PNHP

Another gift of COVID-19: Medical bankruptcy

Another gift of COVID-19: Medical bankruptcy

The threat of coronavirus medical bankruptcy

By Allison K. Hoffman
The Hill, April 1, 2020

With three relief bills passed, Congress addressed the most immediate health and economic threats from COVID-19. Yet, it has neglected a secondary threat that follows just behind. Many Americans will face unmanageable medical bills for coronavirus care.

The relief legislation that Congress passed over the past two weeks addressed only a small sliver of the costs of COVID-19 medical care, primarily to remove financial barriers to testing. The second and third relief bills required health plans to cover COVID-19 testing and medical visits related to that testing without any cost to patients. It also did the same for future preventive care or a vaccine, if either becomes available. These are laudable steps, but not enough.

Congress must address the debt that many Americans will face for medical care when they become infected with COVID-19. More than 180,000 Americans have tested positive, and the number of new cases grows exponentially. Early estimates of the cost of intensive inpatient COVID-19 care range from $20,000 to over $70,000. Many people will be left with a sizable part of that bill, or all of it, possibly at the same time that they lose their jobs (3.3 million people already have filed for unemployment). Unless Congress acts, the costs of coronavirus medical care will cripple many American families.

People in the U.S. are financially vulnerable to coronavirus because of four deeper problems with how we pay for health care.

The first is cost sharing. People in the U.S. face higher cost sharing than in most of our peer nations, which means that even after paying premiums, they are still responsible for more of the costs of their care. This problem is especially acute for someone who does not have insurance through work. For someone who buys a health plan directly, such as through an Affordable Care Act (ACA) exchange, the average annual deductible, or the amount of money she must pay for health care on her own before the insurance plan starts to pay, can be upwards of $4,000 for single coverage and more than twice that for family plans.

For those with insurance through an employer, over fifty percent have deductibles of $1,000 for single coverage and the average deductible for family coverage is nearly $5,000. Even once a deductible is exhausted, people are often still responsible for a share of the costs of their care. The ACA caps total out-of-pocket spending on health care, but this out-of-pocket maximum ($8,150 for an individual and $16,300 for a family in 2020) does not apply to all spending. For example, it largely does not apply to bills for out-of-network care. Aetna was the first insurer to voluntarily waive cost sharing for coronavirus care, but only for some of its plans and only in-network care. Humana and Cigna followed. These private, voluntary efforts are meaningful but will reach only some insured.

Second, overall prices for medical care in the U.S. are high compared to peer nations. This means a high baseline on which cost sharing is calculated.

The third is the especially high price tag for out-of-network medical care. Insurers negotiate prices with in-network providers. Otherwise, the sticker price, or “chargemaster” price applies, and it can be many times higher than already high negotiated rates (see point two). Some uninsured face chargemaster rates subject to ACA limitations, and even people with insurance might be subject to them for out-of-network care.

Even in normal times, someone might use out-of-network care without intending to do so. He or she might go to an in-network hospital but receive treatment from an out-of-network doctor or be transported by an out-of-network ambulance to the hospital. This care can result in extremely high surprise medical bills. By one estimate, 18 percent of in-network admissions for pneumonia with major complications led to an out-of-network bill. Even more, as hospitals reach capacity, someone might not have the choice of an in-network hospital. Congressional efforts to stop surprise medical bills have stalled out.

The fourth is lack of insurance. Even 10 years after the ACA was passed, 10 percent of the population under age 65 remains uninsured, many of whom cannot afford insurance and are the least able to pay for unanticipated medical care.

These problems will be counterbalanced if intensive care is more common among older Medicare beneficiaries, who are the best insured population. But even they face cost sharing in some cases, and most are retirees with fixed incomes.

With the third relief bill, the Coronavirus Aid, Relief, and Economic Security Act (CARES), Congress provided needed aid to families through cash and unemployment support. But this support is temporary and for most families will pay for basic needs like food and housing. Many families lack reserves for unplanned medical care expenses.

The legislation that House Democrats proposed as an alternative to CARES, Take Responsibility for Workers and Families Act, addresses these gaps to some degree. It eliminated cost-sharing for coronavirus care and complications, providing federal funds to reimburse private insurers these costs. It also attempted to increase the number of insured Americans. It gave states the option to cover COVID-19 care for the uninsured through Medicaid, provided premium assistance for people who lose a job to keep their health plan under COBRA, and created special enrollment periods to sign up for an ACA plan or, for Medicare enrollees, to sign up for supplemental insurance coverage.

Even this proposed bill, a significant step forward overall, left gaps. For example, it recognized but did not fix surprise medical billing, and it left some Americans uninsured. But it offers a starting place for round four of relief legislation. Congress cannot devise a quick fix to these four large structural problems, but it can and must act now to head off avoidable coronavirus bankruptcies and financial stress.

Allison Hoffman teaches health law and health law reform at the University of Pennsylvania Law School, where she is also a senior fellow of the Leonard Davis Institute of Health Economics. She is co-editor of the Oxford Handbook of U.S. Health Law, which offers the most comprehensive review of U.S. health law in the post-ACA era.

https://thehill.com…

Comment:

By Don McCanne, M.D.

As of 2020, our national health expenditures are $4 trillion, or $12,118 per capita. Considering that we are already spending that much, you would think that everyone could receive health care without experiencing financial hardship. But in spite of employer-sponsored health plans, in spite of individual plans within or outside of the ACA exchanges, in spite of Medicare, in spite of Medicaid, in spite of publicly-funded safety-net institutions, and in spite of the cash market in health care, Professor Allison Hoffman shows us that our method of allocating these very generous funds is highly dysfunctional – to the degree that the additional stress of the COVID-19 pandemic will significantly expand the already too prevalent problem of personal financial hardship and bankruptcy.

Congress has already passed three emergency relief bills, and Hoffman describes a fourth bill that is urgently needed. Because our current health care financing system does not have even as much integrity as a mangled sieve, it is imperative that this fourth bill be passed.

There is a very important lesson here. We have enough funds to support a high performance health care system that can take care of everyone, even in a crisis, but the financing infrastructure is a disaster. We have four approaches that we can take:

1) Do nothing. That would leave in place the four major problems that Hoffman describes not to mention the multitude of other dysfunctions of our current system. Polls confirm that the public wants reform.

2) We could reduce public funding and rely more heavily on the marketplace through consumer-directed health care. Kenneth Arrow explained many decades ago why the market cannot possibly ensure that everyone has access to essential health care services. Even Friedrich Hayek advocated for the state helping to organize a comprehensive system of social insurance. At nearly one-fifth of our economy, the health care marketplace is unaffordable for the majority of Americans.

3) We could apply patches to our current system and add a public insurance option. This would leave in place the highly inefficient and inequitable financing infrastructure with its profound, costly administrative excesses. It would leave in place the private insurance industry which has been responsible for much of the dysfunction in our system. It is by far the most expensive model of reform and yet still would fall far short of a high performance system.

