September 2020 News

Freedom and Choice in American Healthcare

One of the arguments often heard against universal healthcare in America is that it would restrict our freedom and choice. But how much freedom, and what real choices, do we have in our current healthcare "system"?

Phil Caper, MD, and Peter Arno, PhD, published an article on the Maine AllCare website in March 2020 on the illusion of choice in American healthcare. Phil is a retired physician and founding board member of Maine AllCare with decades of experience in healthcare policy, and Peter Arno is director of Health Policy Research at the Political Economy Research Institute at the University of Massachusetts.

In an Opinion piece in the New York Times in January 2020, former health insurance company executive Wendell Potter shatters the illusion of choice and exposes how it was created to sway voters.

"When the candidates discuss health care, you’re bound to hear some of them talk about consumer “choice.” If the nation adopts systemic health reform, this idea goes, it would restrict the ability of Americans to choose their plans or doctors, or have a say in their care.
It’s a good little talking point, in that it makes the idea of changing the current system sound scary and limiting. The problem? It’s a P.R. concoction."

Historian Timothy Snyder explores these questions in a new book, Our Malady: Lessons in liberty from a hospital diary, based on his recent near-death experiences following a misdiagnosed case of appendicitis in December 2019. In the process, he realized that what seemed at first like a combination of mistakes, bad luck, and circumstance were actually symptoms of a failing healthcare system.

Read: What Ails America

Timothy Snyder, New York Review of Books, September 3, 2020

"If health care were available to everyone, we would be healthier not only physically but also mentally. Our lives would be less anxious and lonely because we would not be thinking that our survival depended on our relative economic and social position. We would be profoundly more free."

Listen: 'Our Malady'

Host Meghna Chakrabarti talks with Timothy Snyder in a recent episode of the On Point radio show on WBUR Boston.

New Maine AllCare website

We have a new website!

Check it out to see the latest news, learn more about what we're doing and why we need universal healthcare, connect with a chapter near you, make a donation to support the work, sign up to volunteer, and much more.

The look has changed and lots of new information and resources have been added, but some things haven't changed--such as our mission and Key Principles.

The new site was only possible thanks to the generosity of one of our supporters and donors, and the work of our Communications Committee, board members, and other volunteers. Huge thanks to all who made it happen!

Call to Action

Support emergency COVID-19 legislation

Physicians for a National Health Program has developed many resources related to COVID-19 and the need for universal healthcare, including a call to support emergency legislation that's been introduced in the U.S. House of Representatives.

"As millions of American workers lose their jobs (and their employer-sponsored health benefits) during the COVID-19 pandemic, the demand is growing for Congress to guarantee health coverage for everybody in the U.S."

Learn more and contact your representatives today

Voices of Maine

The coronavirus crisis is making it all too clear just how essential it is for Americans to have universal healthcare that is affordable, not tied to employment, and publicly funded--for our health, for our economic well-being, and for greater equity. Please consider writing a letter to the editor about our need for universal health care--there is no better time than now.

COVID-19 proves the need for universal health coverage

In a letter to the Portland Press Herald on September 11, Dr. Jeffrey Graham of the Maine AllCare Bangor chapter outlines how COVID-19 is making it clear that we need universal healthcare.

"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...This approach toward healthcare costs less, results in better outcomes, is better for business, and obviously is more equitable."

If you write a letter to the editor, please send us a link. If you want help putting a letter together contact Dan Bryant at bryantdc57@gmail.com.

Love Data?

From Gallup, September 1, 2020:

50% in America fear bankruptcy due to major health event

Learn more and get involved

Check out our website to learn more about health care reform for Maine, who we are, the work we do, and how you can get involved.

Maine All Care chapters usually meet monthly, around the state, and our meetings are open to all. Due to the pandemic, in-person meetings are suspended for now; some chapters may hold virtual meetings, others are focused on other ways to keep the movement for universal healthcare for Maine going. Find your local chapter on our website.

We want to hear your stories: Has the pandemic changed the way you see healthcare in our country? How are you coping? Have you or someone you know recovered from COVID-19? Send your stories to Field Director Abbie Ryder at aryder@maineallcare.org.

Send us your signs! We are building up our online movement and starting a series of Mainers showing their support for healthcare for all Maine. Send your photo to Abbie Ryder at the email address above. Be creative. We need to send a message that we are all in this together, we deserve better, and we can do better.

Make a donation to support Maine AllCare's work--any amount makes a difference! You can choose a one-time gift, or set up a monthly donation, on our website.

Follow Maine AllCare on Facebook and share posts and events.

And please spread the word!

Thank You for Your Support!

Maine AllCare promotes the establishment of publicly funded healthcare coverage for all Maine residents. This system must be efficient, financially sound, politically sustainable and must provide benefits fairly distributed to all. Maine AllCare advocates that healthcare, a basic necessity, be treated as a public good, since it is fundamental to our well-being as individuals and as a democratic nation.

Please forward this email to friends and family, and encourage them to sign up to receive the newsletter.

You can also mail your contribution to: Maine AllCare, P.O. Box 5015, Portland, ME 04101.

Maine AllCare is a chapter of PNHP, Physicians for a National Health Program.

Your donation is tax deductible under Section 501(c)3 of the IRS code, to the full extent allowed by law.

Maine AllCare News

Editor's Note -

I have included this months "Maine AllCare News" because I am particularly proud of this information-packed edition of our newsletter (and not just because it leads off with a reference to the excellent essay I, together with Peter Arno of PERI, wrote about the fallacy of choice in healthcare in the US.

Well done!

-SPC

Grow Support for Improved Medicare for All with Guerrilla Marketing

by Ivan Miller - Colorado Foundation for Universal Health Care - August 28, 2020

Those of us involved in the Improved Medicare for All (IM4A) movement have seen support

grow across the country. But for the movement to succeed, support must grow even more

powerful. A 2020 Gallup survey reports 50% of Americans support and 43% oppose a one-payer

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national health plan . This narrow margin is not enough to make substantial change in our

health care system. Challenged by some of our team at the Colorado Foundation for Universal Health Care (Foundation), I have been on a quest to find messaging that resonates with people.

The Foundation’s messaging team finds it useful to assume that 30% of the people are solidly on the support side and 30% are solidly on the oppose side, and that these groups on each end of the continuum will not change position. This leaves 40% of Americans who have not decided whether or not to support an Improved Medicare for All health care system. They are those in the middle who can be persuaded to one side or the other. We’ll call them the persuadables. Our education and messaging mission is to find out who these 40% are and what would move them to enthusiastically support IM4A now.

