Health Care Reform Articles - March 30, 2020

Editor's Note -

There are several articles in today's posting that point out how much the Coronavirus pandemic is beginning to make the connection between health care policy and clinical medicine crystal clear. Most clinicians, focused as they should be on clinical medicine, have only a rudimentary understanding of the ethical and moral, professional, economic and political forces that act on health care policy.  Each is its own vector, and each contributes in its own way to the resultant that we call health care policy.

For whatever reasons, I have since early in my career more clearly than most practicing physicians appreciated the relationship between clinical practice and the environment in which that practice must function. I have devoted much of my professional career during the past 50 years or so to the study and teaching of the interface between clinical medicine and health care policy.

 The Coronavirus pandemic has created one of the rare "teachable moments", during which the attention of clinicians, the general public, the press and the political and commenteriiat class all have their attention focused on the importance of a good health care policy to the clinical practice of medicine. That would be a policy focused on the welfare of patients and of the caregivers.

For most of the last century, organized medicine has had to be dragged - often kicking and screaming - into the 20th and now the 21st century regarding updating our approach as a profession to bringing public policy in health care up to the standards we have achieved regarding the science and technology of medicine.

Let's hope the current crisis, created by the Coronavirus, will help to accelerate that long overdue transition.

-SPC 

Enough With the Baby Steps on Coronavirus

It’s not too late to start protecting jobs or to make medical care for Covid-19 free.

by Emmanuel Saez and Gabriel Zucman - NYT - March 30, 2020

The coronavirus pandemic is laying bare structural deficiencies in America’s social programs. The relief package passed by Congress last week provides emergency fixes for some of these issues, but it also leaves critical problems untouched. To avoid a Great Depression, Congress must quickly design a more forceful response to the crisis.
Start with the labor market. In just one week, from March 15 to March 21, 3.3 million workers filed for unemployment insurance. According to some projections, the unemployment rate might rise as high as 30 percent in the second quarter of 2020.
This dramatic spike in jobless claims is an American peculiarity. In almost no other country are jobs being destroyed so fast. Why? Because throughout the world, governments are protecting employment. Workers keep their jobs, even in industries that are shut down. The government covers most of their wage through direct payments to employers. Wages are, in effect, socialized for the duration of the crisis.
Instead of safeguarding employment, America is relying on beefed-up unemployment benefits to shield laid-off workers from economic hardship. To give just one example, in both the United States and Britain, the government is asking restaurant workers to stay home. But in Britain, workers are receiving 80 percent of their pay (up to £2,500 a month, or $3,125) and are guaranteed to get their job back once the shutdown is over. In America, the workers are laid off; they must then file for unemployment insurance and wait for the economy to start up again before they can apply for a new job, and if all goes well, sign a new contract and resume working.

Even if unemployment is generously compensated — as it is in the $2.2 trillion bill Congress passed — there is nothing efficient in letting the unemployment rate rise to double digits. Losing one’s job is anxiety inducing. Applying for unemployment benefits is burdensome. The unemployment system risks being swamped soon by tens of millions of claims. Although some businesses may rehire their workers once the shutdown is over, others will have disappeared. When social distancing ends, millions of employer-employee relationships will have been destroyed, slowing down the recovery. In Europe, people will be able to return to work, as if they had been on a long, government-paid leave.
The battle for the speediest recovery starts today. The next congressional bill needs measures to protect employment for the duration of the shutdown. This does not raise insuperable technical difficulties. The bill passed last week provides support for wages in one industry, airlines. Congress could easily extend this program to other sectors. Some countries — like Germany, with its Kurzarbeit system, a policy aimed at job retention in times of crisis — already had the government infrastructure in place to send workers home while the state replaced most of their lost earnings. But several nations with no experience in that area — like Britain, Ireland and Denmark — were able to introduce brand-new employment guarantee programs on the fly during the epidemic.
This situation for laid-off workers would be bad enough if it were not aggravated by a second American peculiarity. As they are losing their jobs, many workers are also losing their employer-provided health insurance — and now find themselves faced with the Kafkaesque task of obtaining coverage on their own.
One option involves continuing to be covered by one’s former employer, a program known as COBRA. It is prohibitively expensive: Participants have to bear the full cost of insurance, $20,500 per year on average. Another option is to go shopping for a plan on the Affordable Care Act insurance exchange, where one is faced with a bewildering choice between plans like Blue Shield’s Bronze 60 PPO (with a deductible of up to $12,600 per year) and Aetna’s Silver Copay HNOnly (with a $7,000 deductible and up to $14,000 in annual out-of-pocket expenses). The last option is to join the ranks of the uninsured, a catastrophic solution during a pandemic. There are reports that people have already died of Covid-19 because they refused to go to the hospital, worried about bills, or because they were denied treatment for lack of insurance.
The bill passed last week does nothing to reduce co-pays, deductibles or premiums on the insurance exchanges; nor does it reduce the price of COBRA. The next bill should introduce a Covidcare for All program. This federal program would guarantee access to Covid-19 care at no cost to all U.S. residents — no matter their employment status, age or immigration status. Fighting the pandemic starts with eradicating the spread of the virus, which means that everybody must be covered.

Covidcare for All would also cover the cost of Covid-19 treatments for people who are insured. Insurance companies would be barred in return from hiking premiums, which might otherwise spike as much as 40 percent next year.
The United States also needs to ramp up its support to businesses. Since containing the epidemic requires government-mandated economic shutdowns, it is legitimate to expect the government, in return, to shelter businesses from the economic disruptions. To keep businesses alive through this crisis, the government should act as a payer of last resort. In other words, the government should pay not only wages of idled workers, but also essential business maintenance costs, like rents, utilities, interest on debt, health insurance premiums, and other costs that are vital for the survival of businesses in locked down sectors. This allows businesses to hibernate without bleeding cash and risking bankruptcy. Denmark was the first nation to announce such a program; it is being emulated by a growing number of countries, including Italy.
In the United States, calls to support businesses have been met with excessive skepticism so far. To be sure, the congressional relief package includes $350 billion in help for small businesses, but the program is complex, limited in scope and only a fraction of eligible businesses are likely to use it.
A liquidationist ideology seems to have infected minds on both the left and the right. On the right, opposition to government grants to businesses is grounded in the view that markets should be left to sort out the consequences of the pandemic. Let airlines go bankrupt; shareholders and bondholders will lose but the airlines will restructure and re-emerge. The best way government can help is by slashing taxes, according to this view. The relief package includes more than $200 billion in tax cuts for business profits.
This view is misguided. There is nothing efficient in the destruction of businesses that were viable before the virus outbreak. The crisis cannot be blamed on poorly managed corporations. Government support, in the case of a pandemic, does not create perverse incentives. Bankruptcies redistribute income, but in a chaotic and opaque way. And while bankruptcy might be a way to deal with the economic fallout of the pandemic for large corporations, it is not well adapted to small businesses. Without strong enough government support, many small businesses will have to liquidate. The death of a business has long-term costs: The links between entrepreneurs, workers and customers are destroyed and often need to be rebuilt from scratch.
On the left, a popular view contends that the government should help people, not corporations. It holds that big corporations acted badly before the crisis — buying back their shares, paying C.E.O.s exorbitant salaries — and should not be bailed out. If they are, in this view, they should be subject to strict conditions, like swearing off share buybacks, reducing C.E.O. pay, and a $15 minimum wage for their employees.
The concerns underlying this view are understandable. Inequality has surged since the beginning of the 1980s. This crisis, however, is unlike the financial crisis of 2008-9. The firms seeking aid today bear no direct responsibility for the disaster that threatens their survival. If the government mandates a shutdown for public health reasons, why should it attach any conditions to temporary financial support for directly affected industries?

