PNHP

Opening the Pandora’s Box of commercial insurance data

Opening the Pandora’s Box of commercial insurance data

Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective

By Amanda Frost, Eric Barrette, Kevin Kennedy, and Niall Brennan
Health Affairs, September 19, 2018

Abstract

Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories of health services, although the increases were not uniform across years or categories. Growth rates for total per capita spending generally slowed after 2009 but increased between 2014 and 2016. Spending on outpatient services grew more quickly (average annual growth of 5.7 percent) compared to spending on the other types of services. However, the overall distribution of spending across categories remained largely unchanged. In the context of the dramatic economic and policy events that have taken place since 2007—including the Great Recession, the Affordable Care Act, and numerous medical innovations—this assessment of ten-year spending trends provides insights into how the largest insured population in the US contributes to health care spending growth.

https://www.healthaffairs.org…

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Comment:

By Don McCanne, M.D.

Previously much of our access to data on health care spending has been through government programs – Medicare and Medicaid. Data on commercial insurance spending, especially employer-sponsored plans, were hidden in a cloud of secrecy as proprietary information. Now a group of major insurers has made that information available though the Health Care Cost Institute. Having this information is helpful because it can reveal underlying health care spending trends in the very large sector of commercial insurance (covering 54 percent of Americans) that was not disturbed by the Affordable Care Act (ACA).

In the decade that included the Great Recession and the enactment and implementation of ACA, there was an initial slowing in the rate of health care spending increases. The ACA enthusiasts were quite willing to take credit for that slowing, though there was not much evidence that the specific polices contained in ACA could be credited for it. It seemed much more likely that the slowing in health care spending growth was merely a manifestation of the global slowing of the economy during the recession.

In the latter part of the decade studied, health care spending growth increased again. Although ACA is still in force, this increase further suggests that the previous slowing was due to the recession and not due to any magical policies contained in ACA. In fact, many other studies have demonstrated disappointing results in the ACA measures that were supposedly designed to contain spending.

The significance of this is that it is wrong to continue to support ACA based on the concept that we merely need to give it more time to work, maybe while adding a public option – an option that would not change in any fundamental way the huge, highly dysfunctional, fragmented infrastructure of our health care financing system. It is wrong to reject a proven model that would be effective in reducing the rate of spending increases to sustainable levels – a single payer national health program.

Now that we have opened the Pandora’s Box of private commercial insurance data, we have confirmed that private insurance is not capable of containing the excessive growth in health care spending. So let’s move forward with establishing our own public program that would work – a single payer improved Medicare for all.

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What do Americans want done about our high prescription drug prices?

High Prices, Broken Promises

NORC at the University of Chicago, September 13, 2018

Three-quarters of Americans consider the cost of prescription drugs in the United States to be “unreasonable,” and despite promises from the President and members of Congress to rein in prices, few approve of either’s handling of the issue, according to a new national poll from the West Health Institute, a nonpartisan, nonprofit healthcare research organization, and conducted by NORC at the University of Chicago.

The survey found the high cost of healthcare is a top public policy issue for Americans. When presented with a list of six issues, 78 percent said addressing healthcare costs was their highest priority, similar to the number who say the same about jobs and the economy (76 percent), and ranking higher than national security (71 percent), the environment (63 percent), immigration (51 percent), or trade (38 percent).

High prescription drug prices are a particular worry for most Americans. Sixty-five percent said they are extremely or very concerned about the issue. Another 88 percent said lowering medication costs should be a top priority for candidates running for Congress.

From the Survey:

To reduce the cost of prescription drugs, should…?

82% – Medicare be allowed to directly negotiate with drug companies to get lower prices on prescription drugs

82% – More lower-cost generic prescription drugs be allowed to compete with the equivalent high-cost brand name prescription drugs

80% – Drug companies be required to release information to the public on how they set their prices

65% – Americans be allowed to buy prescription drugs from Canada

52% – Prescription drug advertisements be eliminated

31% – Drug companies be required to set the price for a drug based on how well it works

Press release:
http://www.norc.org…

Full issue brief and results:
http://www.norc.org…

Topline:
http://www.norc.org…

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Comment:

By Don McCanne, M.D.

Not only do Americans object to the high prices of prescription drugs, they also feel that the President and members of Congress have failed us in not doing more about it.

When offered a list of various options on what we can do, to no surprise at the top was that Medicare should be allowed to negotiate for lower drug prices (along with more generic drug competition and more transparency in the setting of drug prices). Again, Americans support a major government role in drug pricing.

