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Marcia Angell: Coronavirus reinforces moral basis for Medicare for All

Marcia Angell: Coronavirus reinforces moral basis for Medicare for All

Why the U.S. failed the coronavirus test

By Marcia Angell
Santa Fe New Mexican, March 21, 2020

The coronavirus pandemic is the best argument for “Medicare for All.” As it stands, most Americans get health care only if we have insurance that will pay for it. If we don’t or we can’t afford the deductibles and copayments, too bad. Every other advanced country provides universal health care in a predominately nonprofit system.

What happens, then, when Americans develop a fever and cough? Are they likely to seek medical help, despite the hefty bills they are sure to receive, particularly if, say, the radiologist is out of network or the insurance company refuses to pay for some other reason? The new coronavirus, while highly contagious, is usually mild, so people with minimal symptoms might simply take their usual cold remedies while they go about their business and spread the infection widely.

The problem is that we treat health care like a market commodity distributed according to the ability to pay in an uncoordinated system with hundreds of commercial insurers and profit-oriented providers. Some 30 million people have no access to health care because they are uninsured, and millions more don’t use their insurance because the deductibles and copayments are unaffordable. In addition, insurers usually require patients to get their care within a narrow network of providers and exclude certain services.

The shortage of test kits for coronavirus stems from a related problem. Since there was no commercial market for them, they didn’t get made immediately. While we’ve converted health care into a market commodity, we’ve hollowed out our public health system, so it couldn’t do the job.

For all we know, the coronavirus may already have spread widely within the United States. Although it has been in other countries for more than two months, we have not really looked for it here. Until the last week in February, our premier public health agency, the Centers for Disease Control and Prevention, limited its diagnostic testing to symptomatic patients who had traveled to China or had contact with someone known to be infected. This is akin to looking for lost keys only under a lamppost.

The CDC probably could not have done better, given its lack of funding and governmental support. But ignorance is hardly a good public health strategy. Right from the beginning, we should have made test kits available to state and local public health agencies (as was done in Italy and South Korea). The only way to deal with an epidemic of this scope is with a universal health care system like “Medicare for All” and a strong, well-funded public health network.

The political opposition to “Medicare for All” is puzzling, since Medicare is the most popular part of our current fragmented system. In fact, many 64-year-olds can hardly wait to be 65, so they will be eligible. Why, then, do opponents of “Medicare for All” seem to believe that extending this popular program to everyone would be a sacrifice? Would a 64-year-old really prefer private insurance, with its networks and variable benefits, to Medicare, with its free choice of doctors and guaranteed benefits?

It’s true that taxes would have to increase to pay for “Medicare for All,” but the taxes could be as progressive as we wanted. For most Americans, they would probably be completely offset by the elimination of premiums, deductibles and copayments. In addition, the system as a whole would be far more efficient, because of the reduction in our gigantic overhead costs and the elimination of most profits. Most important, cost inflation would slow greatly, so that in a few years we would come out well ahead.

But as important as cost control is, my reason for favoring “Medicare for All” is primarily moral. Health care is not like ordinary consumer goods that people can choose to purchase. Illness is not a choice; it’s a misfortune. So why should people have to pay for it, as if they wanted it? Providing health care, just like providing clean water or police protection or basic education, is simply what decent societies should do. And during an epidemic, it protects all of us. The coronavirus pandemic powerfully underscores the need for a coherent national health system, in which we all pull together.

Marcia Angell is a member of Harvard Medical School’s Department of Global Health and Social Medicine, and a former editor-in-chief of the New England Journal of Medicine. She will soon be a resident of Santa Fe.

https://www.santafenewmexican.com…

Comment:

By Don McCanne, M.D.

Certainly we have all had more than enough reason recently to give considerable thought to factors potentially influencing the health of all of us. As Marcia Angell makes clear, we most emphatically need a coherent national health system like “Medicare for All” with a strong, well-funded public health network. Most of us can cite many reasons for this, but, above all, the reason is primarily moral. How can we not do it?

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America’s extreme neoliberal healthcare system is putting the country at risk

Single-payer healthcare can’t prevent a novel virus like Covid-19 but it could help us plan, coordinate and save lives

By Adam Gaffney, M.D., M.P.H.
The Guardian, March 21, 2020

At the final debate of the Democratic presidential primary on Sunday, Senator Bernie Sanders and Joe Biden clashed on the coronavirus. Sanders contended the pandemic laid bare “the incredible weakness and dysfunctionality” of the US healthcare system, and called for single-payer reform. Biden countered that Italy’s universal system had failed to protect the Mediterranean nation, and asserted that Covid-19 “has nothing to do with Bernie’s Medicare for All”. At first glance, the ex-vice-president seems right: of course single-payer can’t close the door to a novel virus, any more than it can forestall a deadly earthquake or fend off a zombie apocalypse. Nonetheless, a national health program with unified financing and governance – basically the opposite of what we have in America today – is a powerful tool in a health crisis.

