Healrh Care Reform Articles - March 15, 2021

In the shadow of its exceptionalism, America fails to invest in the basics

Stunning advances in medicine and technology have come
alongside systemic breakdowns in infrastructure and health. 

By Griff Witte, Abigail Hauslohner and Emily Wax-Thibodeaux - Washington Post - March 13, 2021

The Perseverance rover, fresh off its flawless landing, was on a mission, scouring the surface of Mars for evidence of ancient life, relaying crystal-clear images of an alien world, proving that when it comes to space exploration, no one does it better than the United States.

And 139 million miles away, back on Earth, 38-year-old Chris Prescott was still washing dishes, bathing and cooking with bottled water.

It had been two weeks since an Arctic blast swooped into Texas, knocked out the power grid and busted Prescott’s pipes just as Perseverance was touching down. For many in his impoverished Houston neighborhood — only a short drive from the Johnson Space Center — the water coming out of their taps was as dark and dingy as the Martian landscape.

“People were already struggling,” said Prescott, who gets by on the money he makes doing occasional yard work, having lost his full-time job to the pandemic. “Now this has put them at the bottom of the barrel.”

Compared with its developed-world peers, America has always been a study in contrasts, a paradox of exceptional achievement and jaw-dropping deprivation. Rarely have the disparities been rendered as vividly as in recent weeks and months.

Historic breakthroughs in science, medicine and technology coexist intimately — and uneasily — alongside monumental failures of infrastructure, public health and equitable access to basic human needs.

America can put a rover on Mars, but it can’t keep the lights on and water running in the city that birthed the modern space program. It can develop vaccines, in record time, to combat a world-altering illness, but suffers one of the developed world’s highest death rates due to lack of prevention and care. It spins out endless entertainment to keep millions preoccupied during lockdown — and keep tech shares riding high on Wall Street — but leaves kids disconnected from the access they need to do their schoolwork.

“What kind of state are we living in, what kind of society are we living in when kids have to educate themselves on the curb of a Taco Bell?” said Brian Smoot, a Salinas, Calif., chiropractor who invited neighborhood students to use his WiFi after two girls were photographed outside a nearby location of the fast-food chain last year, their Chromebooks wobbling on their laps as they tried to connect to high-speed Internet.

And this in a city just a short drive from the extraordinary wealth of Silicon Valley, a global symbol of American innovation, where Apple, Facebook and Google have gleaming campuses — with record stock prices to match.

The disparities reflect a multitude of factors, experts say, but primarily stem from a few big ones: Compared with other well-to-do nations, the United States has tended to prioritize private wealth over public resources, individualism over equity and the shiny new thing over the dull but necessary task of maintaining its infrastructure, much of which is fast becoming a 20th century relic.

“Let’s face it, we don’t have ribbon cuttings when we replace a pipe. Only when there’s a brand new bridge,” said Joseph Kane, an associate fellow at the Brookings Institution. “That’s the American fascination with bigger and better.”

Those choices can pay dividends, as they do when the U.S. leads the world in health-care innovation or electrifies the automobile. They also have consequences.

The nation’s infrastructure — the airports, broadband networks, transit systems, utility lines, ports and sewers that keep society humming — is in a perilous state from decades of underinvestment that has transcended both Republican and Democratic administrations. Perhaps even more important than the lack of cash, Kane said, is the absence of a plan.

“The Eisenhower administration is really the time we really had a goal or a vision for our infrastructure,” he said. “Now we’re in a fundamentally different era with a more unpredictable and extreme climate, more inequality, a lack of accessibility. And we’re still operating as if it’s the 1950s.”

All that neglect is showing: The American Society of Civil Engineers earlier this month gave the country a C-minus for the overall quality of its infrastructure.

That middling mark is actually up slightly from the group’s last report card, four years ago, when the grade was an ignominious D-plus. But it still reflects the decrepitude of a nation where a water main breaks every two minutes, and where nearly half of public roads are in either poor or mediocre condition.

The Biden administration has said that reimagining infrastructure — with increased funding to match — will be a central focus of its legislative agenda this year. In theory, it should be a relatively easy sell: The issue is one of the few that enjoys bipartisan backing.

Yet the same was true during the Trump administration, when the notion of “infrastructure week” became a running gag and the self-described “builder president” ultimately failed to sign legislation to get workers digging and backhoes rumbling.

President Biden has said he will put racial equity at the heart of his efforts on infrastructure, an attempt to remedy a system that has long provided superior public resources to some and inferior ones to others, with skin color often making the difference.

Narrowing the digital divide

The federal level is not the only place where lawmakers will be wrestling with the country’s gaping disparities this year. In 38 states and Puerto Rico, legislators will be weighing whether to spend more to bring broadband Internet to poor and rural communities.

Such measures have been repeatedly delayed in the past because of concerns over the cost. But in California, at least, legislation to help narrow the digital divide has been moving forward. That’s in part because of the outcry over the viral photo of the girls doing their homework outside an East Salinas Taco Bell.

“We know that broadband access is a necessity of everyday life and it’s a moral imperative that we find solutions now,” said Luis Alejo, a county supervisor who represents the area and who has been advocating for the legislation.

Salinas may be geographically close to Silicon Valley, but in other respects it’s a world away.

The city was made famous by John Steinbeck’s Depression-era novel “The Grapes of Wrath,” an account of tenant farmers who escaped the Oklahoma Dust Bowl and set out west for California. The “Okies,” as they were called, found exploitation and discrimination rather than relief.

Today, largely Latino field workers harvest lettuce and strawberries, earning low pay and enjoying few protections. The city has the highest child poverty rate in the state, and the lack of basic Internet access has kept many from attending virtual school during the pandemic.