The conventional way to develop messaging is to hire a marketing expert to conduct surveys and focus groups. The consultant would then develop messages based on findings. Because we do not have the funds for this kind of marketing, we need another way.

In 1994, while developing a small marketing company for 75 independent psychotherapists, I

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was inspired by Jay Conrad Levinson’s 1984 book, Guerrilla Marketing . He showed that with

creativity and strategic thinking, small businesses can compete by finding ways to obtain messaging information from material that is publicly available. My search for accessible polling and focus group information led to an organization that opposes our message — the Partnership for America’s Health Care Future (PAHCF), an alliance of the pharmaceutical and insurance industries, for-profit hospitals, and others who prosper in the current health care marketplace. Their mission is to maintain the multi-payer health care system and defeat single-

1 Kaiser Family Foundation (May 27, 2020) Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage. https://www.kff.org/slideshow/public-opinion-on-single- payer-national-health-plans-and-expanding-access-to-medicare-coverage/. Slide 1

2 Levinson, J. C. (1984) Guerrilla Marketing: Easy and Inexpensive Strategies for Making Big Profits from Your Small Business. Boston: Mariner Books.

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 2

payer proposals. As our opponents, they want to find out who the persuadables are, and, like us, persuade them to their point of view. Funded by these wealthy industries, their messaging is undoubtedly based upon the work of expensive consultants, extensive polling, and in-depth focus groups. The messaging resulting from their findings is displayed on the PAHCF’s “about us” webpage. Paradoxically, this website is a gold mine of information about how to convince the persuadables to support IM4A.

Who are the persuadables?

PAHCF defines the current system as an “employer-sponsored insurance system.” It is likely that their consultant found messaging about “employer-sponsored insurance” more successful than referring to it as “the health care insurance industry.” The website claims that employer- sponsored insurance covers 180 million people, which is likely the group their consultant determined could won over to their side.

This group has insurance. Their health care costs are reduced because employers pay a substantial portion. They likely think that they have a pretty good deal, which they do compared to their cohorts who do not have employer-sponsored insurance. With universal health care, they would lose both the employer’s contribution and their current insurance. The PAHCF messaging suggests this group could be persuaded that if IM4A replaced their insurance, they might lose some quality, choice or control over their treatment.

They may also believe that because they have good insurance, any new taxes for expanding health care would fund other people’s health care. Indeed, this is the case with incremental expansions of health care coverage, including the ACA. This perception that they have nothing to gain can make them more reluctant to support IM4A.

The PAHCF messaging does not mention the people who buy insurance on the individual market, suggesting they found those people are less likely to support the current system and more likely to be persuaded to support IM4A.

Overview of PAHCF messaging

The first paragraph of the PAHCF mission statement is organized around the phrase “Build on

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what’s working in health care and fix what’s not. ” PAHCF decided to make this phrase their

overall theme. Their consultant and research must have found this commonsense statement to be a winner.

The PAHCF messaging professes that it can solve health care problems by building on employer- sponsored health insurance, which they claim is a system that is working. The main thrust of their messaging is that the employer-sponsored insurance system has the best quality, offers most choice, and gives patients the most control over their health care, and this successful, quality health care should not be replaced by a one-size-fits-all program.

3 Op cit, Partnership for America’s Health Care Future

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 3

They consider Medicare for seniors and Medicaid for those in need to be important components of the current system. Both programs are praised and supported. They frame universal health care as threat to these great programs.

The PAHCF has adopted our two strongest arguments — that everyone should have health care and the system is broken. They even promote these two arguments as their own. The difference is that they talk about everyone having health care insurance instead of health care. They imply it should be incremental and argue for expansion of coverage through the current system.

The PAHCF is winning the messaging battle for popular support. While support for IM4A grows

slowly, Kaiser Family Foundation found that 58% of the support disappeared when respondents

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were told that, with IM4A, insurance companies would be eliminated . Gallup Polls report that

among Democrats and Democratic-leaning voters, 55% prefer the incremental step of expanding the ACA while 40% prefer Medicare for All.

Politically, PAHCF’s message has been extremely successful. Moderate Democrats, corporate Democrats, and almost all health care advocacy nonprofits profess that they solidly endorse health care for everyone and that health care is a human right, but they profess that they are working toward it through incrementalism.

Choosing IM4A

Greg Smith, a retired CFO for multiple large corporations and the Foundation’s Business Outreach Coordinator, posed a marketing question for us. “Since you have by far the best product (plan to fix the health care system), why are you having trouble selling it to the American people. There must be something lacking in your marketing. What is it?”

The movement’s advocacy work has been based on two big arguments – that everyone should have health care and that there are terrible problems with our current system. It has been assumed that winning those arguments, the logical conclusion would be IM4A. As the PAHCF has shown us, the persuadables do not necessarily conclude that IM4A is the solution and can be misled to think that the multi-payer system can be the cure.

From a marketing perspective, we have made two fundamental mistakes. First, we don’t have a concise description of what IM4A is. How can we expect to sell a product without saying what it is?

Second, we have not said enough about what a great product it is. You cannot expect to sell a product by spending most of your energy talking about how horrible the competition is. Marketing and selling IM4A requires educating people about what a great, comprehensive, trustworthy, and quality health care system IM4A is.

4 Op cit, Kaiser Family Foundation, Slide 9

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 4 With the guidance of the PAHCF research, we can improve our marketing in major ways.

Build on what is working

Thank you, PAHCF, for coming up with the message, “Build on what’s working in health care

and fix what’s not.” Our side needs to get on this winning message, because we are its rightful

owners. We have evidence of what’s working in the U.S. via what we’ll call the Great American

Health Care Experiment. This real-life experiment compares Medicare with the multi-payer

health care system, and clearly shows that Medicare is the system that works. Medicare and

Medicaid were created in 1965, and Medicare, a single payer system, was given the

responsibility for the health care of people over 65. (The multi-payer health care marketplace,

including Medicaid as a partial safety net, was given responsibility for people under 65.) The

Medicare system was at a disadvantage because it needed to care for older and sicker patients

with complex needs. In spite of this disadvantage, Medicare still showed that it is the superior

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system . A proven, effective, efficient and popular program, Medicare has out-performed

health care insurance in customer satisfaction and cost. Medicare is the system that works best, and the improvements in IM4A fix the parts that are not working well.

