PNHP

Recent Articles of Interest

Medicare for All Explained Podcast: Episode 58

Posted

June 15, 2021

Just Care USA founder and president Diane Archer outlines needed improvements to the Medicare program along the lines of what a single-payer system would provide: new benefits like vision, hearing, and dental, and a cap on out-of-pocket costs. “If you’re income is lower, you’re often faced to forego critical care,” she says. “The out-of-pocket costs are just prohibitive for so many people.”

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

https://medicareforallexplained.podbean.com

Concerns Mount Over Looming Surge in Bankruptcy as COVID Medical Debt Soars

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By Steve Friess
Newsweek, June 14, 2021

Case numbers and daily death tolls continue to drop, the majority of U.S. adults are fully or partly vaccinated, mask mandates are vanishing and summer socializing looks like it’s back on the calendar. But even as America keeps marching steadily toward a post-pandemic future, another COVID-19 crisis looms—a debt and bankruptcy disaster fueled by mounting medical bills associated with treatment, especially among the most financially vulnerable parts of the population.

As many as 12.5 million Americans could already be saddled with COVID-related medical debt, based on a LendingTree survey conducted in March. The nationally representative poll found that 60 percent of the respondents polled had medical debt, with about 10 percent stemming from the virus; the amount typically owed ranged from $5,000 to $9,999. That suggests the collective debt for COVID treatment so far could be between $60 billion and $125 billion.

That number will inevitably grow sharply in coming months, experts say, as a trio of factors kick in: Expenses will mount for COVID “long-haulers” with ongoing health problems; more medical bills related to the virus will pass from the seriously past due stage into collections; and a panoply of government measures that were designed to help people stay afloat during the pandemic will end, from eviction and student-loan-payment moratoria to enhanced unemployment benefits, making it harder for more people to pay off the accumulating bills for treatment. That in turn is expected to lead to a spike in personal bankruptcies by the end of 2021 and into 2022.

“A lot of people are getting bills they can’t pay,” says David Himmelstein, a professor at City University of New York School of Public Health at Hunter College and author of several seminal studies on medical bankruptcy. “We’re heading towards a mounting debt crisis for many people who have been sick during this COVID period that will ripple through the economy unless something is done about it.”

Troublesome signs are already cropping up. From May 2020 to March 2021, medical debt among members of Credit Karma, a credit-monitoring site, grew 6.5 percent, by $2.8 billion, while the number of people facing past-due medical bills jumped 9 percent. In most cases, medical debt doesn’t even make it to a credit reporting agency such as those tracked by Credit Karma until after a 180-day past-due waiting period, so that uptick is only expected to spiral higher as 2021 progresses.

Especially foreboding is the latest data on bankruptcy filings. In March 2021, the number of Americans filing for personal bankruptcy protection shot up 30 percent from February, to 44,103, the biggest number since March 2020 when the pandemic first took hold in the U.S. Rising medical bills and the ending of government pandemic-aid programs are key factors driving the increase, says Jonathan Carson, co-CEO of Stretto, a software company whose technology manages the online filings in most personal and corporate bankruptcy. He says, “It’s gonna be a turbulent ride for the consumer.”

That’s just the start of what’s to come, experts say, given that even before the pandemic medical debt was the leading factor in personal bankruptcy filings, associated with two-thirds of them, according to an American Journal of Public Health analysis. “It’s been just a little over a year since COVID started, and it takes sometimes, a year or two for the medical debt issue to start rearing its head,” says Allison Sesso, executive director of RIP Medical Debt, a non-profit that has bought and retired nearly $4 billion of outstanding debt since 2014. “We’re just on the cusp. It’s going to get ugly.”

Plus, it’s not just COVID-19 sufferers who are in a financial bind now. After medical debt, the other leading cause of personal bankruptcy is unexpected job loss, that other hallmark of a pandemic that resulted at its height in a national 14.7 percent unemployment rate. Add in the looming end on June 30 to the Centers for Disease Control’s national moratorium on evictions—more than 8.3 million renters, or 15 percent of the national total, are behind, according to the Census Bureau—and the expected resumption in October of collection of federal student debt payments.

