Former U.S. Surgeon General: We’re Not Ready as a Nation for Single-Payer Healthcare; High Medical Debt ‘Obliterating Our Country’s Future’, MedPage Today, June 4-5, 2024, by Jeremy Faust

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Question: People in the comments section of your article did say, “Well, wouldn’t Bernie Sanders’ approach be better? Wouldn’t single-payer be the way?” And I always answer this question by saying, “I don’t know. I know it works in other countries, but I’m not sure this country is set up for that.” What do you think about that?

Jerome Adams: “You also can’t go to a system where you’re giving universal access to healthcare and single-payer until you can agree upon what that actually means.

“A real example: you go to Canada or the U.K. right now, and you’ll have no shortage of people who will tell you that they’re waiting 6 to 8 months for their elective surgery [A]. In the United States, if you take someone who comes in to their doctor in pain or with a diagnosis and they get told that they’re going to have to wait 6 to 8 months for their elective surgery, they will lose their minds and they’ll be on the phone with their lawyer or their local news station right away.

“We have a different expectation for what universal access to healthcare and a single-payer system would look like here versus other countries. Until we’re ready to have a very mature and nuanced conversation about that and about the fact that we can do this, but if we do this it means that you’re not going to be able to get what you want when you want [B] just because that’s the cultural expectation here. I think there’s a lot of nuance here.

“So at the end of the day, to answer your question, I don’t think that we are quite ready as a nation to really go there even though it sounds good. But I also think that we don’t have to. Switzerland, for instance, has a system where they provide access to a certain level of care for everyone in the country [C]. If you want more, you can buy it off of the market.

“I think there are hybrid systems that we can and should be thinking about that are predicated on giving people a baseline level of care, guaranteed, that do work and still allow a free market to exist.” …

Question: [T]alking about the high-deductible healthcare plans. I want to take the devil’s advocate [position] here and say, isn’t that the point of a high deductible?

Adams: … This is about the fact that 66% of bankruptcies in the United States are driven by medical debt. So regardless of whether you feel like it’s a person’s fault or not, we have a broader societal issue when … bankruptcies are being driven by this kind of debt [D]. That’s number one.

Number two, as I mentioned earlier about the Affordable Care Act [ACA], we’re now in a place where almost 60% of people with employer-provided health insurance — the ‘good insurance’ — are forced onto high-deductible health plans [E]. It’s not that they made a choice, it’s that that was the only option that they were given, or the plans are priced such that that’s the only one where I can afford the premium to go on. So it’s not like people out there are making the choice that they want this high-deductible health plan, they’re being pushed in that direction.

The final point I’d make about the high-deductible health plan … the whole premise of the high-deductible health plan was also to include HSAs, where you contribute to these HSAs on a monthly basis so you’ve got something in the kitty in case you have an emergency. … But also we know that many people, particularly from marginalized communities like Black and Brown individuals and individuals from under-resourced communities, often are uneducated about their HSA or don’t contribute to their HSA [F].

So you have a system set up that’s dysfunctional because people aren’t educated and they aren’t contributing to it. Even when they do everything right — like I do, I max out my HSA — you still could get hit with a bill in January [G] as opposed to December. Mayo Clinic, in this instance, isn’t waiting until December to get their money. They want their money now. and so I’ve got to come up with it now.

… Nobody thinks that they’re going to need emergency medical care! Heck, I didn’t think that I was going to pass out at a medical meeting after a hike. …

No one’s talking about this on the campaign trail. [H] You don’t hear Biden or Trump talking about this on the campaign trail. You don’t hear people running for Congress talking about this on the campaign trail, but it is 66% of bankruptcies. It’s literally just obliterating our country’s future in terms of putting people in medical debt. …

Again, I raised this because I want people to really understand that this is hitting all of us and it is not sustainable.

[W]e highlight the need for increased transparency and pricing. [I] … we also need to look at state policies to help people avoid surprise medical bills, not just for out of network, but again, from January surprises and all sorts of different ways that people run into surprise medical bills. …

We need collaboration between providers, insurers, and healthcare systems, to really figure out how we unstick this broken system.

Then, we need to improve high-deductible health plans. I think that it’s still workable, [J] but my situation showed that high-deductible health plans are actually setting a lot of people up for medical bankruptcies and the burden of medical debt.

[ HJM comments keyed to bracketed letters ]

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Comment:

By Jim Kahn, M.D., M.P.H.

