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“The Status Quo Is Not Sustainable”: How Medicare for All Would Fill Gaps in Obamacare Coverage

“The Status Quo Is Not Sustainable”: How Medicare for All Would Fill Gaps in Obamacare Coverage

Interview with Dr. Adam Gaffney

Democracy Now!, April 2, 2019

As Trump attacks the Affordable Care Act, we look at the growing case for Medicare for all. More than 100 Democratic lawmakers co-sponsored a House bill last month to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would also eliminate health insurance premiums, copayments and deductibles. We speak with Dr. Adam Gaffney, president of Physicians for a National Health Program, which has endorsed the measure.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman, with Juan González.

JUAN GONZÁLEZ: We continue our conversation on healthcare as we look at the growing case for Medicare for all. Last month, more than a hundred Democratic lawmakers co-sponsored a House bill to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The National Economic & Social Rights Initiative calls the legislation, quote, “by far the strongest healthcare proposal being considered by Congress.” The legislation comes at a time when as many as 30 million Americans have no health insurance and tens of millions more are either underinsured or struggling to pay their health insurance premiums.

AMY GOODMAN: The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would eliminate health insurance premiums, copayments and deductibles, while changing how healthcare providers are paid.

Most 2020 presidential hopefuls have declared support for Medicare for all. Despite the growing support, Politico reports a top aide to House Speaker Nancy Pelosi worked to undercut Medicare for all following the 2018 election. In a November 30th meeting with health policy researchers, Wendell Primus reportedly told a group of two dozen that Medicare for all is a distraction that should be scrutinized, encouraging researchers to oppose the legislation. Pelosi has denied the reports.

For more, we’re joined by Dr. Adam Gaffney, president of Physicians for a National Health Program, instructor in medicine at Harvard Medical School, author of To Heal Humankind.

Welcome to Democracy Now!, Dr. Gaffney. So, we see President Trump somewhat turning around, saying he’s not pushing to end Obamacare right now, just right after the election, when he says Republicans will take over the House. What does that mean for the whole debate around Medicare for all, when in Congress they’re just scrambling to keep the Affordable Care Act?

DR. ADAM GAFFNEY: Well, look, I think it’s very important to protect the gains that are already made, namely the Affordable Care Act, which did cover 20 million people and, as we heard from the last guest, provided some security for many families across the country. But at the same time, we have to acknowledge that the status quo is not sustainable. As you said, 29 million people are uninsured. Forty-four million people are underinsured, meaning that they have health insurance, but it doesn’t actually coverage their costs, doesn’t actually give them the financial security they need. Thirty-five percent of nonelderly adults go without needed care over the course of a year because they can’t afford it. One in five don’t fill a prescription because they cannot afford it.

So, there’s no question that we’ve made gains, and we need to protect those, and we need to push back against those who would degrade them in the name of tax cuts for the rich. But at the same time, we have to acknowledge that this is not good enough, and that as long as these holes and gaps exist, conservatives will attack the status quo. So, we can do both at the same time.

JUAN GONZÁLEZ: How do you respond to those critics who say that if Medicare for all were implemented, that many of the best doctors would desert that system and would not make their services available through it?

DR. ADAM GAFFNEY: That’s a very unreasonable claim. If you look at countries, like Canada, for instance, that have a single-payer system, essentially all of the doctors, all of the hospitals are in network. If anything, in fact, a Medicare-for-all system will increase people’s access to physicians and doctors. There won’t be insurance networks that keeps people separated, that keep people siloed, that cause disruptions in care every time your boss changes the insurance options you have or every time you change jobs. Under a Medicare-for-all system, there will be one big network with all doctors and all hospitals included, essentially. So, it’s really not a valid claim.

AMY GOODMAN: President Trump said he’s having his doctors and health executives in the Senate write legislation to replace the Affordable Care Act, like Rand Paul, who’s a doctor, as well as Dr. Barrasso, a senator, as well as Rick Scott, the now-senator from Florida, who Democrats say oversaw the largest Medicaid fraud in U.S.—Medicare fraud in U.S. history. He was formerly the CEO of Columbia HCA, when the hospital company was fined $1.7 billion for Medicare fraud. So, if you could respond to that, but also explain what exactly Medicare for all would look like when it comes to getting rid of the health insurance companies, for example?

