The U.S. Spends $2,500 Per Person on Health Care Administrative Costs. Canada Spends $550. Here's Why
by Abigail Abrams - Time Magazine - January 6, 2020
Whether it’s interpreting medical bills, struggling to get hospital records, or fighting with an insurance provider, Americans are accustomed to battling bureaucracy to access their health care. But patients’ time and effort are not the only price of this complexity. Administrative costs now make up about 34% of total health care expenditures in the United States—twice the percentage Canada spends, according to a new study published Monday in Annals of Internal Medicine.These costs have increased over the last two decades, mostly due to the growth of private insurers’ overhead. The researchers examined 2017 costs and found that if the U.S. were to cut its administrative spending to match Canadian levels, the country could have saved more than $600 billion in just that one year.
“The difference [in administrative costs] between Canada and the U.S. is enough to not only cover all the uninsured but also to eliminate all the copayments and deductibles, and to amp up home care for the elderly and disabled,” says Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College and co-author of the study. “And frankly to have money left over.”
Research has long shown that the U.S., which uses a disparate system of private providers and insurers, has higher administrative costs than other developed countries that use single-payer systems. But the Annals study puts a finer point on it: as the first major effort to calculate administrative costs across the U.S. health system in nearly two decades, the researchers found that the gap between the U.S. and Canada has widened significantly.
The U.S. now spends nearly five times more per person on health care administration than Canada does. The U.S. administrative costs came out to $812 billion in 2017, or $2,497 per person in the U.S. compared with $551 per person in Canada, according to the Annals study.
Along with Himmelstein, co-authors Steffie Woolhandler and Terry Campbell examined administrative costs for insurance companies and government agencies that administer healthcare, as well as costs in four settings: hospitals, nursing homes, home care agencies and hospices and physician practices. For each category, the researchers determined which costs were administrative and conducted analyses to adjust comparisons between relative costs in the U.S. and Canada.
Insurers’ overhead, the largest category, totaled $275.4 billion in the U.S. in 2017, or 7.9% of all national health expenditures, compared with $5.36 billion in Canada, or 2.8% of national health expenditures. The American number included $45 billion in government spending to administer health care programs and $229.5 billion in private insurers’ overhead and profits, which covers employer plans and managed care plans funded by Medicare and Medicaid.
This insurance overhead accounted for most of the total increase in administrative spending in the U.S. since 1999, according to the study. While the share of Americans covered by commercial insurance plans has not changed much, private insurers have expanded their role as subcontractors handling what are known as “managed care” plans for Medicaid and Medicare. The study notes that most Medicaid recipients are now on private managed care plans and about one third of Medicare enrollees now have Medicare Advantage plans. Both of these types of plans have higher overhead costs than the publicly administered alternatives.
“We were struck, and frankly hadn’t expected it until we delved into the data, by the huge increase in insurance overhead,” Himmelstein told TIME.
Other reports, including one by the Center for American Progress published last April, have identified ways to reduce administrative costs without moving the U.S. to a single-payer health care system. But Himmelstein says his study shows that a public option that preserves private insurance wouldn’t provide the same savings as a traditional single-payer system. “We could streamline the bureaucracy to some extent with other approaches, but you can’t get nearly the magnitude of savings that we could get with a single payer,” Himmelstein says, adding, “If the Medicare public option includes the Medicare Advantage plans, it’s actually conceivable that the public option would increase the bureaucratic costs.”
Most of the public option plans proposed by Democratic presidential candidates are not detailed enough to determine exact costs, Himmelstein says. But overall, he believes they won’t result in significant cost savings.
In addition to their research, Himmelstein and Woolhandler have been longtime advocates for single-payer health care. They co-founded the group Physicians for a National Health Program, which advocates for a single-payer system. They also conducted the initial health administrative costs study on 1999 data and have published other studies comparing hospital administrative costs in the U.S. and other countries.
Himmelstein says his team’s estimates of total U.S. administrative costs in the Annals study are likely conservative. When estimating physicians’ administrative costs, the researchers relied on a 2011 study of time spent by physicians and their staffs interacting with insurers. And he notes that while 2017 data was often the latest available when they were conducting this study, 2018 health spending numbers have since come out showing further increases in insurance overhead.
“We can afford universal coverage with a single payer plan, not just universal coverage but first dollar coverage for everybody in our country if we adopted a single-payer Medicare for all approach,” Himmelstein says. “If you’re going to cover everybody without getting those savings you’re going to have to spend more or you’re going to have to have big co-payments and deductibles that deter people from getting the care that they actually need.”
https://time.com/5759972/health-care-administrative-costs/
Doctors, Nurses and the Paperwork Crisis That Could Unite Them
They don’t always get along. But they are both under siege by the bureaucracy of a failing health care system.
By Theresa Brown and
Broken,
wasteful, inhuman, expensive, deadly. The problems with the American
health care system, or non-system, are neither subtle nor unrecognized —
especially by those of us doctors and nurses who actually provide the
care. And yet we all too often feel the most helpless, seeing how much
of the problem is driven by drug companies and hospital networks.
Too often, each profession sees the other as fighting separate battles, and sometimes against each other. Doctors blame nurses, and vice versa, for the failings of a system that punishes us all, and our patients.
Instead, the two of us are suggesting that nurses and doctors try something unusual. Let’s put our differences aside and work together to achieve real change, starting with a pernicious problem that drives so much of our mutual discontent: electronic health records.
The current system is pushing both doctors and nurses to the breaking point. Enough doctors in the United States commit suicide every year to fill two large medical school classes. A 2019 MedScape report found that 44 percent of physicians feel “burned out,” driving many to alcoholism and depression, or to leave the profession entirely.
Too often, each profession sees the other as fighting separate battles, and sometimes against each other. Doctors blame nurses, and vice versa, for the failings of a system that punishes us all, and our patients.
Instead, the two of us are suggesting that nurses and doctors try something unusual. Let’s put our differences aside and work together to achieve real change, starting with a pernicious problem that drives so much of our mutual discontent: electronic health records.
The current system is pushing both doctors and nurses to the breaking point. Enough doctors in the United States commit suicide every year to fill two large medical school classes. A 2019 MedScape report found that 44 percent of physicians feel “burned out,” driving many to alcoholism and depression, or to leave the profession entirely.
Nurse
suicides are not systematically measured and reported, but a 2017 study
in England found a suicide rate among nurses that was 23 percent above the national average. Half of all nurses are considering leaving the profession, according to a 2017 study by RNnetwork.
Clinicians are notoriously overworked, but ask anyone on a hospital staff, and he or she will tell you that workloads have become heavier the last several years thanks almost entirely to the arrival of electronic health records — detailed reports about a patient’s medical history and care. Originally intended as a work-saving tool, the records have gone in the opposite direction, taking time away from patient care in the name of electronic box-checking.
A new report from the National Academy of Medicine says that on average nurses and doctors spend 50 percent of their work day treating the screen, not the patient, and that “increased documentation time” associated with electronic health records can lead to burnout. Burnout is also tied to finishing documentation at home, a necessity for many physicians, and for nurses who provide home care.
The use of electronic health records increased significantly with the 2009 passage of the Health Information Technology for Economic and Clinical Health Act, which offered financial incentives for hospitals to adopt them. Such records promised efficiency and better teamwork, but as they increasingly serve the needs of America’s corporate, profit-motivated health care, those promises remain mostly unfulfilled.
Insurance companies and hospitals demand ever more data to make decisions about payments and billing, so clinicians have to provide much more information about each patient at each interaction. Mounting regulatory requirements that get built into these records are described as insuring patient safety, but are ultimately tied to compensation, which means money. And in a system rife with legal risks, there is a strong incentive to overdocument everything.
Clinicians are notoriously overworked, but ask anyone on a hospital staff, and he or she will tell you that workloads have become heavier the last several years thanks almost entirely to the arrival of electronic health records — detailed reports about a patient’s medical history and care. Originally intended as a work-saving tool, the records have gone in the opposite direction, taking time away from patient care in the name of electronic box-checking.
A new report from the National Academy of Medicine says that on average nurses and doctors spend 50 percent of their work day treating the screen, not the patient, and that “increased documentation time” associated with electronic health records can lead to burnout. Burnout is also tied to finishing documentation at home, a necessity for many physicians, and for nurses who provide home care.
The use of electronic health records increased significantly with the 2009 passage of the Health Information Technology for Economic and Clinical Health Act, which offered financial incentives for hospitals to adopt them. Such records promised efficiency and better teamwork, but as they increasingly serve the needs of America’s corporate, profit-motivated health care, those promises remain mostly unfulfilled.
Insurance companies and hospitals demand ever more data to make decisions about payments and billing, so clinicians have to provide much more information about each patient at each interaction. Mounting regulatory requirements that get built into these records are described as insuring patient safety, but are ultimately tied to compensation, which means money. And in a system rife with legal risks, there is a strong incentive to overdocument everything.
This
is why nurses and physicians must come together. We must acknowledge the
harm done by these ever-increasing documentation requirements, without
losing the core benefits of electronic record keeping.
One inspiration comes from a surprising place. Electronic health records are almost universally disliked, with one telling exception, those used by clinicians at the Department of Veterans Affairs. The reason: Billing concerns don’t shape the records at government-run V.A. hospitals. They document only what’s necessary to deliver better care.
Why can’t the rest of the health care system do the same? For example, some hospitals already have a periodic review of their electronic health records, paring items that do not relate directly to patients; more hospitals could do the same, and all could do it more aggressively. Another: A group of coders at Intermountain Healthcare in Utah is working on a more radical solution, called “activity-based design,” which updates records by voice, and offers helpful care algorithms to clinicians as they interact with patients.
Part of the reason for inaction is that not enough clinicians are making it loud and clear that change is necessary. Doing so requires a unified voice across our professions — and unfortunately, right now, doctors and nurses are anything but unified.
Physicians earn much more money than nurses and have much higher status in the medical hierarchy, which can lead to resentment from nurses when that higher status is abused. The gendered history of both professions also contributes to a view of nurses as fundamentally subordinate to physicians.
Most important, the experience of nurses is often invisible to doctors, even though they typically work alongside them. There are examples of respectful working friendships on the front lines, but the legacy of hierarchy persists, and keeps us from focusing on our common struggles.
Doctors would be wise to let nurses take the lead. For years, nurses have organized to improve hospital working conditions, in particular fighting for better staffing levels. The Service Employees International Union and National Nurses United represent nurses all over the United States, and in general are good at getting their demands met.
One inspiration comes from a surprising place. Electronic health records are almost universally disliked, with one telling exception, those used by clinicians at the Department of Veterans Affairs. The reason: Billing concerns don’t shape the records at government-run V.A. hospitals. They document only what’s necessary to deliver better care.