Dr. Adams engages in policy analysis by anecdote. This is hazardous; omitting relevant evidence leads to faulty conclusions. He thus dismisses single payer in cavalier fashion. Below is a point-by-point critique (with, I should note, quite a few points of agreement):

[A] “They’re waiting 6 to 8 months for elective surgery” in Canada and the UK. These numbers aren’t relevant to US single payer. For starters, the UK NHS is under assault by the Tories. More generally, the OECD record for elective surgery wait times is quite good, with medians of 4-7 weeks in the best-performing countries … and we’d be starting with higher spending and more surgeons than any of them. Of course, elective surgery isn’t urgent, by definition. On other measures of access, such as for primary care, the US lags far behind other OECD nations.

[B] “If we do [single payer] it means you’re not going to get what you want just because that’s the cultural expectation here.” Hmm. Is the US cultural expectation to skip or delay care for financial reasons? To experience 2-3 years’ lower lifespan? Today, while the best-insured may get the medical care they want right away, most have to wait or can’t get it at all.

[C] “Switzerland, for instance, has a system where they provide access to a certain level of care for everyone in the country.” That “certain level of care” is standard and comprehensive. Only 8.5% of spending is voluntary health insurance.

[D] “66% of bankruptcies in the United States are driven by medical debt.” Got that right!

[E] “about the Affordable Care Act, we’re now in a place where almost 60% of people with employer-provided health insurance — the ‘good insurance’ — are forced onto high-deductible health plans.” Yup – forced into high deductibles. Not a choice.

[F] “we know that many people, particularly from marginalized communities like Black and Brown individuals and individuals from under-resourced communities, often are uneducated about their HSA or don’t contribute to their HAS.” Right – likely can’t afford to contribute. HSAs are regressive, benefiting the healthy and wealthy. They worsen inequality.

[G] “you still could get hit with a bill in January.” Right again … several thousand dollars within the deductible, all at once, with no financial reserves.

[H] “No one’s talking about this (medical debt & bankruptcies) on the campaign trail.” True. Biden mentions lower prescription drug costs for seniors, which help a bit. Trump discusses ending the ACA. Some progressive Congressional candidates discuss single payer.

[I] “we also need to look at state policies to help people avoid surprise medical bills.” We’ve tried that, and federal policies too. It doesn’t work – too complex and gameable, and even if it did succeed it would leave unresolved 25 other major problems with our fragmented insurance.

[J] “we need to improve high-deductible health plans. I think that it’s still workable.” Not really. The problem with high deductibles is that they leave individuals & families financially vulnerable. Other wealthy nations don’t use high deductibles. With good reason – they impair access to care, impoverish people, punish the poor, and don’t control health care costs

Come on, Dr. Adams – endorse a real solution, one proven in dozens of other countries. It’s nice to hear from a former Surgeon General on problems with our insurance. How wonderful would it be for him to endorse the effective and enduring policy solution – single payer.

Financial Burden of Health Care in the Privately Insured US Population, JAMA Internal Medicine, May 28, 2024, by Sukreth A. Shashikumer, et al.

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Improving health care affordability is a national priority, including for nearly 180 million individuals with private insurance coverage who have experienced increased premiums and decreased benefits (eg, increasing copayments and deductibles). This issue is particularly salient for those with low incomes, who are more susceptible to debt, bankruptcy, and worse outcomes due to poverty.

This cross-sectional study used 2007 to 2019 Medicare Expenditure Panel Survey data for respondents and family members younger than 65 years with private insurance. Families’ total health care spending was calculated as contributions to premiums plus out-of-pocket medical and prescription drug spending. We assessed families’ annual financial medical burden by dividing their total health care spending by their postsubsistence income (income less estimated food costs).

The unweighted sample included 96075 families. Among low-income families, mean total health care spending was $3163 in 2007 and $3247 in 2019. Low-income families’ medical burden was 23.5% in 2007 and 26.4% in 2019.  Among higher-income families, mean total health care spending increased from $4071 in 2007 to $5239 in 2019. Higher-income families’ medical burden was 5.4% in 2007 and 6.5% in 2019.

In this national cross-sectional study of privately insured US families, inflation-adjusted health care spending increased from 2007 to 2019, largely owing to increasing contributions to premiums. Annual financial burden increased significantly, both overall and among low-income and higher-income families. Mean financial medical burden was more than 26% of post subsistence income for low-income families, compared with approximately 6% for higher-income families.

