By Héctor E. Alcalá, Amanda E. Ng, Sujoy Gayen, and Alexander N. Ortega
The Journal of the American Board of Family Medicine, July 2020

Abstract

Introduction: Discrimination can compromise access to and utilization of health care and lead to poorer health. As such, it is important to understand the factors associated with experiences of discrimination in health care.

Methods: Using data from the 2015 to 2017 California Health Interview Survey (n = 63,100), this study examined whether insurance types and sites of usual sources of care were associated with reasons for perceived discrimination in health care and whether the reasons were associated with delaying health care. Odds of study outcomes were calculated among insured adults using logistic regressions. Insurance coverage types and sites of usual sources of care were the main independent variables. Six reasons for lifetime discrimination in health care were examined: 1) dissatisfaction with the health care system, 2) race or skin color, 3) age, 4) way the participant speaks English or other barrier to communication, 5) insurance status or type, and 6) income or education.

Results: Adults with Medicaid perceived more discrimination due to race or skin color relative to those with employer-sponsored coverage. This association does not vary by race/ethnicity. Perceived discrimination due to 1) dissatisfaction with the health care system, 2) insurance status or type, and 3) barriers to communication were each associated with increased delays in getting needed medical care.

Conclusions: Findings highlight potential insurance types and sources of care that could contribute to perceptions of being discriminated.

From the Discussion

This study observed that insurance type and sources of care are associated with lifetime perceptions of discrimination in health care. Perceived discrimination in health care was higher for those whose regular source of care is the ED relative to those whose regular source of care is a doctor’s office or HMO, but it did not vary substantially once specific reasons for discrimination were considered. In addition, participants receiving Medicaid were more likely to perceive discrimination in health care, with race or skin color being the only specific reason, when compared with their counterparts with employer-sponsored coverage. This supports prior work that observed that Medicaid patients reported lower satisfaction when compared with individuals with other types of insurance. The present study built on prior research that focused solely on racial and ethnic discrimination and showed that individuals with Medicaid were more likely to report perceiving racial or ethnic discrimination in health care.

Conclusions

This study observed that, even considering substantial health care reform, the experiences patients have in the health care setting vary systematically. Because this seems to be conditioned, at least in part, on the type of insurance a person has and where he or she receives health care, future reforms to the health care system are needed that provide a stronger overhaul of health care quality and must be better at addressing the effects of patients’ prior experiences with health care. In particular, because patients with several different public insurance coverage options experienced a higher burden of discrimination, not addressing these problems will disproportionally affect populations that are poorer and experience worse social determinants of health (eg, Medicaid enrollees). Furthermore, while perceived discrimination has a negative effect on health care utilization, our study suggests that the health care system needs to improve its ability to address certain types of discrimination to promote better population health.

https://www.jabfm.org…

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Comment:

By Don McCanne, M.D.

The Medicaid program works well from the standpoint that the benefits are comprehensive and the out-of-pocket exposure is minimal, providing relatively good financial protection in the event of medical need.

However, Medicaid is a welfare program and, as such, faces certain stigmas. People on the program are certainly aware of that and thus may be on guard for fear that they may be considered by others to somehow be less worthy, which could show up in the quality of care they receive or the enthusiasm with which it is rendered. In fact, the majority are now enrolled in Medicaid managed care programs which have reputations for stinting on care because of the low reimbursement rates they receive. For those receiving care outside of managed care organizations, it is generally known that reimbursement rates are very low and it may be difficult to know if providers are truly altruistic or if they are accepting Medicaid patients by default. At any rate, there is little political support for funding Medicaid at rates comparable to the private sector.

This uncertainty may cause patients to be on the watch for discrimination in their care. This may be particularly true for individuals who are already accustomed to discrimination because of their racial or ethnic backgrounds.

Unfortunately, this study adds to previous studies that confirm that racial and ethnic minorities indeed do perceive discrimination in the care they receive under the Medicaid program.

If we were to replace all current sources of health care funding with a single payer model of an improved Medicare for All, we would automatically eliminate discrimination that is based on the financing source, such as we see with Medicaid. Certainly other sources of discrimination would continue to require further remedies, but Medicare for All would provide a giant step forward toward social solidarity by virtue of an egalitarian health care financing system.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Susan Jaffe
MedPage Today, July 15, 2020

A House committee unanimously approved legislation Wednesday that would make changes for the first time in 50 years to the complex rules for enrolling in Medicare’s Part B, which covers doctor visits and other outpatient care.

