PNHP

Insurers issue defective & deceptive provider directories

Insurers issue defective & deceptive provider directories

San Diego sues Molina, HealthNet, Kaiser, Modern Healthcare, June 25, 2021, by Nona Tepper

The city of San Diego sued three health insurers on Friday, alleging Kaiser Permanente, HealthNet and Molina Healthcare all advertised false networks of providers in an attempt to get consumers to sign up for their plans.

“Consumers should be able to trust their health insurers when seeking medical attention,” San Diego City Attorney Mara Elliot said in a statement. “Error-filled directories create dangerous barriers to healthcare services, with patients struggling to find a directory-listed doctor who will accept their insurance.” California law requires health insurers to update their printed provider directories quarterly and online listings weekly, the complaint said. These payers knew they were advertising false networks.

The complaints allege that up to 35% of the providers in Kaiser Permanente and HealthNet’s directories were listed inaccurately, and 80% of clinicians in Molina Healthcare’s directory were falsely listed as in-network.

Insurers’ error-riddled provider directories allowed them to attract more prospective enrollees and command higher prices, according to the suit. Falsely inflating their network size also made it harder for competitors to compete in the marketplace, the complaint said.

Each complaint said that insurers’ inaccurate listings disproportionately impacted low-income enrollees — who were more likely to be Black or Hispanic, according to the lawsuit — individuals with disabilities, people seeking mental healthcare, seniors lacking digital literacy, and women.

Each complaint noted that this was not the first warning insurers received.

Comment:

By Don McCanne, M.D.

The dishonesty of these insurers in maintaining deceptive provider directories not only represents an unfair business practice, but it is also a violation of law that results in financial harm to patients, the very population that they should be serving.

If we had a single payer Medicare for All program, there would be no need for provider lists because all legal health care professionals and institutions would be automatically covered under one system. Further, we would not need to pay hundreds of billions of dollars to these superfluous intermediaries. (But think of a future for integrated systems such as Kaiser Permanente strictly as health care delivery systems and not as risk-bearing insurers.)

For those who say that we have a moral obligation to support the insurers, think again. Our moral obligation is to the patients, and we need to terminate the burden that the insurers are placing on them, and, incidentally, the burden that they are placing on the health care delivery system itself.

http://healthjusticemonitor.org…

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Yet Another Medicare Advantage Cheating Scheme

Medicare Advantage Chart Reviews Are Associated With Billions in Additional Payments for Some Plans, Medical Care, February, 2021, by David J. Meyers and Amal Trivedi

From the Abstract:

Background: In the Medicare Advantage (MA) program, private plans receive capitated payments that are adjusted based on their enrollees’ number and type of clinical conditions. Plans have the ability to review charts to identify additional conditions that are not present in claims data, thereby increasing risk-adjusted payments.. . .

Results: Chart reviews were associated with a $2.3 billion increase in payments to plans, a 3.7% increase in Medicare spending to MA plans. Just 10% of plans accounted for 42% of the $2.3 billion in additional spending attributed to chart review. Among these plans, the relative increase in risk score from chart review was 17.2%. For-profit plans engaged in chart reviews substantially more frequently than nonprofit plans.

Comment:

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

It’s long been known that Medicare Advantage (MA) plans selectively recruit low-cost Medicare enrollees and evict the expensively-ill, such as those who require nursing home care. As a result, Medicare pays MA plans 4% more than it would cost to care for their patients in the traditional Medicare program.

In response, CMS has tried to risk adjust MA plan premiums based on patients’ diagnoses. MA plans have counter-attacked by pressing clinicians to more assiduously code every diagnosis that might raise the risk score. That’s entirely legal. But this study shows that they’ve  gone even further than that, combing through patients’ medical records for possible indicators of diagnoses that physicians never entered as actual diagnoses. So if, for instance, a doctor never mentioned renal failure, but noted a slightly high creatinine level on one blood test (which might have come down on a subsequent test), that might trigger an MA plan to claim the extra payment for renal failure.

After 40 years of unsuccessful attempts to rein-in MA plans’ profit-driven efforts to cheat the taxpayers, it’s time to end the MA program and return to fully public Medicare.

http://healthjusticemonitor.org…

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Voting Rights Are Health Care Rights

When politicians are no longer accountable to voters, they serve their most powerful and deep-pocketed donors, such as for-profit hospitals and the commercial health insurance and pharmaceutical industries.

