Health Care Reform Articles - July 30, 2020

The Cult of Selfishness Is Killing America

The right has made irresponsible behavior a key principle.

By Paul Krugman - NYT - July 27, 2020

America’s response to the coronavirus has been a lose-lose proposition.
The Trump administration and governors like Florida’s Ron DeSantis insisted that there was no trade-off between economic growth and controlling the disease, and they were right — but not in the way they expected.
Premature reopening led to a surge in infections: Adjusted for population, Americans are currently dying from Covid-19 at around 15 times the rate in the European Union or Canada. Yet the “rocket ship” recovery Donald Trump promised has crashed and burned: Job growth appears to have stalled or reversed, especially in states that were most aggressive about lifting social distancing mandates, and early indications are that the U.S. economy is lagging behind the economies of major European nations.
So we’re failing dismally on both the epidemiological and the economic fronts. But why?
On the face of it, the answer is that Trump and allies were so eager to see big jobs numbers that they ignored both infection risks and the way a resurgent pandemic would undermine the economy. As I and others have said, they failed the marshmallow test, sacrificing the future because they weren’t willing to show a little patience.
And there’s surely a lot to that explanation. But it isn’t the whole story.
For one thing, people truly focused on restarting the economy should have been big supporters of measures to limit infections without hurting business — above all, getting Americans to wear face masks. Instead, Trump ridiculed those in masks as “politically correct,” while Republican governors not only refused to mandate mask-wearing, but they prevented mayors from imposing local mask rules.

Paul Krugman’s Newsletter: Get a better understanding of the economy — and an even deeper look at what’s on Paul’s mind.

Also, politicians eager to see the economy bounce back should have wanted to sustain consumer purchasing power until wages recovered. Instead, Senate Republicans ignored the looming July 31 expiration of special unemployment benefits, which means that tens of millions of workers are about to see a huge hit to their incomes, damaging the economy as a whole.
So what was going on? Were our leaders just stupid? Well, maybe. But there’s a deeper explanation of the profoundly self-destructive behavior of Trump and his allies: They were all members of America’s cult of selfishness.
You see, the modern U.S. right is committed to the proposition that greed is good, that we’re all better off when individuals engage in the untrammeled pursuit of self-interest. In their vision, unrestricted profit maximization by businesses and unregulated consumer choice is the recipe for a good society.
Support for this proposition is, if anything, more emotional than intellectual. I’ve long been struck by the intensity of right-wing anger against relatively trivial regulations, like bans on phosphates in detergent and efficiency standards for light bulbs. It’s the principle of the thing: Many on the right are enraged at any suggestion that their actions should take other people’s welfare into account.

This rage is sometimes portrayed as love of freedom. But people who insist on the right to pollute are notably unbothered by, say, federal agents tear-gassing peaceful protesters. What they call “freedom” is actually absence of responsibility.
Rational policy in a pandemic, however, is all about taking responsibility. The main reason you shouldn’t go to a bar and should wear a mask isn’t self-protection, although that’s part of it; the point is that congregating in noisy, crowded spaces or exhaling droplets into shared air puts others at risk. And that’s the kind of thing America’s right just hates, hates to hear.
Indeed, it sometimes seems as if right-wingers actually make a point of behaving irresponsibly. Remember how Senator Rand Paul, who was worried that he might have Covid-19 (he did), wandered around the Senate and even used the gym while waiting for his test results?
Anger at any suggestion of social responsibility also helps explain the looming fiscal catastrophe. It’s striking how emotional many Republicans get in their opposition to the temporary rise in unemployment benefits; for example, Senator Lindsey Graham declared that these benefits would be extended “over our dead bodies.” Why such hatred?
It’s not because the benefits are making workers unwilling to take jobs. There’s no evidence that this is happening — it’s just something Republicans want to believe. And in any case, economic arguments can’t explain the rage.
Again, it’s the principle. Aiding the unemployed, even if their joblessness isn’t their own fault, is a tacit admission that lucky Americans should help their less-fortunate fellow citizens. And that’s an admission the right doesn’t want to make.
Just to be clear, I’m not saying that Republicans are selfish. We’d be doing much better if that were all there were to it. The point, instead, is that they’ve sacralized selfishness, hurting their own political prospects by insisting on the right to act selfishly even when it hurts others.
What the coronavirus has revealed is the power of America’s cult of selfishness. And this cult is killing us.
https://www.nytimes.com/2020/07/27/opinion/us-republicans-coronavirus.html?action=click&module=Opinion&pgtype=Homepage

