Editor's Note -
The following link will take you to a podcast of the September 8 podcast of the NPR radio show "On Point". It features an interview with Professor Timothy Snyder, author of his recently published book "Our Malady".
'Our Malady': Historian Timothy Snyder On America's Health Care Problem
by Brittany Knotts and Meghna Chakrabarti
https://www.wbur.org/onpoint/2020/09/08/our-malady-historian-timothy-snyder-on-americas-health-care-problem
The book was also reviewed in "The New York Review of Books" recently. That review and a link to the NYRB article were included in my September 8 blog posting. In it, he makes a powerful case for health care as a human right.
The link to the NYRB article is '
https://www.nybooks.com/daily/2020/09/03/what-ails-america/
Additionally, Christianne Amanpour's recent interview with Professor Snyder on her Septembewr 11 show, is well worth watching.
You can find it at:
http://www.pbs.org/wnet/amanpour-and-company/video/the-case-for-universal-healthcare/
-SPC
Editor's Note -
I received the following email from my colleague Dr. Jim Kahn, recently retired from UCSF's health policy program. His blog sounds like a good place to get valuable health policy information between now and the election.
We are in a pivotal moment, with the future of democracy at stake. Thus, I decided to spend these weeks writing about the different health care futures we can expect under Biden vs. Trump presidencies. (I set aside Medicare for All goals, for the duration.)
Specifically, I’ve started a blog“Ask the Policy Doctor”, in which I define and assess key health policy issues, such as insurance, pandemics, and the opioid crisis. I lay out what we can expect from Biden and Trump, and ask the reader to use this to inform his or her vote (no endorsements).
So far I’ve completed three posts: welcome , uninsurance, and underinsurance. More to come on COVID, opioids, and so on … 1-2 per week; suggestions welcome.
I will do a livestream as well, if there is sufficient interest.
My ideal target audience is swing voters in swing states.
I would greatly appreciate your taking a look and sharing as widely as you think warranted.
-SPC
Coronavirus Tests Are Supposed to Be Free. The Surprise Bills Come Anyway.
Congress sought to ensure that patients would not face costs connected to the virus. But rules are not always being followed.
by Sarah Kliff - NYT - September 9, 2020
Sarah Goldstone got a coronavirus test in Massachusetts after her health insurer said it was “waiving cost sharing for Covid-19 testing-related visits.”
Amanda Bowes, a health policy analyst in Maryland, got hers because she knew a new federal law should make coronavirus testing free for insured patients like her.
Kelly Daisley had one after seeing New York City’s ads offering free tests. “Do it for them,” says one bus shelter ad near her home, showing a happy family.
All three were surprised when their health insurers said that they were responsible for a significant chunk of their bills — in Ms. Daisley’s case, as much as $2,718.
“I had seen so many commercials saying there is testing everywhere, it’s free, you don’t need insurance,” said Ms. Daisley, 47, who was tested at an urgent care center three blocks from her Brooklyn apartment. “If I had to pay it off, it would clear out my savings.”
For months, Americans have been told not to worry about the costs of coronavirus tests, which are crucial to stopping the pandemic’s spread. “It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” Medicare’s administrator, Seema Verma, said in April.
Congress passed laws requiring insurers to pay for tests, and the Trump administration created a program to cover the bills of the uninsured. Cities and states set up no-cost testing sites.
Patients, whether with or without insurance, are beginning to find holes in those new coverage programs. Nationwide, people have been hit with unexpected fees and denied claims related to coronavirus tests, according to dozens of bills that The New York Times has reviewed. Insurers have told these patients they could owe from a few dollars to thousands.
These patients responded to a Times request for medical bills related to coronavirus testing and treatment, allowing us to identify previously unreported patterns in medical billing.
They are not alone. About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight. With 77 million tests performed so far, it could add up to hundreds of thousands of Americans who receive unexpected bills.
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“Whether it’s through legislative action or public statements, Congress has made it really clear that there shouldn’t be cost sharing for Covid-19 testing,” said Julie Khani, president of the American Clinical Laboratory Association. “In practice, that’s not really the case.”
In some cases, the charges appear to violate new federal laws that aim to make coronavirus tests free for privately insured patients. In other cases, insurers are interpreting gray areas in these new rules in ways that work in their favor.
When asked about these charges, health plans say they are doing their best to follow the rules and cover all costs related to the testing. “If a claim is submitted with the proper coding to demonstrate that a test was given to diagnose Covid-19, or that a service was delivered to treat Covid-19, generally the claims for those tests and services are being covered at no cost to the patient,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans.
The insurers faulted the complexity of American medical billing, which can sometimes make it hard to tell when a coronavirus test is provided. Insurers can’t know to cover a claim differently if hospitals and doctor offices don’t use the right codes.
