Health Care Reform Articles - April 18, 2020

  Editor's Note -

 The following link will take you to a stunning photo-essay by photographer Philip Montgomery in the April 15, 2020 New York Times Magazine. 

It depicts the work of doctors, nurses and other health caregivers (also known, in this age of corporatized medicine as "providers") in New York City's system of public hospitals.  It is a stark reminder of the professionalism and selfless dedication of one of the most important sets of "stakeholders" in today's comodified, commercialized and corporatized for-profit American health care system. These public servants are characterized by their professional oaths - to put patients first, 

Selflessly.

They are also characterized by the spartan nature of their surroundings, reminding me of the four years I spent as a House-Officer at Boston City Hospital.

They stand in sharp contrast to other important stakeholders in the American health care systerm - the investors and other "stakeholders"(shareholders) on the business side of private medicine who, as often required by law to put maximization of profits (shareholder value) first. 

Selfishly

There is a gargantuan tug-of-war going on between the two groups. The soul of American medicine is at stake.

Who will win?

-SPC

https://www.nytimes.com/interactive/2020/04/15/magazine/new-york-hospitals.html?campaign_id=52&e

 

Joe Biden Can Own Health Care

To achieve affordable health care for everyone, he should look closely at the plan of a particular former rival.

by Jacob Hacker - NYT - April 16, 2020

oe Biden has made overtures to progressive Democrats by saying he’ll upgrade his campaign’s health plan. Specifically, after peace talks with Senator Bernie Sanders, he vowed to add a provision to open up Medicare to Americans aged 60 and over (the current age is 65).

That’s an important and valuable step. Yet even with it, Mr. Biden’s proposal still falls well short of where it should be, given the harsh realities laid bare by the pandemic.
If he is serious about achieving affordable health care for everyone, he needs to look more closely at the health care ideas of his former rivals. And no, I don’t mean Bernie Sanders.
Mr. Biden is correct that Mr. Sanders’s Medicare for All plan — with its threat to existing private plans and big tax requirements — is politically perilous. And he’s correct that a well-designed “public option” (a government insurance plan based on Medicare) could achieve many of the same goals with much less peril.

Yet proposals that include a public option differ greatly in ways that really matter — not just for how many people they cover, but for whether they tackle the affordability crisis that threatens to put health insurance out of reach for more and more Americans. And, unfortunately, Mr. Biden’s plan doesn’t include key features of the most effective such proposals.
The core argument for the public option is that it wouldn’t frighten or disrupt the lives of the roughly 150 million Americans who had employment-based insurance before the pandemic (roughly 10 million of them have likely lost their coverage in the past month, according to the Economic Policy Institute). But that raises an obvious question: What assurances are being provided that those with such plans will continue to have them, be able to afford them, and not be clobbered by bills not paid by them?

After all, even before the current crisis, premiums and out-of-pocket spending were rising rapidly for insured Americans. Last year, the total premium for family coverage (worker plus employer) cost an average of $20,000. Meanwhile, deductibles have more than tripled since 2008. And while virtually all large employers offer coverage, firms with fewer than 200 workers — which employed roughly four in 10 Americans before the pandemic — have continued their retreat from sponsoring insurance.
The basic problem is simple: Health care prices are rising much faster than wages, and private insurers haven’t been able to do anything about it, except narrowing their networks or raising out-of-pocket costs. Nor have employers shown the clout to push back, which is why they’re making their workers pay more — or getting out of the system altogether.