With the current popularity of Medicare for All it would have been interesting to see how strong the support would have been for including drugs as a benefit of an improved Medicare that covered everyone, but they didn’t ask that. Regardless, if we already had in place a comprehensive, single payer, improved Medicare for all that included a drug benefit, there is no question that it would be extremely popular.

We hear the opponents of reform talk about how bad the systems in Canada and Great Britain are, yet we hear from their people that they would never consider transforming their systems into one like ours. Since the majority of our politicians continue to fail us, it seems that we should replace them with leaders who can hear our message.

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

Value-based care would improve under single payer

Payers and Providers Remain Far Apart

By Leemore Dafny, Ph.D. and Namita Seth Mohta, M.D.
NEJM Catalyst, March 2018

Health care stakeholders are not aligned in important goals and in large part are not working together to achieve value-based care, according to the NEJM Catalyst Insights Council. They are waiting on government regulators to change the payment model – including, possibly, single-payer health care.

More than half (58%) of Insights Council survey respondents indicate that their individual organizations are not aligned in working toward achieving value-based care. A higher percentage of clinicians (63%) than clinical leaders (53%) think that payers and providers at their organization are not aligned. At the health care industry level overall, the outlook is even bleaker, with 77% reporting a lack of alignment.

Unlike many industries where the private sector typically takes the lead in driving change, our survey confirms other research that in health care, government payers set the blueprint for private payers to piggyback on. Respondents rate regulatory payment model changes (such as from Centers for Medicare & Medicaid Services) as the most influential among drivers to improve payer-provider collaboration.

Single-Payer Health Care Would Have a Positive Effect on Value-Based Care

Would the ability to provide value-based care get better, worse, or stay the same under single-payer health care?

61% – Better
22% – Worse
16% – Stay the same

Single-payer health care would have a strongly positive impact on the ability to provide value-based care, say Insights Council respondents. This reaction is consistent across all three audience segments of executives, clinical leaders, and clinicians. In verbatim responses, many respondents single out single-payer as the systemic change that would most improve payer-provider collaboration. These results continue the trend that NEJM Catalyst has observed among Insights Council members holding a positive view of single-payer health care.

https://cdn2.hubspot.net…

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Comment:

By Don McCanne, M.D.

In the quest to change from volume to value in health care financing, gimmicky models such as accountable care organizations are being implemented, but the lack of alignment between payers and providers has not achieved the goal of value-based care. This survey of clinicians, clinical leaders and executives reveals that they believe that a single payer approach would have “a strongly positive impact on the ability to provide value-based care.”

Rather than continuing on the path to nowhere laid down by the politicians, bureaucrats, and policy community, doesn’t it seem logical that we should look at the model that those in the trenches – the clinicians, clinical leaders and executives – believe would actually work? Rather than having the payers attempting to align the providers, we should be having the providers who understand the delivery of health care give guidance to the design of the financing system. It becomes ever more evident to those providing the care that instead of a fragmented, dysfunctional market of private payers we should have a single, efficient public payer if we want to inject greater value into our health care system.

It would be infinitely better for the providers to give guidance to the design of the financing system to make it work optimally for patients than it would be to continue to allow the payers to try to design the health care delivery system. That’s how we have ended up with MACRA, MIPS, APMs, ACOs and other screwball ideas. Let’s work on improving the clinics and hospitals instead – under a single payer system. That’s where the value is.

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

Jessica Schorr Saxe, MD

Family Medicine

Dr. Jessica Schorr Saxe is a retired family physician, national board member of Physicians for a National Health Program, and founder of PNHP’s Charlotte chapter, Health Care Justice-NC.

Dr. Saxe received her medical degree from Tufts University School of Medicine, and completed her residency at Duke. From 1980 to 2015, she worked as a family physician for the underserved in Charlotte. Her practice reinforced her interests in access to care, as well as in prevention and lifestyle changes.

Dr. Saxe has written guest columns for the Charlotte Observer for more than 30 years, and frequently speaks to community and medical groups about single-payer health care and other health advocacy topics. She has received numerous community and professional awards, including PNHP’s Dr. Quentin Young Health Activist Award in 2016.

Stephen K. Chao, MD

Family Medicine

Dr. Stephen Chao is an assistant professor of family medicine at the University of Texas Health Science Center at Houston. He was previously a staff physician at Legacy Community Health Services, a federally qualified health center in Houston, and was also previously on the faculty at Baylor College of Medicine.