Currently, seniors who don’t get Part B when they first become eligible for Medicare pay permanent, recurring late enrollment penalties and can only sign up during the first 3 months of the year for coverage that begins July 1, unless they qualify for an exception. To make matters worse, they cannot buy other health insurance during their months-long wait.

Patients often find out they need Part B only after their provider or insurance company sends them a bill for services. That’s because only Social Security beneficiaries currently receive a notice when they become eligible for Medicare.

If the measure, known as the “BENES” Act (Beneficiary Enrollment Notification and Eligibility Simplification Act), becomes law, the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration would be required to notify people before they turn 63, 64, and 65 that they may be eligible for Medicare at age 65. It would eliminate the waiting period by ensuring that coverage begins on the first of the month after they sign up.

Currently, far too many people make honest mistakes when trying to understand and navigate this confusing system. The consequences of such missteps are significant — including late enrollment penalties, higher out-of-pocket health care costs, gaps in coverage, and barriers to accessing needed service. In 2019, 764,000 Medicare beneficiaries paid a penalty for late Part B enrollment, increasing their monthly premiums by an average 28%, according to a May report by the Congressional Research Service.

The House of Representatives is expected to pass the bill sometime this year but its prospects in the Senate are still uncertain.

https://www.medpagetoday.com…

BENES Act:
https://www.aging.senate.gov…

Medicare Part A and B Eligibility and Enrollment:
https://www.cms.gov…

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Comment:

By Don McCanne, M.D.

The eligibility, processes and rules for enrolling in Medicare are relatively complex and vary for Part A – hospital, Part B – physician and outpatient, Part C – private Medicare Advantage, Part D – drug, and Medigap – private supplemental coverage. Original Medicare is Part A and Part B, but enrollment is such that individuals may end up with gaps in coverage or paying significant penalties if the enrollment process for Part B is not followed carefully. The BENES Act would reduce this risk, though not eliminate it.

If you read the CMS eligibility and enrollment instructions for Part A and Part B (link above), you will see that they are unreasonably complex for a program that should be (but is not) automatic for everyone. Although the BENES Act would help, some complexities would remain, not to mention the problems with Part C, Part D, and especially with the Medigap plans. Medigap is particularly important for those who want to remain in the Original Medicare program, but the rules are such that enrollment may have underwriting penalties or coverage can be refused if the initial enrollment period was missed. In the push to privatize Medicare, they have made enrollment in the Medicare Advantage plans easier, but there are still rules to be followed, not to mention that you are limited to the insurers’ provider networks and you lose your almost unlimited choice of providers in the Original Medicare program.

Compare this to single payer improved Medicare for All. Every resident is eligible and is automatically enrolled, forever. Benefits are comprehensive, including drugs, and since care is free at the time of service, there is no reason to have separate private or supplemental plans. There is no Part A, Part B, Part C, Part D, nor Medigap; there is only Medicare for All.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By HwaJung Choi, Ph.D.; Andrew Steptoe, D.Sc.; Michele Heisler, M.D., M.P.H.; Philippa Clarke, Ph.D.; Robert F. Schoeni, Ph.D.; Stephen Jivraj, Ph.D.; Tsai-Chin Cho, M.Sc.; Kenneth M. Langa, M.D., Ph.D.
JAMA Internal Medicine, July 13, 2020

Key Points

Question: What is the difference in health status between high- and low-income individuals in the US vs England?

Findings: In this cross-sectional study including 18 572 persons (46 887 person-years of observations), the health gap between the bottom 20% and top 20% of income distribution was significantly greater for US adults aged 55 to 64 years than their English peers on 13 of 16 health measures. In addition, for most measures, the health of US adults appeared to be poorer than that of their peers in England, especially those from the lower end of the income distribution.

Meaning: The findings of this study suggest that the income-health gradient is greater among US middle-aged adults than among their peers in England, with poor health especially pronounced among those with lower income in the US.

From the Introduction

This study compared the health of US adults aged 55 to 64 years with the health of their peers in England. The US and England have a relatively similar culture, language, and economic system, yet have substantially different health care and social welfare systems. The US provides limited public health insurance for those younger than 65 years, but England provides publicly funded health care free at the time of service for all individuals under the National Health Service. About 17% of US adults aged 55 to 64 years had only public health insurance coverage, and 13% had no health insurance coverage in 2012-2013. The greater level of income inequality with limited public safety net in the US compared with England raises the question of whether those with low income in the US are at greater risk for poor health outcomes than low-income adults in England.

