PNHP

COVID-19 vaccine as a ‘global public good’

COVID-19 vaccine as a ‘global public good’

Chinese vaccine would be ‘global public good,’ Xi says

By Sarah Wheaton
POLITICO, May 18, 2020

China will treat a coronavirus vaccine developed there as a “global public good,” President Xi Jinping said Monday.

China has some of the leading candidates in the global race for an immunization, with four already in human trials. While the practical implications of Xi’s commitment remain unclear, it’s a sign that Beijing is aligning itself, at least rhetorically, with a broader movement to ensure equal access to coronavirus breakthroughs.

“COVID-19 vaccine development and deployment in China, when available, will be made a global public good,” Xi told the World Health Assembly at its virtual gathering. “This will be China’s contribution to ensuring vaccine accessibility and affordability in developing countries.”

Xi’s announcement could further isolate the U.S., which has taken steps to control exports of an experimental treatment and was subject of rumors that it wanted to secure exclusive access to a vaccine.

Washington also objected to casting coronavirus remedies as “global public goods” in a resolution about the COVID-19 response expected to be adopted by World Health Organization member countries on Tuesday. Global public goods could be subject to weaker intellectual property protections or other measures to reduce their costs and make them more widely available.

https://www.politico.com…

Trump Administration Announces Framework and Leadership for ‘Operation Warp Speed’

HHS.gov, May 15, 2020

On Friday, the Trump Administration announced the appointment of Moncef Slaoui as chief advisor and General Gustave F. Perna as chief operating officer of Operation Warp Speed (OWS), the administration’s national program to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics (medical countermeasures).

Dr. Slaoui is a venture capitalist and, formerly, Chairman of Global Research and Development and Chairman of Global Vaccines at GlaxoSmithKline.

https://www.hhs.gov…

Trump fires back against China’s ‘massive disinformation campaign’ about coronavirus

By Dom Calicchio
Fox News, May 21, 2020

President Trump unleashed a series of scathing tweets Wednesday night in response to what he called a “massive disinformation campaign” launched by the Chinese government regarding the coronavirus outbreak.

Trump and other critics have also accused the WHO of echoing Chinese propaganda regarding the virus instead of acting as impartial and vigilant guardians of global health.

https://www.foxnews.com…

WHO Director-General’s closing remarks at the World Health Assembly

World Health Organization, May 19, 2020

Excerpt

For everything COVID-19 has taken from us, it has also given us something:

A reminder of what really matters;

And the opportunity to forge a common future.

Dark and difficult days may lie ahead, but guided by science, together we will overcome.

Let hope be the antidote to fear.

Let solidarity be the antidote to division.

Let our shared humanity be the antidote to our shared threat.

Now, more than ever.

https://www.who.int…

Comment:

By Don McCanne, M.D.

At the virtual meeting of the World Health Organization this week, China expressed its intent to produce a much needed COVID-19 vaccine as a “global public good.” The Trump administration has launched “Operation Warp Speed” apparently in an effort to dominate the world market for the vaccine.

At a time that the world needs to be working together in controlling this terrible pandemic, today President Trump responds with belligerence towards China and the World Health Organization. He accuses WHO of not acting as impartial and vigilant guardians of global health. But that’s precisely what they are doing. President Trump has cut off funding and threatened to withdraw from WHO indicating that it is he who is not acting as an impartial and vigilant guardian of global health.

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

Drs. Adam Gaffney and Victoria Dooley on “The National”

PNHP president Dr. Adam Gaffney and Dr. Victoria Dooley appeared on the CBC program “The National” on May 15, 2020. They discussed the widespread loss of employer-based health insurance during the COVID-19 pandemic, with Dr. Gaffney noting, “My fear is that we’re going to have a second wave of suffering as a result of people going without needed health care because they can no longer afford it.”

The Coronavirus Isn’t the Only American Health Epidemic

When Andra Day’s “Rise Up” plays on the hospital loudspeakers, my spirits lift for a moment. But then I remember.

By Augie Lindmark, M.D.
The Nation, May 21, 2020

Lately my work in the hospital consists of two activities. Admit patients with Covid-19, and, if lucky, discharge patients with Covid-19. The work is monotonous. But then the loudspeakers click on and Andra Day’s “Rise Up” plays throughout the hospital, and for a moment I’m transported away from the oxygen tubes and ventilators. Someone with Covid-19 is going home. The melody offers hope, but that quickly disappears.

A couple of months ago—before all my patients had Covid-19—Peter arrived at the emergency room gasping for air. A severe asthma exacerbation had grabbed his lungs and wouldn’t let go. Peter was intubated, stabilized, and sent to the ICU. The first crisis was avoided.

The second crisis began the following day, within minutes after he was extubated. His nurse paged me: “Patient is distressed. He’s leaving ASAP.” I walked into the room and saw Peter breathing quickly, but asthma was no longer the culprit. “Do you have monthly payment plans?” he asked. His eyes held a familiar fear of uncertainty, of normalcy slipping away. Like millions of Americans, Peter was uninsured. He wanted to leave because of his mounting medical bills.