Tanya Harris’s daughter is among them. Harris, a single mother of three, was laid off from her retail cashier job during the pandemic. She was unemployed for nine months, and with the family bouncing around among shelters, rat-infested motels and friends’ couches, reliable Internet was rare. As a result, her daughter wasn’t able to graduate from high school.

“She was really depressed about [it],” Harris said. “She’s a great student and it was her senior year. I just don’t get it: We have filthy rich people all around.”

Harris recently got a job at another clothing store, again earning minimum wage.

And weeks ago, she was able to get stable, low-income housing in a nearby county.

Her daughter is back online and now has another chance to finish school. But the problem persists.

“I can see from my window students working outside a Starbucks right now for the fast WiFi,” said Carissa Purnell, director of the Alisal Family Resource Center, which helps the area’s vulnerable families. “There are thousands of kids still in this situation.”

And that’s just in the Salinas area. Statewide, an estimated 1.5 million students — more than half of them Black, Latino or Native American — lack adequate Internet access, according to a study co-published by Common Sense, which advocates for children and families, and the Boston Consulting Group. Nationwide, the number is as high as 16 million.

A health-care divide

Top: An intersection in Austin with no power last month. (Sergio Flores for The Washington Post)
Bottom: Troy Watts, left, discusses the damage at the home of Willie Hunt after his pipes burst and flooded his house during Texas's storm. (Callaghan O'Hare for The Washington Post)

In most other wealthy countries, health care is considered a basic human right; a view reflected in the universal healthcare systems in place across Europe, Canada and Australia. In the United States, it is a commodity, a fact that Britons took to Twitter to remark upon recently when they noticed — with considerable alarm — all of the medication advertisements aired during Oprah Winfrey’s interview of the Duke and Duchess of Sussex. “If these medicine ads are what it’s like to not have an NHS [National Healthcare Service] I never want to experience that,” one viewer tweeted.

As with the digital divide, the pandemic has brought disparities in health care into sharp relief.

“We can land a rover on Mars. We can beat a pandemic,” Biden recently proclaimed.

Yet the evidence has shown otherwise.

Even as American scientists, laboratories and pharmaceutical companies working at breakneck pace have helped blaze a path to effective vaccines, the country has consistently lagged behind other developed nations in the more elementary tasks of coronavirus testing and prevention.

Those failings have contributed to a tragic toll: The United States accounts for just four percent of the world’s population but 20 percent of worldwide coronavirus deaths. A disproportionate share are poor or people of color.

“Covid-19 laid bare how systematic inequities exist in this country,” said Rabih Torbay, president and CEO of Bethesda-based Project Hope, an international medical relief organization that provides assistance primarily in war-torn and disaster-ravaged nations, but also increasingly works in the United States.

“Where you have the best hospitals and where you don’t, where you have the best health care and where you don’t,” Torbay said.

Sometimes they exist side by side.

Lark Jones lives in one of the nation’s wealthiest metropolitan regions — Washington, D.C. — and about 15 miles from the National Institute of Allergy and Infectious Diseases labs. That’s where scientists led the development of the spike protein technology that is now at work in the Pfizer-BioNTech and Moderna vaccines.

The announcement late last year of successful vaccine development — a triumphant moment for American science — came around the same time that Jones, and just about everyone she knew, was falling seriously ill to covid-19.

Her 72-year-old mother was especially hard hit: After 2½ weeks in intensive care and weeks more of rehabilitation therapy, she survived. But the disease left her with permanent kidney failure, dependent on dialysis for the rest of her life.

Jones’s own case was milder, but it still left her gasping for breath. Even before she fell ill, the 40-year-old had already fallen through the cracks of American health care.

A resident of Northeast D.C., Jones lost her job as a home health aide in 2017 and, with it, her job-provided insurance. She found new work, in the form of two part-time jobs for minimum wage. But part-time work — even when it amounts to 17-hour workdays with just one day off a week — doesn’t necessarily provide health insurance. And Jones, who requires regular treatment and medication for diabetes and high blood pressure, can’t afford to buy her own.

In her two part-time jobs — as a youth counselor and as a program assistant at a D.C. homeless shelter — she is considered an essential worker. She’s one of the people who continued to go to work, even as others stayed home and as friends and family began to fall ill. The essential worker designation ultimately made her eligible for a vaccine; this month she received her second dose.

But the irony of it all feels outrageous when she thinks about it. There was never any hazard pay, nor any protection should she get sick.

“To care for the community and still not be offered health care, I think that’s just crazy,” Jones said.

Health-care experts say it’s also, simply, American. In 2019, about 28.9 million non-elderly people in the United States were, like Jones, uninsured, according to research from the Kaiser Family Foundation. Roughly 45 percent of non-elderly adults are also considered “inadequately insured”—meaning that even those who have insurance still struggle to afford the care they need. The CEO of GoFundMe in 2019 said that a third of the donations raised through the charitable giving site help people struggling to pay their medical bills.

‘People have no water’

Back in Houston, the inadequacies of America’s basic support systems were compounding and colliding. A failure to properly weatherize power generation systems after Texas’s last major cold snap, in 2011, had led to a power crisis, which led to a water crisis. And that, in turn, was leading to fears of a health crisis made worse by an inability to take basic precautions to ward off illness.

“People have no water,” said Marcel McClinton, a 19-year-old community activist. “How can they wash their hands?”

The water problems were concentrated in neighborhoods of eastern Houston that already struggled with high rates of illness. Also in the city’s east: the Johnson Space Center — home base for decades of extraterrestrial triumphs, though not the most recent one — where workers lacking electricity at home huddled for warmth last month even as their colleagues at mission control in California celebrated.

A native Houstonian, McClinton had moved away, but he returned to join with fellow organizers to distribute bottled water, food and other basic supplies in recent weeks. What he found was enormous need that predates the cold front — and will long outlast it. “We can do this work for a year and our lines will be just as long,” he said.

