Newsom campaigned on single-payer health care for California. This proposal needs his help
Gov. Gavin Newsom made guaranteed health care a central piece of his gubernatorial campaign some four years ago, promising specifically to deliver a single-payer system that would give every resident free access to comprehensive treatment.
In an April 2018 interview with the San Francisco Chronicle, however, Newsom did what he’s done on numerous issues throughout his tenure as governor: He muddied his position by telling the newspaper’s editorial board that “it is not an act that would occur by the signature of the next governor. There’s a lot of mythology about that.”
Heartened by this obfuscation, Blue Shield of California and several health care industry super PACs made six-figure donations to his campaign — relationships that blossomed into tens of millions of dollars of so-called behested payments on Newsom’s behalf during the pandemic. He rewarded the industry’s kindness with massive no-bid government contracts that resulted in botched testing services and underutilized vaccination programs.
It’s unclear which version of the governor will emerge on the vital issue of guaranteed health care this year. One piece of a legislative package to create a single-payer system called CalCare, funded by a mix of tax increases, will reach the state Assembly floor by the end of the month. While many hope public pressure will compel Newsom to revive his promise, his actions as governor inspire skepticism.
Still, California’s top elected official can help foster the statewide discussion he owes to 40 million residents enduring a once-in-a-lifetime pandemic along with the depredations of a profit-driven private health care sector. With the Newsom administration’s support for further consideration of Assembly Bill 1400 and an Assembly vote to keep it alive, lawmakers and the public could begin an honest debate that is as critical as ever for the health and well-being of every California resident.
An estimated 3.2 million people in California lack health insurance. Many more face the crushing rigors of a private system that over-complicates essential medical care and excessively charges patients for lifesaving procedures and prescriptions. Business is generally good for America’s $4.1 trillion health care industry, which grew more than 9% in 2020 and accounts for roughly one-fifth of the nation’s economy.
The benefits of a single-payer system — such as eliminating excessive co-pays, deductibles and prescription costs — are clear. The idea is also popular, supported by more than 6 in 10 Americans, according to the nonpartisan Pew Research Center. Single-payer opponents push a false narrative that caters to business interests over people who need care.
In 2017, the state Senate Appropriations Committee estimated that operating a single-payer system would cost $400 billion annually, requiring an additional $200 billion in new taxes to cover the cost. While the prospect of new taxes can be unsettling, California residents already spend $367 billion on health care each year, with taxpayers footing 70% of that, according to the UCLA Center for Health Policy Research. Replacing employer-provided insurance may not be as dramatic a shift to our paychecks or tax filings as some suggest.
This month, Newsom proposed a much cheaper Medi-Cal extension that would provide care access to undocumented immigrants and — with the help of political semantics — allow California to claim universal health care. It is a necessary and long-overdue measure to protect vulnerable communities that fill critical parts of California’s workforce, which has experienced higher death rates and lower vaccination rates throughout the pandemic due partly to exclusion from the health care system.
California’s Democratic supermajority will likely pass that proposal with ease. The real act of political courage would be supporting AB 1400, which enjoys much more legislative backing than previous proposals. Its supporters include Assembly Speaker Anthony Rendon, who let the last single-payer proposal die in 2017.
Perhaps Newsom could take his own advice from that year. As he tweeted, “I’m tired of politicians saying they support single payer but that it’s too soon, too expensive or someone else’s problem.”
https://www.sacbee.com/opinion/editorials/article257490329.html?akid=133783.1303069.fYGNqH&rd=1&t=1
Editor's Note -
Is the Maine state slogan still "Dirigo"?
-SPC
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U.K.’s Other Health Crisis: A Huge Backlog of Delayed Non-Covid Care
The free health care system was known for delays, caused in part by whittled-down funding. But Covid made waits for transplants, cancer treatments and other essential care even longer.
by Megan Specia - NYT - January 26, 2022
LONDON — Lara Wahab had been waiting for more than two years for a kidney and pancreas transplant, but months had passed without any word. So last month she called the hospital, and got crushing news.
There had been a good match for her in October, the transplant coordinator told her, which the hospital normally would have accepted. But with Covid-19 patients filling beds, the transplant team could not find her a place in the intensive care unit for postoperative care. They had to decline the organs.
“I was just in shock. I knew that the N.H.S. was under a lot of strain, but you don’t really know until you’re waiting for something like that,” she said, referring to the National Health Service. “It was there, but it sort of slipped through my fingers,” she added of the transplant opportunity.
