PNHP

COVID-19 proves need for universal medical coverage

COVID-19 proves need for universal medical coverage

By Erica Heiman, M.D., Jack Bernard, and Henry Kahn, M.D.
Atlanta Journal-Constitution, July 31, 2020

COVID-19 has stolen the lives of over 140,000 Americans so far — with many more to come. Respected forecasters have predicted well over 200,000 US deaths due to COVID-19 before the end of October. (https://covid19.healthdata.org/united-states-of-america).

As a worldwide pandemic, COVID-19 belongs to no single system of health care. It has affected countries with comprehensive, universal care as well as countries with inadequate or incomplete coverage, like us. But COVID-19 has impacted the U.S. particularly hard, with a higher number of confirmed cases than anywhere else in the world (nearly 3.8 million as of July 21st and rising very rapidly), https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html), and a higher mortality rate (3.7%)  than many less-developed nations. In large part this is due to our lack of a comprehensive system of national health insurance, like Medicare for All.

Many casualties of our pandemic are found at the “fault lines” of U.S. society. Think of individuals facing economic hardships who cannot socially distance because it would mean losing a job and precious income. Think of those imprisoned, detained, or the frail institutionalized elderly. Sadly, many of the characteristics that conspire to make people sick are rooted in systemic, long-time racism ingrained in our society and difficult to change.

Our U.S. healthcare financing is a clumsy mixture of public, private, and employer-based insurance. As the COVID-19 calamity has shown, our current “hodgepodge” financing denies high-quality care to people who are economically and socially underprivileged. We also allow increasing numbers of Americans to fall into these deprived categories as massive job losses lead to terminations of health insurance. Prior to the pandemic, unemployment was much lower. When statisticians include those underemployed or discouraged from seeking work, the current unemployment estimate is 18.3% (the long- term average is 10%)(https://ycharts.com/indicators/us_u_6_unemployment_rate_unadjusted).

Our number of uninsured was much too high before COVID-19, but now it has reached heights not seen since the passage of the ACA (Obamacare) in 2010. For example, between May 21 and May 26 of this year, the Census Bureau estimated that 20.5 million U.S. adults were uninsured; of that number 15.5 million were unemployed. The total number who were uninsured at some point during the current year will be much higher. Rates of uninsurance in the South are consistently higher than the national rates (https://www.kff.org/other/state-indicator/total-population/).

Short-term economic assistance meant to help the newly unemployed will generally fail to address their medical needs. Among indigent people with no job, few can successfully negotiate with a private-sector insurance plan whose main goal is to make a profit. Preserving community health is rarely the purpose of private-sector plans. We don’t need to wait for more data on this subject.

The past few decades show that the U.S. spends more per capita on its health care than any other nation in the world, and yet has poorer health outcomes than most developed countries. According to OECD data (2018), U.S. per capita health care cost is $10,586 as opposed to much lower figures in other developed nations, like France ($4,965) and Canada ($4,974) with better mortality and morbidity statistics than ours (https://doi.org/10.1787/4dd50c09-en). Our percentage of GDP spent on healthcare is 16.9% as compared to 11.2% for France and 10.7% for Canada. If we perpetuate our inefficient way of financing health care, we will bankrupt ourselves while doing without vital public expenditures like replacing our decaying infrastructure and investing in education.

No system is perfect, but more-inclusive models around the world finance health care more cost-effectively. Other countries have done better during the coronavirus pandemic, such as Austria, Denmark, Germany and Japan (https://www.endcoronavirus.org/countries). A financing system that includes everyone will minimize discrimination against the poor. It will also expand public-health programs that mitigate the historical impacts of racism.

Protesters of all races and ages in the streets of America’s cities have shown that our country wants major systemic changes. Now is the time to design and implement a simplified U.S. healthcare financing system that leaves no one uninsured or underinsured.

Universal healthcare coverage will not eliminate systemic racism or erase a pandemic, but it will provide a solid platform of good health for Americans to stand on. We call for expanded, improved, Medicare for All to prevent so many of our fellow citizens from falling through the cracks.