No doubt some companies will exploit loopholes in government relief plans. Some businesses, more broadly, will disproportionately benefit from the pandemic. While tens of thousands of brick-and-mortar stores are closed, Amazon sales rise. The Seattle-based company is one of the few S&P 500 firms whose stock price is higher today than at the beginning of the year. Cloud computing is exploding. Facebook traffic is booming.
But these windfall profits have a fair, comprehensive and transparent solution: The government should impose excess profits taxes, as it has done several times in the past during periods of crisis. In 1918, all profits made by corporations above and beyond an 8 percent rate of return on their capital were deemed abnormal, and abnormal profits were taxed at progressive rates of up to 80 percent. Similar taxes on excessive profits were applied during World War II and the Korean War. These taxes all had one goal — making sure that no one could benefit outrageously from a situation in which the masses suffered.
To help make this happen, the next bill needs an excess profits tax. If Congress fails to act, the pandemic could well reinforce two of the defining trends of the pre-coronavirus American economy: the rise of business concentration and the upsurge of inequality.
Some will say that the solutions we’ve outlined show excessive faith in government. They will correctly point out that some of these policies are undesirable in normal times. But these are not normal times. The big battles — be they wars or pandemics — are fought and won collectively. In this period of national crisis, hatred of the government is the surest path to self-destruction.
https://www.nytimes.com/2020/03/30/opinion/coronavirus-economy-saez-zucman.html?action=click&module=moreIn&pgtype=Article&region=Footer&action=click&module=MoreInSection&pgtype=Article&region=Footer&contentCollection=Jennifer%20Senior

The Psychological Trauma That Awaits Our Doctors and Nurses

Don’t underestimate the moral anguish of deciding who gets a ventilator.

by Jennifer Senior - NYT - March 29, 2020

This is the moment to pray for the psychological welfare of our health care professionals. In the months ahead, many will witness unimaginable scenes of suffering and death, modern Pietàs without Marys, in which victims are escorted into hospitals by their loved ones and left to die alone.
I fear these doctors and nurses and other first responders will burn out. I fear they will suffer from post-traumatic stress. And with the prospect of triage on the horizon, I fear they will soon be handed a devil’s kit of choices no healer should ever have to make. It’s a recipe for moral injury.
Succinctly put, moral injury is the trauma of violating your own conscience. It is an experience known to many combat veterans — the term was in fact popularized by Jonathan Shay, a longtime psychiatrist at a Department of Veterans Affairs outpatient clinic in Boston, in his book “Achilles in Vietnam.”
That this violation may be in the service of a larger, more defensible objective doesn’t matter — or rather, it does little to mitigate the guilt, self-reproach or spiritual crisis activated by making choices that feel so very wrong.

Moral injury is now a looming reality for our front-line medical professionals, should they be forced to ration ventilators or other lifesaving resources. This is not why most of them went to medical and nursing school. “It’s something none of us have been trained for, except perhaps military physicians,” Dr. R. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York, told me. “There’s a tremendous amount of worry about what it’ll feel like in the moment.”
An article published on March 23 in The New England Journal of Medicine estimates that the number of American patients who will require ventilation for the coronavirus could be as high as 31 per machine. A New York hospital, according to The Washington Post, is already putting two patients at a time on ventilators designed for one.
Triage, in other words, is probably inevitable.
Twenty-first century doctors in wealthy countries have no scripts for this. But there are resources emerging. Morrison pointed me to an astonishing website run by VitalTalk, an organization that under ordinary circumstances specializes in helping doctors communicate clearly and compassionately about serious illness.
It has a brand-new set of talking points for the coronavirus, including rationing. Morrison said it’s what the health care professionals at Mount Sinai will be referring to, should things get dire. And they’re utterly surreal.
Patient family: You’re playing God. You can’t do that.
Clinician response: I am sorry. I did not mean to give you that feeling. Across the city, every hospital is working together to try to use resources in a way that is fair for everyone. I realize that we don’t have enough. I wish we had more. Please understand that we are all working as hard as possible.

Patient family: Can’t you get 15 more ventilators from somewhere else?
Clinician response: Right now the hospital is operating over capacity. It is not possible for us to increase our capacity like that overnight. And I realize that must be disappointing to hear.
Patient family: How can you just take them off a ventilator when their life depends on it?
Clinician response: I’m so sorry that her condition has gotten worse, even though we are doing everything. Because we are in an extraordinary time, we are following special guidelines that apply to everyone here. We cannot continue to provide critical care to patients who are not getting better. This means that we need to accept that she will die, and that we need to take her off the ventilator. I wish things were different.
New York State does, in fact, have guidelines for ventilator allocation, written in 2015. They recommend that hospitals appoint triage officers or committees — made up of experts who do not have clinical responsibilities for the patients at issue — to make the difficult calls, thus easing the moral burden on the men and women on the ground. Who does and doesn’t get a ventilator, and for how long, will depend on a range of criteria, from the overall health of the patient to how well the patient is doing at that particular moment.
I’ve spoken to a number of doctors who said they’re comforted by these guidelines. There are clear rules to follow.
But Stephen Xenakis, a psychiatrist and retired brigadier general who has spent decades treating veterans, says that rules aren’t sufficient to inoculate first responders from psychological suffering.
“We have rules too, in the military,” he told me. “Rules of engagement. And you may follow the rules of engagement, and everyone around you may say that you followed the rules of engagement. But after the incident occurs, you ask yourself, ‘Did I make the right decision?’ Because the outcome was not acceptable, was not digestible.”
Or it’ll be something even more nuanced than that. The outcome may be acceptable — that is, reconcilable — in the moment. But not later on.