4) We could build a new financing infrastructure by correcting the deficiencies in the Medicare program and then expanding it to include everyone. By funding a universal risk pool with equitable progressive taxes, health care would become affordable for each and every one of us. Besides, this would be the least expensive model of truly comprehensive reform, likely costing less than what we are now spending, primarily because we would be recovering the profound administrative waste in our system.

Today we have no choice but to tackle directly the problems that have been dumped on us by this pandemic. While most of us have been diverted from engaging in many of our usual activities, it should give us reason to give more thought to strategies to fix our health system, not only to be prepared for catastrophic epidemics, but also to be much better prepared to deal with prevention and management of everyday health problems, you know, that $4 trillion of health care that we are already receiving – only we need to fix how we allocate those funds so the system works well for all of us. We need a well designed, single payer, improved Medicare for All.

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Hospitals Got $100 Billion in the Stimulus Package. But A Lot of That Could Go Toward Administrative Costs.

By Abigail Abrams
TIME, April 1, 2020

Hospitals have spent the past few weeks racing to respond to the growing COVID-19 crisis, supplementing shortages of equipment, calling back retired personnel, and transforming entire hospital wings to care for infected patients. So when Congress included $100 billion in the stimulus package passed last week to help hospitals and other health care providers address the pandemic, it was seen as much-needed assistance.

But that’s not the whole story, health care experts say. Due to the patchwork nature of the U.S. health care system, a huge chunk of those emergency funds likely won’t go to lifesaving care or equipment, but to underwriting the astronomical administrative costs of negotiating a complicated network of private insurance providers and other bureaucratic functions.

Advocates of single-payer government health care, like Medicare for All, say that’s yet another reason to support an overhaul of the U.S. health system. “We have a privatized and fragmented healthcare system and it makes administrative costs high and consumes a huge piece of our total health spending,” says Dr. Steffie Woolhandler, a professor of public health at CUNY’s Hunter College, who supports a single-payer system.

A study co-authored by Woolhandler published in the Annals of Internal Medicine earlier this year found that administrative costs now account for about 34% of U.S. health care expenditures. That’s twice the percentage Canada spends. For hospitals alone, the mean share of expenditures devoted to administrative costs in the U.S. was 26.6%.

Those percentages will likely be similar for this relief funding, Woolhandler says. If they are, that means that of the $100 billion hospital relief funds, hospitals would spend in the neighborhood of $26 billion on administrative overhead.

“All of the things that they need to do to administer in a non-crisis situation and collect money, they’re going to have to do with the bailout funds,” Woolhandler says. “I think the administrative costs for $100 billion dollars delivered in this way are going to be slightly lower than the average administrative costs. So at least by several percentage points. But still, the hospital runs the way it runs.”

The text of the stimulus bill says the money must be spent on health care expenses or lost revenues directly related to COVID-19 that will not otherwise be reimbursed.

Of course, any hospital or health care system must spend on administrative costs to function. A dedicated staff must order supplies, do payroll and keep records. But, Woolhandler notes, U.S. hospital costs are exceptionally high. While the Annals study, which was co-authored by Woolhandler, Dr. David Himmelstein and Terry Campbell, was the first major effort to calculate spending across the whole U.S. health care system in nearly two decades, a 2018 study in JAMA looked at billing costs for different kinds of doctor’s visits. It found that billing and administrative costs made up 25.3% of revenue for emergency department visits. For primary care and surgery visits, a smaller portion of revenue went to billing costs.

The COVID-19 pandemic doesn’t change that underlying reality. Hospitals must still negotiate with insurance companies, attach proper codes to each procedure, and engage in a vast billing bureaucracy. Congress recently made COVID-19 testing ostensibly free with its Families First Coronavirus Response Act, and a growing number of private insurance companies have said they will waive prior authorization requirements and in some cases get rid of cost-sharing for coronavirus-related treatment. But the same is not true for all companies, and given the many ways that Americans pay for health care, there are still plenty of administrative tasks to be done, even for patients without any insurance or whose care is getting reimbursed by the federal government.

“There are just a lot of differences in the kind of policies. And so I think that can end up leading to some back and forth between the providers, consumers and the insurers in terms of getting those claims processed,” says Jodi Liu, a policy researcher who studies health care financing at the RAND Corporation. “That makes things more complicated and typically does add on more cost than it would if it was one uniform system.”

In other countries like Canada or the U.K., which have single-payer systems, Liu notes health care providers are not burdened with the task of determining which patient is covered by which company’s plan, which procedures or treatments are covered under what cost-sharing agreement, and which interventions require prior insurance approval.

“Normally at a hospital, when someone comes in, you take their insurance information, you keep track of every service they use individually, every band-aid, every penicillin shot,” Woolhandler says. If out-of-pocket costs have been waived for some people, or if federal stimulus money is reimbursing a hospital for some of its losses, staff might be able to skip a few steps by not sending a bill to an insurance company. “But all of the other steps involved that contribute to the administrative costs are really baked into the way hospitals run now,” she says.

The stimulus funding also comes with a new round of administrative tasks: reporting requirements. The law says that recipients must “submit reports and maintain documentation” to “ensure compliance with conditions that are imposed” by the bill, and that the Health and Human Services Secretary will determine the form of those reports. That means the federal government will still require hospitals to perform a series of administrative functions, and thus spend time and money, to document the emergency funding.

Woolhandler, who has been a long-time advocate for single-payer health care, said the patchwork nature of the U.S. health care system not only contributes to high administrative costs, but also to the competition that has broken out among hospitals and states for essential equipment such as ventilators and ICU beds amid the pandemic.

“I think that’s a terrible way to run a health care system in good times. Because I think the quality of care actually can go up if people develop best practices in their own hospital and share it with other people,” Woolhandler says. “But it’s a disaster right now with every hospital running out and trying to get their own supply chain of equipment, keep their own hospital staffed, even if the staff are needed across town or across the state line.”

Other advocates for health care reform have also noted the ways that the fragmented U.S. system is buckling under the current pandemic. From the beginning of the coronavirus outbreak, it was difficult for many Americans to get tested for the disease. And even as testing has become somewhat more widely available, millions of Americans still fear facing high bills from services related to testing or treatment.

Dr. Adam Gaffney, an instructor in medicine at Harvard Medical School and president of the advocacy group Physicians for a National Health Program, recently called the American system “atomized chaos” in a piece for The Guardian arguing that a single-payer system could help address both the problems patients see with high costs and the hospitals that are struggling to stay afloat while treating COVID-19.

“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,” Gaffney wrote. “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.”

https://time.com…

Drs. Claudia Fegan and Susan Rogers on WGN News

PNHP national coordinator Dr. Claudia Fegan and PNHP president-elect Dr. Susan Rogers appeared on WGN News on April 1, 2020. They discussed the ways in which persistent disparities in U.S. health care could make COVID-19 even deadlier for minority and low-income communities. Drs. Fegan and Rogers cited lack of coverage and lack of community medical facilities as major concerns.

Saez and Zucman explain how we can protect our health and save our economy

Jobs Aren’t Being Destroyed This Fast Elsewhere. Why Is That?

It’s not too late to start protecting employment or to make medical care for Covid-19 free.