The new rules that Congress wrote midyear do not slot neatly into insurers’ billing systems. One health insurer said it was having to manually revise each claim for a coronavirus test, deleting the charges one by one.
Coronavirus Schools Briefing: It’s back to school — or is it?
“This is legitimately a confusing area, and the coding is all evolving,” said Christen Linke Young, a Brookings Institution fellow who helped write federal billing rules during her time at the Department of Health and Human Services. “Even if you’re an insurer or provider operating in good faith, and think you know what the rules are, figuring out how to identify relevant claims is a hurdle.”
Congress has legislated twice on coronavirus test billing. The Families First Coronavirus Response Act, passed in March, told insurers they could not charge co-payments or apply deductibles to coronavirus tests and other “items and services furnished” during the doctor visit. The rules apply to tests both to detect the disease and to those for antibodies.
The CARES Act built on those protections. It created rules for how to handle out-of-network coronavirus tests, telling insurers those, too, had to be covered at no cost to the patient. Insurers estimate that about 10 percent of coronavirus tests have been billed out of network so far, and that those tests tend to be more expensive than those in network.
Patients’ bills suggest that the rules aren’t always being followed. Insurers have, for example, applied co-payments and deductibles to the tests, claim documents show.
Ms. Bowes, from Maryland, was especially surprised to be charged a $50 co-payment for a coronavirus test at an urgent care center. She knew from her work as a health policy analyst for the National Association of Attorneys General that this wasn’t supposed to happen.
“I was really shocked when I got the bill,” she said. “It felt wrong, and I was angry especially because we were being billed before even receiving our results.” After protesting the fee to her insurer, the charge was reversed and covered.
Some patients found that insurance covered the test but denied payment for other services that went with it: another billing decision that could violate federal law.
One mother in California was surprised that her daughter’s coronavirus test was fully covered but that a $49 “after hours” fee was not — the clinic said it provided tests only in the evening, so as to not infect other patients.
Insurers have told some patients they are responsible for out-of-network charges, even though federal law appears to require insurers to at least partly cover them. This includes Ms. Goldstone from Massachusetts, who went for a test after experiencing mild coronavirus symptoms.
UnitedHealth paid $160 for her coronavirus test, but denied the $250 doctor visit that went with it, stating that her plan did not come with out-of-network benefits.
“It’s upsetting and demoralizing,” said Ms. Goldstone, a musician who has been largely out of work since the start of the pandemic. “I’ve spent months being careful with my finances, and already pay $266 a month for insurance.”
Federal law requires insurers to pay for any doctor visit associated with a coronavirus test, specifically noting that visits to urgent care centers are included. It is silent, however, on how much an insurer must pay to an out-of-network facility — although most experts agree a health plan would need to pay something rather than deny the fee.
“They shouldn’t be able to do that,” Ms. Young of Brookings said. “But I have sympathy for them and their claims system. It probably has rules that are saying: This person doesn’t have out-of-network coverage.”
UnitedHealth said it denied the charge because of how the urgent care center did its billing: It divided the coronavirus test and the visit into separate claims. After an inquiry from The Times, the insurer said it would reverse the bill and review how the urgent care center billed for its services.
“UnitedHealthcare is waiving cost share for Covid-19 testing, in accordance with state and federal guidelines, including the test Ms. Goldstone received,” a spokeswoman, Maria Gordon Shydlo, said. “She will not be responsible for the costs.”
Other bills present murkier situations. Ms. Daisley, from Brooklyn, had coronavirus diagnostic and antibody tests last month. She was surprised when she logged into her health insurance portal and saw four claims associated with her tests: one for each test, one for the doctor visit, and one for other tests she didn’t realize were being ordered.
Her insurance covered the visit and the diagnostic test. But it paid nothing for an antibody test and the other lab services, which were both sent off to out-of-network providers.
Experts say federal law requires the insurer to cover the antibody test in full, even out of network. But the rules around the other tests are less clear: The law states that insurers must cover services related to obtaining a coronavirus test but doesn’t identify what type of care makes the cut. Some providers seem to tack on unrelated lab tests. Patients at a drive-through coronavirus testing site in Texas, for example, were unknowingly tested for sexually transmitted diseases. Without clear federal guidance, insurers are left to sift through charges to decide what is related to coronavirus and what isn’t.
Initially, Ms. Daisley was left with more than $2,000 to pay to out-of-network labs: $210 for the antibody test and $2,508 for the other lab services. Her health plan, Anthem, denied the larger charge because her health benefits do not cover out-of-network care.
The insurer covered the charges after The Times inquired. “Seeing as Ms. Daisley was unaware the treating provider would send her samples to multiple out-of-network labs for what she understood was related to Covid testing, Anthem is covering the costs of the outstanding claims,” a spokeswoman for Anthem, Leslie Porras, said.