Born and raised in Houston, Dr. Chao attended Rice University, graduating with degrees in Biochemistry and Health Policy. He received his medical degree from the University of Texas Health Science Center at San Antonio and also a Masters in Public Health from the University of Texas School of Public Health. He completed his family medicine residency training at UT Health San Antonio and is committed to caring for the underserved residents of Houston and Harris County. His interests include care for immigrant and refugee populations, community health, and public policy.

Dr. Chao is an advisory board member of Physicians for a National Health Program, secretary of the National Council of Asian Pacific Islander Physicians, and vice president of Health Care for All Texas. 

Judith Albert, MD

OB/GYN and Reproductive Endocrinology

Dr. Judy Albert is a reproductive endocrinologist. She served as a full-time faculty member of the Departments of OB-GYN at both the University of Pennsylvania and the University of Pittsburgh. For 30 years, Dr. Albert was a physician-owner of a women-owned and operated practice devoted to reproductive endocrinology, infertility, and IVF services in Pittsburgh. She retired in 2019, and currently devotes much of her time to health care justice advocacy. In 2016, Dr. Albert co-founded a local chapter of PNHP in Western Pennsylvania and is a member of the Western PA Coalition for Single Payer, the national board of PNHP, and the steering committee of National Single Payer. 

Dr. Albert received her medical degree from the University of Cincinnati College of Medicine, completed her residency in obstetrics and gynecology at Magee-Women’s Hospital at the University of Pittsburgh Medical School, and completed a fellowship in reproductive endocrinology and infertility at the University of Pennsylvania.

I just want my blood pressure pills, dammit! (and why it should matter to others)

By Don McCanne, M.D.
September 17, 2018

In the big picture of health care in America, the following anecdote is quite trivial, but, as I’ll explain, the implications are of great consequence.

Through the years my wife and I have had great care coordinated by our highly competent primary care physician. He retired recently and his practice was taken over by another physician. I needed a refill on my two blood pressure medications, but rather than interacting with the physician, I was now interacting with OptumCare Medical Group, a subsidiary of UnitedHealth. (You’ve no doubt read about insurers consolidating with physician groups – it’s very real.) Although we have avoided the private Medicare Advantage plans, I found by perusing OptumCare’s website that, without my knowledge, I was assigned to their Medicare Pioneer ACO.

The trivial complaint of mine is that I had to have numerous contacts through an always-busy telephone system and a non-responsive contact point on their website which resulted in many days of effort just trying to get my two basic blood pressure medications refilled. Several errors were made and, in fact, they never were correct even after repeated attempts. The prescriptions had the names of two different nurse practitioners on them, and finally one had the name of my new primary care physician after I was finally able to see him. Part of these glitches were due to the fact that they were transitioning to a computer system.

Not only were my prescriptions under the control of OptumCare, I was also covered by a Part D Medicare drug plan through Anthem Blue Cross. All I wanted was a 90 day supply of each pill with 3 refills, just as I had had under our previous physician. Well, somewhere between OptumCare and the Anthem drug plan, our independent pharmacist of many years was authorized to fill only a 30 day supply, but for only one of them since it was too early to fill the other one. This meant that I would have to come back every 15 days indefinitely to pick up only one prescription at a time. I checked the Anthem website and found that not only was my pharmacy not on the preferred list, it was no longer listed in the Anthem network at all (with a statement that pharmacies could be changed at any time without notice).

I discovered that I could receive 90 day supplies by mail through Anthem’s pharmacy benefit manager, but it seemed unfair to me that they should take over the bread and butter trade of easy long term prescriptions while leaving the local pharmacist with the need to carry a huge stock of a great variety of prescription items that are filled usually only once, creating an overhead headache without a volume offset.

I finally gave up. Since I still have my medical license, I ordered stock jars of 1000 pills each through a medical supplier so I wouldn’t be bothered with the hassle any more (a strategy not available to most people). Of course, that’s not covered by the Part D plan, but I had had enough. (I should mention that though it is unethical for a physician to prescribe for himself, these two medications were actually prescribed by my primary care physician and by my cardiologist.)

Yes, this is very trivial compared to some of the horrendous problems that others face in our health care system. But it is what this annoyance represents that is so objectionable. The system should work so that I can get my very common, tier one generic medications every three months with an effortless system of refilling them. Instead, my physician has been hijacked by one of the largest insurers in the nation, and my pharmacist has had barriers erected by another of the largest insurers, together making it much more difficult for me to obtain my straightforward maintenance medication. What value are these giant insurers adding that we should have to tolerate their inanity?