From the Discussion

Using data on adults aged 55 to 64 years from comparable nationally representative surveys of the US and England, this study provides evidence on disparities in health across income groups in the US vs England. Analyses of 16 health outcomes found substantial income differences in each country and for all outcomes except cancer in both countries and measured high blood pressure in England. Moreover, the disparity in health between low-income and high-income adults was significantly greater in US adults for 6 of the 8 self-assessed or directly measured outcomes, and 7 of the 8 self-reported physician diagnosis outcomes.

Cross-country differences in health were in favor of England for all health outcomes except ADL limitations, depression, and measured blood pressure, which were not significantly different between countries. The US and England disparities were pronounced among lower-income adults.

From the Conclusions

The findings of this study suggest that the gap in health between lower-income vs higher-income adults is substantial and significantly larger in the US than England for most health outcomes that we examined. In addition, lower-income adults in the US appear to have poorer health compared with lower-income adults in England.

https://jamanetwork.com…

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Comment:

By Don McCanne, M.D.

The United States and England have similar cultures but different health care financing systems. This study looked at health care outcomes in both countries in the top and bottom income quintiles of those 55 to 64 – the last decade before most U.S. citizens become eligible for our government Medicare program.

The health gap between the top and bottom quintiles is significantly greater in the United States than it is in England. Further, the health of U.S. adults is poorer than their peers in England, especially for those with lower incomes.

Also income inequality is greater in the United States than it is in England. Everyone in England receives care free at the time of service through their national health service, whereas the health care financing system in the United States is fragmented with a limited public safety net.

What is more remarkable is that England has better outcomes even though its per capita health expenditures are half that of the United States.

We have the money, and we’re already spending it – $4 trillion this year. But we sure could do a lot better on how we spend it. A single payer improved Medicare for All would work just fine. And about that income inequality, we could take a major step forward by using more equitable tax policies to fund a $4 trillion universal risk pool.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Families USA, July 2020

Results in Brief

• Because of job losses between February and May of this year, 5.4 million laid-off workers became uninsured.
• These recent increases in the number of uninsured adults are 39% higher than any annual increase ever recorded. The highest previous increase took place over the one-year period from 2008 to 2009, when 3.9 million nonelderly adults became uninsured.
• Nearly half (46%) of the increases in the uninsured resulting from the COVID-19 pandemic and economic crash have occurred in five states: California, Texas, Florida, New York, and North Carolina.
• In eight states 20% or more of adults are now uninsured: Texas, where nearly three in ten adults under age 65 are uninsured (29%); Florida (25%); Oklahoma (24%); Georgia (23%); Mississippi (22%); Nevada (21%); North Carolina (20%); and South Carolina (20%). All but Oklahoma are also among the 15 states with the country’s highest spike in new COVID-19 cases during the week ending on July 12.
• Five states have experienced increases in the number of uninsured adults that exceed 40%: Massachusetts, where the number nearly doubled, rising by 93%; Hawaii (72%); Rhode Island (55%); Michigan (46%); and New Hampshire (43%).
• No federal COVID-19 legislation signed into law has attempted to restore or preserve comprehensive health insurance, which improves health outcomes, limits financial insecurity, and promotes economic recovery. Federal lawmakers can fill that gap in the next COVID-19 bill.

https://www.familiesusa.org…

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Health Care Administrative Costs in the United States and Canada, 2017

By David U. Himmelstein, M.D., Terry Campbell, M.H.A., Steffie Woolhandler, M.D., M.P.H.
Annals of Internal Medicine, January 21, 2020

Total Costs of Health Care Administration: Health care administrative costs in the United States in 2017 totaled $812.0 billion, $2497 per capita ($2696 per insured person), or 34.2% of total spending in the categories for which data are available. The comparable estimates for Canada are $551 per capita ($593, assuming U.S. wage rates in doctors’ offices), or 17.0% of expenditures. The difference amounts to over $1900 per capita (or over $2100 per insured person), equivalent to more than $600 billion in excess administrative spending in the United States.

https://www.acpjournals.org…

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Comment:

By Don McCanne, M.D.

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

Of major significance, these are nonelderly adults. Medicare – for those over 65 – continued to provide stable coverage after the onset of the pandemic. There would be no uninsured now had we had in place a single payer Medicare for All program.