America’s lack of awareness of the Great American Health Care Experiment is shocking. Defenders of the status quo constantly argue that Medicare for All would be a newly created system unlike anything we have known. They have framed the most successful health care program in the country as an untried experiment.

The IM4A movement needs to get the truth out and speak out about Medicare winning the Great Experiment every place possible. We need to raise awareness to the point that it is common knowledge that Medicare outperforms employer-sponsored health care insurance.

Focus on the fix

The second part of PAHCF’s message, “Build on what’s working, and fix what’s broken,” concedes that there is a lot wrong with the health care system. Each new horrific failure, even a pandemic-sized failure, is framed as just something to be fixed.

The ACA is a good example of attempting to fix what’s broken while keeping the multi-payer system in place. The ACA eliminated pre-existing condition exclusions and made health care available to some who hadn’t had coverage before. Most importantly, the ACA expanded Medicaid. However, to achieve these gains, overall health care costs went up and the system was made even more complex. These drawbacks made the ACA unpopular. Only when some politicians tried to take it away did those benefitting from the ACA speak up. Like so many parts of the health care system, the ACA helps some people and for many is better than nothing.

Medicare is not perfect. IM4A is different than Medicare. The “Improved” part in the name moves it from a program that out-preforms employer-sponsored insurance (a low bar), to a

5 Masterson, L. (2019) Original Medicare tops ratings in survey, beating out Medicare Advantage and employer plans. Insurance.com. https://www.insurance.com/health-insurance/health-insurance-plan-ratings

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 5 truly superior health care system. We know where the problems are and what needs to be

done to fix them. And with all these improvements, IM4A still saves money.

In order to sell the IM4A solution to the public, we need to tell people what IM4A is. Referring to complex legislation, such as HR 1384 or S1129, is no substitute for a straightforward description. Partial descriptions such as saying it adds dental, vision and hearing services do not encapsulate other important issues of quality, cost, and provider payments. We need a concise description of the added benefits and enhancements in IM4A.

Here is the Colorado Foundation for Universal Health Care’s current list6 of the ways IM4A improves on Medicare. It is an aspirational list, and each of the many independent organizations or leaders in the IM4A movement may alter it and have a slightly different list. These variations aren’t the point. There is mostly common ground that holds the movement together, and each organization or leader may describe the aspirational dreams in a slightly different way. When legislation is developed it can be measured against the shared goals of our movement.

The word “improved” alone, is not enough to pique interest. It is one of the most overused words in marketing and politics. Most of the time the improvements are not as great as they are touted to be, and often, the idea of improvement is a lie. As all of us know, members of an audience will energetically talk about what is wrong with Medicare in spite of the word improved.

The description of the benefit additions or enhancements are the key, and they should be introduced early in a marketing pitch. Solely talking about health care equity or justice at the beginning of a presentation may result in a large part of the audience tuning out thinking that it is the same old pitch.

The description of key “Improved” enhancements and benefits set IM4A above the proven Medicare system and infrastructure. With the fixes, IM4A is the real deal.

Improved Medicare for All7 would:

6 Link to list of key benefit improvements on Foundation website:

https://couniversalhealth.org/2020/08/04/whatsimprovedinim4a/

7 There is no official list of the improvements in IM4A because the concept of IM4A is promoted by a number of independent groups, thought leaders, and elected officials. The list is the Foundation’s current version of the improvements that are commonly endorsed by IM4A. Other IM4A groups, leaders, or elected officials may choose to make their own definition by modifying this list or creating one of their own.

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 6

Include dental, vision, hearing, affordable drugs, durable medical equipment, long-term

care, improved mental health services, all of the more comprehensive services that are

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part of Colorado Medicaid , and the popular Silver Sneakers program.
Eliminate the expensive middleman insurance companies that control Medicare Part D and Medicare Advantage.
Regulate the cost of drugs, devices, transport, and other services essential for life and health.
Make Medicare affordable by providing full benefits without deductibles, coinsurance, or copays, thus eliminating the need for supplemental or gap insurance.
Allow full choice of health care provider.
Cover the full range of reproductive health care including pregnancy, birth,

contraceptives, and abortion services.
Negotiate with health care providers from each specialty for fair and equitable

compensation that recognizes their experience, skills, and training.
Include public health services that prepare for pandemics; improve vulnerable, rural, and underserved community access; and focus on infectious disease and prevention.

Explanation of Benefit Improvements

Expansion of benefits and Inclusion of Medicaid benefits

This expansion of benefits is necessary so that IM4A covers the full range of health care needs.

Eliminate middleman

In Medicare Advantage and Medicare Part D, insurance companies serve as middlemen between Medicare funds and the patient/provider team. They have tripled the amount of administration costs, increased overall costs, and are turning Medicare into a typical insurance package that promises a lot but in practice has obscure limitations and restrictions and excessive preauthorization requirements that are not part of traditional Medicare.

Regulate pharmaceuticals as an essential public good

Pharmaceuticals are a matter of life and death. If a product is essential, there is no limit to the amount a supplier may charge. IM4A would regulate the cost of pharmaceuticals in the same manner as essential public utilities. This type of regulation would allow for incentives for new medications, research, and a reasonable profit, but not allow profiteering or charging more than people in other countries pay for the same medication.

Eliminate harmful financial barriers including deductibles, co-insurance, and copays

Medicare has co-pays, co-insurance, and deductibles that keep many seniors and others from being able to afford it.

Full choice of health care provider

8 The Colorado Medicaid program is used here rather than a generic Medicaid program because it is one of the most comprehensive in the country.

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Medicare’s history and reputation for full choice of provider has been sullied by Medicare Advantage plans that use narrow provider networks to cut costs. IM4A would restore full choice of provider.

Full reproductive services

A universal health care plan must ensure that every patient has the religious and personal freedom to choose the health care services they want and need, including reproductive services.

Fair provider compensation

IM4A needs a trustworthy mechanism for ensuring adequate provider compensation. In general, provider pay is not the cause of the out-of-control health care costs, and some specialties such as primary care and psychiatry are currently under-compensated. IM4A needs a trustworthy method and a Board that includes provider representatives for ensuring adequate provider compensation while controlling the payments to some specialists who are overcharging.

Public health services

As the pandemic has shown us, we are all in this together. A universal health care system needs a public health mindset. Preparation for pandemics and epidemics is crucial. Vulnerable, underserved, and rural communities may need extra consideration. Infectious disease is a concern for the general public as well as the individual. And prevention, of course, is a priority for maintaining public health.