Xenakis gave an example of a doctor who removes a 70-year-old patient from a ventilator. The man’s children are pleading. But the if-then of the algorithm requires it. A decade later, that doctor’s own father is 70. And it hits her, hard: Did she really make that decision?
“The angst that clinicians may experience when asked to withdraw ventilators for reasons not related to the welfare of their patients should not be underestimated,” warns the authors of the article in The New England Journal of Medicine. “It may lead to debilitating and disabling distress.”
We look at veterans and thank them for their service, never being able to fully comprehend what they’ve been through. The same may soon be true of some of our health care professionals. We may think we know. But we don’t.
https://www.nytimes.com/2020/03/29/opinion/coronavirus-ventilators-rationing-triage.html?action=click&module=Opinion&pgtype=Homepage

How the World’s Richest Country Ran Out of a 75-Cent Face Mask

A very American story about capitalism consuming our national preparedness and resiliency.

by Farhad Manjoo - NYT - March 25, 2020

Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?
I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.
Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.
That’s where cheap, disposable face masks, eye protection, gloves and gowns come in. That we failed to procure enough safety gear for medical workers — not to mention for sick people and for the public, as some health experts might have recommended if masks were not in such low supply — seems astoundingly negligent.

What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.
I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.
Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.
But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.
“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.

And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.
Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.
But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.
As the coronavirus began to spread in China early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.
Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.
“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”
In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Taiwan, Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.

People in the industry assured me they would prepare better next time. “We are laserlike focused to ensure that our health care systems are never in this scenario again,” Alkire told me. “There will be a lot more domestic manufacturing of these products going forward.”
I don’t doubt it — but that we did not plan, as a nation, for this entirely predictable shortage makes me wonder what other inevitable pothole is lurking out there for all to trip over. Getting enough protective gear was among the cheapest, most effective things we could have done to slow down the pandemic. That we failed on such an obvious thing reveals an alarming national incapacity to imagine and prepare for the worst.
We will get enough masks in time for the next disaster. But wouldn’t it be nice, for once, if we prepared for trouble before it hit us in the face?
https://www.nytimes.com/2020/03/25/opinion/coronavirus-face-mask.html?action=click&module=Opinion&pgtype=Homepage

Bernie Sanders May Be Losing, But COVID-19 Is Keeping Medicare for All Alive and Well 

by Abigail Abrams - Time - March 23, 2020

In response to the U.S. economy tanking, the federal government has moved to provide relief in a range of ways that would have seemed like far-off liberal dreams just months ago. The Department of Housing and Urban Development halted foreclosures and evictions during the emergency; the Department of Education slashed federal student loan interest rates to zero and will allow borrowers to completely suspend payments if needed; Congress is negotiating a plan to send direct cash payments to families; and a version of paid sick leave just became law.
But the COVID-19 outbreak has also proven as good a reason as any for advocates to renew their calls for the ultimate progressive agenda item: Medicare for All.
“Everybody’s seeing that it’s in the interest of all Americans that everyone gets the health care they need when they need it,” says Kelly Coogan-Gehr of National Nurses United, the country’s largest nurses union and one of the most prominent groups campaigning for Medicare for All.
As the number of diagnosed COVID-19 cases in the U.S. shoots up and stories of high hospital bills proliferate, more than two in five Americans say the epidemic has increased their likelihood of supporting universal health care proposals that involve the government providing all Americans with health insurance, according to a recent Morning Consult poll. In exit polls in nearly every state that has held a presidential primary contest so far, a majority of Democratic primary voters have said they support a single government health plan, which is what Medicare for All would bring about.
With the Democratic field narrowed and Senator Bernie Sanders all but eliminated by former Vice President Joe Biden’s victories, Medicare for All advocates say they must capitalize on this moment. One short term goal, they say, is to separate the Medicare for All policy from the handful of candidates who most strongly advocated for it. Democratic and Independent voters who supported Sanders and Senator Elizabeth Warren, for example, overwhelmingly favor of Medicare for All, according to a February poll conducted for health care activist Ady Barkan’s Be A Hero PAC. But so do those who have supported Joe Biden, and former Mayors Pete Buttigieg and Michael Bloomberg.
While 90% of Sanders supporters and 87% of Warren found the policy favorable, 80% of Buttigieg supporters, 78% of Biden supporters and 71% of Bloomberg supporters said the same, the Be A Hero PAC poll found.
Liz Jaff, the president of Be A Hero, says that Barkan’s group plans to explicitly reach out to Democrats who supported more moderate candidates, but who may favor Medicare for All. Republicans and moderates have pushed the message that “this is only tied to Bernie Sanders,” she says, “and so if you don’t like Bernie Sanders, you can’t like Medicare for All.” But in light of the Be A Hero poll, which found that 75% of all Democratic and Independent voters favored the policy, the group is casting a wide net.
“We cannot let Medicare for All, which is supported by three out of four Democrats, fall off the surface,” Jaff says.
Next week, Be A Hero and National Nurses United are planning to buy $2 million in digital and television advertising targeted to general election swing states and places with competitive Senate races this fall. Rather than promoting a single candidate, the ads will focus on individual people’s health care stories, in an effort to underscore the need to overhaul the country’s health care system, especially in light of the COVID-19 crisis.
The groups plan to place ads describing people’s immediate health care needs due to the pandemic, while simultaneously making the case for Medicare for All, Jaff says.
In the lead up to Super Tuesday, Be A Hero PAC spent $500,000 on advertising across nine states. The group found that ads that combined stories about individuals’ health care struggles with a direct push for Medicare for All resonated broadly with Democratic voters in most parts of the country. In the Midwest, ads did much better when they centered on basic messages like “it should be the right for anyone to be able to go to the doctor instead of suffering at home in silence.”
“The only way to build real momentum for this in the long-term is growing our tent, and playing the long game of addition,” Be A Hero’s co-founder Barkan tells TIME. “We need to keep growing our movement for Medicare for All, and I’ll do my part to keep doing that by sharing my story and bringing new people in.”
National Nurses United has also found success in advocating for Medicare for All by appealing to individuals’ personal frustrations with the existing health care system. In the past, the union has spearheaded an ambitious door-knocking campaign in support of Medicare for All, Coogan-Gehr says. During voter interactions, the nurse-advocates would ask to hear people’s experiences with the American health care system. Those conversations would allows them to explain how they want to change the system, she adds.
Barkan, who is dying of amyotrophic lateral sclerosis (ALS), has used this same strategy of focusing on his own health issues to become one of the country’s most prominent Medicare for All advocates, building a large following online, and helping earn the policy its first-ever Congressional hearing last year. The Be A Hero email list is roughly split between Sanders and Biden supporters, Jaff says.
In the past, the left has struggled to bring mainstream Democrats on board with Medicare for All, says Sean McElwee, co-founder of the progressive think tank Data for Progress. “At the end of the day there ended up just being a large enough share of the Democratic electorate that really did not feel like they had been brought into Bernie Sanders’ movement,” he says. To succeed, he adds, progressives must cast a wide net, inviting those who disagree with Sanders on certain policies, but agree on the principles, into the the fold.
“The progressive movement, if it wants to be serious politically, needs to have that approach to governing, which is we build tools, we have power, we have influence, we have connections,” he says. “No matter who the presidency is we will at least have our view heard. We may not always win, but we will not always lose and our voices will always be at the table.”
In recent days, Sanders has repeatedly connected the challenges surrounding the COVID-19 outbreak to his critiques of the existing U.S. health care system. On March 10, when Sanders lost primaries to Biden in Idaho, Michigan, Mississippi, Missouri and Washington, Sanders’s high-profile surrogate, Rep. Alexandria Ocasio-Cortez encouraged her supporters by telling them they were “winning on the issues” and urged them to use the popularity of progressive ideas to push Biden to the left.
“Now is the time to leverage that. Now is the time to ask for accountability, and now is the time to ask for commitments, real commitments, not just gestures, but real commitments to actually confront the problems that we face,” Ocasio-Cortez said in an Instagram Live broadcast.
While Coogan-Gehr says her union is committed during the COVID-19 crisis to ensuring that all nurses have the equipment they need to handle the outbreak, she expects the political landscape post-crisis to be different. “The message cannot be more clear,” she says, ”that Medicare for All is one of the most unifying issues for voters in the Democratic Party.”
https://www.msn.com/en-us/news/politics/bernie-sanders-may-be-losing-but-covid-19-is-keeping-medicare-for-all-alive-and-well/ar-BB11vO30?ocid=msn360#image=1