Prescott, the 38-year-old, was among those standing in them, picking up supplies for himself and his family as the power continued to sputter and the faucets spit out contaminated water. He soon found himself on the other side of those handoffs, volunteering to help his neighbors in the city’s Fifth Ward. He had it bad, but not as bad as many of the people he knew.

In the America of 2021, there was always someone who had it worse.

“I try to look out for other people,” Prescott said. “There might be a time when I get in that situation and need someone to help me.”

https://www.washingtonpost.com/nation/interactive/2021/america-growing-disparities/?

Ralph Nader: Here's how congressional Democrats betrayed voters on Medicare 

by Ralph Nader - Common Dreams -  March 14, 2021

Do you remember the promises made by the Democratic Party's presidential and Congressional candidates on universal health insurance? You can forget their pledges and somber convictions now that your votes put the Democrats in charge of the House and the Senate. The Democrats' leaders are abandoning their promises and retreating into a cowardly corporatist future.

Here is the present scene. Leading Democrats, House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer, have decided to spend tens of billions of taxpayer dollars to subsidize the giant health insurance companies like Aetna and United Healthcare to "cover recently laid-off workers and those who purchase their own coverage," as The New York Times reported. There are no price restraints on the gouging insurance premiums or loophole-ridden policies. That is why giant corporate socialist insurers love the "American Rescue Plan," which gives them socialist cash on the barrelhead. The law lets insurers decide how and whether they pay healthcare bills with co-pays, deductibles, or grant waivers. All these anti-consumer details are buried in the endless and inscrutable fine print.

Whatever happened to the Democrats' (Bernie Sanders, Elizabeth Warren, Pramila Jayapal, etc.) demand for single-payer – everybody in, nobody out – with free choice of doctors and hospitals instead of the existing cruel, and profiteering industry for which enough is never enough? Senator Sanders often mentioned a Yale study, published on February 15, 2020, that found:

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than $450 billion annually…." (See the study: Improving the Prognosis of Health Care in the USA, February 15, 2020).

Well, House Speaker Pelosi is discouraging House Democrats from supporting Representative Pramila Jayapal's H.R. 1384, Medicare for All Act of 2019, the gold standard for single-payer. News reports indicate that Representative Jayapal (D-WA) and Representative. Debbie Dingell (D-MI) will reintroduce their Medicare for All bill next week. Speaker Pelosi is telling Democrats in the House to focus instead on the modest expansion of Obamacare with its corporate welfare, utter complexity and seriously inadequate coverage. Almost eighty million Americans are presently uninsured or underinsured – a level that will not be significantly reduced for deprived workers by tweaking Obamacare during the Covid-19 pandemic.

A modified Obamacare, with no price ceilings, will hardly reduce the tens of thousands of American deaths every year because people cannot afford health insurance to get diagnosed and treated in time to prevent fatalities. The Yale study also found that: "ensuring health-care access for all Americans would save more than 68,000 lives and 1.73 million life-years every year compared with the status quo." Tweaking Obamacare does little to stem the relentless surge in healthcare prices and profits in our country, which is unique for not placing billing ceilings on medical procedures and drugs. This "get whatever you can" behavior by the vendors is so uncontrolled that healthcare billing fraud and abuse is costing people one billion dollars A DAY! Malcolm Sparrow, who is an applied mathematician at Harvard, estimates medical billing fraud amounts to at least ten percent of all healthcare expenses each year.

Obamacare does nothing to limit the perverse incentives of a fee-for-service system that includes unnecessary operations, over-diagnosis, and over-prescribing all of which increase the risks of preventable casualties. A Johns Hopkins University School of Medicine peer-reviewed study in 2016 estimates that close to 5000 lives are lost weekly due to such "preventable problems" just in hospitals (see: Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S., May 3, 2016).

It gets worse. Year after year, the corporate Democrats, along with the Republicans, are facilitating expanding corporate takeovers of Medicare and Medicaid. The giant and widening attack on Medicare is called "Medicare Advantage," which more accurately should be called "Medicare [Dis]advantage." Our corporatized government, under both Parties, has been allowing deceptive promotional seductions of elderly people to take Medicare [Dis]advantage – now fully 40% of all Medicare beneficiaries – which is just a corporate insurance plan with multiple undisclosed tripwires.

Former President Trump worsened what he inherited from the Democrats in outsourcing Medicare. He launched something called "direct contracting" that, "could fully turn Medicare over to private health insurers" declared Diane Archer, former chair of Consumer Reports, in her article on March 8, 2021. Medicare Advantage premiums can be pricey. According to Kay Tillow, Executive Director of the Nurses Professional Organization, "The Medicare Advantage Plans are smiling all the way to the bank. In 2019 each Medicare Advantage beneficiary cost taxpayers $11,822 while those in original Medicare cost $10,813 each – that's over $1,000 more and over 9% more per person for the for-profit insurers!"

Where is the outcry among Democratic politicians to reverse completely the corporate takeover of Medicare? Last year, many Democratic candidates pontificated about the need for single-payer health insurance, but now in Congress, we are scarcely hearing a peep about this vital human right. Their campaign rhetoric is just distant memory. Tragically, it is now harder than ever for the elderly to get out of Medicare [Dis]advantage and go back to traditional Medicare.

Millions of elderly people are deceived by televised marketing lies and slick brochures. The hapless Federal Trade Commission (FTC) should investigate and end the deceptions. Congressional investigations and hearings are long overdue. As the authoritative Dr. Fred Hyde says about the so-called Medicare Advantage: "It's not what you pay, it's what you get." That is, the corporate health plan works until they get sick, until "they want their doctor and their hospital." Dr. Hyde was referring to the narrow networks where these companies park their beneficiaries.

More astonishing in this story of the rapacious corporate takeover of Medicare is that AARP promotes these flawed plans to their members, takes paid ads by big insurers in AARP publications, and derives income from this collaboration.