Seniors and staff caught in the middle of nursing homes' quest for profit

The cycle of buying and selling care homes has led to shortcuts, closures, even fraud – and imperiled vulnerable residents’ health

 

by Anne Neumann - The Guardian - July 30, 2020

 

In the spring of 2018, Shelly Robinson came down with a case of the flu serious enough to send her to the emergency room. “The lady was like, ‘Your insurance is no good,’” she told me, “and I was like, ‘What do you mean my insurance is no good? They’ve been taking money out of my paycheck.’”
But Robinson, a certified nursing assistant at Lancaster Care and Rehab in Lancaster, Pennsylvania, operated by Skyline Healthcare, ended up having to pay the $3,500 out of pocket. She didn’t know at the time that her issue at the hospital would become the subject of a federal class-action lawsuit alleging fraud, theft, and other illicit conduct by a multi-millionaire in the business of flipping nursing homes for profit.

Robinson reported the problem to her union representative, Chris Sloat, who was fielding various complaints from Robinson’s colleagues and staffers at other Skyline facilities including a pregnant woman who found out she had no insurance right before giving birth. At a facility in Rosemont, the elevator went unrepaired for weeks so staff carried patients, food, supplies and trash up and down the stairs. For other staffers, dental bills began to pile up. Some couldn’t afford to stay at their jobs.
These kinds of things were happening in dozens of Skyline facilities all over the country. In 2015 New Jersey-based Skyline Healthcare LLC, owned by Joseph Schwartz, began gobbling up nursing homes, amassing enough facilities to provide them with an estimated several hundred million dollars a year of taxpayer money in the form of Medicare and Medicaid reimbursements. Just two years later, they were managing at least 100, including the 120-bed facility Robinson worked at.
Then Skyline effectively disappeared overnight, leaving staff to wonder why food vendors were no longer being paid, why their paychecks were bouncing, why the lights weren’t on. Nine facilities in Pennsylvania were similarly abandoned, along with dozens more in other states including South Dakota, Kansas and Massachusetts. “They actually just left. We didn’t even know they were gone,” Robinson said.
On average, nursing home workers make $19,000 a year, and many rely on second jobs or food stamps to get by. “The thing that is still sad is these people are low-paid to begin with,” Sloat, an administrative organizer with SEIU Healthcare of Pennsylvania, the largest healthcare union in the state, said about staffers cheated out of pay and benefits by Skyline. “And now the debt that they have, people coming after them for bills, is just mind-blowing. And they don’t have the money. There’s still this residual effect from everything [Schwartz] has done.”
The collapsing of Skyline was a foreboding of disasters to come – a sign of how a cycle of buying and selling had opened the precarious industry up to fraudsters who could amass a string of facilities, suck the money out of them, and then run off, leaving residents and staff without much recourse. The case was an unheeded warning that the industry was insufficiently regulated and absolutely unprepared to withstand any new crisis that might come along.
But Covid-19 came anyway. On Easter weekend, the pandemic struck a remaining Skyline facility in New Jersey, as if to prove a point. An anonymous tip brought police to Andover Subacute and Rehabilitation Center where they discovered the bodies of 17 residents piled into the facility’s tiny four-person morgue. Local news reported that Louis Schwartz, the son of Joseph Schwartz and the vice-president of mergers and acquisitions for Skyline, was a 50% owner of the facility.
According to Skilled Nursing News, as of July, 2019 Skyline still retained an ownership stake in “more than 50 nursing homes”.

