Health Care Reform Articles - December 8 2019

Medicare for All will improve health care, save billions

by Thomas Clairmont - SeacoastOnline.com - December 3, 2019

When is the public going to vote that they have had enough?
Premiums and your contributions for your health care coverage go up every year, decimating any raise. In fact, health care costs have risen twice the rate of inflation for a long time.
The Milliman Index for a family of four is $28,166. Sen. Elizabeth Warren would allow 3.9% increases every year, continuing this pattern. Compounding (try this and be stunned) brings this to $90,107 - $7,500 per month in 2050. Narrow networks deny you choice of your doctor and hospital. Uncontrolled surprise bills, 43% of ER visits in 2016, take more money out of your pocket. And with Wall Street equity firms buying up groups of pathologists, ER doctors, anesthesiologists and radiologists, more unrestrained/surprise charges are coming your way soon.
There are over 250,000 medical campaigns on GoFundMe raising $650 million every year.
There are over 500,000 bankruptcies because of health care costs - zero in Switzerland.
Some 28 million are uninsured and more than that are underinsured, spending 10% or more of income on out of pocket costs for their medical care.
The United States spends 18% of GDP on health care, twice as much as other countries, who cover all of their citizens.
Life expectancy is going down, now trailing Italy by almost five years.
We have the highest infant mortality (among developed countries).
We have the highest maternal mortality, three times that of France.
New Hampshire has the highest percentage rise in death rates in the 25 to 34 age group.
Many say they want to maintain their private insurance coverage. What they really want is for their employer to provide the health care benefit. No one wears a hat with a health insurance company logo.
Medicare for All solves these issues.
This program provides full coverage of the health care you need and adds dental, vision, hearing, long-term care and improves mental health. There are no deterrents to your access like deductibles, co-payments, co-insurance and additional out of pocket expenses.
There are four key components:
Everybody in, nobody out - all in a similar comprehensive plan. No Medicaid, no tiers of care, no special people.
Insurance companies eliminated - an anachronism in 2020, not needed in a single pool of patients. Claim denials an unpleasant memory.
Hospitals paid their costs to operate - billing departments eliminated.
Drug prices negotiated - the VA saves 40% and other countries pay and dictate substantial discounts. In Germany, their minister said “if you have a chronic disease, you shouldn’t be burdened by the cost.” Out of pocket contributions for insulin are less than a $100 per year.
No other plans compare to Medicare for All because they leave the current system intact and forgo the savings needed to provide universal coverage. Professor Friedman of UMass Amherst estimates savings of $234 billion per year by eliminating private insurance, Professor Pollin in a detailed report estimates savings of 19.2% (peri.umass.edu), and Physicians for a National Health Program estimates yearly savings of $618 billion per year.
These savings estimates came out before the Oct. 7, 2019, article in JAMA on waste in the U.S. health care system. The authors estimate 25% of total health care spending is waste with potential saving of $191 billion to $282 billion dollars per year. Much easier to capture these savings in a single system.
A lot of money is going somewhere else besides your health care. Sen. Bernie Sanders deserves great credit and your vote for outlining the problems and has a bill written to address the issues. Of course it should be debated, but dismissal of these concepts will put even more of your money in someone else’s pocket.
Shelley’s poem is appropriate:
Rise like lions after slumber
In unvanquishable number
And shake your chains to earth like dew
Which in sleep have fallen on you
We are many, they are few
Dr. Thomas P. Clairmont is a board certified primary care physician specializing in internal medicine. He has been practicing medicine for over 25 years and has been at Portsmouth Primary Care Associates since 1980. He has a special interest in geriatric medicine and promoting physical activity for patients at any age.
https://www.seacoastonline.com/news/20191203/medicare-for-all-will-improve-health-care-save-billions 

The American Health Care Industry Is Killing People

Yes, transitioning to a more equitable system might eliminate some jobs. But the status quo is morally untenable.

by Farhad Manjoo - NYT - December 3, 2019

Won’t you spare a thought for America’s medical debt collectors? And while you’re at it, will you say a prayer for the nation’s health care billing managers? Let’s also consider the kindly, economically productive citizens in swing states whose job it is to jail pregnant women and the parents of cancer patients for failing to pay their radiology bills. Put yourself in the entrepreneurial shoes of the friendly hospital administrator who has found a lucrative new revenue stream: filing thousands of lawsuits to garnish sick people’s wages.
And who can forget the lawyers? And the lobbyists! Oh, aren’t they all having a ball in America’s health care thunderdome. Like the two lobbyists who were just caught drafting newspaper editorials for Democratic state representatives in Montana and Ohio, decrying their party’s push toward a “government-controlled” health care industry. It’s clear why these lobbyists might prefer the converse status quo: a government controlled by the health care industry. If we moved to a single-payer system, how would lobbyists put food on the table, and who would write lawmakers’ op-ed essays?
Welcome to the bizarre new argument against “Medicare for all”: It’s going to cost us jobs. Lots of jobs. Good, middle-class, white-collar jobs in America’s heartland, where Democrats need to win big to defeat Donald Trump.

