Health Care Reform Articles - June 25, 2020

 Editor's Note -

 I just finished reading David Belk's new book "The Great American Healthcare Scam - How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States".

It's well worth reading. It will help you understand why healthcare costs in the US are the highest in the world, and rising, and how widesptead and deeply embedded the forces driving them up are throughout the healthcare system.

It also explains why there is no time like the present to do something about them, because things left on their own will only get worse - and fast. Here, from 'Belk's website (The true cost of healthcare) is a blurb about the book:

My new book - by David Belk.

The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States
Can now be purchased on Amazon. Here is the link:

https://www.amazon.com/dp/B085PP3LM5

"When I began my medical career more than two decades ago, people were already very concerned about the skyrocketing cost of healthcare. However, as much as everyone knew medical costs were high, no one in my profession seemed to know why. None of my colleagues could answer even simple questions about what, specifically, was costing so much. This seemed to be a real problem: how could we begin to control these costs, if even the people in the field didn’t know what they were?

Why didn’t we know? To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. Patients only rarely pay directly for these services and payment for any service varies substantially from different payers. Hospitals have separate billing departments that are far removed from anyone ordering or performing tests or procedures. No one directly involved with patient care has any notion of the charge or reimbursement for their service. Even most private doctor’s offices contract billing companies, who just send them a check each month from the total amount collected, leaving them no notion of the actual charge or reimbursement for an individual service they provided."

 Reading this book is a great investment of time and $$e.

 

-SPC

Out of the Ashes of Covid-19 Should Rise Our Unstoppable Medicare for All Movement

The battle against this pandemic—and all the associated injustices and inequalities it has exposed—should galvanize a nation to finally embrace the kind of healthcare system it deserves.

by  - Ralph Nader - Common Dreams - June 18, 2020

Frontline healthcare, transit, and grocery clerk workers are too busy risking their lives helping and saving people exposed to the deadly Covid-19 pandemic to see themselves emerging as the force that can overcome decades of commercial obstruction to full Medicare for All.
These heroic, courageous, and selfless people are getting the job done, often without protective equipment and adequate facilities. Many of them get extremely sick or die from Covid-19.
Fat cat CEO’s are placing full-page ads elaborately praising their workers whom they regularly underpaid and disrespected before Covid-19. These bosses are now recognizing both the physical and moral courage it takes for these exceptional saviors to serve their communities.

"What should have been done over a hundred years ago, when Republican President Theodore Roosevelt proposed universal health care, should not be stalled any longer."

