Editor's Note -
THE CASE AGAINST PRIVATE EQUITY IN HEALTH CARE
The following link will take you to an exellent panel sponsored by The Lancet, the British medical journal, making the case against the ownership of health care assets by private equity companies - the most compelling I have heard. Well worth seeing.
- SPC
Thinking about universal health care is changing, even among doctors
by Daniel Bryant - Bangor Daily News - September 14, 2023
Daniel C. Bryant of Cape Elizabeth is a retired physician.
On Sept. 8, at its annual meeting, the Maine Medical Association released its Revised Statement on Reform of the U.S. Health Care System. The document is the result of two years of work by its Ad Hoc Committee on Health System Reform, with extensive input from Maine physicians through listening sessions throughout the state and email and personal commentary.
The statement lists problems with our current health care system, including poor health outcomes, cost, emphasis on profit, poor access for many, administrative burdens for physicians, poor Medicaid and Medicare reimbursement, physician burnout and “moral injury,” restrictions inherent in the employer-based model, inequities and systemic biases. Desirable features of the physician-patient relationship and of an ideal health care system are described and the statement concludes with the organization’s call for major, not piecemeal, reform on the national level. The members present at the meeting moved to enthusiastically endorse it.
What is particularly interesting about this statement is its support for the role of the federal government in ensuring equitable health care for all U.S. residents: “federal health care reform that provides universal coverage through either an adequately funded single payer system or a combination of private and public financing where the federal government has, at minimum, regulatory powers over health care delivery to protect consumers and providers from private profit-driven motives.” This is very different from the cautious, non-specific, state-focused recommendation in the medical association’s previous reform statement (from 2017): “Our objective should be to achieve basic health care for every resident of Maine.”
The Maine Medical Association’s new recommendation is not unique. It reflects an evolution, over the last few decades, of the medical establishment’s attitude toward the health care system of which it is a crucial part. For example, the American Medical Association’s 1957 Principles of Medical Ethics was all about physician autonomy and responsibility to patients in their practices: “A physician may choose whom he [sic] will serve,” physicians shall render to each patient “a full measure of service and devotion;” but then a 2001 revision added, “A physician shall support access to medical care for all people.” In 2018, the Medical Student Section of the AMA went so far as to petition the organization (unsuccessfully, as it turned out) to drop its traditional opposition to the single-payer model. And four other state medical societies (New Hampshire, Vermont, Hawaii and Washington) have published resolutions supporting that model, as have a number of specialty societies such as the American College of Physicians.
Of course, not all physicians share this position, and much of the sometimes vigorous discussion during the workshopping of the MMA statement centered on the question of the federal government’s responsibility or right to ensure health care for all. Many physicians, thinking of Medicare and Medicaid reimbursement rates, fear their income may drop in a publicly funded plan, though some studies suggest that savings in a streamlined system like single payer would compensate for reduced reimbursement for most physicians. And there are practices that receive significant income from special insurance arrangements and side businesses that would be restricted, if not eliminated, in a publicly funded system. Should these physicians be deprived of this income? Does medical professionalism require that of them? The public expects it of them?
As we think about these questions and about the kind of health care reform we want, it will behoove us to consider the ideas expressed in the MMA’s statement. It would be important as well to ask our own physicians (if there’s time in a hurried appointment!) what they think of it, and to let them know our own opinion.
Raise the quality of health care
By John Sytsma, M.D.
By now, most people must realize how expensive the health care system has become under the Affordable Care Act.
Who is paying for all the subsidies to private health care corporations? Taxpayers are.
Who is paying their millionaire CEOs, their lobbyists, lawyers, stockholders and for the TV ads? The taxpayers are.
The Affordable Care Act allows 20 percent of health care costs to go to those wasteful enterprises called "overhead," while the actual health care benefits they deliver are lower than with any other industrialized nation in the world.
A government-sponsored, not for profit, system of universal health care coverage — basically, an improved Medicare for all — can pay for health care services for everybody with an overhead of around 3 percent. According to Physicians for a National Health Program, the U.S. could save $400 billion per year. That money could be spent on medical services that are not presently covered.