Why can’t the rest of the health care system do the same? For example, some hospitals already have a periodic review of their electronic health records, paring items that do not relate directly to patients; more hospitals could do the same, and all could do it more aggressively. Another: A group of coders at Intermountain Healthcare in Utah is working on a more radical solution, called “activity-based design,” which updates records by voice, and offers helpful care algorithms to clinicians as they interact with patients.
Part of the reason for inaction is that not enough clinicians are making it loud and clear that change is necessary. Doing so requires a unified voice across our professions — and unfortunately, right now, doctors and nurses are anything but unified.
Physicians earn much more money than nurses and have much higher status in the medical hierarchy, which can lead to resentment from nurses when that higher status is abused. The gendered history of both professions also contributes to a view of nurses as fundamentally subordinate to physicians.
Most important, the experience of nurses is often invisible to doctors, even though they typically work alongside them. There are examples of respectful working friendships on the front lines, but the legacy of hierarchy persists, and keeps us from focusing on our common struggles.
Doctors would be wise to let nurses take the lead. For years, nurses have organized to improve hospital working conditions, in particular fighting for better staffing levels. The Service Employees International Union and National Nurses United represent nurses all over the United States, and in general are good at getting their demands met.
Doctors,
on the other hand, have no similar organizations, no national unions
and little experience in activism on workplace issues. Maybe it’s the
myth of the single, heroic doctor that keeps them from recognizing the
strength in collective efforts. Or maybe they believe their high status
will protect them from the worst of the profit-focused excesses in
American health care.
If so, those beliefs are collapsing, as most physicians are becoming painfully aware that no one will be spared, and that bureaucratic nightmares like electronic health records have impaired their ability to do their jobs well, much less enjoy them.
The millions of us, nurses and doctors, who directly attend to patients want the best for them, and yet are prevented from caring by profiteering and gross inefficiency. We need to restore caring to health care. For nurses, doctors, and even patients who take on this fight, the life you save may indeed be your own.
Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.” Stephen Bergman is a professor of medicine at New York University and the author, most recently, under the pen name Samuel Shem, of the novel “Man’s 4th Best Hospital.”
https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html?action=click&module=Opinion&pgtype=Homepage
If so, those beliefs are collapsing, as most physicians are becoming painfully aware that no one will be spared, and that bureaucratic nightmares like electronic health records have impaired their ability to do their jobs well, much less enjoy them.
The millions of us, nurses and doctors, who directly attend to patients want the best for them, and yet are prevented from caring by profiteering and gross inefficiency. We need to restore caring to health care. For nurses, doctors, and even patients who take on this fight, the life you save may indeed be your own.
Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.” Stephen Bergman is a professor of medicine at New York University and the author, most recently, under the pen name Samuel Shem, of the novel “Man’s 4th Best Hospital.”
https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html?action=click&module=Opinion&pgtype=Homepage
Hospitals Go From Serving to Suing the Poor
An industry's fall from grace
How did medicine transform from a
charitable profession to one that has put one in five Americans into
collections for medical debt? How is it that hospitals are
scientifically advanced centers of academic genius, but can't even tell
you what anything will cost? And how did the noble profession of healing
lose control of its billing processes, allowing some hospitals to sue
and garnish the wages of thousands of the people in the small town they
serve?
The growing money games of healthcare today are threatening the public trust in the medical profession. I'm reminded of that public trust every day I walk through the historic front door of my hospital, where all who enter are greeted by a 9-foot statue of Jesus standing with arms wide open, and the words, "Come to me all ye who are heavy laden, and I will give you rest" engraved at His feet.
American hospitals were built with a mission to be a safe haven for the sick and injured. Most of these hospitals were sustained by charity and committed to great values of equality. In 1873, Mr. Johns Hopkins stated that the purpose of my hospital was to care for "the indigent sick of this city and its environs, without regard to sex, age or color, who may require surgical or medical treatment, and who can be received into the Hospital ... The poor of this city and State of all races, who are stricken down by any casualty, shall be received into the Hospital without charge."
The Johns Hopkins Hospital operated in the red for its first 8 decades. The annual deficits were covered by gifts from trustees and by dipping into the endowment. Their commitment to serve the community was unwavering. While many paid for their medical care, many landmark procedures and treatments at Hopkins were performed at no cost. The pioneering craniofacial operations and the separation of conjoined twins connected at the head were done gratis. For free.
I'm often inspired by our predecessors who sacrificed so much for the sake of helping patients. I think of Dr. Walter Dandy, a pioneer in neurosurgery who lived in the early 1900s. He developed the first ICU and performed the first vascular clipping of a cerebral aneurysm. Though considered a strict, firm-tempered man, he was also extremely generous. He often paid the hospital expenses of indigent patients. On one occasion, when he learned that the mother of a patient could not afford the train fare to bring her child to Baltimore, he not only paid her way but refused to take any compensation. Dr. Dandy, known as the father of cerebrovascular neurosurgery, routinely declined to accept payment from teachers, police officers, or firemen.
The day the polio vaccine was announced as safe and 90% effective, Jonas Salk refused to commercialize it or obtain a patent. He and polio vaccine developer Albert Bruce Sabin refused to make money from their discovery. Salk and Sabin had seen firsthand how polio paralyzed as many as 20,000 children each year, sentencing some to life in an iron lung machine. Our hospital had wards of them. But Salk and Sabin believed that the polio vaccine was the property of humanity. Because of their compassion, most of the world's children quickly had access to the medical breakthrough. Forbes estimates that Salk alone would have been richer by $7 billion if his vaccine had been patented. But Salk and Sabin were motivated by a higher vision than mere monetary gain. They stayed true to their medical calling to help people and considered their vaccines to be donated for the benefit of mankind.
Dr. Benjamin Rush, son of a blacksmith, never forgot growing up in a family without much money in Philadelphia. Serving as a voice for those with psychiatric disorders, he devoted his medical career to erasing the stigma of mental illness. Having mental illness often meant living in extreme poverty, so Rush would often serve his patients without being paid. Considered the forefather of psychiatry, he held strong views on equality, even publicly calling for the abolition of slavery, declaring it a crime. Dr. Rush would later become one of five physician signers of the Declaration of Independence. He was at George Washington's side during the crossing of the Delaware, and he treated injured soldiers behind enemy lines. Dr. Rush was among the first to call for equal rights for women, free education and healthcare for the poor, citywide sanitation facilities, an end to child labor, universal public education, prison reform, and an end to capital punishment. He was known to call out physicians when he observed greed and incompetence among them.
After his death, Thomas Jefferson said in a letter that he knew no one "more benevolent, more learned, of finer genius, or more honest." In comparing Benjamin Rush to Benjamin Franklin, President John Adams said, "Rush has done infinitely more good to America than Franklin. Both had deserved a high Rank among Benefactors to their Country and Mankind; but Rush by far the highest."
It's not just physicians of the past who embody medicine's noble ideals. I also think of Tom Cetena, MD, who decided that instead of practicing in the U.S. where he could serve thousands of patients, he would practice in war-torn Sudan where he serves a million people. He practices without the regalia of academics or the pay of a U.S. physician, but he loves his job. And his communities love him.
That kind of dedication and sacrifice is contagious. As we struggle today to address the issues driving up the cost of healthcare, let's remember the compassion that first drew us to medicine. The torch that Hopkins, Dandy, Sabin, Salk, and Rush carried has now been passed on to us. Through their example and teachings, they bequeathed to us a mission of a healing profession that values excellence, dignity, and equality. Regardless of circumstances, their mission was to take care of a fellow human being when they were vulnerable, and to be their advocate.
Over the last 3 years, my Johns Hopkins research team and I conducted a deep dive into the root issues corrupting healthcare and making it unaffordable. I present these findings in the new book The Price We Pay, detailing how pricing failures, middlemen, and inappropriate care have resulted in our bloated $3.5 trillion healthcare spend. I also profile the doctors and business innovators who gave me hope. They are hard at work to make healthcare more honest, efficient, and affordable.
The cost of healthcare is perhaps today's most divisive political issue. But many of the solutions needed are not partisan; they're American. We are at a pivotal juncture as spending on healthcare threatens every other national priority, ranging from education funding to affording groceries. The lack of honest prices in healthcare lines the pockets of the special interests of healthcare, while gouging millions. Money games and deceptive practices are eroding the public trust in the medical profession. All of us can play a part in driving badly needed reforms, both in the marketplace and in public policy. Transparency's time has come.
As hospitals consider making their prices more honest and their billing less predatory, we physicians can play a powerful role in advocating for what's best for our patients. Similarly, as policymakers now work to make public the secret negotiated prices between insurers and hospitals, doctors should have a voice of support. And as businesses consider how to provide healthcare for their employees, it's important that doctors become literate in the business of medicine to help them cut through the middlemen and contract with them directly.
Taking action will demand standing up to the powerbrokers of the medical establishment. But I'm emboldened by the pioneers of medicine who modeled a better way. I think of Hopkins, Dandy, Sabin, Salk, and Rush, and I believe there are many more like them practicing medicine today. We have already seen how a committed group of good doctors can make a huge difference for everyone. As Margaret Mead once said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."
Martin Makary, MD, MPH, is a professor at Johns Hopkins University and author of the new book The Price We Pay: What Broke American Health Care and How to Fix It (Bloomsbury Press, 2019)
last updated
The growing money games of healthcare today are threatening the public trust in the medical profession. I'm reminded of that public trust every day I walk through the historic front door of my hospital, where all who enter are greeted by a 9-foot statue of Jesus standing with arms wide open, and the words, "Come to me all ye who are heavy laden, and I will give you rest" engraved at His feet.
American hospitals were built with a mission to be a safe haven for the sick and injured. Most of these hospitals were sustained by charity and committed to great values of equality. In 1873, Mr. Johns Hopkins stated that the purpose of my hospital was to care for "the indigent sick of this city and its environs, without regard to sex, age or color, who may require surgical or medical treatment, and who can be received into the Hospital ... The poor of this city and State of all races, who are stricken down by any casualty, shall be received into the Hospital without charge."
The Johns Hopkins Hospital operated in the red for its first 8 decades. The annual deficits were covered by gifts from trustees and by dipping into the endowment. Their commitment to serve the community was unwavering. While many paid for their medical care, many landmark procedures and treatments at Hopkins were performed at no cost. The pioneering craniofacial operations and the separation of conjoined twins connected at the head were done gratis. For free.