By Susan Rogers, M.D.
Common Dreams, July 6, 2021

Republican lawmakers in 43 states have introduced proposals that will severely limit Americans’ ability to vote, both in person and by mail. And last week’s Supreme Court ruling on Arizona’s voting rules opened the door for states to impose even more restrictions on voting. As a result, our most vulnerable neighbors—primarily low-income and people of color—will not be able to freely and fully exercise their constitutional right to vote.

As a physician who spent my career treating underserved communities, I know that when my patients lose their right to vote, they lose their right to the health care they need and deserve.

What do voting rights have to do with health care? In a free and functioning democracy, elected officials would implement health policies that are both popular and proven to best serve the needs of their constituents. But when politicians are no longer accountable to voters, they serve their most powerful and deep-pocketed donors, such as for-profit hospitals and the commercial health insurance and pharmaceutical industries.

When it comes to health care, the stakes couldn’t be higher. The U.S. spends $4 trillion per year on health care, almost twice as much as any other industrialized country, but we suffer from the worst performance on nearly every measurable health outcome, from life expectancy to maternal mortality. Thirty million Americans are uninsured, and an additional 40 million are underinsured. Nearly every family has a health care horror story: surprise bills, insurance company denials, medical bankruptcy, and—as I have seen much too frequently in my own practice—patients who delay treatment until it is too late.

Meanwhile, the industries that profit from our fractured health system are thriving: UnitedHealth Group, the nation’s largest insurer, reported 2020 profits of $15.4 billion; Cigna’s 2020 profits of $8.5 billion marked a staggering 66% increase over 2019.

Not surprisingly, Americans are outraged, and a majority of voters now support Medicare for All, which would improve Medicare’s benefits to also include necessary health services such as dental, vision, mental health, and reproductive care, and then expand coverage to everyone in the nation. Many studies, including a recent report from the Congressional Budget Office, show that Medicare for All could vastly improve our nation’s health outcomes while also decreasing overall health care costs.

If most voters want Medicare for All reform, why are we still trapped on the sinking ship of our fractured health system? Members of Congress (like all elected officials) respond to power, and political power comes in two forms: money and votes.

When it comes to money, the hospital, pharma, and insurance industries will always have ordinary people beat.

How can the average American compete, since these same industries have caused so much financial harm? Almost half of U.S. adults have skipped paying for essential items and bills so they could afford their medications, and nearly one in five skipped treatment for a health problem in the last year because of cost. The pandemic has pushed millions more Americans—particularly people of color—into poverty.

But, the one thing that every American should have, regardless of our income, zip code, or the color of our skin, is our vote. In an era of unprecedented corporate influence (the lobbying group America’s Health Insurance Plans spent nearly $4 million on lobbying so far this year), our vote is increasingly our only voice in the health care debate; our vote is the firewall that keeps health care from being entirely shaped by those that seek to profit from it.

Any attempt to restrict Americans’ ability to vote, particularly in communities of color, will result in worse health care and worse health outcomes for the most vulnerable.

My patients are desperate for equitable and universal coverage that can only be achieved with Medicare for All. But we won’t get real health care reform until we elect representatives that actually represent us. Health care will never be a right unless voting is a right—for all.

Dr. Susan Rogers is recently retired from Stroger Hospital of Cook County in Chicago, but continues as a volunteer attending hospitalist and internist there. While at Stroger Hospital, she was co-director of medical student programs for the Department of Medicine and received numerous teaching awards from medical students and residents. She is an Assistant Professor of Medicine at Rush University, where she continues to be an active member of the Committee of Admissions. Dr. Rogers currently serves as president of Physicians for a National Health Program, a nonprofit research and education organization whose more than 23,000 members support single-payer Medicare for All reform.

https://www.commondreams.org…

Democracy and Single Payer

Comment:

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

On the 4th of July, my thoughts turn to our system of governance, as it relates to health reform.

