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Arkansas’ Medicaid work requirements proved to be detrimental

Arkansas’ Medicaid work requirements proved to be detrimental

Medicaid Work Requirements — Results from the First Year in Arkansas

By Benjamin D. Sommers, M.D., Ph.D., Anna L. Goldman, M.D., M.P.A., M.P.H., Robert J. Blendon, Sc.D., E. John Orav, Ph.D., and Arnold M. Epstein, M.D.
The New England Journal of Medicine, June 19, 2019

As of April 2019, nine states have received approval by means of a federal waiver to implement work requirements in Medicaid, and six have applications pending. According to the Centers for Medicare and Medicaid Services, work requirements — also known as community engagement requirements — may promote better health and help beneficiaries escape poverty. However, critics dispute these claims and warn that the policy could lead to large coverage losses.

In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Medicaid beneficiaries 30 to 49 years of age were notified by the state (by mail and informational fliers) that they were required to work 80 hours per month, participate in another qualifying community engagement activity such as job training or community service, or meet criteria for an exemption such as pregnancy or disability. Three months of noncompliance or nonsubmission of monthly online reports within a year led to removal from Medicaid. By December, nearly 17,000 adults were notified by mail that they had been removed from Medicaid. In March 2019, a federal judge halted the program owing to concerns about its effect on coverage. Although several analyses have predicted various results of Medicaid work requirements, data from independent assessments since the policy took effect have been limited. Our objective was to assess early changes in insurance coverage and employment after implementation of the work requirements in Arkansas.

From the Discussion

Using a timely survey involving low-income adults in Arkansas and three comparison states, we found that implementation of the first-ever work requirements in Medicaid in 2018 was associated with significant losses in health insurance coverage in the initial 6 months of the policy but no significant change in employment. Lack of awareness and confusion about the reporting requirements were common, which may explain why thousands of persons lost coverage even though more than 95% of the target population appeared to meet the requirements or qualify for an exemption.

Our results show that this loss of Medicaid coverage was accompanied by a significant increase in the percentage of adults who were uninsured, indicating that many persons who were removed from Medicaid did not obtain other coverage.

Although Medicaid has always struggled with high turnover owing in part to legally required annual eligibility redeterminations, our findings suggest that work requirements have substantially exacerbated administrative hurdles to maintaining coverage.

In conclusion, in its first 6 months, work requirements in Arkansas were associated with a significant loss of Medicaid coverage and rise in the percentage of uninsured persons. We found no significant changes in employment associated with the policy, and more than 95% of persons who were targeted by the policy already met the requirement or should have been exempt. Many Medicaid beneficiaries were unaware of the policy or were confused about how to report their status to the state, which suggests that bureaucratic obstacles played a large role in coverage losses under the policy.

https://www.nejm.org…

Comment:

By Don McCanne, M.D.

Should there ever be a circumstance in which individuals are deliberately deprived of appropriate health care? There are certainly financial barriers to care, but shouldn’t public policies be designed to remove those barriers? Yet several states are deliberately attempting to erect financial barriers to care for low-income individuals who fail to meet work or community service requirements for Medicaid.

Arkansas led the way and has shown us that Medicaid work requirements caused thousands to lose their Medicaid coverage as the number of adults who were uninsured increased. Further, there were no significant changes in employment suggesting that this policy did not achieve its intended goal. Also the program increases the administrative burden even though health care in the U.S. is already unique for its wasteful administrative excesses. Hopefully, we will not learn what the long-term results of this policy would be since it has been halted by a federal judge, though the Trump administration is appealing the decision.

What is most perplexing is that it seems that our public policies should be designed to enable everyone to receive appropriate health care when they need it, yet they are not. When our public stewards establish or perpetuate policies that impair access to care, then it seems that we should dismiss them and bring in people who actually do care about the health of the nation.

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Brenda J. Butka, MD, MA

Dr. Brenda Butka is a retired pulmonologist in Nashville. Prior to retirement, she was director of the pulmonary program at Vanderbilt Stallworth Rehabilitation Hospital, and assistant professor of medicine at Vanderbilt University in the division of allergy, pulmonary, and critical care medicine.

Dr. Butka has worked as an intensivist at Nashville General Hospital and as medical director of the progressive respiratory care unit at St. Thomas Hospital. She was medical director of the respiratory therapy department at both hospitals. Her special interests include long-term ventilation, both invasive and non-invasive, and the pulmonary problems of patients with neuromuscular diseases.

Dr. Butka received her undergraduate degree from Andrews University, Michigan, and a masters degree from the University of Michigan. She earned her medical degree from Emory University and completed internal medicine residency and pulmonary fellowship at Vanderbilt.

“I Was Doing It for My Patients”: Dr. Charlie van der Horst on His Life Fighting for Justice

As told to Jonathan Michels
Indy Week (Durham, N.C.), June 19, 2019

The Triangle’s health advocacy community lost one of its most outspoken voices this weekend with the death of Dr. Charlie van der Horst during a 120-mile marathon swimming race in the Hudson River. He was sixty-seven. 

The world-renowned AIDS researcher and professor emeritus of medicine and infectious diseases at UNC–Chapel Hill was not content to fight for his patients in the exam room or from the lab bench. During pivotal moments of his life, van der Horst felt compelled to take a public stand for health care justice by stepping out of the clinic and into the streets.

Perhaps the most iconic act of civil disobedience during the Moral Monday protests of 2013 and 2014 belongs to van der Horst. In a well-known image, van der Horst, wearing a white coat and with his hands bound by zip ties, shoots a glance over his shoulder that showcased his wry sense of humor while Capitol police escort him out of the General Assembly.

What led the medical doctor to be arrested that day?

In a previously unpublished interview—conducted in July 2014 as part of an oral history on the Moral Monday movement—van der Horst reveals how his commitment to social justice stemmed from his early political activism, the difficulty of caring for victims of the AIDS epidemic, and his indignation with the General Assembly’s refusal to expand Medicaid.

This interview will be permanently housed at the Southern Oral History Collection for future scholarship.—Jonathan Michels

I was born in the Netherlands. I was a postwar, World War II baby, and then my family immigrated when I was two months old to the U.S.

My mother was a Holocaust survivor and she didn’t feel safe. She thought it wasn’t safe to be a Jew and be in Europe anymore after that. Didn’t have a lot of rational sense, but that was her fear, and so she really wanted to get out of town.

