Editor's Note -
As far as the non-action yesterday on AB1400 in the California Assembly (see first clipping) is concerned:
"res ipsa loquitur"!
but also
"Illegitimi Non Carborundum"
-SPC
Single-payer healthcare proposal fizzles in California Assembly
by Melody Gutierrez - LA Times - January 312, 2022
SACRAMENTO —
Lawmakers declined to vote on a high-profile effort to overhaul California’s healthcare system on Monday, putting an end to a proposal that would have guaranteed medical coverage to every resident by levying billions in new taxes.
Assembly Bill 1400 by Assemblyman Ash Kalra (D-San Jose) did not have the necessary votes to move forward ahead of a key deadline Monday. Instead of forcing a vote that could be politically damaging for some of his Democratic colleagues, Kalra opted to let the bill die, angering the California Nurses Assn. that has championed single-payer for years.
“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” Kalra said in a statement. “However, it became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today.”
AB 1400 would have created a publicly financed healthcare system called CalCare, which could cost between $314 billion and $391 billion in state and federal funds, according to a legislative analysis. But supporters said residents in the state would ultimately have saved money when compared with paying for insurance, co-pays and deductibles.
“Elected leaders in California had the opportunity to put patients first and set an example for the whole country by passing AB 1400,” the California Nurses Assn. said in a statement. “Instead, Assembly Member Ash Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California.”
It’s the second time in the last five years that a single-payer bill has died in the Assembly. In 2017, a Senate bill to create a single-payer plan was shelved by Assembly Speaker Anthony Rendon (D-Lakewood), who called that proposal “woefully incomplete.” Rendon’s decision at the time angered the nurses’ union, which said failing to put it up for a vote was “a cowardly act.”
On Monday, Rendon said the shortage of votes for AB 1400 shows how difficult it is to implement single-payer healthcare in the state.
“Nevertheless, I’m deeply disappointed that the author did not bring this bill up for a vote today,” Rendon said in a statement. “I support single-payer and fully intended to vote yes on this bill. With time, we will have better and more successful legislation to bring us closer to this goal.”
Supporters of the bill said the COVID-19 pandemic made the importance of healthcare access critically clear. A recent poll by the California Health Care Foundation and NORC at the University of Chicago found 83% of Californians say it is “extremely” or “very” important for Newsom and lawmakers to focus on “making health care more affordable” this year.
Still, Kalra’s bill has faced immense odds since it was introduced last February. For nearly a year, AB 1400 failed to gain traction while it lacked details on how it would be financed. This year, Kalra introduced a second bill, Assembly Constitutional Amendment 11, which would have used $163 billion in proposed new taxes to pay for the single-payer plan under AB 1400.
That helped the bill win support this month in the Assembly’s health and appropriations committees. Lawmakers faced intense lobbying on both sides of the bill leading up to Monday’s critical vote. The Progressive Caucus of the California Democratic Party threatened to withhold endorsements from any Assembly member that did not vote for AB 1400.
Critics of the single-payer plan have been flooding Californians’ cellphones and social media with ads criticizing the bill, saying it would “cause massive disruption to Californians’ healthcare at the worst possible time” and urging people to call lawmakers to tell them to reject AB 1400.
Opponents say even with its massive price tag, the proposal would still come up short of paying for the healthcare system overhaul. Exactly how much the proposal would have cost if it ultimately became law is still unknown. The Assembly recently approved a Republican request for the nonpartisan Legislative Analyst’s Office to review the cost and effects of the legislation.
The California Chamber of Commerce added the proposal to its annual “job killer” list that highlights laws corporate interests say will hurt employment and the economy. A chamber spokesman said the legislation would “ruin quality healthcare delivery” and “create the largest tax increase in state history.”
“AB 1400 was a disaster in the making and an unnecessary distraction from the real work of creating a healthcare system that can provide affordable, high-quality care to all Californians,” said Jim Wunderman, president and chief executive of the Bay Area Council. “It was unworkable and would have cost California taxpayers and businesses hundreds of billions in new taxes, with little or no hope that it would ever produce any results.”