DR. ADAM GAFFNEY: So, I mean, to respond to the first question, I think we should be extremely skeptical that whatever they generate is going to be any better than the really vicious piece of legislation that was proposed during the Affordable Care Act effort back in 2017. As we know, those bills would have slashed spending on public healthcare programs like Medicaid, would have slashed funding for the subsidies that make health insurance more affordable for some people. So, I’m very skeptical that whatever they generate is going to be an iota more friendly than the last bit of, again, vicious proposed legislation. Now, in terms of this—

AMY GOODMAN: Can you respond to Rick Scott, the former healthcare executive, who’s now the Senate? This is what he had to say.

SEN. RICK SCOTT: We do know that Medicare for all, which Senator Sanders is all in on, is going to just ruin our healthcare system.

MARGARET BRENNAN: So, are you—I’m sorry, just to clarify, did you just say that—

SEN. RICK SCOTT: It’s going to ruin Medicare, and it’s also going to ruin private insurance.

MARGARET BRENNAN: Did you just say that you expect the White House to come forward with a proposal first?

SEN. RICK SCOTT: Well, I know—I know the—I know, in the end, the White House is going to have to have their plan. And I know it’s going to be difficult with Nancy Pelosi. But what I’m going to focus on is: How do you drive down costs? The Democrats constantly focus on access. The problem is, the cost of healthcare is too high in this country.

AMY GOODMAN: So, he was speaking on CBS’s Face the Nation. Dr. Gaffney, if you could respond to what he’s saying—Democrats focus on access; I focus on cost?

DR. ADAM GAFFNEY: Well, we know that countries that actually have universal access also have higher costs. These two things go hand in hand. The United States has terrible access and also has overall costs that are about double those of other high-income nations. The notion that there’s a trade-off is simply false. And that’s made clear as soon as you look across the national borders. We can—in fact, we need to—achieve universal coverage, but that will also allow us to control costs moving forward.

JUAN GONZÁLEZ: And how would those costs be controlled moving forward?

DR. ADAM GAFFNEY: So, a universal healthcare system like single payer gives you unique ways of controlling costs. So, for instance, in the House bill that was put forward by lead sponsor Pramila Jayapal recently, that bill would basically create a universal healthcare system in which one plan covered everyone. And what we know about those sorts of plans is that they are far more efficient in terms of administrative overhead.

To give you just a couple of numbers, traditional Medicare, the traditional Medicare program, has a 2% overhead, meaning 2 cents of every dollar go to overhead, 98 cents goes healthcare. For private health insurance companies, if you include profits, the overhead is over 10%. That’s an enormous amount of money when you’re talking about trillions of dollars of healthcare spending. That’s just one way in which a public healthcare system is far more efficient than a privatized, fragmented system like we have now.

JUAN GONZÁLEZ: But to follow up on that, in terms of how this would be paid for, clearly there would be some kind of, I would assume, a payroll tax. And we’re looking at, right now, most Americans—it’s hard to tell what most people pay, because you’re dealing with premiums, you’re dealing with deductibles, you’re dealing with copays, you’re dealiong with co-insurance. Everybody has different plans and different employer contributions. So, what would it look like in the paycheck of average Americans if Medicare for all were actually instituted? Have you been able to cost out what it would mean in terms of a general cost to the average worker?

DR. ADAM GAFFNEY: Sure. Well, I mean, keep in mind for one moment—and I’ll address that directly—that we already publicly finance about two-thirds of our healthcare system. So, about two-thirds of healthcare dollars are already taxpayer-financed. But you are right that people—the other third is things like premiums, copays, co-insurance, deductibles and so on. So we would need to replace much of that private spending with public dollars, with taxes. There was an economic analysis recently from the University of Amherst that looked at a mix of taxes that could replace those payments. And, you know, overall, for the average working American, things would get better.

You know, I think it’s also important to keep in mind how harmful these out-of-pocket costs are for working people. People with high deductibles, we know, go without needed care. They avoid doctors. They avoid the hospitals. In fact, they even avoid the emergency room when they have high-severity conditions. So, it is an issue of dollars and cents, but it’s also an issue of people’s health being on the line, people’s lives, in fact.

AMY GOODMAN: And how do you plan to organize for Medicare for all?

DR. ADAM GAFFNEY: Well, my organization, Physicians for a National Health Program, focuses on the medical professional, although we also work to educate the public. But we do focus on the medical profession. There are many other groups that are involved in this fight—National Nurses United, for one, the largest nursing union in the country, many other organizations.

