Editor's Note -
The following email was sent around by MAC supporter Daniel Bryant. I thought it deserves more attention, so I'm including it it this blog posting - The Maine AllCare message seems to be resonating with some folks. There's some news in today's blog posting.
- SPC
Hello All - Below I've copied a summary of a Keckley Poll confirming popular concern about our health care system. No mention of SP, but the last section, which I've bolded (red sections are Keckley's emphases), certainly sounds like it.
November 20, 2023
In the 4Q 2023 Keckley Poll*, signals about the public’s perception of the U.S. health system are clear:
- The majority think the system is heading in the wrong direction and needs fundamental change. They believe it puts its profits above patient care.
- Trust and confidence in the health system’s major institutions is low: none enjoys “a great deal” of trust from a majority. And few expect politicians to address the system’s issues because it’s too complicated/politically risky.
- 69% think the system is fundamentally flawed and in need of major change vs. 7% who think otherwise.
- 60% believe it puts its profits above patient care vs. 13% who disagree.
- 74% think price controls are needed vs. 7% who disagree.
- 76% think politicians avoid dealing with healthcare issues because they’re complex and politically risky vs/ 6% who think they tackle them head-on.
- And no major institution in the system enjoys “a great deal” of trust and confidence in the public’s view of their ability to “develop a plan for the U.S. health system that maximizes what it has done well and corrects its major flaws.” Hospitals and physicians hold a slight edge over the federal government, retail health and health insurers but none enjoys a solid majority of public support as the system problem solver.
| % Agree with each statement | Strongly Agree | Agree | Mixed Feelings | Disagree | Strongly Disagree |
| The U.S. health system is heading in the right direction. | 11 | 17 | 43 | 13 | 13 |
| I believe the U.S. health system is fundamentally flawed and needs major change | 33 | 36 | 24 | 6 | 1 |
| The U.S. health system puts its profits above patient care. | 30 | 30 | 27 | 9 | 4 |
| I believe the federal government should impose price controls for hospital services, prescription drugs and insurance premiums. | 39 | 35 | 19 | 4 | 3 |
| I believe the tax exemption given not-for-profit hospitals is justified by the community benefits they provide | 18 | 37 | 34 | 7 | 3 |
| Having health insurance that's affordable and comprehensive is essential to financial security | 46 | 37 | 13 | 2 | 1 |
| The majority of physicians care more about caring for their patients more than their income. | 17 | 32 | 38 | 12 | 5 |
| I am confident in my ability to navigate the U.S. system when I have a problem. | 14 | 38 | 32 | 11 | 5 |
| Most politicians avoid healthcare issues because solutions are complicated and they fear losing votes. | 33 | 43 | 18 | 4 | 2 |
How much trust and confidence do you have in … to develop a plan for the U.S. health system that maximizes what it has done well and corrects its major flaws?
| % Trust and Confidence | A great deal | Some | Not much/none |
| Insurance Companies | 18.4 | 43.2 | 38.4 |
| Hospitals | 27.4 | 51.9 | 20.7 |
| Physicians | 32.5 | 52.9 | 13.6 |
| Federal Government | 14.2 | 42.4 | 43.5 |
| National Retail Health Companies | 21.3 | 50.9 | 27.8 |
My take
These findings are consistent with studies by Gallup, Pew and the Kaiser Family Foundation that have shown erosion of public trust in the system. Like those, the root cause seems related to how the business of healthcare is conducted. Since its not widely understood nor taught in K thru 12 or college curricula, public opinion is shaped by individual experiences—good and bad—and media coverage, more often negative than positive.
Thus, the data above are not surprising: the public is fed up with the health system, holds all its major players responsible and lacks confidence any one sector will solve its issues appropriately. They’ve concluded its more about money than mission and purpose.
Pew, Gallup and Kaiser Family Foundation have chronicled the decline in institutional trust that’s eroded faith in the political system, big business, organized religion, the Supreme Court and health system. They attribute their demise to the impact of media coverage and changes in the public’s expectations about its use of time, money and values. In coming Keckley Reports, we’ll explore these more deeply comparing those who are unhealthy vs those who are well, those who have health insurance vs. those without, those of household means vs. those lacking, and others.