Assembly Republican leader Marie Waldron of Escondido praised Democrats who helped stop the “foolhardy plan.”
“Better late than never,” Waldron said. “The fact that a proposal for a government takeover of our state’s entire healthcare system even made it this far shows just how out of touch the Democratic Party is from the needs of everyday Californians.”
The single-payer proposal has largely overshadowed a budget proposal by Gov. Gavin Newsom to allow all income-eligible residents to qualify for the state’s healthcare program for low-income people regardless of immigration status.
California already allows children and young adults living in the country illegally to qualify for Medi-Cal, while Californians 50 and older will be eligible beginning May 1. Newsom’s plan would add the final age group, which includes an estimated 700,000 people who otherwise meet income requirements but can not receive Medi-Cal because of their immigration status.
Newsom, who campaigned four years ago on implementing single-payer healthcare, said he remains committed to the goal, but did not weigh in on Kalra’s bill as he pushed his Medi-Cal expansion.
The governor said he is awaiting a report by the state’s Healthy California for All Commission detailing a plan on how best to create a single-payer model in the state.
“The facts are on our side that a single-payer system will save money and lives — and the people are on our side that meaningful healthcare reform is urgently needed,” Kalra said. “Especially with four democratic vacancies in the Assembly, the votes were not there today, but we will not give up.”
Big Business Will Not Save Us From Itself
Ms. Phillips-Fein is the author of “Invisible Hands: The Businessmen’s Crusade Against the New Deal.”
When Larry Fink, the chief executive of the asset management company BlackRock, wrote in his 2022 annual letter to corporate America that prioritizing environmental sustainability, racial justice and other social goals is not “woke” and “not about politics,” he articulated anew a longstanding hope that business can be a driver for social change.
Mr. Fink’s hymn to stakeholder capitalism — the idea that companies should engage the interests of workers, the environment and local communities alongside shareholders — puts forward a vision in which there is no necessary tension between private profit and collective progress.
In recent years, with traditional engines of progress so often in a state of dysfunction and gridlock, this ideal has appealed to some liberals. After all, even with unified party control in Washington, Democratic senators like Joseph Manchin of West Virginia and Kyrsten Sinema of Arizona have been able to stymie legislation that would protect voting rights and take tentative steps toward addressing climate change. And despite the increasingly favorable perceptions of unions, only about 6 percent of private sector workers are members today — the lowest proportion in more than 100 years. Against such a backdrop, it’s tempting to see hedge funds as a better bet.
But, however seductive it may be, stakeholder capitalism does not offer a real alternative. The ideal of an easy symbiosis between public and private sectors would undermine the kinds of political mobilizations, however difficult to organize and enact, that are needed for reform that benefits most Americans.
Historically, some private companies have occasionally supported goals like health and safety legislation to protect workers or the expansion of the welfare state through unemployment insurance and Social Security. But it has very often followed from focused, tireless efforts by unions and other social movements to get them to take these positions — and only when the disruptions have become so powerful that there appears to be no real choice and adoption offers companies a measure of control.
Mr. Fink’s vision is not new. At the close of the 19th century, after years of intense conflict with workers who sought to organize unions to secure higher wages, shorter work hours and basic safety provisions, a few business executives founded the National Civic Federation. It promoted negotiation between executives and representatives of workers deemed politically reliable. But the federation became increasingly focused on anti-socialist and anti-communist agitation, while the post-World War I labor movement collapsed.
The disaster of the Great Depression prompted some companies to back greater government regulation of economic life. Executives at firms like General Electric supported programs like Social Security in part because they recognized that the mass movements of the era — marches of the unemployed, sit-down strikes and other work disruptions — were potentially explosive if concessions were not made to working-class Americans.
But this alliance proved fleeting: Companies that supported reforms in the depths of the Depression no longer did once they saw other options. General Electric turned on its unions after a strike wave in 1946, relocating plants to the Southwest, where laws favored employers, and adopting hard-line bargaining strategies to weaken the electrical workers’ union.