The debate over Medicare for All in the age of Covid-19 is complicated by the fact that it is our public health agencies – and not the medical care system – that serve as our first line of defense against novel epidemics. In that regard, we’ve shot ourselves in the foot with a 12-gauge shotgun: year after year of underfunding of our federal, state and local public health agencies has left us ill-prepared for the Covid-19 challenge (as evidenced by the testing fiasco). How we finance medical care, however, is also critical. On the most basic level, containing the coronavirus will require those infected to seek medical care, so that they can be diagnosed and isolated. Fear of devastating ER or hospital bills, however, could keep some home – or at work. As a Taiwan government spokeswoman, lauding her country’s single-payer system for its successful containment of Covid-19, told NBC News, “Taiwan’s health insurance lets everyone not be afraid to go to the hospital. If you suspect you have coronavirus, you won’t have to worry that you can’t afford the hospital visit to get tested.”

On Wednesday, Trump signed into law a bill that would make Covid-19 testing – but not treatment – free. It’s hence inadequate, given the predicted looming surge in hospitalizations from Covid-19 pneumonia. After all, 30 million Americans are uninsured – a number that will surely grow as the economy tanks and millions or tens of millions of Americans lose their jobs. Even more are underinsured, and for these individuals, co-pays and deductibles will only become more unaffordable as disposable income falls and savings dwindle. For both groups, medical bills for an intensive care unit (ICU) stay for Covid-19 could be devastating. People, of course, will also not stop having heart attacks, cancer or traffic accidents during this outbreak – on the contrary, medical needs are likely to rise in the face of a recession, as unemployment and misery takes its toll on the nation’s health. Financial ruin from medical costs – whether it stems from Covid-19 pneumonia or the looming Covid-19 recession – is financial ruin all the same, and will compound the harm of the epidemic.

But there’s more to it than that. We need single-payer not only to protect us from healthcare costs, but to transform our healthcare infrastructure. In recent weeks, you may have heard that the US, despite our high healthcare spending, has fewer hospital beds per capita than many other wealthy nations. You may have also heard in recent years about an epidemic of hospital closures in poorly served rural areas, or the 2019 closure of a major academic safety-net hospital in Philadelphia. These hospitals closed not because they are unneeded, but because they are unprofitable. For the American hospital landscape is shaped by market forces, which largely determine where hospitals grow and where they wane.

At the same time, while our hospital bed supply is relatively low, our ICU bed supply per capita is among the highest in the world. Yet those beds aren’t necessarily where they need to be: a 2010 study in the Journal of American Medical Association, for instance, found large regional disparities in the distribution of ICU beds; the researchers concluded that in the face of a major epidemic, some areas might have empty beds, while others would have too few. Again, this distribution, far too often, is driven by market logic – not health needs.

Finally, healthcare in America is uncoordinated – and ungoverned. Since the epidemic’s onset, hospital and city and state governments have waged “bidding wars” over crucial supplies and ventilators, the New York Times noted. It’s every hospital for itself: some are resorting to pleas to the community for donations of masks; presumably, others are well-stocked – but who knows? “Respirators, ventilators, all of the equipment – try getting it yourselves,” Trump suggested to state governors on Monday, quoted by the New York Times. This is not a healthcare system – it is atomized chaos. For again, in the American way of paying for healthcare, our hospitals (or increasingly, our multi-hospital systems) are silos, some rich and some poor, each fending for themselves, locked in market competition.

This is neither necessary nor rational, leading both to excess and shortfalls, to generous overall health system funding yet care that remains unaffordable for many. A single-payer national health program would allow us to move past the market-driven status quo to remake this chaotic healthcare landscape of simultaneous healthcare plenty and poverty. It would, in short, allow us to begin to plan – not merely for this epidemic, but for the one that follows.

Dr. Adam Gaffney is an instructor in medicine at Harvard Medical School and a pulmonary and critical care doctor at the Cambridge Health Alliance. He is President of the advocacy organization Physicians for a National Health Program. He blogs at theprogressivephysician.org.

https://www.theguardian.com…

Why the U.S. failed the coronavirus test

By Marcia Angell, M.D.
Santa Fe New Mexican, March 21, 2020

The coronavirus pandemic is the best argument for “Medicare for All.” As it stands, most Americans get health care only if we have insurance that will pay for it. If we don’t or we can’t afford the deductibles and copayments, too bad. Every other advanced country provides universal health care in a predominately nonprofit system.

What happens, then, when Americans develop a fever and cough? Are they likely to seek medical help, despite the hefty bills they are sure to receive, particularly if, say, the radiologist is out of network or the insurance company refuses to pay for some other reason? The new coronavirus, while highly contagious, is usually mild, so people with minimal symptoms might simply take their usual cold remedies while they go about their business and spread the infection widely.