Imagine, over 50,000 SEIU retirees are automatically placed by their unions in these Medicare [Dis]advantage traps without first being allowed to choose traditional Medicare.

This whole sordid sabotage of the nineteen sixties Democrats' dream, under President Lyndon Johnson, of taking the first step toward universal healthcare coverage for everyone, begs for more exposes. It begs for more clamor by the progressive Democrats in Congress who are strangely passive so far. I'm speaking of Representatives Jayapal, Raskin, Ocasio-Cortez (AOC), and the receding "Squad," as well as Senators Warren and Sanders. If we can't expect these stalwarts to start the counterattack that will save lives, save trillions of dollars over the years, focus on prevention not just treatment, and diminish the anxiety, dread, and fear, that the citizens of Canada and other western nations do not experience because they are insured from birth on, who is left to defend the American people against the arrogant health insurance corporate barons?

I'm sending this column to these self-styled progressive Democrats along with a two-page specific critique of corporate Medicare from the Physicians for a National Health Program (PNHP) website. PNHP's membership counts over 15,000 pro-single-payer physicians. In a comment on the PNHP site, Don McCanne, M.D., says, "Remember, the mission of private, for-profit Medicare Advantage insurers is to make money, whereas the mission of our traditional Medicare program is to provide health care. We are supporting a program that deferentially caters to the private insurers and their interests when we should be supporting a program that is designed to take care of patients. Those being deceived by the private Medicare Advantage marketing materials really do not realize the bad deal they may be getting until they face the private insurer barriers to needed care. Silver Sneakers won't take care of that." (See: https://pnhp.org/news/russell-mokhiber-explains-why-private-medicare-advantage-plans-are-a-bad-deal/)

If you care about this issue, tell your Members of Congress it is time to pass Medicare for All represented by H.R. 1384.

https://www.alternet.org/2021/03/democrats-medicare

Is capitalism compatible with public health? This expert says no

by Matthew Rozsa - Salon - March 14, 2021

Dr. Nicholas Freudenberg thinks that capitalism is damaging to both human health and to the planet. And after reading his new book, "At What Cost: Modern Capitalism and the Future of Health," it is hard to disagree. The food we eat is filled with toxins. The planet is heating up uncontrollably. And that was true long before 2020: since last year, we have learned the hard way that liberal capitalist societies like ours are barely capable of addressing their most basic responsibility, protecting public health.

Dr. Freudenberg, who is a public health professor at the City University of New York School, has written a riveting and inspiring call-to-arms. In his new book, he describes concrete ways that people can address the problems wrought by modern capitalism. Although our conversation occurred before President Joe Biden signed his COVID-19 stimulus relief package into law, it is relevant to both that event and future efforts at reform.

I spoke with Dr. Freudenberg over the phone about reforming capitalism and the relationship of capitalism to health; this interview has been lightly edited for clarity and context.

Tell me a little more about the thesis of your book.

I think there are two key features. The first is that, in the last few decades, capitalism — the political and economic system that is in place in our country and in much of the world — has changed in ways that I think make it more damaging to human health and the environment. In the book, I try to describe some of those changes and how they've played out. The second main thesis is that the current period — after the crises of the COVID pandemic, climate change, deaths of despair — provide an opportunity for our country to chart a different path around health and equity. I'm hoping that by analyzing what we've learned over the last few years about how we change damaging business and corporate practices, we could put together those people who've been working for a change, a more comprehensive approach to making those changes. I think those are the two main theses of the book.

ure. The thinking behind developing these specific suggestions is to look for ways to bring together the streams of work that people who are concerned about healthcare, people who are concerned about food, people who are concerned about pharmaceuticals and healthcare, or climate change, can work together. I think the first of those is that, in many sectors in this country, we have a robust public sector that is already playing a role. Food is a good example, where through the food benefit programs like SNAP and WIC and school food, through the procurement standards that cities and states have, we're spending taxpayer dollars on food. But there hasn't been a coordinated strategy to use that public sector to advance public goals. And because of the power of the food industry, they've often used that public spending for their own benefit rather than for the wellbeing of the population.

So I think to define precisely what the role for the public sector should be in food, healthcare, education, etc. would be a way to articulate a common vision that could bring together the many streams of activism and progressive reform working for change.

I think a second cross-cutting theme, that again many people have been working on, is to level the playing field. There has been a rise of corporate power that has come about as a result of their increased capacity to lobby and make campaign contributions. The Citizens United Supreme Court decision gave corporations an outsize voice in shaping policy, giving them in the view of many scholars who are looking at this really veto power over so many aspects of policy, including those policies that affect well-being. And so I think campaign reform, lobbying restrictions, closing the revolving door, electoral reform are very much an issue these days. Those are all a second plank of a strategy to improve public health and, again, provide a cross cutting platform for those working for change.

When I think of capitalism's issue, the big one that comes to mind is that it seems ecologically unsustainable — like you can't have a planet that can support human life while we consume resources and pollute the environment as we currently do. That's true whether you're talking about the extinction of species, whether you're talking about greenhouse gas emissions, or similar phenomena. What are long-term economic solutions to that problem?

I would just add that, in many cases, what makes the current business models of many sectors unsustainable also through other paths harms human health. There's a double benefit — in the case of food, the ultra-processed diet of food that relies on industrially produced crops and big-scale agriculture that has produced a diet which have made diet-related diseases like diabetes, cancer, heart disease, the leading cause of premature death and preventable illness. That's also the agricultural system that is contributing so significantly to carbon emissions and greenhouse gas emissions. And similarly the transportation system, which relies on individual cars, has created what some people call transportation apartheid, making mobility available to people who are better off, but increasingly unavailable to people of color and poor people. It's that same transportation system that contributes again in very significant ways to carbon and greenhouse gas emissions.