“The magnitude of the coming medical debt crisis is not yet clear,” says Brian Martucci, finance editor at MoneyCrashers.com, a personal finance website. “But given that tens of millions of Americans lack health insurance and hundreds of thousands have been hospitalized with COVID since the pandemic began, it’s certain that many individuals and families will face or are already facing life-changing financial trauma.”

‘I Don’t Know What I’ll Do’

Count retired bookkeeper Sherry Hoak, 65, among those already hit hard by the physical, emotional and financial fallout of COVID. Once or twice a week, she sits at her kitchen table in Fort Worth, Texas with her daughter Cindy Cox, who helps her mom make a few calls to the debt collectors. It’s about all that Hoak, a COVID survivor now grappling with heart and lung ailments that she didn’t suffer from prior to the virus, has strength for since returning home from a two-week hospital stay in January. Her husband Ken Hoak was less fortunate; he was infected around the same time as his wife and died on January 28 in the same hospital, Harris Methodist, after a month on a ventilator.

“My mother doesn’t have enough money to pay everybody what they want right now,” says Cox, 40, who took four months off from working as a teacher to care for Hoak full time after her release from the hospital. Hoak’s total debt: more than $6,500 and climbing. “Everybody says, ‘Oh, we’ll get her on a payment plan,’ but she doesn’t have enough money to do $30 here and $40 here and $30 here,” says Cox. “That adds up quickly.”

Cox has gone through every household bill with her mother looking for places to reduce costs and Hoak plans to raise additional money to pay off her medical debt by selling her motorhome and one of the two cars she owned with her husband. The couple had planned a retirement that relied on both of their Social Security checks as well as their pensions; now Hoak will get only her own Social Security check and pension.

Meanwhile, she’s been seeing two or three doctors a week for various COVID long-haul symptoms including fatigue and breathing problems and the family had to buy a $2,500 motorized scooter because she can’t walk. The hospital debt alone is more than $3,500 and a flood of other bills arrive routinely “and they just keep getting darker and darker in the shades of red they’re printing these bills in,” Cox says. “When she was in the hospital, they used all these out-of-network labs and providers that she didn’t have a choice about. They come in, they take your blood. So we’re getting six or seven bills from different places.”

As so many others have done, Cox started a GoFundMe crowdsourcing campaign in April hoping to raise the $3,500 she needs to settle the hospital bill; so far they’ve received just $475 from six donations. “She’s ongoing sick, and she can’t just go get a part-time job and pay these things off,” Cox says. “They’re going to $5 and $10 her into bankruptcy.”

Similar tales of economic desperation appear all over both GoFundMe as well as the Facebook group called Survivor Corps, a 166,000-member community of COVID long-haulers. Beth Eppler, who posts in the group, is a former CrossFit athlete who was living near Ocala, Florida, when she simultaneously got the flu and COVID-19. She wasn’t hospitalized, but she did lose her job as an accountant in November because she was too weak to return to work; unable to pay her rent and with her landlord threatening eviction, she moved back to hometown of York, Pennsylvania, and got a different job. In February, she had two surgeries for COVID-related kidney ailments—a $13,000 bill for the second operation just arrived—and lost the new job, too, because she was still too fatigued to work. Eppler says she now tosses the bills in the trash and has blocked the numbers that were delivering threatening text messages warning her of what she owes.

“I was healthy, now I can’t do anything,” she says tearfully. “I’m sick. It’s depressing. I still can’t taste, I still can’t smell. I still sleep 12 hours a day. I had a life. I had a vibrant life. Now I have no savings, I have no 401(k)—the only money I have in the bank right now is $3,082, and that’s got to pay the rent until I can find a job. I have nothing to sell. I have no jewelry; no parents, no siblings to help. I don’t know what I’ll do.”

Holes in the Safety Net

It wasn’t supposed to be like this. A variety of government and private programs were put in place early in the pandemic to shield COVID patients from high out-of-pocket medical expenses. But many of those safeguards have either expired, were often not properly implemented or didn’t cover key ways people could be on the hook for treatment costs.