Medicare is not perfect, but we know what improvements are needed to fix it. With this list, IM4A fixes what is not currently working. There are no proposals that come close to fixing the myriad of problems in the current multi-payer system. After decades trying to fix it, our country has created the most complex and expensive health care system in the world, while still leaving millions uninsured and under-insured.

Quality

The PAHCF webpage emphasizes three reasons consumers could be persuaded to want to keep the employer-sponsored health care insurance system — quality, choice, and control.

The idea of quality may be the most powerful reason people do not want to give up their insurance. It is well known in health care economics that when it comes to health care, particularly for serious conditions, people do not have cost consciousness and will pay enormous amounts to get the best.

When it comes to quality, IM4A has some handicaps from the get-go.
• In the market system, people are used to paying more for quality, and it is presumed

that because employer-sponsored health care costs so much, the higher cost must pay for premium quality health care.

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 8

Many people have an unexpressed belief idea that if a system combines people with great health care with people who have poor or no health care, everyone will have medium or mediocre health care. Indeed, many of the persuadables want to know if a single-payer system would give them the option of paying more for higher-quality care.
Employer-sponsored insurance is associated with the highest quality because, in the health care insurance marketplace, the best insurance plans come from employer- sponsored insurance.
Privately financed services sometimes offer higher quality than the equivalent government-financed services.

PAHCF messaging associates employer-sponsored health care with the highest quality health care. Examples of the quality messaging on their mission web page include:

“Tens of millions of patients and families to receive world-class care delivered by world- class doctors and hospitals;”
“working together to ensure every American has access to the affordable, high-quality coverage they deserve;” and

“access to the world’s best doctors, nurses, specialists, treatments, and technology.” These messages about quality are repeated over and over in insurance brochures.

Contrast these statements about quality with the messages that come from the IM4A movement. We promise health care like foreign countries have and promote that everyone will have the same health care. These IM4A messages about quality do not have the same attraction as our opponents’ messages about the best doctors and hospitals in the world.

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T.R. Reid’s Sick Around the World , other reports or analyses, and many travelers’ personal

experiences all attest to the quality of health care in other countries and have converted many to the single payer movement. However, this argument seems unlikely to convince most people. Meanwhile, we have a shining example of excellent health care in the U.S. Medicare

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system, and discussions of foreign health care can distract from this example

The insurance industry has been successful in selling the idea of quality. People spontaneously tell many positive health care stories about how medical care or a physician saved their life. These stories often include the statement, “Thankfully, I had great health care insurance and was able to get great care.” Providers screen patients by asking what health care they have before they accept them as a patient, which in a market system leaves the impression that it takes special insurance to get the good health care. Indeed, when I had a so-called good

9 Reid, T.R. (2009) The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin

10 While discussions of foreign health care seem to have little impact on the persuadables, the message that the U.S. is the only industrialized country that does not have universal health care has had some success. It shames those who believe in American exceptionalism and also makes universal health care a normal governmental goal, not just a socialist goal.

Group, New York, NY.

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 9 commercial health insurance card, I was proud to show it to a provider and to be among the

ones privileged to get good health care.

I have the same feeling now with my Medicare card. Patients with Medicare have access to all and usually more doctors, hospitals, and technology than employer-sponsored health care offers. The U.S. has some world class health care, and most providers accept Medicare. It pays for out-of-state specialty clinics like the Mayo Clinic, while commercial insurance likely would not authorize treatment there. In addition, it would increase the incentive for innovation because advances would be available to all not just the group that is currently well-insured.

Bragging and promoting do not come easily to progressives. As people who value equality and seek to eliminate unjust inequities, it is not natural for us to say that our system, IM4A, is the best. However, it is the best.

Choice

Choice is the second of PAHCF’s big three messages that we should own as ours. They use a deceptive, short message: “Don’t choose a one-size-fits-all system.” The reality is that the insurance industry offers products that restrict benefits and offer narrow networks that limit access to providers. With Orwellian doublespeak, they make this choice of restrictions look like it is a greater choice than no restrictions. That’s backwards to the way choice should be.

IM4A offers full choice of provider and the broadest benefit package, which includes mental health, dental, vision, hearing, and long-term care. It has no deductibles or other barriers to care, offers full choice of provider, and the full range of medically necessary treatments. That’s real choice.

IM4A proponents need to brag about the real choice IM4A offers. Bragging is necessary because we cannot expect people to choose IM4A unless they know how good it is. We need to also call out the insurance industry doublespeak about “choices” that result only in limiting your choices.

Control

Control, the third of the PAHCF’s big three, is another message that IM4A should own. Health care insurance cost-cutting increasingly relies on pre-authorizations, which interfere with the patient’s and providers’ control over treatment. Adding insult to injury, the cost of pre- authorization harassment is not classified as an administrative expense, but it is classified as a patient benefit. The guidelines for pre-authorizations are often secret, and consequently undermine patients and providers by not letting them know the rules for obtaining medically necessary treatment.

Traditional Medicare has proven to be much less intrusive than health care insurance. It uses a successful retrospective review process that allows the patient/provider team to make their

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A methodical inquiry conducted by the Foundation is relevant. Early this year, the Foundation met with a marketing consultant for large corporations who is also a supporter of IM4A. We created a list of all of the criticisms and concerns that we heard during the campaign to pass a 2016 ballot initiative for universal health care in Colorado. With the consultant’s guidance we looked at the values that underlay these voter concerns. What we found is that voters were primarily concerned with two key values or concepts: Trust/Control. Trust is about health care you can trust and count on. It includes quality. Control is about choice and people being able to take charge over their own care (rather than health insurance companies controlling it). These key concepts underline the PAHCF findings while adding the concept of trust.

IM4A is the trustworthy solution. It improves upon Medicare, which has been proven for 55 years covering everyone over 65 well and out-preforming health care insurance plans in cost and satisfaction.

Takeaways

We in the movement need to spread the messages about what a superior plan IM4A is. We need to spread the word about the Great American Health Care Experiment. Medicare has passed the test of time.

Horror stories can motivate people, but stories and testimonials about Medicare’s great health care will make people want to choose it.

IM4A is the proposal that builds on what’s working and fixes what’s not. It offers quality as high as expensive insurance plans. It has more choice, more patient/provider control, and is more trustworthy than commercial insurance.