Each day I spend in the hospital now I hear that Andra Day song. With mounting Covid-19-related deaths I need some source of hope. But when I know patients are expelled back into an unreliable health care system, one that is notorious for financial ruin, celebration feels misplaced.

Far before SARS-CoV-2 dominated news cycles and hospitals alike, there were already established epidemics in US health care: namely, medical bills and uncertainty. In 2019, a third of US adults reported that their families couldn’t afford health care and 44 percent endorsed skipping a doctor’s visit because of cost. Medication affordability wasn’t much better: 29 percent of adults reported not taking a medication as prescribed due to cost.

Enter: Covid-19. You could almost hear the virus salivate.

When this coronavirus arrived in the United States, and when Donald Trump downplayed a pandemic while tests were delayed, the confusion over whether health insurance would cover testing and treatment began. The public needed confirmation that testing and treatment was accessible and affordable. Instead, Trump did what Trump does: make empty promises and baseless claims.

In a White House address on March 11, Trump incorrectly claimed the commercial health insurance industry “agreed to waive all copayments for coronavirus treatments.” He then doubled down and falsely said surprise medical bills—charges that come from out-of-network providers—would also be canceled for Covid-19. Surprise bills were not eliminated, and they still are not.

A spokesperson for America’s Health Insurance Plans (AHIP), the leading US health insurance lobby group, quickly corrected the president that the waivers were, “For testing. Not for treatment.” The beneficence of insurers, if we want to call it that, had its limits. In the president’s defense, dictating to hundreds of health insurers what they should cover outside of preventive care should be possible, but, in our current system, is a laughable proposition.

Still, testing coverage, though far from adequate, was a start. But then parsing began: What constituted coverage? Did that insurance coverage include doctor visits? Ancillary lab tests typically ordered with a Covid-19 test? Stories of Covid-19-related medical bills continued to mount, from ambulance rides to lab tests to medications. In one case reported by NBC News, a patient who recovered from Covid-19 faced over $3,000 in bills. He lamented he would have to “duke it out with my insurance company.”

Four months after the first confirmed case of Covid-19 in the US, most large health insurers now offer some form of cost-sharing waiver for Covid-19 treatment, in addition to testing. The Families First Coronavirus Response Act and the CARES Act expanded coverage for testing and treatment, but universal coverage for Covid-19 care has yet to be established.

But many large health insurers that offered fee waivers for Covid-19 treatment also set expiration dates by June 1, meaning treatment after that date wouldn’t be included, according to a recent report from Public Citizen. Furthermore, of the 25 largest health insurers, only two state that they will cover care for out-of-network providers, which opens the door to surprise medical bills.

“Insurers that are swimming in cash are trying to get credit for doing the bare minimum during an unprecedented health crisis,” said Eagan Kemp, lead author of the Public Citizen report. He further described the waivers as full of “caveats, confusing restrictions and premature end dates.”

If there’s a medical condition that would force people otherwise resistant to seeking medical care into the health system, a deadly virus is one of them. But not even Covid-19 has wiped away hesitation borne of financial fear. Last month, a Gallup poll reported that 14 percent of Americans would avoid health care due to cost if they developed symptoms of Covid-19. This number was higher among low-income individuals and people of color. Testing, contact tracing, social distancing, and treatment are all important components of pandemic responses. But the efficacy of these tools is blunted by a splintered health system that bars easy access to health care.

Perhaps the greatest risk of this pandemic is that we’ll come out on the other side with an unchanged health care system—one that causes harm. There is nothing normal about Kaiser Health News and NPR reporting a “Bill of the Month,” a recurring series on astronomical medical bills sent to unsuspecting patients. There is nothing normal about Equifax constructing a FAQ about how to negotiate your Covid-19 medical bill, which concludes by saying “Don’t forgo treatment to prevent a hospital bill; your health is too important.” There is nothing normal about staggering medical bills.

As political officials begin “reopening” public spaces and relaxing social distancing, the various forms of medical distancing placed on patients, from copays to surprise medical bills, must also be addressed—and not just for Covid-19. When uncertainty and medical bills no longer prevent health care, maybe then I’ll feel like celebrating.

Dr. Augie Lindmark is a physician and writer based in New Haven, Conn.

https://www.thenation.com…

Battle Covid-19, Not Medicare for All: Doctors Demand Hospital Industry Stop Funding Dark Money Lobby Group

"The AHA should immediately leave the PFAHCF and redirect that money to supporting patients and frontline healthcare workers."

By Jake Johnson
Common Dreams, May 21, 2020

A progressive organization of 23,000 physicians from across the U.S. demanded Thursday that the American Hospital Association (AHA) divest completely from a dark-money lobbying group that has spent millions combating Medicare for All and instead devote those financial resources to the fight against Covid-19 and to better support for patients and healthcare workers.