This is a big fight, let’s be honest. Even though it’s a very rational, logical program that we’re proposing, we are going up against powerful interests, namely the insurance industry and, to some extent, the pharmaceutical industry. So this is a big fight. So it’s—

AMY GOODMAN: We’re going to have to leave it there, but we’ll continue the discussion. Dr. Adam Gaffney, president of Physicians for a National Health Program. I’m Amy Goodman, with Juan González. Thanks so much for joining us.

Dr. Adam Gaffney is president of Physicians for a National Health Program. He is an instructor in medicine at Harvard Medical School and the author of “To Heal Humankind.”

https://www.democracynow.org…

Characteristics of Medicare for All and Its Rivals

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
Annals of Internal Medicine, April 2, 2019

The leading option for health reform in the United States would leave 36.2 million persons uninsured in 2027 while costs would balloon to nearly $6 trillion. That option is called the status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life expectancy, the widening mortality gap between the rich and the poor, and rising deductibles and drug prices. Even insured persons fear medical bills, commercial pressures permeate examination rooms, and physicians are burning out.

In response to these health policy failures, many Democrats now advocate single-payer, Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump administration seeks to turbocharge market forces through deregulation and funneling more government funds through private insurers. Here, we highlight the probable effects of these proposals on how many persons would be covered, the comprehensiveness of coverage, and national health expenditures (Table available at link).

(THE FULL ARTICLE CAN BE ACCESSED FOR FREE AT THE LINK BELOW.)

In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and persistent problems with access and quality triggered a roiling debate over single-payer plans. As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative, 1 of several proposals promising broadened coverage on terms friendlier to private insurers. Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet the need.” President Nixon’s pro market HMO strategy—a close analogue of the modern-day accountable care strategy—ultimately won out, although his proposals for coverage mandates, insurance exchanges, and premium subsidies for low-income persons did not reach fruition until passage of the ACA.

Five years into the ACA era, there is consensus that the health care status quo spawned by Nixon’s vision is unsustainable. President Trump would veer further down the market path. Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-for-All proponents aspire to decouple care from commerce.

https://annals.org…

Comment:

By Don McCanne, M.D.

Annals of Internal Medicine and its publisher, American College of Physicians, are providing free access to this article. The Table provides an excellent summary of the characteristics of Medicare for All (Single Payer), Medicare for America, Medicare Public Option, Medicaid Public Option, and Trump Administration White Paper and Budget Proposal (and is much easier to read if it is printed out).

The link should be shared with anyone who cares about the future of health care in America. The status quo is unsustainable, so there will be changes. Out of the quagmire there is the opportunity for comprehensive, affordable, equitable health care for everyone, providing that we select the single payer Medicare for All model.

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

Georgia needs to look beyond Medicaid waivers to solve healthcare crisis

By Jack Bernard
Savannah (Ga.) Morning News, April 2, 2019

State Sen. Ben Watson told his colleagues recently, “I believe that healthcare, or lack thereof depending on where you live, is our state’s largest shortcoming. However, I know that by thoroughly vetting legislation and considering new solutions to increase quality and access to care will help our citizens live longer, healthier lives…”

Watson, a Savannah physician, is correct about the healthcare status of Georgians and that coverage is a “right.” He is also correct that Medicaid is not taken by many physicians due to low reimbursement rates, which limits where recipients can be treated.

Chatham County has an uninsured rate of 15 percent for people under 65. That amounts to 36,000 people.

Georgia currently has 1,375,000 residents who are without insurance, the fourth highest number in the country. Current census data also shows that Georgia’s rate of uninsured is 13.4 percent, much higher than the national average of 8.7 percent. Further, Georgia also has a rate of medically uninsured (under 65) that is more than the national average, 16 percent vs. 11 percent. Many other Georgians are under insured.

By any measure, this situation must be deemed a crisis for our county and state. But, as opposed to what Dr. Watson and others may believe, the answer is not less government via health savings accounts and other Medicaid waiver options Gov. Brian Kemp will explore as part his Patients First initiative. The answer is comprehensive national Medicare for All so that these individuals would get the healthcare that they so desperately need while per capita cost will be more in line with other developed nations, all of which have costs much less than ours.

While the Affordable Care Act is not ideal and nowhere near as comprehensive as a single-payer system, the ACA is certainly better than what existed previously. However, President Donald Trump has done everything he can to increase the number of uninsured and decimate the coverage for many others by throwing roadblocks into implementation. He has tried to gut the ACA, causing premium increases for those covered.