The 2020 Debate Over Health Care Is Getting ‘a Lot More Real’

Joe Biden and other Democrats were already talking about health care before the coronavirus, but the outbreak gives new urgency to a central issue for the party.

by Thomas Kaplan - NYT - March 26, 2020

WASHINGTON — One of the thorniest debates in American politics is over health care. Now add a pandemic.
The future of America’s health insurance system has already been a huge part of the 2020 presidential campaign. At campaign events over the past year, voters have shared stories of cancer diagnoses, costly medications and crushing medical debt.
That was before more than 63,000 people in the United States tested positive for the coronavirus, grinding the country to a halt, upending lives from coast to coast, and postponing primary elections in many states. The virus has made the stakes, and the differing visions the two parties have for health care in America, that much clearer.
“Health care was always going to be a big issue in the general election, and the coronavirus epidemic will put health care even more top of mind for voters,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, a nonpartisan research organization. “Sometimes these health care debates can get a bit abstract, but when it’s an immediate threat to the health of you and your family, it becomes a lot more real.”

On Monday, Joseph R. Biden Jr. sent a letter to President Trump and Republican state officials that emphasized the sorts of immediate threats Americans are feeling, and criticized those Republicans for supporting litigation that targets the Affordable Care Act. The letter called it “unconscionable that you are continuing to pursue a lawsuit designed to strip millions” of coverage in the midst of a pandemic.
Mr. Biden sent his missive on a health care milestone: the 10th anniversary of when President Barack Obama signed the Affordable Care Act into law — with Mr. Biden, then the vice president and now the likely Democratic presidential nominee, standing by his side.
While the Democrats spent much of their primary fighting about whether to push for “Medicare for all” or build on the Affordable Care Act, the coronavirus crisis may streamline the debate to their advantage: At a time when the issue of health care is as pressing as ever, they can present themselves as the party that wants people to have sufficient coverage while arguing that the Republicans do not.
“A crisis like the coronavirus epidemic highlights the stake that everyone has in the care of the sick,” said Paul Starr, a professor of sociology and public affairs at Princeton who served as a health policy adviser in the Clinton White House. “It really strengthens the Democratic case for expanded health coverage, and that should work, I should think, to Biden’s advantage in a campaign against Trump.”
The virus is also having dire economic consequences, depriving Mr. Trump of a potent re-election argument rooted in stock market gains and low unemployment numbers. It is testing Mr. Trump’s leadership in the face of a national emergency like nothing he has encountered, and if voters give him poor marks, that could inflict lasting damage on his chances in November’s general election.

“It’s a leadership argument,” said Representative Donna E. Shalala, Democrat of Florida, who served as secretary of health and human services for President Bill Clinton. “Who do you want to be president of the United States when there’s a big health crisis?”

In addition to those questions, the virus is a providing an unmistakable reminder that Mr. Trump and Mr. Biden have starkly different views about the future of American health care — and starkly different records on the issue.
Four years ago, Mr. Trump ran for president promising to repeal the Affordable Care Act, popularly known as Obamacare. But his campaign pledge quickly turned into a debacle in the first year of his presidency when Republicans struggled and ultimately failed to repeal and replace the health law. In the midterm elections the next year, Democrats emphasized health care, highlighting issues like preserving protections for people with pre-existing conditions, and they won control of the House.
That line of argument has already surfaced in the 2020 election cycle. “Too many Montana families go to sleep at night worried about health care — coverage, costs, now the fear of coronavirus,” the narrator said in a recent ad targeting Senator Steve Daines, Republican of Montana, who is up for re-election. The ad was run by Protect Our Care, a liberal advocacy group that supports the Affordable Care Act and has set up a coronavirus “war room” aimed at holding Mr. Trump accountable over his handling of the crisis.
Mr. Trump is particularly vulnerable on the issue of health care. Over the course of his presidency, his administration has repeatedly taken steps to undermine the Affordable Care Act, including by arguing in court that the entire law should be invalidated. The Supreme Court agreed this month to hear an appeal in that case, which is the latest major challenge to the law. The court is not expected to rule until next year, but Democrats point to the Trump administration’s legal position as yet another example of the president’s desire to shred the Affordable Care Act.
All together, those steps by Mr. Trump and his administration amounted to something of a policy piñata for Mr. Biden and other Democrats to swing at in the general election, even before the coronavirus threat emerged.