An expanded Medicare could negotiate physician fees, hospital costs, drug prices, costs of procedures, and prices of medical equipment. It could do meaningful studies on the effectiveness of medical treatments and of outcome measures.
How can this nation afford to not have a national health insurance program?
How can the people of this nation afford to not raise the quality of health care in this country?
Dr. John Sytsma resides in Farmington.
http://www.sunjournal.com/news/letters/2015/05/17/j-sytsma-raise-quality-health-care/1705364
Medical debt nearly pushed a Colorado family onto the streets
Kayce Atencio used to be haunted by a thought while working at a homeless shelter in downtown Denver. “It could have been me,” said Atencio, 30, who lives in a small apartment with his son and daughter not far from the shelter.
It nearly was. Atencio and his children for years slept on friends’ couches or stayed with family, unable to rent an apartment because of poor credit. A big reason, he said, was medical debt.
Atencio had a heart attack at 19, triggered by an undiagnosed congenital condition. The debts from his care devastated his credit score. “It always felt like I just couldn’t get a leg up,” he said, recalling a life of dead-end jobs and high-interest loans as he tried to stay ahead of debt collectors. By 25, he’d declared bankruptcy.
Across the country, medical debt forces legions of Americans to make painful sacrifices. Many cut back on food, take on extra work, or drain retirement savings. For millions like Atencio, the health care system is threatening their very homes.
That’s proven particularly devastating in communities like Denver, where skyrocketing prices have put housing out of reach for many residents and fueled a crisis that’s left thousands homeless and sleeping on the streets.
At the Community Economic Defense Project, or CEDP, a Denver nonprofit that helps people facing eviction or home foreclosure, about two-thirds of clients have medical debt, an informal survey by KFF Health News and the organization suggests. Close to half of the nearly 70 people surveyed said medical debt played a role in their housing issue, with about 1 in 6 saying it was a major factor.
“All day long I hear about medical debt,” said Kaylee Mazza, a tenant advocate who staffs a CEDP legal clinic at the Denver courthouse that offers aid to tenants going through eviction proceedings. “It’s everywhere.”
Nationwide, about 100 million people have some form of health care debt. Of those, about 1 in 5 said the debts have forced them to change their living situation, including moving in with friends or family, according to a 2022 KFF poll.
A growing body of evidence shows that stable housing is critical to physical and mental well-being. Some major medical systems — including several in Colorado — have even begun investing in affordable housing in their communities, citing the need to address what are sometimes called social determinants of health.
But as hospitals and other medical providers leave millions in debt, they inadvertently undermine community health, said Brian Klausner, a physician at a clinic serving homeless patients in Raleigh, North Carolina.
“Many of the hospitals across the country that are now publicly vowing to address health inequities and break down barriers to health are simultaneously helping to create these very problems,” Klausner said. “Nobody likes the elephant in the room, but the reality is that there are thousands of sick Americans who are likely homeless — and sick — because of medical debt.”
A Downward Spiral
Medical debt can undermine housing security in several ways. For some, it depresses credit scores, making it difficult to get a lease or a mortgage. Last year, about 1 in 8 U.S. consumers with a credit report had a medical debt listed on it, according to the nonprofit Urban Institute.
Patients with chronic medical conditions may fall behind on rent or home payments as they scramble to keep medical debts in check to preserve access to health care. Many hospitals and other providers will turn away patients with outstanding bills, KFF Health News found.
Denise Beasley, who also assists clients at CEDP in Denver, said many older people, who typically depend most on physicians and medications, believe they must pay their medical and pharmacy bills before anything else. “The elderly are terrified,” she said.
For others, such debt can compound financial struggles brought on by an accident or unexpected illness that forces them to stop working, jeopardizing their health coverage or ability to pay for housing.
In Seattle, researchers found widespread medical debt among residents in homeless encampments. And those with such debt tended to experience homelessness two years longer than encampment residents without it.
More broadly, people with medical debt are more likely to say the debt has caused them to be turned down for a rental or a mortgage than people with student loans or credit card debt, according to a 2019 nationwide survey of renters, homebuyers, and property owners by real estate company Zillow.