The reason that everyone should be concerned is that this takeover of health care is expanding rapidly, with no relief in sight. If it doesn’t work well for minor routine matters, how could it work well for the big stuff? A well designed, single payer improved Medicare for all program as is advocated by Physicians for a National Health Program would solve most of the problems with our highly dysfunctional health care financing system. Although there is widespread public support for such a model of reform, look very carefully at what is actually happening in the political arena.

Congress and the administration are continuing to expand the private Medicare Advantage and private Medicaid managed care models. They are continuing to push alternative payment models including accountable care organizations and other so called value-based proposals that involve intrusions by insurers and other managers. While using the Medicare for all rhetoric, they are quietly suppressing the bona fide single payer model while giving the business intermediaries an even greater role in (mis)managing our health care system.

HR 676, the Expanded and Improved Medicare for All Act contains many of the principles of a well designed single payer system. People are enthused to see the formation of a Medicare for All caucus in the House. There has also been considerable enthusiasm over the introduction in the Senate of Bernie Sanders’ bill, S 1804, as supposedly being a single payer Medicare for All bill in the Senate. However, to gain cosponsors, many compromises were made. Exemplifying them is the inclusion of the following:

“Sec. 611 (b) Application Of Current And Planned Payment Reforms.—Any payment reform activities or demonstrations planned or implemented with respect to such title XVIII as of the date of the enactment of this Act shall apply to benefits under this Act, including any reform activities or demonstrations planned or implemented under the provisions of, or amendments made by, the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114–10) and the Patient Protection and Affordable Care Act (Public Law 111–148).”

This means that the payment models of ACA and MACRA with MIPS and APMs including ACOs would be perpetuated under S 1804. What is especially alarming is that members of the House Medicare for All caucus, instead of protecting and supporting the single payer features of HR 676 and encouraging the Senate to endorse the same, they want to change HR 676 to include the highly flawed features of S 1804. It appears that the intent of Congress is to perpetuate the entities that are creating many of the very problems that we are trying to solve with PNHP’s version of an improved Medicare for all. Leaving our dysfunctional system in place while merely adding a Medicare Advantage-style public option is no solution at all.

My wife and I have transferred our care to another excellent physician. We left OptumCare but are continuing with the traditional Medicare program with a Medigap supplement to protect us in the event of catastrophic events. We also are continuing with our Part D drug plan to protect us against the potential of those $100,000 drugs that are becoming so commonplace. But wouldn’t it be nice to have the Medigap benefits and the drug benefits rolled into the traditional Medicare program along with the other improvements that would be ideal in an improved Medicare for all? We’re not going to have that unless we start communicating more effectively with our members of Congress, even if it means using our boot.

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

Universal healthcare was unthinkable in America, but not any more

A single-payer healthcare system appears closer than ever but to make it a reality we must avoid the pitfalls of the past

By Adam Gaffney, M.D.
The Guardian, September 16, 2018

Barack Obama dropped a bombshell into the healthcare debate roiling the Democratic party last Friday. “Democrats aren’t just running on good old ideas like a higher minimum wage,” he said, “they’re running on good new ideas, like Medicare for All…” His endorsement made headlines, and for a good reason: until recently, real universal healthcare had long resided on the margins of the American political discourse. Obama’s announcement, then, was yet one more indication that this idea – also called single-payer healthcare – had migrated to the mainstream. The shift is an encouraging development for proponents, to be sure, but there is also cause for caution: as history shows, formidable political obstacles and pitfalls lie ahead.

It is difficult to overstate how far single-payer has recently moved. Consider, for a moment, where things stood after Democrats took the presidency and both houses of Congress in 2008. “The White House and Democratic leaders have made clear,” the Washington Post reported the following year, “there is no chance that Congress will adopt a single-payer approach…because it is too radical a change.” Single-payer supporters didn’t even have a seat at the table (and some were arrested when they showed up anyway).

Following the passage of the Affordable Care Act, however, several developments pushed single-payer to the fore. First, although Obamacare expanded coverage to some 20 million people – achieving much good – it raised hopes that universal healthcare would be achieved while failing to deliver it: some 29 million remain uninsured today, while many more face onerous deductibles, restrictive insurance networks, surprise bills, unaffordable medications, medical bankruptcies and disruptions in care with every change in insurance plan.