Several major insurance carriers, for instance, announced policies early in the pandemic to fully cover COVID-related treatments, by waiving deductibles, co-pays and other cost-sharing requirements for insured members. Most of the companies, though, rescinded those policies months ago, even though the pandemic was ongoing. Among them: UnitedHealthcare’s cost-sharing moratorium ended in October, Humana’s in December, Aetna’s in January and Blue Shield of California’s in February.

The $2.2 trillion Coronavirus Aid, Relief and Economic Security Act (CARES) passed in March of 2020 also contained key provisions, designed to protect uninsured Americans and those who received care from providers outside of their insurance network, a common occurrence during hospital stays where patients have no control over who attends to them. The legislation allowed providers to bill the government directly for treating the uninsured and made it a condition of receiving aid from the $175 billion Public Health and Social Services Emergency Fund established to help financially struggling hospitals, medical practices and other healthcare providers that patients would not be billed more for COVID treatment than what insurers paid out at in-network rates.

But plenty of patients slipped through the billing cracks. In cases where insurers didn’t waive co-pays or health care providers did not take federal assistance, some patients are being besieged by bills, especially if their coverage comes from one of the industry’s increasingly common high-deductible plans. Older patients on traditional Medicare who don’t have supplemental coverage to help with cost sharing are also especially vulnerable to high out-of-pocket treatment costs.

Meanwhile, experts say that hospitals and health care providers frequently failed to use correct billing codes for COVID expenses or incorrectly delineated treatments for post-COVID maladies as unrelated to the disease itself. “It wasn’t like you actually had to match the aid you received to patients receiving care,” says Elisabeth Benjamin, vice president of health initiatives at the New York-based anti-poverty advocacy non-profit Community Service Society.

Agreed Brianna Wells of the Greenlining Institute, a non-profit advocates for economic equity for people of color, who authored a March 2021 report on the medical debt crisis that focuses on its disproportionate impact on minorities in California: “There seems to be a disconnect between the protections in the CARES Act to prevent people from acquiring medical debt due to COVID-19 and hospital practices. That means that even though people were supposed to be protected from treatment costs, they’re still facing high out of pocket costs for these services.”

A lot of this—billing errors, surprise bills, misused federal money, a lack of communication with patients about the assistance that’s available to them—reflect pre-existing conditions that plagued the U.S. healthcare system long before COVID. Benjamin noted, for instance, that some hospitals that received billions in federal aid nonetheless continued to aggressively pursue patients to pay outstanding medical debt even as the pandemic crashed the economy itself. “The billing infrastructure hums along like it’s a wartime economy,” she says. “We’re fighting a COVID war, but the people that are stuck holding the bag are the patients.”

Himmelstein, the professor and medical bankruptcy researcher from Hunter College, sees accumulating COVID medical debt as a symptom of a bigger problem regarding the use of public money for health care. “The government is spending $2 trillion every year on our system and is not exercising accountability for how that money is used and what it’s going for.” he says. “Increasingly, it’s going for investors and huge profits out of the system rather than actually ensuring people get the care they need and that they’re not in financial trouble. There’s no plan for dealing with long-term illness other than if you’re sick enough, long enough, and you’re finally bankrupted and you happen to live in the right state, then you’ll qualify for Medicaid. If not, then they’re just totally out of luck. But being bankrupt and qualifying for Medicaid is hardly a good outcome either.”

Persistence Pays Off

The kind of persistence and awareness it takes to make sure providers are behaving properly can be exhausting, as DaJuan Hunter discovered. The 40-year-old JetBlue flight attendant was hospitalized for a week in July with COVID-19 in Munster, Indiana, and returned home to receive a $25,000 bill for his stay followed by a flood of other bills from “anybody else who touched me.”

Point / Counterpoint: The State-Based Universal Health Care Act of 2021

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Point: Medicare for None: A Response to the State-Based Universal Health Care Act of 2021

Proponents of a state-based universal healthcare approach believe states can be incubators for change, and that ultimately, once one state shows the way, all states will follow—but we have yet to see any evidence of this.