The PAHCF’s campaign messaging is misleading and at times doublespeak. IM4A is the truthful owner of the messages promoted by the PAHCF.

The key improvements in IM4A fix the imperfections in Medicare. We need to talk about these key improvements so that the American people know what IM4A is.

11 Traditional Medicare programs are different from Medicare Advantage programs. Medicare Advantage plans are run by insurance companies that are given extra funding and allowed to change some of the Medicare rules. The Advantage programs offer highly visible benefits that are greater than traditional Medicare, and they also have many hidden ways of decreasing benefits such as the extensive use of pre-authorization.

. When the guidelines for medically necessary treatment have limits,

own treatment decisions
the rules and regulations are publicly available. IM4A would greatly enhance the ability of patients and providers to control treatment.

Trustworthiness

Grow Support for Improved Medicare for All with Guerrilla Marketing, v3.5, 8.28.20 11 With decades of attempting to fix it, the multi-payer system has only become more

complicated, more expensive, and more problematic.

Conclusion

IM4A is amazing. With IM4A, not only does everyone get health care, but it is provided through the Medicare system, a system that has proven reliable, trustworthy, and less expensive for 55 years and outperforms health care insurance. As with Medicare, everyone would have access to the world-class health care available in the U.S. We thank PAHCF for showing us the results of their research about the persuadables. With the benefits and enhancements that are added to Medicare in IM4A, IM4A has the broadest benefit package of any health care program. As the truthful owners these messages, let us start using them. Let’s start bragging more about how good IM4A is.

Medicare works. IM4A is a superior health care plan. It’s the real deal. Let’s give IM4A to everyone.

couniversalhealth.org/wp-content/uploads/2020/08/GrowSupportforIM4AwithGuerrillaMarketing.pdf

Vaccine maker got $1 billion from taxpayers. Now it’s boosting drug prices

by Noam Levey - LA Times - September 14, 2020

One of the world’s largest drug companies has been aggressively raising prices even as it received hundreds of millions of dollars of U.S. government aid to develop a COVID-19 vaccine.

AstraZeneca, which the Trump administration has lauded for its vaccine work, boosted prices despite renewed promises by President Trump this summer to keep drug costs in check.

The multinational pharmaceutical firm raised prices in a way that stood out even among other big drug companies. It announced not just one set of price hikes in 2020 but two, often on the same drugs, according to an analysis of drug pricing data by The Times and 46brooklyn Research, a nonprofit that studies the pharmaceutical industry.

AstraZeneca hiked prices on some of its biggest-selling medicines by as much as 6% this year at a time when the overall inflation rate is hovering around 1%, the analysis shows. The administration has said nothing about the price increases.

AstraZeneca’s second round of increases came after it secured a $1.2-billion commitment in May from the U.S. for vaccine development and as the company was reporting more than $3.6 billion in operating profit in the first half of 2020.

“They clearly made a decision to do their pricing differently, both from their recent past and from their peers, at the same time they were seeking billions of dollars,” 46brooklyn founder Eric Pachman said.

AstraZeneca, which is based in Britain but also has a large U.S. operation, declined to discuss its pricing practices, instead offering a statement noting the company’s assistance programs for people unable to afford its drugs. “We recognize the challenges many Americans are facing and remain committed to ensuring patients are able to access our medicines,” the statement said.

The company’s price hikes underscored the persistent inability of American policymakers, including Trump, to rein in drug prices, even during a public health crisis when pharmaceutical companies are getting substantial public assistance.

“Pharma corporations are sophisticated political actors that understand this is a risky time to be seen increasing prices, and yet these corporations are addicted to price increases,” said Peter Maybarduk, who oversees drug policy for the nonprofit watchdog group Public Citizen.

Although the federal government has committed more than $10 billion this year to drug companies to develop a COVID-19 vaccine, the administration hasn’t required any commitments from drugmakers on the price they would charge.

Thus far, companies receiving government aid have only made vague promises to make any vaccines they develop affordable.

AstraZeneca has said it wouldn’t profit from vaccine sales during the pandemic, but it remains unclear how this would be verified and whether the company might raise prices after the worst of the crisis passes.

Drugmakers for years have pledged to make their products more affordable, assuring U.S. lawmakers, patient groups and others that they are sensitive to the struggles many Americans have paying for their medications.

Yet patients in the U.S. are finding it increasingly difficult to afford prescriptions, with 1 in 5 households reporting last year that they were unable to pay for a medicine that a doctor had prescribed in the previous year because of costs.

Nevertheless, to start this year, most major pharmaceutical companies continued to hike prices at rates far exceeding inflation, The Times and 46brooklyn found.

Several of the world’s biggest drugmakers announced hikes of 5%, 6%, even 9% on a host of popular medicines, according to the analysis, which looked at list prices by the 15 largest drug companies using the Elsevier Gold Standard Drug Database, which includes pricing and clinical information on tens of thousands of medications.

List prices are typically higher than the final prices health insurers and governments negotiate with drugmakers. But the list price guides negotiations and can have a major effect on what patients pay, especially as high-deductible plans increasingly require people to pay the list price until the deductible is met.

Moreover, in Medicare’s Part D, the nation’s largest prescription drug program, patients’ out-of-pocket costs for drugs typically rise when the list prices for drugs go up.

Other wealthy countries in Europe, East Asia and elsewhere more aggressively control the cost of medications, either directly through government price-setting or indirectly through tightly regulated price negotiations. That has protected patients in these countries from the cost burdens that now routinely overwhelm Americans, studies show.

At the start of the year, AstraZeneca’s 2020 price hikes initially looked relatively modest.

The company announced only 13 price increases in January, averaging 2.7% and none more than 3%, a threshold that is historically in line with inflation and typically attracts minimal attention.

Those hikes suggested that the company would be implementing among the least aggressive pricing strategies in the industry.

Only Swiss drugmaker Roche raised its prices by a lower average, according to the Times-46brooklyn analysis.

By contrast, AbbVie, an American manufacturer, increased prices on many of its drugs by more than 7%, including a 7.4% hike for its popular Humira medication. That followed a 6.2% increase on Humira in 2019.

Shortly after AstraZeneca’s January price increases, as the COVID-19 pandemic quickly spread across the globe, the company began talks with Oxford University to produce a vaccine initially developed by researchers at the British school. A formal agreement was signed at the end of April.

By mid-May, the drug giant had secured $1.2 billion from the U.S. Department of Health and Human Services. The department heralded the grant as paving the way for a major clinical trial in the U.S. and the production of what the Trump administration said would be more than 300 million doses of a vaccine.