By Emmanuel Saez and Gabriel Zucman
The New York Times, March 30, 2020

The coronavirus pandemic is laying bare structural deficiencies in America’s social programs. The relief package passed by Congress last week provides emergency fixes for some of these issues, but it also leaves critical problems untouched. To avoid a Great Depression, Congress must quickly design a more forceful response to the crisis.

Start with the labor market. In just one week, from March 15 to March 21, 3.3 million workers filed for unemployment insurance. According to some projections, the unemployment rate might rise as high as 30 percent in the second quarter of 2020.

This dramatic spike in jobless claims is an American peculiarity. In almost no other country are jobs being destroyed so fast. Why? Because throughout the world, governments are protecting employment. Workers keep their jobs, even in industries that are shut down. The government covers most of their wage through direct payments to employers. Wages are, in effect, socialized for the duration of the crisis.

Instead of safeguarding employment, America is relying on beefed-up unemployment benefits to shield laid-off workers from economic hardship. To give just one example, in both the United States and Britain, the government is asking restaurant workers to stay home. But in Britain, workers are receiving 80 percent of their pay (up to £2,500 a month, or $3,125) and are guaranteed to get their job back once the shutdown is over. In America, the workers are laid off; they must then file for unemployment insurance and wait for the economy to start up again before they can apply for a new job, and if all goes well, sign a new contract and resume working.

Even if unemployment is generously compensated — as it is in the $2.2 trillion bill Congress passed — there is nothing efficient in letting the unemployment rate rise to double digits. Losing one’s job is anxiety inducing. Applying for unemployment benefits is burdensome. The unemployment system risks being swamped soon by tens of millions of claims. Although some businesses may rehire their workers once the shutdown is over, others will have disappeared. When social distancing ends, millions of employer-employee relationships will have been destroyed, slowing down the recovery. In Europe, people will be able to return to work, as if they had been on a long, government-paid leave.

The battle for the speediest recovery starts today. The next congressional bill needs measures to protect employment for the duration of the shutdown. This does not raise insuperable technical difficulties. The bill passed last week provides support for wages in one industry, airlines. Congress could easily extend this program to other sectors. Some countries — like Germany, with its Kurzarbeit system, a policy aimed at job retention in times of crisis — already had the government infrastructure in place to send workers home while the state replaced most of their lost earnings. But several nations with no experience in that area — like Britain, Ireland and Denmark — were able to introduce brand-new employment guarantee programs on the fly during the epidemic.

This situation for laid-off workers would be bad enough if it were not aggravated by a second American peculiarity. As they are losing their jobs, many workers are also losing their employer-provided health insurance — and now find themselves faced with the Kafkaesque task of obtaining coverage on their own.

One option involves continuing to be covered by one’s former employer, a program known as COBRA. It is prohibitively expensive: Participants have to bear the full cost of insurance, $20,500 per year on average. Another option is to go shopping for a plan on the Affordable Care Act insurance exchange, where one is faced with a bewildering choice between plans like Blue Shield’s Bronze 60 PPO (with a deductible of up to $12,600 per year) and Aetna’s Silver Copay HNOnly (with a $7,000 deductible and up to $14,000 in annual out-of-pocket expenses). The last option is to join the ranks of the uninsured, a catastrophic solution during a pandemic.

The bill passed last week does nothing to reduce co-pays, deductibles or premiums on the insurance exchanges; nor does it reduce the price of COBRA. The next bill should introduce a Covidcare for All program. This federal program would guarantee access to Covid-19 care at no cost to all U.S. residents — no matter their employment status, age or immigration status. Fighting the pandemic starts with eradicating the spread of the virus, which means that everybody must be covered.

The big battles — be they wars or pandemics — are fought and won collectively. In this period of national crisis, hatred of the government is the surest path to self-destruction.

Emmanuel Saez and Gabriel Zucman are economists at the University of California, Berkeley.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

Much has been written about how having an equitable, efficient, comprehensive national health program (i.e., single payer Medicare for All) would have been extremely helpful combating illnesses caused by the coronavirus pandemic. We would still have other problems such as the pending permanent closure of a multitude of businesses that are not able to survive the shutdown that is occurring during this pandemic.

Emmanuel Saez and Gabriel Zucman are experts in income and wealth inequality and the adverse consequences that occur when the one entity that could remedy these problems fails to act, and that entity is the government.

In this article, they provide, as an example, an explanation of how in other nations many of the businesses will survive because of implementation of beneficial government policies. They contrast that with the dire prognosis in the United States which we can expect because of our failure to enact and implement socioeconomic programs that would help protect all of us, even during crises like the current pandemic. A recession would be understandable, but our lack of foresight could result in a prolonged depression.

The authors explain why our current health care financing system is not satisfactory. They propose an emergency financing program, but it would have been far better to have had a single payer Medicare for All system already in place. The crisis is difficult enough without adding the additional task of creating a massive new Covidcare for All program.

We are hardly into our national nightmare and yet the lesson for us is already obvious. We need greater solidarity in working together through our government, and that includes following the Willie Sutton rule (go where the money is) in establishing equitable, progressive taxes.

As Saez and Zucman state, “The big battles — be they wars or pandemics — are fought and won collectively. In this period of national crisis, hatred of the government is the surest path to self-destruction.”

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

Medicare for All Explained Podcast: Episode 31

Interview with Dr. Donald Berwick

March 31, 2020

Former Centers for Medicare and Medicaid Services administrator Dr. Don Berwick outlines four principles for health system reform: cover everybody, improve quality, address the social determinants of health, and reduce total costs. He adds that a single-payer national health program would achieve all of those.

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

https://medicareforallexplained.podbean.com

Justice Department accuses Anthem of Medicare Advantage fraud

Justice Department accuses Anthem of Medicare Advantage fraud

By Shelby Livingston
Modern Healthcare, March 27, 2020

The U.S. Justice Department has sued national health insurer Anthem for fraudulently collecting hundreds of millions of dollars from the Medicare program by exaggerating the illnesses of its members.

The lawsuit, filed Thursday by the U.S. attorney for the Southern District of New York, alleged that Anthem combed patient medical charts to find additional diagnosis codes to submit to the CMS for higher Medicare Advantage payments. But in the process, Anthem chose not to delete thousands of inaccurate diagnosis codes because that would have reduced its revenue, according to the complaint.

This practice, which generated about $100 million a year in additional revenue for Anthem, allowed Anthem to improperly obtain taxpayer funded dollars in violation of the False Claims Act.

“Ultimately, the extraordinary profits that Anthem obtained through its one-sided chart review program came at the expense of the public fisc,” the complaint said.

“This litigation is the latest in a series of investigations on Medicare Advantage plans. The government is trying to hold Anthem and other Medicare Advantage plans to payment standards that CMS does not apply to original Medicare, and those inconsistent standards violate the law,” (Anthem) said.