The problem is that we treat health care like a market commodity distributed according to the ability to pay in an uncoordinated system with hundreds of commercial insurers and profit-oriented providers. Some 30 million people have no access to health care because they are uninsured, and millions more don’t use their insurance because the deductibles and copayments are unaffordable. In addition, insurers usually require patients to get their care within a narrow network of providers and exclude certain services.

The shortage of test kits for coronavirus stems from a related problem. Since there was no commercial market for them, they didn’t get made immediately. While we’ve converted health care into a market commodity, we’ve hollowed out our public health system, so it couldn’t do the job.

For all we know, the coronavirus may already have spread widely within the United States. Although it has been in other countries for more than two months, we have not really looked for it here. Until the last week in February, our premier public health agency, the Centers for Disease Control and Prevention, limited its diagnostic testing to symptomatic patients who had traveled to China or had contact with someone known to be infected. This is akin to looking for lost keys only under a lamppost.

The CDC probably could not have done better, given its lack of funding and governmental support. But ignorance is hardly a good public health strategy. Right from the beginning, we should have made test kits available to state and local public health agencies (as was done in Italy and South Korea). The only way to deal with an epidemic of this scope is with a universal health care system like “Medicare for All” and a strong, well-funded public health network.

The political opposition to “Medicare for All” is puzzling, since Medicare is the most popular part of our current fragmented system. In fact, many 64-year-olds can hardly wait to be 65, so they will be eligible. Why, then, do opponents of “Medicare for All” seem to believe that extending this popular program to everyone would be a sacrifice? Would a 64-year-old really prefer private insurance, with its networks and variable benefits, to Medicare, with its free choice of doctors and guaranteed benefits?

It’s true that taxes would have to increase to pay for “Medicare for All,” but the taxes could be as progressive as we wanted. For most Americans, they would probably be completely offset by the elimination of premiums, deductibles and copayments. In addition, the system as a whole would be far more efficient, because of the reduction in our gigantic overhead costs and the elimination of most profits. Most important, cost inflation would slow greatly, so that in a few years we would come out well ahead.

But as important as cost control is, my reason for favoring “Medicare for All” is primarily moral. Health care is not like ordinary consumer goods that people can choose to purchase. Illness is not a choice; it’s a misfortune. So why should people have to pay for it, as if they wanted it? Providing health care, just like providing clean water or police protection or basic education, is simply what decent societies should do. And during an epidemic, it protects all of us. The coronavirus pandemic powerfully underscores the need for a coherent national health system, in which we all pull together.

Marcia Angell is a member of Harvard Medical School’s Department of Global Health and Social Medicine, and a former editor-in-chief of the New England Journal of Medicine. She will soon be a resident of Santa Fe.

https://www.santafenewmexican.com…

Dr. Paul Song on “The Issue Is”

PNHP national board member Dr. Paul Song appeared on “The Issue Is” on March 21, 2020. He discussed the growing COVID-19 pandemic, how it threatens the health and well-being of millions, and how inequality in U.S. health care makes it harder to address the crisis. Dr. Song also discussed the rising threat of racism directed at Asian-Americans owing in no small part to President Trump mislabeling COVID-19 as the “China Virus.”

Emergency coronavirus funds for American Indians languish in bureaucratic limbo

Exclusive: Emergency coronavirus funds for American Indian health stalled

Tribes say they’ve been forgotten in Trump’s coronavirus response and are running dangerously low on medical supplies.

By Adam Cancryn
POLITICO, March 20, 2020

The Trump administration has held up $40 million in emergency aid Congress approved earlier this month to help American Indians combat the coronavirus — a delay that’s left tribal leaders across the nation frustrated and ill-equipped to respond to the fast-growing outbreak.

The number of confirmed coronavirus cases among American Indians has risen in recent days, from four earlier this week to easily more than a dozen. The Navajo Nation has recorded cases 14 alone, and on Thursday, a Cherokee Nation citizen became the first person in Oklahoma to die from the virus just a day after testing positive.

The funding has languished in bureaucratic limbo for weeks, despite increasingly urgent pleas from tribal organizations desperate to stockpile essential supplies and keep health clinics operational. Federally run American Indian health facilities are well short on hospital beds and ventilators, some frontline clinics received fewer than a dozen coronavirus tests, and federal officials have already signaled there will be little in the way of reinforcements — telling tribal leaders that all they can send right now are expired respirators.

That’s fueled alarm throughout American Indian country and on Capitol Hill, where advocates warn the administration has done comparatively little to protect American Indians as it plans drastic action elsewhere to protect vulnerable populations and slow the virus’ spread.

Pressed further on IHS’ readiness, one IHS official characterized the agency as a “shoestring operation.” At another point, (chief medical officer Michael Toedt) downplayed the threat by telling staffers that “IHS believes this virus will be slower to reach Indian country,” according to a person on the call.

Tribes rely heavily on IHS facilities, which provide many health care services to American Indians and Alaska Natives at no cost under the federal government’s long-held trust responsibility. Over a quarter of the tribal population in the U.S. is uninsured, more than double the national rate.