Next, there was the 2016 election of Donald Trump, which made it obvious that Republicans lacked even a semi-serious alternative. Congressman Paul Ryan’s long-awaited ACA repeal bill was mostly a mechanism to transfer healthcare dollars from the poor into the savings accounts of the rich, and it seemed to satisfy no one except for wealthy donors.

Finally, there was a marked progressive shift within the Democratic party, beginning with the 2015-16 presidential primary campaign. Former secretary of state Hillary Clinton opposed single-payer, saying it would “never, ever” happen, but it was central to the platform of Vermont senator Bernie Sanders. Sanders lost the primary, of course, but he advocated better ideas.

Obama’s endorsement of single-payer on Friday (despite having previously said something similar) is therefore tantamount to a major shift in the Overton window, reflecting years of activism by single-payer supporters as well as a historic intra-party shift.

Today, in primary contests across the country, progressive Medicare-for-All proponents are ousting more centrist and establishment candidates – Alexandria Ocasio-Cortez’s surprise primary win in New York’s 14th congressional district being the most popular example. At the same time, public support has soared: a recent Reuters poll found that 70.1% want Medicare for All, including 84.5% of Democrats. One might even argue that for people who want a job as a Democratic politician, in other words, supporting single-payer is nearly becoming a prerequisite.

None of this is to say, however, that enacting it legislatively – even with a new government in power – will be easy. We have, after all, been down this road before.

A concept older than Medicare

As some have noted, Obama wasn’t quite right to call Medicare for All a “new” idea: on the contrary, Medicare for All is a concept older than Medicare itself. Medicare came about after the defeat of single-payer – then called “national health insurance”– during the Truman administration. The campaign against it was led by the American Medical Association (AMA), which famously did it in with the help of a cutting-edge public relations firm that waged an unremitting campaign of cutthroat red baiting (drug firms also lent support).

But something similar is brewing today. As the Hill reported last month, a new anti-single-payer group has recently formed – drawing together the lobbying muscle of both insurance companies and big pharma – and it’s spoiling for a fight. Single-payer poses an existential threat to insurers, after all, and the industry’s coming PR blitz could make the famed “Harry and Louise” TV ad campaign of the 1990s – credited with helping sink Bill Clinton’s healthcare reform –look like an undergraduate’s mediocre final project for a marketing course.

This is a major obstacle, but a surmountable one: all great reforms in history, including Medicare itself, had to overcome powerful opponents. Yet a second potential pitfall lies ahead: despite all that has happened, politicians could still walk away from single-payer – probably by watering “improved Medicare for All” down into something unrecognizable. And again, something similar has happened before.

After the AMA’s defeat of national health insurance, its architects narrowed their proposal to cover just seniors; this became known as “Medicare.” However, the idea was that the Medicare approach could later be used to cover everyone. A push was made to realize this universal vision within a few years of the implementation of the program, and indeed, had things happened somewhat differently, some sort of national health insurance legislation could have been achieved in the 1970s.

Ultimately, however, the movement disintegrated – in large part the consequence of a historic rightward political turn that culminated in the election of Ronald Reagan. Fatefully, this was also the moment when the Democratic party abandoned national health insurance, instead embracing a private-insurance based alternative built on Richard Nixon’s reform proposal, which the ethically compromised Republican president had offered as a counter to single-payer.

Brick-by-brick, the campaign for national health insurance was rebuilt. In the late 1980s, for instance, the organization I serve – Physicians for a National Health Program – was formed, and its proposal for what was newly called “single-payer” became the blueprint for HR 676, the Improved and Expanded Medicare for All Act that was first introduced in Congress in 2003. That year, it had only 38 co-sponsors, but today HR 676 is supported by an unprecedented 123 lawmakers, or some two-thirds of the Democratic caucus. Meanwhile, Bernie Sanders’ companion bill in the Senate, the Medicare for All Act of 2017, has achieved 16 co-sponsors (his previous bills had zero).

The future of single-payer

The danger, however, is that even with the prospects of these bills on the rise, Democrats could turn away from the essence of the vision. Already, some are aiming to mutate Medicare for All into something vastly inferior – for instance, into an expansive “public option”-type program that would retain a major role for private insurers (e.g. the Center for American Progress’s confusingly labelled “Medicare Extra-for-All”). But to achieve real universal healthcare, Democrats can’t afford to repeat the mistakes of the past and flee to a private-insurance based reform a second time around. Medicare for All must remain what it is today – how it is detailed in a bill like HR 676 – if it is to mean anything at all: fully public national health insurance providing comprehensive, universal coverage to the entire nation.