Our findings highlight the need to strengthen financial safeguards for low-income families, including those who do not meet the enhanced state definitions of Medicaid eligibility and are considered well-resourced enough to rely on private insurance. Furthermore, these results suggest that, without stronger emphasis on regulating premiums, controlling out-of-pocket costs is necessary but not sufficient to alleviate the burden of health care.

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Comment:

By Don McCanne, M.D.

Our political leaders who are quite satisfied with our health care system based heavily on private insurance plans (employer-sponsored plans, ACA plans, privately purchased plans, etc.) should make themselves aware of the findings in this relatively simple study. The financial burden of private insurance plans has continued and will continue to creep upward throughout the years, further threatening the affordability of health care, making it an imperative that we do something to stem the tide of increasing private insurance costs, especially for lower-income individuals who are being priced out of health care, experiencing significant medical debt, and suffering medical bankruptcy.

It’s not as if we didn’t understand that there is a way around this dilemma. There are many other defects with the private insurance model, but the most important is that it has been designed to draw off our health care dollars to create wealth for the investors and other intermediaries. Rather, our health care system needs to be financed based on the ability to pay with the funds distributed based on medical need and not for purposes of wealth accumulation.

Of course, that model is the single payer or Medicare for All model of health care financing. Since it would be financed by equitable, progressive taxes, there would no longer be any concern about adjustments in premiums or other cost sharing that would adversely impact lower income individuals. Although the accountants of the extremely wealthy would deal with larger numbers, the amounts would not have a negative impact on their lifestyles.

Instead of listening to the billionaires, Congress should listen to the American Public Health Association:

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American Public Health Association, Policy Number 20219, Excerpt

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Single payer is the best option to ensure equity, fairness, and priorities aligned with medical needs. This approach benefits public health, as everyone will have universal access to needed care, with treatment plans based on what works best for the patient. Clinics and hospitals will be free to provide appropriate treatments based on need.

https://healthjusticemonitor.org…

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The Medicare Bubble Has Burst; Government health-insurance program had been a gold mine for private insurers until recently, Wall Street Journal, May 17, 2024, by David Wainer

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With hundreds of billions of taxpayer dollars flowing to insurers in a fast-growing market buoyed by aging baby boomers, there was little not to like as far as Wall Street was concerned. Companies like UnitedHealth Group and Humana bet big on the program, and investors generally rewarded them for it. Medicare Advantage, in which the government pays insurers a set amount to manage the care of seniors, recently surpassed traditional Medicare’s share of beneficiaries. …

But the gold rush is over for investors, at least for now. After years of reports, lawsuits and whistleblower accounts accusing big insurers of gaming the system and overcharging the government, the Biden administration has made a series of policy changes that have negatively affected what the plans get paid. Meanwhile, a post-Covid surge in seniors’ medical costs caught insurers by surprise.

The stark drop in profitability is rattling corporate boards and investors. One of the biggest losers is CVS Health, whose Aetna unit bet big on Medicare right before costs soared. To gain market share, CVS-Aetna offered generous plans this year, surprising some executives at rival insurers. While the move paid off in terms of membership count—CVS added more than 700,000 Medicare Advantage members this year—the company underestimated what it would cost to insure them. In its first-quarter earnings report earlier this month, CVS said the segment helped drive medical costs $900 million higher than the company had expected. Its shares had their largest one-day drop in almost 15 years in response and are down 26% for the year, giving it a market capitalization of just over $70 billion. That is roughly what it paid for Aetna back in 2018.

CVS isn’t the only one in trouble: Medicare-focused insurers, some of which had vastly outperformed the stock market in the past several years, are underperforming this year. Humana shares are down more than 20% this year and even industry leader UnitedHealth, which was more conservative in how it priced its plans, was down as much as 16% for the year in April before recouping much of the losses.

… [W]hile declining profit expectations have negatively affected share performances, there are still plenty of profits to be made.

Take hard-hit Humana, which is mostly focused on Medicare Advantage. The firm is expected to earn significantly less in 2024, but analysts polled by FactSet still see it making just over $16 per share this year. By 2026, analysts expect earnings to rise back to $26 per share—some $3 billion in net income.