The experience in California also provides us with some important lessons. As one of the most progressive states, California went out of its way to maximize the benefits of the Affordable Care Act and other public programs. Thus we can get a perspective of how well the financing system works when stressed. The number of workers in California who became uninsured due to job loss between February and May 2020 was 689,000. In total, 3,227,000 adults are uninsured in California. There are now about 27% more uninsured adults in California than there were in 2018.

Regardless of all of the praise ACA receives, the program clearly is not working as it should. There are proposals to temporarily fill in some of the gaps, but these proposals fall far short of the comprehensive reform that we need, and most of them would be only temporary, at the end of the pandemic defaulting to our current unsatisfactory financing system.

The primary reason given for not enacting single payer Medicare for All is that it costs too much. Yet comparing our highly inefficient health care financing system with Canada’s single payer system indicates that more than $600 billion in annual administrative waste is recoverable – more than enough to expand the provision of comprehensive health care services to absolutely everyone, permanently, without spending more in inflation adjusted dollars than we already do.

One major candidate for president would forgo this in order to perpetuate, with tweaks, our clearly inadequate health care financing system with its profoundly inefficient and costly administrative excesses. The other major candidate is supporting a repeal of ACA without offering any effective substitute, leaving us worse off than we already are.

I mean, when California has one of the very best programs and it alone has over 3,000,000 adults who are uninsured? That’s unacceptable. It’s criminal! We need to change the system: single payer improved Medicare for All. Now!

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Maggie Mills
Common Dreams, July 11, 2020

A recent study by Yale epidemiologists found that Medicare-for-All would prevent 68,000 deaths a year. These 68,000 deaths are not quiet, peaceful deaths. They are gasping-for-air, writhing-in-pain, bleeding out, wasting, violent, gruesome deaths. These deaths often follow extended periods of physical pain, emotional distress, and financial ruin.

The same study found that Medicare-for-All would save the United States 45 billion dollars annually. In the midst of a pandemic-motivated corporate bailout estimated at between $6 and $10 trillion so far, the ‘’but how will we pay for it” argument has largely been abandoned. And yet, the nominee for the Democratic Party has unequivocally stated that he will veto Medicare-for-All, the Democrats in Congress have proposed a bill to bail out insurance companies that subsidizes COBRA payments rather than provides healthcare for their constituents, and 27 million Americans and counting have lost their employer-based coverage as unemployment soars. Three of the four members of Congress with the highest campaign contributions from the pharmaceutical industry are Democrats, and the healthcare lobby accounts for a third of the contributions to the DCCC in the 2019-2020 election cycle. As usual, the Republicans brazenly broadcast their disdain for the poor, sick, and disabled. Put simply, both Democrats and Republicans receive many millions of dollars from the healthcare lobby to ensure that the industry profits at the expense of human life. There is no relief in sight from either establishment party, not even in the shadow of economic collapse.

I write this not to rage against the bipartisan, healthcare and pharma lobby funded machine. Although, the American public should at minimum educate themselves as to why every developed nation on earth has managed to provide healthcare to its citizens as a right, except for the US.

I write this to appeal, hell, plead, with my fellow Americans to pay attention to the suffering that exists all around us- to recognize our well, able-bodied privilege, and to come together to tear this cruel system down.

I have MS. I have a growing Rolodex of injuries, illnesses, and disabilities. I am exhausted. My prospects are limited. I am a victim of the unwinnable battle with our healthcare system. I work full time to keep my increasingly unaffordable health insurance. Ironically, I will lose this insurance when my full time job makes me too sick to continue working full time. I cannot vote for a candidate that doesn’t support Medicare-for-All.

I have been told that I am part of the Democratic Party’s disunity problem for my decision. I have been told that I am part of the problem as if prioritizing my own ability to remain in the world is petty or immature. I have been told this by people who think millions of lives are expendable in the name of political party loyalty and who refuse to acknowledge that we cannot patiently wait for incremental change when our lives are at stake. I have only been told this by people who are well, able-bodied, or who have excellent health insurance. I am angry and indignant because people who casually vote to sacrifice the most vulnerable of their fellow citizens are the problem, and not the other way around.

Class does not prevent illness and disability, though their onset tends to push the afflicted into poverty. People with disabilities make up 12% of the US population, yet account for more than half of the population living in long-term poverty. Medical bills are responsible for an astounding 66.5% of bankruptcies. As of January, it was estimated that as many as 25% of Americans delayed getting healthcare because of cost, resulting in great physical pain, mental anguish, and death. These numbers have surely grown exponentially during the pandemic.