In a survey published Tuesday by the National Indian Health Board, just 16 percent of its tribal leaders, providers and partners reported receiving federal resources of any form to aid the response. Even fewer — 4 percent — had received basic protective equipment.

https://www.politico.com…

Comment:

By Don McCanne, M.D.

We took their lands and then…

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Masks, Gowns, and Medicare For All

Thoughts and prayers are nice, but healthcare workers need Medicare for All

If patients want to support healthcare workers on the frontlines of the coronavirus pandemic, they should join us in calling for a universal, single-payer healthcare system.

By Jonathan Michels
Piedmont Left Review, March 20, 2020

Any hope that we might emerge from the COVID-19 pandemic unscathed is gone. So far, the novel coronavirus has claimed the lives of 150 Americans and infected 10,442 others. Those figures are certainly higher because access to coronavirus test kits remains severely limited.

I know full well the risks of contracting the deadly disease. I work as a radiology technologist at a large teaching hospital, where patients believed to be suffering from acute respiratory disease are likely to receive a chest x-ray upon check in. That means me.

Like many healthcare workers, I might be infected right now and not even know it because of the lack of testing.

As the coronavirus continues to tear through the United States, there has been a mass outpouring of love and solidarity directed at healthcare workers like me. People have sent us prayers and beautiful songs. More substantively, people have amplified our demands for more personal protective equipment (PPE), like gowns and N95 respirators, as well as paid sick leave.

It means a lot knowing that I have the support of my community.

But it’s not enough.

If patients want to support healthcare workers on the frontlines, they should also join us in calling for a universal, single-payer healthcare system more commonly known as Medicare for All.

Under Medicare for All, coronavirus testing for all US residents would be free at the point of care and more importantly, so would treatment. Providing universal healthcare now will mitigate the damaging effects of COVID-19 and maybe even prevent future pandemics.

Our expensive, inefficient and profit-driven healthcare system has left our communities defenseless against encroaching epidemics, a reality that will come as no surprise to frontline caregivers. We see daily the life-and-death consequences of a medical system in which profits are the chief measure of success.

It was healthcare workers who first sounded the alarm about COVID-19 — weeks before President Trump declared a national health emergency. According to a survey conducted by National Nurses United (NNU), only 30 percent of nurse respondents said they had enough PPE to weather a massive surge in COVID-19 patients.

I can personally attest that at this very moment healthcare workers are treating patients who do not yet know they are positive for coronavirus. Meanwhile, others are caring for confirmed patients without all of the tools to do the job.

It is no coincidence that NNU, the nation’s largest nurses’ union, is also the most vocal proponent for Medicare for All. Nurses understand that the most efficient and affordable way to prevent and contain the spread of diseases like COVID-19 as well as improve the overall health of our communities is to ensure quality healthcare for all Americans, regardless of employment status or ability to pay.

As a healthcare worker, I bear witness to a broad spectrum of suffering; the kind that we are all likely to face at some point during our lives. But what haunts me at the end of each shift is the pain that could have been prevented if patients who are uninsured or underinsured had been able to access care sooner.

So while the scope and severity of the COVID-19 pandemic may be unfathomable, the challenges facing healthcare workers right now like safe staffing ratios and basic supplies are not markedly different from any other day of the week. Our healthcare system routinely undermines caregivers’ ability to treat our patients while maintaining our own safety.

The plan laid out by the presumptive Democratic presidential nominee Joe Biden calls for “eliminating cost barriers for prevention of and care for COVID-19,” but it would bolster and even expand the private health insurance system that is making healthcare workers feel like they are caring for patients with one hand tied behind their backs.

Without transformative health reform like Medicare for All that is based on meeting human needs and not the needs of markets, Americans will continue to die needlessly long after the coronavirus pandemic has ended and the last quarantine is lifted.

Despite some improvements from the Affordable Care Act, 28 million Americans are uninsured, without access to primary care that could prevent costly and life-threatening diseases. An additional 41 million people are underinsured, facing prohibitively expensive co-pays, premiums and deductibles that limit access to care.

Healthcare workers–among the most at risk for contracting COVID-19–are currently not guaranteed access to medical treatment. A 2009 study found that 11 percent of American healthcare workers are uninsured. That’s 1 in 8 caregivers who could be treating coronavirus patients right now.

Medicare for All would prevent more than 68,000 unnecessary deaths each year while saving $450 billion annually in billing costs and administrative waste, according to a study published in The Lancet.

Even if employers provide health insurance, some workers’ low wages prevent them from purchasing coverage. Not only would Medicare for All increase the health of every American, it would be a big step in lifting healthcare workers out of poverty because the money that employers spend on providing health insurance could be shifted to raise wages. That would be life-changing for the estimated 1.7 million female healthcare workers and their children living in poverty.