Our democracy is under siege. First, the President who lost his re-election bid tried to retain power by claiming he won and fomenting a coup. Crisis averted, barely. The vast majority of GOP officials still support this “big lie” about the election. Then, in June, a Democratic Senator – Joe Manchin of W. Virginia – published an op-ed declaring his fealty to the filibuster (anti-majority) and bipartisanship (a myth) over voting rights. This would allow GOP-controlled swing states to selectively disenfranchise Democrats, especially poor people of color living in big cities. Subsequently, Manchin expressed support for a scaled-back but still strong voting rights bill. Encouraging. Last week, the U.S. Supreme Court upheld state laws that manipulate voting rules in ways that will likely selectively disenfranchise blacks, relying on a 6-3 conservative majority enabled by Mitch McConnell’s abandonment of long-standing norms regarding Supreme Court appointments. Worrisome. The future of voting bills and rights – with implications for 2022 Congressional midterms and Biden’s ability to govern – will play out later this month. These events are thoroughly and thoughtfully chronicled by Heather Cox Richardson in Letters from an American. I also recommend Paul Krugman’s forceful take-down of the GOP’s thorough abandonment of reality in favor of ideology and self-interest. Dire challenges loom for democracy.

So what does this have to do with single payer financing of health care?

A lot, actually. The parallels are numerous. For today’s blog, I offer a list. If you care to suggest others, please reply to the email or add comments on the website. In future posts, I’ll delve into specific issues.

Democracy and single payer …

  • Both honor human rights, highlighting human dignity – the ability to participate in collective decisions, and the right to healthcare and health.
  • Both foster equality – everyone is treated the same. No preferential voice, no preferential care. Nobody excluded.
  • Both reflect and strengthen community values – society working collectively to address important decisions and solutions.
  • Both honor majority rule – fair voting to maximize the right and ability to cast ballots, and adoption of a health care financing approach favored by most Americans.
  • Both use simplicity to achieve performance & efficiency – one straightforward, unconvoluted set of rules for everyone, simplifying and maximizing access.
  • Both reduce manipulation of the system for gain by those in control – by requiring neutral voting rules and eliminating exorbitant profits from the provision of health.
  • Both recognize that some societal functions are most efficiently and effectively accomplished by government agencies –e.g., fairly designed and enforced voting, and financing for essential services like health care.

I think I always knew intuitively that single payer is profoundly democratic. Now I’m beginning to understand the details.

Finally, the day-to-day struggles for both causes are linked:

Empowering the maximum number of people with the vote will bolster the prospects for single payer. Because voters – especially those the GOP is trying to exclude – support single payer. And achieving single payer will build commitment to progressive, democratic values, and showcase the advantages of a benevolent government. Linking the battles may prove synergistically enabling, helping achieve both worthy causes.

Enjoy the holiday weekend, and next week let’s all dig in again to fight for justice in democracy and health care.

http://healthjusticemonitor.org…

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High deductibles can kill patients, especially if they’re poor

Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care, Circulation, June 2021, by Shih-Chuan Chou et al.

Methods: Using a commercial and Medicare Advantage claims database, we identified members 19 to 63 years old whose employers exclusively offered low-deductible (≤$500) plans in 1 year, then, at an index date, mandated enrollment in HDHPs (≥$1000) for a subsequent year. We matched them with contemporaneous members whose employers only offered low- deductible plans. Primary outcomes included population rates of index ED visits with a principal diagnosis of nonspecific chest pain, admission during index ED visits, and index ED visits followed by noninvasive cardiac testing within 3 and 30 days, coronary revascularization, and acute myocardial infarction hospitalization within 30 days. Members from higher-poverty neighborhoods were a subgroup of interest.

From Discussion: The contrasting findings between members from neighborhoods of different poverty levels merit particular attention. After HDHP switches, members from lower-poverty neighborhoods reduced invasive procedures after nonspecific chest pain ED visits without changes in ED visits for nonspecific chest pain, hospitalizations, non-invasive testing, or AMI admissions. However, members living in higher-poverty neighborhoods reduced non-specific chest pain ED visits, disproportionately reduced hospitalizations from index ED visits, and significantly increased AMI hospitalization in 30 days after index ED visits. Our findings support that, although HDHPs can reduce potentially low-value acute care among those with higher socioeconomic status, the disproportionate financial pressure from high out-of-pocket costs on lower-income populations appears to lead to unintended consequences with potentially negative health implications.

There is growing evidence that exposing low socioeconomic status populations to high cost-sharing leads to the deferral of appropriate care.