By Ana Malinow, M.D. and Kay Tillow
Common Dreams, May 29, 2021

The Covid-19 pandemic has laid bare the inequities, inefficiencies, and ineffectiveness of our healthcare system. If there was ever a time for healthcare reform, this is it. But some healthcare activists and their progressive allies, suffering from the frustration and disillusion brought on by the refusal of President Joe Biden and Congress to consider structural reform, have accepted this defeat and turned to state-based reform, jeopardizing Medicare across the country. Healthcare is a national responsibility. To palm it off to states is a step backwards: the dream of Newt Gingrich and Ronald Reagan to shrink the federal government.

Based on the historical precedents set by the Affordable Care Act (ACA), the story of Medicaid expansion serves as a cautionary tale to those who’d like to leave healthcare to the states.

On June 28, 2012, the U.S. Supreme Court issued a ruling on the constitutionality of the Affordable Care Act, Congress’s attempt to provide near-universal health coverage by mandating individuals and employers to purchase health insurance, expanding Medicaid by lowering eligibility criteria, and widening health insurance protections. The court upheld the constitutionality of the individual mandate but gave states the “option” not to expand Medicaid, calling expansion “unconstitutionally coercive.” With this ruling, the Supreme Court opened the door to the balkanization of the ACA: those that expanded Medicaid, those that considered it, and those that would oppose it permanently. It gave the southern states a political out and allowed the further racialization of Medicaid.

Of the original 26 states that brought the case before the Supreme Court, 12, mostly southern states with large populations of color, have not expanded Medicaid, two have passed but not yet implemented expansion, and three only did so last year. A decade after the passage of the bill, these are the states that suffer the worst health outcomes: when compared to expansion states, non-expansion states have seen worse overall mortality rates, more hospital closures, and even higher high school dropout rates. In 2018, states that did not expand Medicaid passed up $43 billion in federal funds.

With the reintroduction of Congressman Ro Khanna’s State-based Universal Health Care Act of 2021, we are about to see a similar balkanization of Medicare, the one national program that guarantees healthcare to everyone over the age of 65. The act, which would offer pass-through federal fund waivers, including Medicare, Medicaid, TriCare, Exchange, and federal employee health benefit dollars, to states with a plan to provide comprehensive health benefits to 95% of its residents (defined as citizens or lawfully residing immigrants) within five years, would end Medicare as we know it.

Obtaining a waiver under this act does not set single payer as the model to achieve universal healthcare. In fact, states might choose to go the way of the ACA, a mishmash of employer and individual mandates, greater expansion of Medicaid, and more generous subsidies for the Exchanges. The act would base benefits on the ACA, thus, significant gaps, such as no prescription drug coverage, limited reproductive rights, and no long-term care, would persist. There is nothing in the act that precludes giving Medicare money to private insurance companies, strengthening profit-driven companies to pursue obscene profits and deny care elsewhere. The U.S. would become a nation of 50 different healthcare tiers, at war with each other over federal dollars. States could band into a region to request a waiver application, pitting regions against one another. States unwilling to cover their residents could sit it out, much like the states sitting out Medicaid expansion, creating yet another form of racism and uneven health outcomes. If challenged in court, this new expansion could be ruled “coercive” again, giving some states a political out. But this time, seniors in non-universal states would see their Medicare dollars shunted over to states that provide their residents some form of healthcare. This is the dismantling of Medicare.

Proponents of a state-based universal healthcare approach believe states can be incubators for change, and that ultimately, once one state shows the way, all states will follow. We have yet to see any evidence of this in the U.S., and to bet Medicare on this flawed proposal seems unwise. The Supreme Court ruling set a precedent that states can use federal healthcare dollars as they see fit. Instead of seeing this as the problem, the sponsors of this bill see it as an opportunity to compromise: allow southern states to gut Medicare while allowing more progressive states to “have” universal healthcare.

The U.S. doesn’t need to dismantle Medicare, it needs to improve it and expand it to every person. The country must replace its broken, fragmented, profit-driven and racist system with a universal, affordable, accountable, comprehensive, evidence-based, equitable, single-payer national Medicare for all, not Medicare for none. Every resident of every state deserves this. This is something on which we can all agree.

Dr. Ana Malinow has  spent her career taking care of undocumented, refugee, and poor children in Cleveland, Houston and Pittsburgh before moving to San Francisco, where she is currently practicing as a general pediatrician. She is past President of Physicians for a National Health Program (PNHP), an organization of 20,000 health care providers that support single payer national health care.

Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Kentucky.

https://www.commondreams.org…

Counterpoint: Let’s Go All Out for Universal Health Care in the U.S.

We should continue to vigorously advocate for a universal publicly funded privately delivered health care system at every level throughout America—state as well as national.

By Philip Caper, M.D.
Common Dreams, June 3, 2021

An article last week by Ana Manilow and Kay Tillow published by Common Dreams sounds a cautionary note about attempts to create state-based universal health care systems, because they will certainly increase the amount of fragmentation in the Medicare program. They are almost certainly right, and more fragmentation is the last thing we need in our already too fragmented “system.” I know both Malinow and Tillow, and have the utmost respect for their experience and judgment.

There is no doubt that a uniform national program of Improved Medicare for All would be the best way to go, on the grounds of simplicity, efficiency, effectiveness and political sustainability. But so far I see no evidence that the Congress, as it is now constituted, has any appetite to enact anything close to Improved Medicare for All on a national scale anytime soon.

There are ongoing efforts in over twenty states to enact universal health care. Only one state, Vermont, has made a serious attempt to implement a universal health care system.

That attempt failed. Its failure was not due to economic, technical or statutory barriers, but almost entirely due to politics. Peter Shumlin, the Governor of Vermont at the time of the attempts to enact a universal health care system there, failed to adequately inoculate Vermont voters against the shock of transferring millions of dollars of private sector spending into taxes, as would have been required by full implementation of Green Mountain Care.

Shumlin, who barely won re-election for a second term, consequently throwing his re-election into the legislature, lost his nerve in the face of the prospects of the need to ask the legislature, that was poised to vote on his own election—for a substantial tax increase to fund Green Mountain Care despite the likely savings in overall health care spending that would have resulted if the program had been implemented.

The aversion to taxes and the resultant large government that is baked into American culture, (dating back to colonial times; Thomas Paine labeled government “a necessary evil”) is a major impediment to enactment of a universal health care program in the United States. It is one that proponents of universal health care, whether in the form of a state-wide or a national program, to overcome.

We have to persuade not only the public, but also legislators, that enacting a huge tax increase to fund health care is a good idea. I believe that as our health care system becomes increasingly dysfunctional—and increasingly expensive, voters will become increasingly willing to accept that reality. We UHC advocates must become much more effective at making the case that taxes, not private premiums and out-of-pocket payments, are the only just, merciful, and fair way to fund health care. They are likely the only way to achieve universal coverage. The U.S. is the last of the wealthy democracies to accept this reality.

We must also be more effective about explaining the virtues of everybody being in the same program (one size does fit all), and of a simpler, more transparent health care system with public accountability and the ability to control overall system-wide costs in a less intrusive way than the current system. As the current pandemic has demonstrated, we must also have a system that encourages policy-based investments in public health, whether in a national or state-based system—that only public funding can achieve. If there is any silver-lining in the Covid-19 pandemic, it is that has exposed the need for more investment in public health, which is undeniably a public good.

We must continue our intense focus on defending against the lies we know are coming from the opponents of major systemic changes even as we continue our campaign to win over the public for the idea of a publicly funded, universal health care system.

But at the same time, we must go on offense by focusing more on the benefits of such a systemic change for the vast majority of Americans. We all agree that a universal, federally funded and managed health care system is the best way to making health care as a right a reality in the U.S.

This is a classic example of the perfect being the enemy of the good. The paramount question is not whether we can achieve that perfect result, but how to get there from here, given the clash of interests in our current dysfunctional health care system.

Unfortunately, the current power of the medical-industrial complex in Congress is such that federal legislators must pay “tribute” to the the large health care corporations (just like the Mafia) that increasingly control the American health care system. The ACA is the prime example of one of the outcomes of this reality.

As an advocate for the past ten years of a state-wide program of publicly funded privately delivered universal health care in Maine, I can attest to the power of that idea to the public, if they believe it is achievable.

In reaction to the suggestion of a national solution to the problems of our health care system, people often roll their eyes. They don’t believe it’s achievable, because they don’t believe they have the power to overcome the political barriers that prevent that outcome. But when they hear about the possibility of a state-level solution, they pay attention and become activists in trying to make it happen—because they believe they may make a difference at a state level.