I think one of the insights I gained from working on this book is that our big health problems are connected. Our food problem and our climate problem, our susceptibility to the COVID pandemic, those are connected. The disasters we've seen in California and Texas and the Gulf Coast, those also show the cost to human health as well as the environment from the policies we've been following. I think the Green New Deal is an example of a policy package that puts the pieces together. And by emphasizing the message that making diminishing the climate emergency a priority, we also create new jobs. We also can give communities a bigger voice in shaping their economic future. I think we ought to be looking to similar policy packages around food, healthcare, transportation, etc. And those things will intersect and will also create the potential for a wide range of constituencies to support those measures. The corporate world and the conservative elected officials have demonized Green New Deal, but I think if you look at popular support, public opinion polls show that the majority supports taking action to reduce climate change supports action, to create new jobs using public support to do that. We need to find new ways to bring together those majorities to have an impact in Washington and in the corporate boardrooms.

I think that's a very interesting point. I'd say the other major criticism that I and other people have of capitalism is the fact that it doesn't really seem structurally possible for capitalism to not create massive income inequality. I know that there are social democrats out there who believe that regulated capitalism can be more effective, but it seems like when you have a democratic system, eventually those protections for people in the working class get eroded and reforms get rolled back. I was wondering what your thoughts were about that.

What I write about in the book is that, especially the ways that capitalism has changed since — I start in the 1970s with the response to the reforms of the 1960s and 1970s here in the United States — capitalism has changed in ways that make it increasingly contributing to income inequality. The dominance of the financial sector, the rise of debt, the heavy emphasis on quarterly returns for investors and corporations, those things have all increased inequality. Capitalism always generated inequality. The changes made after World War II reduced that tendency a little, but what's happened in the last period is that that's become increased. Now my thinking is that the vast majority of people in the United States and the world are harmed in some very direct ways by the current ways that capitalism operates. And we don't need to immediately achieve consensus on what comes after the current form of capitalism. That's a very complicated and controversial topic. Of course we need to talk about it, but I think that the thought that we need to agree on what brand of capitalism or democratic socialism or some alternative is the ultimate goal, I think that distracts us from what can we agree on now to stop the most harmful aspects, to stop the pandemics, to stop the climate emergency, or begin to reverse them. My recommendation is that all of us working to make this country and world healthier focused on what we can do together in the short and middle term. Through doing that, the longer term pathways will become clear. The long-term pathway isn't decided by intellectuals or even activists debating with each other. It's decided by what we do in practice and what works and then needs to be changed to work better. I think if those of us working for change could move towards that mindset, we'd be in a better position to make substantial progress, especially with the opportunities from the defeat of Trump, the emergency imposed by both climate change and the COVID pandemic. We have a real opportunity and I'm hoping we can seize it.

https://www.alternet.org/2021/03/capital-health/

The Trump Health Care Policies That Deserve to Stick Around

Biden may want to continue the previous administration’s efforts to lower drug prices and make medical costs transparent.

by Elizabeth Rosenthal - NYT - March 11, 2021

President Biden’s goal of providing health care for more Americans advanced this week with Mr. Biden’s signing of an economic stimulus package that includes subsidies for health insurance premiums and new incentives for states to expand Medicaid, as well as the potential confirmation of Xavier Becerra as secretary of health and human services.

But as the current administration works to reverse the actions of its predecessor, it should recognize that former President Donald Trump introduced some policies on medical care and drug price transparency that are worth preserving. Those measures could help struggling patient-consumers while the new administration pushes for the far more ambitious reforms Mr. Biden campaigned on, which include a public health insurance option and a system that would allow Medicare to negotiate drug prices.

To be clear, the Trump administration, generally, put the health care of many Americans in jeopardy: It spent four years trying to overturn the Affordable Care Act, despite that law’s undeniable successes, and when repeal proved impossible, kneecapped the program in countless ways. As a result of those policies, more than two million people lost health insurance during Mr. Trump’s first three years. And that’s before millions more people lost their jobs and accompanying insurance during the early days of the Covid-19 pandemic.

But the Trump administration did attempt to rein in some of the most egregious pricing in the health care industry. For example, it required most hospitals to post lists of their standard prices for supplies, drugs, tests and procedures. Providers had long resisted calls for such pricing transparency, arguing that this was a burden, and that since insurers negotiated and paid far lower rates anyway, those list prices didn’t really matter.

Of course, prices do matter to the patients who are uninsured or end up at an out-of-network hospital when illness strikes and are charged full freight, or nearly so. Some patients, facing bills of hundreds of thousands of dollars, have been sued by hospitals or forced into bankruptcy or foreclosure.

In 2019, the Trump administration proposed a rule that hospitals disclose the discounted rates that they agree to accept from insurers for common medical services, as well as prices for patients who pay in cash. To be clear, this type of transparency doesn’t directly lower bills, but the information can help patients shop around for medical care.

These master price lists span hundreds of pages and are hard to decipher. Nonetheless, they give consumers a basis to fight back against outrageous charges in a system where a knee replacement can cost $15,000 or $75,000 even at the same hospital. And the requirement might just motivate some providers to lower their prices, if only to compete with neighboring hospitals.

Last summer hospitals said it was too hard to comply with the new rule while they were dealing with the pandemic. They still managed to continue the appeal of their lawsuit against the measure, which failed in December. The rule took effect, but the penalty for not complying is just $300 a day — a pittance for hospitals — and there is no meaningful mechanism for active enforcement. The hospitals have asked the Biden administration to revise the requirement.

Mr. Trump also used his bully pulpit to take on drug prices, remarking at his first news conference as president-elect that pharmaceutical manufacturers were “getting away with murder.” His administration ordered drug makers to list prices in advertisements for medications that cost more than $35 per month. (Some of the most commonly advertised drugs cost thousands of dollars.) Just before the order took effect, a court blocked it.

