Employer-Sponsored Health Insurance Premium Cost Growth and Its Association with Earnings Inequality Among US Families, JAMA Network Open, January 16, 2024, by Kurt Hager, Ezekiel Emanuel, and Dariush Mozaffarian

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Question: What is the association of increasing health care premium costs with earnings inequality and wage stagnation among US families with employer-sponsored health insurance?

Findings: In this economic evaluation of US families receiving employer-sponsored health insurance, the mean cumulative lost earnings from 1988 to 2019 associated with growth in health insurance premiums was $125,340 per family (in 2019 dollars) or nearly 5% of total earnings over the 32-year period. In all 32 years of the study, health care premiums as a percentage of compensation were significantly higher for non-Hispanic Black and Hispanic families than for non-Hispanic White families.

Meaning: This study suggests that increasing health insurance premium costs are likely associated with decreased earnings and increased income inequality, including by race and ethnicity, among US families receiving employer-sponsored health insurance and are meaningfully associated with wage stagnation.

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Comment:

By Don McCanne, M.D.

This study is quite disconcerting because it shows that one of the most important categories of health insurance – employer-sponsored health plans – has some very serious deficiencies that might cause individuals to question whether we should be favoring it over other better methods of financing health care.

Perhaps the most shocking finding in this study is that employers are not footing the premium bill for these policies. Employees explicitly pay a portion of premiums. And the nominally employer component is invisibly paid by employees without their knowledge via forgone wage increases. Lest anyone think this is insignificant, the authors have calculated that it amounts to about $125,000 per worker over the 32-year period studied. Imagine the good that would do if it were an additional contribution to retirement plans, especially for low-income employees.

Another deficiency of employer-sponsored plans is that, since the same premium is usually contributed to each employee’s plan, the contributions are regressive. Low-income employees are paying a much higher percentage of their incomes than are high-income employees. Yet another serious deficiency is that this perpetuates the repulsive social inequities in which Black and Hispanic employees pay a larger percentage of their incomes for health insurance by virtue of the fact that their incomes are lower and yet the same premiums are passively omitted from their incomes. It should embarrass us all that we tolerate a health care financing system that perpetuates such racial inequities.

So not only is private insurance a defective method of financing health care when we purchase it, because of its regressive nature of funding health care (the poor paying as much into the insurance pool as the rich), we now know that it is also a regressive method hidden by what appeared to be the generosity of employer sponsorship actually paid by forgone wages and salaries. We also discuss in a recent HJM post that private insurance, whether or not employer-sponsored, is no longer effective in paying medical bills because large cost-sharing is a major cause of unmanageable medical debt.

Now that we know that there are significant problems with both buying and using private health insurance, it’s quite clear that we should be looking for a health care financing system that serves everyone well.

The obvious solution is a single payer, improved version of Medicare. Rather than the flawed premiums and deductibles that we’ve shown are very unfair, the system is paid through progressive taxes. Low-income individuals pay a lower level of taxes that allows them to keep enough income to meet essential needs. High-income individuals pay more taxes, but keep enough for essentials as well as optional possessions and investments that maintain their status as individuals of wealth.

There remains a political divide over the definition of fairness of progressive taxes. In the past, we were concerned about the injustices of tolerating profound poverty, impairing access to food, housing, health care, education, and other needs, while we protected the elegant lifestyles of millionaires from the tax collectors. Now we protect the billionaires. The business elites are looking forward to the category of trillionaire.

Which public policy should we as a nation support? Using our cumulative excess wealth to address financial and social justice deficiencies such as our impaired health care system by using a progressive tax system that will still keep the wealthy exceptionally comfortable, ensconced in their luxury? Or should we ignore our social injustices while we establish policies that would enable one individual to accumulate the equivalent wealth of one thousand billionaires, thus becoming a trillionaire? It seems obvious: yes on social justice, no on trillionaires.

We would still have to deal with health system ownership issues so that the health care system is designed to benefit patients rather than to create wealth for investors, and we would also have to elect public stewards who would want to support our public financing system rather than the trillionaires, but considering the system we could have that would take care of all of us, wouldn’t that be worth the effort?

https://healthjusticemonitor.org…

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Majority of debtors to US hospitals now people with health insurance, The Guardian, January 11, 2024, by Jessica Glenza

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People with health insurance may now represent the majority of debtors American hospitals struggle to collect from, according to medical billing analysts.

This marks a sea change from just a few years ago, when people with health insurance represented only about one in 10 bills hospitals considered “bad debt”, analysts said.

In 2018, just 11.1% of hospitals’ bad debt came from insured “self-pay” accounts, or from patients whose insurance required out-of-pocket payments, according to Kodiak Solutions. By 2022, the proportion who did (or could) not pay their bills soared to 57.6% of all hospitals’ bad debt. Kodiak receives every billing transaction for a little less than one-third of all hospitals in the country.