I'm often inspired by our predecessors who sacrificed so much for the sake of helping patients. I think of Dr. Walter Dandy, a pioneer in neurosurgery who lived in the early 1900s. He developed the first ICU and performed the first vascular clipping of a cerebral aneurysm. Though considered a strict, firm-tempered man, he was also extremely generous. He often paid the hospital expenses of indigent patients. On one occasion, when he learned that the mother of a patient could not afford the train fare to bring her child to Baltimore, he not only paid her way but refused to take any compensation. Dr. Dandy, known as the father of cerebrovascular neurosurgery, routinely declined to accept payment from teachers, police officers, or firemen.
The day the polio vaccine was announced as safe and 90% effective, Jonas Salk refused to commercialize it or obtain a patent. He and polio vaccine developer Albert Bruce Sabin refused to make money from their discovery. Salk and Sabin had seen firsthand how polio paralyzed as many as 20,000 children each year, sentencing some to life in an iron lung machine. Our hospital had wards of them. But Salk and Sabin believed that the polio vaccine was the property of humanity. Because of their compassion, most of the world's children quickly had access to the medical breakthrough. Forbes estimates that Salk alone would have been richer by $7 billion if his vaccine had been patented. But Salk and Sabin were motivated by a higher vision than mere monetary gain. They stayed true to their medical calling to help people and considered their vaccines to be donated for the benefit of mankind.
Dr. Benjamin Rush, son of a blacksmith, never forgot growing up in a family without much money in Philadelphia. Serving as a voice for those with psychiatric disorders, he devoted his medical career to erasing the stigma of mental illness. Having mental illness often meant living in extreme poverty, so Rush would often serve his patients without being paid. Considered the forefather of psychiatry, he held strong views on equality, even publicly calling for the abolition of slavery, declaring it a crime. Dr. Rush would later become one of five physician signers of the Declaration of Independence. He was at George Washington's side during the crossing of the Delaware, and he treated injured soldiers behind enemy lines. Dr. Rush was among the first to call for equal rights for women, free education and healthcare for the poor, citywide sanitation facilities, an end to child labor, universal public education, prison reform, and an end to capital punishment. He was known to call out physicians when he observed greed and incompetence among them.
After his death, Thomas Jefferson said in a letter that he knew no one "more benevolent, more learned, of finer genius, or more honest." In comparing Benjamin Rush to Benjamin Franklin, President John Adams said, "Rush has done infinitely more good to America than Franklin. Both had deserved a high Rank among Benefactors to their Country and Mankind; but Rush by far the highest."
It's not just physicians of the past who embody medicine's noble ideals. I also think of Tom Cetena, MD, who decided that instead of practicing in the U.S. where he could serve thousands of patients, he would practice in war-torn Sudan where he serves a million people. He practices without the regalia of academics or the pay of a U.S. physician, but he loves his job. And his communities love him.
That kind of dedication and sacrifice is contagious. As we struggle today to address the issues driving up the cost of healthcare, let's remember the compassion that first drew us to medicine. The torch that Hopkins, Dandy, Sabin, Salk, and Rush carried has now been passed on to us. Through their example and teachings, they bequeathed to us a mission of a healing profession that values excellence, dignity, and equality. Regardless of circumstances, their mission was to take care of a fellow human being when they were vulnerable, and to be their advocate.
Over the last 3 years, my Johns Hopkins research team and I conducted a deep dive into the root issues corrupting healthcare and making it unaffordable. I present these findings in the new book The Price We Pay, detailing how pricing failures, middlemen, and inappropriate care have resulted in our bloated $3.5 trillion healthcare spend. I also profile the doctors and business innovators who gave me hope. They are hard at work to make healthcare more honest, efficient, and affordable.
The cost of healthcare is perhaps today's most divisive political issue. But many of the solutions needed are not partisan; they're American. We are at a pivotal juncture as spending on healthcare threatens every other national priority, ranging from education funding to affording groceries. The lack of honest prices in healthcare lines the pockets of the special interests of healthcare, while gouging millions. Money games and deceptive practices are eroding the public trust in the medical profession. All of us can play a part in driving badly needed reforms, both in the marketplace and in public policy. Transparency's time has come.
As hospitals consider making their prices more honest and their billing less predatory, we physicians can play a powerful role in advocating for what's best for our patients. Similarly, as policymakers now work to make public the secret negotiated prices between insurers and hospitals, doctors should have a voice of support. And as businesses consider how to provide healthcare for their employees, it's important that doctors become literate in the business of medicine to help them cut through the middlemen and contract with them directly.
Taking action will demand standing up to the powerbrokers of the medical establishment. But I'm emboldened by the pioneers of medicine who modeled a better way. I think of Hopkins, Dandy, Sabin, Salk, and Rush, and I believe there are many more like them practicing medicine today. We have already seen how a committed group of good doctors can make a huge difference for everyone. As Margaret Mead once said, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has."
Martin Makary, MD, MPH, is a professor at Johns Hopkins University and author of the new book The Price We Pay: What Broke American Health Care and How to Fix It (Bloomsbury Press, 2019)
last updated
The Public Option Is Politically Superior to Medicare for All — But Only As a Sound Bite
by Eric Levitz - New York Magazine - December 28, 2019
The vast majority of Americans believe that every U.S. citizen has a right to quality, affordable health care, and that it is the federal government’s job to uphold that right.
But roughly 70 percent of Americans also believe that their own health-care coverage is either “good” or “excellent” (despite the fact that virtually all of us are getting ripped off). This perennial poll result reflects the fact that voters often evince status-quo bias and loss aversion,
which is to say, they tend to fear losing what they have more than they
long for something better. In the U.S., this tendency is likely
exacerbated by the public’s (understandable) distrust in their governing institutions.
For these reasons, Democratic operatives argue that Medicare for All Who Want It is a safer campaign pitch than Medicare for All. The former, as described by Pete Buttigieg and Joe Biden, would achieve universal coverage by giving all Americans the option
of enrolling in a high-quality, affordable public health insurance
program, while allowing the loss-averse to stick with the lousy private
plans they know and trust. Medicare for All, by contrast, would force
all Americans onto a single government plan, an approach to universal
coverage that would ostensibly be more socially disruptive and fiscally onerous than a public option.
And surveys suggest the operatives are right: When the debate is framed in the terms outlined above, a public option consistently outpolls Medicare for All — even among Democratic voters. In a recent New York Times–SurveyMonkey poll,
58 percent of Democratic respondents said that the statement “The U.S.
should offer government-run insurance to anyone who wants it, but people
should be able to keep their private insurance if they prefer it”
matched their view on health-care policy, while just 25 percent said the
same of the assertion, “The U.S. should adopt a national health-care
plan in which all Americans get their insurance from a single government
plan.”
This
shouldn’t be surprising. It’s hard to see why anyone who isn’t a
self-identified social democrat or progressive policy wonk would find
the latter idea more appealing. In the poll’s framing, the public option
is no risk, all reward; you can enroll in a government plan or “keep”
the one you already have (a benefit that Americans don’t actually enjoy under the existing employer-provided insurance system). Single-payer, by contrast, offers risk without any specified benefit. Thus, unless you happen to be versed in the arguments for Medicare for All’s superiority
to a public option, you’ll be liable to hear the question as, more or
less, “Would you rather have your cake and eat it, too, or be forced to
choose between those alternatives?”
But the actual choice that Democratic candidates are offering the public is far more complicated.
In
truth, the kind of public option that Biden and Buttigieg are
campaigning on — one robust enough to make universal health care a
reality in the United States — would not allow all Americans to “keep
their private insurance if they prefer it.” In fact, their plans would
guarantee massive disruptions to private coverage. As a campaign slogan,
“Medicare for All Who Want It” reconciles the electorate’s desire for
universal coverage with its aversion to disruptive change. But as a
policy, it doesn’t – because no policy can.
The
reason is straightforward. Unlike most other OECD countries, the United
States never imposed strict cost controls on its health-care sector.
And since human beings are willing to pay most any price to avoid death
or severe illness — and since insurance often masks the true cost of
medical services — America’s hospitals, doctors, and drug companies have been able to secure payment rates several times higher
than their peers in other nations. To appreciate how thoroughly we’re
being hosed by our health-care sector, consider this: In 2018, Canada
spent roughly 11 percent of its GDP on health care, which was enough to
provide all of its citizens with premium-free access to the world’s 14th
highest performing health-care system. That same year, the United
States spent roughly 18 percent of its GDP on health care — which, in
our system, was not sufficient to provide any form of insurance to nearly 30 million Americans, nor to prevent more than 50 percent of our people from delaying or forgoing medical care due to affordability concerns.
In
this context, there is no way to provide all Americans with
high-quality, affordable health care without radically disrupting the
status quo. To extend quality coverage to the millions of Americans who
are uninsured or underinsured, you either need to force providers to
accept drastically lower payment rates — which is to say, upend the
business models underpinning nearly one-fifth of the U.S. economy — or
increase federal spending on health care beyond Bernie Sanders’s wildest
dreams. The estimated price tag on the Vermont senator’s plan is
(infamously) $32.6 trillion a decade.
But that estimate assumes that the federal government would force large
pay cuts on health-care providers, while securing administrative
efficiencies through the elimination of redundant private insurance
bureaucracies. A plan that sought to provide universal, comprehensive
health coverage — without disrupting private insurers or imposing big
pay cuts on hospitals and doctors — would be vastly more expensive.
Biden
and Buttigieg haven’t filled in the fine details of their public
options. But both suggest that their plans would be comprehensive, less
expensive than comparable private plans, and available to all Americans.
As the former vice-president puts it,
“Whether you’re covered through your employer, buying your insurance on
your own, or going without coverage altogether, the Biden Plan will
give you the choice to purchase a public health insurance option like
Medicare,” and, “As in Medicare, the Biden public option will reduce
costs for patients by negotiating lower prices from hospitals and other
health care providers.”
If
this is an accurate description of Biden’s plan, then Biden’s plan will
not allow most Americans to “keep their private insurance,” at least,
not for long. Private firms will never have as much pricing power as the
federal government, nor as much capacity to provide coverage at a loss.
If Uncle Sam uses his singular market power to force down costs — and
doles out sufficient subsidies to make his “public option” universally
affordable — then the private insurance industry as we’ve known it will
cease to exist. Meanwhile, to make the provider payment cuts
sustainable, America’s approach to financing hospitals and medical
schools would need to be radically restructured. And to make the public
option fiscally sustainable — once the vast majority of Americans have
enrolled in it — President Biden would need to propose tax increases
nearly as large as those put forward by Sanders and Warren.
Mainstream news outlets (and Democratic debate moderators) have almost all either ignored or failed to comprehend these facts.