The staggering complexity of our healthcare system requires a tremendous number of administrative staff and resources which account for a whopping 25 percent of all US healthcare expenditures. Yes, Medicare for All will eliminate around 1.8 million administrative jobs but in turn lead to the demand for 2.3 million full-time healthcare workers to accommodate the millions of patients newly eligible to receive care. This will help ensure that caregivers have the staffing levels they need to safely and swiftly respond to public health crises like COVID-19.

Medicare for All would also give a boost to healthcare workers who want to unionize over unsafe staffing levels and a lack of basic supplies because hospitals would be barred from using public money to bankroll union-busting campaigns. The very groups that have linked rights in the workplace with the health of their patients have been nurses and healthcare unions, most notably National Nurses United.

The pandemic has likely just begun in America but it has already shifted our attention away from ourselves and towards one another as more and more people come to the realization that collective problems require collective answers.

The coronavirus pandemic has exposed the gaping holes in our social and economic safety nets while underscoring the need for a robust medical system that empowers caregivers to truly meet public health challenges, big and small.

That’s not what we have in the US right now, but it could be.

Medicare for All, despite benefiting everyone, will not be won by appeasing medical profiteers. Private health insurers, medical device manufacturers, pharmaceutical companies and banks (which have ensnared millions of Americans indebted by medical expenses) stand to lose too much if America moves to a single-payer system.

The growing enthusiasm around Medicare for All represents an existential threat to private interests. In a similar act of solidarity, they have coalesced to form the Partnership for America’s Health Care Future in order to stymie the Medicare-for-All movement and keep the money flowing for as long as they can.

Voters have been inundated with anti-Medicare-for-All attack ads bankrolled by the Partnership in an attempt to turn them away from candidates like Democratic nominee Bernie Sanders who support the popular health reform. The dark money group reportedly spent a whopping 50 percent of all political advertising in advance of the Iowa caucus.

In addition to lobbying against universal healthcare, members of the Partnership are advocating for a $100 billion aid package for American hospitals. Leading the charge are the for-profit hospital corporations represented by the American Hospital Association, which stands to win big on the suffering of Americans amidst the coronavirus pandemic.

Americans have a choice. What do we value more — corporate interests? Or each other?

Healthcare workers standing on the frontlines will not be enough to counter the well-financed interests standing in the way of transformative health reform. Thoughts and prayers are nice, but what healthcare workers actually need is for patients to join us in demanding Medicare for All.

Jonathan Michels is a freelance journalist and healthcare worker based in Durham, North Carolina.

https://piedmontleftreview.com…

COVID-19 pandemic provides strong case for Medicare for all

By James Binder, M.D.
The Cincinnati Inquirer, March 20, 2020

I am one of the 23,000 members of the Physicians for a National Health Program (PNHP) who advocate for Medicare for all. Our current health crisis provides strong evidence that we indeed do need a Medicare for all system in this country. Part of the reason the United States has responded so poorly to the crisis is the fragmented, chaotic nature of our private health care system. Of course, the inept and dishonest approach of the White House contributed tremendously to the problem early on, but even this would have been significantly mitigated if we had had a Medicare for all health care system.

 Medicare for all would build an infrastructure that would support caring for all our citizens health during a crisis. In a Medicare for all system, everybody is automatically covered and their information is all in one system. This would allow us to track patients and make timely interventions. This was crucial to Taiwan’s success in containing the COVID-19 virus. Our multiple insurers each have their own system of data collection, which is not shared. In addition, the tens of millions of people who are uninsured are not even in the system.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recently testified before Congress that our current system is not set up to be able to quickly test a number of people, testing that is critical to controlling the early spread of COVID-19. Countries with a solid health care infrastructure are better able to respond to threats like COVID -19. Germany was able to do extensive testing to slow the early spread of the virus because they have a widespread network or regional laboratories. In other words, they had an infrastructure that supported the health needs of the country, not the profits of insurers.

Taiwan was able to make a strong response to COVID-19. Taiwan is only 81 miles from the mainland of China. They were expected to have the second-highest number of cases of COVID-19. Instead, they have had 108 cases and only one death so far. After the 2003 SARs epidemic, Taiwan created a health plan to deal with potential pandemics. Taiwan has a single-payer health care system, which allows it to do real health planning and place a priority on prevention. Private insurers do not invest in prevention because prevention is not in the financial interest of insurance companies with their high patient turnover.

Although this crisis highlights our need for Medicare for all, there are other important reasons for single-payer. Patients with diabetes mellitus can’t afford their insulin and some die tragically. Patients with other chronic conditions are uninsured or underinsured and delay care that would have prevented serious complications. Problems with access, quality and comprehensiveness, racial disparities in health care, unaffordable long-term care of the elderly, and poor rural health care would all improve significantly in a Medicare for all.

When people work together in solidarity and common purpose, they accomplish more through coordination than individuals can on their own. And they feel good about caring for each other. Canadians are proud of including everyone.