A recent investigation by KFF Health News and NPR found more than 100 million Americans have medical debt of some kind, debt which often forces families to make heart-wrenching sacrifices. Hospitals refer patients to aggressive debt collectors, use state courts to garnish wages, place liens on people’s homes and report debt to credit agencies, which can drastically worsen future job and housing prospects.

“Obamacare” plans are notorious for high deductibles. Federal regulations allow insurers on state exchanges to charge an individual as much as $9,450 out of pocket in 2024 – not including monthly premiums.

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Comment:

By Don McCanne, M.D.

Health insurance is designed to assure that a person can access health care when they need it by removing financial barriers to care. But private insurers want to keep their premiums for their insurance products competitive in the marketplace, and, even more important to them, they want to guarantee generous profits for their investors and executives.

With premiums that must be kept competitive, how do they increase profits? Obviously, they attempt to reduce spending on patient care. There are several mechanisms they use, but one of the most important is to have the patient pay a share of the costs of the care through copayments and especially through high deductibles (many thousands of dollars). That way, theoretically according to insurers, patients will obtain only the care that they need. Actually, health care experts find that patients can’t reliably prioritize care based on medical need.

Well, it’s not working out as insurers promise. Americans need and seek a lot of care and the large deductibles are pushing ever more of them into intolerable levels of debt, defeating the very purpose of health insurance.

Since the marketplace has not worked, this is where the government needs to step in, and they did, with the Affordable Care Act, aka Obamacare. But wait a minute. The ACA provided us with insurance exchanges that are selling us, guess what, high deductible plans! The ACA encouraged higher deductibles with job-based insurance. Maybe the ACA helps with coverage rates and subsidies for premiums, but it fosters flawed high deductible plans in the hands of the private insurance industry.

Though it is imperative that we make a fundamental change, fortunately we don’t have to go back to the drawing board to create it. We’ve already designed a single payer system – an improved and expanded version of our traditional Medicare program. We need to enact and implement that.

But that will only be the first step. We will need to follow through with addressing the ownership issue of the delivery system so that our patient care dollars will be going to patient care rather than to wealth building for billionaire investors. For instance, instead of hospital funds going to private equity and other investors, they will go to fund hospital operating budgets. Single payer will obviate the need for designated patient payments.

The ultimate responsibility is going to lie with us, the people. We select our legislators and the heads of the administrations (governors and the president) to carry out our wishes. If we want a health care system that is universal, comprehensive, affordable and equitable for all, then we need to educate our legislators as to the clear benefits of such a system that would serve all of society well. We could try by beginning with the difficult task of convincing the conservatives and neoliberals of how great it would be to pass legislation that would serve the US population so well, or we could simply go ahead and elect all progressives to run the government. Of course, I’m not crazy. Either way, it won’t be easy. But we have to do it!

https://healthjusticemonitor.org…

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The Financialization of Health in the United States, NEJM, January 11, 2024, by JD Bruch, V Roy, CM Grogan

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We believe that health policy discussions concerning quality, equity, and cost must grapple with the emerging influence of the financial sector within the U.S. health care system. …

“Financialization” builds on, but also departs from [corporatization and privatization]. It involves the transformation of public, private, and corporate health care entities into salable and tradable assets from which the financial sector may accumulate capital. Financialization captures … demands of financial markets for short-term profit growth and the distribution of this growth to financial actors that are external to health care entities and U.S. households.

The rise of financialization in the health sector can be traced to economy-wide shifts that occurred in the 1970s and 1980s. … regulatory and policy changes empowered financial actors to make the U.S. health care system a core part of their growth strategies. At the same time, health care entities increasingly began to operate under “shareholder primacy,” a corporate governance strategy that prioritizes the interest of shareholders over other potential stakeholders …

Shifting Patterns of Ownership and Accumulation

One of the most prominent features of financialization in health care is the growing number of health care entities acquired directly by financial actors. For example, in the past decade, PE firms completed more than 8000 transactions involving health care entities, with an estimated combined value of nearly $1 trillion. Leveraging capital from institutional investors (e.g., state pension plans), PE firms fully acquire hospitals, nursing homes, physician practices, dialysis clinics, hospice operators, and a range of other health care operators at a rapid speed. Strapping these acquired health care companies with large amounts of debt, PE firms then engage in quick buy-and-sell turnarounds to make a profit for their partners. Real estate investment trusts (REITs) … acquire health care properties and lease the real estate back to health care facilities (i.e., sale-leasebacks).