Just last month, over 70 Maine voters turned out to testify at a legislative hearing in support of universal health care bills that have been submitted to the legislature this session. The committee of jurisdiction of one of the bills (Maine LD 1045), not quite ready to vote to pass the bill due to concern that the state would lose some of its federal health care funds, carried the bill forward (didn’t kill it), and agreed to support it in the future on the condition that Ro Khanna’s State Based Universal Health Care bill (H.R. 5010), or something like it, was passed by Congress. They plan to introduce a joint-resolution to the full legislature later this year, asking Maine’s Congressional Delegation to support Representative Khanna’s bill.

That likely would not have happened if Maine AllCare, the state-level universal health care advocacy group I helped establish in 2010, had not been conducting educational programs for the public explaining the benefits of universal health care and organizing for support of a state-based plan. In addition, we developed the language of, and are advocating for the passage of, a Resolve that we hope to put on the 2022 ballot expressing public support for a publicly funded, privately delivered universal health care plan in Maine.

We believe such a program would not only be a step towards towards Medicare for All, but may be the only way to achieve such a program in the foreseeable future.

I share the concerns of Manilow and Tillow. I wish it was not so difficult to do the right thing in the U.S. I wish our country did not suffer from the systemic racism that has contributed so much to the difficulties they point out in their essay, and wish the American public had not been so susceptible to the anti-government propaganda from the right wing we have endured for the past 45 years. I wish we had not experienced the massive takeover of our health care system by profit-driven multi-national corporations. I wish the political class and some members of the Supreme Court didn’t think corporations are equivalent to people and money is equivalent to speech. But that is the reality we are living in, and we have to find a way around it.

The idea of state-level universal health care, despite its shortcomings, is a powerful and compelling tool for education and for organizing the power of the people that will be absolutely necessary to overcome the power of the medical-industrial complex.

People, at least here in Maine, respond differently to initiatives that are seen as local as opposed to national and near as opposed to distant, because they feel there’s a better chance they, as individual voters, can have a positive impact on the outcome.

Mobilizing the power of the people is the best shot we have to halt the destruction of our patient-focused health care system, and to preserve medicine as a self-regulating profession governed by the Hippocratic Oath, rather than the pursuit of maximum profitability,

We should continue to vigorously advocate for a universal publicly funded, privately delivered health care system at every level throughout America—state as well as national. That may be the only way to effectively reach and motivate enough of the American public to finally achieve our common goals as a nation—health care as a right for every resident of the U.S.—a goal that is already a reality in most wealthy, industrialized democratic societies, but remains only an aspirational vision in our own. Let’s use every tool at our disposal to turn that aspiration into a reality.

Dr. Philip Caper is a physician and founding member of the National Academy of Social Insurance and currently serves on the Board of Maine AllCare.

https://www.commondreams.org…

Recent Members in the news

Dr. Adam Gaffney on “The Choice”

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This article includes video

PNHP immediate past president Dr. Adam Gaffney appeared on “The Choice” on March 24, 2021. He was joined by Christine Eibner, senior economist at the RAND Corporation, to discuss the merits of a public option compared to single-payer Medicare for All.

Dr. Gaffney argued that, while a public option might help some people, “it would leave the core dysfunctions and injustices of the U.S. health care system intact.”

Dr. Paul Song on “Rising Up With Sonali”

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This article includes video

PNHP national board member (and PNHP-California president) Dr. Paul Song appeared on “Rising Up With Sonali” on Free Speech TV and Pacifica radio stations on March 19, 2021. Dr. Song applauded the recent introduction of single-payer bills at the federal and state level, H.R. 1976 in the U.S. House and A.B. 1400 in the California State Assembly, respectively.

He encouraged activists to check and see if their representatives were co-sponsors of H.R. 1976, and to encourage them to fight for Medicare for All, especially considering what the pandemic revealed about our fractured and unjust health care system.

Dr. Jay Brock on “The Inside Scoop”

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This article includes video

Canadian-trained family physician Dr. Jay Brock appeared on “The Inside Scoop” on Inside Scoop TV in Fairfax County, Va. on March 13, 2021. Dr. Brock contrasted Canada’s single-payer system, which he said was more popular than hockey, with commercial insurance in the U.S., which he said was less popular than the telemarketing industry.