These moves by Trump continue a trend by him to discredit anything and everything that his predecessor, Barack Obama, accomplished without regard for how his own moves affect the taxpayers. Trump once again puts his spite and vindictiveness over the nation’s interests. What a shame; it did not have to be this way. And it still does not.

The 14 red states that have not expanded Medicaid under the ACA are now the states with the highest percentage of uninsured. It just makes sense for GOP politicians to want to help their states. This can be easily accomplished by simply having the Federal government pick up the remaining 10 percent of the cost of Medicaid expansion. After all, they are already picking up 90 percent. At least we could reduce the number of uninsured while figuring out how to get enough political support to pass single payer, the obvious long-term solution and one that is increasingly being sought by Americans.

According to studies, we have the most religious democracy in the world. At the same time, we are the only democracy that does not have universal healthcare / insurance. Is that abysmal, immoral hypocrisy really what we want to portray to our citizens in Chatham County, in Georgia, in the United States and in the world? We need Medicare for All.

Jack Bernard is the former director of health planning for Georgia and a retired health care executive.

https://www.savannahnow.com…

Longtime health care researchers discover historical roots of Medicare for All, public option, and so-called “free market” approaches

When it comes to health care proposals, “everything old is new again”

FOR IMMEDIATE RELEASE: April 1, 2019

Contact: Clare Fauke, PNHP communications specialist, clare@pnhp.org, 312-782-6006

As political leaders debate the future of the U.S. health care system, a pair of health financing experts discovered that all of the current proposals — from Medicare for All to “repeal and replace” — have been circulating in various forms since the 1940s.

In an article published today in the Annals of Internal Medicine, “Medicare for All and its rivals: new offshoots of old health policy roots,” longtime health care researchers Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D., reveal the historical foundations of today’s health care debate.

For example, the Medicare for All Act of 2019 (H.R. 1384), recently filed by Reps. Pramila Jayapal and Debbie Dingell, traces its roots back to the 1948 Wagner-Murray-Dingell national health insurance bill and the 1971 single-payer plan proposed by Sen. Ted Kennedy and Rep. Martha Griffiths. Today’s “public option” plans that would offer individuals the option to buy-in to Medicare or Medicaid were first proposed by two Republicans, Sen. Jacob Javits and Rep. John Lindsay in the early 1960s. Even President Trump’s recent budget proposal — which seeks to shrink the government’s role in health care by cutting trillions in Medicare and Medicaid funding, further privatizing Medicare and the VA, stripping the basic protections of the Affordable Care Act, and saddling patients with higher deductibles – echoes policies favored by President Richard Nixon and others in 1971.

Drs. Himmelstein and Woolhandler inherited the archives of Dr. Sidney S. Lee, who was a professor of health policy at Harvard Medical School and former general director of Beth Israel Hospital in Boston and chief executive of Michael Reese Hospital in Chicago. While recently exploring Dr. Lee’s archives, the researchers came upon news clips, transcripts of Congressional hearings, and other descriptions of proposals that closely mirrored those still being proposed today.

“When Sen. Kennedy introduced a comprehensive single-payer bill in 1971, Republicans countered with a public option alternative that was friendlier to private insurers, and some conservative Democrats proposed settling for coverage with sky-high deductibles,” said Dr. Woolhandler, an internist in the South Bronx, Distinguished Professor at CUNY/Hunter College and Lecturer in Medicine at Harvard. “In response, Sen. Kennedy complained that anything short of single-payer Medicare-for-All ‘…calms down the flame, but it really doesn’t meet the need,’ an observation that still holds true today.”

Dr. Himmelstein, a Distinguished Professor at the City University of New York’s (CUNY) Hunter College and Lecturer at Harvard Medical School, urged current political leaders not to repeat the mistakes of earlier generations that tinkered around the edges of the U.S. health system while ignoring its fundamental flaws.

“The leading option for U.S. health reform would leave 36 million people uninsured in 2027, while costs would balloon to nearly $6 trillion. And the disgraceful trends of decreasing life expectancy, rising drug prices, medical bankruptcy, and physician burnout would persist” said Dr. Himmelstein. “That option is called the status quo.”