… financialization can [also] take the form of indirect control by financial actors that obtain shares in a health care entity, often by means of early-stage investments or through the stock market. For example, venture capitalists fund health care start-ups in exchange for early equity. … Other financial actors — such as pension funds, mutual funds, and hedge funds — have also become heavily intertwined with the health care system. …

From Hospitals to Medical Credit Cards

[H]ospitals, insurance companies, and pharmaceutical firms are increasingly behaving more like financial firms. … In response to uncertainty in reimbursement and enabled by government antitrust deregulation in the 1980s, hospitals began to pursue mergers and acquisitions to increase market power while also pursuing nonoperating income by launching investment arms … can expose hospitals to fluctuations in financial markets. … [N]onprofit hospitals focus on building financial reserves with their investment arms and patient revenue streams because they are preoccupied with maintaining strong credit ratings, which increase their access to the municipal bond market. … finance and business are now the most common professional backgrounds for boardroom members at top-ranked U.S. hospitals.

Publicly traded health care entities such as health insurers and pharmaceutical companies have also become increasingly financialized, pursuing growth through price increases and mergers and acquisitions while distributing accumulated capital to financial market actors — all to maximize shareholder value. …

As health care entities race to generate growth for financial actors and shareholders, patients are facing higher costs in the form of out-of-pocket expenses and rising premiums. [P]hysician practices and hospitals are increasingly partnering with financial institutions to market medical credit cards and installment loans with steep deferred interest rates. …

The Role of the State

… [T]he substantial public financing of the U.S. health care system — which accounts for 60% of national health care expenditures — provides a steady, reliable, and attractive flow of revenue for private companies and the financial actors that invest in them. … capital is flowing to financial actors, including in Medicare Advantage organizations, nursing homes, hospice operators, and other entities …

Third, by means of myriad public policy decisions over a long period, the United States has created an extremely expensive, fragmented, and unequal health care system … contributed to a surge in medical debt and a dependence on medical credit cards.

Confronting Financialization and Its Implications

… Uwe Reinhardt described “value shifting” in health care — a phenomenon in which value is “taken away from some members of society and channeled to the owners of capital.” … Ultimately, the financial sector’s increasing grip on the health care system invites a pressing question: Is the country getting a good deal? …

inequities endemic to and produced by the financial sector — such as unequal access to financial services — may engender health inequities.

… the financial sector … has become a structural determinant of health.

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Comment:

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

This NEJM commentary provides a thoughtful tour of the increasingly pervasive role of financial institutions, practices, and norms in US health care. Distinct from, but mutually reinforcing with, privatization and corporatization. The authors correctly conclude that financialization constitutes a structural determinant of health, fostering health inequities. Their solution, however, falls short – more evidence needed.

No, we don’t need more data. We know what we need to know: (a) There is no credible evidence that financialization (or corporatization) fosters health. (b) A profit focus leads to extracting resources from health care, shifting dollars to shareholders. (c) A profit focus also diminishes attention to patient needs, and thus creates a moral hazard for health care providers. (d) We have evidence from dozens of other wealthy countries that universal coverage with standard comprehensive health insurance prevents health care inequities. Let’s not spend another 5-10 years studying financialization and other structural impediments to health care.

Lest we forget – the primary mission of our health system is … to provide quality health care.

Please, no more nibbling at the edges. Let’s sink our teeth into real health care reform. Single payer will empower patients and providers, and disempower the financial mindset in health.

https://healthjusticemonitor.org…

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Yet Another Blow for the National Health Service in England: A Doctors’ Strike, The New York Times, Jan. 3, 2024, by Mark Landler

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Thousands of young doctors walked off the job in England, dealing another blow to the country’s already-reeling National Health Service and raising concerns about a cascade of cancelled medical appointments and surgeries.

The junior doctors have been seeking a 35 percent wage increase, which they say is needed to counteract a more than 25 percent cut in real wages since 2008.

The waiting list for procedures at N.H.S. hospitals has reached 7.7 million people, up from 4.6 million people before the coronavirus pandemic. Prime Minister Rishi Sunak pledged last year to cut waiting times, making it one of five bedrock goals of his conservative government. Instead, the list has lengthened by 300,000 people.

The doctors complain about long hours, relentless pressure and pay that has failed to keep pace with double-digit inflation, though that has eased recently – issues that have afflicted other health systems, including those in the United States.

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Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

For the past few decades, we have recognized that the health system in the United States is the most expensive of all nations, while falling far short on measures of quality, comprehensiveness, equity, and universality. Many studies show that we could greatly improve coverage and access while saving money by enacting single payer financing. Health care would be affordable and available to everyone. Single payer models include Canada’s public insurance approach with mostly private providers, and Britain’s National Health Service, built largely on government ownership of care delivery.

However, the news of the UK doctor strikes reminds us that there is a major roadblock to adopting and effectively implementing single payer: the nexus of conservative politics and corporatization of medical services. Two nasty, interacting c’s.

We’ve reported on how conservative, corporate-influenced policies in the UK precipitated the current crisis. Note, this is conservative with a small c, both Tories (the worst offenders) and Labor (seriously complicit). Neo-liberalism undermines the public orientation of the NHS.