Health and Human Services Secretary Alex Azar, a former executive at U.S. drugmaker Eli Lilly, called the award “a major milestone.” AstraZeneca last week put its clinical trials on hold after a participant developed a potentially serious complication.

The company received money from other governments over the summer as well. European nations — through the European Inclusive Vaccines Alliance and the European Union — put forward more than $1 billion. AstraZeneca signed deals with Japan, China, Brazil and other nations too.

At the same time, the company reported that its revenue for the first half of the year had increased 14%. Operating profit surged more than 20% from the first six months of 2019, according to the company’s earnings report.

Pascal Soriot, the company’s chief executive, at the time hailed the “strong performance” as “another step forward in profitability and cash generation.”

Nevertheless, AstraZeneca raised its prices again, announcing hikes in July on 10 more drugs. Unlike in January, the increases weren’t so modest.

The company pushed up the price on two drugs by 5%, including its popular Pulmicort, a steroid used to treat Crohn’s disease that the company reported generated nearly $1.5 billion in sales in 2019.

AstraZeneca also boosted prices by 6% on Nexium and Crestor, two old blockbusters that now have generic competitors but together still generate more than $300 million in U.S. sales, and much more globally. The two drugs are nearly 20 years old.

The company also raised prices on some of its most expensive drugs after holding off increases in January. Those included Tagrisso, one of the company’s big-selling cancer drugs, which costs more than $15,000 for a monthly supply. AstraZeneca increased Tagrisso’s price tag by 2% in July.

In addition to these increases, AstraZeneca raised prices a second time on 11 of the 13 drugs it had already bumped up in January.

That pushed the total 2020 price increases for most of these drugs to 5% or 6% as well.

No other major drug company made as many double price increases in 2020, the Times-46brooklyn analysis shows.

GlaxoSmithKline, another British pharmaceutical firm, raised prices twice on four drugs, the second most among the 15 major drug companies. Eight such companies didn’t implement a single double increase in 2020.

“AstraZeneca is the real outlier in 2020,” Pachman said.

In one nationwide survey earlier this year, 9 in 10 Americans said they were concerned that the pharmaceutical industry would take advantage of the current pandemic to increase prices.

Sensitive to voters’ concerns, Trump this summer said he would undertake new efforts to control prices, a promise he had made a centerpiece of his 2016 presidential campaign.

To date, none of the administration’s major proposals to restrict prices have been fully implemented.

https://www.latimes.com/politics/story/2020-09-14/drug-maker-got-1-billion-from-taxpayers-boosting-prices?

Many Hospitals Charge More Than Twice What Medicare Pays for the Same Care

The gap between rates set for private insurers and employers vs. those by the federal government stirs the debate over a government-run health plan.

by Reed Abelson - NYT - September 18, 2020

Hospitals across the country are charging private insurance companies 2.5 times what they get from Medicare for the same care, according to a new RAND Corporation study of hospital prices released on Friday.

In a half-dozen of 49 states in the survey, including West Virginia and Florida, private insurers paid three or more times what Medicare did for overnight inpatient stays and outpatient care.

“The prices are so high, the prices are so unaffordable — it’s just a runaway train,” said Gloria Sachdev, the chief executive of the Employers’ Forum of Indiana, a coalition that worked with RAND on the study. This year’s report expanded on the research the nonprofit organization conducted in 2019 on hospital prices in 25 states.

The study, which exposes the aggressive pricing by mega-hospital systems that have gained enormous market power through widespread consolidation, is sure to kick-start the debate over the U.S. health care system and the need to overhaul it.

While the pandemic caused losses for many hospitals, many of these big systems are sitting on large profit reserves, while also receiving some of the $175 billion in aid Congress allocated to make up for their costs and lost revenue.

Employers provide health insurance coverage for more than 153 million Americans. The companies and insurers in the study paid nearly $20 billion more than Medicare would have for the same care from 2016 through 2018, according to the RAND researchers.

The findings cast doubt on the ability of private employers and insurers to competitively purchase health care for workers and their families compared to the federal government, said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, which helped fund the study. “You have this widening gap,” she said.

Proponents of a so-called public option seize on such price-gouging news to argue that creating a government health plan that could use its clout to demand lower prices would help bring down the cost of care.

“There’s a lot of energy behind the public option, and this is clearly one of the reasons,” said Dan Mendelson, the founder of Avalere Health, a Washington, D.C., consulting firm.

Employers say the proof of how much more they pay underscores the need for change. “The report lays out in stark terms what the employers have been dealing with for years,” said Elizabeth Mitchell, the chief executive of the Pacific Business Group on Health, a San Francisco group that represents employers and companies in the region. “If we want to keep a private market in U.S. health care, it has to function,” she said. “It’s really not functioning.”

A public option, distinct from the more controversial “Medicare for all” proposals that would do away with private insurance, has been embraced by Joseph R. Biden Jr., the Democratic presidential nominee. Democrats and even some Republicans seem open to the idea, according to a recent poll from the Kaiser Family Foundation.

Hospitals warn that they might not be able to function if they were paid Medicare rates. “There is certainly a cost shift, because the government knowingly underpays,” said Tom Nickels, an executive vice president for the American Hospital Association, a trade group. He warned that hospitals would lose billions of dollars in revenue. Some could be shuttered if forced to operate at lower Medicare payments.

“We cannot survive in that kind of the world,” he said, adding that many hospitals are struggling financially because of the pandemic. “To suggest cutting hospitals during a pandemic is outrageous.”

The report, which has data from the District of Columbia and every state but Maryland (because that state sets hospital rates), provides a sweeping view into the wide variation of prices paid by private insurers, which pay multiples of what Medicare does for a hospital stay or an M.R.I. “The magnitudes are quite eye-catching,” said Michael R. Richards, a health economist at Baylor University who reviewed the study.

The most costly hospital system in the nation from 2016 through 2018, according to the researchers, was John Muir Health in Walnut Creek, Calif., near San Francisco. Private insurers pay its hospitals four times what Medicare reimburses for care.

In Indiana, Parkview Health, based in Fort Wayne, also remained one of the most expensive, charging private insurers in 2018 three times what Medicare paid for an overnight hospital stay and more than four times the Medicare rate for outpatient care. Employers pressured Anthem, the state’s largest insurer, to force Parkview to lower prices by threatening to drop it from the plan’s network.