Erica Heiman, M.D., is an internist and medical educator based at Grady Memorial Hospital in Atlanta. She is an active member of the Georgia Chapter of Physicians for a National Health Program (PNHP). Jack Bernard, former Director of Health Planning for Georgia, is a retired SVP with a national healthcare corporation and a former Republican county commissioner in Georgia. Henry Kahn, M.D., practiced medicine for nearly 40 years. He is Professor Emeritus at the Emory University School of Medicine and adjunct faculty at the Rollins School of Public Health and Morehouse School of Medicine.

https://www.ajc.com…

Stuart Butler has another proposal for us

Medicare Advantage for All, Perhaps?

By Stuart M. Butler, Ph.D.
JAMA Health Forum, July 30, 2020

The coronavirus disease 2019 (COVID-19) pandemic is forcing a much-needed questioning of the US health system. What is the right balance of authority between the federal government and the states? How should the profound inequities and gaps in the system be better addressed? Should emergency regulations, like those allowing more telemedicine and flexible funding, become permanent features of the system?

Hopefully, this reassessment will encompass a constructive conversation about the basic structure of the US health system and how it can be based on a more robust chassis. What should that guiding framework be? Although I view the system though a center-right lens, I believe a variant of the Medicare-for-all idea could prove to be a new chassis that can attract broad support.

In practice, unlike most high-income countries, the US has several different health systems for different segments of the population—each with distinctive rules, subsidy arrangements, and eligibility criteria. There is 1 system for poor individuals; an employment-based system for most working individuals and their families; and yet another for elderly individuals. Transitioning between these systems, as almost all US residents must do at some point, often means disruptions in coverage and care. Millions also continue to fall through gaps between these systems. Moreover, the amount of assistance available to individuals seeking coverage differs greatly depending on such circumstances as geography and work status.

Many progressives have responded to this patchwork by calling for Medicare to become the chassis for the whole system. However, the Medicare-for-all proposals advanced by such politicians as Sen Bernie Sanders (I, Vermont) and Sen Elizabeth Warren (D, Massachusetts) have encountered skepticism from many liberals, as well as heavy criticism from conservatives.

Concerns About Medicare for All

One objection is the enormous increase in federal expenditure that would be involved in such a switch, and although supporters point to the large savings in private expenditures, the net costs depend on many considerations and design features.

Another concern, applying to some versions of Medicare for all, is that although the Medicare benefit package is comprehensive, traditional Medicare has significant out-of-pocket costs for all but the lowest income beneficiaries (who qualify as “duals” for overlapping Medicaid coverage). This feature effectively requires seniors to purchase private “Medigap” coverage as a supplement.

A third concern is disruption. This is the other side of the coin associated with having multiple health systems in the US; Medicare for all would mean big changes for most individuals with existing coverage.

However, it is important to remember that even Medicare is really 2 distinct systems. The focus of Medicare-for-all proposals is traditional Medicare, which is a fee-for-service program with a detailed payment schedule administered by the government. But in parallel with this is Medicare Advantage, which operates differently from traditional Medicare with private plans receiving a single capitated payment for each beneficiary enrolled in their plan, adjusted according to the beneficiary’s general health condition.

Medicare Advantage as the Framework

Medicare Advantage for all could be a good starting point for a bipartisan discussion on creating a new framework for the US health system. Unlike the higher-profile Medicare-for-all approach, a Medicare Advantage–for-all approach would have several advantages. For instance:

Medicare Advantage has wide popular support as well as broad political support. Medicare Advantage enrollment has been growing rapidly, doubling in the last decade, with the proportion of Medicare beneficiaries in such plans now exceeding 34% and rising. Moreover, Republicans as well as Democrats have supported and expanded Medicare Advantage, and the idea of making Medicare Advantage plans available to younger US residents has begun to intrigue some reformers on the right.

The capitation system permits competing Medicare Advantage plans to offer a variety of benefits beyond a required core of basic benefits. Moreover, in contrast to traditional Medicare’s rigid and detailed payments system, it allows plans to explore different payments as a means of achieving greater efficiency and beneficiary satisfaction.