“Medicare for All and its rivals: new offshoots of old health policy roots.” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. Annals of Internal Medicine. Published online April 2, 2019. DOI:10.7326/M19-0780

The public’s view of high health care costs

POLITICO, Harvard T.H. Chan School of Public Health, March 2019

PART I: REASONS FOR THE NATION’S HIGH HEALTH CARE COSTS

The Public’s Views about the Reasons for High Health Care Costs in the Nation – % saying each of the following is a “major reason”:

  • 79% – High prices charged by drug companies
  • 75% – High prices charged by insurance companies
  • 74% – High prices charged by hospitals
  • 66% – High prices charged by doctors and other health professionals
  • 64% – Actions taken by the federal government that raise health care prices
  • 58% – People not taking good enough care of their own health
  • 56% – Waste in the health care system
  • 55% – Fraud in the health care system
  • 52% – Administrative costs in handling insurance claims
  • 51% – The American population is aging and needs more medical care
  • 49% – Unnecessary use of expensive new drugs, treatments, and medical technology
  • 46% – Too many malpractice lawsuits
  • 45% – People are receiving more advanced medical treatments and prescription drugs
  • 43% – Doctors recommending health care that patients often do not need
  • 41% – The American population is getting sicker, regardless of age
  • 33% – Patients seeking health care that they often do not need
  • 31% – Patients not taking responsibility to find the lowest-cost health care

The Public’s Views on Whether High Prices or Overuse Is the More Important Cause of High Health Care Costs:

  • 60% – Prices too high for health care services and drugs
  • 23% – Americans are getting more health care and Rx drugs then they need
  • 11% – Both
  • 3% – Neither
  • 2% – Don’t know/ Refused

PART II: REDUCING THE NATION’S HIGH HEALTH CARE COSTS

The Public’s Views About Proposed Ways to Reduce the Nation’s Health Care Costs:

  • 84% – Make greater efforts to prevent future diseases and to have people live healthier lives.
  • 67% – Have the government making it easier for health care professionals and for hospitals to compete with each other based on price and quality.
  • 65% – Have the government establish limits on what health care professionals and hospitals can charge.
  • 61% – Allow people age 50 to 64 to buy into Medicare.
  • 52% – Change our health care system so that most people have Medicare and there is little or no private health insurance.
    • 70% Democrats
    • 30% Republicans
  • 37% – Have government and private health insurance plans NOT pay for some high-cost prescription drugs and medical or surgical treatments, which have been shown to be safe and effective, but whose high cost many experts feel is not justified by the amount of benefit they provide.
  • 37% – Give individuals tax incentives to buy high-deductible health plans. High-deductible plans require consumers to spend several thousand dollars out of pocket before their insurance kicks in to help cover the cost of drugs and services. Some think these plans would encourage consumers to shop for lower-priced health care and use fewer unnecessary tests and treatments.

The Public’s Views About the Effectiveness of Proposed Ways to Reduce the Nation’s Health Care Costs:

  • 41% – Make greater efforts to prevent future diseases and to have people live healthier lives.
  • 36% – Change our health care system so that most people have Medicare and there is little or no private health insurance.
    • 51% Democrats
    • 20% Republicans
  • 34% – Have the government establish limits on what health care professionals and hospitals can charge.
  • 32% – Have the government making it easier for health care professionals and for hospitals to compete with each other based on price and quality.
  • 25% – Allow people age 50 to 64 to buy into Medicare.
  • 19% – Give individuals tax incentives to buy high-deductible health plans. High-deductible plans require consumers to spend several thousand dollars out of pocket before their insurance kicks in to help cover the cost of drugs and services. Some think these plans would encourage consumers to shop for lower-priced health care and use fewer unnecessary tests and treatment.
  • 18% – Have government and private health insurance plans NOT pay for some high-cost prescription drugs and medical or surgical treatments, which have been shown to be safe and effective, but whose high cost many experts feel is not justified by the amount of benefit they provide.

The Public’s Views About Whether Government or Private Health Insurance Plans Would Do a Better Job at Reducing the Nation’s Health Care Costs:

  • 47% – Government
    • 65% – Democrats
    • 25% – Republicans
  • 38% – Private health insurance plans
    • 25% – Democrats
    • 61% – Republicans

https://www.politico.com…

Comment:

By Don McCanne, M.D.

This POLITICO/Harvard T.H. Chan School of Public Health poll reveals the public’s views on what they believe are the reasons for the nation’s high health care costs and the ways they believe we can reduce those costs and how effective that would be. Let’s see how well they understand the issues.