In the US, while we may dissect why we have not enacted single payer, it is largely due to conservative political opposition and to both conservative and moderate political support of market over government approaches to health insurance and care provision. Tragically, this preference for the market created the severe deterioration in health care services that we see today.

Those paying attention are painfully aware of the harm done by using health care dollars for the primary mission of personal wealth enhancement rather than improving the health of our population. This is exemplified by private equity’s leveraged purchase of delivery system sectors (e.g., physician groups) to capture wealth for the investors – patients and providers be damned.

Unfortunately, widespread corporate for-profit ownership of health care delivery will likely undermine single payer functioning. Thus, single payer alone would be inadequate. Far too large of a percentage of our health care delivery system is now owned by those motivated primarily by profits rather than by patient care.

So, instead of private, for-profit control of the delivery system, what about non-profit community ownership? Community hospitals and primary and multi-specialty clinics, dialysis clinics, and long term care. Couldn’t we do this on a community basis yet have it funded equitably via national single payer? Functioning like a national health service but with more local control.

What lesson does the current British NHS boondoggle provide for us in today’s fraught political environment? The UK experience demonstrates that public insurance and public ownership together are inadequate, if politicians don’t sustain it. Also in the US, even with a Democratic President, the private actors have too much sway. Biden, who called Obamacare a BFD, strongly supported private health plans in the exchange and in Medicare. Although there are recent baby steps to regulate Medicare drug prices, Medicare Advantage is running amok.

That’s bad enough. But imagine a government health system under the control of Trump appointees. No more constraints on exploitive corporate behaviors. No more attention to real health insurance needs. A deadly free-for-all. Oh, and also – no more democratic governance norms.

Whoa! The first task before us is to elect a government that cares about us – all of us. This may seem like a formidable task before us, but we have to do it! See 13 New Year’s resolutions in pursuit of this essential goal. From there, we must galvanize communities to fight for greater control of health services.

https://healthjusticemonitor.org…

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Q: How did the US health care system perform in 2023?

In 2023, the US healthcare system faced significant challenges and shortcomings, as highlighted by the provided information. Here’s a summary of its performance in 2023:

• Financial Barriers to Care: A survey by the Commonwealth Fund revealed that US health insurance, across all types, posed widespread financial barriers to care, leaving a large percentage of insured working-age adults struggling to afford healthcare. This underscores the financial burdens and difficulties faced by individuals and families in accessing essential medical services, indicating a systemic issue within the healthcare system.
• Privatization Challenges: The founders of Physicians for a National Health Program emphasized the growing hold of giant for-profit corporations on the healthcare system, including banks and for-profit ownership of health providers. This increasing involvement of for-profit entities has made it harder to address the systemic dysfunctions and challenges within the healthcare system, contributing to growing dissatisfaction among doctors and the public.
• Dysfunctional System: The healthcare system continued to face significant dysfunctions, leading to massive medical bills, unaffordable lifesaving treatments, and growing dissatisfaction among healthcare professionals. This dysfunction has created a strong interest and constituency for fundamental health reform, reflecting the urgent need for comprehensive healthcare financing reform to address the systemic issues and dysfunctions within the US healthcare system.

These insights collectively indicate that the US healthcare system faced significant challenges and dysfunctions in 2023, highlighting the pressing need for comprehensive and equitable healthcare financing reform.

Sources:

• healthjusticemonitor.org/2023/09/14/us-health-care-is-pretty-good-if-you-own-an-insurance-company/
• healthjusticemonitor.org/2023/10/27/survey-confirms-again-that-us-health-insurance-makes-us-sicker-poorer/
• healthjusticemonitor.org/2023/05/04/call-for-a-national-health-system/

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Q: What were the problems with job-based insurance in 2023?

In 2023, job-based insurance faced several significant problems, as highlighted by the provided information. Here’s a summary of the key issues with job-based insurance in 2023:

• Biased Reporting: The Chamber of Commerce’s online poll claimed overwhelming worker support for job-based health benefits. However, the methods and reporting were biased, leading to a skewed representation of worker sentiments. This biased reporting obscured the true challenges and concerns faced by workers regarding job-based insurance.
• Erosion of Benefits: The traditional appeal of employer-sponsored plans has diminished due to skyrocketing deductibles, which have obscured the lower wage effect. This erosion of benefits has undermined the attractiveness of job-based insurance as a reliable and comprehensive healthcare option for workers and their families.
• Lack of Solidarity: Relying on decent job-based insurance has undermined the principle of solidarity, which is a fundamental value in ensuring healthcare for everyone. The Affordable Care Act (ACA) aimed to enhance solidarity while preserving employer-sponsored plans, but the rapid growth of high deductible plans and the failure to provide decent coverage for everyone have led to an erosion of solidarity in healthcare coverage.