Dr. Adam Gaffney, president of Physicians for a National Health Program (PNHP), said in a statement that “the Covid-19 pandemic has stretched hospitals’ resources to the limit, and the AHA should not waste precious member hospitals’ funds lobbying against universal health coverage” as a member of the Partnership for America’s Health Care Future (PFAHCF).

Because Medicare for All would provide a lifeline to hospitals in underserved areas that have been hit hard by Covid-19, Gaffney argued, the AHA “cannot claim to represent hospitals while also opposing a single-payer system that would keep struggling hospitals open.” The AHA represents around 5,000 hospitals and other healthcare providers in the U.S.

As Common Dreams reported earlier this month, public health officials are accusing the Trump administration of directing billions of dollars in Covid-19 hospital bailout funds to high-revenue providers while restricting money to hospitals that serve low-income areas.

Tenet Healthcare, an investor-owned hospital company that has donated hundreds of thousands to PFAHCF, has received $345 million in Covid-19 bailout funds, Axios reported last month.

“The AHA should immediately leave the PFAHCF,” Gaffney said, “and redirect that money to supporting patients and frontline healthcare workers.”

“As physicians, we can no longer tolerate a health system that puts profits ahead of patients and public health,” Gaffney added. “It’s time for health professionals to hold accountable the organizations that claim to represent us.”

Formed in the summer of 2018 by an alliance of pharmaceutical, insurance, and hospital lobbyists with the goal of countering the push for universal healthcare, PFAHCF’s anti-Medicare for All “army” has grown rapidly since its founding, with the AHA joining the fray in 2019.

As The Intercept reported last October, the for-profit hospital industry has played an “integral role” in the corporate fight against single-payer.

“America’s hospitals and health systems strongly support improving patient access to health coverage for all Americans,” Rick Pollack, AHA’s president and CEO, wrote in a blog post last February. “That’s why we’ve joined with the American Medical Association and others as part of the Partnership for America’s Health Care Future to build on the strength of the existing reforms.”

The American Medical Association dropped out of PFAHCF last year in the face of protests from doctors and nurses, and now healthcare workers are pressuring AHA to do the same.

PNHP said it originally planned to protest outside of the AHA’s annual meeting in Washington, D.C. in April but has been forced by the coronavirus pandemic to take its pressure campaign online, “with tactics such as a petition and letter-writing campaign directed at AHA officials.”

Rev. Richard Ellerbrake, president emeritus of Deaconess Health System in St. Louis, Missouri, wrote in a letter to AHA board members that “it often seemed to me that the AHA was ahead of the American Medical Association (AMA) on many important issues of the day.”

“Today I would hope the AHA would follow the example of the AMA and discontinue supporting the PFAHCF,” wrote Ellerbrake.

https://www.commondreams.org…

COVID-19 and Medicare for All

By Ashley Duhon, M.D. and Sara Robicheaux, M.D., M.P.H.
The Lens,

Last week, we officially began our careers as physicians in the middle of a global pandemic and public health crisis. Over the previous four years as medical students, we saw countless examples of patients wronged by our health care system, which incentivizes disease treatment and not disease prevention. We saw patients lose their limbs to diabetes when they could not afford to begin insulin until it was too late. We saw patients whose access to comprehensive healthcare began with their enrollment in Medicare only after they were placed on dialysis, when we know that preventing kidney failure is more cost effective than treating it. We held the hands of our dying patients knowing that, if they could have afforded care sooner, they would be holding their loved ones’ hands instead.

Prior to COVID-19, over 40,000 New Orleanians were without health insurance. Now, with unemployment numbers rising daily, the uninsured rates will rise steadily as insurance plans tied to employment are lost. The costs of COVID-19 treatment have amounted to tens of thousands of dollars for the uninsured and could exceed $1,000 for patients with employer-based insurance. The promises of private, profit-based insurers to cover COVID-19 treatment are not enough. Many of these corporations exploit gaps in coverage to avoid having to pay for this treatment, like refusing payment for care performed by an out-of-network provider or when a patient does not receive or qualify for a COVID-19 test. As we have seen with our patients, commercial health insurance is a defective product, like an umbrella that melts in the rain. With skyrocketing premiums, copays, and deductibles, even insured patients are forced to choose between paying for rent and food or the bills for supposedly “covered” procedures. Not surprisingly, most choose food and rent. Many are avoiding treatment for symptoms concerning for COVID-19 due to concerns over the bills they will receive later in the mail.

Medical bills amounting to $1,000 or more could send many into medical bankruptcy. Medical problems have contributed to two-thirds of all bankruptcies in America, a figure that is virtually unchanged since before the passage of the Affordable Care Act (ACA). This means, even though more people have private health insurance, 530,000 families suffer bankruptcies each year that are linked to illness or medical bills. In the U.S., a whopping $450 billion of unpaid medical debts are sent to collections agencies every year. This problem disproportionally affects Louisiana and the greater New Orleans area; our state ranks second for the proportion of people living with unpaid medical bills. In Orleans Parish, the percentage of residents living with medical debt is higher than the national average. It remains to be seen how COVID-19 will continue to worsen this statistic as New Orleans has become a hot spot for cases.