What is emerging from this catastrophe is an exceptional class of millions of potential advocates receiving mass media coverage. Deeply personal profiles and first-person accounts of the pain and anguish they endure fills the news. They have experienced firsthand the perverse priorities of the profiteering corporate health vendors that are leaving tens of millions of innocent families uninsured, underinsured, and without paid sick leave.
Now shift the scene to the only obstacle to single-payer universal health insurance in America—the corporate indentured Congress. Out of 535 Senators and Representatives, 135 in the House already support H.R. 1384 full Medicare for All with free choice of doctors and hospitals. This much more efficient and comprehensive lifesaving system is far superior to our current profits-first morass. In the Senate, add another 30 supporters. With about 200 more converts for Medicare for All, a veto-proof passage is possible.
Now can come the steely determined Covid-19 workers with their national advocates representing all their skills and geographic regions, heading straight for Congress. In relays, day after day, observing CDC guidelines, they will find Congress mostly AWOL. These days Congress is only periodically present for pressing financial legislation. The frontline workers can push for Congressional hearings, floor debates, and then voting. No more lies, delays, distortions, or domination of members of Congress by the corporate crime complex. The legislators are directly told they work for the people, not the corporations pouring money into their campaign coffers.
These Covid-19 workers cannot be stared down or flimflammed. They have the decisive karma that veterans’ groups often have with Congress. They have seen more fatalities among their protectees in three months then the U.S. soldiers lost in the Korean and Vietnam wars (apart from the massive greater casualties on the native peoples). They have experienced the staggering pressures of their hands-on service from ambulances to intubations and the solitary deaths of their patients. While members of Congress huddle at home, they are shamed by the low-paid valiant toil of exposed grocery, public transit, and sanitation workers who don’t have the luxury of laboring remotely.
This new unstoppable non-partisan assemblage of Americans will have plenty of backup. Funding by well-to-do people will be forthcoming. Experts like Dr. Stephanie Woolhandler, Dr. David Himmelstein, Dr. Sidney Wolfe, Dr. Michael Carome, former Nurses Union leader RoseAnn DeMoro, who keenly understand the tactics of the medical corporatists, are on hand. So are the Physicians for a National Health Program (PNHP) and many other consumer and labor groups.
The polls will expand from a present, majority of Americans, doctors, and nurses to even greater numbers backing universal health care coverage. Rising to greater prominence to lead the way in Congress will be the long-supportive Representatives and Senators energized and propelled by this new, relentless citizen dynamic demanding action now!
What should have been done over a hundred years ago, when Republican President Theodore Roosevelt proposed universal health care, should not be stalled any longer.
Not when 1500 to 2000 people lose their lives every week because they can’t afford to be diagnosed or treated in time, according to a new Yale study.
Not when an average of a billion dollars a day is taken by billing fraud according to a conservative estimate by the leading expert on such crimes—Professor Malcolm Sparrow of Harvard University.
Not when a minimum of five thousand people a week die from preventable problems in hospitals (not including clinics) as reported in a peer-reviewed Johns’ Hopkins School of Medicine analysis. Putting people before profits would lower that horrendous casualty toll substantially.
Not when numerous countries, including Canada, cover all their people at half the price per capita with better outcomes, free choice of physicians and hospitals, and peace of mind.
Not when documentation for fundamental change is so overwhelmingly at everyone’s fingertips (See: SinglePayerAction.org). Dr. John Geyman’s latest in a series of educational books by this sagacious practitioner and scholar—the galvanizing “Profiteering, Corruption and Fraud in U.S. Health Care” will be available very soon (See: johngeymanmd.org).
The Covid-19 pandemic and its bungling by Trump and Trumpsters leading to the loss of loved ones, the loss of patients, and the horrific experiences of frontline workers would pave the way to this long-overdue change. The humane laser-beamed arrival of workers, who have witnessed the tragedies caused by the pandemic will push Congress to provide Americans universal care and relief, from economic anxiety, dread, and fear. Americans deserve the same health care coverage enjoyed by people in every other western country.
https://www.commondreams.org/views/2020/06/18/out-ashes-covid-19-should-rise-our-unstoppable-medicare-all-movement

G.O.P. Faces Risk From Push to Repeal Health Law During Pandemic

Republicans and the Trump administration continue to press to end the Affordable Care Act even as the virus leaves more Americans worried about affordable health coverage.

By Sheryl Gay Stolberg - NYT - June 22, 2020

WASHINGTON — Republicans are increasingly worried that their decade-long push to repeal the Affordable Care Act will hurt them in the November elections, as coronavirus cases spike around the country and millions of Americans who have lost jobs during the pandemic lose their health coverage as well.
The issue will come into sharp focus this week, when the White House is expected to file legal briefs asking the Supreme Court to put an end to the program, popularly known as Obamacare. Speaker Nancy Pelosi, seizing on the moment, will unveil a Democratic bill to lower the cost of health care, with a vote scheduled for next week in the House.
Republicans have long said their goal is to “repeal and replace” the Affordable Care Act but have yet to agree on an alternative. This week’s back-to-back developments — Ms. Pelosi’s bill announcement on Wednesday, followed on Thursday by the administration’s legal filing — has put Republicans in a difficult spot, strategists say.
“Politically, it’s pretty dumb to be talking about how we need to repeal Obamacare in the middle of a pandemic,” said Joel White, a Republican strategist who specializes in health policy and has presented legislative proposals to House and Senate Republicans and the White House. “We need quick solutions here; we need stuff that we can do tomorrow, because our countrymen are hurting.”

Health care is consistently near the top of the list of issues voters care about. While Republicans and President Trump tend to have an edge on the economy, Democrats won the House in 2018 in large part by emphasizing health care — a playbook they intend to revive in 2020. The pandemic has also put Republicans at risk of losing the Senate, said Jessica Taylor, who analyzes Senate races for the nonpartisan Cook Political Report.
“There are a lot of factors that have put the Senate into play, but the pandemic and how it has affected health care and the economy is a major one that have made these races competitive,” Ms. Taylor said.
Democrats need to win three Senate seats to take the majority if they also win the White House, four if they do not. Although Cook Political deems one Democratic incumbent, Senator Doug Jones of Alabama, an underdog in his race, it also rates Senate races in five states — North Carolina, Maine, Colorado, Arizona and Montana — as tossups. All have Republican incumbents.
In Montana, Gov. Steve Bullock, a Democrat, jumped into the race to defeat the Republican incumbent, Senator Steve Daines, in March, just as the pandemic was exploding. Three days later, a liberal group, Protect Our Care, announced a $250,000 ad campaign attacking Mr. Daines as “dead set on taking on away Montanans’ health care” after voting five times to repeal the health law. Cook Political moved the race to its tossup column last week.
The public has been deeply divided over the Affordable Care Act since it became law in March 2010, according to surveys by the Kaiser Family Foundation. But with people now worried that infection with Covid-19 will become a pre-existing condition, Democrats say the health law — which requires insurers to cover such conditions — is becoming more attractive to voters.