In contrast with the design of traditional Medicare, Medicare Advantage plans are generally consistent with the growing managed care pattern in nonelderly coverage, including within the employer-based system. Today, about 90% of Medicaid beneficiaries are enrolled in some form of managed care. Meanwhile, about two-thirds of workers with employment-based plans are enrolled in health maintenance organizations or other network coverage that is similar to most Medicare Advantage plans. Medicare’s income-adjusted premiums are also broadly compatible with the structure of income-based subsidies available for plans in state health insurance exchanges, and many insurers offer Medicare Advantage and health insurance exchange plans that have similar designs. Thus, for a large proportion of households, transitioning from their existing coverage to coverage more like Medicare Advantage plans would not involve a big adjustment.

Recent changes in laws and regulations allow Medicare Advantage plans to include more nonclinical services that can influence health, such as nonurgent transportation, nutritional services, and even some simple home modifications to reduce the risk of injuries. This reflects the growing interest in addressing so-called social determinants of health.

Gradual, Not Radical

Choosing Medicare Advantage as the organizing theme for reforming the whole US system does not necessarily imply there must be radical legislation that literally replaces all existing coverage with the current Medicare Advantage program. That would be unnecessarily disruptive and regimented. Rather, it should mean gradually adapting existing forms of coverage so that over time they become very similar to Medicare Advantage, and there would essentially be no change in coverage as individuals change jobs, lose their jobs, or retire.

One step toward that outcome would be to merge state exchange plans with Medicare Advantage plans in the state. Another would be to slowly reconcile the subsidy system available for exchange plans with the tax benefits for employer-sponsored insurance, such that a similar structure of income-related subsidies would apply to everyone enrolling in insurance. Seniors would continue to receive assistance toward the cost of coverage that is reflective of the payroll taxes they paid and the national commitment to their health care, at least until there was agreement on a more comprehensive revenue and financing system, and the state-federal share of support would continue for lower-income households. A third step would be to move further toward the place of work being just a convenient location to facilitate plan selection, with employers handling the mechanics of government subsidies and payments by workers, and to move away from employers as plan sponsors.

None of these steps are small details, of course. They are major issues and would involve contentious debate. But to reach eventual agreement on big changes in society, it is necessary to have a framework in mind that is likely to command broad support and that the current system could evolve toward with minimum disruption. Medicare Advantage for all is such a framework. Medicare for all is not.

https://jamanetwork.com…

Medicare Advantage is a Shell Game

By Stephen Kemble, M.D., Physicians for a National Health Program
JAMA Published Comment, July 31, 2020

A fundamental problem with competing private plans in health care is that too much of the per-beneficiary financial risk is predictable due to pre-existing conditions and social determinants of health, so that the primary driver of competition is to avoid risk. This means “cherry picking” the healthy and “lemon dropping” sicker and costlier patients from Medicare Advantage (MA) plans. Risk adjustment is far too crude to prevent this, and efforts to make it more accurate encounter prohibitive complexity and administrative cost. There is pervasive evidence that MA plans do selectively enroll healthier-than-average Medicare beneficiaries, and sicker, more complex patients selectively disenroll from MA plans. There is also extensive evidence of increased coding intensity in MA plans to beat risk adjustment formulas, and MA plans carry much higher administrative cost than traditional Medicare. The outcome is that the MA program has never saved money for the Medicare program as a whole, and MA claims of more cost-effective care are much better explained by the favorable risk pool the MA plans have been able to secure.

Comment:

By Don McCanne, M.D.

In response to the strong support of single payer Medicare for All there have been several sources recommending instead Medicare Advantage for All – using private insurance instead of a public insurance program based on an improved version of the traditional Medicare program. This particular article is important because of its author, Stuart Butler.

Stuart Butler was the primary architect of the Heritage reform proposal that led to the Patient Protection and Affordable Care Act (ACA), aka Obamacare. Butler’s views are more moderate than those of the conservative Heritage Foundation and thus he transferred to the centrist Brookings Institution. In this JAMA article, he labels himself as viewing the system through “a center-right lens.” As his article indicates, he rejects a publicly-administered Medicare for All program but rather supports a market of competing private plans. His primary innovation for ACA was the exchanges (marketplace) for the private plans that would receive government subsidies to make them more affordable. The market of private Medicare Advantage plans have far more similarities with the ACA exchanges than there are differences.