Flipping, or the buying and selling of nursing homes with the purpose of turning a quick profit, is exceedingly common. Once dominated by individual, family-owned non-profits, over the past few decades the industry has experienced the penetration of for-profit corporate ownership leading to an increase in facility sales and contributing to the overall uptick in closures across the US – more than 550 nursing homes (out of a total of 15,600) have closed since June 2015.
While that wave of closures has not affected Pennsylvania “just yet”, nursing homes in the state inhabit an “extremely volatile market”, according to Zach Schamberg, the president and CEO of the Pennsylvania Health Care Association, which represents the nursing home industry. There are a total of 700 facilities in the state. In just the past three years, there have been 100 nursing home sales, changes of ownership, or reorganizations, he told me, a rate that has doubled between 2007 and 2017.
According to industry advocates like Schamberg, the increased number of sales is due to the costs of care rising about 2.5% a year while Medicaid reimbursements do not. “So do the math,” Shamberg said. But patient advocates, who acknowledge the stagnation of reimbursement rates, strongly deny that increasing those rates alone will solve the industry’s problems. Rather, studies have shown, when Medicare and Medicaid rates increase, care quality often doesn’t.
In an already fraught industry embattled by a variety of problems – particularly those that directly affect residents’ care, like eviction of Medicaid patients, lack of regulation, chronic understaffing, and poor infection control – massive fraud cases are as shocking as they are common.
Philip Esformes, whose string of nursing homes stretched from Illinois to Florida, was sentenced to 20 years in prison last September for paying doctors to refer patients to his facilities and for taking taxpayer money that he never applied to residents’ care. His indictment included money laundering, receiving healthcare kickbacks, bribery conspiracy and obstruction of justice. Esformes, who owned multiple homes and drove around Miami Beach in a Ferrari, amassed $1.3bn in Medicare and Medicaid money. The case reached court several years after reporting by dogged journalists at the Chicago Tribune, David Jackson and Mario Ariza. In a 2016 documentary about the case, Jackson states, “the scope of the schemes is staggering”.
HCR ManorCare, a national chain of facilities, collapsed after investment from private-equity firm the Carlyle Group. Within four years, ManorCare sold most of the buildings its facilities operated in for $6.1bn, funneling the profit to shareholders. ManorCare continued operation of the facilities but became strapped with monthly rent payments they couldn’t make. With $7.1bn in debt, the company filed for Chapter 11 bankruptcy in 2018.

The elusive multi-millionaire Joseph Schwartz, owner of Skyline, has become, to thousands of elders, their families and their caregivers, the face of all that is wrong with the American nursing home industry.
When Schwartz abandoned dozens of facilities, starting in 2017, residents were left sitting in their own feces, unfed and unbathed. Whatever staff remained, like Shelly Robinson, were left to buy food for elders and to pay the facility’s utility bills. “Sometimes, as employees, we purchased snacks for our residents so they had snacks,” Robinson told me.
In some cases, state governments stepped in to care for the abandoned residents, overseeing operations until a buyer could be found for the facility. Families were shocked by not just the neglect but the blatant lack of communication about their loved ones’ status.
“It seems like they had a plan to go in there for two or three years, bleed the nursing homes and then just bail out,” Thomas Pasternack, the owner of Walsh Pharmacy in Fall River, Massachusetts, told southcasttoday.com after three Skyline facilities left him with $200,000 of unpaid bills.
When they left Lancaster Care and Rehabilitation, Skyline refused to pay staff for any of the time off they had accrued. “Skyline said they weren’t paying us for our sick time or vacation time,” Robinson told me. “It was actually our time that we accrued through working, but they said they weren’t going to pay us.” Pennsylvania does not require that staff and residents of a facility be notified of a change of ownership for the first 30 days. When staff are finally informed of the sale, they must scramble to negotiate livable salaries and benefits with the new owner. The incremental erosion of wages and benefits increases the precarity of staff and their families but it also jeopardizes the health of residents who suffer from short staffing and staff members who can hardly pay their own bills.
The Covid-19 pandemic has escalated the repercussions of mismanagement, fraud, and the lack of regulations. The grim Easter Sunday discovery at Andover Subacute in New Jersey, the state’s largest licensed facility, was not the end of unnecessary deaths there. By mid-June, at least 70 residents and staff members had died in the facility, where nearly 550 residents lived.
Still, states all across the country, like New York, are moving to provide immunity from Covid-19 litigation to nursing homes. Last month, 250 patient advocacy organizations wrote a letter asking legislators to not provide immunity to the nation’s facilities. The letter states: “Essentially, the only mechanism available for a nursing home resident to hold facilities responsible for substandard care is judicial recourse. By removing this safety net, nursing homes will have little to no oversight.”