We must fix our broken health care system once and for all. The only way to eliminate the nightmare of medical debt and bankruptcy is to cover everybody for all medically necessary care without the financial burden of premiums, copays, and deductibles, during and beyond a pandemic. In our view, the only way we can afford to cover everyone is through single-payer Medicare for All. Medicare for All would cut through the wasteful administrative costs and go-betweens of private insurance, and pay doctors and hospitals directly for patient care, saving our nation as much as $600 billion annually — enough to cover the uninsured and upgrade coverage for everyone else.

We don’t want to practice medicine in a system that rations healthcare based on ability to pay, or that punishes people who get sick with a lifetime of financial instability. We have seen our government take steps to cover COVID-related costs during this pandemic. However, this is not enough. The people of New Orleans deserve more comprehensive medical care that will not drain their pocketbooks. As recently graduated physicians, our first prescription is for single-payer Medicare for All.

Dr. Ashley Duhon is a recent New Orleans area medical school graduate. She will begin her residency in Obstetrics and Gynecology in the Bronx, New York in July. 

Dr. Sara Robicheaux is a recent New Orleans area medical school graduate. She will begin her residency in Emergency Medicine this July and is excited to continue to serve the people of Louisiana.

https://thelensnola.org…

Doctors’ group demands the American Hospital Association leave anti-single payer dark-money organization

The Partnership for America’s Health Care Future — partially funded by the AHA — has spent millions on lobbying and ads against universal health care

FOR IMMEDIATE RELEASE: May 21, 2020

Contact:
Dr. Adam Gaffney, PNHP President, gaffney.adam@gmail.com
Clare Fauke, PNHP communications specialist, clare@pnhp.org

Physicians for a National Health Program (PNHP), a nonprofit organization of 23,000 doctors who support Medicare for All reform, has called on the American Hospital Association (AHA) to divest its membership in the Partnership for America’s Health Care Future (PFAHCF), a dark-money lobbying group that spends millions fighting against reforms that would lead to universal health coverage. 

“The COVID-19 pandemic has stretched hospitals’ resources to the limit, and the AHA should not waste precious member hospitals’ funds lobbying against universal health coverage,” said PNHP President Dr. Adam Gaffney, who is also a pulmonary and critical care physician.

The PFAHCF is a dark-money group founded by health insurance and pharmaceutical companies, two industries whose profits are most threatened by a single-payer Medicare for All system. The PFAHCF spends millions of dollars each year running ads against Medicare for All and other reforms such as a public option. Last summer, the group bought half of all political advertising in Iowa, and spent a total of $1.2 million on anti-reform ads ahead of the Iowa caucuses. 

Several medical associations were also early members of the PFAHCF, including the AHA and the American Medical Association (AMA), the largest physician membership organization in the U.S. In August 2019, the AMA left the PFAHCF after pressure from physicians and other health advocates who protested at the AMA’s annual meeting in Chicago. Other medical professional groups, including the American College of Radiology, have recently quit their membership in the PFAHCF under pressure from health professionals. Remaining provider groups include the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the The Virginia Orthopaedic Society. 

PNHP had planned a protest outside the AHA’s annual meeting in Washington, D.C. in late April. Due to the COVID-19 pandemic, the doctors’ group has taken its campaign online, with tactics such as a petition and letter-writing campaign directed at AHA officials. 

The letter-writing campaign caught the attention of Rev. Richard Ellerbrake, who is President Emeritus of Deaconess Health System in St. Louis, Mo. When he learned that the AHA was a member of PFAHCF, Rev. Ellerbrake wrote to AHA board members that, “During my 30 years as COO/CEO of Deaconess Health System, it often seemed to me that the AHA was ahead of the American Medical Association (AMA) on many important issues of the day. Today I would hope the AHA would follow the example of the AMA and discontinue supporting the PFAHCF,” a reference to the decision by the AMA to leave the PFAHCF in August of 2019.

PNHP President Dr. Adam Gaffney said that as millions of Americans lose both their jobs and their health coverage during the COVID-19 pandemic, the need for Medicare for All is more urgent than ever before. “As physicians, we can no longer tolerate a health system that puts profits ahead of patients and public health. It’s time for health professionals to hold accountable the organizations that claim to represent us.”

Dr. Gaffney added that a Medicare for All program such as H.R. 1384, the Medicare for All Act of 2019, would provide a lifeline to struggling hospitals in rural and other underserved areas that serve an increasing number of uninsured patients. He notes that a single-payer system would fund hospitals through annual global budgets that are based on community health needs, not corporate profits. 

“The AHA cannot claim to represent hospitals while also opposing a single-payer system that would keep struggling hospitals open,” said Dr. Gaffney. “The AHA should immediately leave the PFAHCF, and redirect that money to supporting patients and frontline health care workers.”