These problems with job-based insurance in 2023 underscore the need for comprehensive healthcare financing reform to address the evolving challenges and ensure equitable access to high-quality healthcare for all individuals and families.

Sources:

• healthjusticemonitor.org/2023/01/05/the-problems-with-job-based-insurance/
• healthjusticemonitor.org/2023/10/01/denied-medical-claims-most-likely-with-private-insurance-rarely-resolved/

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Q: What happened with Medicaid post-COVID disenrollment in 2023?

In 2023, the post-COVID disenrollment from Medicaid led to significant challenges and disruptions in healthcare coverage for many individuals. Here’s a summary of the key developments related to Medicaid disenrollment post-COVID in 2023:

• Disenrollment Estimates: In 20 reporting states, it was estimated that approximately 13% of Medicaid enrollees would be disenrolled when the continuous enrollment requirement ended. However, the estimates varied widely across states, ranging from about 8% to over 30% of total enrollees. The primary reasons for disenrollment included an increase in income and incomplete renewals or missing documentation.
• Impact on Coverage: The potential disenrollment of millions of people from Medicaid coverage following the end of the public health emergency (PHE) posed a significant risk of leaving many individuals uninsured. However, it was noted that many children would likely be eligible for CHIP, and adults would likely be eligible for Marketplace or other coverage. Successfully transitioning these individuals into alternative coverage options could help reduce the number of individuals who lose coverage altogether.

These developments underscore the complexities and potential consequences of the post-COVID disenrollment from Medicaid, emphasizing the need for ongoing efforts to ensure access to comprehensive and equitable healthcare coverage for all individuals.

Sources:

• healthjusticemonitor.org/2023/07/26/round-up-pause-for-reflection-makeover/
• healthjusticemonitor.org/2022/03/17/medicaid-coverage-turmoil-as-covid-pandemic-eases/

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Q: What did new evidence from 2023 reveal about the prevalence and severity of medical debt in the US?

New evidence from 2023 revealed alarming insights into the prevalence and severity of medical debt in the US, shedding light on the significant financial burdens faced by individuals and families. Here’s a summary of the key findings:

• The prevalence of medical debt: A multi-year survey of US adults found that medical debt affected 18% of households, indicating a substantial portion of the population grappling with healthcare-related financial challenges.
• Risk factors for medical debt: The survey highlighted that individuals with no insurance, high deductible private insurance, or Medicare Advantage faced a higher risk of accumulating medical debt. This underscores the vulnerability of certain segments of the population to healthcare-related financial burdens.
• Impact on social determinants of health: Medical debt was found to exacerbate social determinants of health, leading to increased food insecurity, the inability to pay for housing and utilities, and heightened risk of eviction or foreclosure. These consequences underscore the far-reaching impact of medical debt on overall well-being and stability.

The new evidence from 2023 underscores the urgent need for comprehensive healthcare financing reform to address the pervasive and detrimental effects of medical debt on individuals and families across the US.

Sources:

• healthjusticemonitor.org/2023/10/31/history-of-us-medical-debt-collection/
• healthjusticemonitor.org/2022/06/17/medical-debt-in-the-us-pervasive-harmful-unnecessary/
• healthjusticemonitor.org/2022/09/19/medical-debt-prevalence-risk-factors-effects-on-social-determinants-of-health/

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Q: In 2023, what percentage of US families skipped or delayed medical care for financial reasons?

• In 2023, the percentage of US families who skipped or delayed medical care due to financial reasons was alarmingly high. According to the provided information, the data from Gallup in January 2023 revealed that 38% of Americans reported postponing medical treatment in 2022 due to cost, marking a significant 12-point increase from the previous year. This trend indicates a growing financial barrier to accessing necessary healthcare services.
• Furthermore, the data highlighted that insured adults also faced challenges, with 29-42% of them or their family members delaying or skipping needed healthcare or prescription drugs due to unaffordability over the past 12 months. This percentage varied across different types of insurance coverage, with the highest rates observed among those enrolled in Medicaid (39%) and individuals with Medicare (42%).
• These findings underscore the widespread impact of financial barriers on healthcare access, affecting a significant portion of US families across different insurance categories. The high percentage of families experiencing cost-driven delays in obtaining care or missing care, coupled with the prevalence of medical debt, paints a concerning picture of the challenges individuals and families face in accessing essential medical services.

The data from 2023 emphasizes the urgent need for comprehensive healthcare financing reform to address the pervasive financial barriers that hinder access to healthcare for a substantial portion of the US population.

Sources:

• healthjusticemonitor.org/2023/01/21/galluping-in-the-wrong-direction-higher-cost-barriers-lower-quality/
• healthjusticemonitor.org/2023/10/27/survey-confirms-again-that-us-health-insurance-makes-us-sicker-poorer/
• healthjusticemonitor.org/2022/09/29/the-dismal-state-of-us-health-insurance/

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Q: How are other wealthy countries doing with health insurance in 2023?