In the late 1960s, after the legal victories of the civil rights movement in the South, the rise of Black power and uprisings of the decade in cities across the country, some corporate leaders suggested that they would do more to try to fight urban poverty — committing to hiring and training the long-term unemployed and to making philanthropic contributions. At the high point of protest against the Vietnam War, some business leaders tried to rally support for ending the war; one organization, Business Executives Move for Vietnam Peace, included almost 1,000 business leaders.
Today, some of the wealthiest Americans may be growing uncomfortable with the political destabilization that can accompany extreme inequality, and some may be anxious about the impact of climate change on their ability to generate profits. But this does not mean that they are eager to do the kinds of things that might actually address inequality or provide a meaningful way forward to a world less in danger of destroying itself. Mr. Fink’s letter may be partly born of good intentions, but the opposition of the Business Roundtable (whose members lead many of the economy’s largest corporations, including BlackRock) to potential corporate tax increases in Build Back Better played a key role in squashing it — and its relatively limited climate proposals.
As Andrew Perez and David Sirota have reported in Jacobin, the U.S. Chamber of Commerce has strongly opposed any reform of the filibuster, in part because it would simplify the passage of laws that, for example, could make it easier for workers to unionize.
A fantasy capitalism that magically balances the interests of workers, investors, communities and shareholders has a strong allure, but pursuing it is a self-defeating strategy — and rooted in political despair. Focusing political energy on securing the commitment of a group of business elites would undermine the engagement of a broad democratic base that must be the real basis of substantial reform. To address many of our deepest problems, nothing less than a redistribution of economic and political power will be needed, and it will be achieved only over the opposition of business and the wealthy.
The social responsibility trend in general undermines the idea of citizenship and of a public sphere as the place where decisions and arguments over economic and social policy play out. The commitment of business to democratic norms is pretty shallow, or at least it emphasizes a narrow understanding of what those are.
You can see this dynamic even at BlackRock. Environmental activists have protested BlackRock for years, calling on it to withdraw its investments in oil, gas and coal companies. But for all Mr. Fink’s talk about the long-term problem of climate change, his company has been unwilling to divest from these firms, despite his company’s 2020 pledge to halt investment in firms that earned more than 25 percent of their revenue from thermal coal. (Businesses, he wrote in defending his approach, “cannot be the climate police,” and he called on governments to increase their efforts.)
The reality is that there is no way to bypass the arduous, contentious work of building a politics that can sustain a more democratic culture. The only thing that brought elites to support such causes in the past — however tentative such support may be — is the pressure of political and social movements.
Were these stronger today, the obstruction of Senators Manchin and Sinema would look like the actions of reactionaries with nowhere else to turn rather than an intractable stranglehold on any reform efforts. And while we might hear less about stakeholder capitalism, we would have a public realm that could make real the idea of the common good.
https://www.nytimes.com/2022/02/01/opinion/corporations-democracy.html
The Ten Year War review: Obamacare, Trump and Biden's battles yet to come
Jonathan Cohn’s study of the fight for healthcare coverage delivers depth, dish and much for Democrats to ponder
Lloyd Green - The Guardian - February 21, 2021
Once upon a time, the Affordable Care Act (ACA) was unpopular, viewed by many as welfare redux. Barack Obama’s promise that “If you like your healthcare plan, you’ll be able to keep your healthcare plan”, didn’t exactly work out. By the middle of the 2010s, so-called Obamacare had cost the Democrats both houses of Congress.
Yet one great recession and one raging pandemic later, the ACA is liked, if not necessarily loved, by a majority of Americans.
The political process “doesn’t stop just because a bill becomes a law”, according to Jonathan Cohn.
As if to prove Cohn’s point, the US awaits a ruling by the supreme court on another challenge to Obamacare, this one brought by the Trump administration and Republican state attorneys general. If they prevail, more than 20 million Americans may lose health coverage. Nearly a half-million have died from Covid. Markets don’t always deliver what is needed.