But what’s clear is this: public opinion about the health system is negative lending to calls for change that are systemic: predictable, understandable, accessible, transparent prices across the board; proof of quality and guarantees of outcomes; access that’s simple and hassle-free and affordability. No single sector in healthcare can deliver these: a collective solution is the only answer.
It’s more than a PR problem. More effective messaging is a start but not enough. The public’s fed up with the status quo and frustrated by its benign neglect of systemness solutions. So, what else is new?
The AMA may reconsider single-payer health care
The AMA flirts with a big change: Embracing (or at least not opposing) single-payer
Is the American Medical Association going soft on single-payer health care? We’re about to find out.
For more than a century, the most influential U.S. physician group has stridently opposed what could generally be described as “national health insurance.” It famously helped defeat health reform efforts in the 1930s and 1940s, delayed the establishment of Medicare for years, and helped sink President Bill Clinton’s health overhaul in the 1990s.
So it was a big deal when the AMA endorsed the Affordable Care Act in 2009.
(An aside: A main reason the organization offered its support was the promise, in its early forms, that Obamacare would end a pernicious Medicare payment cut. That didn’t happen until 2015. But that’s a whole ‘nother story.)
The last time the AMA’s House of Delegates, its policymaking body, debated single-payer health care was in 2019. That effort was spearheaded by the more left-leaning medical student section. The students’ resolution would not have specifically endorsed a single-payer program, such as Medicare-for-all. Instead, they just aimed for the AMA to be neutral on single-payer, dropping its longtime official opposition.
The students’ resolution failed, but much more narrowly than anticipated: 53 percent to 47 percent.
This time, it’s not the student section of the organization pushing for a single-payer resolution to be offered at the House of Delegates meeting later this month, at National Harbor outside Washington. It’s the delegation of practicing doctors from New England.
That alone should help the resolution get taken more seriously than in 2019, said Rohan Khazanchi, who was involved in the student effort in 2019 and is now a second-year resident in internal medicine and pediatrics at Harvard.
- “For better or worse, the student section is the conscience of the organization,” Khazanchi said. “They’re always bringing issues of health and social justice to the floor. But sometimes it’s a little harder for other stakeholders in the House to get behind that.”
He’s also more optimistic because the makeup and leadership of the AMA has shifted in recent years, embracing challenges like health inequities and racism in medicine. “Really big, meaty health justice issues are now being taken on as an express priority of the organization,” he said.
That leftward shift in political outlook is showing up not just in the AMA, but in medicine as a whole. As the physician population has become younger, more female and less White, doctors (and other college graduates in medicine) have moved from being a reliable Republican constituency to a more reliable Democratic one.
But even if the AMA votes to stop fighting single-payer, as a practical matter, the resolution won’t have much impact. The organization maintains other policies that would still preclude support for any proposal that would increase the power of payers — including the government — over patients and physicians, an AMA spokesperson said in an email.
Another stab at a broad overhaul of the U.S. health-care system is pretty unlikely in the near future anyway, said Zeke Emanuel, a physician who helped former president Barack Obama win passage of the Affordable Care Act and is now vice-provost for global issues and co-director of the Healthcare Transformation Institute at the University of Pennsylvania.
- “The system sucks worse than ever. I do think there’s more dissatisfaction” among patients and care providers, he said, despite the ACA extending insurance coverage to millions of Americans.
- “I don’t think it’s at a critical level, and more importantly, we don’t know how to do the strategic reform,” he added.
So the AMA adopting a single-payer resolution won’t “fundamentally change the equation,” Emanuel said. But he feels it would send an important signal. “Docs feel pulled in a million different ways,” he said, “undermining their ability to do the job and their satisfaction. They’re not doing what they came into medicine for, to care for patients.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism.
Maine Medical Association releases bold policy statement on health care reform
Big news! Maine doctors speak up for publicly funded, universal health care
The Maine Medical Association adopted a new policy on health care reform at their annual meeting in Portland in early September, calling for a national single-payer plan, or failing that, action at the state level for publicly funded, universal health care.
This is a big step, as only four other state medical associations have adopted similar resolutions and we consider the MMA’s new policy to be the most detailed and robust of all of these. Maine AllCare’s Phil Caper and Henk Goorhuis were members of the committee that worked on the policy for nearly two years. We wholeheartedly support the new statement and applaud MMA for their leadership.