Payments to Medicare Advantage plans, which enroll about 24 million seniors and people with disabilities, are based in part on the medical conditions of the enrollees. Insurers ultimately are paid more for sicker members with multiple diagnoses and are paid less for healthier members because they use fewer resources. The payment methodology creates a strong incentive for health insurers to submit as many diagnosis codes as possible to drive up payments. The traditional fee-for-service Medicare program does not have the same incentive.

Diagnosis codes are supposed to be backed up by the patient’s medical record, but the federal government has in recent years accused several insurers of disregarding that rule. The Justice Department has also sued UnitedHealth Group over its Medicare Advantage billing practices but so far has been unsuccessful in court.

One Anthem executive called the program a “cash cow,” the complaint states. The insurer’s retrospective chart review program produced a return-on-investment of up to 7 to 1.

According to the lawsuit, one Anthem finance vice president estimated in 2017 that switching from a one-sided chart review to a program that deleted inaccurate codes would reduce the value of chart review for Anthem by 72% or $86 million that year.

“As Anthem knew, identifying and deleting such inaccuracies in its diagnosis code submissions could lead CMS to calculate lower risk adjustment payments to Anthem. So it did not make an effort to do so,” the complaint said.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

Many readers are aware that the private Medicare Advantage plans (previously Medicare + Choice) that were offered as a supposedly higher quality and lower cost option to traditional Medicare successfully engaged in deceptive favorable selection through cherry picking (e.g., marketing their plans to healthier beneficiaries in upstairs restaurant banquet rooms with no elevator) and lemon dropping (e.g., pulling out of markets with a disproportionately high percentage of beneficiaries with major health problems).

Because the insurers were enrolling healthier patients while being paid at rates appropriate for a population that included a greater mix of chronically ill patients, it was recognized that their payment rates needed to be adjusted based on risk. Insurers would be paid more for those patients with greater health problems.

We all know what happened next. Insurers began padding the diagnoses (upcoding) through chart reviews and home visits to make the patients appear more ill than they really were, and at the same time failing to remove diagnoses that were not adequately substantiated. As one Anthem executive said, this proved to be a “cash cow.”

A similar Justice Department lawsuit against UnitedHealth did not get very far basically because adding additional diagnoses supposedly did not constitute a false claim even if the care rendered was not for the specific diagnoses added. That was just a good business practice on the part of the insurer, but that did not refute the fact that they were being paid for healthier patients at rates more appropriate for patients with multiple significant disorders.

Try this experiment: list every disorder you have or have had, no matter how minor – headaches, allergic rhinitis, lumbar myalgia, refractive error, tinnitus, sunburn, pyrosis, URI, Trump disaffection syndrome, contusion, arthralgia, urinary urgency, white coat hypertension, and so on until you’ve listed 50 items. Then look at that list. Wow! Better call the paramedics… Of course, that’s silly, but it simply shows how easy it is to play games with taxpayer funds when you compare the business model of the private insurers with the service model of the public Medicare program.

Look, it’s this private insurance industry that has really screwed up health care financing, wasting tremendous resources while setting up barriers to care, all to benefit their executives and passive shareholders. Why are we giving them a most-favored-status with our Medicare funds, or, for that matter, with funds for employer-sponsored plans, ACA exchange plans, and Medicaid managed care plans? It’s time to dump them and establish our own public single payer Medicare for All program that takes care of all of us equitably and efficiently.

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

You don’t need a pandemic to lose your health plan at work

Millions of Americans are about to lose their health insurance in a pandemic

Americans are about to learn something horrifying: how irrational it is for health insurance to be linked to your employment status

By Wendell Potter
The Guardian, March 27, 2020

The tragic effects of our battle with the novel coronavirus are seemingly endless. But arguably the most mind-blowing is this: the very pandemic that threatens to infect and kill millions is simultaneously causing many to also lose their health coverage at their gravest time of need.

Here’s how: the virus has caused a public health crisis so severe that people have been forced to stay home, causing businesses to shutter and lay off workers. And with roughly half of Americans getting their health insurance from their employer, these layoffs mean not only losing their income but also their medical coverage. In other words, just as our need for medical care skyrockets in the face of a global pandemic, fewer will have health insurance or be able to afford it.

America needs to finally get out of the business of linking health coverage to job status. Even in better times, this arrangement was a bad idea from a health perspective. Most Americans whose families depend on their employers for coverage are just a layoff away from being uninsured. And now, when many businesses are shutting down and considering layoffs, it’s a public health disaster.

It’s worth noting that even in good times, the employer-based model fails to cover enough of us, with the number of Americans covered through an employer steadily dropping in general. Since 1999, the percentage of those with job-based coverage has declined by nine points. And it most certainly will drop like a rock in the coming weeks and months.

https://www.theguardian.com…

Comment:

By Don McCanne, M.D.

A well designed single payer model of an improved Medicare for All would meet the health care financing needs of everyone forever while being affordable for each of us based on our ability to pay. Yet some politicians and pundits keep telling us that we want to protect our choice of continuing to be covered through private insurance, which for about half of us means keeping the insurance we receive through our employment.

But that’s a fallacy. Think back twenty years ago. Do you have the same insurance now that you had then? Likely not, unless you are over 85 and on Medicare or perhaps if your long-term employer has provided benefits under Kaiser Permanente. But most of you have not had the opportunity to continue on the plan you had twenty years ago.

Coverage under employer-sponsored plans is highly unstable. The most common reason is that, each year, over 60 million people leave their jobs and thus lose the coverage they had, if any. Though many will find other coverage through a new employer, through ACA exchanges, through Medicaid if income eligible, or through Medicare if age eligible, virtually none will be able to keep their previous plan once COBRA runs out. Also employers frequently change the plans they offer which often means changing the network of physicians and hospitals that are covered or changing the benefits and cost sharing, especially the deductibles.

Right now, job instability due to the coronavirus pandemic demonstrates how fragile coverage under employer-sponsored plans can be, as Wendell Potter describes in his article. Many of those being laid off will find that their options for health care coverage may be very limited if for no other reason than that the options may be unaffordable if the individual does not qualify for a government subsidized program.

If there ever was an opportune time to talk up single payer improved Medicare for All, that time is now. With the tremendous insecurity that so many of us are facing, it would be a relief if at least we had in place a system that would ensure health security forever, no matter what crises we may or may not face. If the people demand it, we can have it.

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

Arno and Caper: What is left out in the discussion of Medicare for All

Medicare For All: The Social Transformation Of US Health Care

By Peter S. Arno and Philip Caper
Health Affairs Blog, March 25, 2020

There is a large elephant in the room in the national discussion of Medicare for All: the transformation of the US health care system’s core mission from the prevention, diagnosis, and treatment of illness—and the promotion of healing—to an approach dominated by large, publicly traded corporate entities dedicated to growing profitability and share price, that is, the business of medicine.

The problem is not that these corporate entities are doing something they shouldn’t. They are simply doing too much of what they were created to do—generate wealth for their owners. And, unlike any other wealthy country, we let them do it. The dilemma of the US health care system is due not to a failure of capitalism or corporatism per se, but a failure to implement a public policy that adequately constrains their excesses.