There are a great multitude of reasons why the private Medicare Advantage plans are vastly inferior to a well designed improvement in the traditional Medicare program. The JAMA comment provided by Stephen Kemble explains probably the most fundamental flaw, and it’s a matter of ethics. Medicare Advantage plans have profited by enrolling healthier, less expensive patients, and by gaming risk adjustment to qualify them for higher payments. The U.S. is noted for the profound administrative waste in its financing system, and Medicare Advantage plans add significantly to that waste, not only for their own excessive costs but also for the heavy financial burden they place on the health care delivery system.

Amongst other reasons that Medicare Advantage plans are inferior include: their restricted provider networks frequently do not allow access to the care that you need; coverage may be unstable as plans enter and leave markets at their will; rules may prohibit enrolling in supplemental Medigap plans if returning to traditional Medicare; plans may profit by withholding beneficial care that you did not know was available and appropriate for your circumstances; plans may not have contracts with centers of excellence; etc., etc.

Responding to a few additional points made by Stuart Butler:

  • Butler says that Medicare for All has encountered skepticism from many liberals, but it is really some of the neoliberals and not the progressives who prefer market solutions who have been less supportive; the majority of Americans support Medicare for All
  • Butler cites the objection to the increase in federal expenditures, but he concedes the offset of the large savings in private expenditures
  • He notes that traditional Medicare has significant out-of-pocket costs requiring the purchase of Medigap plans, but a well designed Medicare for All program folds in the benefits of Medigap plans plus adds other important benefits, eliminating most out-of-pocket costs (except for the equitable taxes used to fund the system)
  • He states that Medicare for All is disruptive, but, like John Lewis has said, this is good trouble – patients have their full choice of providers while eliminating financial barriers to care; that’s disruption we would all like to have
  • He states that Medicare Advantage has popular support, but that is primarily because Congress provided an unfair competitive edge to private plans by enabling them to offer their plans at low premiums – virtually all enrollees would prefer traditional Medicare free at the time of service with a full choice of providers, if it were available, as it would be with Medicare for All
  • He notes that Medicare Advantage can offer additional benefits beyond the core benefits, but if they are benefits that should be covered with taxpayer funds, then, in fairness, Congress should offer the same benefits through the traditional Medicare program
  • He describes Medicare Advantage managed care as being advantageous, not acknowledging the managed care backlash of the 1990s
  • He suggests merging ACA exchange plans with Medicare Advantage plans – of course he would

In conclusion, we tried Stuart Butler’s previous proposal, and we have a very expensive mess on our hands. Let’s not do that again. Let’s go straight to single payer improved Medicare for All. We need some good trouble.

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

Private insurers offload financial risk to the providers

Variation in Health Care Prices Across Public and Private Payers; NBER Working Paper No. 27490

By Toren L. Fronsdal, Jay Bhattacharya, Suzanne Tamang
National Bureau of Economic Research, July 2020

Abstract

We study a unique all-payer data set spanning 38 states to examine the differences in inpatient reimbursement rates paid by traditional Medicare (TM), Medicare Advantage (MA), Medicaid, and private (under-65) insurers, and the differences in negotiated rates across the 60 largest private insurers. After controlling for enrollee and hospital mix, we find that private insurers pay 37 percent more than TM, and MA pays 10 percent more than TM for the five most common inpatient diagnoses. The correlation in risk-adjusted payments by private insurers and by TM at the same hospital for the same diagnosis is only 0.10. There is significant variation in negotiated prices within and across private payers. Among the five largest US insurers, the most expensive insurer negotiates prices that are 5-26 percent higher than the mean price for the 20 most common inpatient diagnoses. Additionally, we find a 10 percent increase in insurer market share corresponds to a 7 percent decrease in inpatient negotiated prices and a 10 percent decrease in the standard deviation of prices. This finding suggests that increased insurer market power allows payers to negotiate prospective payment contracts – rather than the more common fee-for-service payments – thereby offloading financial risk to providers.