For Atencio, who left home at 16, his struggles with medical debt began with the heart attack. He was working at a gas station and living in Trinidad, a small city in southern Colorado near the New Mexico border.
Rushed to a local hospital, he underwent surgery. The bills, which topped $50,000, weren’t covered by his health plan because he’d unknowingly gone to an out-of-network provider, he said. “I fought it as hard as I could, but I couldn’t afford a lawyer. I was stuck.”
Atencio, who is transgender, has close-cropped dark hair and a large tattoo on his right forearm memorializing two friends who died in a car accident. Sitting on an aging couch in an apartment with bars on the windows, he’s philosophical about his long journey from that medical crisis through years of debt and housing insecurity. “We’ve pulled ourselves out of this,” he said. “But it took a toll.”
When Atencio’s credit score dipped close to 300, the lowest rating, there were few places to turn for help. Atencio’s relationship with his parents, who divorced when he was 2, had been strained for years. Atencio got married at 18, but he and his husband rarely had enough to make ends meet. “I remember thinking, ‘What kind of a start to my adult life is this?’”
They were ultimately taken in by Atencio’s mother-in-law. “If it wasn’t for her, we would have been homeless,” he said. But getting out from the debt was agonizing.
“You end up in this cycle,” he said. “You get into debt. Then you take out loans to try to pay off some of the debt. But then there’s all this interest.” With poor credit, Atencio relied at times on payday lenders, whose high interest rates can dramatically increase what borrowers owe. Many employers also check credit scores, which made it difficult for Atencio to land anything but low-wage jobs.
The job at the shelter was a step up, and Atencio this year got the apartment, which is reserved for single-parent families at risk of being homeless. (Atencio separated from his husband last year.)
Colorado’s Housing Challenges
Atencio’s housing struggles are hardly unique. Jim and Cindy Powers, who live in Greeley, a small city north of Denver, saw their own housing dreams collapse after Cindy was diagnosed with a life-threatening condition that required multiple surgeries and left the couple with more than $250,000 in medical debt.
When the Powers declared bankruptcy, the settlement protected their home. But their mortgage was sold, and the new lender rejected the payment plan. They lost the house.
Lindsey Vance, 40, who moved to Denver five years ago seeking more affordable housing than the Washington, D.C., area where she was from, still can’t buy a house because of medical debts. She and her husband have a six-figure income, but medical bills for even routine care that she’s struggled to pay since her 20s have depressed her credit score, making it difficult to get a loan. “We’re stuck in a holding pattern,” she said.
In and around Denver, elected officials, business leaders, and others have become increasingly concerned about medical debt as they look for ways to tackle what many see as a housing crisis.
“These things are deeply connected,” Denver City Council member Sarah Parady said. “As housing prices have gone up and up, I’ve seen more and more people, especially people with a medical issues and debts, lose housing security.” Parady, who ran for office last year to address housing affordability, is helping lead an effort to get the city to buy and retire medical debt for city residents.
Fueled by skyrocketing prices and rising interest rates, the cost of buying a home more than doubled in Denver from 2015 to 2022, according to one recent analysis. And with rents also surging, evictions are rocketing upward after slowing during the first two years of the pandemic.
Perhaps nowhere is Denver’s crisis more visible than on the streets. The city’s downtown is dotted with tents and encampments, including one that stretches over several blocks near the shelter and clinic where Atencio used to work. By one count, metro Denver’s homeless population increased nearly 50% from 2020 to 2023.
CEDP, which was founded to help residents with housing challenges sparked by the pandemic, this year joined other Colorado consumer and patient advocates to push the legislature for stronger protections for patients with medical debt.
And in June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores, a move that put the state at the forefront of efforts nationally to expand debt protections for patients.
A few other states are considering similar steps. And in Washington, D.C., consumer and patient advocates are pushing for federal action to limit medical bills on credit reports. In most states — including many with the highest rates of medical debt — patients still have no such protections.
For his part, Atencio is hoping the new apartment marks a turning point.