We should be outraged at the injustices that our fellow citizens suffer at the hands of this predatory healthcare system. We should be outraged at the violence that it inflicts on its innocent victims. We should be outraged that this violence has been normalized as if there is nothing to be done to stop it. We should not accept it, nor should we be quiet about it. We should educate our neighbors, withhold our votes, and shout that we will do so from the streets. Tens of millions uninsured, underinsured, bankrupt, suffering, and dead constitutes an unforgivable injustice. Please allies, I beg of you, demand justice.

And please, allies; recognize that by settling for anything less than universal healthcare and by voting for someone who does not support Medicare-for-All, we are committing a deliberate and willing act of violence against the poor, sick, and disabled among us.

Maggie Mills is an artist and assistant professor of art at Cedar Crest College.

https://www.commondreams.org…

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Comment:

By Don McCanne, M.D.

The important message from this article is that many Democrats who emphatically support single payer Medicare for All are so disappointed in the fact that the presumed Democratic Party candidate for president is outspoken in his opposition to Medicare for All that some are considering not supporting him in the general election – the Democratic Party’s disunity problem.

What other options are there? Not showing up to vote? There are many other important issues that are certainly worthy of a vote. Defecting to the Green Party? We still have a predominantly two party system so casting a vote for a third party candidate will have a similar net impact as not voting at all, except for the personal satisfaction of having cast a protest vote. Vote for President Trump? With our highly polarized politics, without overlap in the middle, abruptly flipping on all policies would defy reason.

Many people have cautioned that if the Democrats endorse Medicare for All, President Trump may be reelected by those opposing Medicare for All, and getting him out of office is their highest priority. That is ridiculous. Even Democrats who want to keep their current health plans are not going to vote for Trump just to prevent enactment of Medicare for All. In fact, many Republicans, though not a majority, also support Medicare for All.

The disunity is not in opposed views on Medicare for All, and it is not even in opposition to the reelection of Donald Trump. Rather than disunity, the problem is disappointment in the fact that Joe Biden continues to reject Medicare for All.

The current health care situation is horrendous for many of those with significant health care needs, and that can be any of us at any given time. So what can we do? Simply, don’t let up. Continue with advocacy through education, coalitions, and grassroots efforts. Some say that is not enough, so go ahead and expand your efforts. Any and all activities that will take us beyond the threshold for action are certainly welcome. Just don’t fall into the trap of walking away because of the perception of a disunity problem.

Though PNHP does support single payer Medicare for All, PNHP does not endorse any political candidates nor political parties. Political views expressed here are those of the author and not of PNHP.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Melissa Repko
CNBC, July 8, 2020

Walgreens Boots Alliance will soon have doctor offices inside of hundreds of its U.S. drugstores.

The pharmacy chain said Wednesday it has struck a deal with VillageMD, which will staff and run the primary-care clinics. The companies said they will open the clinics in 500 to 700 stores in more than 30 U.S. markets over the next five years.

Walgreens will invest $1 billion in equity and convertible debt in VillageMD over the next three years as part of the deal, including a $250 million equity investment completed Wednesday. Most of the money will be used by VillageMD to open the clinics and integrate its technology with Walgreens.

VillageMD will recruit and pay employees’ salaries, cover other operating expenses and pay Walgreens to use the space. Walgreens said it will own about 30% of the primary-care company after the multiyear investment.

The company wants to turn its drugstores into health and wellness destinations where people spend more time and money.

Through the new partnership, patients will be able to visit the Village Medical at Walgreens clinics for a wide range of medical services from annual checkups to walk-in appointments if they feel sick. Each clinic will have nine exam rooms, a waiting area and a four-person physician-led staff that coordinates with store pharmacists. They can also request a home visit or get care around the clock through telemedicine.

Walgreens and VillageMD will face stiff competition. Walmart has opened four primary-care clinics, with plans for more. The big-box giant’s clinics, called Walmart Health, emphasize its signature low costs and upfront pricing. Amazon’s acquisition of online pharmacy PillPack underscores its broader health-care ambitions. And CVS Health, which acquired health insurer Aetna, plans to open 1,500 HealthHUB stores by the end of 2021. The redesigned stores have a variety of health-related features such as expanded clinics, wellness rooms for yoga and more medical-related products.