“Trump wants to take health care away,” said Representative Ami Bera of California, a physician. “Democrats and Vice President Biden want to extend health care and make it affordable.”
In his campaign, Mr. Biden has already put a focus on health care, promising to build on the Affordable Care Act and create a so-called public option, an optional government plan that consumers could purchase. On the campaign trail, he has talked about his own exposure to the health care system, including when his late son, Beau Biden, had brain cancer. He has also regularly heard from people about their own struggles. “They walk up and grab me and say, ‘I just lost my daughter, cancer,’ or, ‘My son’s dying,’ or, ‘I have Stage 4,’” he recalled this year.

Andrew Bates, a spokesman for the Biden campaign, said Mr. Trump had “spent almost his entire presidency attempting to cost millions of Americans their health coverage,” adding: “The coronavirus outbreak, which Trump has egregiously mishandled, would be even more catastrophic if he had his way on health care.”
At a Fox News town hall event this month, Mr. Trump said he had not “been able to sell what a great job we’ve done” on health care. While the president and congressional Republicans failed at repealing the Affordable Care Act, they succeeded at undoing a key part of the law when, as part of their 2017 tax overhaul, they eliminated the tax penalty for people who go without insurance.
The Trump campaign has already attacked Mr. Biden over health care, including by arguing that he poses a threat to private health insurance with his proposal to create an optional government plan.
“As President Trump is leading our country and taking unprecedented action to stop the coronavirus, Joe Biden is campaigning on his Bernie Sanders-inspired, socialist health care agenda, which would take away Americans’ access to quality health care,” said Sarah Matthews, a Trump campaign spokeswoman. “Make no mistake about it, Biden’s government-run ‘public option’ is just another name for a government takeover of the entire health care system.”

And although the Affordable Care Act has gained in popularity during Mr. Trump’s presidency, Republicans can still point to rising health care costs as a problem that voters want to see addressed. In that vein, Senator Bill Cassidy, Republican of Louisiana and a physician, cited the substantial premiums and high deductibles that many consumers have.
“Democrats have to have a credible plan to control health care costs,” Mr. Cassidy said. “If you look at what the No. 1 concern is, it is the cost of health care.”
In the Democratic primary race, the health care debate has largely focused on the divide between moderate-leaning Democrats looking to build on the Affordable Care Act and progressives calling for Medicare for all, a government-run health insurance program. Mr. Biden and Mr. Sanders represent the two sides of that argument.
Mr. Sanders, the Vermont senator, faces long odds at catching up to Mr. Biden in the delegate race, but he has remained in the primary and continues to push progressive policy ideas, including on health care. In response to the virus, he has pointed once again to the need for Medicare for all.
“It is nearly impossible to believe that anyone can still think it’s acceptable to continue with a health care system that leaves tens of millions of people uninsured,” Mr. Sanders said this month. “The cruelty and absurdity of that view is more obvious in the midst of this crisis than it has ever been.”
In a poll this month by Morning Consult, four in 10 Americans said the coronavirus outbreak made them more likely to support universal health care proposals in which everyone would receive their health insurance from the government.

Under the single-payer system that Mr. Sanders is proposing, private health insurance would be eliminated — a potential political vulnerability that Republicans would most likely exploit in a general election if the Democratic nominee supported Medicare for all. Mr. Biden, who has repeatedly criticized Mr. Sanders’s health care proposal during the primary, does not share that vulnerability.

At one of his final campaign stops before the virus shut down in-person campaigning, Mr. Biden visited a community health center in Grand Rapids, Mich., where he spoke of his pride in having worked with Mr. Obama to pass the Affordable Care Act.
“I’m running to protect the progress we fought for,” Mr. Biden said. He cast doubt on Mr. Sanders’s plans for a single-payer system and spoke about the urgent need to improve health care — now more evident than even two weeks ago.
Talking about the patients at that clinic, he said, “They can’t afford to wait for a revolution.”

 https://www.nytimes.com/2020/03/26/us/politics/coronavirus-health-care.html?action=click&module=News&pgtype=Homepage

US private health insurance companies clog system amid Covid-19 pandemic 

by Ankita Rao - The Guardian - March 26, 2020

As Augie Lindmark, a resident physician at Yale University prepared for an onslaught of Covid-19 patients last week, he noticed something at his hospital: there were still patients without the virus, completely stable, in the beds.
These patients, many of whom should have been moved to a rehab facility or released, were stuck waiting until their private health insurance company authorized the next steps, which can take days.
Usually, the prior authorization process is an expected inefficiency at Yale, and most other American hospitals. But with thousands of Covid-19 patients being admitted every day across the country, and a critical shortage of hospital beds, that red tape now carries much more weight.
“Any sort of slowing in the health system has dire consequences,” Lindmark said.
In the past two weeks the reality of the Covid-19 pandemic has hit the country. States and cities have been weighing public health measures, making changes to government health plans, and pushing sweeping changes to everyday life. Physicians have largely sought to reschedule and cancel elective surgeries and other patient visits deemed non-essential to free up resources to handle the virus.
But with a history of restrictive and confusing policies, private health insurance companies have lagged behind: making incremental changes to plans even as health providers seek to change course.