The industry’s volatility has not been easy for vulnerable residents and staff. “I’ve been working in that building for nine years,” Shelly Robinson told me. “Since I have been there it’s been bought and sold and bought and sold.” When she started, the facility was called Golden Living Care, but the Texas-based company sold the operations of 36 facilities, including Robinson’s, after a lawsuit in 2015, but they kept the real estate. That’s when Skyline became Robinson’s boss – and Golden Living’s tenant.
Robinson works the night shift there. Her teenagers have busy lives but her beloved dog, Prince Brixx, is waiting for her each morning when she gets home. These days she worries about Covid-19. But she loves her residents. “If I don’t show up and the next person don’t show up, then who takes care of them?” she said.
When I ask Robinson, a veteran of the industry – she’s worked in nursing facilities for more than 30 years and joined SEIU in 1993 – what needs to be done to correct course, she tells me: “Stop making money the bottom line and care for our elders. They are people and they have lives and families and you can’t just put a dollar sign on their head.”
https://www.theguardian.com/us-news/2020/jul/30/care-homes-seniors-nursing-homes-flipping-profit
 

UnitedHealth posts most profitable quarter in its history

by Bob Herman - Axios - July 15, 2020

UnitedHealth Group registered more than $6.6 billion in profits in the second quarter — by far the conglomerate's highest quarterly profit ever, according to an analysis of company financial data from FactSet.
Why it matters: Most companies struggled in the second quarter as the coronavirus pandemic froze the economy, but health insurers like UnitedHealth heavily benefited as people held off on going to the doctor or hospital, resulting in fewer medical claims that needed to be paid.
The big picture: The jump in profits exceeded Wall Street's predictions, and was heavily driven by UnitedHealth's insurance division.

• The operating margin in the second quarter for UnitedHealthcare was 14.3% vs. 6.8% for Optum, which is the division of the company that runs doctors' practices, technology, consulting and pharmacy benefits.

Zoom in: UnitedHealth's "medical loss ratio" in the quarter was 70.2% compared with 83.1% during the same time last year — meaning UnitedHealth paid out just 70 cents in medical claims for every dollar it received in premiums.
Yes, but: The company expects that ratio will rise later this year as more people get the care they delayed. UnitedHealth also said some of its commercial employers cut coverage for workers due to the pandemic, which affected its revenue.
Go deeper: UnitedHealth's political and financial heft just keeps growing

https://www.axios.com/unitedhealth-coronavirus-second-quarter-profits-0ff4a160-6e50-4b77-84d9-9a2bff9358d7.html 

How I changed my mind on 'Medicare For All'

By Dr. Li Tso - The Hill - July 14, 2020

I know most of the arguments against "Medicare for All." I’ve been making them for most of my professional life as a physician:

1) We don’t need it; our current mix bag of public and private insurance coverage is adequate

2) Disrupting the private insurance industry would result in too many job losses

3) The government cannot be trusted to run a program of this size

4) We don’t have buy-in from a majority of constituents

5) We simply can’t afford it.

I’ve said all of these for 30 years. I now know that I am wrong.

Health care policy can be simplified to answering the basic question of who gets covered and at what cost. Universal coverage was once championed only by the most progressive. Then came COVID-19.

COVID has taught us that every member of our society needs adequate health care. This is not just a progressive talking point, it is the reality of infectious disease: those without proper care run the risk of acquiring and transmitting the disease to the rest of us.

The most marginalized segments of our population such as the homeless, undocumented workers, and the incarcerated still have contact with clerks in coffee shops, police officers, and staff in our emergency rooms. This was made evident when a homeless patient came to my practice’s office for wound care seven times over a two weeks period at the beginning of the pandemic before strict safety protocols were instituted. This patient subsequently tested positive for COVID-19. Fortunately, none of the staff in my practice contracted COVID from this patient. This scenario is just a microcosm of what can go wrong if we do not care for everyone.