We moved to a town of about eighteen thousand people called Olean, New York, south of Buffalo. It was sort of this sleepy town at the northern tip of the Appalachian Mountains. Not very wealthy, surrounded by farmland, and it was a quiet place. They ended up there because my grandfather had a patent, a special patent, and he had established a small factory there to be close to the factory that made those big engines because they used his patent.

My parents were active in the Civil Rights movement. We never had Welch’s grape juice in the house or Welch’s jelly because Robert Welch was I think a founding member or big supporter of the John Birch Society, which is a right-wing organization. My parents belonged to the ACLU their first year they immigrated to the United States. My father was a member of the NAACP and raised money for the United Negro College Fund.

I remember marching with my father. My mother wouldn’t have done that because she was still sort of scarred from the Holocaust. She wouldn’t have gone out and marched. But I remember marching with my father and a black friend of mine. A big crowd of people, black and white, just marched downtown. We held signs and sang songs.

Later, I got involved in the anti-war movement. I remember getting signatures for George McGovern. I don’t remember a lot, but I got a lot of people who were supportive of it. What was shocking to me was more students didn’t get involved. They just didn’t want to.

People do a lot of talking, but they don’t—for a variety of reasons—they don’t actually walk the walk. I’m a child of a Holocaust survivor, and people who didn’t walk the walk died. But you never get change unless you put a little effort into it. It should be a little painful.

‘That Goddamned Nutcase’

After attending Andover, I applied to Harvard and I applied to Duke. I wrote this incredibly left-wing essay for Harvard. It was like this stream-of-consciousness thing about standing up for what’s right.

The admissions advisor at Andover, he couldn’t understand why I didn’t get into Harvard. I was a little disappointed because all my friends had gotten in. Now, remember this was when Nathan Pusey was president at Harvard and had called in the Cambridge police who had beaten, literally a bloody, bloody battle with the students who were occupying an office on campus.

He called up the admissions director at Harvard. He said, “I don’t understand why didn’t you take van der Horst?” He said, “Did you read his essay?” [The admissions director] said, “Have you looked at the newspaper headlines. Do you think I’m going to take that goddamned nutcase?”

I think I wrote the same essay for Duke. For them, that was a positive, despite all that. It was a culture shock [coming to Duke]. Andover was a lot of negative things. It was a lot of wealthy kids from New York City who had been in prep school all their life. Harry Steinway of Steinway pianos. The son of The New York Times owner. All these very rich and famous people, and I was this country bumpkin. I didn’t know that heir to the throne was pronounced heir or herb was pronounced herb. And I would get them mixed up in English class, and they would all laugh and tease me and things like that.

On the other hand, they were really, really smart and very outspoken. People weren’t shy about giving their opinions, and the faculty just pushed you hard and you had to write, write, write.

At Duke, it was a lot of Southern boys who were quiet. They were smart, but they were quiet. They didn’t participate, so if you were in a small group, it was no one talked. At one point, I had this wonderful history professor. He was a European history teacher named Harold Parker. After the first three weeks or something like that, he took me aside and he said, “Mr. van der Horst, I really enjoy the conversations we’re having in class with me. But you know, there’s eight other people there. I want you to do me a favor and count to ten before you open your mouth.”

No one else would say anything. Then my senior year, and people were not—it was much better than it is now, where 60 percent of the men and women are in fraternities and sororities.

Oh god, they kept trying to recruit me. The Jews wanted me, and the Jewish fraternity and the jocks, I was a varsity swimmer. They wanted me in the jock fraternity. And the prep school kids wanted me in the prep school fraternity. And I just wanted none of them. It was just nauseating. I just was so against it.

I was an old-fashioned intellectual. I worked in the library six days a week until it closed. I was also a jock. I was on the swim team. I just loved it, but I didn’t have a lot of friends until I was writing the history honors thesis and I met all these wonderful people.

So then I went to Harvard. The joke about Harvard is that there are three major religions at Harvard Medical School. Orthodox, conservative, and reformed. So I had not been raised as a Jew, but I was finding an increasing affinity for Judaism. I felt like I had instantly thirty-two friends. They were people who got it. They went into medicine for the same reasons I did. They were politically active. They were snarky. We raised holy hell.

There’s a very famous surgeon, and he used to do grand rounds. And they’d bring a patient there. You don’t do that anymore. But in those days, they’d actually bring the patient, and so Franny Moore brought the patient and sort of exposed the patient because the patient was just a piece of flesh. It wasn’t a human being. And this [female student] who was like a Madame LaFarge kind of character—she was from, I think, Jamaica—and she would just sit there knitting the whole time in class. She was older. She was like forty and a mother already. And she stood up in the middle of the grand rounds and just dressed down this faculty member as if he was a three-year-old.

The pharmaceutical industry, they gave us free stethoscopes, and we would send them away to doctors in the West Indies.

So we were very, very feisty. This was a very conservative medical school. People did not protest at Harvard Medical School. No way.

‘We Went on Strike’

I wanted to see what public medicine was like, so I did a rotation at Boston City Hospital, which was no longer a Harvard teaching hospital. So Harvard hospitals at the time, they’re all private hospitals. It may still be true. So I did it at Boston City Hospital, which is a public hospital. I really enjoyed that. So when we looked at our residency, our residency was a little complicated because by then Laura and I were involved. We weren’t engaged yet. So we sort of lied and said we were engaged so we could match together. And we ended up going to New York.

It was very hard. We worked so hard for three years, every third night. You slept in the hospital. So you’d be on, you’d go in at seven a.m. in the morning, like, on a Monday. And you’d go home at seven p.m. on Tuesday. And then you’d get up the next morning at seven a.m. and you’d work just the day and get out at seven p.m. and then—. So that would be Wednesday and then start all over again Thursday, seven a.m. going until Friday night at seven p.m. or about that. But there were no set hours. You left when the work was done.

We had to push our patients to X-ray. There weren’t enough staff. If they needed emergency antibiotics, we had to run to the pharmacy to get them and hand them to the nurse to hang. All the blood, we drew ourselves, and all the lines, we started ourselves. And we ran the blood up to the lab.

I learned an enormous amount of medicine. It was very, very, very good, but we went on strike.

It was actually the longest physician strike in U.S. history. I think we went on strike in 1981, as I recall. And the issue was that we said the hospital was not hiring enough staff to take care of the volume of patients.

They were admitting people, critically ill people, to waiting rooms that didn’t even have proper plugs in them. So when they had a cardiac arrest, you had to just like move the bed to a different place so you could plug in the crash cart because they weren’t battery-powered then. You needed a plug so you could shock the patient. It was just ridiculous.