“They’re doing healthcare to make money, not to take care of people,” said Dr Judd Hollander, an emergency medicine physician and associate dean at Thomas Jefferson University in Philadelphia. Hollander has been instrumental in implementing Jefferson’s telemedicine program, which allows patients to consult health providers through secure video, over the past few years.
Telemedicine, most experts agree, is an impactful and low-cost tool in slowing the spread of the virus. Telemedicine eases the burden on hospitals and hospital beds by redirecting patients without in-person needs.
Donald Trump recently expanded telemedicine provisions under the Medicare plan – a public insurance plan for senior Americans – allowing physicians to get paid equally for in-person or remote visits, and approving more devices and programs like Skype to be used to telemedicine.
But private health companies do not have to follow the same rules.
“The federal government never aligned incentives, most states never passed meaningful legislation, and many commercial payers didn’t pay health systems for telemedicine,” Hollander said. “So now we’re left in this horrible scenario.”
Several private physicians the Guardian spoke to were struggling to implement the systems from scratch as Covid-19 cases started to flood their states. Some physicians said older patient populations didn’t know how to use the technology. Others said the variations in private plans made it hard to make any new protocols without risking revenue, which could affect their employees.
“I think the issue is that private insurances have not really made it clear that they will reimburse these visits and if so at what cost,” said Dr Vipul Patel, an orthopedic surgeon in Brooklyn.
Riddhi Shah, the director of operations at a mental health clinic in Michigan, said insurance companies are hard to contact right now, and while the plans have dropped the prior authorization restrictions, the clinic still has to navigate new billing codes and financial loss.
For those who have already built telemedicine systems, the demand is clear.
As NYU Langone absorbs some of the largest populations of Covid-19 patients in the country, the telemedicine system has gone from serving 1,500 patients a month to about 3,000 a day in the past week, said Shabana Khan, a child psychiatrist at NYU Langone who has been helping build the hospital system’s telemedicine capacity for the past few years.
She said many private doctors, meanwhile, are burdened by the restrictions that insurance companies have placed in the past, which made it harder for them to set up a system like NYU. She pointed out that only 10 states have true telemedicine parity, which means providers can treat and bill for telemedicine visits like in-person visits.
With the bureaucracy standing in their way, some doctors are trying to work around private insurance altogether. Sas Ponnapalli, founder of Beam Health Group, a telemedicine platform that connects patients and providers, saw 400 new health providers sign on last week. While the platform does allow private insurance, Ponnapalli said doctors are choosing to set their own rates to make the transition faster.
“Doctors sometimes have to close their doors or quarantine themselves even if they’re still able to practice,” he said. ”They want to get up and running as soon as possible because they’re losing revenue so they’re bypassing insurance completely and charging cash.”
Health insurance companies insist they have been adapting to the crisis.
A spokesperson at Humana, one of the nation’s largest insurance companies, told the Guardian it is not charging patients for Covid-19 testing, and a representative of the Association of Health Insurance Plans (AHIP) pointed to a letter signed by various private payers about their commitment to fighting Covid-19. This is partly because the federal government is requiring the plans to cover all visits, virtual and not, related to testing, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, a health research and advocacy firm, who tracks the private market.
But that hasn’t stopped insurers from charging patients for other Covid-related charges. AHIP confirmed that out-of-pocket expenses for the treatment would not be waived, and could cost patients thousands of dollars. The average amount for someone admitted to the hospital with pneumonia, a respiratory condition that many coronavirus patients are facing, was $20,000 in 2018 for patients covered by private insurance, according to an analysis by the Kaiser Family Foundation and Peterson.
That could leave many people falling back on the age-old American dilemma: get healthcare or lose all financial security. And it could leave physicians finding loopholes and workarounds to stay afloat.
“Insurance companies are not beholden to the patient, they are beholden to the shareholder,” Hollander said.
https://www.theguardian.com/us-news/2020/mar/26/us-insurance-companies-coronavirus-hospitals

Millions of Americans are about to lose their health insurance in a pandemic 

by Wendell Potter - The Guardian - March 27, 2020

The tragic effects of our battle with the novel coronavirus are seemingly endless. But arguably the most mind-blowing is this: the very pandemic that threatens to infect and kill millions is simultaneously causing many to also lose their health coverage at their gravest time of need.
Here’s how: the virus has caused a public health crisis so severe that people have been forced to stay home, causing businesses to shutter and lay off workers. And with roughly half of Americans getting their health insurance from their employer, these layoffs mean not only losing their income but also their medical coverage. In other words, just as our need for medical care skyrockets in the face of a global pandemic, fewer will have health insurance or be able to afford it. According to one recent report, the cost of treatment for Covid-19 can run around $35,000. As the patient in the report exclaimed: “I was pretty sticker-shocked. I personally don’t know anybody who has that kind of money.”
So, how did we get to such a dire place? Many will sadly lose their jobs over the coming weeks – with one estimate projecting as many as 30%. And as they do, Americans are about to learn something horrifying: how irrational and irresponsible it is for so many to be dependent on employers for health insurance. Take it from me. I’m a former health insurance executive who once profited from this system. It’s time for it to stop.
America needs to finally get out of the business of linking health coverage to job status. Even in better times, this arrangement was a bad idea from a health perspective. Most Americans whose families depend on their employers for coverage are just a layoff away from being uninsured. And now, when many businesses are shutting down and considering layoffs, it’s a public health disaster. Across the country we’re seeing reports of layoffs in almost all industries. As we approach a global recession, some analysts suggest that a million or more US workers will lose their jobs in April alone. Consider what this means for health care in this country.
We’ve seen this before. During the last big recession, researchers at Cornell University found that 9.3 million Americans lost their health insurance between 2007 and 2009. Why? As people lost work, their employer-provided insurance went away. During this time, roughly six in 10 Americans who lost their jobs became uninsured. And this problem compounds itself. If the reason you lost your health insurance is that you no longer have steady employment, how are you now going to be able to afford monthly premiums for some other private health care plan? This problem becomes particularly acute when you consider that premiums for health plans sold on exchanges are projected to soar, as well, due to “unexpected Covid-19 costs”.
It’s worth noting that even in good times, the employer-based model fails to cover enough of us, with the number of Americans covered through an employer steadily dropping in general. Since 1999, the percentage of those with job-based coverage has declined by nine points. And it most certainly will drop like a rock in the coming weeks and months.
It’s now clear that this system cannot handle our current reality. With so many Americans sadly on the verge of unemployment, the number that will lose health coverage will be crushing. As we rebuild our country’s economic base and reimagine the roles various industries play in our new future, we must also begin a difficult conversation about health care. If we’re dependent on jobs in order to have it, a lot of us will be left out in the cold. And at a time in our nation’s history where more will need quality care than ever before, the human cost will simply be too much to bear.

• Wendell Potter, a former vice-president for corporate communications at Cigna, is president of Business for Medicare for All

 

https://www.theguardian.com/commentisfree/2020/mar/27/coronavirus-pandemic-americans-health-insurance?CMP=oth_b-aplnews_d-1 

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Fears of medical bills, lost pay may hamper coronavirus efforts

The U.S. is more vulnerable to the epidemic than countries with universal health coverage and sturdier safety nets. 