Then, last summer, Mr. Trump issued a bunch of executive orders aimed at forcing drug price reductions. In September his health secretary, Alex Azar, certified that importing prescription medicine from Canada “poses no additional risk to the public’s health and safety” and would result in “a significant reduction in the cost.” This statement, which previous health secretaries had declined to make, formally opened the door to importing medication. Millions of Americans, meanwhile, now illegally purchase prescription drugs from abroad because they cannot afford to buy them at home.

In Congress, bills allowing prescription drug importation have for years gained bipartisan support, but without the go-ahead from the Department of Health and Human Services, they were nonstarters. Now a number of states are moving ahead with efforts to import drugs from Canada.

Mr. Biden said he supported the legalization of importing drugs during his presidential campaign. Mr. Becerra, Mr. Azar’s potential successor, voted for an importation bill in 2003 when he was a member of Congress.

But the drug lobby will no doubt prove a big obstacle: The Pharmaceutical Research and Manufacturers of America, an industry trade group, filed suit in federal court in November to stop the drug-purchasing initiatives. The industry has long argued that importation from even Canada would risk American lives.

Finally, shortly before the election, Mr. Trump issued an executive order paving the way for a “most favored nation” system that would ensure that the prices for certain drugs purchased by Medicare did not exceed the lowest price available in other developed countries. The industry responded with furious pushback, and a court quickly ruled against the measure.

Some of these initiatives, such as posting hospital prices, have already taken effect. But executive orders have limited power; some are stuck in court or require further governmental action to move forward. The Biden administration will have to decide which, if any, to pursue.

Mr. Biden’s proposals to get better, more affordable health care to every American are far more substantial — and disruptive to the health industry —  than any of Mr. Trump’s efforts. But Mr. Biden may find it difficult to get support for his plans in a Congress that is narrowly controlled by Democrats. The Democratic Party has historically been friendly to the health care industry: According to the Center for Responsive Politics, 71 percent of the money spent by the pharmaceutical industry in the 2020 elections went to Democratic candidates. Mr. Biden raised twice as much money from hospitals and nursing homes during the 2020 presidential campaign as Mr. Trump. The health care industry is already aggressively advertising and lobbying against any sort of public option.

The Trump administration’s attempted market-based interventions shined some light on dark corners of the health market and opened the door to some workarounds. They are not meaningful substitutes for larger and much-needed health reform. But as Americans await the type of more fundamental changes the Democrats have promised, they need every bit of help they can get.

https://www.nytimes.com/2021/03/11/opinion/biden-trump-health-care.html?action=click&module=Opinion&pgtype=Homepage 

 

Need Health Insurance? A Guide to New Options Under the Stimulus.

By Margot Sanger-Katz - NYT - March 12, 2021

The stimulus package signed by President Biden on Thursday provides new options for Americans who need health insurance — and new resources to help lower costs for those who are already insured.

Few of these changes apply to Americans who get insurance at work or through Medicare. But if you buy your own insurance, have been uninsured, or have recently lost job-based coverage because of a layoff, the bill introduces new programs and new funding to help you get and stay covered. The new programs are temporary — none last longer than two years.

The array of programs can be complicated and tough to navigate, and some will take a little time to update. Here is some guidance.

I need insurance, and I am collecting unemployment insurance benefits.

The stimulus bill provides substantial, short-term subsidies to buy coverage on the Obamacare marketplaces. Regardless of your income, if you collect unemployment insurance at any time this year, you will qualify for a free silver plan with special bonus coverage that will lower your deductible and co-payments.

It may take a little time for Healthcare.gov or your state exchange website to update. But if you sign up for a silver plan now, you will be able to get these benefits for the rest of the year. You may need to pay a higher premium at first while the system is adjusting, but you will eventually be eligible for a refund.

If you used to get insurance at work, you may also qualify for up to six months of free COBRA coverage, meaning you have a choice about which kind of free insurance you want.

I just lost my job-based coverage, but I’d really like to keep it.

Under federal law, you can stay enrolled in your workplace coverage for up to 18 months after losing your job-based insurance. Normally, you would need to pay the full price of this insurance, which can be expensive. But under the new stimulus bill, you can qualify for up to six months of free COBRA coverage, if you lost your coverage in the last year. You can also qualify for the free COBRA if you still have your job but your hours have been cut and you lost your insurance as a result.

After Sept. 30, though, you will need to pay to keep the COBRA plan, or you will need to switch to a different option.

I currently buy Obamacare insurance.

The legislation introduces additional subsidies meant to lower the amount most people pay for insurance purchased on Affordable Care Act marketplaces. These extra subsidies will be retroactive to Jan. 1. The details of how you will get this new discount are still unclear: Your premium amount may reset automatically to a lower price, or you may need to go back to Healthcare.gov or your state marketplace to request the discount once the new system is set up. In the District of Columbia, one of the first places to announce a policy, prices will adjust automatically in April. Regardless, once those policies are completed, there will be a way to get a refund for any overpayments you make.

To get an approximate sense of how much your premiums will decrease, these maps may be helpful. To know your new premium more precisely, try the Kaiser Family Foundation’s online calculator, available here.

The stimulus package funds these extra subsidies for two years. Any extension after 2022 will require new legislation.

If you already have Obamacare coverage, but you have received unemployment insurance any time this year, you now qualify for additional assistance. You should go back to the marketplace to make sure you are signed up for that extra benefit once it is set up.

I didn’t buy health insurance this year, but I want coverage now.

Normally, you can buy insurance only during a six-week period each fall. But the Biden administration established a special enrollment period that runs through mid-May, and most state marketplaces have done the same. This means you can go to Healthcare.gov and sign up for insurance now.