This is likely because, in the Beltway’s popular consciousness, the
phrase “public option” is still associated with the policy that
Democrats nearly implemented under Barack Obama. In 2009, the House
passed a version of the Affordable Care Act that would have established a
public health insurance plan. But even if that public option had
survived the Senate, it wouldn’t have been available to 90 percent of
the already insured because the House bill restricted eligibility for
that plan to the small minority of Americans who purchase insurance for
themselves, rather than through their employers. What’s more, the 2009
public option did not seek to outcompete insurers by forcing big cuts on
providers. In fact, the Congressional Budget Office estimated that the public plan would have higher
premiums than most of its private competitors on the ACA’s exchanges,
and that only about 6 million Americans would choose to enroll in it.
That
kind of public option wouldn’t require hiking taxes or disrupting
private insurance. It also wouldn’t ensure universal coverage. Biden and
Buttigieg are, in essence, promising to deliver all the benefits of
single-payer, at the political and fiscal cost of a marginal provision
of the ACA. And the press has largely affirmed their “free pony” pitch. But the health-care industry isn’t fooled. The hospital, pharmaceutical, insurer, and physicians’ lobbies acknowledge no distinction between Medicare for All and a strong public option, and are already funding messaging campaigns against both.
All
of which is to say, when Medicare for All Who Want It stops being a
campaign pitch, and becomes a bill before Congress, it will face almost
all of the same political obstacles as single-payer. Unless Biden and
Buttigieg are misrepresenting the content of their plans, or their own
commitment to universal coverage, then their health-care policies will
require Congress to vote to (effectively) abolish the private insurance
industry as we’ve known it, slash doctors’ salaries and hospitals
profits, enact hefty tax increases, and disrupt the existing insurance
coverage of millions of Americans.
Precisely
because the health-care industry is such a gargantuan parasite on the
U.S. economy, it will be willing and able to inundate the airwaves with
negative messaging on a public option. Many doctors will likely warn
their patients that those “clowns in Congress” are trying to disrupt
their coverage, while many physicians’ groups will mount protests and
lobbying campaigns. And the face of the opposition won’t just be
high-paid hospital executives or millionaire surgeons. When you let an
industry commandeer 18 percent of GDP, many millions of working-class
Americans will owe their livelihoods to that industry. In cities
throughout the country, (price-gouging) hospitals are the top employers.
Private insurers provide jobs for 2.7 million Americans. Substantively,
that is an indictment of the existing system, not a defense of it.
Workers are a scarce resource, and the fact that millions currently
labor for an industry that produces little to nothing of social value is
an outrage. But politically, private insurance workers are a
sympathetic interest group invested in the status quo. Sanders’s bill
includes funds to help those displaced workers regain their footing in
the labor market. Such workers would likely rally in opposition to
Medicare for All, regardless; people typically do not like losing a
source of stable employment, and the past three decades of trade policy
have given American workers no reason
to trust the government’s promises of retraining and reemployment. But
Biden and Buttigieg’s plans don’t even offer such promises.
To be sure, the obstacles to getting a strong public option through Congress would not be identical
to those of Medicare for All. The fiscal cost of the former would be
much lower in the short term, and somewhat lower in the long term, as
Sanders’s specific version of single-payer is exceptionally
comprehensive in its benefits, and includes no cost-sharing. Further,
although the public option’s broad popularity may be partially
attributable to misunderstanding, those poll numbers are nevertheless
politically helpful. And while Democratic candidates and the media are
wildly underselling how disruptive a public option would be, the policy
would still be less disruptive in the immediate term than Medicare for All.
That
said, a strong public option would also present its own unique
political liabilities. To achieve universal coverage through a
premium-funded public option — as Buttigieg has proposed — you need to
automatically enroll the uninsured in the plan, and then bill them for a
service they never signed up for. As the Washington Post reported
this week, this would ostensibly function as “supercharged individual
mandate,” where (in the words of socialist policy wonk Matt Bruenig)
instead of “paying a $695 fine at the end of the year for being
uninsured, you are hit with a bill to pay an entire year of premiums
that could be ten times that amount.”
Further,
to the extent that public option proposals lack detailed transition
plans for when they render private insurers uncompetitive, they’re
liable to create more medium-term disruption than single-payer. And in
the short term, unlike single-payer, a public option would not have all
U.S. doctors in its provider network. In fact, if the new public plan is
linked to Medicare – such that any doctor who accepts the latter must
accept the former – it is possible that some physicians would stop seeing Medicare enrollees, so as to avoid having their practices flooded with patients whose insurance pays the low government rates.
But
such hairsplitting is beside the point, which is that passing a strong
public option — or any genuinely universal health-care plan — will
require fomenting a nigh-unprecedented “political revolution.”
It
will take a minor miracle for Democrats to secure a two-vote Senate
majority in 2021; in which case, Kyrsten Sinema — a “Blue Dog” Democrat
who has suggested that she might prefer Trump to a progressive in 2020 — will be the median Senate vote. This month, legislation outlawing the odious practice of “surprise billing” could not make it out of a House where Democrats boast a 36-vote majority. That bill had 78 percent support
in opinion polls, and enjoyed the backing of the insurance industry.
But hospitals and certain specialty physicians wanted to preserve their
God-given right to charge $26,000 for a throat swab. So, they spent millions on a lobbying campaign to kill the provision. So, it died.
The
honest, pragmatic argument for Democrats to campaign on Medicare for
All Who Want It instead of Medicare for All in 2020 goes something like
this: There is zero chance of enacting either policy in the near future
because the health-care industry is too powerful, America’s governing
institutions are too corrupt, the Senate is too biased against progressives,
and the vast majority of enfranchised Americans are too healthy,
ill-informed, or terrified of change to realize that their existing
coverage is neither “excellent” nor “good.”
Thus, universal health care ain’t happening in 2021, no matter what
gets written into the 2020 Democratic platform. We’re just gonna have to
let Big Health Care keep eating a larger and larger chunk of our
economy, while nonaffluent residents of the world’s wealthiest country
keep losing loved ones to preventable illnesses.
Nevertheless, for whatever reason, the mainstream media is both very hostile to single-payer and extremely friendly to a public option — so friendly, major news outlets routinely frame the latter as a policy that would end all disruption in the private insurance market, and
give all Americans access to a high-quality, low-cost public plan.
Given these realities, running on Medicare for All would marginally
reduce the Democrats’ odds of winning the presidency in 2020, while
doing nothing to meaningfully advance the cause of universal health
care. And winning in 2020 does matter, even if it will be insufficient
for achieving universal health care: With the White House and a slim
Senate majority, Democrats could realistically be expected to make marginal improvements to the health-care system (perhaps, if we’re lucky, improvements that make the fight for universal a bit easier
down the road); increase funding for clean-energy R&D; restore
civil-rights enforcement at the DOJ; adopt more progressive labor,
financial, and environmental regulations; and forestall the conservative
movement’s complete domination of the federal courts, among other
things. Therefore, Democrats should run on the more popular, politically
impossible health-care plan.
I personally don’t find this argument 100 percent
persuasive. But it does strike me as coherent and difficult to dismiss.
Anyhow, if every moderate Democrat and center-left pundit started
framing their preference for a public option in these terms, it might
make the American public a bit less complacent about the status-quo
health-care system, and a bit more sympathetic to calls for radical
change. (Which may be one reason why we’re hearing so many dishonest arguments for the public option instead.)
The Public Option Is More Popular Than M4A — As a Sound Bitehttps://nymag.com/intelligencer/2019/12/public-option-vs-medicare-for-all-debate-biden-buttigieg-sanders-polls.html
Hospitals Sue Trump to Keep Negotiated Prices Secret
The
administration wants to require hospitals to reveal the rates they
privately negotiate with insurers for all sorts of procedures, amid the public outcry over surprise medical bills.
by Reed Abelson - NYT - December 4, 2019
The
nation’s hospital groups sued the Trump administration on Wednesday over
a new federal rule that would require them to disclose the discounted
prices they give insurers for all sorts of procedures.
The hospitals, including the American Hospital Association, argued in a lawsuit filed in United States District Court in Washington that the new rule “is unlawful, several times over.”
They argued that the administration exceeded its legal authority in issuing the rule last month as part of its efforts to make the health care system much more transparent to patients. The lawsuit contends the requirement to disclose their private negotiations with insurers violates their First Amendment rights.
“We make the case that the burden placed on our members to come up with this information is extensive,” Tom Nickels, an executive vice president with the American Hospital Association, said in an interview.
The hospitals, including the American Hospital Association, argued in a lawsuit filed in United States District Court in Washington that the new rule “is unlawful, several times over.”
They argued that the administration exceeded its legal authority in issuing the rule last month as part of its efforts to make the health care system much more transparent to patients. The lawsuit contends the requirement to disclose their private negotiations with insurers violates their First Amendment rights.
“We make the case that the burden placed on our members to come up with this information is extensive,” Tom Nickels, an executive vice president with the American Hospital Association, said in an interview.
The administration wanted
the disclosure rule, which would go into effect in 2021, to allow
patients to better shop for deals on a range of services, from M.R.I.s
to hip replacements.
“Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” Caitlin Oakley, a spokeswoman for the Department of Health and Human Services, said in an emailed statement. “President Trump and Secretary Azar are committed to providing patients the information they need to make their own informed health care decisions and will continue to fight for transparency in America’s health care system.”
While the administration already requires hospitals to post some of their list prices, the public outcry over surprise medical bills and high out-of-pocket costs led the administration to seek even more detail on the discounted prices that are kept secret between hospitals and insurers.
Patients have long complained that they are completely in the dark about what a doctor’s visit or surgery will cost until after they receive the bill. Knee surgery, for example, can cost thousands of dollars more at one hospital than at another in the same region.
The administration clearly anticipated a legal challenge. In fact, when he announced the hospital price disclosure rule, Alex M. Azar II, the health and human services secretary, was adamant that the rule would withstand a court challenge. “We may face litigation, and we feel we are on a very firm legal footing,” he said last month.
“Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” Caitlin Oakley, a spokeswoman for the Department of Health and Human Services, said in an emailed statement. “President Trump and Secretary Azar are committed to providing patients the information they need to make their own informed health care decisions and will continue to fight for transparency in America’s health care system.”
While the administration already requires hospitals to post some of their list prices, the public outcry over surprise medical bills and high out-of-pocket costs led the administration to seek even more detail on the discounted prices that are kept secret between hospitals and insurers.
Patients have long complained that they are completely in the dark about what a doctor’s visit or surgery will cost until after they receive the bill. Knee surgery, for example, can cost thousands of dollars more at one hospital than at another in the same region.