Wilbur Cohen, a chief architect of both Truman-era national health insurance and Medicare, recognized this when he asserted that private insurance companies should have no role in a Medicare for All system, although it was not yet called that. “[O]nce the Federal Government decides that everybody is going to be insured,” he put it in 1977, “there is no need for a private insurance company to go out and sell coverage…using private insurance agencies to achieve the public responsibility seems to me to be wasteful and unnecessary, imposing an additional cost…without any essential advantage.”

His point is even more salient today: private insurance companies add only fragmentation and cost, something we can’t afford as we work to provide everyone in the nation with comprehensive first-dollar coverage.

For the first time in a generation, the realization of a right to healthcare – through implementation of a single-payer system – is on the horizon. But achieving it requires not repeating the mistakes of history. It means somehow countering a staggeringly rich corporate opposition while at the same time preserving the essence and the details of the vision – one which, by necessity, leaves no room for the waste and avarice of the private insurance industry. It is a formidable task, but one that has never seemed so winnable.

Dr. Adam Gaffney is an instructor in medicine at Harvard Medical School. He is secretary of the advocacy organization Physicians for a National Health Program.

https://www.theguardian.com…

A cost-effective alternative for U.S. health care

By Ken Lefkowitz
Courier Post (Cherry Hill, N.J.), September 15, 2018

If someone paid $1,000 for a service they could purchase elsewhere for $512, you’d think they were quite foolish. Yet, that’s the situation facing healthcare in America today.

Our current system for financing healthcare has been ineffective in controlling costs or providing the highest-level quality care. In 2016, the U.S. spent 17.2% of its GDP on a system that still leaves tens of millions of Americans uninsured or underinsured. In contrast, Canada spent 10.6% of GDP for universal coverage while the United Kingdom spent 9.7%. The nations of the European Union spent an average 8.8% of their GDP on healthcare1 (i.e. $512 for every $1,000 spent here). Despite the high cost, the U.S. ranked only 5th of 11 wealthy nations in quality.

American healthcare is financed through a free market. But free markets require transparency, so that buyers can compare the price and quality of competing products. Healthcare simply doesn’t lend itself to these comparisons. The dizzying complexity of both medical care and insurance plan design precludes the consumer from making informed choices. The average person cannot be expected to have knowledge of illness or treatment options, and primary care physicians strongly influence or dictate choice.

For example, you might select an insurance plan as an individual, or one offered by your employer, because it has a low price and includes your doctor in its network. This feels like an informed choice. However, when you become ill and require surgery, your doctor (probably not you) selects the hospital you go to. Much to your surprise, the anesthesiologist and radiologist are not “in-network” and, as a result, you incur huge bills. Transparency did not exist beyond choosing your plan and primary doctor. This is but one example of many in our complex system.

While the Affordable Care Act introduced many needed reforms, it too relies on market forces to control costs.

There is an alternative worth considering. A single-payer system can deliver both cost-effective and high-quality care.

One model of a single-payer system, H.R. 676, the Expanded and Improved Medicare for All Act, if enacted, would fund all necessary care including dental, vision and prescriptions, with no co-pays or deductibles. Patients are free to choose any doctor or hospital since the delivery of care continues to remain in private hands. A study by Professor Gerald Friedman of the University of Massachusetts estimates H.R. 676 could cover everyone in the U.S. while yielding $592 billion in gross savings annually. These savings are mostly achieved by eliminating the duplicative administrative and marketing costs of our profit-based insurance industry, and allowing for the negotiation of medical services and pharmaceuticals on a national level.

Single-payer systems can provide additional savings by emphasizing evidence-based medicine, preventive care and improved health outcomes, vs. our current method of fee-for service. Additionally, single-payer will reduce the high cost of care for those uninsured citizens using hospital emergency rooms for their healthcare. Focus on quality of care, and early disease intervention resulting from eliminating co-pays and deductibles, can lower costs even further.

Research I have spearheaded demonstrates that a single-payer system would be a boon to businesses by reducing absenteeism and increasing labor productivity gained through a healthier workforce, all while lifting employers’ burden of providing healthcare, allowing them to be more competitive in today’s global economy.

According to the Pew Research Center, 60% of Americans currently believe the government should be responsible for ensuring health coverage. And the government is already heavily involved in financing healthcare. In fact, a 2016 study found taxpayers fund 63% of U.S. healthcare through Medicare, Medicaid, Veterans Affairs, government employee benefits, and tax subsidies for employer plans.