In 2023, other wealthy countries have continued to demonstrate more efficient and equitable approaches to health insurance compared to the United States. Here’s a summary of the key insights from the provided information:

• Automatic Enrollment and Comprehensive Coverage: Dr. Danielle Ofri’s experience highlighted the inefficiencies of the US health insurance system, where an email glitch led to her automatic enrollment in a basic plan, excluding her family. This contrasts with the streamlined and comprehensive coverage provided in other wealthy nations, where individuals and families are not subjected to the bureaucratic hurdles and uncertainties associated with annual re-enrollment.
• Lessons from Other Countries: An op-ed in the New York Times emphasized the importance of learning from other wealthy nations, underscoring that single payer is the only plausible path to achieving efficient and equitable healthcare financing in the US. This suggests that other countries have established successful models that prioritize accessibility and fairness in healthcare coverage.
• Comparative Health Outcomes and Expenditure: The data from John Abramson’s publication highlighted the stark disparities in health outcomes and healthcare expenditure between the US and other comparable countries. Despite the US spending significantly more on healthcare per person, the health outcomes remain inferior, indicating the need for a reevaluation of the US healthcare system in comparison to those of other wealthy nations.

These insights collectively indicate that other wealthy countries have continued to prioritize efficient, comprehensive, and equitable health insurance systems, providing valuable lessons for addressing the shortcomings of the US healthcare system.

Sources:

• healthjusticemonitor.org/2023/10/25/how-to-get-health-insurance-in-other-countries-be-born/
• healthjusticemonitor.org/2023/06/15/learning-from-other-countries/
• healthjusticemonitor.org/2023/05/30/de-sickening-america/

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Q: What were the major developments with single payer reform in 2023?

In 2023, there were significant developments and discussions surrounding single payer reform, reflecting the ongoing push for comprehensive healthcare financing reform. Here’s a summary of the major developments:

• The issue of corporate takeover of primary care emerged as a significant challenge for single payer reform. The large-scale corporate appropriation of primary care was highlighted as enabling profiteering that dominates the US healthcare system, potentially jeopardizing the doctor-patient relationship and the viability of single payer financing. This underscores the need to address corporate dominance in healthcare to ensure the success of single payer reform.
• Discussions emphasized the typical features of single payer systems, highlighting key elements necessary to achieve universal, equitable, efficient, and affordable access to care. These features include universal coverage, identical comprehensive benefits for everyone, standardized payment rates, minimal cost-sharing, centralized capital spending decisions, negotiated drug and medical equipment prices, and inclusion of long-term care as an essential need. These features underscore the fundamental principles and goals of single payer reform.
• Legislative efforts led by Bernie Sanders in the Senate and Pramila Jayapal in the House were highlighted as providing the basis for comprehensive single payer reform. The focus was on the need for a system that brings health care justice to all individuals, emphasizing the importance of understanding the principles that underpin an ethically superior healthcare system and selecting politicians with the moral fortitude to enact such a system.

These developments in 2023 underscore the ongoing efforts to address the challenges and principles of single payer reform, reflecting the continued push for a more just and equitable healthcare system.

Sources:

• healthjusticemonitor.org/2023/05/09/primary-care-corporate-takeover-a-challenge-for-single-payer/
• healthjusticemonitor.org/2022/06/04/what-is-single-payer/
• healthjusticemonitor.org/2023/11/27/saving-lives-in-the-middle-east-via-political-solution-the-us-via-health-reform/

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Q: What were key health reform developments in California in 2023?

In 2023, California saw several key health reform developments, reflecting the ongoing efforts to address healthcare access, equity, and financing. Here’s a summary of the significant developments:

• The 2023 CHCF California Health Policy Survey revealed concerning findings related to healthcare costs and medical debt. Half of Californians reported skipping or delaying healthcare due to cost, with half of them experiencing worsened conditions as a result. Additionally, more than one-third of respondents reported having medical debt, with disparities in debt rates among different income and racial groups. These findings underscore the urgent need for comprehensive healthcare reform to address access limitations and financial burdens.
• A proposed law in the California Senate aimed to advance the state’s single payer process by instructing state officials to engage with the federal government on approvals and coordination for a state single payer bill. This legislative effort highlighted the ongoing push for a government-run health system in California, reflecting the state’s commitment to exploring avenues for comprehensive healthcare financing reform.
• California enacted SB 770, establishing a formal process to explore federal waivers necessary for state-level “unified financing,” such as a single-payer health care system, building on the findings of the Healthy California for All Commission. This legislation marked a potent mechanism to advance single payer, emphasizing the state’s commitment to pursuing unified financing and high-quality healthcare for all Californians.