The American Medical Association has yet to support universal health care (and has actively opposed it for much of its history), but momentum is building in that direction as medical professionals and students across the country push for the AMA to change its position — and state medical associations, which are AMA chapters, also take action.
The list of health care system failures outlined in the statement is fully aligned with issues Maine AllCare has been highlighting for more than 10 years. And the recommended solution — a federal single payer-type system or, as a fallback, a state-based universal system — is what we also support. Hearing this statement from Maine doctors who are on the health care front lines is especially powerful.
The MMA annual meeting also featured a keynote by T.R. Reid, a nationally recognized filmmaker and author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” and panel sessions with physicians who practice in countries around the world that have universal health care. Every physician on these panels, from Germany, Australia, Canada, and other countries, described challenges in their systems. And ALL said they are glad to work in a place where everyone has health care and profit-making doesn’t drive the health care system.
“As a society we have worn out the arguments for the status quo in health care,” said Maine AllCare Board Chair Karen Foster. We hope that policymakers will heed this clarion call for broad reform that considers health care to be a public good, available to all.”
The Maine Monitor, Portland Press Herald, Maine Public, and Bangor Daily News covered this news, and published several responses. See links below.
Maine Monitor, reported by Emily Bader (Sept. 11) and also published by the Bangor Daily and the Portland Press Herald:
Maine Medical Association says American healthcare system needs an overhaul
“’While we are among a small number of medical associations to do this, we think our actions represent a growing consensus of physicians, both in Maine and nationally, that it’s time for every American to have healthcare insurance and to figure out how to do that in a way that’s affordable and equitable,’ [Dr. Erik Steele, immediate past president of the MMA] said.”
Maine Public, reported by Patty Wight (Sept. 11):
Group representing Maine doctors urges lawmakers, governor to adopt universal health care
“The statement was prompted by growing frustration among physicians about the complexities of the current health care system that interfere with patient care ‘that result in needless patient illness and suffering, and, in some cases, death,’ says Dr. Erik Steele, immediate past-president of the Maine Medical Association.”
Dr. Phil Caper’s response in the Portland Press Herald (Sept. 17):
Kudos to Maine Medical Association’s call for reform
“Sometimes, fundamental change is necessary to serve the public interest. Such change may require disruption and adaptation. In such times, we must follow our oath as physicians to ‘put the patient first’ and ‘first do no harm’ (including economic harm) ahead of all other considerations.”
Dr. Daniel Bryant’s response in the Bangor Daily News (Sept. 14):
Thinking about universal health care is changing, even among doctors
“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.”
—Liz Solet, Maine AllCare Communications
Maine Medical Association releases bold policy statement on health care reform
Held in bondage: US patients losing equity in homes to hospital lawsuits
Terry and Sandra Belk’s medical bills began to pile up after a series of illnesses – including breast cancer, prostate cancer and gallbladder surgery – repeatedly sent them to the largest hospital system in Charlotte, North Carolina, Atrium Health.
Despite having commercial insurance, the Belks received bills for tens of thousands of dollars. When the couple couldn’t pay, Atrium sued them through North Carolina’s civil courts.
Like millions of Americans, Terry Belk – Sandra died in October 2013 – is stuck in medical debt. Unlike so many others, because of North Carolina’s debt system, it also means that when the hospital successfully won a judgment against him, they claimed ownership of part of the equity on Belk’s home.
“This is putting tremendous pressure on my health,” said Belk from the dining room of his three-bedroom, two-bath one-story ranch that sits atop a small hill. “On one end, they help you get well. On the other, you get sick again.”
In North Carolina, a successful debt lawsuit automatically places a lien on real property, a kind of collection method that secures a debt against the value of a home. For most people, that property lien is on the family home.
Belk, 67, cannot retire because of the debt. Sandra nearly refused to see doctors in her dying days because of the debt. The lien will need to be paid before the home can be sold or transferred to Belk’s heirs – he has five children and 10 grandchildren. For Belk, medical debt is nothing short of “bondage”.
“I’ll probably die before it’s paid out,” said Belk. “We are married,” he said of himself and the hospital. “It’s till death do us part.”
Medical debt and the burden it places on Americans has come under increasing scrutiny following the pandemic. A recent investigation by Kaiser Family Foundation news found the majority of the nation’s 5,100 hospitals likely use “extraordinary” collection measures, including suing patients.