They were putting us in a position where we would admit a sixty-year-old with cardiogenic shock due to massive heart attack to the coronary care unit, and then we’d have to kick them out two days later because we had a forty-five-year-old with the same thing. So they were having people who’d been physicians for twelve months having to make these life-and-death decisions. It was just intolerable. We thought it was harming the patients. The patients were dying because of this. And so we went out on strike.

We ended up getting busted in the end. Everyone got a FedEx that says if you don’t show up to work tomorrow, you’re fired. Not only will you be fired, but we’ll make sure you can’t get boarded in your specialty or whatever.

The medical establishment is not very liberal. How many doctors do you see joining me on the picket lines?

On the one hand, it was exhilarating but also exhausting. I felt proud of things like that, and then I ended up, I got blackballed from what I was going to do for fellowship. The associate chair of medicine, who was also chief of cardiology, had written this wonderful letter of recommendation for a fellowship of infectious diseases. Then when I went on strike, he just personally felt so betrayed that he wrote secretly another letter and sent it to all the fellowship programs.

He said he wanted to withdraw my previous letter, and I was a danger to patients. So very strong. I was devastated, and I didn’t know what the hell I was going to do. I consulted a lawyer, who said you could probably sue, but you would never, ever be able to succeed professionally if you did that. So his recommendation was just to let it slide. So I did. And the telling thing is the folks at UNC just ripped it up.

I didn’t like the plumbing specialties. They just seemed sort of boring. Cardiac cathing, pulmonary, GI, colonoscopy. They just seemed sort of boring. It was more semi-surgical and not very intellectual. So I liked thinking about the whole body. They’re also just focused on like just one organ or something like that. And I liked internal medicine. So if I was going to do a specialty, then I wanted to think about the whole body.

So I said well, I’ll go into infectious diseases. And this was 1981, mind you. And I’ll just take care of little old ladies with pneumonia and make them better.

And I loved viruses, the symmetry of viruses. They’re just very pretty, elegant. The way they look, these spiked knobs. I mean, you’ve seen the electron micrographs of—3D micrographs of influenza and HIV. They’re very pretty looking.

So I thought it would be fun to do [infectious disease]. Then what happened in June of 1981? Do you remember? That’s when the first HIV/AIDS cases were recognized.

I started taking care of some HIV patients. In fact, the AIDS house in Durham is called the Blevins House, named after Nat Blevins, who was my patient. I took care of him right from the very beginning.

[HIV/AIDS] was a huge problem then because no one wanted to take care of the patients. Fear of contagion, fear of this whole idea that they were gay and just afraid of them. It was a terrible time. It was just physically draining. It was like being a resident again. I was always in and out of the hospital, and we set up a ward. We set up a clinic. We were the only hospital from Miami to New York that had a dedicated HIV ward. Almost all of the patients passed.

Most of [my] political activity had to do about AIDS issues. Usually discrimination issues. We had a lieutenant governor, Jim Gardner was his name, and he was trying to do testing of food service workers, and health care workers and teachers, and then wanted to fire them all. It was a huge issue that we beat that off, and so that didn’t happen. That was sort of the limit of my political activism in that arena.

‘I Was Pissed Off’

I held a big rally for the Affordable Care Act before it was passed here at the hospital, got all the press involved. That was very successful. I had written a couple of editorials on why [the Affordable Care Act] needed to be passed, and then it got passed. Then [Republican legislators] were making all these pronouncements that they weren’t going to expand Medicaid.

I got involved [in Moral Mondays], particularly about Medicaid expansion. I was pissed off. It was going to harm my patients.

I can’t tell you how awful it is to be put in place to make a diagnosis of a very difficult issue and then not to be able to treat it because they don’t have health insurance. It’s such a terrible feeling. It goes back like when we went on strike—when here I have the skillset, but for want of an aide or a plug in a room that works, I can’t save this person’s life.

I didn’t know about Reverend Barber at all. I went to Raleigh and talked with a couple of other people, including Perri Morgan.

That was in February and then they passed the law that [banned Medicaid expansion]. I opened up the paper and saw that Perri had gotten arrested, and I said, well, shit. If she’s doing this, I need to start doing this stuff. The next Monday, that’s when I met Reverend Barber.

I thought I wanted to protest. I didn’t know that I wanted to be arrested. I don’t think I made a foregone conclusion. It just sort of happened.

That picture became a sort of symbol for doctors being unhappy with not expanding Medicaid. In the white coat, in handcuffs—that sort of woke up a bunch of people I think.

The North Carolina Board of Medical Examiners launched an investigation, which they do for anybody, any physician who’s arrested, and then said it was not an issue. The hospital, I decided to notify risk management, and they also said they didn’t think it had anything to do with my ability to practice medicine. The, and I know the hospital and the dean have been getting pressure from someone in, or more than one person in either the governor’s office or the legislature’s leadership to do something about me, and they haven’t done anything.

People have quietly come up to me and said they were glad. They admired that I had done it. I’ve got a lot of positive press and interviews, and people stop me in grocery stores, and it’s a little bit because I wear the white coat now.

It’s a potent symbol, and I was doing it for my patients.

Jonathan Michels is a freelance journalist. As a board member of Health Care for All NC, he advocated for a Medicare for All health care system along with van der Horst.

https://indyweek.com…

ACOs may not be associated with improvements in spending or quality

Performance in the Medicare Shared Savings Program After Accounting for Nonrandom Exit: An Instrumental Variable Analysis

By Adam A. Markovitz, BS; John M. Hollingsworth, MD, MS; John Z. Ayanian, MD, MPP; Edward C. Norton, PhD; Phyllis L. Yan, MS; Andrew M. Ryan, PhD
Annals of Internal Medicine, June 18, 2019

Abstract

Background:
Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are associated with modest savings. However, prior research may overstate this effect if high-cost clinicians exit ACOs.

Objective:
To evaluate the effect of the MSSP on spending and quality while accounting for clinicians’ nonrandom exit.

Design:
Similar to prior MSSP analyses, this study compared MSSP ACO participants versus control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. To further account for selection effects, the share of nearby clinicians in the MSSP was used as an instrumental variable. Hip fracture served as a falsification outcome. The authors also tested for compositional changes among MSSP participants.

Setting:
Fee-for-service Medicare, 2008 through 2014.

Patients:
A 20% sample (97 204 192 beneficiary-quarters).

Measurements:
Total spending, 4 quality indicators, and hospitalization for hip fracture.