The home is modest — a small unit in an aging concrete tower. There’s a security guard by the front door and long, linoleum corridors painted institutional blue and brown.
Atencio’s family is settling in, along with four pet rats — Stitch, Cheese, Peach, and Bubbles — who live in a large cage in the living room. “This feels like freedom,” said Atencio.
He’s tried to give his children, who are 5 and 11, a sense of security: home-cooked meals and the space to play or hang out in their own bedrooms. Like parents everywhere, he frets over their screen time and rolls his eyes when they critique what’s for dinner. (They didn’t like the potatoes he put in a pot roast.)
They are all full-time students: Atencio, who left his job at the shelter, is working on a master’s in social work. His son just started kindergarten, and his daughter is in middle school. “I have big plans and big goals,” he said.
And with several thousand dollars of medical debt still to pay off, Atencio said he’s careful not to take his kids to an out-of-network hospital or physician. “I won’t make that mistake again,” he said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
The Maine Millennial: Why won’t we think of health care as a public good?
By Victoria Hugo-Vidal - Portland Press Herald - September 24, 2023
Contrary to popular misconception, most doctors don’t become doctors to get rich. If you have the intelligence, drive and focus to become a doctor, there are much easier ways to get rich. Doctors become doctors because they genuinely want to help people, and then they get thrown into the psychological meat grinder of the American health care system.
One of the factors that led to my dad’s death from cancer at age 59 was a misdiagnosis of fibromyalgia. For months, he assumed that’s what his pains were, rather than a recurrence of melanoma growing inside his body. By the time the tumors were discovered, it was too late for treatment to work. And he died.
Did you know that there’s a statistically significant jump in cancer diagnoses at age 65 in America? That’s the age that most American adults become eligible to go on Medicare (you know, the evil scary socialist government health insurance) and, as such, can finally afford to go to the doctor and get the recommended tests and screenings done. More than maybe any other illness, early detection and treatment of cancer saves lives. It also saves money; it’s a lot cheaper to treat a Stage 1 tumor than a Stage 3 one. Money, however, can be replaced. People can’t.
My dad’s late cancer diagnosis wasn’t because of a lack of insurance (we actually had good insurance at the time). It was because of an honest mistake, an error in judgment. But it just makes me even angrier that other girls have to watch their dads die unnecessarily for something as banal and stupid as money because we, as a country, haven’t managed to decide that providing health care shouldn’t be an entirely for-profit enterprise.
It wasn’t my fancy liberal arts college education that radicalized me into wanting universal health care and/or insurance for all of us (something that dozens of other countries on earth have managed to figure out). It was watching the stiff little bounce my dad’s body made as he was transferred from the hospice bed to the funeral home’s stretcher. There is a yawning black hole inside me that screams at injustice and greed. I used to fill it up with wine. Now I don’t. The hole has only gotten bigger; if I could swallow up every health insurance executive and make them feel the grief of the families who died as a direct result of their profitable financial choices, I would. I would trap them in the pain with me.
There are lots of businesses we have outlawed because our lawmakers have decided they are immoral. Prostitution is the big one. Gambling, although in some places, that prohibition is relaxing more and more. Dogfighting. The sales of certain drugs. Cocaine, immoral. Alcohol, moral and available at your local gas station. Marijuana, morality varies by jurisdiction. So why have we, as a culture, decided it’s moral to profit off the act of denying payment for health care?
That’s how for-profit insurance companies make those big bucks, by denying payment for claims. And those claims aren’t just numbers on an investor’s spreadsheet. They translate to real people with real bodies. Bodies with lurking tumors, in too many cases. Actual tests and treatments. Treatments that are often time-sensitive. There’s a word for those people who make money off the suffering of others, and it rhymes with “weevil.”
I’m actually not surprised that the Maine Medical Association joined the medical associations of four other states to call for a system of universal health care coverage. Dirigo, right? Well, Dirigo after state medical associations in Hawaii, Vermont, New Hampshire and Washington. But fifth out of 50 is pretty dang forward-thinking!