The high cost of covering seniors is likely a temporary problem for insurers, who get to submit their bids to the Centers for Medicare and Medicaid Services every year. While they are limited in the changes they can make, CVS and others said they are planning to exit some counties and cut back on things such as vision benefits to boost margins.

“The goal for next year is margin over membership,” CVS Chief Financial Officer Thomas Cowhey said at a recent conference. “Could we lose up to 10% of our existing Medicare members next year? That’s entirely possible.” By all indications, other large players such as Humana will also be shifting from growth to profits. …

The tougher challenge is on the regulatory side. The Biden administration’s changes, from releasing stingier payment rates to changes in how programs can code patient risk, signal an era of tighter purse strings. With such a big part of their business at stake, the industry’s effort to sway public and policymakers’ opinions is expected to go into overdrive.

For decades, policymakers have sought to bring private insurers along as a way to manage soaring Medicare costs. In 2003, Congress passed the Medicare Modernization Act, which created Medicare Advantage as we know it. The idea, in a nutshell, is to bring down costs and improve care by allowing insurers to manage care, much like they do for the nation’s employers.

But critics point to studies showing that Medicare Advantage plans cost the government and taxpayers billions of dollars more than traditional Medicare.

“For well over a decade, Medicare Advantage plans have been making extremely high profits. What’s going on now are long overdue policy changes to bring their pricing and coding practices back into line,” said Dr. Don Berwick, former head of the Centers for Medicare and Medicaid Services.

In the near term, the best hope for a quick shift to insurers’ fortunes could be a Donald Trump win in the coming presidential elections …

[HJM bolding]

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Taking Advantage: How Corporate Health Insurers Harm America’s Seniors, Physicians for a National Health Program, May 23, 2024

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7.3 million: Number of MA beneficiaries who are underinsured based on their reporting of high health care costs, based on 2023 Commonwealth Fund study and STAT estimate of 2024 enrollment.

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CVS CEO to Wall Street: People in Medicare Advantage Are in for a World of Hurt as We Focus on Profits, HEALTH CARE un-covered, May 13, 2024, by Wendell Potter

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We’re introducing the HEALTH CARE un-covered Magic Translation Box (MTB). We’ll fire it up occasionally to decipher the coded language executives use when they have to deal with analysts and investors in a public setting. We’ll start with what Lynch and her team told analysts on May 1 when CVS announced first-quarter 2024 results that caused a stampede at the New York Stock Exchange.

Lynch: We recently received the final 2025 (Medicare Advantage) rate notice (from the Center for Medicare and Medicaid Services), and when combined with the Part D changes prescribed by the Inflation Reduction Act, we believe the rate is insufficient. This update will result in significant added disruption to benefit levels and choice for seniors across the country. While we strive to deliver benefit stability to seniors, we will be adjusting plan-level benefits and exiting counties as we construct our bid for 2025. We are committed to improving margins.

Magic Translation Box: Can you believe it? CMS did not bend to industry pressure to pay MA plans what we demanded for next year. We only got a modest increase, not enough, in our opinion, to protect our profit margins. To make matters worse, starting next year we won’t be able to make people enrolled in Medicare prescription drug plans (Part D) pay more than $2,000 out of their own pockets, thanks to the Inflation Reduction Act President Biden signed in 2022. So, to make sure you, our most important stakeholder, once again have a good return on your investment, we will notify CMS next month that we will slash the value of Medicare Advantage plans by reducing or eliminating some benefits, like dental, hearing and vision, that attract people to MA plans in the first place. And, for good measure, we’ll be dumping Medicare Advantage enrollees who live in zip codes where we can’t make as much money as we’d like. For them: too bad, so sad. For you: more money in your bank account. And for extra good measure, to keep seniors from blaming greedy us for what we have in store for them, our industry will be bankrolling dark money ads to persuade voters that Biden and the Democrats are the bad guys cutting Medicare.

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Comment:

By Jim Kahn, M.D., M.P.H.

The major private insurers have relied on public programs like Medicare Advantage to drive huge revenue and profit growth in recent years. Profits were record-breaking during COVID, when overall medical care use dropped. Now finances are tumbling, due to pent-up medical demand and correction of out-of-control capitation rates by the Center for Medicare and Medicaid Services (CMS). MA momentum is slowed, if not stopped.