Regarding the reasons for high health care costs, they certainly understand correctly that high prices are the greatest factor, blaming especially the drug and insurance companies, though hospitals and physicians rank up there. They place too much blame on patients not taking care of themselves. They do not place enough blame on the high administrative costs in our system, indicating the need for us to increase our emphasis on the structural reform that we need in health care financing. They seem to understand that Americans are not seeking more health care than they need. They also do not believe that patients should do more shopping for lower health care prices, which suggests that we should put the consumer-driven health care movement to rest.

How about the ways they believe that we could reduce our high health care costs? They place the greatest emphasis on prevention, which is certainly recommended, but there is not a lot of data that would suggest that there is much in the way of savings there. Yes, prevent, but look elsewhere to reduce our excessive spending. Their second choice is to encourage competition within the health care delivery system. No, markets do not work in health care. We need to get real here. They do believe correctly that government price controls would help. They do not believe that we should restrict appropriate health care and drugs, nor do they believe that we should use high deductibles as a barrier to health care access. On the most effective method – replacing private health insurance with Medicare for all – there is a sharp partisan divide, with 70 percent of Democrats but only 30 percent of Republicans in agreement.

So how effective do they believe these methods of reducing health care costs would be? Across the board, less than half of the public believe that these methods would be effective, with the sole exception that 51 percent of Democrats believe that replacing private insurance with Medicare would be effective.

When asked which entity would do a better job at reducing health care costs, 65 percent of Democrats said the government and 61 percent of Republicans said private health insurance plans. In fact, our government Medicare program has been far more effective than private insurers.

So the nation does have more to learn if they want a truly affordable health care system that works for all of us. Let’s teach them the basics.

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

House Democrats on key committees receive funding from anti-single payer groups

Special interests try to sway Democrats.

By Amanda Michelle Gomez
Think Progress, April 1, 2019

Medicare for All has attracted widespread support in the Democratic Party. But the ambitious overhaul of the nation’s health care system faces a major threat: big spending by health care and insurance interests determined to preserve the status quo.

A ThinkProgress analysis found that those industries, part of a coalition called the Partnership for America’s Health Care Future, donated nearly $1.2 million in the 2017-2018 election cycle to Democratic members of four key House committees that could determine the fate of Medicare for All.

Asked at a recent press conference about the greatest hurdle facing her bill, the most far-reaching Medicare for All proposal out there, Rep. Pramila Jayapal (D-WA) replied, “the money, money, money, ain’t it funny of the industry groups that are going to fight us every step of the way.”

The Jayapal bill, H.R.1384, would radically transform the health care system by abolishing virtually all private insurance and moving everyone into one government-run program.

Sen. Bernie Sanders (I-VT), a 2020 Democratic presidential candidate who popularized the idea during the last presidential campaign, shares her concern.

“This is not going to be an easy fight,” he said in a conference call after the midterms. “You’re taking on the drug companies, you are taking on the insurance companies, and these people have unlimited amounts of money — unlimited. They buy and sell politicians every single day.”

Jayapal and Sanders have reason to be worried.

Last summer, leading pharmaceutical, insurance, and hospital interests formed the Partnership for America’s Health Care Future to curb favor for Medicare for All in the Democratic Party. And they’ve been donating a lot to get their views across.

ThinkProgress analyzed political action committee (PAC) contributions to Democratic members on four key House committees — Ways and Means, Energy and Commerce, Budget, and Rules — on the website Political Money Line as of March 2019.

House Energy and Commerce Committee Chairman Rep. Frank Pallone (D-NJ), who has declined to hold any Medicare for All hearings, received $56,000 from partnership members — the most of any chairman of those committees. Notably, he received thousands more than committee chairmen who promised to hold Medicare for All hearings, jump-starting conversations about the future of health reform. Pallone did not respond to a request for comment.

But even co-sponsors of the Jayapal bill have received donations from partnership members. Rep. Jimmy Gomez (D-CA), who is a co-sponsor, received $66,769 — more than any other member on the four committees.

The partnership has been waging a quiet war to shape the national conversation around single-payer health care and to ensure Medicare for All isn’t part of the Democratic Party platform in 2020. The coalition intends to do this by “engaging stakeholders…including key committees and staff on the Hill,” as the coalition put it in documents obtained by the Intercept. In other words, the partnership will try to meet with and influence congressional lawmakers responsible for health reform. The coalition does not lobby directly, but it does have “a diverse set of members who do lobby, raising concerns about Medicare for All proposals,” a spokesperson for the partnership, who wished to remain anonymous, told ThinkProgress.

The Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created the coalition last June. By August, when the Hill first reported the coalition’s formation, the partnership had 16 organizations. Today, nearly 30 organizations belong.