The administration clearly anticipated a legal challenge. In fact, when he announced the hospital price disclosure rule, Alex M. Azar II, the health and human services secretary, was adamant that the rule would withstand a court challenge. “We may face litigation, and we feel we are on a very firm legal footing,” he said last month.
“H.H.S. has been willing under
this administration to test the limits of their authority, that would
subject them to more litigation,” said Emily J. Cook, a health care
lawyer in Los Angeles. While her firm is not representing any of the
plaintiffs in the lawsuit, one of them is a client, she said.
At the heart of the administration’s efforts is an attempt to tackle rising hospital costs, which have outpaced the increase in physician prices, according to a recent study by health economists in Health Affairs. The economists estimated that hospital inpatient prices increased 42 percent from 2007 to 2014.
In an op-ed article published in The Chicago Tribune on Tuesday, Seema Verma, the administrator for the Centers for Medicaid and Medicare Services, promoted the administration’s efforts to benefit patients.
“The decades-long norm of price obscurity is just fine for those who get to set the prices with little accountability and reap the profits, but that stale and broken status quo is bleeding patients dry,” she wrote. “The price transparency delivered by these rules will put downward pressure on prices and restore patients to their rightful place at the center of American health care.”
The hospital groups, which also include the Association of American Medical Colleges, the National Association of Children’s Hospitals and the Federation of American Hospitals, which represents for-profit hospitals, argued in the lawsuit that the rule would not accomplish the administration’s aim of helping consumers avoid surprise bills. Three individual hospitals also joined the case.
“America’s hospitals and health systems remain committed to providing patients with the information they need to make informed health care decisions,” the lawsuit said. It contended that the rule “will generate confusion about patients’ financial obligations, not quell it.” The lawsuit was first reported by The Wall Street Journal.
The Trump administration has also proposed a rule requiring insurers to allow patients to get advanced estimates of their out-of-pocket costs before they see a doctor or go to the hospital. The industry’s major trade associations wrote a letter on Tuesday, requesting an additional 90 days to comment on the proposal, pushing the deadline to mid-April.
At the heart of the administration’s efforts is an attempt to tackle rising hospital costs, which have outpaced the increase in physician prices, according to a recent study by health economists in Health Affairs. The economists estimated that hospital inpatient prices increased 42 percent from 2007 to 2014.
In an op-ed article published in The Chicago Tribune on Tuesday, Seema Verma, the administrator for the Centers for Medicaid and Medicare Services, promoted the administration’s efforts to benefit patients.
“The decades-long norm of price obscurity is just fine for those who get to set the prices with little accountability and reap the profits, but that stale and broken status quo is bleeding patients dry,” she wrote. “The price transparency delivered by these rules will put downward pressure on prices and restore patients to their rightful place at the center of American health care.”
The hospital groups, which also include the Association of American Medical Colleges, the National Association of Children’s Hospitals and the Federation of American Hospitals, which represents for-profit hospitals, argued in the lawsuit that the rule would not accomplish the administration’s aim of helping consumers avoid surprise bills. Three individual hospitals also joined the case.
“America’s hospitals and health systems remain committed to providing patients with the information they need to make informed health care decisions,” the lawsuit said. It contended that the rule “will generate confusion about patients’ financial obligations, not quell it.” The lawsuit was first reported by The Wall Street Journal.
The Trump administration has also proposed a rule requiring insurers to allow patients to get advanced estimates of their out-of-pocket costs before they see a doctor or go to the hospital. The industry’s major trade associations wrote a letter on Tuesday, requesting an additional 90 days to comment on the proposal, pushing the deadline to mid-April.
“The
sheer volume of data that the government is proposing health plans
disclose is staggering — dollar amounts for every single item or
service, for every single provider and facility, for every single
individual and employer plan,” wrote executives from America’s Health
Insurance Plans and the Blue Cross Blue Shield Association.
The administration’s efforts to push the industry to make more information public to patients faces a real legal challenge, and it has been unsuccessful in other attempts.
When the administration earlier tried to require pharmaceutical companies to disclose the list price of prescription drugs in television ads, the drug companies argued that the Department of Health and Human Services had exceeded its regulatory authority and that the requirement also violated its First Amendment rights. A federal judge ruled last summer that H.H.S. had, in fact, exceeded its regulatory authority with the rule, which was seen as largely symbolic because list prices are not what patients typically pay. The decision is under appeal.
The hospitals have also been successful to date in other cases arguing that the agency lacks the authority to issue payment rules, said Ms. Cook, although the government could also win those cases on appeal.
The courts are displaying less deference to rule making by government agencies, said Douglas Hallward-Driemeier, a lawyer in Washington who works with clients to challenge administrative actions.
The hospitals could also succeed by raising First Amendment grounds, he said. “That argument has gained a lot of traction over last 10 years,” he said.
https://www.nytimes.com/2019/12/04/health/hospitals-trump-prices-transparency.html?smid=nytcore-ios-share
“We are honored by this poll and what it reflects - that our patients, their families and the public know that they can trust and count on nurses to stand up for them. This year’s results have special meaning for us as we move into 2020, which the World Health Organization has declared the ‘Year of the Nurse and Midwife,’” said National Nurses United Executive Director, Bonnie Castillo, RN.
“With people and the planet under siege like never before, the public knows they can depend on nurses to use our collective power to advocate for our patients and the broader conditions that support health, justice and dignity for all people, especially the most vulnerable among us,” said Castillo.
“As nurses we know that to defend our patients and realize our vision for a better world our advocacy must encompass union organizing and legislative action. Our efforts in both of these areas have been very fruitful this year,” said NNU President Zenei Cortez, RN.
Despite growing efforts to undermine nurses’ ability to effectively advocate for their patients through union organizing, thousands of nurses voted in 2019 to join NNU affiliates, California Nurses Association (CNA), Minnesota Nurses Association (MNA), and National Nurses Organizing Committee (NNOC) in states across the country.
NNU’s legislative advocacy also moved into high gear with introduction of the Medicare for All Act of 2019 - H.R. 1384, a bill that would guarantee comprehensive health care to all. Thanks to growing grassroots activist pressure in support of the bill, it now has 120 co-sponsors and was considered in legislative hearings by four key congressional committees.
“The public can count on nurses to stand up, show up, and speak up until the broken U.S. healthcare system is profoundly transformed,” said RN and another NNU President, Jean Ross, who testified at a recent congressional hearing. "We will not settle for band aid-fixes. We want the real deal, comprehensive medical care for all, regardless of ability to pay.”
Nurses are also celebrating the U.S. House of Representatives’ bipartisan passage of a groundbreaking federal bill to protect health care and social service workers from extremely high rates of workplace violence—H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act. The bill is modeled after the gold-standard protections won previously by California Nurses Association/National Nurses United.
“This legislation will hold our employers accountable, through federal OSHA, for having a prevention plan in place to stop workplace violence before it occurs,” said NNU President Zenei Cortez, RN. “This is literally a life or death issue for our patients, their loved ones, and the nurses and health care workers that care for them.
This year the Registered Nurses Response Network (RNRN), a disaster relief program sponsored by NNU and the California Nurses Foundation, deployed 20 teams of volunteer registered nurses from around the country to provide basic medical care to asylum seekers at border shelters. In follow up to these border deployments, RNRN has released the report, Compassion Without Borders: RNs Report on the Public Health Crisis at the Border. The report outlines the health crisis at the border and can be viewed here.
NNU members have also continued to speak out for environmental justice, endorsing enactment of a Green New Deal and calling on policy makers to seriously address the climate crisis. Nurses have seen firsthand the grave consequences of this crisis as volunteers participating in medical missions to communities devastated by hurricanes and wildfires. This year, RNRN sent volunteers to Florida and Grand Bahamas in the wake of Hurricane Dorian.
Photos from RNR's Hurricane Dorian mission can be viewed here.
2019 was also the year CNA/NNU organized the Global Nurses Solidarity Assembly in San Francisco, California. The convening brought together nurses, labor leaders, and activists from across the globe, including representatives from 25 countries.
“While we may be from opposite sides of the globe, we know that as nurses we share a common mission and are all bound by the same fundamental convictions: to heal the sick and injured, and fiercely advocate for the well-being of our patients, our communities, and our planet,” said Bonnie Castillo, RN, CNA/NNOC and NNU executive director.
To view a short video made for the international gathering, Global Nurses United in Solidarity, visit: https://vimeo.com/357727371/c97645e7d1
The administration’s efforts to push the industry to make more information public to patients faces a real legal challenge, and it has been unsuccessful in other attempts.
When the administration earlier tried to require pharmaceutical companies to disclose the list price of prescription drugs in television ads, the drug companies argued that the Department of Health and Human Services had exceeded its regulatory authority and that the requirement also violated its First Amendment rights. A federal judge ruled last summer that H.H.S. had, in fact, exceeded its regulatory authority with the rule, which was seen as largely symbolic because list prices are not what patients typically pay. The decision is under appeal.
The hospitals have also been successful to date in other cases arguing that the agency lacks the authority to issue payment rules, said Ms. Cook, although the government could also win those cases on appeal.
The courts are displaying less deference to rule making by government agencies, said Douglas Hallward-Driemeier, a lawyer in Washington who works with clients to challenge administrative actions.
The hospitals could also succeed by raising First Amendment grounds, he said. “That argument has gained a lot of traction over last 10 years,” he said.
https://www.nytimes.com/2019/12/04/health/hospitals-trump-prices-transparency.html?smid=nytcore-ios-share
It Looks Like Health Insurance, but It’s Not. ‘Just Trust God,’ Buyers Are Told.
Some
state regulators are scrutinizing nonprofit Christian cost-sharing
ministries that enroll Americans struggling to pay for medical care, but
aren’t legally bound to cover their members’ claims.
by Reed Abelson - January 2, 2020
Eight-year-old
Blake Collie was at the swimming pool when he got a frightening
headache. His parents rushed him to the emergency room only to learn he
had a brain aneurysm. Blake spent nearly two months in the hospital.
His family did not have traditional health insurance. “We could not afford it,” said his father, Mark Collie, a freelance photographer in Washington, N.C.
Instead, they pay about $530 a month through a Christian health care sharing organization to pay members’ medical bills. But the group capped payments for members at $250,000, almost certainly far less than the final tally of Blake’s mounting medical bills.
“Just trust God,” the nonprofit group, Samaritan Ministries, in Peoria, Ill., said in a statement about its coverage, and advises its members that “there is no coverage, no guarantee of payment.”
His family did not have traditional health insurance. “We could not afford it,” said his father, Mark Collie, a freelance photographer in Washington, N.C.
Instead, they pay about $530 a month through a Christian health care sharing organization to pay members’ medical bills. But the group capped payments for members at $250,000, almost certainly far less than the final tally of Blake’s mounting medical bills.