Today’s excerpts illustrate three important angles for this story. Coverage by the Wall Street Journal – the newspaper of record for US business – reveals the high perceived impact of this story. An excellent PNHP report systematically highlights how MA practices harm beneficiaries. And HEALTH CARE un-covered provides the much-needed interpretation of corporate-speak into honest and unpleasant truths.

Check out an upcoming PNHP webinar, “Taking Advantage: How corporate health insurers harm America’s seniors” with Sen. Elizabeth Warren, on June 3 (Monday) at 8 pm Eastern / 7 pm Central / 6 pm Mountain / 5 pm Pacific. Sign up here.

There’s no way to reconcile MA profits and patient welfare. Hundreds of billions of dollars extracted from Medicare into shareholder profit means less for patient care and a financial burden for all of us.

Is there another way? Well, yes, you may have seen it here once or twice before: A single public funder, paying providers directly without private for-profit intermediaries. It’s adapted from traditional (non-MA) Medicare.

https://healthjusticemonitor.org…

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Privatization Warning, The American Prospect, April 11, 2024, by Suzanne Gordon and Steve Early

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A VA advisory panel issues a red alert on outsourcing.

In response to cost overruns on care for nine million patients of the Veterans Health Administration (VHA), the Department of Veterans Affairs (VA) recently convened a high-level “Red Team…”

The panel of six health care leaders includes former VHA undersecretaries for health, ex-DOD officials with military health experience, and prominent health care system executives. …

Rarely has a group of inside-the-Beltway experts gotten to the point so quickly or sounded the alarm so clearly. In the report, obtained by the Prospect before its public release, the group unanimously concluded: “The increasing number of Veterans referred to community providers … threaten to materially erode the VA’s direct care system.” Without a course correction, they said, mass closures of VA clinics or certain services could ensue, “eliminating choice for the millions of Veterans who prefer to use the VHA direct care system for all or part of their healthcare needs…”

The cost of reimbursing the 1.7 million private-sector providers enrolled in the five-year-old Veterans Community Care Program (VCCP), which facilitates patient outsourcing, has “dramatically increased, rising from $14.8 billion in FY 2018 to $28.5 billion in FY 2023,” the report states. Referrals outside the VHA are rising by 15 to 20 percent per year and now involve more than 40 percent of all patients, who are getting at least some care in the private sector.

The Red Team members lay out a series of very concrete steps that VA leaders can take to address problems identified in the report. Many can be implemented without remedial action by Congress…

Many can be implemented without remedial action by Congress.

High on the list is that Veterans Affairs Secretary Denis McDonough revise the “drive time and wait time” standards that his pro-privatization predecessor Robert Wilkie implemented, and which are now bankrupting the VA.

As the Prospect has suggested for several years, the authors state that the VA could immediately save over $1 billion by making telehealth services count as access to care. Secretary McDonough himself said this should happen two years ago.

The report urges McDonough to go further, by conducting a more thorough revision of the Wilkie access standards. Right now, a veteran who has to drive a long distance for a medical appointment could show up at a private-sector facility across the street from a VHA hospital or clinic that could provide the patient with the same service.

To better manage overuse and misuse of private-sector services, the report recommends that the VA should replace its use of what are called standardized episodes of care (SEOCs). Currently, VCCP providers can deliver services that a veteran might not need, or that the VHA could provide following an initial VCCP visit. The VCCP can bill for a veteran’s initial visit to an orthopedist for back pain, and for X-rays or MRIs, and for physical therapy services, and for 20 sessions of massage therapy. No utilization review is applied, and the veteran is not sent back to the VHA, where these services may be available in a more timely fashion, at higher quality, and for a lower cost. This practice, the authors argue, should be jettisoned, and a more effective utilization management system developed.

Similarly, when it comes to controlling ER costs, the Red Team says the VA should make it easier for veterans to access VA ER care through telehealth, and “repatriate” patients back to the VHA for follow-up care once they have been stabilized. VA should also make sure veterans aren’t directed to VCCP ERs as their main option on VA websites.

Another critical recommendation is that VA initiate an “attraction campaign” so that veterans, VA staff, policymakers, and the public understand what reams of data confirm: The VA delivers stellar care to some of the nation’s most complex patients, more quickly and at lower cost than private-sector providers. Marketing the system’s remarkable successes, the Red Team insists, should be “a top organizational priority.” …

These would be welcomed by longtime advocates for veterans like Michael Blecker, director of Swords to Plowshares in San Francisco.