By contrast, Medicare does have effective tools for restraining prices, which is a major reason Medicare for All has gained ground. But universalizing Medicare isn’t the only way to tackle the affordability crisis. Lots of rich countries have multiple health plans and sensible pricing. To achieve this, however, requires major changes that the Affordable Care Act, for all its value, didn’t deliver.
First, there have to be much higher standards for all health plans, so they provide broad benefits without shifting costs onto patients. Second, these plans should cover everyone — not just because losing coverage is the ultimate affordability crisis (as we’re tragically learning), but also because universal coverage facilitates uniform, reasonable pricing. Third, there has to be a plausible way of financing this high-standard coverage as its reach broadens and costs rise.
Which brings us to the biggest prerequisite for success: power to push back on prices. If expanding Medicare is the route to broader coverage, then Medicare needs the reach and authority to rein in costs — for drug prices and medical devices as well as doctor and hospital charges. The alternative is a cycle of disappointment, in which gains in the breadth and generosity of coverage are continually undermined by skyrocketing prices.
In short, how you design the public option matters. You have to get people in it, and give it the authority needed to push back against an increasingly consolidated delivery system.
We can see these differences if we compare Mr. Biden’s proposal with the most ambitious public option plan offered during the campaign: the “transition” plan proposed by Elizabeth Warren after she backed away from an immediate leap to Medicare for All. Her transition plan is itself a more robust version of a public option proposal introduced in Congress by Representatives Rosa DeLauro and Jan Schakowsky (which, full disclosure, I helped design).

Although we don’t have detailed budget “scores” like those the Congressional Budget Office provides for legislation before enactment, a number of independent organizations have looked at plans that resemble Mr. Biden’s and Ms. Warren’s, as well as Mr. Sanders’s, using sophisticated models.

The bottom line is that Mr. Biden’s plan would not achieve universal insurance and would leave many with private insurance continuing to face high costs. Yes, his plan also has a relatively modest 10-year cost. But, partly for that reason, it would expand the reach of federal insurance only modestly, which means in turn it would be unlikely to rein in prices on its own.
Ms. Warren’s public option is very different. It would offer broader benefits on more generous terms than any existing proposal besides Mr. Sanders’s, including free coverage for everyone under age 18. Her public option would automatically enroll everyone younger than 50 who lacked alternative coverage. Those over age 50 would be able to enroll directly in Medicare — that is, a full decade before they could join Medicare under Mr. Biden’s current proposal.
Ms. Warren’s plan also includes a number of specific measures to reduce the prices paid by the federal government. Moreover, her public option is so generous, it’s certain to get substantial enrollment, so that pricing power will reach a big and growing share of the market.
Indeed, Ms. Warren’s public option is so generous that if it were set up, tens of millions of insured Americans with workplace coverage would likely jump into it. (Mr. Biden also allows those with employer-sponsored insurance to enroll in the public option, but his public option is much less attractive.) Based on an independent analysis of a similar plan I developed roughly a decade ago, I estimate that 50 million Americans would immediately enroll, with the number rising over time.
The big challenge with Ms. Warren’s proposal is that it also would involve much more new tax financing than Mr. Biden’s. Still, there’s ample ground between the two approaches for a broader, better public option than Mr. Biden’s. It wouldn’t be hard to add stronger measures to enroll people who lack alternative coverage — to make the public option essentially a default source of coverage for everyone without private workplace plans. Nor would be it be hard to make sure that these private plans meet high (and rising) standards. And Mr. Biden’s public option would have more long-term potential if he committed himself to beefing up the federal government’s pricing power while making his promised benefits more generous.
Whether or not these steps would be good for his candidacy, they would be good for Americans who desperately want to know they’ll have quality coverage not tied to a specific job that won’t keep piling health care costs onto them.
Jacob S. Hacker, a professor of political science at Yale, is the author of “The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream” and, with Paul Pierson, the forthcoming “Let Them Eat Tweets: How the Right Rules in an Age of Extreme Inequality.”
https://www.nytimes.com/2020/04/16/opinion/joe-biden-health-care.html?referringSource=articleShare