Results:
In adjusted longitudinal models, the MSSP was associated with spending reductions (change, −$118 [95% CI, −$151 to −$85] per beneficiary-quarter) and improvements in all 4 quality indicators. In instrumental variable models, the MSSP was not associated with spending (change, $5 [CI, −$51 to $62] per beneficiary-quarter) or quality. In falsification tests, the MSSP was associated with hip fracture in the adjusted model (−0.24 hospitalizations for hip fracture [CI, −0.32 to −0.16 hospitalizations] per 1000 beneficiary-quarters) but not in the instrumental variable model (0.05 hospitalizations [CI, −0.10 to 0.20 hospitalizations] per 1000 beneficiary-quarters). Compositional changes were driven by high-cost clinicians exiting ACOs: High-cost clinicians (99th percentile) had a 30.4% chance of exiting the MSSP, compared with a 13.8% chance among median-cost clinicians (50th percentile).

Limitation:
The study used an observational design and administrative data.

Conclusion:
After adjustment for clinicians’ nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects — including exit of high-cost clinicians — may drive estimates of savings in the MSSP.

Primary Funding Source:
Horowitz Foundation for Social Policy, Agency for Healthcare Research and Quality, and National Institute on Aging.

https://annals.org…

Spending Reductions in the Medicare Shared Savings Program: Selection or Savings?

By J. Michael McWilliams, MD, PhD, Alan M. Zaslavsky, PhD, Bruce E. Landon, MD, MBA, and Michael E. Chernew, PhD
The Incidental Economist, June 17, 2019

Prior studies suggest that accountable care organizations (ACOs) in the MSSP have achieved modest, growing savings. In a recent study in Annals of Internal Medicine, Markovitz et al. conclude that savings from the MSSP are illusory, an artifact of risk selection behaviors by ACOs such as “pruning” primary care physicians (PCPs) with high-cost patients. Their conclusions appear to contradict previous findings that characteristics of ACO patients changed minimally over time relative to local control groups.

Conclusion

Monitoring ACOs will be essential, particularly as incentives for selection are strengthened as regional spending rates become increasingly important in determining benchmarks. Although there has likely been some gaming, the evidence to date — including the study by Markovitz et al. — provides no clear evidence of a costly problem and suggests that ACOs have achieved very small, but real, savings. Causal inference is hard but necessary to inform policy. When conclusions differ, opportunities arise to understand methodological differences and to clarify their implications for policy.

https://theincidentaleconomist.com…

Comment:

By Don McCanne, M.D.

This important study in the highly reputable Annals of Internal Medicine concludes that accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) did not show any improvement in spending or quality when adjustments were made for selection effects, especially the non-random exit of high-cost clinicians (“I’m worth the extra money, and if you’re gonna cut my fees, I’m outta here.”)

The conclusions were immediately challenged by others in the policy community who have previously published studies indicating that “ACOs have achieved very small, but real, savings,” albeit admitting that “there has likely been some gaming.” And the savings were, indeed, very small. Others have suggested that the very small savings did not take into consideration the significant increase in provider administrative costs for technological equipment and personnel to run the ACOs, and certainly did not consider other unintended consequences such as the tragic increase in physician burnout.

Another problem with the infatuation for ACOs is that politicians and the policy community are insisting that we continue with this experiment in spite of the disappointing results to date. That simply postpones the adoption of truly effective policies, such as those in a single payer Medicare for All program, that would actually improve quality while greatly reducing administrative waste. The tragedy is that this also perpetuates uninsurance, underinsurance, and personal financial hardship from medical bills.

People are suffering and dying while the policy community continues to diddle with ACOs and other injudicious policy inventions. Enough! It’s long past time to reduce suffering and save lives! Single Payer Medicare for All!

(Yes, I’m angry, but even more I’m terribly anguished over the health care injustices that we continue to tolerate through our collective inaction.)

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Confusion on Medicare for All

KFF Health Tracking Poll - June 2019: Health Care in the Democratic Primary and Medicare-for-all

By Ashley Kirzinger, Cailey Muñana, Lunna Lopes, Liz Hamel, and Mollyann Brodie
Kaiser Family Foundation, June 18, 2019

The most recent KFF Health Tracking Poll finds majorities across partisans think taxes for most people would increase under a national health plan, sometimes called Medicare-for-all (78 percent), and about half (53 percent) think private health insurance companies would no longer be the primary way Americans would get health coverage under such a plan. However, when it comes to other key changes that the leading Medicare-for-all bills introduced by Sen. Bernie Sanders and Rep. Pramila Jayapal would bring, large shares are unaware of how the current health care system may be affected. For example, majorities say people would continue to pay deductibles and co-pays (69 percent) and continue to pay premiums (54 percent) under a Medicare-for-all plan. Likewise, majorities say people with employer-sponsored or self-purchased insurance would be able to keep their plans (55 percent each) under a Medicare-for-all plan.

Though lowering costs and increasing access emerge as the top issues that Democrats and Democratic-leaning independents want to hear presidential candidates talk about, there are some notable differences between liberals and moderates. One-fourth of liberal Democrats and Democratic-leaning independents (23 percent) offer implementing a single-payer or Medicare-for-all system when asked what health care issue they want to hear the candidates discuss, making it among the top health care issues offered by this group along with increasing access (27 percent) and lowering the amount people pay for health care (24 percent). Among moderate Democrats and Democratic-leaning independents, more than three times as many offer lowering the amount people pay for health care (34 percent) than implementing a Medicare-for-all system (9 percent).

A National Health Plan or Medicare-for-all

Eight in ten (78 percent) think that under a national health plan, sometimes called Medicare-for-all, taxes for most people would increase. Majorities of Democrats (71 percent), independents (80 percent), and Republicans (85 percent) say that taxes for most Americans would increase under a national health plan.

In addition, about half of Americans (53 percent) – including half of Democrats and independents (52 percent each) and most Republicans (57 percent) – think that under a national health plan, private health insurances would no longer be the primary way Americans would get health coverage. Still, a substantial four in ten of the public believe that under such a plan, private health insurance companies would still be the primary source of coverage for most Americans and an additional seven percent say they do not know what would happen under a national health plan.

In focus groups, many participants expressed skepticism about the idea that private insurance companies would cease to exist under a Medicare-for-all plan. Some thought these companies were just too powerful, and others thought they would continue to exist for people who want to buy extra coverage beyond what a national plan would offer.