 Physicians for a National Health Program (PNHP) is a nonprofit organization whose 23,000 members advocate for single-payer Medicare-for All. It was founded in 1987.

Tsung-Mei Cheng explains Taiwan’s single-payer lesson for America

A Lesson for America? Taiwan’s Single-Payer National Health Insurance

By Tsung-Mei Cheng
Milken Institute Review, May 4, 2020

If Americans are somewhat familiar with any single-payer system, it’s the one in Canada. Here, I outline another single-payer system built almost from scratch more recently — and in a place that’s even more affluent than Canada: the island of Taiwan. Arguably the most startling aspect of Taiwan’s National Health Insurance (NHI) system is how they manage to get high-quality outcomes for a small fraction of what Americans pay — and how well they have managed the coronavirus pandemic.

Insights for the United States

Despite vast differences between the two cultures and insurance structures, Taiwan’s high-performing single-payer NHI does offer some insights.

Distributive Ethics Matter

In his final book, Priced Out, Reinhardt observed:

“Health reformers in Europe, Canada, or, say, Taiwan (which operates a government-run single-payer system) usually begin their debate on health reform by making explicit the ethical principle that should constrain health policy. … In Germany, for example, policymakers frequently recite the principle of social solidarity. … The U.S. is different … in that it has never been able to reach a politically dominant consensus on a distributive ethic for American health care. My personal experience is that merely bringing up the topic of distributive ethics for health care can easily raise the ire of an audience, because it is viewed as ‘too personal,’ ‘too political,’ and ‘too divisive.’ So instead, we prefer to discuss health reform mainly in technical terms — usually economic terms — and let social ethics fall where they may.”

The United States stands out today as the only country in the developed world that does not recognize health care as a right and have health insurance for everyone. This is an “American exceptionalism” that Americans cannot take pride in.

Cost Containment

Taiwan provides health insurance with generous benefits for its whole population at a cost of 6.1 percent of GDP, or just 36 percent of what the United States spends as a percentage of GDP. On a per capita basis, the contrast between Taiwan and the United States is even starker: Taiwan’s per capita health spending of $3,047 (in terms of purchasing power) was just 30 percent of U.S. spending per capita of $10,207 in 2017.

No Surprises or Price Discrimination

Since the government sets all health care prices, and extra billing above the government-set fee is not allowed (except for a few government-specified medical devices, such as artificial joints), Taiwan is noted for its conspicuous absence of “surprise” medical bills. By the same token, Taiwan does not have to cope with price discrimination, in which hospitals charge vastly different amounts for identical services.

Note, too, that, although hospital mergers do take place in Taiwan, such mergers only expand the market share of acquiring hospitals, but cannot create market power that increases the prices of services and products. The United States, by contrast, has seen rapid concentration in the market for hospital services precisely because size provides more bargaining power with insurers.

Indeed, it appears that consolidation on both the hospital and insurance sides of the equation in the United States has made a mockery of the idea that competition can contain prices.

Administrative Savings

The simplicity and IT-enabled efficiency of Taiwan’s NHI make its overhead cost extremely low. NHI’s administrative cost accounted for 0.87 percent of the total NHI expenditure in 2018.

This is far, far lower than the average of 3 percent of total health spending in OECD economies (in 2014), and strikingly lower than U.S. insurers, whose administrative cost is 7 percent for traditional government-run Medicare and Medicare’s private plans (Medicare Advantage) combined, and 13 percent (no misprint) for private health insurance plans. It long has been known that excessive administrative costs are a significant part of the waste in U.S. health spending.

Satisfaction

The latest NHI satisfaction poll, conducted in November 2019, showed a satisfaction rate of 90 percent, a new high for the NHI. Reasons given for patient happiness: easy access to health services, reduced financial burden of medical care and the “reasonable” premiums. Many Taiwanese-Americans continue to pay their NHI premiums and go back to Taiwan for their medical care. (Our Taiwanese-American daughter-in-law returned to Taiwan to obtain her highly technical, life-saving surgical care – DMc)

Live and Learn

Taiwan is the poster child for how a wellrun single-payer system can do the job efficiently and still enjoy high public satisfaction. Taiwanese regard the NHI as a national treasure and the guardian of social peace.

But a single-payer Medicare for All for the United States may be a bridge too far, if only because the $3.6 trillion (in 2018) American health care system has effectively been captured by interests ranging from private insurers to hospitals to physicians to organized groups of chronic illness sufferers seeking preferential access.

https://www.milkenreview.org…

Comment:

By Don McCanne, M.D.

Tsung-Mei Cheng has provided us with another excellent article on the features of single-payer national health insurance in Taiwan. This time she also provides us with insights for the United States. The full article is well worth downloading and saving as a reference on Taiwan’s very successful single payer system.

She cites her late husband, Uwe Reinhardt, in cautioning that we have a problem with distributive ethics, limiting our reform discussions to economic terms and letting social ethics fall where they may. She points out that single-payer Medicare for All may be a bridge too far for the United States since our health care system has effectively been captured by financial interests. In contrast, the Taiwanese regard their national health insurance as “a national treasure and the guardian of social peace.”