Because of the stimulus bill, the tax credits that help you buy insurance will be higher than ever before — enough to pay for a free silver plan for someone with an annual income of around $19,000, or to lower premiums by as much as $1,000 a month for someone earning around $60,000 in an expensive market. If you go to Healthcare.gov today, you won’t see those new prices, but you will still qualify. If you want coverage right away, you will eventually qualify for a refund if you pay too much at first.

The changes in premiums affect nearly everyone, but are particularly valuable for two groups. If you have a low income, subsidies will cover enough to give you a free silver plan with extra benefits that lower your co-payments and deductibles. And if you earn more than 400 percent of the federal poverty level — about $51,000 for a single person or $105,000 for a family of four — for the first time you will qualify for help buying insurance.

Frequently Asked Questions About the New Stimulus Package

The stimulus payments would be $1,400 for most recipients. Those who are eligible would also receive an identical payment for each of their children. To qualify for the full $1,400, a single person would need an adjusted gross income of $75,000 or below. For heads of household, adjusted gross income would need to be $112,500 or below, and for married couples filing jointly that number would need to be $150,000 or below. To be eligible for a payment, a person must have a Social Security number. Read more.

Buying insurance through the government program known as COBRA would temporarily become a lot cheaper. COBRA, for the Consolidated Omnibus Budget Reconciliation Act, generally lets someone who loses a job buy coverage via the former employer. But it’s expensive: Under normal circumstances, a person may have to pay at least 102 percent of the cost of the premium. Under the relief bill, the government would pay the entire COBRA premium from April 1 through Sept. 30. A person who qualified for new, employer-based health insurance someplace else before Sept. 30 would lose eligibility for the no-cost coverage. And someone who left a job voluntarily would not be eligible, either. Read more

This credit, which helps working families offset the cost of care for children under 13 and other dependents, would be significantly expanded for a single year. More people would be eligible, and many recipients would get a bigger break. The bill would also make the credit fully refundable, which means you could collect the money as a refund even if your tax bill was zero. “That will be helpful to people at the lower end” of the income scale, said Mark Luscombe, principal federal tax analyst at Wolters Kluwer Tax & Accounting. Read more.

There would be a big one for people who already have debt. You wouldn’t have to pay income taxes on forgiven debt if you qualify for loan forgiveness or cancellation — for example, if you’ve been in an income-driven repayment plan for the requisite number of years, if your school defrauded you or if Congress or the president wipes away $10,000 of debt for large numbers of people. This would be the case for debt forgiven between Jan. 1, 2021, and the end of 2025. Read more.

The bill would provide billions of dollars in rental and utility assistance to people who are struggling and in danger of being evicted from their homes. About $27 billion would go toward emergency rental assistance. The vast majority of it would replenish the so-called Coronavirus Relief Fund, created by the CARES Act and distributed through state, local and tribal governments, according to the National Low Income Housing Coalition. That’s on top of the $25 billion in assistance provided by the relief package passed in December. To receive financial assistance — which could be used for rent, utilities and other housing expenses — households would have to meet several conditions. Household income could not exceed 80 percent of the area median income, at least one household member must be at risk of homelessness or housing instability, and individuals would have to qualify for unemployment benefits or have experienced financial hardship (directly or indirectly) because of the pandemic. Assistance could be provided for up to 18 months, according to the National Low Income Housing Coalition. Lower-income families that have been unemployed for three months or more would be given priority for assistance. Read more.

These changes were devised to make insurance more affordable for people who have found premiums out of reach. To get a sense of what you will need to pay, the Kaiser calculator may be helpful while the government sites update.

I need insurance, but my income is very low.

In most — but not all — states, simply having a low income can qualify you for Medicaid coverage. Medicaid generally charges no premiums and has very low co-payments for doctor visits or prescriptions. In the states shown below, you can qualify by having an income that is lower than around $1,400 monthly for a single person or $2,950 for a family of four.

Missouri and Oklahoma are in the process of expanding Medicaid, so people there may also become eligible later this year. The stimulus bill provides a financial incentive for other states to expand their programs, too. So far, it is unclear whether any of them will take advantage of the offer.

In the states that haven’t expanded, you may also qualify for Medicaid if you are poor and fall into some other category, such as being the parent of a young child. If you think you could qualify for Medicaid, it is worth applying to find out.

Eligibility for Medicaid will endure even after stimulus provisions expire.

I bought a short-term plan, a health-sharing ministry plan, or my own insurance outside of Healthcare.gov.

The changes under the stimulus bill make it worth considering a switch in insurance type.

Many Americans with higher incomes bought their insurance outside the state marketplaces because they didn’t qualify for subsidies. The new legislation changes that: Higher-income people can now get financial help buying insurance, but only if they sign up for a marketplace plan.

Obamacare plans cover a broader array of benefits than short-term plans or health-sharing ministries do, and they can’t deny your claims based on a pre-existing condition.

Whether switching is a good decision for you depends on how much you’ll save in premiums and how much you’ve already paid in deductibles. But switching will pay off for enough people that “they should absolutely come in and just see what the prices are,” said Sabrina Corlette, a co-director at the Center on Health Insurance Reforms at Georgetown University. Ms. Corlette notes that this is especially true for older people; new subsidies could cut their cost of insurance by more than half.

https://www.nytimes.com/2021/03/12/upshot/need-health-insurance-a-guide-to-new-options-under-the-stimulus.html

Biden's Neoliberal Rescue of For-Profit Health System Proves We Need Medicare for All

 We need a system that is truly universal—everybody in, nobody out. Biden's proposal will add more participants to the current program, but still leave millions out.

by F. Douglas Stephenson- Common Dreams - March 11,  2021

President Biden, the Democratic Party and America's neoliberal vision of world order is rooted in an economic philosophy of privatization and financialization. To assure privatization goals of the 1% oligarchs, distinguished economist Michael Hudson writes that this is achieved by "conquering the brains of a country by shaping how people think. If you can twist their view into unreality economics, to make them think you are there to help them and not to take money out of them, then you've got them hooked." To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