Dr. James Binder is co-founder of the Cincinnati Chapter-Physicians for a National Health Program (PNHP).

https://www.cincinnati.com…

Protect workers, provide health coverage

By Joyce Schlag, CCW
Pittsburgh Post-Gazette, Letters, March 19, 2020

We are all connected, a community of people experiencing vulnerability in the face of the coronavirus which threatens us, our families, neighbors and friends. We are becoming aware of how the well being of one person can affect the well being of many. This puts a focus on community.   We are all inter-connected in the web of our complicated lives. This pandemic causes interruptions for all of us.

Social distancing, reports of closures, concerns about cascading economic fallout are all part of our national conversation. Health issues such as the availability of tests, treatment, masks, ventilators are high priority. We are missing the conversation about the need for universal health coverage, how important it is, and critical in time of a pandemic.

This is the time when we must call for universal health coverage. This virus should be our wake up call, Many of our own citizens are uninsured or cannot afford medical care. When the public service industry does not provide health coverage for their employees, workers who have much contact with the public are vulnerable. Among others, there are those who work in the food industry, restaurants, bars, fast food places, grocery stores, barber shops, hair salons. They need to be protected, as well as the customers they serve.

Many uninsured workers have low incomes and live paycheck to paycheck. They don’t qualify for government programs, ironically, because they have jobs. Seven out of 10 uninsured have jobs, but no insurance. Others have jobs that offer health care coverage, but the premiums, the deductibles, co-pays and medications essentially make that coverage unaffordable. The reality of at least 29 million uninsured cannot be ignored. There is no safety net for them.

Today, it’s the coronavirus. In the future, there likely will be other infectious diseases that threaten the health of our nation. We can do better. We must have universal health coverage.

https://www.post-gazette.com…

GOP-led states diverge on easing Medicaid access during COVID-19

By Harris Meyer
Modern Healthcare, March 18, 2020

At least two Republican-led states want to temporarily ease their Medicaid waiver requirements and make it easier for residents to get and keep coverage under Medicaid and the Children’s Health Insurance Program during the coronavirus pandemic.

On Tuesday, Arizona and Iowa sent requests to the CMS so they can make temporary changes to their Medicaid programs, including eliminating premiums and pausing disenrollments.

Meanwhile, two other Republican-led states, Oklahoma and Utah, are pushing ahead with Medicaid waiver changes intended to tighten eligibility for expanded coverage to low-income adults under the Affordable Care Act, including work requirements.

The sharply different directions these states are taking illustrate the pull between pragmatic and ideological pressures in the midst of the COVID-19 outbreak, which experts say requires making testing and treatment as accessible and affordable as possible to limit the spread of the epidemic.

“Work requirements and premiums are precisely the kinds of policies that are dangerous now and divert energy for state government staff, who are under enormous stress,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “They need to focus on facilitating as many people’s access to care as they can.”

The Arizona Health Care Cost Containment System’s request would help them mitigate any disruption in care for their members during the emergency declaration, the agency said in a March 17 letter to CMS Administrator Seema Verma.

Iowa asked to temporarily waive premiums and copays and permit continuous eligibility for adults and children. That runs counter to the Trump administration’s effort to test beneficiaries for eligibility more often to ensure program integrity, which has led to hundreds of thousands of people being disenrolled.

Going in the other direction, the Oklahoma Health Care Authority on Monday published its Medicaid Section 1115 waiver application and announced the start of a 30-day public comment period. The waiver would include a work requirement, premiums and co-pays.

Utah is proceeding with its plan to require Medicaid expansion enrollees report at least 48 job searches in the first 90 days of eligibility, as well as to complete an online job readiness survey.

“At a time when the job market is collapsing, the absurdity of that requirement is even more apparent,” Alker said. “I hope good-faith leaders in Utah will drop that requirement, which is a threat to public health.”

Indiana, another Republican-led state that established premiums and other restrictive conditions on coverage through a Section 1115 waiver, did not respond to requests for comment on its plans in light of the pandemic.

A handful of states have limited Medicaid’s traditional 90-day retroactive eligibility when people seek care. Experts warn that may put a heavy financial burden on hospitals serving lots of uninsured, low-income coronavirus patients.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

You would think that the COVID-19 pandemic would provoke state administrators to look for ways of reducing barriers to health care. Expanding Medicaid coverage for low-income individuals would seem to be a logical step, but it appears that some states are making Medicaid access more difficult by adding a work requirement and adding premiums and copays at a time that the job market has collapsed.

How can they? Are their hearts made of stone?

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

Dr. James Kahn on “The Real News Network”

Health systems expert and epidemiology professor Dr. James Kahn appeared on “The Real News Network” on March 19, 2020. He discussed Democratic front-runner Joe Biden’s focus on Italy’s struggles with COVID-19, and pushed back on the notion that single payer “doesn’t work.” Dr. Kahn pointed to the pandemic response in Taiwan and South Korea as examples of how national health systems could address public health emergencies.