Profit over people, cost over care: America's broken healthcare exposed by virus

by Amanda Holpuch - The Guardian - April 16, 2020

With over 21,00 people dead and more than a 547,000 infected with the coronavirus in the US the last question on a person’s mind should be how they will pay for life-saving treatment.
But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”
Those were the patient’s final words to his medical team, Derrick Smith, nurse anesthetist at a New York City hospital wrote on Facebook last week: “Next-level heartbreak – having to hear a dying patient use his last words to worry about healthcare finances.”
In the wealthiest country in the world, the Covid-19 pandemic has exposed the core of a healthcare system that is structurally incapable of dealing with the pandemic. Federal and local governments, health insurers and employers have pledged to help Americans pay their way through this crisis, but to do so requires a dramatic overhaul of a system which has for decades prioritized cost over care.
“As this epidemic makes clear, at any moment, any of us could become sick, could become hospitalized, could be on a mechanical ventilator,” said Adam Gaffney, an ICU doctor in Boston. “And that, in the United States, could mean potentially ruinous healthcare costs.”
Gaffney is president of Physicians for a Nationalized Health Plan, a group of more than 20,000 medical professionals who support universal healthcare in the US. PNHP members see first hand the consequences of people being forced to make medical decisions based on cost.
“I’ve heard from patients saying they’ve skipped their inhaler because they couldn’t afford the dose,” Gaffney said. “I’ve heard from patients who’ve gone for years without primary care because they were uninsured and wound up in the ICU.”
There were 27.9 million people without health insurance in 2018 and that figure is projected to increase by millions because of record-high unemployment. In the meantime the US has 600,000-plus confirmed coronavirus cases and more than 27,000 deaths, the true numbers will be far higher.
The US government and major health insurers said they are covering the costs of Covid-19 testing and treatment, but fear of bankrupting costs and the byzantine complexities of the system leave unanswered questions about whether people will even seek care, let alone escape a potentially crippling medical bill weeks or months later.
How much testing and treatment costs individuals depends on if the patient was insured, how they were insured, and whether they survived. For example, a company that pays for its staff’s health insurance could decide not to cover an employee’s treatment, even if the health insurance company it’s using had said it would waive Covid-19 related payments.
And simply overcoming the American instinct to question how much medical treatment costs is a hurdle in the pandemic.
Since 2006, 30% of Americans each year on average have delayed any sort of medical treatment for cost, according to the polling firm Gallup. In that time, 19% of Americans each year on average have delayed treatment for a serious condition, according to Gallup’s December 2019 report.
More Americans are afraid of paying for healthcare if they became seriously ill (40%) than are afraid of getting seriously ill (33%), according to a 2018 poll by the University of Chicago and the West Health Institute.
“It’s hard to fight an epidemic if people are afraid to go to the doctor, to be seen in the emergency room,” Gaffney said. “It could mean some people not getting tested, it could mean some people delaying getting care and potentially harming their own health.”

Medical clinic closures and job losses in a pandemic

The pandemic crisis is being further exacerbated by the system’s devotion to profits over people. Medical workers are being furloughed and losing jobs because of the pandemic – including those on the frontlines – as their employers seek to cut costs.
Alteon Health, a private-equity backed company which employs about 1,700 emergency medicine doctors and other physicians, said it would temporarily stop providing benefits including paid time off, according to the health website STAT.
While intensive care units and emergency rooms are billing sky-high figures, there has been a pause on non-essential care that has, in turn, cut medical system profits.
Without high-margin treatments such as physical therapy, cosmetic surgery and orthopedic procedures, medical systems are struggling to pay salaries and cover administrative costs.
The American Academy of Family Physicians projected 60,000 family practices will close or significantly scale back by June and 800,000 of their employees will be laid off, furloughed or have their hours reduced.
And in hospital corridors across the country, staff aren’t just extra mindful of a dry cough and high temperature, but also that their salaries and work equipment are dependent on the bottom line.

And simply overcoming the American instinct to question how much medical treatment costs is a hurdle in the pandemic.
Since 2006, 30% of Americans each year on average have delayed any sort of medical treatment for cost, according to the polling firm Gallup. In that time, 19% of Americans each year on average have delayed treatment for a serious condition, according to Gallup’s December 2019 report.
More Americans are afraid of paying for healthcare if they became seriously ill (40%) than are afraid of getting seriously ill (33%), according to a 2018 poll by the University of Chicago and the West Health Institute.
“It’s hard to fight an epidemic if people are afraid to go to the doctor, to be seen in the emergency room,” Gaffney said. “It could mean some people not getting tested, it could mean some people delaying getting care and potentially harming their own health.”