When it comes to other potential impacts of a national health plan, many Americans say most aspects of the current health care system would remain unchanged. Majorities of Democrats, independents, and Republicans say people would continue to pay deductibles and co-pays when they use health care services (71 percent, 68 percent, and 68 percent, respectively). In addition, majorities of both Democrats and independents also believe people with employer-sponsored insurance would be able to keep their current coverage (68 percent and 53 percent), people who purchase their own plans would be able to keep their current coverage (65 percent and 55 percent), and individuals and employers would continue to pay health insurance premiums (61 percent and 53 percent). At least four in ten Republicans also say each of these things would happen under a national health plan. Small shares of the public overall say they don’t know whether each of these things would happen under such a plan (4 percent say they don’t know if people would continue to pay deductibles and co-pays, 7 percent say they don’t know for the other changes included).

https://www.kff.org…

Navigating the Medicare Debate

Navigator, June 17, 2019

The simple ideas of protecting and expanding Medicare are more popular than any branded program.

The most popular Medicare ideas among the public are also the simplest – the ideas of “protecting Medicare” and “expanding Medicare.” Both ideas are popular and have low negative ratings. “Medicare for All” as a brand shows promise, as it’s more popular than not (51% say it’s a good idea versus just 33% saying it’s a bad idea), though, as noted below, there is also clear confusion about the program. Proposals using more prescriptive language (e.g., “buy-in” or “single-payer”) score less positively, mostly due to a lack of knowledge as indicated by higher “don’t know” ratings.

Confusion: Medicare for… All who want it?

Only one in five Americans are very confident they know what “Medicare for All” would mean for our health care system (18% very confident) or their personal health care (20% very confident). When asked to characterize what “Medicare for All” means to them, respondents are divided: 40% think “Medicare for All” would eliminate the private insurance market and require everyone to switch to Medicare, while 60% think it would let anyone buy Medicare who wants to, while allowing others to stay on their private insurance. Perhaps most fascinating: Democrats are most likely to think “Medicare for All” is a “buy-in” program, while Republicans are much more likely to believe it will eliminate private insurance.

And those different interpretations of “Medicare for All” have dramatic consequences on the program’s support.

When respondents are asked whether they support “Medicare for All” – described as a buy-in program – 73% support it. However, when respondents are asked whether they would support “Medicare for All” – described as eliminating private health insurance – support drops significantly, with 47% saying they support it. This illustrates how support for Medicare for All is driven more by branding with the term “Medicare” than by specific knowledge of the program.

Concerns about Medicare for All center on costs.

Americans are most concerned that “Medicare for All” will raise taxes, cost too much, and increase the deficit. Given Americans’ top health care concern is cost, progressives should take serious note of and grapple with these cost concerns.

https://navigatorresearch.org…

Toplines:
https://navigatorresearch.org…

(Note that the KFF poll is designed to be neutral, whereas the Navigator poll is designed to inform the progressive community.)

Comment:

By Don McCanne, M.D.

Unfortunately, these polls demonstrate that Americans are not well informed on the single payer model of Medicare for All. There are two important factors that have contributed to the confusion: 1) Moderate Democrats who support adding a public option the current system under the Affordable Care Act have confused the public by using the label “Medicare for All” or variations of it when their proposals are actually only Medicare for some, and 2) the conservatives have been much more effective in disseminating negative messages about Medicare for All including threats of having their employer-sponsored plans taken away from them and having to pay egregiously high taxes.

Regarding the effectiveness of messaging, it is interesting that more Republicans believe that Medicare for All will eliminate private insurance (correct except for supplemental coverage of non-essential services), whereas more Democrats believe that Medicare for All is a buy-in (public option) preserving current private insurance (incorrect, except for the Medicare for some copycats) – Question 133X in the Navigator toplines.

Our message is quite straightforward, but it has not gained enough traction. We should probably specify Single Payer Medicare for All to distinguish it from the Medicare for Some models, and then keep the message simple:

Single Payer Medicare for All

  • Universal (everyone in)
  • Affordable (no medical bills; prepaid through equitable taxes)
  • Comprehensive (including drug, dental, eye, hearing and long-term care)
  • Free choice of doctors and hospitals (no insurer provider lists)
  • Accessible (regional planning)
  • Efficient (eliminate private insurance and administrative waste)
  • Portable (care throughout the United States)
  • Permanent (throughout life)

President Trump once again is promising us, within the next two months, “something terrific” to overhaul the nation’s health care system. Let’s see him match this list.

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

Do you really ‘like’ your private health insurance plan?

Are You Sure You Actually 'Like' Your Private Health Insurance?

By Dr. Sanjeev K. Sriram
Common Dreams, June 12, 2019

When I talk to friends, family, and colleagues about Medicare for All, sometimes someone asks, “but don’t people like their insurance?” It’s not hard to see where they got that idea. America’s Health Insurance Plans (AHIP), the leading lobbyist for the for-profit insurance industry, says 71 percent of Americans “like” their private health insurance. It’s important to scrutinize the messenger and the message here. If McDonald’s told us that 71 percent of their customers said their food was healthy and nutritious, we’d be reasonably skeptical at the very least.

When independently surveyed, only 16 percent of Americans trust the health insurance industry to put patients before profits. The only group we trust less is Big Pharma (only 9 percent believe these corporations prioritize patients). So how do we make sense of all this? Do people really “like” health insurance plans sold by such untrusted corporations?

As a physician who regularly haggles with insurance companies, I have many four-letter words for that industry. “Like” is not one of them. Similar to millions of Americans with private health insurance, I have paid absurd co-pays, premiums, and deductibles to different insurance companies over the course of my career. I am certain I have never “liked” private health insurance the way I like comic books or the way my wife likes spin classes. I begrudgingly tolerate private health insurance (for now). The same goes for my patients, colleagues, friends, and family. Out of fear of financial ruin, we have allowed ever-increasing portions of our paychecks to go to health insurance companies.

Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.

Of Americans reporting problems paying medical bills, 73 percent are cutting back on food, clothing, and other basic necessities. Over six in ten of these everyday Americans have already depleted what little savings they had. One in three GoFundMe crowdfunding pages is directed toward paying for health care. For millions of patients and families, private health insurance is a source of, not a savior from, financial hardship.

As a physician and public health policy adviser, I used to believe the insurance industry would become better partners in our health care through the very reasonable guidelines and expectations set by the Affordable Care Act. Over the last several years, I have lost faith and accepted the insurance corporations for what they are: machines of unappeasable greed, accountable only to shareholders, never my patients or other families. In 2018, as millions of Americans borrowed $88 billion to pay for health care, 62 CEOs of health care companies made a combined total of $1.1 billion in compensation. When it comes to our current health care system’s priorities, patients are no match for profits.