What Is New? High deductible health plan enrollment was associated with increased 30-day acute myocardial infarction rate after emergency department visits for nonspecific chest pain among patients living in neighborhoods with higher poverty rates.

Comment:

By Don McCanne, M.D.

Keep in mind that high deductibles are a tool used by private insurers to discourage patients from obtaining health care that the insurer might have to pay for. It is a profit-motivated business tool and not a tool to provide assistance to a patient in obtaining beneficial health care. It especially negatively impacts those with greater financial needs. Of note, this study evaluated private commercial and Medicare Advantage plans and not patients in the public Medicare program which avoids high deductibles (though even modest deductibles may be a hardship for those of limited financial means).

In this study of emergency department patients presenting with chest pain, it was found that those with low socioeconomic status who had high deductibles “reduced non-specific chest pain ED visits” and “significantly increased acute myocardial infarction hospitalization in 30 days after index ED visits.” They conclude, “the disproportionate financial pressure from high out-of-pocket costs on lower-income populations appears to lead to unintended consequences with potentially negative health implications.”

We can conclude that “potentially negative health implications” from deferred diagnosis of acute myocardial infarctions includes the potential for death. Since the delays were due to high deductibles, we can further conclude that high deductibles used by private health plans kill people.

We don’t need high deductibles, and we certainly don’t need expensive private insurers who use them to create more wealth for themselves at a cost of providing optimal patient service. After many decades, their profit-maximizing behavior only grows worse. Time to replace them with a single payer improved Medicare for All – no profits, just patient service.

http://healthjusticemonitor.org…

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Medicare for All Explained Podcast: Episode 59

Interview with Traci Gleason

July 1, 2021

Missouri Budget Project vice president Traci Gleason urges the state legislature to respect the will of voters and expand Medicaid. She says fears that the program would be too costly are overblown since “no state that has expanded Medicaid has had to come back and raise taxes in order to pay for it.”

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Medicare for All Would Guarantee Health Care for the Undocumented

Desperate for Covid Care, Undocumented Immigrants Resort to Unproven Drugs, New York Times, June 20, 2021, by Amy Maxmen

“It’s disappointing but not surprising” that people living below the poverty line have spent large sums of money for unproven treatments for Covid-19, said Rais Vohra, the interim head of Fresno County’s health department. “People are desperate and bombarded with misinformation and may not have the skills, time or context to interpret medical evidence.” …

During the pandemic, many immigrants shut out of mainstream health care have turned to such markets for Covid-19 treatments. About 20 percent of Hispanic people in the United States lack health insurance, and the proportion is far higher among undocumented immigrants.

What’s more, some immigrants mistrust doctors who don’t speak their language or who treat them curtly — and those concerns have been amplified by harsh political rhetoric directed at Mexicans and Central Americans. …

“My community fears that the government might be trying to get rid of us,” said Oralia Maceda Méndez, an advocate at a Fresno-based community group for Indigenous people from Oaxaca, Mexico. She has heard many stories from immigrants in her community who treat themselves for Covid-19 with penicillin, other antibiotics or a mix of vitamins and herbal therapies bought from shops or travelers selling medications bought in Mexico.

“I am not surprised that people are taken advantage of,” she said. “We don’t have the care we need.”

Comment:

By Eagan Kemp

Barring undocumented immigrants and workers from getting health care is cruel and inhumane. As the cited NYT article notes, the COVID-19 crisis has further exacerbated the costs and dangers of lacking health insurance in America. This is particularly severe for undocumented workers in frontline industries where they are unable to social distance. Even before the pandemic, almost half of undocument immigrants were uninsured, placing them at risk for financial ruin if they got sick.

It may also be suicidal — lack of regular medical care will prevent many from getting the COVID-19 vaccine. We must protect everyone from even more dangerous COVID-19 variants through inoculating a sufficient percentage of people in the U.S. and around the world.

And while undocumented immigrants make up only around 3 percent of the U.S. population and 4.4 percent of the workforce, they are make up a large share in certain industries, including some deemed essential during the COVID-19 crisis.

For example, more than half of all agricultural workers are undocumented, many of whom were deemed essential during the COVID-19 crisis, placing them at increased risk for the virus. Similarly, around 40 percent of workers in meatpacking plants in the U.S. are reported to be undocumented, with many unable to effectively social distance or fight for better worker protections.