Since the late 1970s, US public policy regarding health care has trended toward an increasing dependence on for-profit corporations and their accompanying reliance on the tools of the marketplace—such as competition, consolidation, marketing, and consumer choice—to expand access and assure quality in the provision of medical care.

This commercialized, commodified, and corporatized model is driving the US public’s demand for fundamental reform and has elevated the issue of health care to the top of the political agenda in the current presidential election campaign.

We must therefore ask: How is it that we spend more on health care than any other nation, yet have arrived at such a sorry state of affairs?

The answer is that only in the United States has corporatism engulfed so much of medical care and come so close to dominating the doctor-patient relationship. Publicly traded, profit-driven entities—under constant pressure from Wall Street—control the financing and delivery of medical care in the US to an extent seen nowhere else in the world. For instance, seven investor-owned publicly traded health insurers now control almost a trillion dollars ($913 billion) of total national health care spending and covers half the US population. In 2019, their revenue increased by 31 percent, while their profits grew by 66 percent.

The corporatization of medical care may be the single most distinguishing characteristic of the modern US health care system and the one that has had the most profound impact on it since the early 1980s. The theology of the market and the strongly held—but mistaken—belief that the problems of US health care can be solved if only the market could be perfected have effectively obstructed the development of a rational, efficient, and humane national health care policy.

What Is The Best Approach To Reform?

It is not an exaggeration to say that no reforms except publicly financed, single-payer universal health care will solve the problems of our health care system. This is true whether we are talking about a public option, a Medicare option, Medicare buy-in, Medicare extra, or any other half-measure. The main reason is because of the savings that are inherent only in a truly universal single-payer plan. Specifically, the administrative and bureaucratic savings gained by eliminating private insurers are the largest potential source of savings in a universal single-payer framework, yet all the “option” reforms listed above leave largely intact the tangle of wasteful, inefficient, and costly private commercial health insurers. The second largest source of savings comes through reducing the cost of prescription drugs by using the negotiating leverage of the federal government to bring down prices, as is done in most other developed countries. The ability, will, and policy tools (such as global budgeting) to restrain these and other costs in a single-payer framework are the key to reining in the relentless rise in health care expenditures and providing universal coverage.

The various “option” reform proposals will not simplify our confusing health care system nor will they lead to universal coverage. None have adequate means to restrain health care costs. So why go down this road?

Conclusion

The real struggle for a universal single-payer system in the US is not technical or economic but almost entirely political. Retaining the status quo (for example, the Affordable Care Act) is the least disruptive course for the existing medical-industrial complex, and therefore the politically easiest route. Unfortunately, the status quo is disruptive to the lives of most Americans and the least effective route in attacking the underlying pathology of the US health care system—corporatism run amok. Following that route will do little more than kick the can down the road, which will require repeatedly revisiting the deficiencies in our health care system outlined above (see full article at link) until we get it right.

The US public and increasingly the business community are becoming acutely aware of the rising costs and inadequacies of our current system. It is the growing social movement, which rejects the false and misleading narratives, that will lead us to a universal single-payer system—truly the most effective way to reform our health care system for the benefit of the US people.

Peter S. Arno, PhD, is an economist and senior fellow and director of health policy research at the Political Economy Research Institute at the University of Massachusetts–Amherst and a senior fellow at the National Academy of Social Insurance.

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

https://www.healthaffairs.org…

Comment:

By Don McCanne, M.D.

Earlier this month, the National Academy of Social Insurance released a report on expanding Medicare eligibility through three options: lowering the eligibility age for Medicare, establishing a Medicare buy-in or a Medicare-like public option, or extending Medicare to cover everyone (Quote of the Day, 3/4/20). Peter Arno and Philip Caper were members of the study panel that wrote the report, but they felt that the final report missed the elephant in the room: “the transformation of the US health care system’s core mission from the prevention, diagnosis, and treatment of illness—and the promotion of healing—to an approach dominated by large, publicly traded corporate entities dedicated to growing profitability and share price, that is, the business of medicine.”

They decided that it was important to issue a “minority view” in response to the NASI report that would raise alarms over the business transformation of US health care. Excerpts of their response appear above though it is highly recommended that the full article be accessed at the Health Affairs website, not only for the sake of completeness but also because the article should be distributed widely to inform the public on why our health care system requires much more than a Medicare option to fix its problems.

Perhaps if enough of you recommend the article to Joe Biden, he might actually read it. He needs to. For that matter, so does Donald Trump.

PNHP does not support any political candidates for office, but we do encourage all candidates to be thoroughly and accurately informed on health policy so that they will support health care measures that are truly in the best interests of all of us.

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

Medicare For All: The Social Transformation Of US Health Care

By Peter S. Arno, Ph.D. and Philip Caper, M.D.
Health Affairs Blog, March 25, 2020

There is a large elephant in the room in the national discussion of Medicare for All: the transformation of the US health care system’s core mission from the prevention, diagnosis, and treatment of illness—and the promotion of healing—to an approach dominated by large, publicly traded corporate entities dedicated to growing profitability and share price, that is, the business of medicine.

The problem is not that these corporate entities are doing something they shouldn’t. They are simply doing too much of what they were created to do—generate wealth for their owners. And, unlike any other wealthy country, we let them do it. The dilemma of the US health care system is due not to a failure of capitalism or corporatism per se, but a failure to implement a public policy that adequately constrains their excesses.

Since the late 1970s, US public policy regarding health care has trended toward an increasing dependence on for-profit corporations and their accompanying reliance on the tools of the marketplace—such as competition, consolidation, marketing, and consumer choice—to expand access and assure quality in the provision of medical care.

This commercialized, commodified, and corporatized model is driving the US public’s demand for fundamental reform and has elevated the issue of health care to the top of the political agenda in the current presidential election campaign.

Costs have risen relentlessly, and the quality of and access to care for many Americans has deteriorated. The cultural changes accompanying these trends have affected every segment of the US health care system, including those that remain nominally not-for-profit. Excessive focus on health care as a business has had a destructive effect on both patients and caregivers, leading to increasing difficulties for many patients in accessing care and to anger, frustration, and burnout for many caregivers, especially those attempting to provide critical primary care.

As a result, the ranks of primary care providers have eroded, and that erosion continues. One of the major reasons for burnout in this group is the clash between its members’ professional ethics (put the patient first and “first do no harm”) and the profit-oriented demands of their corporate employers. Applying Band-Aids can’t cure the underlying causes of disease in medicine or public policy. Ignoring the underlying pathology in public policy, as in clinical medicine, is destined to fail. 

Many of the symptoms of our dysfunctional health care system are not in dispute:

  • An average employer-sponsored family health insurance policy now exceeds $28,000 per year, with employers paying about $16,000 and employees paying about $12,000.

We must therefore ask: How is it that we spend more on health care than any other nation, yet have arrived at such a sorry state of affairs?

The answer is that only in the United States has corporatism engulfed so much of medical care and come so close to dominating the doctor-patient relationship. Publicly traded, profit-driven entities—under constant pressure from Wall Street—control the financing and delivery of medical care in the US to an extent seen nowhere else in the world. For instance, seven investor-owned publicly traded health insurers now control almost a trillion dollars ($913 billion) of total national health care spending and covers half the US population. In 2019, their revenue increased by 31 percent, while their profits grew by 66 percent.