We do not have to live like this. Thousands of physicians, medical students, nurses, and our colleagues across health care (but sadly, not the American Medical Association) are joining the Medicare for All movement because we want our work to be about protecting people’s health, not destroying their wealth.

Dr. Sriram completed his medical degree and his pediatrics residency at UCLA, where he served as Chief Resident at the Department of Pediatrics. In June 2009, he earned his Master’s in Public Health after completing the Commonwealth Fund Mongan Fellowship in Minority Health Policy at the Harvard School of Public Health. He currently practices general pediatrics in southeast Washington, D.C.

https://www.commondreams.org…

Sanders on Medicare for All: ‘People don’t like insurance companies, they like their doctors’

By Zack Budryk
The Hill, June 16, 2019

Sen. Bernie Sanders (I-Vt.), a 2020 presidential candidate, defended one of his signature policy proposals, Medicare for All, on “Fox News Sunday.”

“Medicare itself is far, far more popular than our private insurance,” Sanders told Fox’s Chris Wallace. “People don’t like insurance companies, they like their doctors and they like their hospitals.”

https://thehill.com…

Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

Kaiser Family Foundation, April 24, 2019

Would you favor or oppose a national Medicare-for-all plan if you heard that it would do each of the following?

Percent opposed

  • 58% – Eliminate private insurance companies
  • 27% – Guarantee health insurance as a right for all Americans

How important is it that a national plan….?

Percent stating very or somewhat important

  • 98% – Covers all Americans
  • 97% – Simplifies the health care system
  • 89% – Eliminates monthly premiums
  • 88% – Eliminates out-of-pocket costs like co-pays and deductibles
  • 83% – Shifts what people pay for health care to taxes
  • 67% – Eliminates private health insurance companies

https://www.kff.org…

Comment:

By Don McCanne, M.D.

One of the most common reasons given for rejecting single payer Medicare for All is that individuals would lose their choice of continuing with the health plan they receive through their work. In fact, without supporting evidence, it is frequently claimed that people want to keep the plans they have rather than being forced into a one-size-fits-all program in which government bureaucrats dictate your care. Of course, the one size that is all inclusive is the size that most of us would prefer, and Medicare bureaucrats do not intervene in the physician-patient relationship.

Some polling has suggested that support for Medicare for All diminishes when told that private insurance would be eliminated. The KFF poll cited indicates that 58 percent would be opposed to elimination of private plans. The problem is that not enough information has been provided. When asked about a series of features of a national plan, two-thirds believe that it is important that the national plan would eliminate private health insurance companies. Other features strongly supported include universality, simplification of the system, eliminating monthly premiums, eliminating copays and deductibles, and shifting the financing to the tax system. When individuals know more about the details of single payer Medicare for All, they become even more supportive.

The point is that people do want to have their choice of physicians and hospitals, as they would under Medicare for all, but those choices are limited by the provider networks established by private insurers. They do like their doctors and hospitals that they have personally chosen, but they don’t “like” their insurers to which they are often assigned by default, especially when the insurers fail to protect them against financial hardship.

So do not let opponents of single payer infer that individuals like private plans better than Medicare for All when they haven’t been given the facts. The list in the KFF poll of what people think is important is a good place to start when describing what people really do like in health care financing.

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

Medicare for All Explained Podcast: Episode 14

Interview with Dina van der Zalm

June 15, 2019

Dina van der Zalm, a health care organizer at the Missouri Rural Crisis Center discusses the worsening state of health care in rural America, where needs are significant, providers are scarce, and insurance coverage is lacking. Hosted by Joseph Sparks. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Med students are on the right side of Medicare for All debate

By Jack Bernard
Modern Healthcare, Letters, June 15, 2019

Modern Healthcare last week reported that the American Medical Association membership narrowly defeated a resolution to repeal the AMA’s opposition to Medicare for All. Significantly, it was a large contingent of medical students as well as younger physicians who wanted the AMA to endorse single-payer. Physicians for a National Health Program, having thousands of mostly younger members, was there.

As someone with a strong health policy background who has written about the topic extensively, I agree with those med students; Physicians for a National Health Program; Sens. Bernie Sanders, Kamala Harris, Elizabeth Warren and others regarding healthcare reform. Medicare for All is not only a moral imperative and completely feasible, it is the only way to control our nation’s runaway health expenditures.

Those who advocate maintaining Obamacare vs. single-payer assume the effectiveness of private enterprise vs. government. Generally, yes, private enterprise is more efficient than government. However, the exception to the rule is healthcare. Medicare’s overhead is 2% vs. about 12% for the for-profit insurers.

Repeated analyses by the Organisation for Economic Co-operation and Development illustrate that we pay much more per capita than any other affluent democracy for healthcare—every year. All developed nations have greater involvement of government in their healthcare financing systems compared with the U.S. and most have found a way to cover 100% of their citizens at a much lower cost.

Jack Bernard is the former director of health planning for Georgia and a retired health care executive.

https://www.modernhealthcare.com…

AMA’s opposition to single-payer healthcare is uninformed

By Samuel Metz, M.D.
Modern Healthcare, Letters, June 15, 2019

I’m an American Medical Association member. My leadership’s opposition to single-payer healthcare is uninformed and possibly deceptive.

At last week’s meeting, Dr. Daniel Johnson, former AMA president, asked “What is best for patients?” The AMA should not confuse this question with “What is best for physicians?” The questions differ. The answers conflict. The AMA should not pretend otherwise.

Dr. Barbara McAneny, the outgoing AMA president, exacerbates this conflict when she refers to AMA support of “pluralism, freedom of choice, freedom of practice, and universal access for patients.” But physician freedom to reject patients with poor insurance differs from patient freedom to choose physicians. Pluralism of insurance differs from universal access.

Single-payer plans do indeed restrict physician practice by eliminating competition among insurers. Single-payer plans instead create uniform benefits and physician fees. Both compromise physician ability to maximize income.

But single-payer plans do benefit patients. They guarantee access regardless of employment or finances. They reduce patient costs (healthcare taxes, premiums and out-of-pocket payments). They improve outcomes by promoting primary and preventive care. They even provide modest benefits to physicians. Their expenses decrease when every patient becomes a paying patient. Professional costs plummet. But not all physicians consider this benefit worth the compromised income potential.