As noted in the parenthetical comment above under “Satisfaction,” we have the utmost reason to be thankful for the services of Taiwan’s national treasure. May our health care system be transformed from a system captured by financial interests to a system that is the guardian of social peace.

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

Balanced budget requirements threaten Medicaid program

Governors eye Medicaid cuts to ease COVID-19 budget pain

By Jessie Hellmann
The Hill, May 17, 2020

Governors facing huge budget shortfalls are eyeing cuts to Medicaid, even as millions of unemployed Americans flock to the health insurance program after losing their employer-based coverage.

States that are buckling under declining revenues and increased Medicaid enrollment due to COVID-19 say they may have no choice but to cut the program for the poor unless they get more financial support from the federal government.

Federal law requires states to balance their budgets, and during economic downturns, governors and state legislatures tend to cut costly programs like Medicaid.

Medicaid consumes about 20 percent of state budgets, with spending on the program spiking during recessions as more Americans sign up after losing their jobs.

And because this economic downturn was caused by a pandemic, Medicaid spending is expected to increase even more as beneficiaries seek care for COVID-19 testing and treatment.

Cuts would result in a devastating blow to the social safety net when it is needed most, experts say.

Federal law prohibits states receiving increased Medicaid funding from cutting benefits, increasing premiums or restricting eligibility — restrictions Congress put in place to protect beneficiaries from losing coverage during the pandemic.

That means in order to find savings, states turn to cutting provider rates, which some experts say could be disastrous.

“The Medicaid provider network is highly stressed and particularly fragile,” said Edwin Park, a research professor and Medicaid expert at the Georgetown University McCourt School of Public Policy.

“If you cut Medicaid rates, the impact on access would likely be much more harmful than even after a typical recession where states look to cut Medicaid and they look to cut provider payments.”

https://thehill.com…

Comment:

By Don McCanne, M.D.

The COVID-19 pandemic combined with a major economic downturn, massive loss of employment, often with the loss of health insurance, has resulted in much greater demand for enrollment in the Medicaid program – a joint federal-state health insurance program for low-income individuals and families. Just at a time that state budgets are severely stressed, the increased demand for Medicaid will be very difficult to meet because of state requirements for balanced budgets. The Medicaid program is already severely underfunded, and the states do not have much in the way of other options than to further reduce payments to the providers. This could result in insolvency of the providers and a shutdown of their crucial safety net.

The mere fact that Medicaid is a welfare program makes the political support tenuous. In contrast, if they were enrolled in the popular Medicare program, the political support is already there. However, the out-of-pocket costs in Medicare are too great for those who would qualify for Medicaid. Some could qualify for the dual Medicare/Medicaid program, but that won’t work for those not otherwise qualified for Medicare.

Suppose we improved Medicare by expanding benefits and eliminating the cost sharing. That would work for both Medicare and Medicaid eligible individuals, but what about everyone else, such as those currently under financial stress who have lost their employer-sponsored plan, who do not have enough funds for COBRA extension of coverage, who do not qualify for or have the funds for the plans offered in the ACA exchanges, and who are not eligible for either Medicare or Medicaid. That amounts to tens of millions who would be left uncovered or inadequately covered. Wouldn’t it be far better to simply improve Medicare and then expand it to include everyone?

The governors are certainly familiar with the concept of the single payer model of an improved Medicare for All that is federally funded through equitable taxes. That would take care of this terrible problem they are facing in trying to get health care for everyone. Why aren’t the governors clamoring for Medicare for All? If it helps, we could arrange to space them at six feet intervals as they march on Washington.

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The Lancet: Fix the CDC by replacing the president

Reviving the US CDC

The Lancet, Editorial, May 16, 2020

The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

The US Centers for Disease Control and Prevention (CDC), the flagship agency for the nation’s public health, has seen its role minimised and become an ineffective and nominal adviser in the response to contain the spread of the virus. The strained relationship between the CDC and the federal government was further laid bare when, according to The Washington Post, Deborah Birx, the head of the US COVID-19 Task Force and a former director of the CDC’s Global HIV/AIDS Division, cast doubt on the CDC’s COVID-19 mortality and case data by reportedly saying: “There is nothing from the CDC that I can trust”. This is an unhelpful statement, but also a shocking indictment of an agency that was once regarded as the gold standard for global disease detection and control. How did an agency that was the first point of contact for many national health authorities facing a public health threat become so ill-prepared to protect the public’s health?

In the decades following its founding in 1946, the CDC became a national pillar of public health and globally respected. It trained cadres of applied epidemiologists to be deployed in the USA and abroad. CDC scientists have helped to discover new viruses and develop accurate tests for them. CDC support was instrumental in helping WHO to eradicate smallpox. However, funding to the CDC for a long time has been subject to conservative politics that have increasingly eroded the agency’s ability to mount effective, evidence-based public health responses. In the 1980s, the Reagan administration resisted providing the sufficient budget that the CDC needed to fight the HIV/AIDS crisis. The George W Bush administration put restrictions on global and domestic HIV prevention and reproductive health programming.