The Ten Year War is a look back at the “crusade” for universal healthcare coverage, and a sequel to Cohen’s earlier book, Sick: The Untold Story of America’s Healthcare Crisis. Cohn is a senior correspondent at the Huffington Post. His take remains informed and nuanced, not breathless. The Ten Year War also captures acrid and tectonic shifts in US politics.
Cohn persuasively argues that the combatants in the healthcare fight operated with less than perfect knowledge, and that preconceived convictions too often clouded their judgment. Cohn aims at both policy wonks and political junkies. Laced with interviews and quotes from both sides of the aisle, his book is definitely newsworthy.
Obama and Tom Price, Donald Trump’s short-tenured health secretary, speak on the record. David Axelrod, Obama’s counselor, and Michael Carvin, a veteran conservative litigator who unsuccessfully argued against Obamacare’s constitutionality, also talk to the author. Years earlier, in the 2000 election, Carvin was on brief in George W Bush’s winning supreme court gambit.
Obama admits his surprise over Republicans not moving on after the ACA passed, unlike Medicare in 1965 under Lyndon Johnson. “We got no take-up on any of that stuff,” he says. Left unsaid is that blue and red are more than just colors – they are tribes.
By the same measure, Obama acknowledges “that there were those … who suggested that we shouldn’t do anything other than the economy”. That is an understatement.
One of those “outsiders” was Chuck Schumer, now the Senate majority leader. Even then, Cohn writes, the New Yorker grasped the political consequences of going all-in on healthcare amid a meltdown in the jobs and housing markets.
Indeed, after the Democrats lost the Senate in 2014, New York’s senior senator unloaded on Obama before the National Press Club: “After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs.” Said differently, the ACA highlighted the inherent instability of the Democrats’ upstairs-downstairs coalition.
Instead, in Schumer’s telling, “we took their mandate and put all of our focus on the wrong problem – healthcare reform.” Apparently, there are few things more gratifying in politics than telling a sitting president: “I told you so.”
Of course, political myopia is not the sole province of any one party. Price admits that Republicans too operated in their own universe.
“I think there was a lack of appreciation on the part of all of us in the administration about how difficult” repealing Obamacare would be, he says. Price is a physician as well as a former Georgia congressman.
Price criticizes Trump for fashioning policy to comport with the last voice to whisper into his ear, and for a fundamental lack of understanding of healthcare and insurance.
“We would make concrete decisions about what we were going to do,” he says, “get presidential sign-off, and then within 24 hours the decision would change.”
For Price’s boss, pulling the rug out from under others was standard operating procedure.According to recent reports, Steve Bannon, then ensconced at the White House, believed Trump was in the throes of dementia and ought to have been removed. That didn’t happen but Price did leave government – amid a swirl of controversy surrounding his use of taxpayer funds to finance travel on private aircraft.
No book on Obamacare would be complete without a retelling of John McCain’s late-night thumbs-down on the Senate floor. Here, Cohn definitely delivers. Adding to the legend, Cohn relays the Arizonan’s loss of patience with Senator Lindsey Graham, his longtime wingman who was already morphing into a Trump acolyte.
Hours before McCain dealt a death blow to ACA repeal, he appeared at a press conference with Graham to discuss the latest administration-backed gambit. As told by Cohn, “McCain seemed not to be paying attention to what Graham was saying.” One Republican aide saw what was happening, Cohn reports, and surmised that McCain had come to believe: ‘This thing is so fucking stupid I’ve got to kill it.’”
More than five in nine Americans believe it is the federal government’s responsibility to ensure that “all Americans have healthcare coverage”, a level of support actually smaller than 15 years ago. During the 2020 Democratic primaries, Joe Biden was the only top-tier contender who opposed both “Medicare for All” and efforts to abolish private health insurance.
He also understood the Democratic center better than Bernie Sanders or Elizabeth Warren. The core of the party wanted reassurance, not socialism or Massachusetts-style McGovernism. Neither senator would have beaten Trump.Utopia could wait.
When Biden, as Obama’s vice-president, exclaimed that the ACA was a “big fucking deal”, he was tacitly recognizing that Obamacare had pushed the boundaries of what was practicable. To quote Cohn, “In America, that is what change looks like”.