Of the policy reforms under consideration by Congress, only Medicare for All would guarantee all necessary health care to all undocumented immigrants, by finally treating health care as a human right instead of as a means for profit.

No one in the U.S. should be forced to go without health care, especially the COVID-19 vaccine. And leaving immigrants to fend off the medical vultures seeking to exploit them and take their money is no solution at all. We need reform now.

http://healthjusticemonitor.org…

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The Financialization of US Health Care Is Responsible for the EHR Burden on Clinicians

Assessment of Electronic Health Record Use Between US and Non-US Health Systems, JAMA Internal Medicine 2021; 181(2):251-259, February 1, 2021, by A. Jay Holmgren et al.

From the Abstract: Design, Setting, and Participants: This cross-sectional study analyzed the deidentified metadata of ambulatory care health systems in the US, Canada, Northern Europe, Western Europe, the Middle East, and Oceania from January 1, 2019, to August 31, 2019. All of these organizations used the EHR software from Epic Systems and represented most of Epic Systems’s ambulatory customer base.

Results: US clinicians spent more time per day actively using the EHR compared with non-US clinicians (mean time, 90.2 minutes vs 59.1 minutes; P < .001). In addition, US clinicians vs non-US clinicians spent significantly more time performing 4 clinical activities: notes (40.7 minutes vs 30.7 minutes; P < .001), orders (19.5 minutes vs 8.75 minutes; P < .001), in-basket messages (12.5 minutes vs 4.80 minutes; P < .001), and clinical review (17.6 minutes vs 14.8 minutes; P = .01). Clinicians in the US composed more automated note text than their non-US counterparts (77.5% vs 60.8% of note text; P < .001) . . . . The median US clinician spent as much time actively using the EHR per day (90.1 minutes) as a non-US clinician in the 99th percentile of active EHR use time per day (90.7 minutes) in the sample. These results persisted after controlling for organizational characteristics, including structure, type, size, and daily patient volume.

Comment:

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

US clinicians complain bitterly about their documentation burden and unwieldy EHRs that sap the joy of patient care, and these burdens are a main cause of the widespread and growing burnout problem. This study makes clear that the US payment system inflicts much of this burden. In other nations, clinicians using EPIC – the most widely used EHR in the US – spend far less of their time staring at computer screens and checking the endless boxes needed to assure payment. A single payer reform that simplifies payment would greatly improve clinicians’ work lives.

http://healthjusticemonitor.org…

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Proper funding for home-based long-term care is essential

Time to Rethink Nursing Homes, The JAMA Forum, April 13, 2021, by Stuart M. Butler

“Hundreds of thousands of people who are older and disabled live in nursing homes not because they need specialized care or want to live in those facilities, but because Medicaid payment rules make that the only housing with daily living care they can afford.

Nursing homes serve two quite different populations. One requires short-term postacute care services. The other is long-stay residents who mostly need only basic daily living care, many of whom would prefer to be living in their own communities and among friends.”

Comment:

By Allison K. Hoffman, J.D.

The COVID pandemic led many to question the safety and wisdom of long-term care in nursing homes, where the virus spread dramatically and tragically. In response, nursing homes and their regulation are under scrutiny, and some people are advocating for their end.

However, moving long-term care into personal homes is not easy and not always the right option, even if older people might prefer to “be living in their own communities and among friends.” Historically, Medicaid had a distinct institutional bias, funding long-term care in institutional settings as a mandatory benefit and in home-based settings as an optional benefit. Over the past few decades, however, funding for Medicaid long-term services and supports has shifted dramatically from paying for care in institutions toward home- and community-based services (HCBS) – a process called “rebalancing.” Now, over half of Medicaid dollars fund care in home-based settings.

When long-term care happens in homes, however, much of the cost of that care is incurred by family members who serve as informal caregivers. Elsewhere, I’ve called these sizeable costs the “invisible copayment” of long-term care. Some scholars like Butler suggest that we’ll save money by moving care out of institutions and into homes.

But this move does not truly save costs; it shifts and hides them. Family members incur costs invisibly and behind closed doors in the form of lost wages, leisure time, and benefits and retirement savings, as well as poor health. My colleague Norma Coe and co-authors estimate that the median and indirect cost of caring for an older parent over two years are equal to the cost of full-time institutional care. Any response to nursing home problems that increases the already strong trends of relying on family caregiving will exacerbate these costs.