“Just trust God,” the nonprofit group, Samaritan Ministries, in Peoria, Ill., said in a statement about its coverage, and advises its members that “there is no coverage, no guarantee of payment.”
More than one million Americans,
struggling to cope with the rising cost of health insurance, have joined
such groups, attracted by prices that are far lower than the premiums
for policies that must meet strict requirements, like guaranteed
coverage for pre-existing conditions, established by the Affordable Care
Act. The groups say they permit people of a common religious or ethical
belief to share medical costs, and many were grandfathered in under the
federal health care law mainly through a religious exemption.
These Christian nonprofit groups offer far lower rates because they are not classified as insurance and are under no legal obligation to pay medical claims. They generally decline to cover people with pre-existing illnesses. They can set limits on how much their members will pay, and they can legally refuse to cover treatments for specialties like mental health.
“Nothing is guaranteed,” said Dr. Carolyn McClanahan, a physician who is also a financial planner in Jacksonville, Fla. “You have to depend on the largess of the program.”
The main requirement for membership is adherence to a Christian lifestyle. And the alternative sharing plans keep flourishing, especially now that the Trump administration has relaxed rules to permit alternatives to the A.C.A. that don’t provide such generous coverage.
But state regulators in New Hampshire, Colorado and Texas are beginning to question some of the ministries’ aggressive marketing tactics, often using call centers, and said in some cases people who joined them were misled or did not understand how little coverage they would receive if they or a family member had a catastrophic illness.
These Christian nonprofit groups offer far lower rates because they are not classified as insurance and are under no legal obligation to pay medical claims. They generally decline to cover people with pre-existing illnesses. They can set limits on how much their members will pay, and they can legally refuse to cover treatments for specialties like mental health.
“Nothing is guaranteed,” said Dr. Carolyn McClanahan, a physician who is also a financial planner in Jacksonville, Fla. “You have to depend on the largess of the program.”
The main requirement for membership is adherence to a Christian lifestyle. And the alternative sharing plans keep flourishing, especially now that the Trump administration has relaxed rules to permit alternatives to the A.C.A. that don’t provide such generous coverage.
But state regulators in New Hampshire, Colorado and Texas are beginning to question some of the ministries’ aggressive marketing tactics, often using call centers, and said in some cases people who joined them were misled or did not understand how little coverage they would receive if they or a family member had a catastrophic illness.
On Monday, Washington
State fined one of the larger health-sharing ministries, Trinity
Healthshare, $150,000 and banned it from offering its product to state
residents because it was operating as an unauthorized insurer.
In December, Nevada insurance regulators warned consumers to beware of these plans. “They may seem enticing because they may be cheap, look and sound like they are in compliance with the Affordable Care Act (‘A.C.A.’), when in reality these plans are not even insurance products,” the department said.
The Texas attorney general brought a lawsuit last summer against Aliera Healthcare, which marketed Trinity’s ministry program, to stop it from offering “unregulated insurance products to the public.” The Houston Chronicle featured one couple who was left with more than $100,000 in unpaid medical bills. Trinity said most members are satisfied with its services.
Aliera, which says it has stopped offering its plans in Texas, said it is working with regulators to resolve their concerns. The company says it has taken steps to make sure its customers are not confused about what they are buying.
In December, Nevada insurance regulators warned consumers to beware of these plans. “They may seem enticing because they may be cheap, look and sound like they are in compliance with the Affordable Care Act (‘A.C.A.’), when in reality these plans are not even insurance products,” the department said.
The Texas attorney general brought a lawsuit last summer against Aliera Healthcare, which marketed Trinity’s ministry program, to stop it from offering “unregulated insurance products to the public.” The Houston Chronicle featured one couple who was left with more than $100,000 in unpaid medical bills. Trinity said most members are satisfied with its services.
Aliera, which says it has stopped offering its plans in Texas, said it is working with regulators to resolve their concerns. The company says it has taken steps to make sure its customers are not confused about what they are buying.
Because the groups are not
technically considered insurance, they operate with no government
oversight. “Regulators haven’t been willing to assert any control or
regulatory authority over these plans,” said Katie Keith, who serves as a
consumer representative to the National Association of Insurance
Commissioners and teaches health law at Georgetown University. “They
feel their hands are tied. At the end of the day, it’s not insurance.”
Families who have joined the groups recount winding up with medical bills not covered by the ministries, with no legal way to appeal decisions to reject coverage for care. Some groups ask their members to push hospitals and doctors to write off their bills rather than use members’ money to pay their expenses.
Families who have joined the groups recount winding up with medical bills not covered by the ministries, with no legal way to appeal decisions to reject coverage for care. Some groups ask their members to push hospitals and doctors to write off their bills rather than use members’ money to pay their expenses.
“These plans
offer a false sense of security,” said Jenny Chumbley Hogue, who runs an
insurance agency in the north Dallas area of Texas. She refuses to
offer them to her clients.
Several states have taken action against one ministry they say has deceived people about what they are buying. “The nature of what we’re hearing from consumers around the state is absolutely heart breaking,” said Kate Harris, chief deputy insurance commissioner in Colorado, one state that is trying to prevent the ministry from operating there.
But health-share ministries have become particularly attractive to people like the Collie family who don’t qualify for a federal subsidy and can’t afford an A.C.A. plan. Even though premiums in the A.C.A. market have stabilized, critics of the law insist people need alternatives. “That’s the real driver behind the growth,” said Dr. Dave Weldon, a former Republican congressman from Florida who is president of the Alliance of Health Care Sharing Ministries, which represents the two largest groups.
When Dan Plato left his job to become self-employed as a consultant, he discovered that an A.C.A. policy for 2018 would cost his family around $1,300 a month. “It was very expensive and beyond our needs,” he said. Membership in Liberty Healthshare, a ministry established by Mennonites in Canton, Ohio, was less than half the price, according to Mr. Plato, who blogged about his experience.
But some Liberty members reported trouble getting their medical bills covered. Mr. Plato says a small bill for flu shots went unpaid and ended up in collection. At the end of the year, he was left wondering if Liberty would be able to cover the family in the event of a serious medical emergency. “It’s not something we could trust in that situation,” said Mr. Plato, who switched to one of the plans offered by United Healthcare also exempt from the A.C.A. rules for 2019.
Robyn Lytle, who works as an event planner in Chicago, joined Liberty for 2018, only to find that her daughter’s medical tests were never paid. “It’s been a year and a half, and I’ve been sent to collection,” said Ms. Lytle, who says Liberty had covered some of her family’s other expenses. She switched to an A.C.A. plan for 2019.
Liberty Healthshare declined to comment.
Other people complain that the ministries can be vague about coverage. Greg Snider and his wife joined Medi-Share, the program offered by Christian Care Ministry. Based in West Melbourne, Fla., Medi-Share says it has more than 400,000 members across the country.
Several states have taken action against one ministry they say has deceived people about what they are buying. “The nature of what we’re hearing from consumers around the state is absolutely heart breaking,” said Kate Harris, chief deputy insurance commissioner in Colorado, one state that is trying to prevent the ministry from operating there.
But health-share ministries have become particularly attractive to people like the Collie family who don’t qualify for a federal subsidy and can’t afford an A.C.A. plan. Even though premiums in the A.C.A. market have stabilized, critics of the law insist people need alternatives. “That’s the real driver behind the growth,” said Dr. Dave Weldon, a former Republican congressman from Florida who is president of the Alliance of Health Care Sharing Ministries, which represents the two largest groups.
When Dan Plato left his job to become self-employed as a consultant, he discovered that an A.C.A. policy for 2018 would cost his family around $1,300 a month. “It was very expensive and beyond our needs,” he said. Membership in Liberty Healthshare, a ministry established by Mennonites in Canton, Ohio, was less than half the price, according to Mr. Plato, who blogged about his experience.
But some Liberty members reported trouble getting their medical bills covered. Mr. Plato says a small bill for flu shots went unpaid and ended up in collection. At the end of the year, he was left wondering if Liberty would be able to cover the family in the event of a serious medical emergency. “It’s not something we could trust in that situation,” said Mr. Plato, who switched to one of the plans offered by United Healthcare also exempt from the A.C.A. rules for 2019.
Robyn Lytle, who works as an event planner in Chicago, joined Liberty for 2018, only to find that her daughter’s medical tests were never paid. “It’s been a year and a half, and I’ve been sent to collection,” said Ms. Lytle, who says Liberty had covered some of her family’s other expenses. She switched to an A.C.A. plan for 2019.
Liberty Healthshare declined to comment.
Other people complain that the ministries can be vague about coverage. Greg Snider and his wife joined Medi-Share, the program offered by Christian Care Ministry. Based in West Melbourne, Fla., Medi-Share says it has more than 400,000 members across the country.
Mr.
Snider said he had just dropped traditional coverage when his wife was
diagnosed with a heart condition, but he says he was assured by
Medi-Share that her care could still be covered. She underwent surgery
last year to address an abnormal heart rhythm. “After the procedure, the
bills start rolling in,” Mr. Snider said, including $177,000 for the
surgery alone.
Mr. Snider says Medi-Share urged
him to plead with the hospital after determining he would owe more than
$100,000. He said he had assumed the $800 a month he paid into a pool
would help cover the expenses. After he tweeted his frustrations, the
ministry told him that he would owe only $1,500 for the surgery because
the hospital had forgiven the rest, he said. He now owes thousands of
dollars in related medical bills and is unsure of their status.
If Medi-Share decides not to pay, Mr. Snider knows he has little recourse: “It is completely and solely up to them.” He has since gotten a job where he is covered under his employer.
Medi-Share says that more than 80 percent of the $774 million it collected last year went to members’ medical bills. “We take great care to ensure prospective members understand what is considered a pre-existing condition and what is eligible for sharing,” it said.
It does its part to reduce medical spending, it says, through negotiating with doctors and hospitals and claims it saved members more than $500 million last year. “We consider this process to be one way in which we contribute to the overall objective of reducing medical costs,” the ministry said in a statement.
Medi-Share says it has an extensive network of more than 700,000 providers. But even if a member goes to an in-network provider, the ministry may still decide not to pay the bill. “Fundamentally, we have found that there is often a lack of understanding of what is covered,” said Brendan Miller, an executive with MultiPlan, which arranges networks for Medi-Share as well as insurers.
If Medi-Share decides not to pay, Mr. Snider knows he has little recourse: “It is completely and solely up to them.” He has since gotten a job where he is covered under his employer.
Medi-Share says that more than 80 percent of the $774 million it collected last year went to members’ medical bills. “We take great care to ensure prospective members understand what is considered a pre-existing condition and what is eligible for sharing,” it said.