In Iowa, Democrats are running ads attacking Senator Joni Ernst, the incumbent Republican, over her vote to repeal the health law. In Alaska, the Republican incumbent, Senator Dan Sullivan, is facing a tougher-than-expected challenge from a doctor named Al Gross, who is running as an independent but has been embraced by Democrats.
At least one Republican lawmaker — Representative Tom Cole, Republican of Oklahoma and a member of House leadership — conceded that the pandemic has made the electoral terrain for his party more challenging. He said he agreed with Mr. White, the strategist, that now may not be the best time to talk about the repeal.

“Yeah, people are very worried about any kind of change in the middle of a crisis, there’s no question about that,” Mr. Cole said in an interview. “On the other hand, ask Americans: ‘Are you really happy with the health care you’ve got? Do you think it’s reasonably priced?’ and the answer is inevitably no.”
The coronavirus has changed the national discussion around health care in ways that go beyond the issue of cost. The pandemic has exposed racial disparities in care, making health care a more important issue for African-Americans and Latinos, core Democratic constituencies.
And with everyone at risk from a fast-spreading, and sometimes fatal, infectious disease, Democrats have an easier time making the case that everyone should be covered.
“For years, Republicans banked on the idea that people didn’t care about other people’s health care — that you would only care about your own, and their entire campaign against the Affordable Care Act was built on that assumption,” said Jesse Ferguson, a Democratic strategist who specializes in health care messaging.

“People now see a clear and present threat when others don’t have health care,” he said. “Republicans have no response to that because their entire worldview on health care is built on an assumption that’s now out of date.”
And with Mr. Trump making dubious claims about health care — like suggesting people inject or drink bleach, and promoting an unproven malaria drug — Democrats are seeking to paint him and his party as ignorant on an important issue.
“We have become the party of health care — this is increasingly our brand, this is what we have fought for,” said Representative Cheri Bustos, Democrat of Illinois and the chairwoman of the House Democrats’ campaign arm. “They are becoming the party of drinking bleach.”
With more than 120,000 Americans now dead of coronavirus and infections rising in states across the country, Republican strategists say the pandemic has made it imperative for their party to have a health care proposal of its own — both in the short term, to help people who have lost insurance, and the long term.
“It certainly increases the pressure for some sort of minimal health care coverage that everyone can count on,” said Whit Ayres, a Republican pollster.
In a recent survey, Mr. Ayres asked swing-state voters how government should help workers who have recently lost insurance coverage. The poll found that 47 percent supported a major government expansion of health care, 31 percent believed the best option for laid-off workers was to go on Medicaid, and only 16 percent preferred federal subsidies for Affordable Care Act premiums.
Based on that research, and given the Republican inclination to favor a private-sector approach, Mr. White, who is president of a business-oriented coalition called the Council for Affordable Health Coverage, has called for the government to help pay for premiums under COBRA, the program that allows unemployed workers to buy into their former employers’ plan.

“Republicans must offer private market coverage solutions that are preferable to Medicaid (which is now more popular than Obamacare),” Mr. White wrote in a policy memo.
Ms. Pelosi’s bill is aimed at shoring up the Affordable Care Act, which she helped muscle through Congress during her first speakership, and reducing premiums, which are skyrocketing. Ms. Pelosi had intended to unveil the measure in early March, for the health law’s 10th anniversary, at a joint appearance with former President Barack Obama. But the event was canceled amid the mounting coronavirus threat.
The bill would expand subsidies for health care premiums under the Affordable Care Act so families would pay no more than 8.5 percent of their income for health coverage; allow the government to negotiate prices with pharmaceutical companies; provide a path for uninsured pregnant women to be covered by Medicaid for a year after giving birth; and offer incentives to those states that have not expanded Medicaid under the law to do so.
One thing it will not have, aides to Ms. Pelosi say, is a “public option” to create a government-run health insurer, an idea embraced by former Vice President Joseph R. Biden Jr., the presumptive Democratic presidential nominee. The bill being introduced by Ms. Pelosi has no chance of passing the Senate and becoming law, but it will give Democrats another talking point to use against Republicans.
The health law has already survived two court challenges. In the current Supreme Court case, 20 states, led by Texas, argue that when Congress eliminated the so-called individual mandate — the penalty for failing to obtain health insurance — lawmakers rendered the entire law unconstitutional. The Trump administration, though a defendant, supports the challenge.
The justices are expected to hear arguments in the fall, just as the presidential and congressional races are heating up. But Mr. Cole, the Republican congressman, said other issues related to the coronavirus pandemic would also be at play in November.
“If we look like we’re on top of it in September or October and we’re on the way to a vaccine, then it will break to the president’s advantage,” he said. “If we’re in the middle of a second wave, obviously not.”
https://www.nytimes.com/2020/06/22/us/politics/republicans-health-care-coronavirus.html?a