The statement didn’t surprise me because I’ve been working with Maine doctors for a few years now. I’ve seen them behind the scenes. I mean, maybe it surprised me that they had enough time to attend these meetings to put it all together. All of them are overworked and underpaid for the amount of work they do. If they weren’t on the edge of burnout before the COVID-19 pandemic started, they are now toasted to a crisp. And they still show up every day. They still are constantly squeezing in one more patient, making one more phone call. I’d bet literally all of my savings (calm down, it’s four figures) that each and every provider in the Maine Medical Association would gladly take a pay cut if it meant all of their patients could afford their prescriptions and tests and procedures.
The Maine Medical Association’s verbose statement says, among other things: “We are calling for federal health care reform that provides universal coverage through either an adequately funded single-payer system or a combination of private and public financing where the federal government has, at minimum, regulatory powers over health care delivery to protect consumers and providers from private profit-driven motives.”
Translation: We’ll go with any system as long as it works. Personally, I think Medicare for All is the best way for America to transition to a system of single-payer health insurance. The infrastructure is already there, we’d just have to build it out to cover everyone. But honestly? I’m flexible. As long as everyone’s in, nobody is left out and we don’t see any more deaths of delay, I’m happy.
Victoria Hugo-Vidal is a Maine millennial. She can be contacted at:themainemillennial@gmail.com
Giant Medicare Advantage Company Rolls into Upstate New York to Gobble up Medicare Benefits
by Corthammer - Daily Kos - September 28, 2023
Apparently, no group of retirees is too small for these companies. A combination of an Insurance Brokerage (Assured Partners) and United Health Care have descended into tiny upstate New York Cortland County to engorge themselves on the Medicare benefits from about 400 retired county employees.
The majority cohort of our grossly ill-informed county legislators were told they were going to save $800,000 per year if they forced the retirees into the UHC “advantage” program. That was all they needed to hear. On August 24th after shockingly minimal notice to the retirees, and even deceiving the retirees as to when they would actually vote on it, the legislators voted to shove the retirees into the “advantage” pipe. They first announced they would not vote on it until October. Then the Legislative Chairman pulled a sneak maneuver and suddenly put it on the agenda for August 24th-- contrary to what he had publicy stated previously. He apparently feels this was an appropriate thing to do, he must think himself very clever putting that one over on the retirees. They then bum-rushed the vote through before hardly anyone knew they had moved the vote up by over a month. No hearings, no chance to present witnesses or actual evidence about why the plan might not be best for the retirees---just a rushed, sneak vote with the republican majority ramming it through.
It also appears from what we can discern ( which is very little given the lack of notice) that the legislators never even saw the contract from UHC that they were voting on. They also never saw the fine-print benefits book (called the “Evidence of Coverage” document in UHC-speak), before voting on it. We know they did not see that, because when we asked for it, they said it won’t be available until October! It’s like signing the bottom of a note and mortgage and telling the bank to fill in the details later. The utter lack of due diligence is stunning, but that’s what we have here. The advantage companies and their front-men know they can pull the wool over the rubes’ eyes in these tiny rural counties.
Unlike the retirees in Vermont (10,000) and in New York City (250,000), they likely calculate that they can easily roll over 400 elderly retirees living on fixed incomes who do not have the resources to hire a large law firm to beat them back. Easy pickings for these so called “advantage” health care companies to pick off little groups of retirees who don’t have the money to fight back.
We now have some very elderly retirees, some with stage 4 cancer and other extremely ongoing serious issues who on January 1st, 2024, may now face losing their provider or having their current treatments discontinued subject to the whims of a privatized for profit conglomerate.
This is truly shameful what is being allowed to happen to retirees who worked 30+ years for the Medicare benefit they were promised and paid for out of their own pocket and then to have it stolen away towards the end of their lives for the enrichment of the big private healthcare companies. Letters have been written to our state representatives for this district (Democrats, Anna Kelles and Lea Webb) asking them to at least use their platform to make some noise about this, but so far---no comment.
https://www.dailykos.com/stories/2023/9/14/2193359/-Giant-Medicare-