The argument is specious and morally suspect. Last week, health researchers reported that American life expectancy is declining for the first time in half a century, and some of the leading causes have to do with the ruinous health care system. Even if it is the case that reforming American health care might eliminate some jobs, it would seem to be a good trade for the likely benefit: More people might gain access to affordable health care and get to keep living.

But I worry that the jobs argument might sway moderate politicians, centrist pundits and much of the establishment, because it plays on one of the major fault lines of health reform: that in fixing the system so that more people benefit, those who now enjoy a privileged slice of American health care might end up worse off than they are today.
As a matter of ethics and equality, this should be O.K.; sticking with a system that is the source of so much death, debt and financial ruin just because you like your doctor or your insurance company or your medical-billing job is not really a defensible position.
On the other hand, in America, “I’ve got mine and I don’t want to lose it” is always pretty good politics.
The jobs argument goes like this: There’s a lot of fat in the American health care industry, and any effort to transform it into a simpler system in which everyone is covered would necessarily eliminate layers of bureaucracy and likely reduce overhead costs. Every year Americans collectively pay about $500 billion in administrative costs for health care — that is, for things like billing and insurance overhead, not for actual medical care.

These costs are significantly higher than in most other wealthy countries. One study on health care data from 1999 showed that each American paid about $1,059 per year just in overhead costs for health care; in Canada, the per capita cost was $307. Those figures are likely much higher today.
Wouldn’t lowering overhead costs be an obviously positive outcome?
Ah, but there’s the rub: All this overspending creates a lot of employment — and moving toward a more efficient and equitable health care system will inevitably mean getting rid of many administrative jobs. One study suggests that about 1.8 million jobs would be rendered unnecessary if America adopted a public health care financing system.
So what if some of these jobs involve debt collection, claims denial, aggressive legal action or are otherwise punitive, cruel or simply morally indefensible in a society that can clearly afford to provide high-quality health care to everyone? Jobs are jobs, folks, as Joe Biden might say.
Indeed, that’s exactly what Biden’s presidential campaign is saying about the Medicare for all plans that Senators Elizabeth Warren and Bernie Sanders are proposing: They “will not only cost 160 million Americans their private health coverage and force tax increases on the middle class, but it would also kill almost two million jobs,” a Biden campaign official warned recently.
Note the word “kill” in the statement. That word might better describe not what could happen to jobs under Medicare for all but what the health care industry is doing to many Americans today.
Last week, the medical journal JAMA published a comprehensive study examining the cause of a remarkably grim statistic about our national well-being. From 1959 to 2010, life expectancy in the United States and in other wealthy countries around the world climbed. Then, in 2014, American life expectancy began to fall, while it continued to rise elsewhere.
What caused the American decline? Researchers identified a number of potential factors, including tobacco use, obesity and psychological stress, but two of the leading causes can be pinned directly on the peculiarities and dysfunctions of American health care.