From the Conclusion

We find an inverse relationship between insurer market share and negotiated prices. A 10 percent increase in insurer market share is associated with a 7 percent decrease in negotiated prices. Additionally, a 10 percent increase in insurer market share is associated with a 10 percent decrease in the standard deviation of negotiated prices at a provider. This suggests that insurers with greater market share are able to negotiate favorable payment structures that offload financial risk to the providers.

https://www.nber.org…

Comment:

By Don McCanne, M.D.

Health care providers are paid to provide health care. Insurers are paid to accept and manage risk of health care costs. This study indicates that insurers with greater market share are able to offload financial risk to the providers. Then why do we need private insurers? About $600 billion of administrative costs could be recovered if we got rid of the private insurers – funds which could be used to expand comprehensive health care to everyone. The government should be the logical agent to accept and manage risk and would be under single payer Medicare for All.

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

Medicare for All Explained Podcast: Episode 39

Interview with Barbara Berney

July 30, 2020

Public health expert and documentary producer Barbara Berney, M.P.H., Ph.D. discusses the documentary she produced, “Power to Heal: Medicare and the Civil Rights Revolution.” The film tells the story of how the creation of Medicare was used to desegregate thousands of hospitals within a matter of months in the late 1960s.

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

https://medicareforallexplained.podbean.com

Tweaking value-based health care delays real reform

Lawmakers Propose Changes to MACRA to Boost ACO, APM Participation

The Value in Health Care Act aims to increase APM participation by extending incentives and correcting arbitrary qualification standards under MACRA and the Medicare Shared Savings Program.

By Jacqueline LaPointe
REVCYCLE INTELLIGENCE, July 28, 2020

A bipartisan bill introduced late last week aims to increase alternative payment model (APM) participation by making “commonsense changes” to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Specifically, the Value in Health Care Act seeks amendments to many program parameters of Medicare’s APMs, including MACRA’s Advanced APM pathway and the Medicare Shared Savings Program (MSSP). Among the changes would be a six-year extension of the 5 percent incentive payment for Advanced APM participants and lower thresholds for Advanced APM participation from 75 percent to 50 percent of Medicare patients in performance year 2021.

HHS would also be able to increase the threshold by no more than 5 percent each performance year under the bill.

The bill also intends to increase accountable care organization (ACO) participation in the MSSP by increasing shared savings rates for shared savings-only ACOs. The levels would be at least 50 percent for ACOs in Levels A and B of the BASIC track and 55 percent for those in Levels C and D.

The shared savings rate would be at least 60 percent for ACOs in Level E.

Also, the bill would modify risk adjustment to allow for a greater score increase and adjust benchmarking to remove ACO beneficiaries from the regional reference population under regional benchmarking.

Additionally, the bill would eliminate the high-low revenue distinction implemented during an overhaul of the MSSP in 2018. If passed, all ACOs in the program would be subject to low revenue policies, according to the legislation.

The changes would incent participation in the models, while accelerating the transition to value-based care, Representatives Suzan DelBene (D-WA), Peter Welch (D-VT), and Darin LaHood (R-IL) said.

Signed into law in 2015, MACRA established a value-based reimbursement system for Medicare providers. The law created the Quality Payment Program, which includes the Merit-Based Incentive Payment System (MIPS) and the Advanced APM pathway.

While most Medicare providers participate in the Quality Payment Program via MIPS, policymakers intend for the program to ramp up participation in APMs through the Advanced APM pathway.

https://revcycleintelligence.com…

“Value in Health Care Act of 2020”:
https://delbene.house.gov…

Association between specialist compensation and Accountable Care Organization performance

By Ishani Ganguli, MD, MPH; Claire Lupo, BBA; et al
HSR Health Services Research, July 27, 2020

Objective

To determine if Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance.