Our current system has failed us. Americans need to understand the evidence for more cost-effective financing of healthcare and further support a single-payer program like Medicare for all.

Ken Lefkowitz is a former senior director of benefits and compensation for several major corporations. He is a member of the Physicians for a National Health Program and the New Jersey Universal Healthcare Coalition.

https://www.courierpostonline.com…

The support for Medicare for all is solid

The Nation’s Pulse: Year Four

Texas Medical Center Health Policy Institute
Survey completed June-July 2018 (4,020 national participants)

Support for Medicare for All U.S. Adults

Q: Are you in favor of the federal government providing Medicare insurance coverage for all U.S. adults?

59% – All
71% – Democrats
46% – Republicans
55% – Independent

http://www.tmc.edu…

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Comment:

By Don McCanne, M.D.

Although this question asks about providing Medicare insurance coverage for all U.S. adults without mentioning children, nevertheless it still shows strong support for Medicare for all, including close to one-half of Republicans.

Efforts are being made to discredit these surveys by tacking on questions such as “even if it means the government raising your taxes,” or “even if it means losing your choice of health plans,” or “even if it means they take away your insurance through your work.” Inevitably these questions slightly reduce polling support for Medicare for all.

Polls that we don’t see are those that would tack on questions that would increase the credibility of the Medicare for all model. Instead of threatening an increase in taxes, suppose they were asked, “even if it meant that all but the very wealthiest would end up paying on average less overall for health care.” Instead of threatening loss of choice of health plans, suppose they were asked “even if it meant that you would no longer be limited to a list of physicians and hospitals dictated by the insurer but rather you had complete free choice of your health care professionals and institutions.” Instead of threatening loss of your health plan through work, suppose they were asked, “even if it meant that you would never have to worry about health insurance again because you would automatically have full comprehensive coverage for life.”

Obviously we could go further. “Even if Medicare for all meant that we would save hundreds of billions of dollars in administrative waste.” “Even if Medicare for all meant that nobody would ever have to go without care because they couldn’t afford it.” “Even if it meant that wherever you are in the country, you would never have to worry whether your insurance is good.” “Even if it meant that you would never have to busy yourself with insurance paperwork because coverage and billing is automatic.” “Even if it meant that you would not have to worry about whether you could afford the care you are about to receive since out-of-pocket costs would be eliminated for all essential health care services.”

Well, the good news is that people are gaining a better understanding of the benefits of the Medicare for all single payer model. Republican voters are realizing that the Republican promise of a better replacement for Obamacare proved to be false, and yet they understand that we need more than what the Affordable Care Act brought us. Democratic voters largely understand the benefits of single payer, but they are just beginning to realize that some Democratic politicians are using the Medicare for all rhetoric deceptively to maintain the status quo that caters to the insurers and pharmaceutical firms. It is no wonder that we are seeing an increase in independent voters who are wary of both major parties but who also seem to understand that Medicare for all seems to be a much better option than our current dysfunctional system.

We need to keep on with what we’re doing, except do a whole lot more of it. Maybe those of us who are octogenarians will no longer have to say, “but not in my lifetime.”

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The coverage of the uninsured has plateaued

Health Insurance Coverage in the United States: 2017

By Edward R. Berchick, Emily Hood, and Jessica C. Barnett
United States Census Bureau, Current Population Survey Annual Social and Economic Supplement (CPS ASEC), September 2018

In 2017, 8.8 percent of people, or 28.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured in 2017 were not statistically different from 2016 (8.8 percent or 28.1 million).

https://www.census.gov…

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Comment:

By Don McCanne, M.D.

This definitive report on the health insurance status of U.S. residents provides an extensive breakdown of the statistics on insurance coverage, but the one highlight above pretty well summarizes the status. There was no statistically significant change in the numbers of uninsured between 2016 and 2017.

Although the reported change from 28.1 million to 28.5 million uninsured may not be statistically significant, there are likely 400,000 people out there who personally believe it is significant for themselves even if the statistical analysis is dismissive of it. At any rate, there are still over 28 million people who can’t be pleased with their lack of insurance coverage.

The major lesson in this report is that the gain from the Affordable Care Act has appeared to plateau, although the numbers may not have fully stabilized yet, largely because of the policies being adopted by the Trump administration and the various state governments. But it is safe to say that complete elimination of uninsurance is not imminent and cannot possibly occur without a major policy change.

One of the least promising policy changes would be a Medicare public option, or Medicare buy-in, which some have mislabeled as Medicare for All. It would provide only one more option in the market of plans that already exists and thus would have very little impact on overall coverage or affordability since the other options are already available.