The first is the opioid epidemic, whose rise can be traced to the release, in 1996, of the prescription pain drug OxyContin. In the public narrative, much of the blame for the epidemic has been cast on the Sackler family, whose firm, Purdue Pharma, created OxyContin and pushed for its widespread use. But research has shown that the Sacklers exploited aberrant incentives in American health care.
Purdue courted doctors, patient groups and insurers to convince the medical establishment that OxyContin was a novel type of opioid that was less addictive and less prone to abuse. The company had little scientific evidence to make that claim, but much of the health care industry bought into it, and OxyContin prescriptions soared. The rush to prescribe opioids was fueled by business incentives created by the health care industry — for Purdue, for many doctors and for insurance companies, treating widespread conditions like back pain with pills rather than physical therapy was simply better for the bottom line.
Opioid addiction isn’t the only factor contributing to rising American mortality rates. The problem is more pervasive, having to do with an overall lack of quality health care. The JAMA report points out that death rates have climbed most for middle-age adults, who — unlike retirees and many children — are not usually covered by government-run health care services and thus have less access to affordable health care.
The researchers write that “countries with higher life expectancy outperform the United States in providing universal access to health care” and in “removing costs as a barrier to care.” In America, by contrast, cost is a key barrier. A study published last year in The American Journal of Medicine found that of the nearly 10 million Americans given diagnoses of cancer between 2000 and 2012, 42 percent were forced to drain all of their assets in order to pay for care.
The politics of Medicare for all are perilous. Understandably so: If you’re one of the millions of Americans who loves your doctor and your insurance company, or who works in the health care field, I can see why you would be fearful of wholesale change.
But it’s wise to remember that it’s not just your own health and happiness that counts. The health care industry is failing much of the country. Many of your fellow citizens are literally dying early because of its failures. “I got mine!” is not a good enough argument to maintain the dismal status quo.
https://www.nytimes.com/2019/12/04/opinion/healthcare-industry-medicare.html?action=click&module=Opinion&pgtype=Homepage

Life Expectancy and Mortality Rates in the United States, 1959-2017

Steven H. Woolf, MD, MPH¹; Heidi Schoomaker, MAEd^{2,3 - JAMA - November 26, 2019}

Importance  US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.
Objective  To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence  Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.
Findings  Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.
Conclusions and Relevance  US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

https://jamanetwork.com/journals/jama/article-abstract/2756187

Pelosi sets Medicare showdown on drug costs and new benefits

While the bill is expected to pass the Democratic-controlled House, it has no chance in the Republican-run Senate. 

by RICARDO ALONSO-ZALDIVAR - Associated Press - December 5, 2019

WASHINGTON — The House will hold a showdown vote next week on Speaker Nancy Pelosi’s bill empowering Medicare to negotiate drug prices, expanded Thursday to provide seniors with dental, vision and hearing benefits not currently covered.
Leading Democratic committee chairmen said the Congressional Budget Office has indicated that Pelosi’s bill would save the government $500 billion over 10 years, which they pledged to use for new Medicare benefits and other health care priorities such as the National Institutes of Health and the opioid crisis.
“These significant investments are made possible as a result of our promise to finally empower the federal government to negotiate lower drug prices for the American people,” Reps. Frank Pallone, D-N.J., Richard Neal, D-Mass., and Bobby Scott, D-Va., said in a joint statement.
While the bill is expected to pass the Democratic-controlled House, it has no chance in the Republican-run Senate. Most Republicans oppose authorizing Medicare to negotiate drug prices, arguing the job is better done by private insurers who deliver the program’s prescription benefit.
President Trump, as a candidate, called for giving Medicare negotiating clout, but since taking office, he has backed off. The White House now strongly opposes Pelosi’s bill, arguing it will keep up to one-third of new drugs from coming to market over a decade, an estimate far higher than the nonpartisan Congressional Budget Office has calculated.
The legislation from Pelosi, D-Calif., would authorize Medicare to negotiate prices for the costliest drugs, including insulin, using lower prices paid in other economically advanced countries as the reference point.
The budget office says that could result in price cuts of 40 to 55 percent for pharmacy drugs subject to negotiations. The bill would allow private insurance plans to also get Medicare’s price.
As a hammer to force companies to negotiate, Pelosi would impose steep sales taxes on the medications at issue. Overall, budget analysts estimated the legislation would cut industry revenues by $500 billion to $1 trillion over 10 years.
Updated estimates from the budget office are expected before the bill goes to the House floor next Wednesday or Thursday.
Trump is backing a competing bill in the Senate, bipartisan legislation that would require drugmakers to pay rebates to Medicare if they hike prices above inflation. Pelosi’s bill also includes inflation rebates.
Both the House and Senate bills would cap what Medicare recipients must pay annually in out-of-pocket costs for their prescriptions.
A White House report released this week said Pelosi’s bill “will harm American patients in ways that far outweigh any benefits” by making it harder for pharmaceutical companies to develop breakthrough drugs and bring them to market.
In the middle of an impeachment, chances of a deal between Pelosi, Trump and congressional lawmakers of both parties appear slim.
Though Medicare is very popular among seniors, it has always had gaps in coverage. Dental, vision and hearing are seen as the biggest. Many seniors pay out-of-pocket for hearing aids, dentures and eyeglasses. Others rely on limited benefits offered through private Medicare Advantage plans.
Separately, a government report out Thursday found that prices for prescription drugs bought at the pharmacy edged down by 1 percent last year, the first such drop since the 1970s.