“If the VHA collapses, we will see an increase in veteran homelessness, veteran suicides, veteran unemployment, and a host of other serious consequences,” Blecker predicts. “Plus, the nation will have lost its only model of comprehensive health care. We in the veteran community cannot allow this to happen.”

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Comment:

By Suzanne Gordon, M.D.

Over the past decade, the outsourcing of VA care to the private sector has increased dramatically.  Market ideologues have helped the medical industry grab more and more taxpayer dollars as they’ve crafted, and then lobbied for, legislation that would drain the Veterans Health Administration of both funds and patients. HJM has covered these worrisome trends.

Now we see a call for action. The Red Team Report, referred to in the article above, and a follow up article – Is Denis McDonough a Slow Reader? – is perhaps the most significant challenge to VHA outsourcing. The authors are classic inside-the-beltway players not known for their anti-privatization positions.  Yet, they unanimously conclude that the VHA faces an existential threat – and by this they are not referring to something abstract or philosophical.

What has been most frustrating about following the Red Team story has been the response of the very VA leaders who commissioned the report.  The report provides the Biden administration with just the mainstream cover it needs to initiate a reversal of VA privatization.  And yet, instead of taking this opportunity, they are maintaining the course Republican privatizers, from John McCain to Donald Trump have charted.

Our hope in writing this article for The American Prospect and many others like it, is that healthcare reform activists and those concerned with veterans’ issues will pressure the administration to do what’s needed before it’s too late.  If the DoD (which is reversing the privatization of the military health system)  can do it, the VA certainly can – and must.

https://healthjusticemonitor.org..

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The day will come when we will succeed in making health care a human right, YouTube video (7 min), May 23, 2024, by Bernie Sanders

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Transcript:

Thank you very much for joining me. I want to say a few words today about our broken health care system and the need for us to join the rest of the industrialized world and guarantee health care for all as a human right. The quality of health care that a nation provides is not only a major factor in determining whether people live long happy and productive lives, but it gets to the heart of what a country stands for and what its values are. In a sense nothing is more important than that. In my view there is a fundamental and simple question that all of us have got to answer: Should health care in the United States be a right for all people or should it be a privilege based on our wealth and our ability to pay?

Let’s be clear the health care system of the United States is broken. It is dysfunctional and it is cruel. It is a system which spends nearly twice as much per capita as any other major country, while 85 million Americans are uninsured or underinsured, where one out of four Americans cannot afford the cost of the prescription drugs that doctors prescribe, and where over 60,000 people die each year because they don’t get to a doctor on time.

It is a system in which our life expectancy is lower than almost all other major countries and is actually declining, a system in which working class and low-income Americans die at least 10 years younger than wealthier Americans. It is a system in which some 500,000 people go bankrupt because of medically related debt. It is a system in which large parts of our country are medically underserved, where rural hospitals are being shut down, and where people even with decent Insurance have to travel hours in order to find a doctor. It is a system in which amidst a major mental health crisis when over a 100,000 people in our country died last year from drug overdoses and where suicide, alcoholism, depression, and anxiety are rising, Americans are unable to find the affordable mental health care and substance abuse treatment that they need.

It is a system where despite our huge expenditures, we don’t have enough doctors, nurses, dentists, mental health professionals, pharmacists, and other health care providers. And where we spend less than half than in other countries on primary care.

It is a system in which people spend endless hours filling out form after form after form and arguing with insurance agents. It is a system in which the quality of care you receive is largely dependent on the generosity of your employer or whether you have a decent union. It is a system in which millions of people stay in their jobs not because they like them but because they need the insurance that the job provides.

Further, our current health care system is not, as everybody knows, comprehensive. Yes dental care is health care, yet tens of millions of our people including many seniors cannot afford to see a dentist. Yes the treatment of mental illness is health care, yet our long-standing mMental health crisis is now worse than ever. Yes providing services to millions of elderly and disabled Americans in their homes is health care.

Let’s also be clear and understand that while our health care system is failing ordinary Americans it is working exceptionally well for the people who own the system. While more than 60,000 people die from preventable deaths every year in the US, the seven largest health insurance companies in America made over 70 billion in profits last year, led by United Health Group which made over 32 billion. Not surprisingly the CEOs in the insurance companies and the pharmaceutical industry receive huge and I mean huge compensation packages.