Every single-payer system provides better care to more people for less money than the dysfunctional, employer-dependent, multirisk-pool American system reinforced by the Affordable Care Act and supported by the AMA.

Even at risk to my income, I want the AMA to acknowledge single-payer. If it won’t, integrity demands that it cite real physician benefits, not specious patient benefits.

https://www.modernhealthcare.com…

In health care, the free-market model has failed

By Kenneth Dolkart, M.D.
Valley News (West Lebanon, N.H.), June 15, 2019

“Medicare for All” is at the confluence of currents running through our nation. Consciousness is rising that we might enjoy the automatic, universal and high-quality care that is taken for granted in many nations. We trail the developed world in metrics of care like longevity, access, equity, infant and maternal mortality, and rates of death from causes otherwise amenable to care. All too often, ZIP code determines life expectancy.

The health industry sector outperforms the stock market, even as schools cannot afford insurance premiums for teachers.

Nurses and doctors watch countless people lose their health, since absent or inadequate medical coverage promotes belated attention to symptoms.

As some Americans enjoy wondrous medical advancements, others cannot afford the insulin they need. And a growing undertow of “diseases of despair,” such as suicide, alcoholism and opioid overdose, have taken their toll.

U.S. life expectancy has been declining the past three years, for the first time since 1918.

The consequences of the deregulation of medical insurance are obvious.

Costs of employee-sponsored family health insurance plans leaped ahead of inflation, from $5,791 in 1999 to $18,142 in 2016, according to the Kaiser Family Foundation. Middle-class incomes have been stagnant as wages are diverted to the “health dollar” and destined for insurance company profits and CEO salaries. Health insurance deductibles have risen 200 percent since 2008, along with other tactics that shift costs to the enrollee and discourage obtaining services.

The private managed care bureaucracy is geared to profit, and overall U.S. administrative costs are four times that of Canada and three times that of European nations, according to the Organization for Economic Cooperation and Development. Absent regulation allows unbridled and unjustified increases in drug and equipment prices. The cartel-like practice of “pay-for-delay” occurs regularly as drugmakers pay off generic companies to not produce cheaper — but otherwise identical — medication.

Apart from antitrust actions, the prices of medical products and services explode beyond what a reasonably functioning market would dictate.

It is evident that applying free-market consumer models to health care is as appropriate as applying rules of baseball to hockey.

Profits above patients

The recent effects of the corporatization of medical “providers” are also clear.

The vanishing primary care doctor runs gauntlets to get tests reimbursed and hires staff solely to interact with insurers. Burnout from the ever-expanded clerical burdens of electronic medical records thins the ranks of doctors and nurses. The promise of electronic medical records was lost when it was hijacked for capturing billings, rather than clinical utility.

(Wouldn’t it be nice if the clinician could “ask Siri” to “find last pathology report” and “schedule blood count in two weeks,” or “analyze drug interactions”?)

Companies with a duty to put stock prices above patient interests cynically exploit the professional accountability of medical staff, as physician and author Danielle Ofri observed in a recent New York Times piece, “Is Exploiting Doctors the Business Plan?”)

Abuse of the public trust is certainly not unique to health care.

Industry-aligned Cabinet billionaires dismantle the federal oversight agencies they command. “Dark money” influence is unabated and oligarchs pull the levers of national legislation. Lobbyists for Big Oil mythologize climate change, big banks set the terms of their next failures and the National Rifle Association legislates a gun dystopia. So too, Big Pharma and health insurers profit from the legislation they draft.

Urban hospitals convert health dollar surplus into real estate investments, while rural hospitals collapse in the absence of coordinated support. The Justice Department tries to dismantle the Affordable Care Act scaffolding while millions of Americans are still on it.

Our multiple, episodically introduced, parallel public insurance systems still leave 30 million Americans uninsured.

Now there are numerous proposals to achieve universal coverage, reduce complexity and cut overall costs. Some “Medicare for All” plans propose incremental dissolution of profit-directed insurance bureaucracies with a single federal payer built upon Medicare. There is no “nationalization” of hospitals or doctors, as some critics charge.

“Medicare for Some” proposals, such as the “public option,” allow non-seniors to purchase Medicare and may be more politically palatable to those with employer-coverage, but they do not reduce complexity nor lower costs, and future recessions will eliminate such coverage for many.

Other well regulated and simplified hybrid systems can be envisioned. Still, any cost-effective system, “all-payer” or otherwise, requires transparent and uniform insurance industry practices, enforcement of existing regulations and the enabling of negotiation between tax-supported payers and drugmakers. So expect smoke, mirrors and twitters of fear, uncertainty and disinformation from the Partnership for America’s Health Care Future — a coalition of lobbying groups including America’s Health Insurance Plans, the American Medical Association, the Federation of American Hospitals and BigPharma — which is already hard at work.

We realize that the anonymous “dark money” financing of election efforts and the sanctioned bribing of Congress is incompatible with a representative democracy. Citizen efforts to create legislation for policies that have long had overwhelming support have been stymied by misinformation and the stoking of division, whether it be by the AMA or the NRA.

Still, the tide may be turning. Young people and an energized electorate are clamoring to “promote the general welfare, and secure the blessings of liberty” offered in the preamble to the Constitution. We will recognize such a democracy when, among other changes, this wealthy nation fulfills the moral imperative of assuring modern, universal and affordable health care to all Americans.

Dr. Kenneth Dolkart is a physician who lives in Grantham

https://www.vnews.com…

New rule using HRAs to further destroy health equity for employees

Employers can fund workers' individual plans under new Trump rule

By Harris Meyer
Modern Healthcare, June 13, 2019

Employers will be able to hand their workers a chunk of tax-sheltered health reimbursement money and send them off to buy an individual health plan under a controversial rule issued by the Trump administration Thursday.

The final rule, which takes effect Jan. 1, 2020, will prompt an estimated 800,000 large and small employers to fund individual coverage through health reimbursement accounts (HRAs) for about 10 million workers, nearly 800,000 of whom would be newly insured.

Reversing prior policy, the 497-page rule lets employers dole out HRA funds—previously used to reimburse out-of-pocket medical expenses—to employees to buy individual-market plans.

While the HRA money can be used mostly for buying plans that meet Affordable Care Act requirements, employers under the rule can establish a special type of “excepted benefit” HRA for employees to use in buying cheaper short-term plans that don’t comply with ACA rules such as pre-existing condition protections. These special accounts are capped at $1,800 a year.