 https://www.pressherald.com/2019/12/05/pelosi-sets-medicare-showdown-on-drug-costs-and-new-benefits/

 

Labor Unions Team Up With Drug Makers to Defeat Drug-Price Proposals

A low-profile group, financed by the pharmaceutical industry, has hired former union officials to oppose drug-price proposals around the country.

by Katie Thomas - NYT - December 4, 2019

House Speaker Nancy Pelosi’s bill to lower drug prices has the backing of many of the nation’s biggest labor groups, including the United Auto Workers, the A.F.L.-C.I.O., and unions representing teachers and other government workers.
But a wave of Facebook ads that ran this fall appeared to suggest otherwise. The ads, featuring a dejected-looking man in a hard hat, warned that the bill “threatens thousands of good-paying jobs and restricts access to lifesaving medication.”
The ads were paid for by a little-known group, the Pharmaceutical Industry Labor-Management Association, that is trying to defeat drug-pricing proposals around the country, from statehouses in Nevada, Maryland and Oregon to Congress. The Facebook ads targeted 15 recently elected Democrats in Congress, including Harley Rouda of California and Andy Kim of New Jersey.
The group, a coalition that includes major drugmakers like Pfizer and Johnson & Johnson as well as large construction-industry unions whose members help build pharmaceutical plants and research labs, has been buying print advertisements in local newspapers, mailing fliers to voters in vulnerable Democratic districts, and hiring former labor officials and well-known union lobbyists to deliver their message. It aligns closely with the talking points of drug companies, which claim that Ms. Pelosi’s bill would stifle innovation and damage a vital American industry.

Even in the nation’s capital, where coalitions and dark-money groups are routinely used to repackage corporate interests in a more sympathetic light, the pairing of the drug industry and unions is an unusual one. Many unions, including some who are members of Pilma, help oversee their workers’ health plans and have an interest in lowering drug costs. And out-of-pocket costs for prescription drugs are a financial strain on many Americans, including union members.
“It’s really odd,” said Representative Rob Nosse, a Democratic Oregon lawmaker who helped pass a drug-pricing transparency bill in 2018. Pilma, which opposes transparency bills, contending they expose proprietary information, hired the former political director of the regional chapter of the International Brotherhood of Electrical Workers to lobby for the group. Mr. Nosse said that he was surprised the unions’ health care experts didn’t “tell them, you know what’s killing our health insurance? The cost of medications.”

The drug companies who are members either did not respond, or declined to comment.
Tim Dickson, the executive director of Pilma, said the group’s position was aimed at creating jobs for union workers. “We place a premium on the partnership that yields jobs,” he said. “And we have a longstanding position that we’ve held for quite some time that certain policies, such as price controls, will have a negative effect on union construction jobs.”
Ms. Pelosi’s bill would require the federal government to negotiate the prices of insulin and as many as 250 other high-priced drugs on behalf of Medicare, and impose financial penalties if companies failed to comply.

Although the bill is seen as unlikely to become law in its current form — Senator Mitch McConnell, Republican of Kentucky and the majority leader, has come out against it, as has the Trump administration — the drug industry has fought hard against it. Its main lobbying group, the Pharmaceutical Research and Manufacturers of America, has called the bill “devastating,” and said it would lead to fewer new drugs coming to market.
Some of the bill’s biggest backers are labor groups, including the national A.F.L.-C.I.O., some of whose members are part of Pilma. A spokesman for the federation declined to comment beyond pointing a reporter to its position supporting Ms. Pelosi’s bill.
Other unions that support efforts to lower drug costs avoided criticizing labor groups, either declining to comment or choosing their words carefully. “National Nurses United is really focused on the real culprits behind these outrageous drug prices, which is the pharmaceutical industry specifically,” said Amirah Sequeira, the lead legislative advocate for the nurses union, which has not yet supported Ms. Pelosi’s bill because it believes it does not go far enough in lowering costs.
In addition to Facebook ads, Pilma also mailed fliers to voters in swing districts like Mr. Kim’s in New Jersey, a state where the pharmaceutical industry plays a major role in the economy. The mailing warned that Ms. Pelosi’s bill would jeopardize 54,000 jobs in the state and would “risk access to critical medicines.”
Mr. Kim’s office declined to comment.
Among Pilma’s members are unions that represent a range of building trades involved in manufacturing plants for pharmaceuticals, like sheet metal and iron workers, electrical workers, and plumbers and pipe-fitters. The International Union of Police Associations and the International Association of Fire Fighters are also members. According to Pilma, the pharmaceutical industry is responsible for 4.7 million jobs in the United States, including many highly skilled union jobs.
A spokesman for the International Association of Sheet Metal, Air, Rail and Transportation Workers, whose president, Joseph Sellers, Jr., is chair of Pilma, said that while the union supported expanding access to prescription drugs, it also relied on companies like drug makers to provide good-paying jobs. “Without jobs to fund them, there are no health care plans in the first place,” said the spokesman, Paul Pimentel.
One of Pilma’s members, the International Brotherhood of Boilermakers, has been outspoken about its struggle to contain high drug prices — one family covered by its health plan requires a drug that costs about $1.5 million a year per person.