Medical clinic closures and job losses in a pandemic

The pandemic crisis is being further exacerbated by the system’s devotion to profits over people. Medical workers are being furloughed and losing jobs because of the pandemic – including those on the frontlines – as their employers seek to cut costs.
Alteon Health, a private-equity backed company which employs about 1,700 emergency medicine doctors and other physicians, said it would temporarily stop providing benefits including paid time off, according to the health website STAT.
While intensive care units and emergency rooms are billing sky-high figures, there has been a pause on non-essential care that has, in turn, cut medical system profits.
Without high-margin treatments such as physical therapy, cosmetic surgery and orthopedic procedures, medical systems are struggling to pay salaries and cover administrative costs.
The American Academy of Family Physicians projected 60,000 family practices will close or significantly scale back by June and 800,000 of their employees will be laid off, furloughed or have their hours reduced.
And in hospital corridors across the country, staff aren’t just extra mindful of a dry cough and high temperature, but also that their salaries and work equipment are dependent on the bottom line.

 

Joe Manginn, an ER nurse in Madison, Wisconsin, said: “The bottom line has always been very forefront and this now puts into an extra level of being conscious on our mind to not waste money.”
Manginn and his wife, who is also a healthcare worker, are on alert for their own healthcare costs.
“If we do get sick and need to be hospitalized, it hits us financially with the insurance and those kinds of payments, but it also hits us financially because we’re not able to work any longer,” Manginn said. “It’s a double whammy for the healthcare workers doing this right now.”
His health insurance, which also covers their three children, costs $5,000 a year plus the money they set aside for out-of-pocket costs in a tax-free account.
“We work for the hospital, it should be that we would have the most access to it [healthcare], but unfortunately yeah, that’s not how our country is set up.”
Congress has allocated $100bn to help hospitals. On Friday, the White House said hospitals that accept the funds will not be allowed to use two common billing practices: to bill uninsured patients or bill them for getting care from a doctor who is at the hospital, but not directly employed by it.
Like other parts of the planned government response, questions remain about just how effective that money will be in addressing the convoluted healthcare landscape and if it will arrive in time to save jobs and clinics.

Financial burden on the frontlines, not the insurers

This major disruption to the US healthcare system may leave nurses and doctors jobless, but there are early indications insurance companies could be insulated from the damage.
Not only did health insurance companies enter the crisis with capital, several analysts have anticipated these companies could have lower costs because fewer people are seeking routine medical care.
David Blumenthal, president of the global health thinktank the Commonwealth Fund, said people who have coverage year-round will still be paying premiums, while insurers have fewer procedures to cover.
“We will continue to pay our premiums, because we know that we could get coronavirus and end up in the intensive care unit and have to pay hundreds of thousands of dollars if we don’t have insurance,” Blumenthal said. “So we’re going to keep paying, but we’re not going to the doctor unless we absolutely need to. So that’s all good news for insurance companies.”
At the same time, the 16 million people who have lost their jobs in the past three weeks will put an increased burden on the healthcare system if they join the ranks of the uninsured or those who use Medicaid, government health insurance for low-income people.

Blumenthal said there were also knock-on health effects to the economic crisis, such as depression from income loss and malnutrition, which would make people more susceptible to illness.
Benjamin Sommers, professor of health policy and economics at Harvard TH Chan school of public health said there are few signs the pandemic is driving the Trump administration to reflect on the healthcare system.
“We’ll have to see where the public ends up settling on in terms of what it demands from public officials in response to this epidemic,” said Sommers, a practicing primary care physician.
The ICU doctor, Gaffney, said he was certain the way healthcare is financed in the US is exacerbating the overall harm of the epidemic.
“At a time of soaring unemployment and at a time of deepening recession, people are going to be losing coverage and seeing more and more medical bills if they get sick,” Gaffney said. “That doesn’t make any sense.”
 https://www.theguardian.com/us-news/2020/apr/16/profit-over-people-cost-over-care-americas-broken-healthcare-exposed-by-virus

'Thriving During a Pandemic': UnitedHealth Group Posts Surge in Profits as Millions Lose Insurance and Thousands Die