The wrong choice of Medicare Advantage plan could kill you
by Diane Archer - Just Care - September 9, 2020
Older adults and people with disabilities have the choice of private health plans that offer Medicare benefits, sometimes called Medicare Advantage plans. Through an analysis of mortality rates at different Medicare Advantage plans, Jason Abaluck, a Yale economist, found that the wrong choice of Medicare Advantage plan could kill you. The government would save thousands of lives if it terminated contracts with Medicare Advantage plans that have high mortality rates.
After studying mortality rates in hundreds of Medicare Advantage plans over several years, Abaluck determined that people who choose the wrong Medicare Advantage plan have a much higher risk of dying. He suggests that giving people the ability to choose between a plan that has their primary care doctor in network and one that saves them money is crazy. And, who knows which of these plans will prolong people’s lives and which will shorten them?
Abaluck recognizes that people cannot make good health plan choices. He further recognizes that the private health insurance market is broken. The Medicare Advantage plans have very little reason to put money towards keeping people healthier. In fact, some have mortality rates as high as eight percent; others have mortality rates of two percent.
Abaluck looked specifically at what happened to people’s risk of death when they switched out of one Medicare Advantage plan and into a different Medicare Advantage plan. He found that a Medicare Advantage plan’s mortality rate had a direct effect on whether a person lived or died.
Inexcusably, people have no clue what the mortality rate is for a given Medicare Advantage plan. That data is not publicly reported. And, star-ratings of Medicare Advantage plans are of no help.
Abaluck says that Medicare Advantage plans with higher premiums and better drug coverage tend to have better health outcomes. But, these two factors alone will not tell you whether you have a better chance of survival in a particular Medicare Advantage plan.
What’s the solution? Abaluck recommends that the government terminate contracts with Medicare Advantage plans that have the highest mortality rates. The better solution: Terminate all Medicare Advantage plans, eliminate out-of-pocket costs in traditional Medicare and enroll everyone in traditional Medicare or, better still, Medicare for All.
https://justcareusa.org/the-wrong-choice-of-medicare-advantage-plan-could-kill-you/?
Cambie Ruling a Victory for Public Health Care in Canada
Business Wire - September 10, 2020
VANCOUVER, British Columbia--(BUSINESS WIRE)--In today’s landmark ruling in the Cambie Surgery Centre case, Justice Steeves dealt a strong blow to the efforts of Dr. Brian Day and others to undermine Canada’s publicly-funded health care system. The decade-long legal attack launched by one of the largest for-profit surgical centres in Canada sought to invalidate key sections of the BC Medicare Protection Act (MPA). This decision ensures that access to health care will continue to be based on need and not on ability to pay.
“This is a victory for everyone who uses health care in Canada. Even though the attack had been launched in BC, it took aim at the very heart of the Canada Health Act and every provincial health care insurance plan.”
“This is a historic victory against profit-driven health care in Canada,” said Dr. Danyaal Raza, Chair of Canadian Doctors for Medicare. “We know that single-payer publicly-funded health care is the fairest way to pay for health care, rather than forcing patients to pay out-of-pocket or buy private insurance. This case was never about wait times - it was always about profit.”
The sections of the MPA that the plaintiffs sought to strike down are in place to preserve a public health care system in which access to necessary medical care is based on need and not an individual's ability to pay. This case has always been about increasing profits for doctors and investor-owned health care facilities.
“As a group of patients, doctors and health care advocates, we became involved in this case in order to defend and protect public health care,” said Edith MacHattie, co-chair of the BC Health Coalition. “This is a victory for everyone who uses health care in Canada. Even though the attack had been launched in BC, it took aim at the very heart of the Canada Health Act and every provincial health care insurance plan.”
Justice Steeves’ ruling affirmed that access to health care be based on need and not the ability to pay. He wrote that the sections of the MPA challenged in this case are in keeping with the “objectives of preserving and ensuring the sustainability of the universal public healthcare system and ensuring access to necessary medical services is based on need and not the ability to pay.”
The recent public health emergency caused by COVID-19 has underscored just how important our public health care system is. This decision protects our ability to endure crises and care for one other into the future.
About the Intervenors:
The BC Health Coalition and Canadian Doctors for Medicare, along with two doctors and two patients, are Intervenors in this case.
The BC Health Coalition (BCHC) advocates for evidence-based improvements to our public health care system, stimulates public education on health care issues, and drives positive change to our health care system through campaigns across the province.
Canadian Doctors for Medicare (CDM) provides a voice for Canadian doctors who want to strengthen and improve Canada's universal publicly-funded health care system. We advocate for innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability.
Why Has Canada Fared Better Than US In The pandemic?