Ms. Wahab, 34, from North London, is part of an enormous and growing backlog of patients in Britain’s free health service who have seen planned care delayed or diverted, in part because of the pandemic — a largely unseen crisis within a crisis. The problems are likely to have profound consequences that will be felt for years.
The numbers are stark: In England, nearly 6 million procedures are currently delayed, a rise from the backlog of 4.6 million before the pandemic, according to the N.H.S. The current delays most likely impact more than five million people — a single patient can have multiple cases pending for different ailments — which represents almost one-tenth of the population. Hundreds of thousands more haven’t been referred yet for treatment, and many ailments have simply gone undiagnosed.
There was already a huge and rising backlog of patients before the pandemic, but the unrelenting burden of the past two years, with health staff and hospital capacity stretched even thinner by coronavirus cases, saw it balloon to record proportions. The latest official figures are almost two months out of date, and experts say that severe staffing shortages this winter and the wildfire spread of the Omicron variant have almost certainly made the situation worse.
“Just because we’ve got Omicron doesn’t mean that other illnesses have just stopped still and don’t emerge and develop in people, sadly,” said Saffron Cordery, the deputy chief executive of N.H.S. Providers, a membership organization for health workers.
Public health experts worry that even if the pandemic eases and relieves some of the immediate burden, the pandemic and delayed care could do lasting harm to the health system, as well as patients.
This month, a report from the parliamentary health committee revealed a complex and troubling picture of record waiting lists, high caseloads and severe staffing shortages. It warned that a major expansion of the labor force was needed, but that the government was not doing enough to recruit and train health workers.
Generations of Britons have endured longer waits for treatment than many insured Americans, with most accepting that as the price of caring for everyone. But the problem has worsened for almost a decade, with critics accusing Conservative governments of steadily underfunding the system.
In 2012, there were 2.5 million cases awaiting specialist treatment in England. By the start of 2020, the backlog had swelled to 4.6 million cases, according to the N.H.S.
At the end of November 2021, the caseload was six million. More than 300,000 cases have been waiting for more than a year for planned care. A decade ago, there were fewer than 500.
The true backlog is probably much bigger, experts and government officials say. As the health committee noted in its report, the pandemic has greatly disrupted normal patterns of assessments and referrals by primary care doctors, keeping people off the official tallies.
A recent report from the National Audit Office estimated that there were 7.8 million to 9.8 million “missing” referrals — those that ordinarily would have occurred but never did — by primary care physicians from the start of the pandemic to September 2021, including 240,000 to 740,000 for suspected cancer cases.
“We are likely to see knock-on effects with people with other diseases, including but not limited to cancer, where treatment got delayed or postponed or we missed out on it,” said Peter English, a retired consultant in communicable disease control. “And they died because they didn’t have treatment they would otherwise have had.”
By the time the pandemic hit Britain, Ms. Wahab had been on the transplant list for months. In April 2019, her doctor told her that the Type 1 diabetes she has had since age 7 had left her with kidney failure and that her best chance at recovery was a simultaneous pancreas and kidney transplant.
Her doctors told her that it would take about six months to get onto the transplant list and then typically about a year to be matched with a donor.
But in the spring of 2020, overwhelmed hospitals across the country halted nonemergency care, including transplants, diverting staff to coronavirus response.
Since then, transplants have resumed and stopped, again and again. With each pandemic surge that filled intensive care units, the first treatments to be put on hold were planned procedures requiring intensive care beds — like transplants.
Because she has managed to stay off dialysis despite her worsening condition, Ms. Wahab is a more desirable transplant candidate because her likelihood of a positive outcome is better. But she is not sure how much longer she can hold on.
“It’s having a devastating effect on my day-to-day life,” she said. “I feel really hopeless going into 2022 — I’ve been waiting for this operation now for nearly three years.”
James Wilkinson, 46, was diagnosed with endocarditis, an inflammation of the lining of his heart caused by an infection that ate away at his aortic valve, and he had originally been booked for an operation in May 2020. The operation was canceled because of the pandemic. And then it was rescheduled and canceled three more times.
Mr. Wilkinson, who testified in front of a parliamentary committee late last year about his experience, said that he had eventually turned to private care to have the operation — something few people could afford.
“If it wasn’t for the private health care, we don’t know when my operation would have happened,” he said.
But it is not only those waiting for care they know they need who have been hurt. Cancer charities have warned that delays in diagnosing will also have devastating impacts.