The RAND data “predates Parkview’s new agreements with several major insurance companies and direct-to-employer partnerships,” as well as significant prices reductions for outpatient care, said Parkview’s chief executive, Mike Packnett, in a statement.

The RAND report also documents a wide variation in prices within the same hospital system. Mass General Brigham, formerly Partners Healthcare, was the most expensive system in Massachusetts, but Massachusetts General, one of its premier hospitals, charged private insurers nearly three times what Medicare paid in 2016 through 2018, compared to roughly two times for the system’s Newton-Wellesley Hospital, according to the study.

Well-known and well-respected hospitals like Mass General “are the hospitals within the system that are likely to get the highest prices,” said Christopher M. Whaley, one of the RAND authors.

In some markets, the lack of an alternative means employers have no room to negotiate, said Suzanne Delbanco, the executive director of Catalyst for Payment Reform, a nonprofit that works with businesses to develop new ways of paying for medical care. “In a market that is highly consolidated with no choices, it can be logistically infeasible,” she said.

The pandemic could make things worse as big hospitals scoop up struggling physician practices or their smaller competitors. In West Virginia, Mountain Health Network is made up of the 2018 merger of two hospitals, after Cabell Huntington acquired its competitor over the objections of federal officials. Cabell was one of the nation’s most expensive systems from 2016 through 2018, according to the study. Mountain Health now has its eyes on a local physician group.

Some hospitals argue they charge more because they deliver better care, and there does seem to be some association. “What we see is quality and the ability to charge high prices are intrinsically related,” said Craig Garthwaite, a health economist at the Kellogg School of Management at Northwestern University, who says some hospitals may be taking the extra money to invest in ways of improving quality.

Employers have had mixed success in pushing back against high-priced hospitals. Indiana employers succeeded in pressuring Anthem to take action, according to Ms. Sachdev. The insurer threatened to drop Parkview from its network, before reaching an agreement in July in which the hospital offered significant savings. Two state employees’ plans, in Montana and Oregon, have also been able to negotiate contracts that use Medicare prices as a benchmark for what they will pay, according to the RAND researchers.

But in other areas, the hospitals have been less willing to budge. In Colorado, employers have had productive discussions with some of the specialty hospitals and independent hospitals, said Robert J. Smith, the executive director of the Colorado Business Group on Health. “We’ve made very little progress with health systems,” he said.

Many employers, including some represented by the U.S. Chamber of Commerce, oppose government action, but others are growing more open to the idea of some sort of government intervention, ranging from rate regulation to a public option. “They are increasingly seeing in some cases the need for regulatory intervention because the market is broken,” Ms. Mitchell said.

But the pandemic and the potential threat it poses for many hospitals could put off any discussion, even if the Democrats were to win the White House and the Senate. “The hospitals are the most effective, most sympathetic lobby there is,” said Dr. Robert Berenson, a policy analyst at the Urban Institute.

Democrats will also have to figure out how to design a plan that people find both affordable and comprehensive, in contrast to some of the mid-tier plans sold under the Affordable Care Act, said Rodney Whitlock, a former Republican Senate staffer who now works for McDermott+Consulting. “How can the Democrats create a public option that is not clearly better than private insurance?” he asked. “If they don’t, they will be tagged as failing.”

https://www.nytimes.com/2020/09/18/health/covid-hospitals-medicare-rates.html?action=click&module=Latest&pgtype=Homepage

Republicans Killed the Obamacare Mandate. New Data Shows It Didn’t Really Matter.

Many experts now view the individual mandate as a policy that did little to increase health coverage — but did a lot to invite political backlash.

by Sarah Kliff - NYT - September 18, 2020

Health economists long had a favorite metaphor for explaining why Obamacare’s unpopular individual mandate was good policy: the three-legged stool.

Obamacare would work, they’d explain, only if it did three things: stop denying people insurance coverage (or raising premiums) if they have pre-existing conditions; subsidize coverage; and require everyone to sign up. Take away one of those legs, and it would topple over.

But Congress did ultimately chop off a leg when it repealed the mandate penalties in 2017 — and, despite these predictions, the Affordable Care Act still stands. New federal data and economic research show the law hasn’t collapsed or entered the “death spiral” that economists and health insurers projected.

Many experts now view the individual mandate as a policy that did little to increase health coverage — but did a lot to invite political backlash and legal challenges.

The newest evidence comes from census data released Tuesday, which shows health coverage in the United States held relatively steady in 2019, even though Congress’s repeal of the mandate penalties took effect that year.

“The stool might be a bit rocky, but you can get away with two legs,” said Evan Saltzman, a health economist at Emory University who studies the topic. “It’s like the table at the restaurant that is a little wobbly. You can still sit at it, even if it’s not quite as pleasant.”

Like many economists, he initially thought the health law’s mandate to purchase coverage was essential. He worked at the RAND Corporation, and its economic models estimated that without the mandate, 12 million fewer Americans would gain coverage.

Those projections were in line with those offered by the Congressional Budget Office, which estimated as recently as 2017 that mandate repeal would increase the number of uninsured Americans by four million in 2019.

Economists had little data to rely on when they tried to understand how Obamacare’s mandate would work. Most of the evidence came from Massachusetts, which had introduced a larger penalty that didn’t stir much political controversy.

“We didn’t have that much information to go on in modeling the effects of the mandate,” said Doug Elmendorf, who directed the Congressional Budget Office during the health law’s passage. “We and others put weight on Massachusetts because the Affordable Care Act looked a lot like what Governor Romney did there. But Massachusetts is just one of 50 states, and each state is different.”

Mr. Saltzman went on to earn a doctorate in economics after his job at RAND, and focused his research on the mandate. He has found that the mandate isn’t a very effective tool for increasing enrollment. One recent paper of his estimated that eliminating the mandate penalties would reduce marketplace enrollment by 2 percent and increase premiums by 0.7 percent.

“My viewpoint on the mandate has changed,” he said. “Back in 2012, my sense was it was essential. The evidence indicates that the marketplaces are doing about the same as they were before the mandate was set to zero.”

Separately, in The New England Journal of Medicine last year, researchers concluded that “the individual mandate’s exemptions and penalties had little impact on coverage rates.” Instead, they found that generous subsidies for middle-income Americans, coupled with Medicaid expansion in most states, drove health law enrollment.