Of course, the most promising policy change under consideration that would be fully effective would be a single payer national health program – a bona fide Improved Medicare for All.

It has now been a decade since we started down the path of Obamacare. Regarding the goals of universality, equity, affordability, administrative efficiency, and guaranteed lifetime coverage, it is clear that the Affordable Care Act has been a failure. Rather than merely adding a Medicare Advantage-like public option to our expensive but mediocre system, we should finally provide the fix our system truly needs – an Improved Medicare for All. Just make sure it’s the real thing.

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

Where do we stand now with health care?

By George Bohmfalk, M.D.
The Aspen (Colo.) Times, September 13, 2018
(Part 2 of 6. Read parts 1, 3, 4, 5 and 6.)

In this series of weekly articles, I will describe the current status of health care in America and how we might improve it. Inasmuch as most people younger than 65 have no great need to understand what Medicare is, and as Medicare may be a good model on which to build a universal system, I’ll briefly explain a bit about it.

Medicare began over 50 years ago, in response to poor medical care and high poverty rates among our seniors. It has succeeded in alleviating both of these crises and continues to be a very popular and efficient health insurance program. Medicare is a universal, single-payer system, meaning that it covers everyone in the designated group, and that payments for medical care are all made via a single source — the federal government. Funding comes from both taxes and premiums. In striking contrast to some European-style socialized systems, medical care under Medicare is privately delivered, at private hospitals by doctors in private practice. Every Traditional Medicare enrollee has free choice of doctors and hospitals.

Notwithstanding its many successes, Medicare is not a perfect system. Its most glaring deficiency is that it pays only 80 percent of charges, leaving the enrollee to pay the remainder, either out-of-pocket or through Medigap plans sold by for-profit private insurers. While seemingly small, this 20 percent difference, along with deductibles and copayments, can become an insurmountable financial burden in complex cases. Seniors are filing bankruptcy because of medical debt.

Another major deficiency when Medicare began was that it did not cover prescription drugs. As medicines became unaffordable to many seniors, Congress attempted to remedy this in 2003 by adding Medicare Part D, the prescription drug program, available for an added premium. Unfortunately, the pharmaceutical lobby arranged for a provision to be included in the law that forbids Medicare from negotiating drug prices. As a result, we in the world’s largest pharmaceutical market pay the world’s highest prescription drug prices. Productive young people are dying because they can’t afford insulin, once one of the least expensive and most life-saving prescription drugs.

Traditional Medicare still does not cover dental, hearing or vision care, aspects which can have large impacts on our overall health. I once operated on a man whose tooth infection spread to his brain. Dental problems contribute to arterial disease, and poor hearing and eyesight lead to higher injury rates and accelerated mental deterioration. These and other deficiencies can be readily corrected in a national Improved Medicare for All program.

Where do we stand now overall? Unfortunately, we don’t have the best health care system in the world. We do have many great doctors and hospitals, but we pay about twice per person what most other industrialized countries pay for their excellent health care. Yet nearly 30 million of us remain uninsured and 40 million underinsured. You may know someone, or find yourself, among the underinsured. These are folks who believe they have good insurance, often through their employer, but when a health issue arises, the high deductibles and copayments are daunting. If you’re underinsured, you may be forced to choose among wiping out your life savings to pay for care, filing for bankruptcy when the bills come in, or delaying or declining needed care, if that’s possible.

Even people with good insurance are often surprised by its deficiencies and disruptions. In order to maximize their profits, insurers seek discounts from doctors and hospitals and form provider networks of those low-bid participants. These narrow networks become very inconvenient when you are covered only at a remote hospital or forced to change doctors. There are dozens of stories of people being stuck with $25,000 to $60,000 bills from air ambulance companies that were not in their insurance networks. How were they to know that beforehand? Health insurance isn’t what it used to be, and it’s getting worse.

You might think that paying such high prices gets us good results, but it doesn’t. Reports by the OECD (Organisation for Economic Co-operation and Development) show that we rank below most industrialized nations in many health outcomes, including life expectancy. Our maternal and infant mortality rates are among the highest. We pay the most, and get the least for it.

In subsequent articles, we’ll see where all our money is going and how it might be redirected to improve our nation’s health. The short answer is by expanding Medicare to cover everyone, and improving it to remove the deficiencies described above.

Spoiler alert: In the end, we’ll spend less overall. It’s a mind-boggling thing.

Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.

https://www.aspentimes.com…