Can we put partisan politics aside during the pandemic?

Poll: As Coronavirus Spreads, Fewer Americans See Pandemic As A Real Threat

By Bobby Allyn, Barbara Sprunt
NPR, March 17, 2020

In the face of the coronavirus worsening across the U.S. and reordering the daily life of millions of Americans, fewer people view the pandemic as a real threat, according to a new NPR/PBS NewsHour/Marist poll.

Just about 56% of Americans consider the coronavirus a “real threat,” representing a drop of 10 percentage points from last month. At the same time, a growing number of Americans think the coronavirus is being “blown out of proportion.”

The differences between political parties are stark, with a majority of Republicans saying it is overblown and the vast majority of Democrats considering it a legitimate threat.

“Since the pandemic has taken root and grown in the United States, Democrats and Republicans are now poles apart,” said Lee Miringoff, director of the Marist College Institute of Public Opinion. “The consequences of these differing perspectives are shaping how people are responding to calls for action.”

Overall, fewer than half of U.S. adults are changing behaviors such as eating from home more often or canceling plans to avoid crowds, as recommended.

The poll was conducted Friday and Saturday, beginning the same day President Trump declared a national emergency, and before Tuesday’s stricter guidelines from the administration on social distancing.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has cautioned, “The worst is yet ahead for us.”

Views on the threat level

In February, a little more than a quarter of U.S. adults believed the coronavirus was being blown out of proportion. Now, that number has risen to nearly 40% of respondents.

Pollsters found that both shifts are largely driven by changes in opinion by Republicans. For instance, 72% of Republicans saw the coronavirus as a real threat in early February, but that figure has now plummeted to 40% of Republicans now believing the deadly virus is a serious menace.

And a majority of Republicans — 54% — now say the response to the coronavirus is overblown, a significant jump from last month, when about 23% of Republicans held that view.

Fewer independents, too, see the coronavirus as a real threat. Fifty percent of them view it as such now, compared with 64% of independents last month who said the virus was legitimately threatening.

Democrats remained the most unchanged on this question. An increasing number of them — 76% — now say the danger of the coronavirus is real, up from 70% last month.

Changing your behavior? Depends on your party

Some 59% of Democrats report they have made a point to dodge large gatherings, while 60% of Republicans and 54% of independents have not.

The same party division is illustrated in something as routine as choosing to eat at home versus dining out. About 60% of Democrats say they are eating in more often because of the virus, while 63% of Republicans and 60% of independents are not. (A number of states have recently banned eating out, limiting restaurants to takeout to enforce social distancing.)

https://www.npr.org…

Fauci successfully walks tightrope with Trump

By Morgan Chalfant and Brett Samuels
The Hill, March 18, 2020

Dr. Anthony Fauci has become one of the most important public figures in Washington amid a coronavirus pandemic that is quickly changing American life.

Fauci has been at the helm of the National Institute of Allergy and Infectious Diseases for nearly four decades, but the global virus shutting down much of the U.S. economy has thrust him to the forefront of the federal government’s effort to address the crisis.

At briefing after briefing, Fauci takes a factual, no-nonsense approach — one that at times has created a dissonance with President Trump, who in the past has clashed with officials who have publicly contradicted him.

There appears to be little if any friction, however, between Trump and Fauci, who has avoided direct criticism of the president and earned plaudits from members of both parties for conveying a sense of control in a crisis.

He’s seemed to win over Trump, too.

Trump, who views media coverage as a critical barometer, declared that the 79-year-old Fauci had “become a major television star.” Fauci appeared on every major Sunday show over the weekend to discuss the administration’s response efforts.

At a press briefing on Tuesday, Trump looked to be listening intently as Fauci spoke about specific data and efforts to “flatten the curve” and stave off the worst of the pandemic. When Fauci at one point stepped away from the podium, Trump urged him to keep taking questions.

Trump has also adopted a new tone this week in discussing the coronavirus, taking heed of calls from public health experts to recommend that Americans drastically limit their contact with others to prevent the spread of the virus.

People in the health community say Fauci’s role has been important and note that the White House has not pushed back on or silenced the top health official after he has contradicted the president.

“When there are misconceptions or misperceptions … he is right then and there interjecting, which we should all be very thankful for because if it wasn’t him, we don’t know who would be that person,” said (Dr. Anand Parekh, chief medical adviser at the Bipartisan Policy Center). “As much as it matters to hear from government leaders, it’s really the scientists that need to have the voice here.”

Only 37 percent of Americans have a good or great deal of trust in what they’re hearing from Trump on the coronavirus, while 84 percent say they have such trust in what they’re hearing from public health experts, according to an NPR-Marist poll released Tuesday.

https://thehill.com…

Comment:

By Don McCanne, M.D.

Unfortunately, President Trump did not get off to a sterling start in his response to the coronavirus crisis. He first wanted to minimize it so as to not distract from his campaign for reelection, and then when it appeared to be a more serious problem, he seemed more concerned about its impact on the economy rather than the potentially disastrous consequences that it would have on the health of the people (numbers counted more than people).