A mother left a Missouri ER before her son saw a doctor for his burned hand. Her family was billed $1,012.
by Jonathan Edwards - Washington Post - January 28, 2022
Mansi Bhatt panicked when her 2-year-old son burned his hand on the stove and blisters started to swell up on his palm.
She faced a choice: treat the burn at home or rush him to the emergency room. The 34-year-old mother contacted the family’s pediatrician, who, after looking at photos of the burn, told her to go to the local children’s hospital.
“I was very much worried,” she told The Washington Post.
Bhatt took her son, Martand, to the emergency room at SSM Health Cardinal Glennon Children’s Hospital in St. Louis. After checking in, seeing a nurse who took her son’s vitals and then waiting an hour and a half for a surgeon, Bhatt left with her rambunctious toddler before seeing a doctor or receiving any tangible medical treatment.
Within days, Martand’s burns healed, and the Bhatts thought that was the end of it.
Then came the hospital bill — $1,012.
Bhatt’s husband, Dhaval, 37, was shocked. He spent the next seven months fighting the charges and struggling to figure out what they were for.
The Bhatt family’s experience reveals a practice many Americans don’t know about: Some hospitals start charging emergency room patients almost as soon as they walk in the door, whether or not they see a doctor or get treatment. Sometimes they even charge a “facility fee” for telehealth appointments during which patients are home and never set foot in a medical facility.
SSM Health spokeswoman Stephanie Zoller Mueller told The Post in an email that the Bhatt family’s charges were appropriate. She said the hospital values transparency, which is why it posts information about pricing online and at the hospital itself, although she admitted it can “cause confusion for patients.” In the case of the Bhatts, hospital staffers explained that the charges were based on several factors, including “acuity of condition, traumatic wound care and numerous other assessments.”
“A patient does not have to receive additional treatment — procedure, labs, x-rays, etc. — to validate an ED [emergency department] level charge,” Zoller Mueller told Kaiser Health News, which originally reported the Bhatts’ emergency room charges.
The Bhatt family’s medical billing ordeal started on April 7. As Dhaval prepared for an upcoming yoga retreat in Tennessee, which was to last several days, his wife, Mansi, made them tea. Although she had turned off the stove, the burner was still hot when Martand, just weeks shy of his third birthday, reached to get something, touching the stovetop in the process.
His parents put his hand under cool, running water and slathered the burn in antibiotic ointment, the Bhatts told The Post. Martand was in pain and cried a bit but seemed fine as his father left for the retreat.
But when his mother checked the burn the next morning, blisters had started to form. With her husband away and the weekend approaching, she worried about getting her son medical treatment if his condition worsened.
Undergirding the decision of whether to seek medical care was her husband’s aversion to engaging with the American health system. Before moving to the United States from India 13 years ago, Dhaval Bhatt had been warned that going to emergency rooms was expensive. Bhatt told The Post he’s avoided them — and going to the doctor generally — ever since, preferring to treat minor ailments at home.
“It’s mainly because of how crazy the charges are,” he said. “It’s not just the ER [where] the charges are high.”
Still, Mansi decided to seek care for their son, in part because she was going to an address the pediatrician had given her, not knowing it was an emergency room. After arriving and checking in, a nurse looked over Martand, listened to his heart and stomach, and peered in his nose, mouth and ears, according to notes prepared by the hospital that Bhatt shared with Kaiser Health News.
“My objection to this is that there was no care provided,” Dhaval Bhatt wrote when communicating with Kaiser Health News.
The nurse left, telling Mansi a surgeon would come to check on Martand. With a toddler bouncing around the room, Mansi decided to leave with her son after about 90 minutes.
The bill came a few weeks later. The hospital had charged $1,012. Dhaval Bhatt’s insurance, UnitedHealthcare, had covered $153 of that, leaving the Bhatts with an $859 bill.
Most of that — $820 — was a “facility fee,” not for any treatment that was provided. According to Kaiser Health News, hospitals defend facility fees as necessary to keep emergency rooms open 24/7.