“We want to be everywhere in America where people need health care,” (Walgreens co-Chief Operating Officer Alex Gourlay said). “That’s always been our position and always will be.”

https://www.cnbc.com…

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Walmart quietly registers insurance business in its latest move into health care

By Melissa Repko
CNBC, July 8, 2020

Walmart is making yet another move in the health-care world: It’s getting into the insurance business.

The Bentonville, Arkansas-based retailer confirmed to CNBC on Wednesday that it will start selling health insurance plans. It has job openings listed on its careers website for “Walmart Insurance Services LLC.” In the job posts, it says it’s looking to hire insurance agents in the Dallas area to sell supplemental Medicare insurance.

Walmart currently provides insurance information at Walmart Health, its primary clinic locations, and has an education program called Healthcare Begins Here that helps people find an insurance policy.

The big-box retailer has opened primary-care clinics, made health-care acquisitions and spoken about its broader ambitions. It previously teamed up with insurer Humana to offer a Walmart-branded Medicare prescription drug plan, but this marks the first time the retailer is setting up as an insurance broker.

The retailer has opened four Walmart Health clinics in the U.S., with plans for more. The clinics offer a wide range of low-cost services, such as an annual checkup for $30 or a strep test for $20.

https://www.cnbc.com…

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Comment:

By Don McCanne, M.D.

Our health care financing system is highly inequitable. In spite of being the most expensive health care system, we fall behind most other wealthy nations in leaving too many individuals uninsured or underinsured, with impaired access to care. We’ve been trying to fix that by advocating for single payer Medicare for All. But, as we have been directing our attention to health care financing, what has been happening with the health care delivery system?

Well, horizontal and vertical consolidation has changed the market dynamics in health care. The private insurance companies and the benefit managers have been moving in and becoming an integral part of the health care delivery system. The expansion of control by the medical-industrial complex has changed the nature of traditional relationships between patients and their health care professionals. Today’s articles on Walgreens and Walmart provide examples of how control of health care is shifting away from the health care professionals and institutions and more towards the investment community.

This is serious. How is a single payer Medicare for All program going to be able to manage making appropriate payments to the health care delivery system when it has become part of an amalgamation with other business interests, many of which we have been trying to remove from health care financing if for no other reason than their profound administrative waste?

Earlier this week we discussed the importance of planning in health care. Adam Gaffney stated, “We need a health system where the distribution of infrastructure and resources is not left to the dictates of the market, but rationally planned according to the needs of communities.”

In the future, when you are taken by ambulance to a hospital emergency department, after they ask you for your insurance card, instead of asking who your physician is, will they be asking, “Are your medical records at Walgreens or Walmart?” That might please the advocates of market competition, but it shouldn’t be about markets. It should be about patient service.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Achieving Universal, Affordable, Quality Health Care (Pages 28-37)

(Excerpts)

We are going to at last build the health care system the American people have always deserved: One that finally provides universal health care coverage; reduces prescription drug prices, premiums, and out-of-pocket costs; reins in overall health care expenses; and tackles the deep-seated inequities in our health care system. We will build a health care system that is driven by the needs of patients and the people who care for them, instead of the profit motives of big corporations.

Democrats will always fight to save Americans’ lives by making it easier and more affordable to go to the doctor, get prescription medicines, and access preventive testing and treatments. Our policy agenda is designed to produce real results for the American people—not hollow platitudes. As Democrats, we fundamentally believe health care is a right for all, not a privilege for the few.

Responding to the Coronavirus Pandemic

We must start by making COVID-19 testing widely available, convenient, and free to everyone. That includes expanding programs to proactively extend testing services to populations we know are especially vulnerable, including the homeless and those living in nursing homes and long-term care facilities. We must also expand funding so state and local public health departments can hire sufficient staff to adequately conduct contact tracing for everyone who tests positive for the novel coronavirus. Only through testing, tracing, and targeted quarantining can we hope to fully understand the scope of the pandemic, contain it, and stop it.

In a public health crisis, we all have to rely on each other. That’s why Democrats support making COVID-19 testing, treatment, and any eventual vaccines free to everyone, regardless of their wealth or their immigration status.

In the midst of this pandemic, we will provide direct, increased support to states to enroll eligible adults in Medicaid, have the federal government cover a higher percentage of the bill, and add incentives for states which have not yet expanded Medicaid to do so.

