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Tuesday, December 3, 2019

Health Care Reform Articles - December 3, 2019

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.




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.

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.
Even in the case of a slower transition to universal health insurance (such as the creation of a public option) it is essential to legislate that workers who migrate to the public option can take their current health insurance premiums as extra wages. If not, the transition will either never happen (as workers won’t see any upside to migrate), or it will be a boon for employers who will pocket the health care premiums. But if a law mandates that all premiums be added to wages, “Medicare for all who want it” will become “Medicare for All” faster that anyone believes (and the funding equation for both programs will become the same).
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.”

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.
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.
"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."

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.
"I'm not stupid, Kahn said. "There's part of the Democratic Party that's bought into this."
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.

By - NYT - December 3, 2019

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.
“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.
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.
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
  

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
A key feature of our health care system is cost shifting.
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.
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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.
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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.”
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.
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?
“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

Thursday, Nov. 28, 2019: Thankful but also hurt, time for universal health care, a silence that speaks volumes






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