In my view the function of a rational and humane health care system is to provide quality care for all as a human right. It is not to make tens of billions of dollars every year for the insurance companies and the drug companies. In 1965 president Lyndon B Johnson signed the Medicare and Medicaid Act into law declaring that the time had finally come to end “the injustice which denies the miracle of healing to the old and to the poor.” Today almost six decades later Medicare is the most popular Healthcare program in America, providing comprehensive health care for all those 65 and older.

It is also the best model in my view for health care reform in the United States in the face of a dysfunctional and failing health care system. The time is long overdue for us to improve and expand Medicare to cover all Americans and that is why I have introduced Medicare for All legislation in the Senate which would provide comprehensive health care coverage without out-of-pocket expense for every man, woman, and child in America – regardless of age, regardless of family income or where they live. Medicare for All is a system based on addressing the health care needs of the American people not the profit needs of insurance companies and the pharmaceutical industry. Under Medicare for All there will no longer be insurance premiums, deductibles, or co-payments; no more worrying about whether you can afford to see a doctor, no more arguing with insurance agents about the nature of your coverage, no more hounding by bill collectors for unpaid medical bills, no more worries about going bankrupt if you end up in a hospital. This legislation not only expands Medicare to cover all Americans, it also significantly improves upon the services for the elderly and disabled.

Would a Medicare for All health care program be expensive? Yes it would. But while providing comprehensive health care for all it would be significantly less expensive than our current dysfunctional system because it would eliminate an enormous amount of the bureaucracy, profiteering, administrative costs, and misplaced priorities inherent in our current for-profit system. In fact the Congressional budget office has estimated that Medicare for All would save Americans $650 billion a year, a year.

Charting the right course, the humane and healthy course for this country, in terms of health care, is not going to be easy. We are taking on the most powerful economic and political forces in the entire world. But I have no doubt that the day will come sooner than later when we will succeed in making health care what it must be: a fully recognized and fully supported human right. Thank you all very much.

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Comment:

By Jim Kahn, M.D., M.P.H.

As a health economist, I sometimes encounter a fraught situation: potential spending on life-saving health care exceeds available resources. In other words, the ethically compelling position that quality health care is a human right is unaffordable.

Not so with single payer. As Bernie notes (and has been demonstrated repeatedly by economists), single payer saves money while saving lives. Health care as a human right at no cost, indeed at lower cost. The economists’ supposedly non-existent “free lunch” is offered to us on silver platter.

All we need to sacrifice is massive profits for insurers and other health care profiteers. Sounds right to me.

Nobody makes the argument better than Bernie. Let’s redouble our efforts for the humane and efficient single payer path.

https://healthjusticemonitor.org…

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I’m a Former Surgeon General and I Couldn’t Believe My $10k Medical Bill, MedPage Today, May 17, 2024, by Jerome Adams, M.D., M.P.H.

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While attending a conference in Arizona in January, I embarked on a popular hike up the renowned Camelback Mountain. Unfortunately, mirroring the experiences of many who preceded me, I underestimated the effects of the dry desert air and midday temperature. I consequently found myself dizzy and dehydrated, necessitating an emergency department visit. 6 weeks later, I received medical charges approaching $10,000. Despite my insurance company negotiating it down to $4,800, the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP).

The ordeal underscores a harsh reality: Millions of Americans face unforeseen out-of-pocket expenses, but few can shoulder such a burden.

Surprise medical bills, such as the one I received, often stem from patients unwittingly receiving care from out-of-network providers, resulting in substantially higher costs that insurance fails to cover.

Despite healthcare purportedly operating as a free market, I was not furnished with the requisite information to make an informed decision regarding my purchase. Moreover, I was not apprised of the cost of my care until 6 weeks later!

The proliferation of HDHPs, encompassing almost 60% of individuals with employer-provided health insurance post-ACA, compounds the issue.

To address the scourge of surprise and exorbitant medical bills and ameliorate the healthcare system for all Americans, I proffer several recommendations:

1. Enhance transparency in healthcare pricing
2. Institute arbitration for billing disputes
3. Advocate for consumer protections
4. Support legislative efforts to address surprise medical bills
5. Foster collaboration between providers and insurers
6. Improve HDHPs

My advocacy transcends personal interests; it serves as a clarion call for healthcare reform, ensuring that everyone can access necessary care without fear of financial ruin.

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Published Comment:

By Don McCanne, M.D.