Universal coverage is no longer charity or a luxury, it’s now medically necessary as protection for us all.

COVID has also taught us that tying insurance to employers no longer makes sense. It’s a historical accident that we even have this system: The Stabilization Act of 1942 was passed to limit war-time inflation and limited employers’ ability to raise wages, but there was an exemption for "insurance and pension benefits" which could grow "in a reasonable amount" during the freeze.

Suddenly, employers were in the health insurance business as health benefits could be considered compensation but did not count as taxable income.

When Congress rewrote the tax code in 1954, it preserved the tax subsidies for third-party insurance, and by 1964, almost 80 percent of the population had some form of employer-sponsored health insurance.

This system sort of worked until the cost of health coverage became too expensive and companies, especially small companies, reduced or eliminated coverage. Today, Kaiser Permanente estimates that only about 49 percent of Americans get their coverage this way.

COVID made it clear what a weak link this is as sudden massive unemployment can quickly result in public health catastrophe. More than 30 million people lost their jobs — and for many, their health insurance--in just a few months of lockdown.  Many of these people run the risk of being suddenly uninsured.

Yes, Medicare for All will cost a lot, and it will cause huge disruptions. But disruption is part of free enterprise and innovation. Why should health care companies be exempt? It makes little sense and is almost un-American. Think electricity replacing whale oil, combustible engine replacing horse and buggy, the invention of the computer, the internet, smartphones, fax machines. Each innovation caused massive job restructuring but they also made our lives better and easier. By some estimates, Amazon has resulted in the elimination of 1.5 million retail jobs. Are health insurance jobs more vital than retail jobs? In the case of Medicare for All, displaced private insurance workers are the very ones the government would need to hire and help implement the new program.

For many years I didn’t trust the government to run a system as large as Medicare for All — not when the DMV can barely handle your license renewal. Consider our newest department, the Department of Homeland Security, which was created in 2002. DHS now has over 240,000 employees and a budget of nearly $50 billion. Bureaucracy exists within any large organization. We now readily accepted this new department after the terrorist attacks of 9/11. Aside from the extremists, no one is calling for the dismantling of major departments due to bureaucracy.

Medicare for All will certainly be expensive. Projections range from 13-47 trillion dollars over 10 years.

Critics claim that this enormous amount would bankrupt our treasury and unfairly pass down this debt to our children and grandchildren.  However, other than for a short duration in the 1990s, the U.S. government has run a budget deficit every year since 1970. Our national debt is now over 25 trillion dollars and will surely grow in the future. Economists continue to debate about the meaning and consequence of this large debt.

The United States government has spent more than six trillion dollars to help support the economy during the pandemic with widespread support from both politicians and the public and very muted dissent from the traditional deficit hawks. That’s because it’s clear to politicians that the stimulus is preventing a broader crisis. Deficit spending is considered not only reasonable but a wise use of resources when it provides benefit to a large segment of our population.

The sizable cost of 1 to 4 trillion per year for universal health coverage is justifiable and may even appear to be a bargain considering the amount we have already spent on COVID, and the amount people will continue to spend on the most expensive health care system in the world. We currently are already spending nearly $4 trillion per year on U.S. healthcare. Despite this enormous amount, we still have gaps in coverage and we rank poorly as measured by healthcare access and quality index compared with other developed countries.

COVID has made clear that we need to reframe the way we think about universal health coverage. It would be naïve to think that COVID will be our last novel pathogen or last economic shock. The disruption and cost of permanent universal coverage is indeed high but the cost of not pursuing this policy will likely be much higher.

Li Tso, M.D. is a primary care physician at Mass General Hospital, assistant professor of medicine at Harvard Medical School. 

https://thehill.com/opinion/healthcare/507348-how-i-changed-my-mind-on-medicare-for-all

'Red Line for a Humane Society': 360+ DNC Delegates Vow to Oppose Democratic Platform If It Doesn't Support Medicare for All

"Democrats who understand the profound need for Medicare for All don't want a pat on the head. We want a genuine political commitment to healthcare as a human right."

by

Jake Johnson - Common Dreams - July 17, 2020

 

More than 360 delegates to the Democratic National Convention have signed a petition vowing to vote against the 2020 party platform if it does not include a plank supporting Medicare for All, a policy solution one progressive delegate described as "a red line for a humane society."