Of the partnership’s early members, 11 operate a PAC that donated more than $7.5 million to congressional candidates during the midterm elections, when the Medicare for All rallying cry was prevalent. House Speaker Nancy Pelosi (D-CA) received $27,500 from partnership members, but that’s far less than the $60,000 her Republican counterpart, House Minority Leader Kevin McCarthy (R-CA), received.

Republicans aren’t interested in Medicare for All; in fact, the Trump administration is more concerned with repealing Obamacare, a goal laid bare when it supported a federal judge’s decision to declare the entire health law unconstitutional last week. But many Democrats are open to the idea of Medicare for All, so are more susceptible to persuasion.

The 11 PAC members of the partnership are the National Association Of Insurance And Financial Advisors (NAIFA), the Council Of Insurance Agents & Brokers, the American Medical Association, the American College Of Radiology Association, the National Association Of Health Underwriters, the Blue Cross Blue Shield Association, the Federation Of American Hospitals, the National Retail Federation, the Pharmaceutical Research and Manufacturers of America (PhRMA), America’s Health Insurance Plans, and the Association For Accessible Medicines.

“Like most Americans, we are concerned with Medicare for All-style proposals that would scrap our current health care system and start from scratch with a one-size-fits-all program run by the government, and we strongly believe that approach would cause more harm than good for patients throughout our country,” said Lauren Crawford Shaver, executive director of the Partnership for America’s Future, who also served in Hillary Clinton’s 2016 presidential campaign and as a health advisor in the Obama administration.

The statement to ThinkProgress echoes the group’s past talking points — but in reality, the partnership isn’t against only single-payer health care. It’s against any proposal to expand access to federal health programs like Medicare and Medicaid. For example, earlier this year, the partnership opposed a modest bill that would allow people to buy into Medicare beginning at age 50.

PhRMA and NAIFA were the only partnership members to respond to ThinkProgress, but neither spokesperson would comment on PAC contributions.

“We believe that the current health care system must be improved to help patients achieve affordable and accessible health care that fits their unique health needs. We joined this coalition to contribute to policy conversations that look to deliver affordability, expand options, improve access and foster innovation,” PhRMA spokesperson Holly Campbell said in a statement.

“NAIFA routinely meets with Members of Congress on a variety of issues including health reform,” said NAIFA spokesperson Sheila Owens in an email.

“NAIFA strongly supports the employment-based private sector health insurance system which provides quality health insurance coverage to millions of individuals and businesses in the small and large group markets. We believe any expansion of government programs should be narrowly limited to those persons who are not appropriate candidates for private coverage, and it should expressly authorize the use and compensation of agents in placing insureds in such coverage,” she added.

With Republicans controlling the White House and the Senate, Medicare for All is unlikely to become law any time soon. But activists who support it stress that this moment is about starting the national conversation on where the country should go next on health care reform. The House committees on Energy and Commerce, Ways and Means, Budget, and Rules will oversee any reform legislation, which is why members of the partnership have given contributions to these lawmakers.

“We know for a fact that corporate opposition to Medicare for All has deep pockets and they wouldn’t be giving this money to Congress if they didn’t think it would have its desired effect… it should raise people’s skepticism about the motivations of leaders,” said Dr. Adam Gaffney, the president of the single-payer advocacy group Physicians for a National Health Program.

“It’s sort of like when people talk about pharmaceutical companies giving money or gifts to physicians — they wouldn’t be doing it if it didn’t matter.”

Rep. Richard Neal (D-MA), the chairman of the other critical House committee, Ways and Means, received slightly less than Pallone, $54,500.

Meanwhile, the chairmen of the Budget and Rules committees, Reps. John Yarmuth (D-KY) and James McGovern (D-MA), received $5,000 and $3,500 respectively.

The House Budget Committee has six members who received no contributions from partnership members — the most of any of the four committees — including Jayapal, Reps. Ro Khanna (D-CA), Sheila Jackson Lee (D-TX), Steven Horsford (D-NV), David Price (D-NC), and Ilhan Omar (D-MN). The NAIFA PAC sent $2,000 to the Khanna campaign, but the campaign did not accept it. “We just pledged to be completely PAC free,” said Khanna’s campaign manager, Cooper Teboe. Horsford and Price aren’t cosponsors of the Jayapal bill.