It does its part to reduce medical spending, it says, through negotiating with doctors and hospitals and claims it saved members more than $500 million last year. “We consider this process to be one way in which we contribute to the overall objective of reducing medical costs,” the ministry said in a statement.
Medi-Share says it has an extensive network of more than 700,000 providers. But even if a member goes to an in-network provider, the ministry may still decide not to pay the bill. “Fundamentally, we have found that there is often a lack of understanding of what is covered,” said Brendan Miller, an executive with MultiPlan, which arranges networks for Medi-Share as well as insurers.
That uncertainty has led some
hospitals and doctors in the MultiPlan network to refuse to treat
ministry patients rather than absorb unpaid costs.
Colorado is one of several states, including Washington, Texas and New Hampshire, that are trying to stop Trinity Healthshare, and its administrator, Aliera Healthcare, from operating in their states because they say the ministry is misleading its residents.
In a statement, Aliera said “it’s deeply disappointing to see state regulators working to deny their residents access to more affordable alternatives offered by health care sharing ministries.”
Trinity says its website makes clear that the ministry does not offer health insurance.
Regulators also worry about these plans siphoning off healthy individuals from the A.C.A. marketplaces, leading to higher premiums for Obamacare policies.
“The ministries have been very concerned about bad actors invading this space,” said Dr. Weldon, the alliance president, who says his members are very clear that they are not insurance companies. “They all operate call centers, and they all bend over backward to inform people inquiring that it is not insurance,” he said.
In the case of Samaritan, which says it covers 271,000 people, the ministry pointed to its Save to Share program, where members can contribute extra to cover more of their bills.
With Blake’s bills likely to far exceed the cap — Mr. Collie has not yet tallied them — he created a GoFundMe account to help pay for his son’s care.
Colorado is one of several states, including Washington, Texas and New Hampshire, that are trying to stop Trinity Healthshare, and its administrator, Aliera Healthcare, from operating in their states because they say the ministry is misleading its residents.
In a statement, Aliera said “it’s deeply disappointing to see state regulators working to deny their residents access to more affordable alternatives offered by health care sharing ministries.”
Trinity says its website makes clear that the ministry does not offer health insurance.
Regulators also worry about these plans siphoning off healthy individuals from the A.C.A. marketplaces, leading to higher premiums for Obamacare policies.
“The ministries have been very concerned about bad actors invading this space,” said Dr. Weldon, the alliance president, who says his members are very clear that they are not insurance companies. “They all operate call centers, and they all bend over backward to inform people inquiring that it is not insurance,” he said.
In the case of Samaritan, which says it covers 271,000 people, the ministry pointed to its Save to Share program, where members can contribute extra to cover more of their bills.
With Blake’s bills likely to far exceed the cap — Mr. Collie has not yet tallied them — he created a GoFundMe account to help pay for his son’s care.
Mr.
Collie says the ministry remains a viable alternative, noting it paid
for numerous medical bills before his son’s hospitalization. “Every
single person has prayed for me and my family,” he said. But he was
enormously relieved when he found out recently his son qualified for
Medicaid, the state-federal insurance program, which will cover the
boy’s full medical care.
In some states, officials are starting to consider requiring the groups to register, to obtain more information for consumers.
Peter V. Lee, a former Obama administration official who now runs the California A.C.A. marketplace, said ministries should be subject to some oversight, including disclosure of how much of the money collected is spent on care.
“There should not be a religious exemption for transparency — where the money goes and if it will be there if consumers need it,” he said.
California is also requiring brokers, who are paid hefty commissions by some of the ministries to enroll members, to make sure their clients understand they are not buying insurance.
Some ministries, like Samaritan, say they do not use brokers or agents. “We also have never, nor will we ever, use insurance agents or brokers to sell Samaritan because we don’t want people to confuse us with insurance,” it said.
https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html?smid=nytcore-ios-share
Peter V. Lee, a former Obama administration official who now runs the California A.C.A. marketplace, said ministries should be subject to some oversight, including disclosure of how much of the money collected is spent on care.
“There should not be a religious exemption for transparency — where the money goes and if it will be there if consumers need it,” he said.
California is also requiring brokers, who are paid hefty commissions by some of the ministries to enroll members, to make sure their clients understand they are not buying insurance.
Some ministries, like Samaritan, say they do not use brokers or agents. “We also have never, nor will we ever, use insurance agents or brokers to sell Samaritan because we don’t want people to confuse us with insurance,” it said.
https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html?smid=nytcore-ios-share
Nurses Top Gallup Poll as Most Trusted Profession for 18th Consecutive Year
“The public can count on nurses to stand up, show up, and speak up until the broken U.S. healthcare system is profoundly transformed.”
Nurses topped the 2019 Gallup Poll's annual ranking of how Americans view 22 major professions with 85% of the public, four in five Americans, rating their honesty and ethical standards as “high” or “very high.” Nurses have ranked first for 18 consecutive years and every year except for one since 1999 when Gallup started to survey public opinion on the honesty and ethical standards of various occupations.“We are honored by this poll and what it reflects - that our patients, their families and the public know that they can trust and count on nurses to stand up for them. This year’s results have special meaning for us as we move into 2020, which the World Health Organization has declared the ‘Year of the Nurse and Midwife,’” said National Nurses United Executive Director, Bonnie Castillo, RN.
“With people and the planet under siege like never before, the public knows they can depend on nurses to use our collective power to advocate for our patients and the broader conditions that support health, justice and dignity for all people, especially the most vulnerable among us,” said Castillo.
“As nurses we know that to defend our patients and realize our vision for a better world our advocacy must encompass union organizing and legislative action. Our efforts in both of these areas have been very fruitful this year,” said NNU President Zenei Cortez, RN.
Despite growing efforts to undermine nurses’ ability to effectively advocate for their patients through union organizing, thousands of nurses voted in 2019 to join NNU affiliates, California Nurses Association (CNA), Minnesota Nurses Association (MNA), and National Nurses Organizing Committee (NNOC) in states across the country.
NNU’s legislative advocacy also moved into high gear with introduction of the Medicare for All Act of 2019 - H.R. 1384, a bill that would guarantee comprehensive health care to all. Thanks to growing grassroots activist pressure in support of the bill, it now has 120 co-sponsors and was considered in legislative hearings by four key congressional committees.
“The public can count on nurses to stand up, show up, and speak up until the broken U.S. healthcare system is profoundly transformed,” said RN and another NNU President, Jean Ross, who testified at a recent congressional hearing. "We will not settle for band aid-fixes. We want the real deal, comprehensive medical care for all, regardless of ability to pay.”
Nurses are also celebrating the U.S. House of Representatives’ bipartisan passage of a groundbreaking federal bill to protect health care and social service workers from extremely high rates of workplace violence—H.R. 1309, the Workplace Violence Prevention for Health Care and Social Service Workers Act. The bill is modeled after the gold-standard protections won previously by California Nurses Association/National Nurses United.
“This legislation will hold our employers accountable, through federal OSHA, for having a prevention plan in place to stop workplace violence before it occurs,” said NNU President Zenei Cortez, RN. “This is literally a life or death issue for our patients, their loved ones, and the nurses and health care workers that care for them.
This year the Registered Nurses Response Network (RNRN), a disaster relief program sponsored by NNU and the California Nurses Foundation, deployed 20 teams of volunteer registered nurses from around the country to provide basic medical care to asylum seekers at border shelters. In follow up to these border deployments, RNRN has released the report, Compassion Without Borders: RNs Report on the Public Health Crisis at the Border. The report outlines the health crisis at the border and can be viewed here.
NNU members have also continued to speak out for environmental justice, endorsing enactment of a Green New Deal and calling on policy makers to seriously address the climate crisis. Nurses have seen firsthand the grave consequences of this crisis as volunteers participating in medical missions to communities devastated by hurricanes and wildfires. This year, RNRN sent volunteers to Florida and Grand Bahamas in the wake of Hurricane Dorian.
Photos from RNR's Hurricane Dorian mission can be viewed here.
2019 was also the year CNA/NNU organized the Global Nurses Solidarity Assembly in San Francisco, California. The convening brought together nurses, labor leaders, and activists from across the globe, including representatives from 25 countries.
“While we may be from opposite sides of the globe, we know that as nurses we share a common mission and are all bound by the same fundamental convictions: to heal the sick and injured, and fiercely advocate for the well-being of our patients, our communities, and our planet,” said Bonnie Castillo, RN, CNA/NNOC and NNU executive director.
To view a short video made for the international gathering, Global Nurses United in Solidarity, visit: https://vimeo.com/357727371/c97645e7d1
The Americans dying because they can't afford medical care
Millions of Americans – as many as 25% of the population – are delaying getting medical help because of skyrocketing costs
by Matt Sainato - The Guardian - January 7,2019
Susan Finley returned to her job at a Walmart retail store in Grand
Junction, Colorado, after having to call in sick because she was
recovering from pneumonia.
The day she returned, the 53-year-old received her ten year associate award – and was simultaneously laid off, according to her family. She had taken off one day beyond what is permitted by Walmart’s attendance policy.
After losing her job in May 2016, Finley also lost her health insurance coverage and struggled to find a new job. Three months later, Finley was found dead in her apartment after avoiding going to see a doctor for flu-like symptoms.
“My grandparents went by to check on her, and they couldn’t get into her apartment,” her son Cameron Finley told the Guardian. “They got the landlord to open it up, went in and found she had passed away. It came as a complete surprise to everybody. It just came out of nowhere.
“She was barely scraping by and trying not to get evicted. She gets what appears to her as a basic cold or flu, didn’t go to the doctor and risk spending money she didn’t have, and as a consequence she passed away.”
Asked about Finley losing her job, Walmart declined to comment, saying personnel files from 2016 had been moved offsite.
Finley is one of millions of Americans who avoid medical treatment due to the costs every year.
A December 2019 poll conducted by Gallup found 25% of Americans say they or a family member have delayed medical treatment for a serious illness due to the costs of care, and an additional 8% report delaying medical treatment for less serious illnesses. A study conducted by the American Cancer Society in May 2019 found 56% of adults in America report having at least one medical financial hardship, and researchers warned the problem is likely to worsen unless action is taken.
Dr Robin Yabroff, lead author of the American Cancer Society study, said last month’s Gallup poll finding that 25% of Americans were delaying care was “consistent with numerous other studies documenting that many in the United States have trouble paying medical bills”.
High healthcare costs are causing Americans to get sicker from delaying, avoiding, or stopping medical treatment.