Macmillan Cancer Support, a charity, estimates that some 50,000 people across Britain have not yet been diagnosed with some form of cancer that should have been caught earlier, in a direct result of the pandemic’s hindering screenings and referrals. The number of women being diagnosed with Stage 4 breast cancer — which means that the disease is advanced and very dangerous — has jumped by 48 percent in recent months.
Danni Moore, now 31, found a lump in her breast in early 2020, just before the pandemic. Ms. Moore, a mother to two children, was still breastfeeding her youngest and thought that she had a blocked milk duct. But her doctor referred her to a specialist clinic.
That appointment was canceled because of the pandemic. She rescheduled, but then had to cancel herself because her partner had contracted the virus and their household had to isolate.
“The knock-on effect Covid had has made everything much more difficult, and I had the lump way longer than I should have,” she said. “And it’s partly my fault. I should have gone much sooner, but equally hindsight is a wonderful thing.”
Ms. Moore said she put off making another appointment, and months went by. But then the lump grew, and in the spring of 2021, a year after she first found it, it was diagnosed as breast cancer. The months since have been an exhausting whirlwind of chemotherapy treatments and complications, which she has documented on her Instagram account.
While her treatment this year has continued without delay, and she credits the doctors and nurses with saving her life, she knows her initial diagnosis would have come sooner without the pandemic.
The surgery backlog has also influenced her decisions on what comes next. Ms. Moore has opted to have a double mastectomy, which is scheduled for early February. She said that she felt she could more readily live with having both breasts removed than having one removed and waiting an unknown length of time to have reconstructive surgery to reach a “new normal.”
“I have two young children,” she said. “I’ve already given up over a year to having cancer.”
She added: “I just don’t want to sit and just wait for another two or three and make this process longer than it ever needed to be.”
https://www.nytimes.com/2022/01/26/world/europe/coronavirus-uk-nhs-backlog.html
UnitedHealth's $24 Billion Profit
by Wendell Potter - The Potter Report - January 24, 2022
Just days after a Commonwealth Fund report showed that American families are sending health insurance companies more and more of their income every year even as their deductibles skyrocket, the country’s biggest insurer reported massive 2021 profits and told investors to expect even higher profits in 2022.
UnitedHealth on Wednesday reported 2021 profits of $24 billion on revenue of $287.6 billion. Executives told Wall Street they expect United will be the first insurer to take in more than $300 billion from its customers this year.
Instead of giving its health plan customers relief from ever-increasing out-of-pocket requirements, United spent $5 billion last year buying back its own shares of stock, a gimmick that boosts the value of shares and makes shareholders richer. United also paid shareholders $5.3 billion in dividends in 2021.
No insurer has ever made that kind of money in U.S. history. It’s even more notable when you consider that United is not growing by attracting substantially more new customers.
At the end of 2021, United had about 26.6 million people enrolled in its commercial (individual and employer-sponsored) health plans. That’s just 700,000 more than the 25.9 million the company had 10 years ago. Most of United’s membership and revenue growth now comes from the company’s Medicare Advantage plans and the state Medicaid programs it manages. In other words, from us as taxpayers. United and other insurers are padding their top and bottom lines by charging their existing commercial customers higher and higher premiums every year.
Consider this: an employer-sponsored family policy that cost an average of $15,073 in 2011 cost $22,221 in 2021, a 47% increase, according to the Kaiser Family Foundation. And during that time, insurers have forced their health plan enrollees to pay more and more out of their own pockets through ever-increasing deductibles, copayments and coinsurance. Most Americans now have to pay on average twice as much out of their own pockets as they did 10 years ago.
That Commonwealth Fund report I mentioned earlier shows that with the relentless increase in both premiums and out-of-pockets, Americans are shelling out far more of their household income for health insurance and to cover out-of-pockets than a decade ago. Premiums and deductibles now take up more than 10% of median income in 37 states, up from just 10 in 2010.
Insurers argue that high deductibles are necessary to control premium increases. Unfortunately, most employers and policymakers seem to have bought that argument. But when you look at the research from both the Commonwealth Fund and Kaiser Family Foundation–and then the record profits United and other insurers are reporting–that talking point just doesn’t hold up.
Sign-ups in Affordable Care Act marketplaces reach record 14.5 million
by Amy Goldstein - Washington Post - January 27, 2022
About 14.5 million Americans have signed up to get health coverage this year through Affordable Care Act insurance marketplaces, eclipsing the previous record enrollment by nearly 2 million.
The popularity of ACA health plans is a substantial slice of good news for President Biden, who has made expanding access to affordable health insurance one of his principal domestic policy aims, while some approaches he favors to achieve that goal have stalled on Capitol Hill.