For people who risk losing their insurance coverage if they lose their jobs in this pandemic, Democrats believe the federal government should pick up 100 percent of the tab for COBRA insurance, which keeps people on their employer-sponsored plans. For those who are still unemployed or do not have access to employer-sponsored health care when their COBRA eligibility period expires and are eligible for premium-free coverage, we will take action to automatically roll them over to other coverage options, so they do not experience any gap in health care. We will also re-open the Affordable Care Act marketplaces, even outside of the normal open enrollment season, and expand subsidies to make it easier for people to buy coverage.

Democrats will also make available on the marketplace a platinum-level, federally administered health insurance option with low fees and no deductibles, so that everyone will have access to this high-quality, low-cost plan. Low-income Americans will be automatically enrolled in this federally-administered option at zero cost to them.

We will keep these emergency measures in place until the pandemic ends and unemployment falls significantly.

Democrats will direct the federal government to work with private-sector manufacturers to dramatically scale up the United States’ domestic manufacturing capacity for both personal protective equipment and essential medicines.

Reinvesting in Public Health

Democrats will act swiftly to stand up a comprehensive, national public health surveillance program for COVID-19 and future infectious diseases, including recruiting 100,000 contact tracers to help state and local health departments identify people at risk of contracting or spreading the coronavirus.

We will substantially increase funding for the Centers for Disease Control and Prevention and for state and local public health departments, many of which suffered deep budget cuts during the Great Recession. And we will restore American leadership on global public health by working with our allies and partners around the world, including through the World Health Organization.

Securing Universal Health Care Through a Public Option

We will give all Americans the choice to select a high-quality, affordable public option through the Affordable Care Act marketplace. The public option will provide at least one plan choice without deductibles, will be administered by the traditional Medicare program, not private companies, and will cover all primary care without any co- payments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people. The lowest-income Americans not eligible for Medicaid will be automatically enrolled in the public option at no cost to them, although they may choose to opt out at any time. Everyone will be eligible to choose the public option or another Affordable Care Act marketplace plan, even those who currently get insurance through their employers, because Democrats believe working people shouldn’t be locked in to expensive or insufficient health care plans when better options are available.

For the 4.8 million adults who should be eligible for Medicaid, but who live in states where Republican governors have refused to expand the program, Democrats will make the public option available without premiums. And we will enable millions of older workers to choose between their employer-provided plans, the public option, or enrolling in Medicare when they turn 60, instead of having to wait until they are 65.

Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal health care approaches.

We also know that finally covering every American through the public and private insurance system alone is not enough to guarantee universal access. That is why Democrats support doubling investments in community health centers and rural health clinics, including increased support for dental care, mental health care, and substance use services like medication-assisted treatment. We will expand the National Health Service Corps to address critical shortages of health care providers in rural areas, including primary care nurses, dental professionals, and mental health and substance use counselors.

Bringing Down Drug Prices and Taking on the Pharmaceutical Industry

Democrats will take aggressive action to ensure that Americans do not pay more for prescription drugs than people in other advanced economies. We will empower Medicare to at last be able to negotiate prescription drug prices for all public and private purchasers—for families and businesses, as well as older Americans—no matter where they get their coverage. We will also ensure and enforce that the price of brand-name and outlier generic drugs cannot rise faster than the inflation rate. We will cap out-of-pocket drug costs for seniors, and ensure that effective treatments for chronic health conditions are available at little or no cost.

Reducing Health Care Costs and Improving Health Care Quality

We will make it easier for working families to afford high-quality insurance in the Affordable Care Act marketplaces by ensuring that no one pays more than 8.5 percent of their income in premiums and eliminating the cap on subsidies.

We will work to increase price transparency in the health care system across all payers, and reduce paperwork through uniform medical billing.

Democrats will support policies that increase the number of primary care practitioners, registered nurses, dentists, and dental therapists, especially in rural and low-income metropolitan areas, so it’s easier for every American to access preventive and primary health care.

Expanding Access to Mental Health and Substance Use Treatment

Democrats will aggressively enforce the federal mental health parity law and ensure that health insurers adequately cover mental health and substance use treatment.

Expanding Long-Term Care Services and Supports

Democrats support measures to eliminate state waiting lists for home and community based care, including through a significant expansion of the home care workforce, and will work to develop a broader approach to eliminate the institutional bias within Medicaid.