Vancouver – Why has Canada been more successful at limiting the spread of COVID-19 than our neighbours in the U.S.?
One “critically important” factor is Canada’s universal health care system, B.C. health officials said Thursday.
“People don’t have to pay for a test,” provincial health officer Dr. Bonnie Henry said after being asked to weigh Canada’s advantages. “They weren’t worried that if they got sick they would not be able to get care.”
Her remarks came hours after advocates of paid alternatives to public care were dealt a major blow in B.C. Supreme Court.
B.C. Health Minister Adrian Dix agreed with Henry’s assessment, calling the public health system “at the core” of Canada’s success in battling the pandemic.
The structure of the public system made it easy for officials to co-operate and consolidate their approach, both nationally and provincially, Dix said.
“It means that we have an organized public health care system, that when Dr. Henry and (deputy health minister Stephen) Brown chair our response to COVID-19, all of the health authorities were in the room,” Dix said.
Henry noted that she and her fellow health officers from across the country began meeting regularly early on in the pandemic to develop their approach – though provinces did react differently and at different times, based on their own circumstances.
She also credited “incredible experts” on testing both in B.C. and nationwide for the country’s success.
“Our National Microbiology Laboratory and our public health lab network was able to develop tests, and we used them widely very early on,” she said.
Since the start of the pandemic, many Canadians have watched the U.S. handling of the coronavirus crisis with great concern.
As of Friday morning, the number of U.S. deaths blamed on COVID-19 had surpassed 192,000, while Canada’s death toll remained below 9,200.
And while the U.S. has a vastly larger population — 328.2 million to Canada’s 37.6 million — the number of deaths per capita is still much higher south of the border. There have been about 585 deaths per million residents in the U.S. and 244 per million in Canada.
In terms of overall cases, the U.S. has recorded some 6.42 million, compared to about 135,000 in Canada. That works out to more than 19,500 cases per million residents in the U.S. and roughly 3,600 per million here.
Maine Voices: COVID-19 proves the need for universal health coverage
No other developed country puts its people through what Americans face when they need health care.
by Jeffrey Graham - Portland Press Herald - September 11, 2020
No other developed country puts its people through what Americans face when they need health care.
As a charter member of the Bangor chapter of Maine AllCare, I have been an advocate for universal healthcare for some time.
Healthcare for all is the norm in essentially all other developed countries. In those countries, healthcare generally costs less than what we pay for it, routinely results in better health outcomes and is more clearly equitable to all citizens.
The current COVID-19 pandemic has put an even finer point on this issue. Health insurance – which in no way is an assurance of actual healthcare – currently is tied to employment and will now be lost by millions of people in the United States.
Those who once opted out of healthcare coverage because they were “healthy individuals” will have a rude awakening if they or their loved ones face a prolonged hospitalization with ICU care due to COVID-19 or, in fact, any other serious medical problem. Providing healthcare coverage for employees already is an albatross around the necks of employers who know those costs are an ever-rising and uncertain expense.
These expenses, passed on to employers and consumers by insurance companies, primarily are due to huge administrative costs – huge when compared to the healthcare systems in other countries or our own Medicare and Veteran Administration systems. So bad are these costs that Canadian companies near our border commonly recoil from expanding into the U.S. in the face of these large and unpredictable expenses.
Universal healthcare does not encourage unemployment, but it does encourage routine and preventative care. It also encourages patients to seek care when they have a problem instead of waiting for it to become an emergency. This results in an overall healthier population and work force.
People at all levels of employment, from skilled workers to administrators, also would be able to move anywhere in the U.S. to get jobs and not fear losing healthcare coverage or to go through the hassle of re-enrolling for coverage. Entrepreneurs could start businesses without the added start-up expense of health insurance and without the fear of losing healthcare if the business fails. Young people could choose jobs and careers base on their training, dreams, and desires rather than whether a job offers healthcare coverage.
It was disheartening to hear on the news the other day recommendations for avoiding unexpected costs if you or a loved one contracts COVID-19 and is hospitalized. Among the hits were making sure that the hospital was compliant and could receive all appropriate federal and insurance payments, and making sure that all the providers who treated you were “in network.” All of this was to be accomplished by a worried family member of a patient who potentially would be cared for by dozens of providers – while the family member would not even be able to visit in the hospital or ICU. This approach by insurance companies to avoid paying the bills is repulsive and simply is not allowed in other countries.
It is time for us to stand up for universal healthcare. This has only become more evident in these times of COVID-19. A pandemic means we truly are all in this together (ditto when it comes to climate change). This approach toward healthcare costs less, results in better outcomes, is better for business, and obviously is more equitable.
Even if you don’t think healthcare is a human right, it at least should be a moral imperative here in the richest country in the world.
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