Conclusion

Incentivizing specialists on cost reduction was not associated with ACO savings in the short term. Further work is needed to determine the most effective approach to engage specialists in ACO efforts.

https://onlinelibrary.wiley.com…

Comment:

By Don McCanne, M.D.

The policy community, with the support of the politicians, has been fixated on MACRA, ACO, MSSP, MIPS, APM, P4P, etc., etc. as a means of achieving value-based health care. So far the results have been very unimpressive, though some reports claim that the approach is about to show some benefit, so they wish.

As an example of how inadequate this approach is, the HSR study shows that incentivizing specialists has not been associated with ACO savings. If it is not working for specialized services, then it is not working, period.

Now the “Value in Health Care Act of 2020” is being introduced to provide some tweaks to the system in an effort to increase participation in these payment models. If you read the proposed legislation you will see that it will likely have very little net impact, but it will have been effective in further delaying truly beneficial reform such as the single payer model of Medicare for All. Sometimes it seems as if that is their primary goal after all.

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

Is Now the Time for Single-Payer?

The "American Model" is failing

By Toby Terwilliger, M.D.
MedPage Today, July 28, 2020

With the news that nearly 6 million Americans have lost their employer-sponsored health coverage due to COVID-19, it is finally time to ask ourselves: is the “American Model” of healthcare working?

The “American Model” is a system of fragmentation: one in which changing jobs can mean lapses in insurance, moving to a new state can mean losing Medicaid eligibility, and getting a raise can mean financial ruin when you no longer qualify for subsidies. It is a system of waste: waste in administrative costs, waste in doctors’ time spent battling with insurers, and waste in the inability and unwillingness of insurers and hospitals to negotiate fair prices for their patients. And finally, it is a system that creates insecurity: insecurity in that a sudden illness or a surprise bill or a global pandemic has the potential to sideline a loved one, a family, or even the entire economy of a nation.

Even prior to the pandemic, the average American family spent nearly one-sixth of their income on healthcare, and medical debt was involved in most bankruptcies. This is not the prescription for a healthy economy; it is a risk factor for total collapse. And now we are seeing how vulnerable our economy is in the face of COVID; at a time when we must rely on our healthcare system to conquer a global health threat, that same system is becoming our biggest economic liability.

How can we ensure that our healthcare system endures the pandemic? And how do we guarantee that we emerge from this pandemic stronger and healthier than before? The answer is quite simple: through universal, publicly-funded healthcare for all. We need a system that administers healthcare equitably and cost-effectively to every citizen who needs it. And the private insurance industry is incapable of rising to the task.

The most obvious shortcoming of the private insurance industry is that it leaves millions of Americans uninsured. And too often, those who are insured are left with high deductibles and exorbitant costs in drug prices, co-pays, and other out-of-pocket expenses. And when COVID hits, individuals who are under- and uninsured delay seeking care, have higher rates of transmission, worse outcomes, and, of course, more expensive medical bills.

Furthermore, cost-sharing between private insurers, employers, and employees is unsustainable at a time when the economy is maximally strained. When purse strings are tight, many businesses choose to stop offering health benefits to their employees, while others are forced to let employees go. And in the aftermath, private insurers can inflate premiums in an effort to make up for loss of revenue, creating additional barriers to economic recovery.

Eventually, if and when the economy begins to recover, there will be huge swathes of people competing for a relatively small number of jobs. Prospective employees will have less bargaining power over health benefits, creating an even larger pool of individuals left out of the employer-based healthcare system.

Single-payer is the solution. And the time for it is now.

A single-payer system would guarantee healthcare coverage immediately to every American. So whether a loved one gets sick from COVID, has a heart attack, or gets in a car accident, she will receive the care she needs without it causing financial hardship.

A single-payer system will eliminate employer health insurance contributions. This will provide huge relief to hundreds of thousands of struggling small businesses across the country. The money saved can go towards paying their employees a living wage or hiring new workers, which will help get our economy back on track.

A single-payer system will relieve the burden of finding health insurance from individuals. Freelancers and gig, self-employed, and per diem workers can pursue employment without having to worry about providing health coverage for their families. And with families relieved of the insecurities created by surprise medical bills and massive out-of-pocket costs, they will be more likely to contribute to our consumer-driven economy.