What is disconcerting is that the highly polarized political environment in this nation has extended into molding the public and private responses to this pending pandemic of the Covid-19 virus. As the NPR/PBS NewsHour/Marist poll shows, Democrats were more concerned about the health consequences of Covid-19, whereas the Republicans seemed to follow the lead of President Trump, dismissing it as an overblown threat, often to the point of failing to take recommended personal safeguards to prevent infection with this potentially lethal agent.

We’ve said many times that we support optimal health policy but that politics has kept us from implementing those policies. If there ever were a time that we should set politics aside and move on with optimal policy, it certainly should be now. Millions of lives are potentially at stake.

It is reassuring to see that President Trump seems to have had an epiphany and now wants to move forward with aggressive policies to help reduce both the adverse health and economic consequences of this pandemic. In selecting Anthony Fauci to provide unrestrained guidance and direction in our national response, and then calling for implementation of public health measures based on sound policy science, the president has shown that he is now truly concerned.

The question at this point is whether Trump’s base will follow him forward and begin to support the measures that we must take to reduce the intensity of harm caused by the Covid-19 havoc, or will they stand firm in insisting that this threat is overblown and thus they do not need to adhere to the recommended preventive measures. If they do decide to move in the right direction, following President Trump, then it would demonstrate a very important point – that is that politics can be manipulated to enable forward movement with policies designed to benefit the public good. It would also demonstrate the importance of leadership in good governance. Let’s hope.

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Coronavirus: A good argument for Medicare for All

By Alice Rothchild, M.D.
The Seattle Times, March 18, 2020

As an obstetrician-gynecologist and member of Physicians for a National Health Program, I have long supported sweeping changes in how health care in the U.S. is financed, from challenging the cost and gate-keeping roles of health-insurance companies to the price gouging by big pharma. COVID-19 has laid bare the weaknesses in our system and the urgent need for Medicare for All. We cannot nationally isolate or personally buy our way out of this outbreak.

As Washingtonians shelter at home and our economy plunges into recession, the problem with a health-insurance system based on employment becomes increasingly clear. Workers are financially incentivized to avoid screening and show up for work despite symptoms. The threat from loss of wages for small businesses and gig workers as well as those on unpaid sick leave raises the negative impact of insurance payments, copays, premiums and the ability to self-pay. GoFundMe reports that a third of its campaigns are done to pay medical bills. The Trump administration’s talk of sending $250 billion directly to millions of Americans is a desperately needed temporary fix that will explode the deficit and ignore the demands for structural changes.

To make matters worse, the Trump administration’s public-charge rule, recently upheld by the U.S. Supreme Court, allows federal officials to refuse immigrants green cards if they use social-safety-net programs. Add to that the tens of thousands of migrants and asylum seekers housed in the more than 200 immigrant prisons and jails in the U.S., not to mention our general prison population, and we have a vast pool of vulnerable, disenfranchised people who suffer from lack of access to adequate nutrition, health care and housing. Poor communities are most susceptible to infectious disease and to a lack of resources to screen and treat. Recently, 700 public-health experts called on the federal government to maintain safety programs, to fund local health centers in underresourced areas, and to be sure that testing, vaccines and treatment be available regardless of ability to pay.

Even before this crisis, millions of U.S. citizens suffered financial disasters due to medical bills, were forced to declare personal bankruptcy, or forego needed care. Some polling shows there is support for Medicare for All, even in populations that are “satisfied” with their health insurer. Often not reported is that Medicare and Medicaid recipients are even more likely to be “satisfied.” The myth that most citizens are “happy” with their private insurance belies the fact that the private health-insurance industry restricts our choices, dictating which physicians, hospitals, treatments or medications we can use. Under Medicare for All, every physician would be in-network, and physicians and their staff would not spend hours battling with insurers.

Ironically, despite the fact that we spend much more money on health care than other first world countries, we are not the healthiest. U.S. infant mortality is 5.8 per thousand live births, in Canada 4.5 and Britain 4.3. The “mortality amenable to health care,” i.e., deaths that could have been prevented by medical intervention, also reveals distressing numbers: 112 per 100,000 in the U.S., but 78 in Canada, and 85 in the U.K.

Medicare for All would restrain drug prices and dismantle wasteful administrative costs, freeing up billions of dollars for health care. This isn’t about restricting care, but rather developing a more effective and fair way to pay for it. Traditional Medicare spends about 2% on administration, less than one-sixth the cost of private health insurance companies.

The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.

Dr. Alice Rothchild is a Seattle author, filmmaker, and retired obstetrician-gynecologist. She is the author of three books, most recently “Condition Critical: Life and Death in Israel/Palestine,” and has contributed to a number of anthologies including “Reclaiming Judaism from Zionism: Stories of Personal Transformation.”

https://www.seattletimes.com…