not
to let things stress me out because stress can kill,” Baxter said at
court.
When a reporter asked TeamHealth how its decision would
impact patients like Baxter, TeamHealth said that the outside collection
agency “is sending a release to remove the garnishment and will be
working with the court system to process it as soon as possible.”
It’s Not Just Poor White People Driving a Decline in Life Expectancy
A new study shows that death rates increased for middle-aged people of all racial and ethnic groups.
byGina Kolata and Sabrina Tavernese - NYT - November 26, 2019
As the
life expectancy of Americans has declined over a period of three years —
a drop driven by higher death rates among people in the prime of life —
the focus has been on the plight of white Americans in rural areas who
were dying from so-called deaths of despair: drug overdoses, alcoholism
and suicide.
But a new analysis of more than a half-century of federal mortality data, published on Tuesday in JAMA, found that the increased death rates among people in midlife extended to all racial and ethnic groups, and to suburbs and cities. And while suicides, drug overdoses and alcoholism were the main causes, other medical conditions, including heart disease, strokes and chronic obstructive pulmonary disease, also contributed, the authors reported.
“The whole country is at a health disadvantage compared to other wealthy nations,” the study’s lead author, Dr. Steven Woolf of Virginia Commonwealth University, said. “We are losing people in the most productive period of their lives. Children are losing parents. Employers have a sicker work force.”
But a new analysis of more than a half-century of federal mortality data, published on Tuesday in JAMA, found that the increased death rates among people in midlife extended to all racial and ethnic groups, and to suburbs and cities. And while suicides, drug overdoses and alcoholism were the main causes, other medical conditions, including heart disease, strokes and chronic obstructive pulmonary disease, also contributed, the authors reported.
“The whole country is at a health disadvantage compared to other wealthy nations,” the study’s lead author, Dr. Steven Woolf of Virginia Commonwealth University, said. “We are losing people in the most productive period of their lives. Children are losing parents. Employers have a sicker work force.”
That some Americans’
life spans were decreasing has been well established. But the level of
detail in Tuesday’s study was new, as was the rich analysis of the
geography of the declines. Health experts say the full effect was
startling.
The
increase in deaths among people in midlife highlighted the lagging
health measures in the United States compared with other wealthy
nations, despite the fact that the United States has the highest per
capita health spending in the world, noted an editorial that accompanied the study.
“Mortality has improved year to year over the course of the 20th century,” said Dr. Samuel Preston, a demographer at the University of Pennsylvania. “The 21st century is a major exception. Since 2010 there’s been no improvement in mortality among working-aged people.”
While the total number of excess deaths — meaning the number of deaths that would not have happened if the mortality rate had continued to improve — is small, at 33,000, deaths in younger people have a much bigger effect on national life-expectancy estimates than deaths of people in their 80s or 90s.
Death rates are actually improving among children and older Americans, Dr. Woolf noted, perhaps because they may have more reliable health care — Medicaid for many children and Medicare for older people.
“Mortality has improved year to year over the course of the 20th century,” said Dr. Samuel Preston, a demographer at the University of Pennsylvania. “The 21st century is a major exception. Since 2010 there’s been no improvement in mortality among working-aged people.”
While the total number of excess deaths — meaning the number of deaths that would not have happened if the mortality rate had continued to improve — is small, at 33,000, deaths in younger people have a much bigger effect on national life-expectancy estimates than deaths of people in their 80s or 90s.
Death rates are actually improving among children and older Americans, Dr. Woolf noted, perhaps because they may have more reliable health care — Medicaid for many children and Medicare for older people.
According
to the new study, the death rate from 2010 to 2017 for all causes among
people ages 25 to 64 increased from 328.5 deaths per 100,000 people to
348.2 deaths per 100,000. It was clear statistically by 2014 that it was
not just whites who were affected, but all racial and ethnic groups and
that the main causes were drug overdoses, alcohol and suicides.
“The fact that it’s so expansive and involves so many causes of death — it’s saying that there’s something broader going on in our country,” said Ellen R. Meara, a professor of health policy at Dartmouth College. “This no longer limited to middle-aged whites.”
The states with the greatest relative increases in death rates among young and middle-aged adults were New Hampshire, Maine, Vermont, West Virginia and Ohio.
Dr. Woolf said one of the findings showed that the excess deaths were highly concentrated geographically, with fully a third of them in just four states: Ohio, Pennsylvania, Kentucky and Indiana.
“What’s not lost on us is what is going on in those states,” he said. “The history of when this health trend started happens to coincide with when these economic shifts began — the loss of manufacturing jobs and closure of steel mills and auto plants.”
For demographers like Kenneth Wachter, a professor emeritus at the University of California, Berkeley, the study’s findings are not surprising because there have been a number of similar reports. But, he said, “it is a valuable paper in bringing together these trends.”
The study leaves unanswered questions, including, Why is there an increased death rate only in the 25-to-64 age group?
“The fact that it’s so expansive and involves so many causes of death — it’s saying that there’s something broader going on in our country,” said Ellen R. Meara, a professor of health policy at Dartmouth College. “This no longer limited to middle-aged whites.”
The states with the greatest relative increases in death rates among young and middle-aged adults were New Hampshire, Maine, Vermont, West Virginia and Ohio.
Dr. Woolf said one of the findings showed that the excess deaths were highly concentrated geographically, with fully a third of them in just four states: Ohio, Pennsylvania, Kentucky and Indiana.