COVID has absolutely quelled consumerism; single-payer can help to bring it back.

Dr. Toby Terwilliger is an internal medicine-pediatric resident. This post originally appeared on KevinMD.

https://www.medpagetoday.com…

Democratic platform challenge on Medicare for All

Bernie Sanders delegates mount convention rebellion over 'Medicare for All'

At least 360 Democratic delegates, mostly his supporters, have signed a pledge to oppose the Democratic platform unless it endorses single-payer.

By Holly Otterbein
POLITICO, July 27, 2020

More than 360 delegates, most of whom back Sanders, have signed on to a pledge to vote against the Democratic Party’s platform if it does not include support for “Medicare for All,” the petition’s organizers told POLITICO. They argue that single-payer health care is an urgent priority amid a worldwide pandemic and the biggest unemployment crisis since the Great Depression.

The warning is all but certain to set up a clash between Sanders’ most dedicated supporters and presumptive Democratic nominee Joe Biden, who opposes Medicare for All, at a time when the party is seeking to demonstrate unity ahead of its August convention. Though the petition signers have little chance of revising the platform to include Medicare for All support, they do have the numbers to draw attention to their protest and cause.

The left-wing groups Progressive Democrats of America and RootsAction.org are announcing Monday that they support the vow to vote against the platform if it doesn’t include Medicare for All. The Bernie Delegates Network, a coalition made up of hundreds of Sanders delegates, said it will also publicize the petition. Organizers expect those efforts will net hundreds more signatures, including from Biden delegates.

“The sea change that’s underway could swell as a result of this initiative,” said Norman Solomon, national director of RootsAction.org and a Sanders delegate. “It’s a reasonable hope that historians will look back at the next couple of weeks as a time when hundreds of delegates stepped forward and said, ‘This is a red line for a humane society and we’re not going to stop saying so.’”

Despite their frustration with Biden, progressive leaders behind the pledge all said they are voting for Biden and working to elect him.

https://www.politico.com…

Comment:

By Don McCanne, M.D.

The majority of Democrats support Medicare for All, but the presumed candidate, Joe Biden, is opposed. The task force that was to bring the moderates and progressives together was deliberately weighted in favor of the Biden supporters, and thus they rejected a recommendation to include single payer Medicare for All in the party platform.

The progressives and many of the moderates have not given up. They are organizing to have Medicare for All included in the platform. At the same time, they agree to support Joe Biden regardless of the outcome. That should allay the fears of the moderates who are concerned that the progressives would split off, allowing Donald Trump to be reelected.

Joe Biden has made his position clear, so it really doesn’t matter whether or not single payer is included in the platform; Biden will oppose it. If the delegates do vote to include it in the platform, more progressives will stay on board. Although the progressive leadership will continue to support Biden, even without a single payer plank, the rank and file progressives may fail to vote or may cast a protest vote for a third party candidate.

Between the pandemic and the recession, Democrats really don’t need the additional hit of being told by their leadership that Medicare for All is off the agenda for the foreseeable future. We don’t need a superimposed second pandemic of clinical depression.

PNHP does not endorse any political party or candidate.

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

Please, someone destroy the insurance companies — before they destroy me

By Rebecca Levy-Gantt, D.O.
Napa Valley (Calif.) Register, July 28, 2020

You would think as a physician and owner of a small private solo medical practice I would be against a Medicare For All, Single-Payer plan since that approach would have doctors earning a salary and not allow earning more for doing additional procedures and visits.

Well, I say, bring it on.

The private insurance system is unsustainable. Without major change, I will not be in private practice much longer.

The last six years of running a private practice has been my education in private health insurance. If I contract with a particular insurance plan, we take that insurance. If a patient has a Preferred Provider Organization (PPO) plan like United Healthcare or Cigna, we can likely see them since I have contracted with those plans.

A significant drawback of health maintenance organizations (HMOs) and PPOs is both limit patient freedom to choose. I am contracted with many insurance companies, but a contract does not guarantee a particular company will pay for my services.