The ACA requires that companies with more than 50 full-time workers provide their employees with health insurance. Employers can satisfy the requirement if they provide adequate HRA contributions to employees to buy individual coverage.

A wide range of groups expressed fears about negative effects on the individual market if employers offloaded their sicker, more costly workers from their employer group plans to the individual market.

“If the administration’s estimates are right, this would result in a huge influx into the ACA-regulated individual insurance market,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. “But these new accounts could shift employer-provided health insurance to a defined-contribution approach, leaving workers at greater risk for premium increases over time.”

In the final rule issued Thursday, the agencies decided that an “individual coverage” HRA can only be used to buy ACA-compliant plans. But this type of HRA will only be available to workers who are not offered a traditional group plan, according to Matthew Fiedler, an economist at the Brookings Institution’s Center for Health Policy.

Employers that provide a traditional group plan can offer workers an “excepted benefit” HRA, capped at $1,800 a year, that they can use to buy a short-term plan but not an ACA-compliant plan.

The final rule retained the proposed rule’s provision that employers cannot offer the same class of employees the choice of either a traditional group plan or an HRA-funded individual-market plan.

But the agencies declined to include specific enforcement guidance to determine whether employers are targeting individual coverage HRAs to high-cost employees.

The agencies also acknowledged the likelihood that employees will find the new HRA benefit system confusing, and that they may not understand the coverage limitations of short-term plans.

Contrary to the agencies’ finding that the rule would have a net beneficial effect, Brookings’ Fiedler argued that it will increase individual-market premiums and federal premium subsidy costs by encouraging larger employers with sicker workforces to shift their workers into the individual market.

He was particularly critical of the provision allowing use of excepted benefit HRAs, which are tax-sheltered, to buy short-term plans.

“At best, it’s a poor use of federal funds,” he said. “At worst, it will give firms a tool to shift costs from their healthier workers onto their sicker ones.”

https://www.modernhealthcare.com…

Final rule (497 pages): Health Reimbursement Arrangements and Other Account-Based Group Health Plans
https://s3.amazonaws.com…

Trump’s new rule will give businesses and workers better health care options

By Brian Blase (special assistant to the president at the National Economic Council focused on health care policy)
CNN Business, June 14, 2019

While some recklessly claim that the administration has been sabotaging the individual market, this rule makes clear we have been focused on expanding affordable options through choice and competition in all possible venues. We aim to deliver better results than previous policies centered on mandates and a “Washington-knows-best” mentality. Obamacare’s many mandates still keep individual market premiums too high in many parts of the country, but this rule may spur necessary deregulatory reforms as more stakeholders now stand to benefit from a more competitive and free individual market.

https://www.cnn.com…

Comment:

By Don McCanne, M.D.

The Trump administration is once again using the fiction that deregulation and choice and competition in health plans “will give businesses and workers better health care options.” What they are enforcing through the rule-making process is further fragmentation of risk pools, greater administrative complexity and confusion, greater transfer of employees into the deficient individual insurance market (or out of the market altogether), greater use of cruelly inadequate short-term insurance plans, and use of health reimbursement arrangements (HRAs) as a tool to switch employees from guaranteed defined benefit health plans to health plans with ever-diminishing defined contributions, shifting yet more health care costs to the already overburdened employees and their families.

As Matthew Fiedler of Brookings states, “At best, it’s a poor use of federal funds; at worst, it will give firms a tool to shift costs from their healthier workers onto their sicker ones.”

The good news is, once we have enacted and implemented a single payer Medicare for All program, this 496 page rule can be dumped into the electronic trash bin along with billions of other pages from the private insurers and from the administrative-procedures electronic files of the health care professionals and institutions, finally allowing us to use our resources for the benefit of patients in an affordable and equitable health care financing system that benefits all.

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

Por qué los estudiantes de medicina exigen Medicare para todos

Por Jessica Osorio, Christian Pérez y Stephanie Navarro, Estudiantes de un Programa Nacional de Salud
La Opinión, 14 de Junio 2019

Como estudiantes de medicina de EEUU, estamos aprendiendo de la manera más difícil que es más probable que la salud de nuestros pacientes esté determinada por su situación económica y no por su estado de salud.

Si menos personas sin seguro es un objetivo loable, los programas como el ACA, hacen poco para abordar los problemas inherentes a un sistema con fines de lucro que depende de las compañías de seguros comerciales para el racionamiento.

Los EEUU necesitan desesperadamente un sistema de pago único y mejorado de Medicare para todos.

Eso se debe a que incluso los que tienen la suerte de tener un seguro privado enfrentan enormes obstáculos para obtener atención. Toma a una de nuestras primeras pacientes, Karen, que se cayó y se lesionó en el trabajo y necesitaba un reemplazo de cadera. Si bien la responsabilidad fue repetidamente aprobada entre el seguro de salud patrocinado por su empleador y el seguro de compensación de su trabajador, la dolorosa condición de Karen empeoró hasta que tuvo dificultad para caminar.

El pronóstico de Karen, con tratamiento, fue excelente. Aunque su equipo de atención médica hizo todo bien, las compañías de seguros se interponían entre ella y el tratamiento que necesitaba desesperadamente.

Ahora es común que los proveedores de salud traten la condición de pacientes no solo con evidencia empírica, como se nos enseña en la escuela de medicina, sino más bien con las limitaciones del seguro de ellos. En lugar de preguntarnos “¿es este el mejor tratamiento?” preguntamos, “¿está cubierto este medicamento o tratamiento?”

Este no es el tipo de medicina que queremos practicar, o debemos tolerar, en una sociedad civilizada.

Incluso a aquellos con gran cobertura se les puede negar el tratamiento necesario. Mientras tanto, los pacientes asegurados a través de sus trabajos o a través de los planes de ACA tienen dificultades para cumplir con las primas, copagos y deducibles en aumento que pueden superar los $ 10,000 por año.

Mientras tanto, los EEUU se ha desempeñado de manera deficiente en los principales indicadores de salud, como la esperanza de vida y la mortalidad infantil.

¿Cuál es la solución? La representante Pramila Jayapal y el senador Bernie Sanders presentaron proyectos de ley que cubrirían a todos para toda la atención médicamente necesaria, incluidas las visitas de los médicos, la hospitalización y la atención a largo plazo.

Nuestros pacientes nunca deben perder un tratamiento médico esencial debido al costo.

La mayoría del público ahora apoya Medicare para todos. Es hora que nuestros funcionarios electos presten atención.

https://laopinion.com…