People Have Stopped Going to the Doctor. Most Seem Just Fine.

Do Americans really need the amount of treatment that our health care system is used to providing?

by Sandeep Jauhar - NYT - June 22, 2020

As stay-at-home orders ease and cities reopen for business, many doctors and hospital administrators are calling for a quick return of health care to pre-pandemic levels. For months now, routine care has been postponed. Elective procedures — big moneymakers — were halted so that hospitals could divert resources to treating Covid-19 patients. Routine clinic visits were canceled or replaced by online sessions. This has resulted in grievous financial losses for hospitals and clinics. Medical practices have closed. Hospitals have been forced to furlough employees or cut pay.
Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey, only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.
Admittedly, postponing health care had terrible health consequences for some patients with non-Covid-19 illnesses, such as those with newly diagnosed cancers that went untreated because outpatient visits were canceled, or because patients avoided going to the hospital out of fear of contracting the coronavirus. The spike in deaths in major cities like New York during the crisis almost certainly includes such patients.
Still, a vast majority of patients seem to have fared better than what most doctors expected. It will probably take years to understand why. Perhaps patients mitigated the harm of delayed care by adopting healthful behaviors, such as smoking less and exercising more. Perhaps the huge increases in stress were balanced out by other things, such as spending more time with loved ones.

However, there is a more troubling explanation to consider: Perhaps Americans don’t require the volume of care that their doctors are used to providing.
It is well recognized that a substantial amount of health care in America is wasteful, accounting for hundreds of billions of dollars of the total health care budget. Wasteful care is driven by many forces: “defensive” medicine by doctors trying to avoid lawsuits; a reluctance on the part of doctors and patients to accept diagnostic uncertainty (which leads to more tests); the exorbitant prices that American doctors and hospitals charge, at least compared to what is charged in other countries; a lack of consensus about which treatments are effective; and the pervasive belief that newer, more expensive technology is always better.
One of the most significant factors in wasteful health care is having too much supply of health care per capita in certain areas. In specialist-heavy Miami-Dade County, for example, Medicare spends more than twice per person what it spends in Santa Fe, N.M., largely because there is more per capita utilization of doctors’ services. Sadly, more care doesn’t always result in better outcomes.
If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. If so, this has implications for how we should reopen our health care system. Doctors and hospitals will want to ramp up care to make up for lost revenue. But this will not serve our patients’ needs.
The start-up should begin with a renewed commitment to promoting beneficial care and eliminating unnecessary care. Most doctors recognize the importance of this distinction, even if we don’t always act on it. In a survey a few years ago, two-thirds of doctors in the United States admitted that between 15 percent and 30 percent of health care is probably unnecessary.

Medical societies already produce lists of procedures that are essential and those that are better avoided. The latter include M.R.I. scans for most lower-back pain and nuclear stress tests when there are no signs of heart disease. As hospitals and clinics reopen for non-Covid-19 care, such lists should be more widely publicized.
Patients have an important role to play, too. Studies suggest that up to 20 percent of surgeries in some specialties are unnecessary. If your surgery was postponed because of the pandemic, it is worth having a conversation with your doctor about whether it is still needed. Despite the complexity of disease today, ailments sometimes do get better by themselves. And in some cases, scheduled surgeries weren’t necessary in the first place.
Many institutions are using this difficult time in our nation’s history to make changes. The health care system should do the same. The pandemic has given us a glimpse of a world in which business as usual in our health care system was upended. It has also provided an opportunity to start up again in a healthier and more financially responsible way. Reflexively returning to the status quo may be good for our bottom line, but it won’t serve our patients well.
https://www.nytimes.com/2020/06/22/opinion/coronavirus-reopen-hospitals.html?