The corporatization of medical care may be the single most distinguishing characteristic of the modern US health care system and the one that has had the most profound impact on it since the early 1980s. The theology of the market and the strongly held—but mistaken—belief that the problems of US health care can be solved if only the market could be perfected have effectively obstructed the development of a rational, efficient, and humane national health care policy.

There are three main reasons to pursue a public policy that embraces genuine health care reform:

  1. Saving lives: To simplify our complex and confusing health care system while providing universal affordable health care coverage;
  2. Affordability: To rein in the relentless rise in health care costs that are cannibalizing private and public budgets; and
  3. Improving quality: To eliminate profitability and share price as the dominant and all-consuming mission of the entities that provide health care services and products when that mission influences clinical decision making. Profitability should be the servant of any health care system’s mission, not its master as seems to be increasingly the case in the US.

What Is The Best Approach To Reform?

It is not an exaggeration to say that no reforms except publicly financed, single-payer universal health care will solve the problems of our health care system. This is true whether we are talking about a public option, a Medicare option, Medicare buy-in, Medicare extra, or any other half-measure. The main reason is because of the savings that are inherent only in a truly universal single-payer plan. Specifically, the administrative and bureaucratic savings gained by eliminating private insurers are the largest potential source of savings in a universal single-payer framework, yet all the “option” reforms listed above leave largely intact the tangle of wasteful, inefficient, and costly private commercial health insurers. The second largest source of savings comes through reducing the cost of prescription drugs by using the negotiating leverage of the federal government to bring down prices, as is done in most other developed countries. The ability, will, and policy tools (such as global budgeting) to restrain these and other costs in a single-payer framework are the key to reining in the relentless rise in health care expenditures and providing universal coverage.

The various “option” reform proposals will not simplify our confusing health care system nor will they lead to universal coverage. None have adequate means to restrain health care costs. So why go down this road? Is it too difficult for the US to guarantee everyone access to affordable care when every other developed country in the world has done so?

The stated reason put forth in favor of these mixed option approaches is that Americans want “choice.” But choice of what? We know with certainty from former insurance company executives such as Wendell Potter that the false “choice” meme polls well with the US public and was used to undermine the Clinton reform efforts more than 25 years ago. It is being widely used today to manipulate public opinion.

But choice in our current system is largely an illusion. In 2019, 67.8 million workers across the country separated from their job at some point during the year—either through layoffs, terminations, or switching jobs. This labor turnover data leaves little doubt that people with employer-sponsored insurance are losing their insurance constantly, as are their spouses and children. And even for those who stay at the same job, insurance coverage often changes. In 2019, more than half of all firms offering health benefits reported shopping for a new health plan and, among those, nearly 20 percent actually changed insurance carriers. Trading off choice of doctors or hospitals for choice of insurance companies is a bad bargain.

The other major objection to a universal single-payer program is cost. Yet, public financing for health care is not a matter of raising new money for health care but of reducing total health care outlays and distributing payments more equitably and efficiently. Nearly every credible study concludes that a single-payer universal framework, with all its increased benefits, would be less costly than the status quo, more effective in restraining future cost increases, and more popular with the public—as 50 years of experience with Medicare has demonstrated.

The status quo generates hundreds of billions of dollars in surplus and profits to private stakeholders, who need only spend a small portion (millions of dollars) to influence legislators, manipulate public opinion, distort the facts, and obfuscate the issues with multiple competing reform efforts.

Conclusion

The real struggle for a universal single-payer system in the US is not technical or economic but almost entirely political. Retaining the status quo (for example, the Affordable Care Act) is the least disruptive course for the existing medical-industrial complex, and therefore the politically easiest route. Unfortunately, the status quo is disruptive to the lives of most Americans and the least effective route in attacking the underlying pathology of the US health care system—corporatism run amok. Following that route will do little more than kick the can down the road, which will require repeatedly revisiting the deficiencies in our health care system outlined above until we get it right.

The US public and increasingly the business community are becoming acutely aware of the rising costs and inadequacies of our current system. It is the growing social movement, which rejects the false and misleading narratives, that will lead us to a universal single-payer system—truly the most effective way to reform our health care system for the benefit of the US people.

Health spending for the next decade

National Health Expenditure Projections, 2019–28: Expected Rebound In Prices Drives Rising Spending Growth

By Sean P. Keehan, et al, CMS Office of the Actuary
Health Affairs, March 24, 2020

Abstract

National health expenditures are projected to grow at an average annual rate of 5.4 percent for 2019–28 and to represent 19.7 percent of gross domestic product by the end of the period. Price growth for medical goods and services is projected to accelerate, averaging 2.4 percent per year for 2019–28, which partly reflects faster expected growth in health-sector wages. Among all major payers, Medicare is expected to experience the fastest spending growth (7.6 percent per year), largely as a result of having the highest projected enrollment growth. The insured share of the population is expected to fall from 90.6 percent in 2018 to 89.4 percent by 2028.

  • $4,014.2 billion – National health expenditures 2020
  • $6,192.5 billion – National health expenditures, projected 2028

National health spending is projected to increase 5.4 percent per year, on average, for 2019–28, compared to a growth rate of 4.5 percent over the past three years (2016–18). The acceleration is largely due to expected faster growth in prices for medical goods and services (2.4 percent for 2019–28, compared to 1.3 percent for 2016–18). Growth in gross domestic product (GDP) during the projection period is expected to average 4.3 percent. Because national health spending growth is expected to increase 1.1 percentage points faster, on average, than growth in GDP over the projection period, the health share of GDP is expected to rise from 17.7 percent in 2018 to 19.7 percent in 2028.

Although growth in economywide prices is projected to accelerate during 2019–28, growth in personal health care prices is expected to increase more quickly, partly reflecting faster expected growth in the wages paid to health care workers.

Over the projection period, Medicare is expected to have the highest spending growth among the major payers of health care each year and on average (7.6 percent), largely reflecting the continued shift of the baby-boom generation out of private health insurance and into Medicare.

The modest rate of growth in private health insurance enrollment is influenced both by the impact of the repeal of the Affordable Care Act (ACA) individual mandate in the early part of the projection period and by the expectation that the working-age population will continue the recent trend of enrolling in private health insurance (primarily employer-sponsored insurance) at lower rates. As a result, by 2028 the insured share of the population is expected to fall to 89.4 percent (from 90.6 percent in 2018).

The share of health care spending financed by federal, state, and local governments is expected to increase by 2 percentage points during 2019–28, reaching 47 percent in 2028. The increase is primarily due to the federal government’s share, which is projected to grow from 28 percent in 2018 to 31 percent by 2028, driven by faster growth in Medicare spending related to increasingly higher enrollment. The projected business and household share is expected to fall from 55 percent in 2018 to 53 percent in 2028.