Biden and many Democrats have spent their careers defending the financial sector, including big insurance and big pharma, whose leading policy is also to maintain and further privatize basic health care financing and infrastructure. Economist Hudson notes that, "Biden's long political career has been right-wing. He's the senator from Delaware, the country's most pro-corporate state—which is why most U.S. corporations are incorporated there. As such, he represents the banking and credit-card industry. He sponsored the regressive bankruptcy "reform" written and put into his hands by the credit-card companies. As a budget hawk, he's rejected Modern Monetary Theory (MMT), and also "Medicare for all" as if it is too expensive for the government to afford—thereby making the private sector afford to pay 18% of US GDP for health-insurance monopolies, far more than any other country. That means blocking governments from providing basic services at cost or on a subsidized basis—education, health care/health insurance, roads and communications. Privatized and financialized economies are high-cost."

Although health insurance affordability for the majority of US citizens remains a very large problem, Pres. Biden's latest health insurance plan wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of health insurance by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system. Profiteering continues unabated as private insurance sells us services we don't need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

The American Rescue Plan (ARP), a $1.9 trillion stimulus package increases government subsidies to health insurers for covering recently laid-off workers and those who purchase their own coverage. The ARP spends $34 billion expanding the Affordable Care Act subsidies for two years. The changes would make upper-middle-income Americans newly eligible for financial help to buy plans on the Obamacare marketplaces, and would increase the subsidies already going to lower-income enrollees. The stimulus package also subsidizes private health insurance premiums for newly unemployed workers. The legislation that the House passed would cover 85 percent of COBRA premiums through September.

To protect and enhance high profits by opposing improved Medicare for All, the private health insurance industry, ever since 'Obamacare', the Affordable Care Act (ACA), was enacted in March, 2010, has lobbied Congress hard to ensure that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

When compared to an improved, single payer Medicare for All (M4A) insurance plan, Biden's plan is disappointing and at best a bandaid approach. We need a system that is truly universal—everybody in, nobody out. Biden's proposal will add more participants to the current program, but still leave millions out. M4A is truly universal:

1). Patients should have free choice of their professionals and health care institutions. Biden would continue health plans with restrictive networks that take away free choice. M4A allows choices within the entire health care system.

2). The privatization of public programs such as Medicare through Medicare Advantage and Medicaid through private managed care programs have proven to provide poor value for the taxpayer (obscured by cherry picking and lemon dropping) and should be eliminated. Biden would continue these programs, whereas M4A would eliminate them.

3). Fragmentation results in dysfunctional financing of health care. Biden would perpetuate fragmentation whereas M4A would bring an end to it.

4). Biden's proposals would add more administrative burden along with the costs they entail. M4A is specifically designed to greatly reduce this burden and its associated costs.

5). Medicaid carries the stigma of being a welfare program which results in legislative underfunding and neglect. Biden would attempt to expand Medicaid in those states that have underutilized it. M4A would terminate the program and move everyone into a universal, comprehensive and equitable program.

6). We need a program that is affordable for each individual and for society as a whole. Biden's plan will add significantly more spending to the program while leaving it still unaffordable for too many individuals. M4A would achieve all goals of financing reform without significantly increasing spending.

7). Health care coverage should be stable and permanent throughout life. Biden's proposed fixes would be temporary, many expiring in two years. It is likely that legislators would develop reform fatigue in this session and fail to follow up with more permanent measures. M4A would be a single program—permanent throughout life.

8). Employer-sponsored insurance can create problems such as job lock, which many conservatives and progressives believe should be terminated. Biden would perpetuate it since it involves less government involvement—predominantly private spending with a tax benefit. M4A would end employer-sponsored insurance, and, for many, M4A would be better.

The highly respected British medical journal, "The Lancet", recently summarized the health insurance situation in the USA:

"Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal/revise the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo."

Even with todays dangerous and burgeoning coronavirus(Covid-19) pandemic, big insurance and big pharma still oppose legislation for the new Medicare for All (HR-1384/S-1129). These resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government, community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It's no wonder so many beholden members of Congress want to protect the interests of big insurance and big pharma, industries who spent $371 million on lobbying in 2017 alone.

These industries always seek to lock us into an obsolete private insurance-based model that holds everyones health hostage to profiteering HMOs and unaccountable big insurance companies for years to come. For proponents of political expediency, the question remains, who will be lost while profiteering continues and basic principles of public health are rejected. Every year, well over 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health insurance coverage. Pandemics like COVID-19 are quickly increasing these numbers.

The COVID-19 pandemic and its economic consequences have caused the greatest losses in health insurance enrollment in U.S. history: 5.4 million laid-off workers have become uninsured. Also important to remember that all was not well before the pandemic. Nearly 28 million people were already uninsured and tens of millions more were underinsured—unable to afford the out-of-pocket costs that were not covered by insurance.

We have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. With millions losing their jobs due to Covid-19, the dangers of connecting health insurance to employment are painfully clear. Health insurance must be tied to citizenship, not employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as the health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

The real boogeymen opposing M4A are the private health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of insurance and Pharma. Big Pharma and Big Insurance donor industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.

If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it's important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry's need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House Bill H.R. 1384 or Senate Bill S.1129, which improve Medicare's benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.

Although Medicare for All supporters are often derided as unrealistic, in fact it's not realistic to expect that Americans will continue passively accepting 'how much money is in the bank account' as the most significant factor in their mortality. The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All legislation now filed in Congress, H.R. 1384/S.11

https://www.commondreams.org/views/2021/03/11/bidens-neoliberal-rescue-profit-health-system-proves-we-need-medicare-all