The enrollment figure is the heart of a report released Thursday by the Department of Health and Human Services. The White House rushed out a statement from the president in advance, in which Biden said he was proud that the sign-ups are “the highest numbers ever produced in an open enrollment period.”
The tally is not quite final, so it probably will be higher in the end.
The 14.5 million figure includes a final count of 10.3 million consumers who chose health plans during the most recent open-enrollment window through HealthCare.gov, the federal insurance marketplace on which 33 states rely. For 17 states and the District of Columbia, which run their own insurance marketplaces under the ACA, the data released Thursday includes 4.2 million sign-ups they had through Jan. 15, the deadline for the federal open enrollment.
Five state-run marketplaces plus the District’s are still open for consumers to buy health coverage for 2022. And three states and the District have created special enrollment periods that will allow uninsured residents longer to sign up for ACA coverage.
The ACA is a sprawling health-care law, pushed through a Democratic Congress in 2010, that has become a source of partisan warring ever since.
The insurance marketplaces created under the law began offering coverage in 2014.
The health plans are intended for consumers who cannot get affordable benefits through a job, meaning they must buy plans on their own — a part of the U.S. insurance industry that was especially dysfunctional in the past, with companies charging high prices for such individual coverage and rejecting many people with medical conditions. The ACA stopped the practice of spurning or overcharging people with preexisting conditions and for the first time provided federal subsidies to most people buying marketplace plans.
President Donald Trump was a vehement foe of the law. During his administration, he and a Republican Congress repeatedly tried to repeal large parts of the statute but didn’t succeed. Trump and his health-care aides nevertheless took aim at the insurance marketplaces, slashing federal money for advertising and other outreach activities, as well as for “navigators” who serve as community-level enrollment coaches.
Biden’s arrival in the White House a year ago marked a striking turnabout. The president moved swiftly to rehabilitate the law as the main tool to expand the number of Americans with insurance coverage and to make health plans more affordable. It had been a central campaign goal but assumed greater significance as the coronavirus pandemic cost millions of people their jobs and health benefits — and as the virus laid bare the importance of being able to get appropriate care when sick.
ACA open-enrollment periods typically run for several weeks starting mid-fall for the coming year. A week into his presidency, Biden announced an unprecedented special enrollment period for eligible people to buy an ACA health plan if they needed coverage because of the pandemic. The period eventually stretched six months and attracted 2.8 million people to sign up for plans.
The coronavirus relief law Congress adopted in March contained the first expansion of federal subsidies for ACA health plans in the program’s history. Through the end of this year, the law, known as the American Rescue Plan, increases tax credits for monthly insurance payments and allows people with higher incomes to qualify for such help.
And the administration reversed its predecessor’s cuts in funding for outreach and navigators, putting more money into those activities than in the past. Federal health officials also extended the open-enrollment period a month longer than it had been in recent years.
During a call with reporters Thursday to announce the large number of sign-ups, Health and Human Services Secretary Xavier Becerra said, “It’s historic, but it’s not accidental or coincidental that so many people have quality health insurance and peace of mind.”
Becerra highlighted that several states that run their own insurance exchanges are giving residents more time to sign up but did not say whether the federal government will reprise the special enrollment time Biden ordered in his first year. The secretary has hinted before that is possible.
The number of people who sign up for an ACA health plan typically dips somewhat as bills from insurance companies arrive. People secure coverage only if they pay whatever share of the monthly premiums they owe after taking into account the subsidy that most consumers get.
Still, even without being final, the new sign-up figure is 21 percent greater than the final enrollment — 12 million — in federal and state marketplaces a year ago. The previous record was nearly 12.7 million sign-ups for 2016, the marketplaces’ third year. Even during the Trump years, ACA enrollment never fell below 11 million, and it increased slightly for 2021, during the pandemic.
Nearly 2.4 million people who chose health plans through HealthCare.gov for this year are new to the ACA marketplaces, HHS figures show, compared with 1.9 million a year ago.
The marketplaces’ increased popularity contrasts with the fate of other health policies Biden espouses.
Congress has never seriously considered some of his campaign positions, such as creating a public insurance alternative to compete with private health plans. Other goals, such as adding Medicare benefits and helping insure more low-income people in states that have not expanded Medicaid under the ACA, have become bogged down as Democrats battle over the social spending bill that proponents call Build Back Better. Under the legislation, the expansion of insurance subsidies would continue for additional years,
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