John T. Fultz, the international vice president for the Northeast States Section of the International Brotherhood of Boilermakers, declined to comment on the union’s membership in Pilma but said that drug prices were a major concern. He is also the secretary of the boilermakers’ health and welfare fund, which oversees benefits along with the workers’ employers.
“Our concern is drug pricing, so we can afford the medications that our members need,” Mr. Fultz said. If the cost of high-priced specialty drugs is not reined in, “it will eventually break many plans.”

Alexander Hertel-Fernandez, an assistant professor of international and public affairs at Columbia University, said unions that form corporate alliances can wield considerable influence. Others said groups like Pilma can contribute to a broader sense that taking sides on a thorny issue like drug prices carries political risks.
“Union-management coalitions have been successful in the past in pressuring Democrats to moderate their policy agenda, especially on climate and environmental legislation,” Mr. Hertel-Fernandez said in an email. “When Democrats are hearing from powerful corporate interests and labor interests, it’s harder for them to resist.”
Pilma has had federal tax-exempt status since 2004 as a business association and is run out of the offices of a public relations firm, Groundswell Communications. Its executive director, Mr. Dickson, is the owner of Groundswell and a longtime grass-roots organizer for Democrats. Pilma had revenues of about $2.3 million in 2018, according to federal tax documents. Mr. Dickson said the pharmaceutical industry supplied the group’s revenues, which he said was standard practice for coalitions between industry and unions.
Union activists are the group’s public face. Pilma has spent $465,000 on federal lobbying in the first three quarters of this year, according to the Center for Responsive Politics, and most of its lobbyists are former labor officials or have clients that include other unions.

Pilma’s positions hew closely to the views of the pharmaceutical industry. Pilma also opposes more moderate, bipartisan proposals like the one put forward this year by Senators Chuck Grassley, Republican of Iowa, and Ron Wyden, Democrat of Oregon. It has also come out against a Trump administration proposal that would allow more importation of drugs from Canada and other countries.
Mr. Dickson noted that the group had also supported laws favored by unions, such as one recently signed into law in Nevada, strengthening prevailing wage requirements for public construction projects.
In 2017, when Nevada lawmakers were working on a bill to require drug makers to disclose insulin prices, Pilma hired Danny Thompson, who had just retired as head of the state A.F.L.-C.I.O., to work on its behalf. The group’s presence generated some tension in the local labor world. The Nevada A.F.L.-C.I.O. wrote in a tweet that Pilma “doesn’t speak for NV labor, we do!”

“I was very surprised,” said Yvanna D. Cancela, a state senator. Ms. Cancela, who is the former political director of the state’s largest union, the Culinary Workers Union, said her insulin bill had the support of most of the state’s biggest unions and ultimately became law. Still, she said, “it was an unexpected alliance.” Mr. Thompson did not return calls for comment.
In Maryland, Pilma neutralized some of the union support for a bill — which has since become law — that created a board that can limit payments for drugs on behalf of public sector employees. The state’s A.F.L.-C.I.O. did not take a position on the bill because Pilma and some individual unions opposed it, said Donna S. Edwards, the federation’s state president. “If we have one union that is not on board with a decision, then we’re neutral,” she said.
“We had hopes that A.F.L.-C.I.O. would endorse this right away,” as other unions did, said Vincent DeMarco, the president of the Maryland Citizen’s Health Initiative. “And then we saw that they were getting pushback from this Pilma group.”
https://www.nytimes.com/2019/12/03/health/drug-prices-pelosi-unions.html?action=click&module=Latest&pgtype=Homepage