"The earnings were so good, the company said it still expects to make as much in total profits this year as they predicted in December... when no one could predict the massive loss of life and jobs caused by the coronavirus."
by Jake Johnson - Common Dreams - April 16, 2020

"That's the story of healthcare in America today," former insurance executive Wendell Potter said Wednesday after the largest private health insurance provider in the U.S. announced that it saw a significant increase in profits over the last three months while the Covid-19 pandemic killed thousands of people and forced millions more off their employer-sponsored coverage.
UnitedHealth Group, whose CEO is an outspoken opponent of Medicare for All, said the coronavirus outbreak had "minimal impact" on its earnings in the first quarter of 2020 and is unlikely to disrupt the company's profit outlook for the rest of the year. As of Thursday morning, the novel coronavirus has officially infected more than 636,000 people and killed more than 28,000 in the United States.

"Americans are getting sick and dying, and doctors risking their lives to save them, in this crisis. Meanwhile, health insurance companies are denying coverage and squeezing doctors to generate record profits."
—Wendell Potter, Medicare for All NOW!

"UnitedHealth Group's first quarter 2020 revenues grew $4.1 billion or 6.8% to $64.4 billion, reflecting broad-based revenue growth across Optum and UnitedHealthcare," the company said in its quarterly earnings report (pdf). Optum and UnitedHealthcare are both owned by UnitedHealth Group.
"First quarter earnings from operations grew $164 million or 3.4% year-over-year to $5.0 billion," the company said, noting that the costs of the coronavirus pandemic were offset by "lower elective care demand," meaning fewer people sought out non-essential medical treatment over the last three months as Covid-19 spread across the U.S.
Potter, a self-described "reformed insurance propagandist" who now heads the advocacy group Medicare for All NOW!, wrote in a series of tweets Wednesday that "while America's reeling from the Covid-19 crisis, my old industry—the private health insurance racket—is winning big."
"UnitedHealth easily blew away Wall Street's expectations for the first 3 months of 2020. The $5 billion it reported earning over the first 3 months of the year is actually UP 3.4% over the same quarter last year—despite losing almost 1.2 million in health plan membership," said Potter. "In other words, they're thriving during a pandemic."
Potter noted that instead of using profits to reduce premiums and out-of-pocket expenses for its customers amid the coronavirus pandemic, UnitedHealth Group "used $1.7 billion to buy back its own shares."
"The bottom line: Americans are getting sick and dying, and doctors risking their lives to save them, in this crisis," Potter wrote. "Meanwhile, health insurance companies are denying coverage and squeezing doctors to generate record profits."
https://www.commondreams.org/news/2020/04/16/thriving-during-pandemic-unitedhealth-group-posts-surge-profits-millions-lose


Letter to the Editor - Ellsworth American - March 20, 2020

Dear Editor:
The outbreaks of coronavirus in our country are laying bare the inequities and dangers inherent in our systems of health care and employment. At present more than 28 million Americans have no health insurance and tens of millions more are seriously underinsured. Likewise, more than 30 million workers in America have no paid sick leave. And those without insurance and those without sick leave are very often the same low-wage workers.
When we think about people in these situations, we may feel sympathy for them or gratitude at our own good fortune; we rarely feel threatened by their plight. Think again. Many, if not most, people who are uninsured (as well as many underinsured) will not seek testing or treatment for coronavirus infection simply because they can’t afford it. And for the same reason they won’t be able to stay home from work if they are ill. All of this greatly increases the likelihood that the virus will spread further. To make matters worse, many of these workers are employed in service industries where they regularly interact with the public — the food services industry, child care, nursing homes and other services for the elderly, who are at greatest risk for serious complications from coronavirus infection.
For far too long our leaders and legislators have done far too little to address these fundamental inequities. Our government must ensure that every American has paid sick leave on the job and access to high-quality, affordable health care. As the coronavirus makes clear, it’s not just the right thing to do; it’s in all of our self-interest.

David Jolly - Penobscot, Maine
https://www.ellsworthamerican.com/opinions/letters-to-the-editor/coronavirus-a-wake-up-call/