Anamaria Markle, of Port Murray, New Jersey was diagnosed with stage three ovarian cancer in 2017. A clerk for nearly twenty years at the same firm, her family says her employer laid her off after the diagnosis, with one year’s severance and health insurance coverage. When the insurance coverage ended, Markle struggled to pay for coverage through Cobra (a health insurance program for employees who lose their job or have a reduction in work hours), additional expenses, copays (an out-of-pocket, upfront fee for a medical service ), and medical debt not covered by insurance.
Laura Valderrama, Markle’s daughter, said: “It wasn’t financially sustainable to keep paying Cobra out of pocket. On top of the premiums you still have to pay the bills. We kept getting lots of bills for surgeries, chemotherapy, all these treatments, all these bills kept coming in.”
Markle decided to stop receiving medical treatment due to the rising costs and debt, and died in September 2018 at the age of 52.
“My mom was constantly doing the math of treatment costs while she was on the decline,” Valderrama said. “I really miss my mom. She shouldn’t have had to make the decision to stop her treatment based on financial costs.”
One of those Americans was the father of Ashley Hudson, who died in 2002 due to an untreated liver disease, an illness that went undiagnosed until a few weeks before his death. It was only discovered when he went to the emergency room because he was unable to afford to see a doctor due to lack of insurance coverage and inability to afford treatment out of pocket.
Now Hudson’s mother, Sue Olvera, who works at McDonald’s and has no insurance coverage, is facing similar cost barriers while struggling with kidney issues and type 2 diabetes.
“She’s had pain for a long time, but she doesn’t usually go to the doctor unless it gets excruciating because she can’t afford to go,” said Ashley Hudson.
The family is trying to raise money via GoFundMe to help cover the costs of Olvera’s surgery to remove kidney stones earlier this year, which Olvera was expecting to be covered under a charity program, but was denied and now is stuck with over $40,000 in medical debt.
Healthcare is one of the most contentious issues surrounding the 2020 presidential election as Democratic candidates battle over policies to expand healthcare access and lower costs, from Bernie Sanders’ medicare for all bill which would create a government funded healthcare system providing universal coverage to all Americans, while eliminating surprise medical bills, deductibles, and copays, to healthcare plans that focus on creating a public option under the Affordable Care Act. As Democrats debate solutions to America’s healthcare crisis, the Trump administration is delaying any plans for repealing the Affordable Care Act passed under Obama until after the 2020 election.
Several people the Guardian interviewed are currently avoiding medical treatment for serious illnesses or struggling to treat illnesses worsened by delaying medical care due to costs.
Substitute teacher Gretchen Hess Miller, 48, of Carlisle, Pennsylvania, was diagnosed with oral cancer in 2009 while pregnant. She has had surgery to remove the cancer, but is supposed to receive annual scans to monitor the cancer, but hasn’t received one in four to five years because her family can’t afford it.
“My doctor told me this is an aggressive form of cancer that will come back someday and I need to stay on top of it, but the deductible and the difficulty with dealing with the insurance keeps me from having it done,” said Hess-Miller.
Her insurance coverage currently requires a $5,000 deductible, and says she’s previously had to fight to receive coverage because medical care is constantly denied because insurance classifies oral care as dental rather than medical care.
“I have kids. I worry about our future. I want to be here for them,” she said. “We’re very thankful to have insurance at all, but families should not have to compromise on if I’m going to pay for my kid’s college or pay for a test to see if I have cancer. People shouldn’t be put in a position to make choices like that.”
Amy Keeling, 51, a paralegal in New Hampton, Iowa, avoided seeing a doctor for over a year due to her partner’s surgery costs in 2018 for triple bypass surgery.
“I hadn’t felt good for awhile, but I just thought it was my age. In September 2019, I got the flu, and ended up in the emergency room because I couldn’t breathe,” said Keeling.
She was diagnosed with Grave’s Disease, an autoimmune disorder.
“If I had been going in to the doctor and checking on this a lot sooner, we may have been able to do other alternatives and get a handle on this before it got this serious. I’m at the point where medication won’t control it and my only option is surgery,” she said.
Her insurance requires a $5,000 deductible. Having met it in 2019, she scrambled to have her surgery scheduled before 2020, when it would reset. All while her partner is looking to file for bankruptcy because he currently has around $40,000 in medical debt.
The day she returned, the 53-year-old received her ten year associate award – and was simultaneously laid off, according to her family. She had taken off one day beyond what is permitted by Walmart’s attendance policy.
After losing her job in May 2016, Finley also lost her health insurance coverage and struggled to find a new job. Three months later, Finley was found dead in her apartment after avoiding going to see a doctor for flu-like symptoms.
“My grandparents went by to check on her, and they couldn’t get into her apartment,” her son Cameron Finley told the Guardian. “They got the landlord to open it up, went in and found she had passed away. It came as a complete surprise to everybody. It just came out of nowhere.
“She was barely scraping by and trying not to get evicted. She gets what appears to her as a basic cold or flu, didn’t go to the doctor and risk spending money she didn’t have, and as a consequence she passed away.”
Asked about Finley losing her job, Walmart declined to comment, saying personnel files from 2016 had been moved offsite.
Finley is one of millions of Americans who avoid medical treatment due to the costs every year.
A December 2019 poll conducted by Gallup found 25% of Americans say they or a family member have delayed medical treatment for a serious illness due to the costs of care, and an additional 8% report delaying medical treatment for less serious illnesses. A study conducted by the American Cancer Society in May 2019 found 56% of adults in America report having at least one medical financial hardship, and researchers warned the problem is likely to worsen unless action is taken.
Dr Robin Yabroff, lead author of the American Cancer Society study, said last month’s Gallup poll finding that 25% of Americans were delaying care was “consistent with numerous other studies documenting that many in the United States have trouble paying medical bills”.
US spends the most on healthcare
Despite millions of Americans delaying medical treatment due to the costs, the US still spends the most on healthcare of any developed nation in the world, while covering fewer people and achieving worse overall health outcomes. A 2017 analysis found the United States ranks 24th globally in achieving health goals set by the United Nations. In 2018, $3.65tn was spent on healthcare in the United States, and these costs are projected to grow at an annual rate of 5.5%t over the next decade.High healthcare costs are causing Americans to get sicker from delaying, avoiding, or stopping medical treatment.
Anamaria Markle, of Port Murray, New Jersey was diagnosed with stage three ovarian cancer in 2017. A clerk for nearly twenty years at the same firm, her family says her employer laid her off after the diagnosis, with one year’s severance and health insurance coverage. When the insurance coverage ended, Markle struggled to pay for coverage through Cobra (a health insurance program for employees who lose their job or have a reduction in work hours), additional expenses, copays (an out-of-pocket, upfront fee for a medical service ), and medical debt not covered by insurance.
Laura Valderrama, Markle’s daughter, said: “It wasn’t financially sustainable to keep paying Cobra out of pocket. On top of the premiums you still have to pay the bills. We kept getting lots of bills for surgeries, chemotherapy, all these treatments, all these bills kept coming in.”
Markle decided to stop receiving medical treatment due to the rising costs and debt, and died in September 2018 at the age of 52.
“My mom was constantly doing the math of treatment costs while she was on the decline,” Valderrama said. “I really miss my mom. She shouldn’t have had to make the decision to stop her treatment based on financial costs.”
Families ‘should not have to make these choices’
A 2009 study conducted by researchers at Harvard Medical School found 45,000 Americans die every year as a direct result of not having any health insurance coverage. In 2018, 27.8 million Americans went without any health insurance for the entire year.One of those Americans was the father of Ashley Hudson, who died in 2002 due to an untreated liver disease, an illness that went undiagnosed until a few weeks before his death. It was only discovered when he went to the emergency room because he was unable to afford to see a doctor due to lack of insurance coverage and inability to afford treatment out of pocket.
Now Hudson’s mother, Sue Olvera, who works at McDonald’s and has no insurance coverage, is facing similar cost barriers while struggling with kidney issues and type 2 diabetes.
“She’s had pain for a long time, but she doesn’t usually go to the doctor unless it gets excruciating because she can’t afford to go,” said Ashley Hudson.
The family is trying to raise money via GoFundMe to help cover the costs of Olvera’s surgery to remove kidney stones earlier this year, which Olvera was expecting to be covered under a charity program, but was denied and now is stuck with over $40,000 in medical debt.
Healthcare is one of the most contentious issues surrounding the 2020 presidential election as Democratic candidates battle over policies to expand healthcare access and lower costs, from Bernie Sanders’ medicare for all bill which would create a government funded healthcare system providing universal coverage to all Americans, while eliminating surprise medical bills, deductibles, and copays, to healthcare plans that focus on creating a public option under the Affordable Care Act. As Democrats debate solutions to America’s healthcare crisis, the Trump administration is delaying any plans for repealing the Affordable Care Act passed under Obama until after the 2020 election.
Several people the Guardian interviewed are currently avoiding medical treatment for serious illnesses or struggling to treat illnesses worsened by delaying medical care due to costs.
Substitute teacher Gretchen Hess Miller, 48, of Carlisle, Pennsylvania, was diagnosed with oral cancer in 2009 while pregnant. She has had surgery to remove the cancer, but is supposed to receive annual scans to monitor the cancer, but hasn’t received one in four to five years because her family can’t afford it.
“My doctor told me this is an aggressive form of cancer that will come back someday and I need to stay on top of it, but the deductible and the difficulty with dealing with the insurance keeps me from having it done,” said Hess-Miller.
Her insurance coverage currently requires a $5,000 deductible, and says she’s previously had to fight to receive coverage because medical care is constantly denied because insurance classifies oral care as dental rather than medical care.
“I have kids. I worry about our future. I want to be here for them,” she said. “We’re very thankful to have insurance at all, but families should not have to compromise on if I’m going to pay for my kid’s college or pay for a test to see if I have cancer. People shouldn’t be put in a position to make choices like that.”
Amy Keeling, 51, a paralegal in New Hampton, Iowa, avoided seeing a doctor for over a year due to her partner’s surgery costs in 2018 for triple bypass surgery.
“I hadn’t felt good for awhile, but I just thought it was my age. In September 2019, I got the flu, and ended up in the emergency room because I couldn’t breathe,” said Keeling.
She was diagnosed with Grave’s Disease, an autoimmune disorder.
“If I had been going in to the doctor and checking on this a lot sooner, we may have been able to do other alternatives and get a handle on this before it got this serious. I’m at the point where medication won’t control it and my only option is surgery,” she said.
Her insurance requires a $5,000 deductible. Having met it in 2019, she scrambled to have her surgery scheduled before 2020, when it would reset. All while her partner is looking to file for bankruptcy because he currently has around $40,000 in medical debt.
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