In North Carolina, the practice received heightened attention after the state’s treasurer, the Republican Dale Folwell, published a report finding “litigious” hospitals in the state had filed more than 7,500 lawsuits in just five years. The most litigious, in sheer volume, was Atrium. Officials there said they stopped suing patients in November 2022, “as part of our journey in making health care more affordable”.
However, the non-profit stopped short of providing relief to patients such as Belk, who both has liens on his home and was encouraged to take on credit card debt to pay the hospital, because he worried about future lawsuits.
“They’re making indigent and poor people and people of color’s life hell,” said Belk, who is Black, about hospital debt collections.
He wants only one thing: “Release the liens” – not for himself, but for others whom hospitals “hold in bondage”.
Atrium said that it has a “generous financial assistance policy” and that it does not turn patients away “regardless of their ability or inability to pay”.
Thanks to a recent merger, Atrium is the third-largest non-profit health system in the country. It serves 6 million patients per year across 67 hospitals and more than 1,000 other clinical sites located in several states in the midwest and south-east. The non-profit reported $15.2bn in revenue in the first half of the year, with nearly $998m in excess revenue after expenses.
“As a leading, nonprofit health system, Atrium Health is working to ensure access to high-quality care for everyone in the communities we serve,” said a spokesperson for Atrium Health. “For us, there are no profits – just outcomes, in the form of improving health, elevating hope and advancing healing – for all.” Atrium said it could not comment on Belk’s specific case, citing patient privacy laws.
Sandra Belk was working in the shoe department in Macy’s when she was diagnosed with breast cancer. She and Terry each had insurance, but still racked up bills. In 2005, to secure a debt of $23,311 from Sandra’s treatment, a lawyer for the hospital convinced the couple to sign a deed of trust to their home. It required Atrium’s debt and attorneys’ fees to be paid before the home could be sold, transferred or refinanced.
In 2010, Belk was diagnosed with prostate cancer. Suddenly, he owed another $6,792, which he could not pay. In 2012, the hospital sued to collect its money and succeeded. Another lien was placed on the family home, with an 8% annual interest rate and more attorneys’ fees on top. Worse, Sandra’s cancer returned.
“She was the most wonderful person,” Belk said, and repeated it twice more, shaking his head. “She had months to live, and they were suing her right along with me.”
In 2013, Sandra died at 61. That did not stop the hospital from refiling the debt lien from her initial treatment, when it would have otherwise expired in 2022. That has allowed the hospital to retain a stake in Belk’s home to this day.
By 2023, Terry again needed hospital care, but was well aware of Atrium’s collections practices. He did not want to return to Atrium, but felt he had no choice. Not only was Atrium the only hospital his health insurance covered, but it also dominated the area with 52% of the healthcare market share in the 13-county region surrounding Charlotte.
According to the US government, Atrium used that very dominance to gain an “anti-competitive” advantage, insisting insurers send patients to them and limit information about price and quality.
This time, instead of waiting to be sued, Belk took out a credit card through the medical financing company AccessOne to pay Atrium. He owes $1,707 on the card, and as of late September was 30 days behind on his payments.
Belk is hardly alone.
“Most every one of my clients has six or eight or 12 [bills],” said Ed Boltz, a bankruptcy attorney based in Durham, North Carolina. “They owe this doctor $900 or $600,” or, perhaps, “$10-, $20-, $30,000 on some catastrophic medical event they were hit with.”
“A large number, particularly of private hospitals, are very aggressive in bringing lawsuits for those balances and getting judgment liens so they can collect on those debts,” said Boltz. Hospitals rarely initiate foreclosure proceedings, though they could choose to. Instead, he said: “They’re willing to be patient to wait and collect on those debts.”
The US has the highest healthcare prices in the world, and an insurance system that has pushed more and more costs onto patients in the last 10 years. It’s a system that has increasingly concerned Folwell, whose agency is the largest provider of private health insurance in North Carolina – providing care to 750,000 teachers, police and other public servants.
“What I’ve observed in dealing with this healthcare cartel is the biggest transfer of wealth in my lifetime,” said Folwell, “especially from low- and middle-income individuals to these multibillion-dollar corporations who describe themselves as nonprofits”.