We’re far from a solution that will fully pay for home-based care, whether provided by formal caregivers or by family. President Biden proposed an additional $400B over the next 10 years to help fund home and community-based as part of the Americans Jobs Plan. Even if this full amount were to be enacted into law (a big if!), it barely scratches the surface of what it would take to fund the demand for long-term care at home. Already, states’ waiting lists for HCBS are long and formal caregivers are grossly underpaid, causing workforce shortages.

To meet the need for long-term care and to pay for it at a living wage, whether provided by formal caregivers or by family members, will take a much more dedicated effort. This is an essential topic in the single payer discussion.

http://healthjusticemonitor.org…

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We cannot rely on charities; US must overhaul system of health care and how we pay for it

By Raymond Feierabend, M.D.
Bristol (Tenn.) Herald Courier, Letters, June 27, 2021

Your recent editorial from the Roanoke Times “Why do we have so much medical debt?” was appropriate in posing the question of why we must resort to charity to pay medical bills of so many people; but it doesn’t fully address the underlying problems with our current system of health care financing.

Ours is by far the most expensive health care system in the world. We spend an average of almost $12,000 for every man, woman and child on health care. Yet 30 million of us are uninsured and 40 million underinsured; that means over 40% of adults under age 65 have inadequate health care coverage. When they can’t pay for the care they need, they go without or the rest of us pay for them. Debt forgiveness such as the arrangement between Ballad and RIP Medical Debt or Go Fund Me campaigns may sound good on the surface, but when 43 million Americans are in arrears on medical debt it isn’t the way to address the crisis! Every other industrialized country has universal health care coverage; none of them depends on charity to meet their health care needs.

While the ACA and Medicaid expansion have helped some previously uninsured people, neither completely protects individuals from major medical debt. Both are administered primarily by private, for-profit insurance companies. Far from being government run health insurance programs, they are essentially government handouts to the insurance industry, which still leaves many beneficiaries struggling with medical debt.

The way we pay for health care in this country must change. We need a complete overhaul of the system. We can do better if we have the political will to do so. Continuing to depend on charity to keep the most expensive health care system in the world afloat makes no sense whatsoever.

https://heraldcourier.com…

Public insurance claims data can save lives

COVID-19-Related Deaths And Excess Deaths Among Medicare Fee-For-Service Beneficiaries, Health Affairs, June 2021, by Wafa W. Tarazi, et al.

The experience with COVID-19 has brought to light a number of data limitations in the health care system. … Medicare’s administrative and claims data systems can support detailed analyses of morbidity, mortality, service use, and spending for beneficiaries in Medicare fee-for-service, to inform the nation’s response to COVID. … these data can be accessed and analyzed on a near-real-time basis to inform the response to future public health emergencies. Similar data for the rest of the population, however, are not readily available despite the efforts of some states to create all-payer claims databases.

Developing policies and methods around data collection and access will be important to address the consequences of future pandemics and other health emergencies.

Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California, Health Affairs, May 12, 2021, by Marissa B. Reitsma, et al.

Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California’s populations of color.

Comment:

By Don McCanne, M.D.

Medicare’s administrative and claims data systems support detailed analyses of morbidity, mortality, service use, and spending for beneficiaries in Medicare fee-for-service that was used to inform the nation’s response to COVID. Similar data for the rest of the population was not available through the fragmented administrative system prevailing in the remainder of our health care financing system. It would have been had we had a single payer Medicare for All system.

Routine data can make a real difference, if comprehensive and quickly available.. “Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among… populations of color.”

The current pandemic has certainly reinforced the importance of public health, and, by extension, the importance of enacting and implementing a single payer system.

http://healthjusticemonitor.org…

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The COVID-19 case for Medicare for All

By Chot VanAusdall
The Cincinnati Enquirer, June 23, 2021

At the height of the COVID-19 pandemic, 20 million Americans lost their jobs, according to The Pew Research Center. This was bad enough but 5.4 million of them lost their health insurance as well. This is even worse than it looks because the “good” news is that of the 20 million newly-unemployed by the virus, 59% or just under 11 million of them never had health insurance to begin with.