These developments in 2023 underscore the ongoing efforts to address healthcare access, equity, and financing in California, reflecting the state’s commitment to comprehensive healthcare reform.

Sources:

• healthjusticemonitor.org/2023/02/23/california-survey-on-health-care-access-debt-equity/
• healthjusticemonitor.org/2023/03/27/legislation-to-advance-california-single-payer-process/
• healthjusticemonitor.org/2023/11/11/california-seeks-federal-waivers-for-unified-health-care-financing/

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Q: Will single payer save money for families?

Yes, single payer healthcare has the potential to save money for families, as evidenced by comprehensive research and analysis. Here’s a summary of the key findings:

• Research conducted by academic teams at Yale University and the University of California, San Francisco (UCSF) concluded that single payer healthcare, such as Medicare for All, will save money overall. These findings are based on rigorous, peer-reviewed scientific papers, which have undergone close examination by experts in the field for validity and reliability.
• The evidence indicates that single payer healthcare will generate substantial savings by eliminating unnecessary paperwork and insurance company profits, reducing drug costs, and other cost-saving factors. These savings are projected to more than offset the cost of improving coverage and expanding it to everyone.
• A specific example from California’s context revealed that nearly 9 out of 10 individuals who used a cost calculator for single payer found that they would save money. The average savings were reported to be more than $5000 per year, demonstrating the potential financial benefits for households.

These findings provide strong support for the assertion that single payer healthcare has the capacity to save money for families, offering a more cost-effective and equitable approach to healthcare financing.

Sources:

• healthjusticemonitor.org/2023/01/29/single-payer-savings-for-households-calculator-results/
• healthjusticemonitor.org/2022/01/10/california-single-payer-lower-net-cost-to-families/
• healthjusticemonitor.org/2023/05/18/medicare-for-all-legislation-in-the-senate-house/

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Q: What are some amusing & informative videos about health care from 2023

In 2023, there were several amusing and informative videos about healthcare that effectively conveyed the complexities of the US healthcare system and the need for reform. Here are some noteworthy videos from 2023:

• Dr. Glaucomflecken’s 30 Days of US Healthcare Series: This series of 2-minute videos covered a wide range of crucial topics, including job benefits, deductibles, co-insurance, surprise billing, pharmacy benefit managers, insurance kickbacks, hospital price transparency, and more. Dr. Glaucomflecken’s amusing skits, in which he plays all roles, provided a master class on concisely conveying the issues with US health insurance in a biting and entertaining manner.
• John Stewart’s Insightful Video: John Stewart’s video effectively highlighted how the government-funded healthcare system benefits private for-profit corporations, particularly insurers, at the expense of the public. This video provided valuable insights into the dynamics of the US healthcare system and its impact on individuals and private corporations.

These videos offered engaging and informative content, distilling complex healthcare policy discussions into entertaining and insightful snippets. They effectively conveyed the fundamental issues plaguing the US health insurance system in an accessible and engaging manner.

Sources:

• healthjusticemonitor.org/2023/09/25/health-reform-essentials-in-entertaining-2-minute-videos/
• healthjusticemonitor.org/2023/09/20/understanding-fighting-investor-ownership-of-health-care/
• healthjusticemonitor.org/2023/01/16/martin-luther-king-and-health-justice/

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Q: Are there arguments for single payer that might resonate with my politically conservative uncle?

It’s great to see the engagement and discussions around healthcare reform and the potential for single payer. Here are some compelling arguments for single payer that might resonate with politically conservative individuals, such as your uncle:

• Efficiency and Cost Savings: Single payer healthcare systems have been shown to be more efficient in terms of administrative costs. For example, a study by the Political Economy Research Institute at the University of Massachusetts Amherst found that a single payer system could result in approximately $600 billion in annual savings on administrative costs. This aligns with conservative principles of fiscal responsibility and reducing government waste.
• Market Competition and Freedom of Choice: Contrary to common misconceptions, a single payer system can actually enhance market competition by leveling the playing field for healthcare providers. It allows individuals the freedom to choose their healthcare providers without being restricted by narrow networks or in-network requirements, fostering a more competitive and consumer-driven healthcare market.
• Simplicity and Streamlined Access: A single payer system simplifies the complex web of insurance plans and billing processes, providing streamlined access to healthcare services. This aligns with conservative values of reducing bureaucracy and promoting individual autonomy.
• Protection from Financial Burdens: Single payer systems provide comprehensive coverage and protection from financial burdens, ensuring that individuals and families are not overwhelmed by medical expenses. This resonates with the conservative principle of personal responsibility and financial stability.

These arguments emphasize the potential benefits of single payer healthcare in terms of efficiency, market competition, simplicity, and financial protection, aligning with principles that may resonate with politically conservative individuals.