Notably, assessing the true scope of medical debt is difficult. A 2019 survey by KFF suggests it could total $195bn in 2019. What is clear is who is most affected. The US Consumer Financial Protection Bureau (CFPB) confirms Belk’s observations that collection practices hit Black, Latino and young and poor people of all races hardest.
“Over the course of the years, it became clear this was a major issue,” said Corine Mack, the president of the Charlotte NAACP. Because property is the most common way Americans pass on wealth, “What is happening now will affect generations of people,” said Mack.
Folwell has vociferously pushed for change – advocating for the passage of the Medical Debt De-Weaponization act in North Carolina, a bill that would enact a raft of consumer protections, including shouldering the burden of a family member’s medical debt. The bill sailed through North Carolina’s Senate, but died in committee in the house.
Hospitals have lobbied against the bill, but Folwell points out that nothing is stopping them from lifting liens on people’s homes today.
“The hospital executives without a law could snap their fingers and make most of this go away,” said Folwell.
Until liens are lifted on people’s homes, Belk said he has no intention of staying quiet.
“I’m not special. I’m not even smart – but what I am is committed,” said Belk. In an effort to lift liens from medical debt, he exhorts others: “Come join me.”
https://www.theguardian.com/us-news/2023/nov/06/hospitals-lawsuits-atrium-north-carolina
Sen. Sanders pushes NIH to rein in drug prices
Can the National Institutes of Health bring down drug prices? It doesn't approve new medicines or pay for them, but its role in drug research gives it surprising leverage.
Sen. Bernie Sanders, chairman of the Health, Education, Labor and Pensions committee, voted against confirmation of Dr. Monica Bertagnolli as NIH director. Sanders, a Vermont independent who caucuses with the Democrats in the Senate, said that he didn't think Bertagnolli was prepared to stand up to the pharmaceutical industry.
But Sanders tells NPR he plans to work with Bertagnolli, who was confirmed Nov. 7. He says something has to change at the NIH, which spends billions of dollars each year on biomedical research that lays the foundation for lucrative profits for the drug industry.
"And yet, despite the huge amount of money that taxpayers spend developing these drugs, the drug companies get the product and they end up charging us the highest prices in the world for it," Sanders says.
Government contracts could exert leverage
The Moderna COVID vaccine is an example of the problem, he says. The vaccine was developed with the National Institute of Allergy and Infectious Diseases, part of the NIH. And the government agreed to buy 100 million doses even if it failed clinical trials, wasn't authorized by the Food and Drug Administration and all those doses wound up in the trash.
Ameet Sarpatwari, assistant director of the Program on Regulation, Therapeutics and Law at Harvard Medical School, says the government could have made more use of its leverage as a funder. "That could have been to ensure reasonable pricing for Americans at the very least, ensuring that Americans aren't paying more than people in other countries," he says.
Moderna increased the price of its COVID shot this year from about $26 a dose to $130 a dose. The company has downplayed NIH's role.
Generally, the pharmaceutical industry discounts the importance of NIH-funded research in its work. But Sarpatwari says the NIH is actually the largest single funder of biomedical research in the world.
A lot could be built into NIH contracts to protect Americans. "It's quite possible to at least put in terms that will ensure fair access to the fruits of all of that support," he says, adding the NIH has been hesitant to flex its muscles on pricing.
Sanders asks for scrutiny of licensing deal
Sanders wants that to change and says he hopes that the agency will be less cozy with the pharmaceutical industry under new leadership. He sent a letter last monthasking for the administration to investigate NIH moves to grant an exclusive patent license for a cervical cancer drug developed at the agency to a mysterious startup incorporated in Delaware with no website.
The startup, Scarlet TCR, has a relationship with a former NIH employee and the deal could allow the company to someday charge high prices for a government invention.
The agency says no decision has been made regarding Scarlet TCR.
"NIH shares concerns about high drug prices and the burden they place on patients and their families," NIH spokesperson Renate Myles wrote in an email to NPR. "As stated during her Senate confirmation hearing, Dr. Bertagnolli has expressed her commitment to ensuring that the benefits of NIH-funded research are affordable and available to all the Americans."
Bertagnolli will work with Congress, Myles added.
https://www.mainepublic.org/npr-news/2023-11-17/sen-sanders-pushes-nih-to-rein-in-drug-prices
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