The Trump administration further chipped away at the CDC’s capacity to combat infectious diseases. CDC staff in China were cut back with the last remaining CDC officer recalled home from the China CDC in July, 2019, leaving an intelligence vacuum when COVID-19 began to emerge. In a press conference on Feb 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, warned US citizens to prepare for major disruptions to movement and everyday life. Messonnier subsequently no longer appeared at White House briefings on COVID-19. More recently, the Trump administration has questioned guidelines that the CDC has provided. These actions have undermined the CDC’s leadership and its work during the COVID-19 pandemic.

There is no doubt that the CDC has made mistakes, especially on testing in the early stages of the pandemic. The agency was so convinced that it had contained the virus that it retained control of all diagnostic testing for severe acute respiratory syndrome coronavirus 2, but this was followed by the admission on Feb 12 that the CDC had developed faulty test kits. The USA is still nowhere near able to provide the basic surveillance or laboratory testing infrastructure needed to combat the COVID-19 pandemic.

But punishing the agency by marginalising and hobbling it is not the solution. The Administration is obsessed with magic bullets—vaccines, new medicines, or a hope that the virus will simply disappear. But only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency. The CDC needs a director who can provide leadership without the threat of being silenced and who has the technical capacity to lead today’s complicated effort.

The Trump administration’s further erosion of the CDC will harm global cooperation in science and public health, as it is trying to do by defunding WHO. A strong CDC is needed to respond to public health threats, both domestic and international, and to help prevent the next inevitable pandemic. Americans must put a president in the White House come January, 2021, who will understand that public health should not be guided by partisan politics.

https://www.thelancet.com…

The Lancet blasts Trump, says voters should not reelect him

The Hill, May 15, 2020

https://thehill.com…

Comment:

By Don McCanne, M.D.

The entire world is experiencing the severe deleterious impact of the COVID-19 pandemic. This is a time that the world would normally turn to the US Centers for Disease Control and Prevention (CDC) for assistance and guidance in dealing with this crisis. Sadly, the CDC is not currently up to the standard that they had set. The problem is political.

It is astonishing that we are in a situation wherein the editor of a highly prestigious international medical journal feels compelled to lecture the United States on the need to replace our president with one who understands the important role that the United States needs to be playing in the betterment of worldwide public health. We should be ashamed.

PNHP does not support any candidates for political office, but we do support health care justice for all. Encourage your candidates to do the same.

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Best of times, worst of times

By Robert S. Kiefner, M.D.
Concord (N.H.) Monitor, May 16, 2020

‘It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.”

With the opening paragraph of “The Tale of Two Cities,” Charles Dickens provided an overview of our new reality; our lives in the time of COVID-19. First responders, health care workers, maintenance workers, grocery workers, and all of those who allow others to stay home have risen to the occasion at significant personal risk. Yet the pandemic has bought into sharp focus the disturbing realities of American injustice, including poverty, income disparity, ineffective health care delivery, food insecurity, and racism.

We are witnessing the heroic efforts of scientists and public health officials who are working on antiviral medications and vaccines, while developing evidence-based models of viral spread, morbidity, and mortality designed to save as many lives as possible. Sadly, their efforts to promote reason and clarity are consistently undermined by the president, whose daily toxic rants are brimming with delusion and superstition, with his conga line of sycophants bellowing behind him.

We are at our best when neighbors take care of neighbors, when people dust off sewing machines to make masks by the thousands, when teachers and parents work together to educate kids, and when virtual connections bring long lost friends and family together. But we collectively sigh in despair as we witness fellow citizens calling themselves patriots, strutting around state houses without masks, loudly spewing their viral laden aerosols while caressing their AR-15s, jittery fingers on the triggers.

Our better selves shine when we look to alleviate suffering and financial hardship by coming together in support of universal health coverage, no longer tied to employment or one’s ability to pay premiums.

Improved and expanded Medicare for All could provide a measure of security for countless millions of newly unemployed with no insurance or inadequate coverage, while assuring patient choice of provider and reliable prescription drug coverage. But an equal measure of dismay emerges when we are cajoled by well-financed lobbying groups such as the Partnership for America’s Healthcare Future, who exploit the pandemic to bad mouth Medicare for All while promoting the health insurance companies, Big Pharma, and expansive hospital systems. Those who support the status quo for these for-profit entities, especially in the midst of a public health catastrophe, are bereft of compassion, possessed by greed, and blind to the common good.

And finally, the best of times will be realized when elected officials at all levels do the right thing in support of every piece of legislation designed to improve the health and financial security of those who are suffering, regardless of perceived negative impact on their electability. People no longer have bootstraps with which to lift themselves up. These may indeed by the worst of times but better times, if not the best of times, will surely follow.

https://www.concordmonitor.com…

What should we do about the payer-provider disconnect?