“The mandate made a difference, but not a huge difference in terms of the numbers of people signing up,” said Jonathan Gruber, a health economist at the Massachusetts Institute of Technology and a co-author of the study. He advised the Obama administration on health reform and recommended the mandate, but now says “it was not as effective as anticipated.”

Participation in Obamacare marketplaces has decreased slightly, to 11.4 million this year from 12.2 million in 2017. But it hasn’t plummeted or shown any signs of a “death spiral,” in which only sick patients purchase coverage and premiums become unaffordable. When Obamacare enrollees are asked about why they buy coverage, the mandate is the least common reason given.

Economists have done plenty of speculating about why the mandate didn’t work as expected. The penalties were relatively small — $695 or 2.5 percent of income, whichever was higher — in an effort to tamp down political resistance and court Republican legislators. That was largely unsuccessful: No Republican legislators voted for Obamacare and, within days of its passage, false claims went viral that the Internal Revenue Service would send thousands of armed agents to Americans’ homes to collect the fees.

Massachusetts used a higher penalty, and researchers found it increased coverage. European nations that achieve universal coverage with an insurance mandate typically use even harsher tactics. In Switzerland, for example, local governments can pick a health plan for you and force you to pay for it.

Obamacare’s insurance subsidies, via tax credits, brought more stability to the marketplace than originally expected. The credits are structured to keep premiums affordable for low- and middle-income Americans even when the base price of insurance rises. The vast majority of Obamacare enrollees — between 80 percent and 90 percent, depending on the year — buy their coverage with these credits.

“The linchpin policies were those that made coverage more affordable, like expanding Medicaid or giving people large premium tax credits,” said Dr. Benjamin Sommers, a professor of health policy at Harvard and a physician. “The carrots were more effective than the stick.”

It’s also possible the mandate did have some effect during its brief life in making the purchase of health insurance more of a norm. When the Kaiser Family Foundation surveyed the public on the issue in 2018, it found that only half of respondents knew the penalties had been repealed. The mandate penalty may live on in Americans’ minds, even after Congress wiped it off the books.

The mandate lingers in other ways. Joe Biden said last summer that he would bring back the mandate penalties if he won the election. The policy is at the heart of a Supreme Court challenge to the Affordable Care Act that will be heard this fall. In that case, the Republican challengers argue that the entire law must fall because the now-repealed mandate was so essential to Obamacare’s functioning.

The case strikes some economists as especially weak in light of what they’ve learned in recent years: that the mandate is doing much less to prop up the Affordable Care Act than they expected a decade ago.

Sarah Kliff is an investigative reporter for The New York Times. Her reporting focuses on the American health care system and how it works for patients.

https://www.nytimes.com/2020/09/18/upshot/obamacare-mandate-republicans.html?action=click&module=News&pgtype=Homepage

The View From Here: Collins not in the middle of health care debate

There is a substantive policy debate in Maine's U.S. Senate race, but it's between Democrat Sara Gideon and independent Lisa Savage.

by Greg Kesich - Portland Sunday Telegram - September 20, 2020

In her long Senate career, Susan Collins has always been able to find the middle on health care policy.

Look at her position on the Affordable Care Act: She never supported Barack Obama’s sweeping reforms, but in 2017 she cast a crucial vote to save it from repeal, saying such a move would put the security of too many of her constituents at risk.

That didn’t stop her just a few months later from voting for a tax bill that eliminated a key element of the health care law – the mandate that everyone buy insurance or pay a tax penalty – putting Obamacare in danger of being killed in the courts.

In the meantime she has backed a number of health care bills, often co-sponsored with Democrats, that focus on specific aspects of health policy. They are usually good ideas that would have strong support but tend to disappear into the void of a legislative body that can only confirm judges and pass emergency budget stopgaps.

So when Collins and the three candidates trying to displace her took the debate stage Sept. 11, it was no surprise that one of the first questions would be on health care. And it was no surprise that Collins would be ready for it.

Asked what she would do to address the flaws of a health care system that have been exposed by the coronavirus pandemic and resulting economic upheaval, Collins rolled out one of her signature good ideas: price transparency.

Collins is a co-sponsor of a bill that would require hospitals to list their real prices for procedures and make insurers provide accurate and timely information to their customers. If enacted, it would let patients shop around for the best deals, in theory forcing providers to compete on price.

Not knowing how much anything costs until you get the bill is definitely a problem with our health care system. But with millions of Americans still uninsured and millions more opting for high-deductible plans that discourage them from getting anything but emergency care, is it “the” problem?

A much bigger debate on health care policy is taking place inside the Democratic Party, or in this Senate race, between Democrat Sara Gideon and independent Lisa Savage.

Savage supports “Medicare for All,” a national single-payer, universal coverage system, like Canada’s but more comprehensive. Her proposal is similar to the plans promoted by Democratic presidential candidates Bernie Sanders and Elizabeth Warren, which would replace private insurance with a government-run plan. Instead of paying premiums based on their level of coverage, enrollees would pay a tax based on their income.

Gideon has adopted the moderate, incremental approach backed by Democratic presidential nominee Joe Biden, which would expand the Affordable Care Act by, in part, supplementing the private insurance market with a Medicare-like public option. Gideon also wants to use the market clout of the federal government to negotiate lower prescription drug prices.

These are big, meaty issues that affect hundreds of millions of lives. In comparison, helping consumers shop around for providers, assuming that there’s no emergency and they live in a place where they have options, comes across as kind of small.

The problem for Collins is that her party has put her in a box. There is no Republican health care reform plan. The party isn’t even trying to offer an alternative to the Democrats.

It’s not just Republican office holders. A Pew Research Center poll released in August asked likely voters what issues were most important to them in the upcoming election. More than two-thirds said health care (68 percent), coming in second place only to the economy (79 percent).

But you get a very different picture when the answers are filtered by party. Eighty-two percent of Biden supporters say health care is an important issue, while fewer than half of Trump supporters (48 percent) say the same.

If Collins were trying to get only Republican votes, she would not need much of a health care agenda. But to win in Maine, she will need Biden voters to pick her over Gideon or Savage.

Collins needs those voters to decide that even though Biden should be president, they want him surrounded by senators like Collins who oppose his policies – a rational choice if you think the health care system is basically OK and you don’t want the government to do much about it.

Gridlock is less popular with people who want to see change. This is one time that Collins’ instinct for the middle could leave her out in the cold.

https://www.pressherald.com/2020/09/20/the-view-from-here-health-care-debate-pushes-collins-from-the-middle/

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Health Care Reform Articles - September 21, 2020