Recent Quote of the Day

John Geyman: The Medical-Industrial Complex…plus exciting changes at qotd

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“America’s Mighty Medical-Industrial Complex: Negative Impacts and Positive Solutions”

By John Geyman

This book has three goals: (1) to bring an historical perspective to how medicine and health care have evolved over the last 100 years, including the transformation of their original ethic of service with a moral purpose and how that ethic has been compromised by corporate greed; (2) to describe where an engulfing medical-industrial complex has brought us in terms of decreasing access to affordable health care, unacceptable quality of care, profiteering and fraud; and (3) to consider whether and how our unsustainable health care system can be brought into line against this deepening crisis in serving the needs of our people.

Copernicus Healthcare: http://www.copernicus-healthcare.org

Amazon: https://www.amazon.com…

Comment:

By Don McCanne, M.D.

Most of us want a health care system that has a mission to maintain and improve our health, yet we have a system that has lost its way in that its mission places a priority on advancing the interests of the medical-industrial complex at the cost of compromising our health care. John Geyman explains how we got there and how detrimental the impact has been. Although the political barriers to reform seem almost insurmountable, he does show us that there is a path to the essential reform that we need to bring health care justice to all. By understanding the source and nature of the dysfunctions, we can find our way out.

Exciting changes at qotd

As some of you may have heard, the interruption in the Quote of the Day messages was due to a TIA/stroke suffered by the author. Fortunately, the recovery has been dramatic, though incomplete. As a result, after two decades of daily commentaries in his retirement years, it is time for a change.

Future messages will be from noted health policy experts within and outside of PNHP. We will be receiving the latest from the best. With this change in format, we will also be changing the name to “Health Justice Monitor.” Launch is planned for next week.

I hope that you are as excited as I am as I become a consumer rather than a producer of the latest in health policy science. The more we understand, the sooner we will have health care justice for all.

Peace,
Don McCanne

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

Quote of the Day interlude

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By Don McCanne, M.D.

Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.

See you soon.

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

More trouble: Drug industry consolidation

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Over 30 years, dramatic consolidation has meant higher prices, fewer treatment options and less incentive to innovate

By Robin Feldman
The Washington Post, April 6, 2021

In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.

All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.

As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.

Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.

In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.

Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.

In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.

As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.

Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.

The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.

Robin Feldman is director of the UC Hastings Center for Innovation.

https://www.washingtonpost.com…

Comment:

By Don McCanne, M.D.

Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.

We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.

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

Recent State Single Payer News

N.Y. Assembly passes universal health care bill

Posted

By Dan Goldberg
Capital New York, May 27, 2015

The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.

The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.

Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.

“You do not have to be an Einstein to understand New York Health is the right choice for New York,” Gottfried said.

Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.

The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.

“What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies,” he said.

The plan’s benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.

For some Republicans, it was all too good to be true.

“This bill promises remarkable things for New York State residents,” said Assemblyman Andy Goodell, a Republican from Chautauqua. “It says providers, ‘you’ll be paid a lot more money,’ and it says to the employees ‘you’ll contribute a lot less money,’ and it says to the patients ‘you’ll have much broader access,’ and to the employers ‘you’ll pay $45 billion less.’ My background is in math and economics and I haven’t been able to figure out how this all works. … There is no free lunch, there is no free health care.”

Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said the bill “represents an unrealistic, utopian view of a universal health care system where everyone would be covered, everything would be covered and the system would magically pay for it all.”

One problem, pointed out by Republicans, is that the offering, while generous, is the opposite of what public health officials are pushing, including those in the Cuomo administration, who have professed that insurance systems, and high deductibles and co-pays help ensure people use the health system judiciously instead of opting for more, often unnecessary, care.

“There is a role for insurance companies,” state health commissioner Dr. Howard Zucker said Wednesday before the debate.

The last time a universal health care bill was on the Assembly floor was 1992. It passed but the debate was sidelined because of federal efforts to reform health care, which ultimately failed under the Clinton administration.