Eliminate Racial, Gender, and Geographic Health Inequities

Democrats are committed to eliminating health disparities by race, ethnicity, gender, and geography. We recognize it is not enough to have a commitment: We must have a plan. That is why Democrats will launch a sustained, government-wide effort, with leadership at the highest levels, to eliminate racial, ethnic, gender, and geographic gaps in insurance rates, access to quality care, and health outcomes. That includes tackling the social, economic, and environmental inequities—the social determinants of health like poor housing, hunger, inadequate transportation, mass incarceration, air and water pollution, and gun violence—that contribute to worse health outcomes for low-income Americans and communities of color.

(More on Black people and Latinos, pollution, maternal mortality, data collection to understand disparities, Indian Health Service, reproductive health care services, sexual assault and domestic abuse, LGBTQ+ discrimination, and HIV/AIDS treatment and prevention.)

We will expand access to health care for people living and working across the United States by extending Affordable Care Act coverage to Dreamers, and working with Congress to lift the five-year waiting period for Medicaid and Children’s Health Insurance Program eligibility for low-income, lawfully present immigrants.

Democrats believe that gun violence is a public health crisis. We believe that expanding access to mental health care is key to confronting the epidemic of suicides-by-firearm, including among veterans. Democrats will ensure the Centers for Disease Control and Prevention have sufficient resources to study gun violence as a public health issue and support evidence-based programs for preventing gun violence.

Strengthening and Supporting the Health Care Workforce

We will invest in community health worker care-forces around the nation proven to prevent, manage and better treat chronic illness now burdening tens of millions of Americans, and empower first-time mothers with nurse home visiting. We will close provider gaps and increase diversity in the health care profession by creating a robust pipeline of talent with career ladders for work advancement. And we will also increase opportunities for community health workers to come from the communities they serve.

Investing in Health Science and Research

We will support increased and sustainable funding for federal health and medical research across agencies, including at the National Cancer Institute and other components of the National Institutes of Health, the Centers for Disease Control and Prevention, and the Agency for Health Care Research and Quality. We will increase the federal investment in research and development for new medications through the National Institutes of Health, and make sure that there is a return on that investment for taxpayers.

Democrats also support increasing funding for research into health disparities by race, gender, age, geographic area, and socioeconomic status, with a particular focus on how the social determinants of health contribute to differences in health outcomes.

Rep. Pramila Jayapal, Co-chair
Vivek Murthy, Co-chair
Donald Berwick
Abdul El-Sayed
Sherry Glied
Mary Kay Henry
Chris Jennings
Rep. Robin Kelly

https://joebiden.com…

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Comment:

By Don McCanne, M.D.

When the neoliberals commandeered the Democratic primary process and bumped Bernie Sanders out of the running, it was recognized that Joe Biden would have to do something to reunite the Democrats since the flame of the popular progressive revolution had been extinguished, and the Democrats were left with a candidate basically representing the status quo. Perhaps the greatest disappointment was that single payer Medicare for All had been removed from the agenda.

The report of the recommendations of the Biden-Sanders Unity Task Force(s) is 110 pages long and covers many areas of policy. The ten page section on health care basically perpetuates the current health policies, led by the Affordable Care Act, while adding a public option and reducing Medicare eligibility age to 60. The most glaring feature is invisible – the total lack of any mention of single payer Medicare for All.

Single payer Medicare for All is not simply an expansion of Medicare to cover everyone. It is a comprehensive revision of the financing of health care making it universal, comprehensive, efficient, effective, equitable, accessible, and affordable for everyone, for life. The Biden-Sanders Unity Task Force proposal meets none of those criteria.

Biden has said that we cannot afford single payer Medicare for All, yet his model perpetuates much of the excessive spending in health care, failing to recover hundreds of billions of dollars in administrative waste. For administrative efficiency he suggests reducing paperwork through uniform medical billing, but we already have that in Form 1500. He also suggests price transparency as if Nobel laureate Kenneth Arrow never explained why health care markets don’t work. Biden’s proposals would significantly add to our health care spending, and thus would be much more expensive than an efficient single payer Medicare for All.

The goal of the Unity Task Force is to bring disappointed progressives back into the fold. It is likely that President Trump is going to orchestrate his own defeat, and Joe Biden will be elected by default. Regardless, it is important that progressives not give up on single payer. Assuming Biden is elected, it is imperative that we continue to educate everyone on the virtues of the single payer model. If President Biden truly understood the single payer model (and he doesn’t), he would certainly sign legislation enacting it.

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