by Amy Goldstein - Portland Press Herald - March 2, 2020

The race to curb the spread of the new coronavirus could be thwarted by Americans fearful of big medical bills if they get tested, low-income workers who lose pay if they take time off when sick, and similar dilemmas that leave the United States more vulnerable to the epidemic than countries with universal health coverage and sturdier safety nets.
As the test for the virus becomes more widely available, health-care experts predict that some people with flu-like illnesses – or those who may have been exposed – will avoid finding out whether they have been infected because they are uninsured or have health plans that saddle them with much of the cost of their care.
Making sure the right people get tested – and keeping them away from others if they are infected – is crucial to help diminish the virus’s spread within communities as it pops up in a growing number of states.
Now that federal health officials have ironed out initial problems with the test itself and enabled more labs to take part in the hunt for infection, this work of testing and quarantining is the essential second stage. Yet the government has not yet begun to tell Americans where to go for testing, and neither public nor private insurers are changing their rules to buffer people from testing-related charges.
Some preparations recommended by the Centers for Disease Control and Prevention are incompatible with the way benefits work. Officials have urged people to keep an adequate supply of their routine medicines in case of they end up quarantined. But insurance companies seldom permit refills until a patient is nearly out of pills. The agency also urges people with respiratory illnesses to stay home from work. But with no federal sick leave requirements, some experts fear the virus will spread more rapidly.
For an international, fast-spreading epidemic, the nation’s health-care system and many workers’ benefits are “certainly not optimally designed,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.
Federal funds cover the cost of the coronavirus test itself when it is run in federal, state or local public health laboratories. But that changes as academic and commercial labs get involved. In neither case does the government buffer people from bills for visiting a doctor’s office, urgent care center or emergency room, though nearly half of the 160 million Americans with insurance through their jobs have health plans with high deductibles.
“Deductibles are designed to make people think twice about going to the doctor if they are feeling sick,” said Larry Levitt, executive vice president for health policy of the Kaiser Family Foundation, a health-research organization. “In a potential pandemic, the last thing you want people to do is thinking twice about going to the doctor.”
America’s Health Insurance Plans, the industry’s main trade group, has issued guidance called “Keeping Americans Safe from Coronavirus.” The statement says insurers are “carefully monitoring the system” and working with the CDC to share information.
But it does not urge insurance companies to eliminate out-of-pocket costs for the tests or for visits to doctors or clinics for respiratory illnesses, saying health plans may want to determine “whether policy changes are needed to ensure that people get essential care.”
Thomas Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said eliminating the financial disincentive to get tested “needs to be at the top of the list” of problems that federal health officials tackle.
Inglesby said other countries, including Western democracies with government-financed health-care systems, have not been fully publicizing their testing strategies. But he said, “Countries where patients could get large bills for diagnostic testing will have additional challenges identifying people.”
Even before the test was widely available in the United States, a few instances of people ending up with large, coronavirus-related medical bills have lit up Twitter.
In one case, a 29-year-old Miami-based engineer, Osmel Martinez Azcue, had been in China for work, returned home briefly, then flew to Italy for another quick assignment. By the time he arrived home on Jan. 27, he said in an interview, he had spent a miserable, feverish night in the Lisbon airport, popping ibuprofen as he waited for a connecting flight.
His mother, who lives in the same apartment building as him, started researching the coronavirus and persuaded him that he needed a test. He thought it was probably the flu, but the next morning, he called an urgent care center, which told him that two hospitals in town could help him.
He went immediately to Miami’s public hospital, Jackson Memorial, where emergency room workers, already alerted, said they rushed him into a quarantine room. A nurse in protective gear quizzed him about his travels, and a doctor told him he needed a CT scan, Azcue said.
He knew the inexpensive insurance he had switched to last fall requires him to pay $5,000 upfront, so he asked the doctor to first give him a routine flu test, and, if it was positive for influenza, to send him home.
Less than two hours after he arrived, he left the hospital with a flu diagnosis and a Tamiflu prescription.
On Valentine’s Day, a bill arrived from National General Insurance that upset Azcue so much that he did not take his longtime girlfriend out to celebrate. It said he owed $3,270.75, unless he sent the insurer three months of records to prove that the flu had not been a preexisting medical condition. After his story appeared in the Miami Herald, the insurer withdrew the records demands late last week, saying he would owe $1,400.
Said Hopkins’ Inglesby: “It is in the public interest for us to have free testing available for people – not just the test itself but the process of getting tested.”
So far, doctors are not getting a lot of calls from worried patients, said Robert McLean, president of the Americanren College of Physicians – the professional association of internists – and medical director of a 400-doctor medical group in southern Connecticut affiliated with the Yale New Haven Health System.
The health system has designed protocols so “if someone is sick with a cough, everyone gets asked whether they have been to China,” or other outbreak sites. “If there is any of that stuff, it gets triaged to a doctor for a phone call.”
But Scott Becker, chief executive of the Association of Public Health Laboratories, said he was thinking about the health system’s capacity the other night, when his wife wasn’t feeling well after work with what turned out to be the flu. They went to an urgent clinic in suburban Maryland that was crowded.
“I’m thinking, this place is busy, and it’s a one-and-a-half-hour wait now. And we don’t have community spread here. What’s going to happen? We are going to quickly overwhelm clinics,” he said.
Meanwhile, Georgetown’s Corlette said work-related worries may also deter people from taking time off to get a test or staying home if they are sick. She noted that nearly one-third of workers – and more than two-thirds of low-income workers – do not get paid sick days.
“Workers who serve our food, take care of our elderly, take care of our kids, change our sheets – that’s a thing that should be keeping people up at night,” she said.

 https://www.pressherald.com/2020/03/02/fears-of-medical-bills-lost-pay-may-hamper-coronavirus-efforts/

 Editor's Note -

The following clipping demonstrates how irrational and arbitrary our way of financing hospitals is in the US. "Market-based" prices value high tech elective procedures over more mundane but arguably more valuable care for seriously ill patients. As we move more toward global budgets for all hospitals, this problem (along with many others) will be eliminated.

- SPC

Fighting coronavirus won’t help struggling Maine hospitals pay the bills

by Charles Eichacker - Bangor Daily News - March 30, 2020

Hospitals across Maine are steeling themselves for a possible spike in patients with the coronavirus by stocking up on equipment and freeing up beds and workers.

But while those efforts are critical from a public health perspective, they could make it harder in the long run for rural hospitals to sustain their current operations when many of them are already struggling to pay the bills.

Besides spending heavily on additional staffing and equipment to handle the outbreak, many hospitals recently have been delaying elective services that are reliable money-makers — such as colonoscopies, physical therapy, lab tests and joint replacements — in order to conserve resources and prevent the spread of the virus.

Hospitals themselves have acknowledged the long-term financial effects of the coronavirus will be serious, but they say it’s hard to forecast the eventual impact on their bottom lines.

For one thing, it’s uncertain how much reimbursement they will receive from federal stimulus efforts. They also don’t know exactly what to expect in the coming weeks from COVID-19, the disease caused by the virus, but are watching the stress it has placed on hospitals in places such as New York City.