The passing of the Affordable Care Act, which subsidizes private insurance for people below a certain income level, was a valid effort, Gottfried said, but ultimately served to highlight why the system needs to be entirely scrapped.

“I think the A.C.A. has made it clear to people … there are profound problems in our health care system that cannot be addressed by incremental change in that system,” Gottfried said.

Wiping out an industry — even the insurance industry — was not seen as popular by many Republicans who worried about the loss of jobs and what might happen should this plan fail.

Goodell asked why the state should go down this road when when Medicaid — a government run insurance program for lower-income residents — is expensive, burdensome and not well liked.

“Why would we want to expand that type of approach,” he asked.

Gottfried responded that his bill would improve Medicaid by putting everyone into one pot. He would, he said, eliminate the two-tiered system. There’d be no greater risk of fraud under this law than in the current Medicaid program.

Republicans also pointed out how much was left to be done. The income tax rates have yet to be decided, but would likely cost the highest earners more than they currently pay for health insurance, while subsidizing lower income residents.

The analysis provided by Gottfried estimates no income tax on the first $25,000, an income tax of 9 percent on income between $25,0001 and $50,000, graduating to 16 percent tax for income over $200,000.

The legislation is also not specific on how to deal with residents of New York State who retire to another state.

That would have to be resolved at a later date, Gottfried said.

“Though we have numerous pages on this legislation, we have numerous holes also,” said Al Graf, a Republican from Holbrook. “There is no way I can go back to my constituents and tell them you may have coverage in the future. … This is an exercise in insanity.”

Moran said there is no certainty that providers would accept government set reimbursement, though Gottfried said almost all would receive more for their services than they are currently being paid.

The bill also “completely disregards the economic contribution of health plans — both to the state and to local communities,” Moran said.

Joseph Borelli, a Republican from Staten Island, cited Vermont, which tried and failed to enact a single-payer health system.

Vermont’s collapse has been a cautionary tale for even the most enthusiastic supporters of government sponsored health insurance, but Gottfried was having none of it.

“New York … bears no resemblance to Vermont,” Gottfried said. “The bill bears very little resemblance to Vermont. Their financing system is different. The two have absolutely nothing to do with one another, nothing! Why don’t you ask me whether New York will flood Just like Texas flooded if we enact this plan. The weather in Texas has as much to do with this as Vermont does.”

Read the bill here: http://bit.ly/1JVUg1I

http://www.capitalnewyork.com/article/albany/2015/05/8568890/assembly-pa…

N.Y. Assembly votes for universal health coverage

By Michael Virtanen, Associated Press
Democrat & Chronicle (Rochester, N.Y.), May 27, 2015

ALBANY – The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.

With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates. It would be funded through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.

Also, waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.

“Employers are shifting more and more health care costs to workers or are dropping it entirely,” said Assemblyman Richard Gottfried, chief sponsor. “The only ones who benefit are the insurance companies.”

The Manhattan Democrat estimated universal care would save New Yorkers more than $45 billion annually, cutting the statewide total cost for health care to about $255 billion in 2019.

Assembly Republicans doubted Gottfried’s estimate and questioned what would happen to everyone now employed by insurance companies.

“All I can say right now I think this is the last think New York state needs as far as an additional cost,” said Assemblywoman Jane Corwin, an Erie County Republican. She said they’re still trying to grapple now with the cost of the federal Affordable Care Act. That extended health care coverage to about 1 million New Yorkers, more than half in Medicaid and the others in private insurance with possible tax subsidies to offset costs.

An identical bill hasn’t advanced in the state Senate and isn’t expected to before the legislative session ends in June. Senate Health Committee Chairman Kemp Hannon said Wednesday that Gottfried’s bill faces two major hurdles, resistance from senior citizens to giving up Medicare for a new state program and obtaining federal waivers to apply Medicaid and Medicare funding to support it.

http://www.democratandchronicle.com/story/news/local/2015/05/27/assembly…

Single-Payer Health-Care Bill to be Introduced in Pa.

Posted

Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-sin…

Single-Payer Health-Care Bill to be Introduced in Pa.

Posted

Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-single-payer-health-care-bill/article_a41a6da0-7996-11e5-b8a4-2ba3ba19b536.html