Conclusion

As it has over the past several decades, health spending is expected to grow, on average, more rapidly than the rest of the economy in each year of the projection period through 2028 and to consume an increasingly larger share of GDP. Thus, health spending is projected to reach 19.7 percent of GDP in 2028, even with a modest projected decline in the insured share of the US population. Anticipated increases in inflation for medical goods and services are key drivers of accelerating national health spending growth, since the use and intensity of services are expected to grow more slowly than in recent years—in part because the share of the population with insurance coverage is projected to decline slightly. The government is projected to pay a larger share (nearly half) of the nation’s total health bill by 2028, as the baby boomers continue aging into Medicare and the program’s beneficiaries consume $1 out of every $4 spent on health care. Policy makers and other stakeholders will undoubtedly continue to monitor these trends and their implications for the health sector, federal and state budgets, and the economy as a whole.

(Given the timing of publication and the uncertainty associated with the impacts of the COVID-19 pandemic, those impacts are not reflected in the estimates.)

https://www.healthaffairs.org…

Comment:

By Don McCanne, M.D.

Two important take-home points from this annual report from CMS Office of the Actuary: 1) Health care spending will continue to increase at a rate greater than the growth of the GDP, comprising 19.7% in 2028, and 2) The percentage uninsured will increase from 9.4% in 2018 to 10.6% in 2028.

Thus the Affordable Care Act has fallen short of the goals of reform, especially when you consider all of the other deficiencies of our health care financing system that will remain in place (profound administrative waste, rampant underinsurance, restrictive provider networks, job lock with employer-sponsored plans, etc., etc.).

Of course, the system could be changed in the next decade. Since the Republicans have been unable to come up with a replacement plan for the Affordable Care Act, it is likely that not much would happen under their control. It now appears that, if the Democrats were to gain control, a public option might be added, but that would have very little impact on the financing system at large. The public option would be only one more administratively-complex player added to our fragmented, dysfunctional system of financing health care.

Of course we don’t know yet what COVID-19 will do, but it may well have a major impact on the health care delivery system and its financing. The health and economic consequences could jar the minds of the political and policy communities such that it is possible that they may regret that we did not have in place a well designed, single payer improved Medicare for All program. Imagine if we enacted and implemented such a system what the following 10 year projection by the Office of the Actuary would be. Pretty good, I’d say.

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Vets Say We Need a Strong VA to Combat Coronavirus and Win Medicare for All

By Candice Bernd
Truthout,

Not many know about the Department of Veterans Affairs’s (VA) so-called “fourth mission.” In 1982, Congress expanded the VA’s role beyond providing care, benefits and burial services to the nearly 9 million veterans it currently serves. Its additional role is to provide a backup health care system in a national emergency — for example, taking on non-veteran patients in the event of a global pandemic.

The agency’s Veterans Health Administration is the country’s largest government-run, integrated health system, with more than 300,000 staffers and 1,200 medical facilities across its sprawling administration. The agency stands ready to deploy 16,500 acute-care beds, including 1,000 isolation units and at least 3,000 ventilators. Such resources could prove crucial as COVID-19 continues to spread, threatening to overwhelm hospital capacity across the nation.

In fact, according to VA Press Secretary Christina Mandreucci, VA staff are actively assisting the Centers for Disease Control and Prevention (CDC) in coordinating its emergency response, including deploying a liaison officer to the Department of Health and Human Services (HHS) secretary’s Operations Center, and deploying 16 nursing assistants to assist the CDC with screening returning U.S. soldiers.

But even as the agency prepares to fulfill this fourth mission, its leadership under the Trump-appointed Secretary Robert Wilkie threatens to jeopardize its success. Even as criticisms mounted over the agency’s prior failure to release a comprehensive plan for addressing the crisis in late February, Wilkie told legislators that the VA did not need additional resources to fight the outbreak. To make matters worse, the agency quietly deleted any mention of its fourth mission from its Office of Emergency Management page on its website earlier this month.

Yet, lawmakers are quickly recognizing the urgent need for the VA’s resources. As part of the just-reached deal over a massive economic stimulus to combat the economic fallout of the outbreak, Congress has allocated nearly $20 billion in new funding for VA hospital expansion and upgrades, testing kits, protective equipment and other resources.

Despite this expected funding increase, many veterans and experts familiar with the VA told Truthout they’re worried about whether the agency is up to the task after decades of disinvestment and more recent privatization schemes, including the administration’s unprecedented overhaul of the VA in its 2018 Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, which has funneled billions toward private-sector care for veterans.

The new stimulus bill includes $2 billion to fund private-sector care for veterans. However, VA officials announced Wednesday that the department would freeze its private care program under the 2018 MISSION Act to prevent private hospitals from being overwhelmed. Experts say that such increased funds and an end to outsourcing will be needed for the VA to do what’s necessary to take on COVID-19.

Still, the agency must fill 49,000 vacant positions — including a permanent deputy secretary position. In fact, five federal public sector unions representing nearly 350,000 VA workers are so worried that they recently urged agency leaders to put better plans and protocols in place.

Such disinvestment, outsourcing and understaffing has put the VA in a poor position to handle its role as an emergency health care provider amid the current crisis, and it remains to be seen whether or not an infusion of $20 billion can get the institution on its feet. As of publishing, the VA said it had administered 3,378 COVID-19 tests, and was tracking 365 positive veteran cases, with four confirmed deaths.

Joining President Trump in a White House press briefing last week, Secretary Wilkie said his department has 3,000 medical staff on standby, ready to deploy to areas overwhelmed by the virus. “We’re gaming out emergency preparedness scenarios, and we stand ready when the president needs us to expand our mission,” Wilkie said.

A Vulnerable, At-Risk Population

The staffing shortages and current lack of tests and other supplies at VA facilities could put older veterans — a patient population among the most vulnerable to infection due to many veterans’ service-connected, underlying conditions — at an increased risk.

Denny Riley, 75, an Air Force veteran who regularly receives VA care for his disability, is among the demographic most at risk. If he begins to have symptoms of COVID-19, he will be able to quickly call a VA doctor remotely, using the agency’s Telehealth program, and be directed from there. Even in a worst-case scenario in which Riley becomes critically ill and VA medical providers become quarantined or a VA facility is otherwise inaccessible, he can still use the VA’s Tele-ICU program, which brings remote intensive care physicians into a facility’s ICU rooms via video screens to assist localized staff in treating and diagnosing patients.

Riley understands the necessity of the VA abetting the civilian health care system as the outbreak intensifies, but says he is increasingly worried about being pushed out of the VA system and sent to a civilian hospital if the VA becomes overwhelmed.

He greatly prefers his VA care, but says even at his local VA facility, he has witnessed a reduction in staffing levels. “That’s the kind of cutback they’ve made, is in hiring people, so that staffs seem incomplete,” he told Truthout. “If you defund something so that it doesn’t work adequately for the people, then you can point at it and say, ‘See, it doesn’t work,’ and send these people to private health care, and that’s a total boondoggle.”

Another demographic at extreme risk are veterans without permanent housing and those who live on the street. Tramecia Garner is associate director for housing and residential programs at the San Francisco-based Swords to Plowshares, a nonprofit that provides housing and other social services to veterans in the California Bay Area.