"Millions of people have lost their jobs and their healthcare at the same time. There's people leaving the hospital now with millions of dollars in medical bills. What are we going to do about that?"
—Judith Whitmer, delegate for Sen. Bernie Sanders

The petition, led by supporters of Sen. Bernie Sanders (I-Vt.) from Nevada's DNC delegation, says the Covid-19 pandemic has highlighted "the need to separate healthcare from employment" and ensure that healthcare is guaranteed to all as "a basic human right, not a luxury."
Judith Whitmer, a Sanders delegate and chair of the convention's Nevada delegation, told Politico Monday that while a majority of petition signatories are Sanders delegates, some of presumptive Democratic nominee Joe Biden's delegates have also taken the pledge. The largely virtual Democratic convention is scheduled to begin on August 17.
"This pandemic has shown us that our private health insurance system does not work for the American people," Whitmer said. "Millions of people have lost their jobs and their healthcare at the same time. There's people leaving the hospital now with millions of dollars in medical bills. What are we going to do about that?"
Advocacy group Families USA estimated earlier this month that at least 5.4 million Americans lost their health insurance between February and May, the largest three-month spike in uninsurance on record. Major private insurance companies, meanwhile, have seen their profits soar amid the deadly pandemic.
A draft version (pdf) of the 2020 Democratic platform released last week mentions Medicare for All once but does not endorse the proposal, which has grown in popularity among Americans since the coronavirus pandemic hit the U.S. in March. The Democratic Platform Committee, a panel of 180 delegates, is expected to begin considering the draft and offering amendments on Monday before the document is advanced to the full convention for a vote.
"Generations of Democrats have been united in the fight for universal healthcare," the draft reads. "We are proud our party welcomes advocates who want to build on and strengthen the Affordable Care Act and those who support a Medicare for All approach; all are critical to ensuring that healthcare is a human right."
Throughout the 2020 Democratic primary race, Biden repeatedly attacked Medicare for All with right-wing talking points and pushed a public-option alternative that would leave millions of Americans uninsured. In an interview with Medicare for All advocate Ady Barkan earlier this month, Biden reiterated his opposition to single-payer and said he supports preserving a role for the private insurance industry.
Norman Solomon, national director of progressive advocacy group RootsAction.org and a Sanders delegate from California, told Politico that "Democrats who understand the profound need for Medicare for All don't want a pat on the head," referring to the draft of the Democratic platform.
"We want a genuine political commitment to healthcare as a human right," said Solomon. "Biden hasn't gotten there."
Read the full petition:
Bernie Sanders delegates from the Nevada delegation to the Democratic National Convention call on all delegates to sign on to this petition and pledge to vote against any platform that does not include a plank supporting universal, single-payer Medicare for All.
Whereas, this Country is currently in the throes of a catastrophic public health crisis; and
Whereas, this emergency has led to massive job losses due to the Country’s response to that crisis; and
Whereas, millions of Americans have lost their healthcare insurance because of those job losses at a time when healthcare is needed most; and
Whereas, this crisis has highlighted the need to separate healthcare from employment; and
Whereas, we believe that healthcare is a basic human right, not a luxury; and
Whereas, our current, for-profit health care system is inherently racist and discriminatory; and
Whereas, the majority of Americans now believe that a universal, single-payer, Medicare-For-All system is the best way to achieve equitable, affordable and accessible healthcare for all Americans; and
Whereas, the Democratic Party and their Platform Committee process has failed, to date, to incorporate a clear and progressive platform plank for Medicare-For-All for adoption by the 2020 National Convention; therefore
Be it resolved that we, the undersigned delegates to the Democratic National Convention, pledge to vote against any 2020 Platform that does not include a universal, single-payer, Medicare-For-All, platform plank.
https://www.commondreams.org/news/2020/07/27/red-line-humane-society-360-dnc-delegates-vow-oppose-democratic-platform-if-it?c