The payer-provider disconnect

By Merrill Goozner
Modern Healthcare, May 14, 2020

Call it the big disconnect. Thousands of healthcare provider groups face financial ruin. Tens of millions of Americans are losing insurance coverage. Yet private health insurers are doing just fine, thank you.

So far, Congress has responded only to the provider crisis. Social distancing has cut hospital revenue by an estimated 30% to 40%. Local physician practices, with primary care hardest hit, have seen declines of up to 90%.

It’s nearly impossible for actuaries to estimate how much of the lost healthcare spending will reappear in the second half of the year as businesses gradually reopen. Some, certainly. But with 30% of healthcare considered waste, and tens of millions of laid-off Americans returning to work slowly, most of that potential revenue is probably gone forever.

As things stand now, the government is doing everything in its power to reassure providers and payers that not much will change.

If the current crisis teaches us anything, it’s that healthcare providers need far greater flexibility to respond to emergencies like the current one. What is a “bailout” but a guaranteed budget? Isn’t this a logical direction for payment reform to take post-COVID-19?

And as for an insurance system that leaves private insurers with no responsibility for those suddenly uninsured, it’s way past time for designing a seamless system where everyone is covered, and people never fall through the cracks. This country needs mechanisms for people to switch automatically between private plans and public programs so no one ever gets left out.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

The current pandemic certainly demonstrates the payer-provider disconnect in health care. The private insurers are doing spectacularly well whereas the players in the health care delivery system – many hospitals and especially physicians – are facing a financial crisis.

The view expressed by Merrill Goozner – the editorialist of Modern Healthcare, a publication that covers the medical-industrial complex – provides a lesson for us all. The solution for the disconnect is to have a guaranteed budget (including provisions to fund surge capacity), with him stating, “it’s way past time for designing a seamless system where everyone is covered, and people never fall through the cracks.”

He then suggests that we need mechanisms to switch automatically between private plans and public programs. Of course, this is where he veers off track. The administrative complexity and high costs of such a system are not warranted when you can have a single, seamless public program that covers everyone forever. By acknowledging that a public program must be there as the safety net that the private sector does not provide, he has presented an ironclad case for the single payer model of an improved Medicare that will always be there for all of us, no matter what crises we face.

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Physicians’ group responds to Emergency Health Care Guarantee Act

Statement from Dr. Adam Gaffney, president of Physicians for a National Health Program, in response to the Emergency Health Care Guarantee Act

FOR IMMEDIATE RELEASE: May 15, 2020

Contact: Adam Gaffney, President of Physicians for a National Health Program, gaffney.adam@gmail.com
Clare Fauke, Physicians for a National Health Program, clare@pnhp.org

“Each week, millions of Americans are losing their jobs — and their health coverage — with no end in sight. To minimize suffering during the COVID-19 pandemic, we need strong medicine from Washington. The Health Care Emergency Guarantee Act introduced earlier today fits the bill. It would use Medicare to provide immediate coverage of health care costs for the uninsured, and to provide wrap-around coverage of copays and deductibles for those with existing insurance.

“In contrast, proposals to subsidize private health insurance premiums through COBRA would still leave tens of millions uninsured, and far more under-insured, facing high deductibles and copays that stand in the way of care. COBRA subsidizes prop up the health insurance industry while leaving families in the lurch. In the long run, we need Medicare for All to provide full health protections for Americans. But the Health Care Emergency Guarantee Act could ensure protection for American families today.”

Adam Gaffney, M.D., M.P.H. is the president of Physicians for a National Health Program, instructor at Harvard Medical School, and a pulmonary and critical care physician at the Cambridge Health Alliance, a Massachusetts safety-net hospital system which has the highest share of beds devoted to the care of COVID-19 patients of any hospital in that state. Dr. Gaffney can be reached at 917-539-0434 (call or text), or gaffney.adam@gmail.com. He Tweets at: @awgaffney.

Physicians for a National Health Program (PNHP) is a nonprofit organization whose 23,000 members advocate for single-payer Medicare-for All.

The Emergency Health Care Guarantee Act is sponsored by Sens. Bernie Sanders (I-Vt.), Kirsten Gillibrand (D-N.Y.), Edward Markey (D-Mass.), Elizabeth Warren (D-Mass.), Cory Booker (D-N.J.), Jeff Merkley (D-Ore.), and Kamala Harris (D-Calif.).

House sponsors include Reps. Jayapal (D-Wash.), Bass (D-Calif.), DeFazio (D-Ore.), Garcia, J. (D-Ill.), Kennedy (D-Mass.), Khanna (D-Calif.), Meng (D-N.Y.), Ocasio-Cortez (D-N.Y.), Omar (D-Minn.), Pocan (D-Wis.), Pressley (D-Mass.), Raskin (D-Md.), Bonamici (D-Ore.), Dingell (D-Mich.), Cohen (D-Tenn.), Norton (D-DC), Tlaib (D-Mich.), and Espaillat (D-N.Y.).