Sources:

• healthjusticemonitor.org/2023/11/15/excessive-corporate-control-in-medicine/
• healthjusticemonitor.org/2023/11/11/california-seeks-federal-waivers-for-unified-health-care-financing/
• healthjusticemonitor.org/2021/09/16/crowdsource-ideas-on-government-role-in-single-payer/

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Original Post: https://healthjusticemonitor.org…

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Serious Medical Errors Rose After Private Equity Firms Bought Hospitals, The New York Times, December 26, 2023, by Reed Abelson and Margot Sanger-Katz

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The rate of serious medical complications increased in hospitals after they were purchased by private equity investment firms.

The study, published in JAMA, found that, in the three years after a private equity firm bought a hospital, adverse events including surgical infections and bed sores rose by 25 percent among Medicare patients when compared with similar hospitals that were not bought by such investors. The researchers reported a nearly 38 percent increase in central line infections, a dangerous kind of infection that medical authorities say should never happen, and a 27 percent increase in falls by patients while staying in the hospital.

“This is a big deal because it’s the first piece of data that I think pretty strongly suggests that there is a quality problem when private equity takes over,” said Dr. Ashish Jha, the dean of Brown University School of Public Health, who has studied hospital safety extensively.

Over the last two decades, private equity firms have become major players in health care, purchasing not just hospitals but also a growing number of nursing homes, physician practices and home health care companies. The firms pool money from institutional investors and individuals to form investment funds, often buying hospitals and other entities through high levels of debt, with an eye to reselling them in a few years.

Several media reports have shown that some of the acquired hospitals have been forced to close because of financial distress, and some have come under regulatory scrutiny for quality problems.

The researchers examined a range of errors that Medicare tracks. All of the eight individual measures studied in the paper worsened in the hospitals purchased by private equity funds.

“They are preventable adverse events that everyone thinks shouldn’t happen in hospitals,” said Dr. David Blumenthal, the former president of the Commonwealth Fund.

The researchers said the most likely explanation for the increased errors was fewer hospital employees.

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Changes in Hospital Adverse Events and Patient Outcomes Associated with Private Equity Acquisition, December 26, 2023, JAMA, by Sneha Kannan, Joseph Dov Bruch and Zirui Song

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Key Points:

Question: How do quality of care and patient outcomes change after private equity acquisition of hospitals?

Findings: In a difference-in-differences examination of 662 095 hospitalizations at 51 private equity–acquired hospitals and 4 160 720 hospitalizations at 259 matched control hospitals [from 2009-2019] using 100% Medicare Part A claims data, private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions, which was driven by falls and central line–associated bloodstream infections.

Meaning: Private equity acquisition of hospitals, on average, was associated with increased hospital-acquired adverse events despite a likely lower-risk pool of admitted Medicare beneficiaries, suggesting poorer quality of inpatient care.

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Comment:

By Don McCanne, M.D.

Haven’t we heard enough? Study after study has shown that when private equity, with its primary mission of creating wealth for its investors, takes control of sectors of health care, our costs of health care increase and our access and quality of health care outcomes deteriorate. Meanwhile, other studies demonstrate that a well-designed single payer system would not only control costs and improve outcomes, but would make health care equitably accessible for everyone.

Why do we give our health care dollars to billionaires for their own personal enrichment while we tolerate mediocrity and worse in our health care system – when we could take those same health care dollars and spend them much more efficiently in creating a health care nirvana for all of us? It is true that it will require a legislative solution, but the legislators must understand that that is the demand of their constituents. Isn’t it?

Editor: Happy New Year. Next post will be the 2023 summary.

https://healthjusticemonitor.org…

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Unintentional Firearm Injury Deaths Among Children and Adolescents Aged 0-17 Years – National Violent Death Reporting System, United States, 2003-2021, CDC, December 15, 2023

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Summary:

What is already known about this topic?

Unintentional injury is a leading cause of death among U.S. children and adolescents aged 0-17 years, and firearms are a leading injury method.

What is added by this report?

Approximately one half of unintentional firearm injury deaths among children and adolescents occurred at their home; playing with or showing the firearm to another person was the most common precipitation. Overall, firearms used in unintentional injury deaths were often stored both loaded and unlocked and were commonly accessed from nightstands and other sleeping areas.

What are the implications for public health practice?

Unintentional firearm injury deaths are preventable. (Bold by HJM) Securing firearms (e.g., locked, unloaded, and separate from ammunition) is protective against unintentional firearm injury deaths among children and adolescents, underscoring the importance of promoting secure firearm storage.

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MOTHERS FOR DEMOCRACY, Thoughts & Prayers are NOT Enough, A one-minute video, December 14, 2023

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Also viewable on the Mothers for Democracy website (may need to scroll down)

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Comment:

By Don McCanne, M.D.

This video has gone viral, and it is easy to understand why: thoughts and prayers are meaningless when we can do something about the number one killer of children in the United States!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.