“What’s not lost on us is what is going on in those states,” he said. “The history of when this health trend started happens to coincide with when these economic shifts began — the loss of manufacturing jobs and closure of steel mills and auto plants.”
For demographers like Kenneth Wachter, a professor emeritus at the University of California, Berkeley, the study’s findings are not surprising because there have been a number of similar reports. But, he said, “it is a valuable paper in bringing together these trends.”
The study leaves unanswered questions, including, Why is there an increased death rate only in the 25-to-64 age group?
“We
need to look at root causes,” Dr. Woolf said. “Something changed in the
1980s, which is when the growth in our life expectancy began to slow
down compared to other wealthy nations.”
The increased deaths from drug overdoses reflected increased rates of addiction to opioids. But they have also risen because of changes in the drug supply in the East and Midwest. Over the last decade, the synthetic drug known as fentanyl has been mixed into heroin — or in some places has replaced it. That has made the drug supply more deadly, since it is difficult for users to know the dose they are taking.
This is not the first time that life expectancy has gotten stuck in the United States. Male life expectancy stalled in the 1960s, Dr. Preston said. It picked up again, and the gains made since have been substantial.
Sam Harper, an epidemiologist at McGill University in Montreal, offered a word of caution.
“I’m not sure the dramatic, ‘there’s something desperately wrong with the entire country’ narrative is entirely accurate,” Dr. Harper said. “Certain groups, such as Hispanics and Asians, are doing O.K. It’s not like the entire country is being subsumed by a single social phenomenon that can explain all of this. There are a lot of moving parts.”
He added: “The U.S. has made dramatic gains in life expectancy over the past several decades. It’s important to remember that people here live a very long time compared to a lot of places in the world.”
John G. Haaga, director of the division of behavioral and social research at the National Institute on Aging, which funded this study, also saw a bright spot: Life expectancy in the coastal metro areas — both east and west — has improved at roughly the same rate as in Canada.
“It’s important because it means this is not somehow deep in our national soul or genetics or something,” he said. “We know we can do better right here in America. It proves that it’s possible.”
https://www.nytimes.com/2019/11/26/health/life-expectancy-rate-usa.html?smid=nytcore-ios-share
The increased deaths from drug overdoses reflected increased rates of addiction to opioids. But they have also risen because of changes in the drug supply in the East and Midwest. Over the last decade, the synthetic drug known as fentanyl has been mixed into heroin — or in some places has replaced it. That has made the drug supply more deadly, since it is difficult for users to know the dose they are taking.
This is not the first time that life expectancy has gotten stuck in the United States. Male life expectancy stalled in the 1960s, Dr. Preston said. It picked up again, and the gains made since have been substantial.
Sam Harper, an epidemiologist at McGill University in Montreal, offered a word of caution.
“I’m not sure the dramatic, ‘there’s something desperately wrong with the entire country’ narrative is entirely accurate,” Dr. Harper said. “Certain groups, such as Hispanics and Asians, are doing O.K. It’s not like the entire country is being subsumed by a single social phenomenon that can explain all of this. There are a lot of moving parts.”
He added: “The U.S. has made dramatic gains in life expectancy over the past several decades. It’s important to remember that people here live a very long time compared to a lot of places in the world.”
John G. Haaga, director of the division of behavioral and social research at the National Institute on Aging, which funded this study, also saw a bright spot: Life expectancy in the coastal metro areas — both east and west — has improved at roughly the same rate as in Canada.
“It’s important because it means this is not somehow deep in our national soul or genetics or something,” he said. “We know we can do better right here in America. It proves that it’s possible.”
https://www.nytimes.com/2019/11/26/health/life-expectancy-rate-usa.html?smid=nytcore-ios-share
Permit me to introduce you to LE-MERIDIAN FUNDING SERVICES. We are
ReplyDeletedirectly into personal loan and pure loan and project(s) financing in terms of
investment.
We provide financing solutions to private/companies/individual seeking access to
funds in the capital markets i.e. oil and gas, real estate, renewable
energy, Pharmaceuticals, Health Care, transportation, construction,
hotels and etc.
We can finance up to the amount $10,000 to $1,000,000. ( One
Million Dollars) in any region of the world as long as our 1.9% ROI
can be guaranteed on the projects.Interested individual / companies
should reply with the following details below to lemeridianfund@gmail.com
Full Name:
Employment status:
Amount of Loan requested:
Age:
Country:
For further information how you can secure your loan.
Best Regard,Le-Meridian Funding Service.
Address:60 Piccadilly, Mayfair, London W1J 0BH, UK)
Website:www.lemeridianfds.com
Permit me to introduce you to LE-MERIDIAN FUNDING SERVICES. We are
ReplyDeletedirectly into personal loan and pure loan and project(s) financing in terms of
investment.
We provide financing solutions to private/companies/individual seeking access to
funds in the capital markets i.e. oil and gas, real estate, renewable
energy, Pharmaceuticals, Health Care, transportation, construction,
hotels and etc.
We can finance up to the amount $10,000 to $1,000,000. ( One
Million Dollars) in any region of the world as long as our 1.9% ROI
can be guaranteed on the projects.Interested individual / companies
should reply with the following details below to lemeridianfund@gmail.com
Full Name:
Employment status:
Amount of Loan requested:
Age:
Country:
For further information how you can secure your loan.
Best Regard,Le-Meridian Funding Service.
Address:60 Piccadilly, Mayfair, London W1J 0BH, UK)
Website:www.lemeridianfds.com