Garner, who oversees 476 veteran-dedicated housing units, including two VA-funded, short-term transitional housing sites, says most of the veterans she works with are over 60, and many struggle with service-connected conditions and disabilities. The VA has tested at least three veterans involved in the program for COVID-19; all three of their tests came back negative, she said.

“Folks spending time on the streets and being chronically homeless will come to us with a number of challenges already, so of course [COVID-19] doesn’t help the situation,” Garner said. Still, she says, the VA has been responsive and crucial to her clients’ care.

A Nationalized System

Suzanne Gordon, author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans says the media’s depictions of the VA as a failing institution are not only unfair but also inaccurate. She points to an increasing body of research showing that VA facilities deliver care equal or superior to that provided by the private sector. Studies have confirmed such quality even after it was revealed that faulty record keeping concealed lengthy wait times at some VA facilities in 2014.

“What I think we’re suddenly realizing, and the media is realizing, after years of bashing the VA, is that it serves a very important function,” Gordon says.

Despite the agency’s dysfunctional leadership, she says, the VA may prove to be one of the few health care institutions in the country with the proper expertise to contain the outbreak. In fact, the VA has a long record of responding effectively to emergencies, including in climate change-fueled crises in Puerto Rico in the aftermath of Hurricane Maria and more recently during the California wildfires.

The VA set up command posts in both situations and actively reached out to every veteran enrolled in its system to make sure they had access to their medications. “[A national health care system] doesn’t just care for you when you book the service and come in and pay the fee. It cares for you throughout, and it reaches out to you,” Gordon says.

The very fact that the VA’s health administration is a government-run system is its biggest strength in a time of crisis, she says, as it doesn’t have to deal with the profit-driven complexities of the private sector. Because of this, its medical providers can quickly shift staff away from certain tasks to address more urgent needs.

Moreover, the VA’s research and development is not proprietary, meaning all its research toward a possible vaccine for COVID-19 is free and accessible to the public. Still, Gordon says, the agency’s health administration can’t perform any of these necessary functions if it remains underfunded, understaffed and overburdened.

“This crisis really underscores the problems, and really folly, of the MISSION Act, because [the Trump administration] paid so much attention to outsourcing veterans’ care to the private sector,” Gordon told Truthout. “You don’t want veterans going to the private sector now.”

It’s not just Trump who deserves scrutiny, however. The MISSION Act was a bipartisan effort, with Democratic Senators Jon Tester and Doug Jones signing on as co-sponsors, and the bill passing with clear majorities in both chambers. Additionally, Gordon is not very confident that 2020 Democratic presidential frontrunner former Vice President Joe Biden would steer the agency toward a better future if he wins in November.

“Biden makes wisecracks about Italy’s single-payer system, and it doesn’t bode well toward his attitude toward the VA. What’s President Biden going to do with the VA if he doesn’t like single-payer systems and doesn’t understand how they work?” Gordon says. “I would hope that the Democrats, if they get back in office after this … would repeal most of the MISSION Act.”

Paul Cox, a Marine Corps veteran and president of the Veterans Healthcare Policy Institute, agrees, telling Truthout that Democratic presidential candidate Sen. Bernie Sanders has a better track record of strengthening the VA as the former chair of the Senate Veterans Affairs Committee. In fact, Cox says, if Republicans hadn’t filibustered Sanders’s omnibus VA bill in 2014, its health administration would be better prepared to handle the COVID-19 pandemic today.

Ultimately, the question of whether the VA sinks or swims as the outbreak intensifies will play a vital role in the larger fight for a Medicare for All system in the United States. If the VA succeeds in helping to stem the pandemic’s impacts, it could serve as a key example of how a single-payer system is uniquely able to address an unprecedented public health crisis.

“The VA is being looked at right now as a sort of model for what a single-payer health care system looks like, and in a lot of ways it does a very good job of that,” says Essam Attia, an Army veteran and activist with Veterans for Peace and Common Defense who gets his care from the VA. “If the VA does get the funding that it needs to be able to respond to this crisis properly, it could be an amazing message to the country as to what a different health care system could look like. On the flip side, if it fails in a major way, it could backfire, and it could be something that is used against the idea of a single-payer health care system…. It’s a double-edged sword.”

Riley, the 75-year-old disabled Air Force veteran, is more hopeful. “I think in this particular situation, the VA will outshine private health care. I think the VA is in a better position to be a star player in this. I may be completely wrong, but I think they are,” he said.

This story has been updated to reflect additional details regarding Wednesday’s stimulus deal and its allotments to the VA, as well as the department’s announcement that it will be temporarily freezing reimbursements under its private care program.

https://truthout.org…

Spend a life-changing hour with Frances Perkins

Summoned: Frances Perkins and the General Welfare

By Mick Caouette, Filmmaker
South Hill Films

About the Film:

In the depths of the Great Depression, Franklin Roosevelt appointed Frances Perkins as the first woman on a presidential cabinet. Against overwhelming odds, she became the driving force behind Social Security, the 40-hour work week, the eight-hour day, minimum wage and unemployment compensation. “Summoned: Frances Perkins and the General Welfare” features compelling interviews with David Brooks, Nancy Pelosi, Amy Klobuchar, Lawrence O’Donnell and others while telling Perkin’s heroic story which explores the history of women in politics, Social Security, our attitudes toward immigration, poverty, Socialism, and the role of government. Without this context our current dialogue is ill-informed and diminished.

“Some of us decided that the purpose and the reason for government should be the improvement of life for all of its people.” – Frances Perkins

This link includes a six minute preview of the film:
https://www.southhillfilms.com…

“Summoned: Frances Perkins and the General Welfare” (full video – 57 minutes):
https://www.kcet.org…

Also a DVD can be purchased through PBS:
https://shop.pbs.org…

Comment:

By Don McCanne, M.D.

These are difficult times. The highly contagious nature and the lethality of Covid-19 has caused many of us to accept the advice and direction of experts in epidemics of infectious diseases to retreat and practice “social distancing.” This should give us time for contemplation and values clarification.

Somewhere in your schedule, or what’s left of it, you should be able to find an hour to sit down and watch this video. I would say that it is an imperative in that it shows how a nation, with the inspiration provided by leaders like Frances Perkins, can address the problems of our times. Although the specific issues are not all the same now as they were then, the general concept is the same: society is not functioning well even though the nation has the ability and resources to do something about it.

How are we not functioning well now? We are facing a pandemic at a time that our government stewards had elected to diminish our public health resources so that we were not adequately prepared for this. We have diverted too much of our very high national health expenditures away from patients and to administrators and passive investors, while leaving too many without access to the health care they need. We have shifted decades of the gains in productivity to the wealthy at the top while leaving workers and their families struggling just to try to make ends meet. We have continued to engage in endless, meaningless wars. We have allowed democracy to deteriorate to the point that our elections all too often no longer represent the will of the people. And the list goes on.

Viewing this will be an hour well spent, but much more important will be the contemplation that follows. That can lead to an epiphany for each of us. Dammit, we can do something about this!

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