Each company is different. One will pay for preventive care, but another will not. The guidelines are rarely clear. If I am planning a biopsy in my office, and if we have called the patient’s insurance company for authorization, getting that authorization does not guarantee the insurance company will pay the cost of the biopsy.

This is our process: we call for authorization, get approval for a procedure, and bill the insurance company, but half the time the insurance company then decides not to pay or the patient must pay a larger portion. We often have to appeal or resubmit bills or remain on hold for hours to discuss the authorization with an insurance representative.

In what world would this be acceptable? Can you imagine telling your plumber after your pipes were fixed that you would pay nothing or only 40 percent of the cost? Then you make your plumber wait three months for payment?

We physicians have no automatic explanation of benefits that pops up when patients give us their insurance card. Contracts are confusing, vague, and contradictory. This is so even for my staff of insurance experts.

We do not know if something will be covered sometimes until after the service has been authorized and provided. We bill the insurance company, only to receive a notice: “This is not a covered service.”

This occurs even when the exact service was covered last year with the same insurance company.

I recently delivered a baby. In the sixth month of pregnancy, my office called the patient’s insurance company to ask about coverage for the delivery. She was informed that “the patient’s delivery will be covered at 80 percent of the contracted delivery rate.” We then know the patient will be responsible for 20 percent.

After the delivery, the bill went to the insurance company. We expected to receive 80 percent of the contracted fee from the company. We did not. The insurance notice said “This is not a covered service. No payment is forthcoming. The patient is responsible.”

My biller spent over two hours on the phone trying to understand what had happened. A second insurance representative recommended “resubmitting the bill.” We did so.

We are still waiting.

In what world would this be an acceptable practice? Two months have now passed. Once three months go by the insurance company can refuse to pay because of a “delay in billing.”

More time on the phone. More money uncollected.

If I want to care for their patients, I must sign the contract the insurance company presents. If I do not, I cannot care for patients with their insurance.

I cannot negotiate. I have tried. The contract is “take it or leave it.”

This is anti-small business. Our country was founded on the idea that individuals and small businesses were the backbone of our nation.

The only reliable coverage is Medicare. If a rep says ‘yes,’ they mean ‘yes.’ An approach where the government pays the bills seems to be the answer. We would be removing barriers standing between patients and health care providers.

When people say some love their insurance, it is not their insurance they love but their providers. Single-payer health care has a proven track record.

We look to Canada, Taiwan, and South Korea where the population lives longer and has a lower maternal death rate.

If the health insurance industry remains as is, I fear that small private practices such as mine will no longer be an option. The dream I worked so hard and so long for will die, and I will have to start the slow process of closing down my practice before the insurance companies help to close it down on me.

https://napavalleyregister.com…

Social Determinants of Death: Addressing Institutional Racism in American Healthcare

Sponsored by PNHP-Oregon

Oregon Health Forum, July 28, 2020

Racism in medicine is not just individual acts by individual people; it is embedded in our health care institutions. Join this discussion between Alan Weil, Editor-in-Chief of the prominent health care policy journal, Health Affairs, and Rachael Banks, Multnomah County Director of Public Health. They will dive into Alan Weil’s provocative editorial, “The Social Determinants of Death,” which spotlights how money and power maintain institutional racism in American health care.

Rachael Banks was appointed the county’s Public Health Director in 2017. She has focused on narrowing health disparities among communities of color since she joined the county in 2002. She began her career as a community health worker focused on prevention of sexually transmitted diseases, HIV and hepatitis. She later took on a broader role as a health educator to help public health staff better reach communities of color and others disproportionately impacted by health disparities.

Alan Weil is Editor-in-Chief of Health Affairs, the nation’s leading peer-reviewed health policy journal. Alan Weil was previously executive director of the National Academy for State Policy (NASHP), a non-partisan organization helping states achieve excellence in health policy and practice. Prior to that, Mr. Weil was director of the Urban Institute’s “Assessing the New Federalism” project which assessed changes in federal and state health, welfare, and social services programs.

https://www.oregonhealthforum.org…