Dhaval Bhatt didn’t pay the $859. Thinking the hospital had made a mistake, he called several times to try to get representatives to lower or waive the bill. He reached out to his insurance company, which confirmed that, in its assessment, the hospital had charged him appropriately. Bhatt contacted the human resources department at Washington University in St. Louis, where he works as a pharmacologist and research scientist. He emailed the Missouri Department of Health, whose officials told him they don’t deal with billing issues.
“I tried pretty much everything,” Bhatt told The Post.
All of his efforts failed, and in October, the hospital sent his debt to a collections agency.
Bhatt tried one more thing: In early fall, he contacted Kaiser Health News, and in November, reporter Noam Levey responded. The two began working together to figure out the charges.
Bhatt finally broke through. After Levey reached out to the hospital, officials there waived the facility fee, lowering Bhatt’s bill to just under $39 — the cost for seeing the nurse.
Bhatt said he paid that bill.
Bhatt said he thinks the whole thing was unfair and sees it as validation for his years of avoiding the U.S. health-care system. If he had been home when his wife spotted the blisters, Bhatt said, they would have stayed put.
“People always told me to avoid the ER in America unless you are really dying,” he told Kaiser Health News.
Bhatt told The Post a story to illustrate his point. In November, Martand got hurt in another accident. While climbing and jumping on the couch, he fell and hit his head, opening up a deep cut in his brow, right between the eyes. Again, their pediatrician recommended they take him to the emergency room.
This time, the Bhatts didn’t go. Instead, they treated the cut themselves.
“We just stayed home and let it heal on its own,” he said. “Nothing happened. Everything was fine.”
Colorado Mom Hit With $847 Facility Fee for Son's Virtual Doc Visit
— Colorado Children's Hospital rep says same fee is charged for telehealth and in-person visits
by Jennifer Henderson - MedPage Today - January 25, 2022
A Colorado mom got quite the shock when she received a hefty "facility fee" bill for her toddler's telehealth appointment.
Brittany Tesso said she had already paid a bill from Children's Hospital Colorado for $676.86 for the 2-hour virtual visit for her 3-year-old son to determine if he required speech therapy, according to a report by KDVR, a Colorado TV station.
But 2 weeks later, she received a separate bill for an additional $847.35, leading Tesso to tell the station: "I would've gone elsewhere if they had told me there was an $850 fee, essentially for a Zoom call."
Tesso said she was told the additional amount was for a "facility fee."
"I was like, 'Facility fee? I didn't go to your facility,'" Tesso told the station. "I was at home and, as far as I could tell, some of the doctors were at home too." Tesso said she was told by a hospital representative that it charges the same fee whether patients come to the facility or receive care via telehealth.
KDVR had reported an earlier story of a father who said he was charged a $503 facility fee after his son was seen at a medical practice in a building owned by Children's Hospital Colorado, and roughly 20 viewers reached out to the news outlet about their similar experiences.
Tesso told KDVR that she believed the second bill was a surprise bill, and suggested that state lawmakers could do more to prevent such instances. An HHS rule banning surprise billing went into effect on January 1 of this year.
Adam Fox, deputy director at the Colorado Consumer Health Initiative, told KDVR that patients have little recourse because there are no regulations in the state regarding facility fees charged by hospitals.
In a statement provided to KDVR, Children's Hospital Colorado said that the issue was not exclusive to the hospital, and that it continually looks at its own practices "to see where it can adjust and improve."
The hospital added in the statement that it continues "to advocate for state and federal policies that address healthcare consumer cost concerns through more affordable and accessible insurance coverage and hospital and provider price transparency, while also defending children's access to care and the unique needs of a pediatric hospital."
In response to a MedPage Today request for comment, the hospital said it had no further information to share.
Telehealth is likely to remain a mainstay in healthcare delivery, according to a December Kaiser Health News (KHN) article, but experts also told KHN that it's not yet clear how such appointments, and any accompanying facility fees, will be handled moving forward.
https://www.medpagetoday.com/special-reports/exclusives/96855
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