Some hospitals may have to hire temporary staff from outside agencies, but that kind of measure would further tax their balance sheets. The fees for those workers have been quickly rising as a result of new demand from the outbreak, according to Modern Healthcare.

For now, Maine hospitals say that they are more focused on the need to treat any cases of COVID-19 than how those efforts will affect their long-term finances. They have also been urging residents to adopt social distancing measures to blunt the spread of the illness and prevent a flood of patients from arriving in a short span of time.

“Absolutely it’s a challenge, but first it’s staff and patient safety, and then we’ll figure out the rest of it,” said Tim Dentry, the current chief operating officer of Northern Light Health who will soon lead the 10-hospital system. “We’re in the eye of the storm right now.”

Julie Hixson, the spokesperson for Down East Community Hospital in Machias, said they are now seeing lower volumes of patients for a variety of procedures and testing services, since providers have become unavailable and patients have postponed that work, but it’s unclear how sustainable the current traffic will be.

“We are working with the unknown,” Hixson said “We believe we can maintain operations at these lower volumes for several months, but things could change. We don’t know exactly how this is going to play out, but we are certain that it will have a significant impact.”

Even if Maine hospitals do see a surge of respiratory cases, the irony is that those gains would probably not make up for all the other income that’s been lost to prepare for the influx, according to John Morrow, a managing director of Franklin Trust Ratings, a company which analyzes the financial performance of U.S. hospitals. While it might seem like hospitals would benefit from all that demand, he said, they could actually struggle to afford it.

“That’s really the oxymoron of health care and of epidemics and pandemics,” Morrow said

“Hospitals make money on elective care to pay the bills on all other sorts of care where they don’t make money, but these elective procedures are being postponed effective immediately in order to preserve resources.”

It’s difficult to predict the specific effects the coronavirus will have on hospital operations, but Morrow said it could lead systems to delay capital improvements and technology investments. He added that many patients will probably end up declining to seek the elective procedures that are now being postponed.

National credit rating agencies also have issued dire forecasts about the damage the virus will bring to the healthcare industry. One of them, Moody’s Investors Service, recently changed its outlook from “stable” to “negative” for not-for-profit and public hospitals in the U.S.

In a March 18 report, the agency said those hospitals will see declining revenues from canceled elective services and rising costs for staffing and supplies to fight the coronavirus. It noted that hospitals additionally could be affected by widespread layoffs or rising unemployment across the country, which would deprive Americans of the insurance they need to pay for medical care.

While many hospitals should be able to “withstand a temporary coronavirus disruption,” Moody’s said the challenge could be greater for hospitals that do not belong to larger health care organizations and in areas that already have shortages of nurses and doctors, which have been problems in rural Maine.

Moody’s also found that the disruption could exacerbate factors that have already been hurting hospitals’ bottom lines, such as increased dependence on public health insurance programs — which generally pay less than private insurers — and a growing preference by patients for less expensive competitors.

In Maine, hospitals already have been challenged by a shrinking number of patients and an inability to cover all costs with existing revenue. Fifteen of the state’s 36 hospitals ended the 2018 fiscal year with a negative operating margin, and the median operating margin that year was just 0.39 percent, according to the latest information from the Maine Health Data Organization.

Those factors have led some hospitals to either cut services or outsource them to private companies that offer them more cheaply. Others have merged with larger organizations, such as Brewer-based Northern Light Health and Portland-based MaineHealth.

And in the last 13 months, two independent hospitals, Penobscot Valley Hospital in Lincoln and Calais Regional Hospital, both filed for Chapter 11 bankruptcy protection to help pay off their debts.

In recent bankruptcy court filings, both facilities warned that they may have additional trouble repaying their creditors as a result of the pandemic.

https://bangordailynews.com/2020/03/30/news/state/fighting-coronavirus-wont-help-struggling-maine-hospitals-pay-the-bills/ 

Letter to the editor: Pandemic reveals glaring deficiencies in health care system

by Dr. Karen Saylor - Portland Sunday Telegram - March 29, 2020

As a geriatrician serving the most vulnerable population, I feel compelled to comment on the glaring deficiencies in our health care system that the coronavirus pandemic has brought to light.
Our system does not have the capacity to respond to a public health crisis of this magnitude, in part because it never had to. At no time in this country’s history have we been adequately resourced to tend to even the basic health care needs of our entire population. It’s not that we lack the resources, but that we lack the political will.

Because we as a country have chosen to tolerate a for-profit health care system, health care organizations are suffering significant financial strain as patients are canceling routine visits and procedures or are being turned away because of symptoms of infection or a history of exposure to COVID-19. Under the current system, only in-person visits are reimbursed, with few exceptions. The loss of revenue resulting from the dramatic decline in face-to-face encounters poses serious, and, in some cases, existential challenges to the viability of many practices.
If we had a publicly funded health care system, this would be one less crisis to deal with. Of the many take-home points from this experience, shouldn’t one of them be that health care is a basic human right?
Karen Saylor, M.D., FACP
Falmouth
https://www.pressherald.com/2020/03/29/letter-to-the-editor-pandemic-reveals-glaring-deficiencies-in-health-care-system/ 

Letter to the Editor: Crisis shows value of progressive policies

Letter to the Editor - Portland Press Herald - March 30, 2020

How quickly things change in the midst of a real crisis – the worst of which is yet to come – is telling. Our healthcare system and the federal government have been so slow to react to the pandemic because there is no centralized, publicly accountable authority in the system. It is a hodgepodge collection of for-profit entities who are ultimately accountable to their shareholders, not the public. Only during a genuine public health emergency do the scales seem to fall from so many eyes. The necessity of having a publicly run healthcare system in which every person can get tested and treated regardless of their ability to pay does not just benefit low-income people, it benefits everyone. Viruses do not discriminate based on socioeconomic status.
Earned paid sick leave was seen by the Portland City Council as too radical of an idea last year. Ways of making it easier for renters to stay in their homes have also been consistently quashed at the municipal and state levels. Belatedly, many are coming to realize that those without homes are unable to “shelter in place.” Those are policies that would’ve softened the blow of the onslaught of the coronavirus.
All this points to what progressives have been saying all along – progressive policies aren’t just good ideas that would alleviate hardship for millions – they are public health and safety necessities. Let’s hope it doesn’t take another Great Depression for our elected officials to wake up to that fact.
Grayson Lookner
Portland
https://www.pressherald.com/2020/03/30/letter-to-the-editor-crisis-shows-value-of-progressive-policies/