Although we desperately need reform, Dr. Adams’ recommendations would have a negligible impact on our system. With a well designed single payer system – an improved version of Medicare provided for everyone – we could provide accessible, affordable, equitable, high quality health care for all. The single payer model removes billions of dollars in administrative waste. It allows free choice of health care providers without the need for cost sharing barriers. It is affordable for all because it is funded through progressive taxes. All would pay less than they are currently paying under the current system, except for the very wealthy who would pay more but not so much that it would have any negative impact upon their lifestyles. (Keep in mind that the wealth of society is a product of the individual workers and the resources of nature and that the wealthy use capitalistic tools to segregate that wealth to their own ends. Returning some of that wealth in the form of health care for all should achieve the altruistic goal of health justice for all.)

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HJM Comment:

By Don McCanne, M.D.

We can thank Jerome Adams for providing us a fine example of one of the reasons why we have such an expensive health care system that ranks so poorly (U.S. spends the most but ranks last amongst 11 modern nations, per the Commonwealth Fund). This reason here is that our political leaders frequently resort to garbage policy science when we know what policy would actually bring us a vastly superior system. Of course, that’s single payer.

When you see how our former Surgeon General was stung by our current system, and then he makes recommendations that are sort of an offshoot of market economics that he says would “ameliorate the healthcare system for all Americans,” you know that he has not learned anything. The market concepts he supports have kept us as the most expensive and poorest performing system of wealthier nations.

In contrast, single payer policies would accomplish the goals of universality, affordability, equity, accessibility, freedom of choice, prevention of medical debt and other features that people are looking for in health care today. This is evident around the world. Many economists have explained how a great excess of wealth is accumulating at the top, and the tax system can be used to lower health care costs for the rest of us, notably without threatening the extreme affluence of the wealthy.

But we, the people, have to do it. We have to elect legislators and government politicians who demonstrate to us that they do understand policy, rejecting policies that are for the billionaires with a few crumbs for the masses, but rather advancing policies for all of the people, so that we all have a right to housing, food, education, retirement, and, yes, health care.

https://healthjusticemonitor.org…

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Health costs threaten to overshadow Biden’s historic coverage gains, Axios, May 14, 2024, by Caitlin Owens

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President Biden has come closer than any of his Democratic predecessors to reaching the party’s standing goal of universal health coverage, but unaffordable care costs may overshadow the achievement.

Voters feeling the pain of inflation are more concerned about their own health costs than whether everyone will have some level of coverage.

• Voters’ most common health care priority by far is lowering out-of-pocket costs, KFF polling found.
• “Certainly we have more people covered, whose concern has shifted from fear of being discriminated against (by insurers) to fear of not being able to access care affordability,” said Democratic strategist Chris Jennings.
• “Health reform efforts in the past have been largely framed around expanding insurance coverage,” said KFF executive vice president Larry Levitt. “Whenever the next health reform debate comes, it will likely be focused on the cost burden, including for those with insurance.”
• A Commonwealth Fund survey last year found that more than half of people who buy their own coverage on the ACA marketplaces or elsewhere said it was difficult to afford care.
• People have always been concerned about health care costs, but the salience goes up when I can’t pay for food and milk and gas and everything else,” said Harvard professor emeritus Robert Brendon, an expert on public opinion and health care. “The temperature about this rises because they’re having trouble paying their bills.”

The bottom line: “We’re always going to be (going) at the quality of health care and the cost,” said Wendell Primus, a former adviser to House Speaker Nancy Pelosi. “Those issues are not going to go away. Even if we solve them temporarily, they’re never going to go away.”

[HJM bolding]

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Comment:

By Don McCanne, M.D.

So people are more concerned about their own health care costs than they are about whether or not other people are covered for their costs. This would be better phrased if we said that people are concerned about their own health care costs, but they also want to be participants in a thriving economy where everyone else is doing well.

What do you suppose they would think if they were offered a system that provided better coverage than they have now but cost them less? Do you think that they would object if that system offered the same comprehensive benefits to everyone else, but was made affordable by funding it through progressive taxation? Would the fact that the very wealthy paid more taxes that would have absolutely no negative impact on their lifestyles be a reason to reject a program that ensured that everyone had access to the health care that they needed? Of course, that is precisely what a well-designed single payer system would bring us. The cost might not ever go away, but we can readily manage it for everyone by the simple process of enacting and implementing single payer.

https://healthjusticemonitor.org…

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