What a great way to head into America’s worst health crisis in a century. And you know where this was going – more medical bills, less medical care, more sick people sticking it out at home, and much sicker people finally seeking medical help. And, of course, we entered 2021 with a looming tsunami of new COVID-linked medical bankruptcies, already the leading cause of bankruptcy in the United States.

The lesson of COVID-19 for America’s fractured and failing health insurance system is clear. Our national motto may be E. pluribus unum, but don’t get sick here, especially if you’re unemployed and especially if there’s a pandemic loose in the country. The COVID-19 pandemic is yet another demonstration that America needs Medicare for All.

The COVID pandemic has laid bare a fundamental flaw in the American system – the link between employment and health. Being unemployed and uninsured can cost you more than your life savings, your house and your credit rating. A review of studies published in the Annals of Internal Medicine found that having health insurance before the pandemic raised your chances of living longer by between 3-29% for adults aged 18-64.

In COVID times, it’s clear that the disease and the suffering has fallen most heavily on the lowest income earners, particularly in communities of color. It is another irony of American health care that some of the lowest paid and least likely to be insured Americans were also our most “essential” workers. The COVID-19 Health Task Force recently recommended that health care access and coverage should be considered a human right. Human rights should not be tied to your employment or your wealth.

COVID brought out some of the best in American medicine and some of the worst in American medical billing. In March 2020, the Families First Covid Response Act offered “free” testing but with enough loopholes to sink a cruise ship. High out-of-pocket costs were routinely tacked onto “free” tests at emergency rooms or non-public sites. Many patients with no or minimal symptoms were sent home without testing, only to be billed for a clinical visit because they hadn’t had a “free” test. Many who signed up for low-cost “alternative” insurance, instead of more expensive Affordable Care Act compliant plans, found out that their bargain plans weren’t subject to new federal emergency mandates.

One woman who tested negative for COVID-19 on such a plan from United Health Care was told that her plan only covered lab tests that came back positive. A national survey by the Kaiser Family Foundation found that “free” COVID tests were costing many patients between $20 and $852.

I am a member of SPAN Ohio, the Single Payer Action Network for Ohio. At SPAN Ohio’s urging, a bill has been introduced into every session of the Ohio Legislature for the last 14 years. In December 2018, Rep. Tom Brinkman (R-Cincinnati), who was chair of the House Insurance Committee, agreed to hold hearings on the single-payer option but without Republican support, the bill went nowhere.

The SPAN Ohio bill would offer standard medical and hospital coverage along with hearing, dental and vision care. Our bill has been vetted by Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst, who concluded that over 95% of Ohioans would save money. In 2018, Friedman calculated that if Ohio had Medicare for All in 2019, Ohioans would save $2,300 per capita. To read the SPAN OHIO bill and Friedman’s economic analysis, go to www.spanohio.org.

Nationally, studies have shown that a Medicare for All option would save money. Even studies by Republican-leaning think tanks, such as the Mercatus Center, recently projected $2 trillion in net savings over 10 years for a single-payer, Medicare for All system. The bonus? The Mercatus study added that every American would have access to high-quality health care.

So why aren’t single-payer bills advancing through the Ohio House and Senate? Is it possibly another case of lobbyists having the ears of politicians and elected officials not looking out for their constituents? (Think First Energy.)

The COVID-19 crisis has cost Ohioans bitterly in jobs, savings, peace of mind and, of course, in the lives of loved ones lost to the disease. We need to learn many things from Ohio’s COVID experience, but I hope one would be understanding the unsustainability of tying health care to employment, especially in a time of natural and medical disaster.

One definition of insanity is doing the same thing over and over while expecting the outcome to be different. If we learn nothing else from COVID-19, we should learn that in a pandemic, everyone is vulnerable and everyone deserves protection, especially if you just lost your job.

Chot VanAusdall is a member of Single Payer Action Network (SPAN). This opinion is cosigned by SPAN members: Dee Chavez; Dr. Jeanne Corwin; Dr. Jim Binder; Don Rucknagel, emeritus professor of medicine at the University of Cincinnati; Dr. Lee Hughes; Carolyn Meyers-Hughes; Kimball Strickland; Lee Meyer; Erin Rosiello; Kendall Mays; Donna Hermann; Ellen Bierhorst; Dinah Hawkins; Antoinette Asimus; and Dr. Debbi Silverman.

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