Two members of the Rules Committee, Reps. Alcee Hastings (D-FL) and Jamie Raskin (D-MD), received no contributions from partnership members. Only one member of Energy and Commerce and one of Ways and Means — Reps. John Sarbanes (D-MD) and Steven Horsford (D-NV), respectively — received no money from these special interests. The Energy and Commerce and Ways and Means committees are usually comprised of more seasoned lawmakers who are also more likely to receive more industry money.

Two of the four committees (Budget and Rules) have announced plans to hold hearings on single-payer health care — but there’s a catch.

Jayapal told The Washington Post in January that she secured Pelosi’s commitment to hold the first-ever hearings about Medicare for All legislation in those two committees. But a Budget Committee spokesperson told ThinkProgress that the chairman, Yarmuth, would hold a hearing on “various approaches” to making coverage more accessible. “It will not be a hearing on any specific proposal,” said a spokesperson who asked to remain anonymous.

The Rules Committee is the only panel that has committed to a hearing focused on Jayapal’s Medicare for All legislation, though a committee spokesperson who asked to remain anonymous said no date has been set yet.

Neal, chairman of House Ways and Means, is open to holding a hearing on the issue but nothing’s scheduled yet, said committee spokesperson Erin Hatch.

The Energy and Commerce Committee, meanwhile, will be “focused on legislation that will reverse the Trump administration’s sabotage of our health-care system, protect people with pre-existing conditions, and make health care and prescription drugs more affordable,” a committee spokesperson who asked to remain anonymous said. The partnership has reportedly been encouraging lawmakers to focus on shoring up the Affordable Care Act, or Obamacare, instead of adopting single-payer health care.

The partnership denies that campaign contributions will stand in the way of Medicare for All. Shaver, the executive director, asserted that the obstacles to passage are the plan’s cost and a lack of public support. (In reality, support fluctuates based on how the argument around Medicare for All is framed). She added that the midterm elections weren’t a referendum on Medicare for All, but on Obamacare.

“It would be worth going back to Rep. Jayapal and asking her to explain why she thinks so many members of her own party – especially her own House Democratic Caucus colleagues – are not with her on this,” said Shaver.

Supporters of Medicare for All counter that health care industries always have fought proposals to change the status quo.

“The corporate opposition is unquestionably the biggest obstacle ahead of us — that’s been the case throughout the history of the fight for universal health care in America and this stage is not different,” said Gaffney, of Physicians for a National Health Program.

“But look back at history and you see grassroots movements succeeding when they are able to change the conversation around an issue,” he said. “We’ve already seen that — look at where we’ve come in the last two years.”

Medicare for All supporters have also been trying to meet with lawmakers to build support for the Jayapal bill. Activists with the Center for Popular Democracy, for example, tried to meet with lawmakers on the first day the new Congress convened, but typically just left information packets at the front desk. Even so, they’re optimistic.

“Health insurance companies, the pharmaceutical industry, and other corporate players make billions of dollars off of America’s illness — and they want to keep it that way,” said Jennifer Flynn Walker, director of mobilization and advocacy at the Center for Popular Democracy, an advocacy group that promotes progressive policies.

“Corporations prioritize profits over people, which keeps health care out of reach for millions,” she said. “We will win because the time has come for a change. We are organized in a way that we never have been before.”

Josh Israel, Ryan Koronowski, and Diana Ofosu contributed to this story. 

https://thinkprogress.org…

Medicare for All Explained Podcast: Episode 9

Interview with Gerald Friedman (Part Two)

March 31, 2019

Economist Gerald Friedman argues that, if we can afford our current, inefficient (and deadly) health care system, then we can certainly afford something that’s both cheaper and better: improved Medicare for all. Hosted by Joseph Sparks. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Misinformation About Single Payer Medicare for All

A rebuttal to David Brooks' “Undo the Revolution”

By Joel A. Harrison, Ph.D., M.P.H.
East County Magazine (San Diego), March 30, 2019

Unfortunately, our media is dominated by misinformation designed to protect our private for-profit health insurance industry. One of the latest, by syndicated columnist David Brooks, was published in the San Diego Union-Tribune on March 6th. Since that newspaper reaches over 1 million San Diegans, I hope those reading this article will agree and share it with others. At the bottom I list several articles/papers that give a more comprehensive detailed discussion of why a single-payer system designed to benefit people trumps a for-profit health insurance industry designed first and foremost to enrich corporations.

According to Brooks, “Patients would have to transition. Right now, roughly 181 million Americans receive health insurance through employers. About 70 percent of these people say they are happy with their coverage.”

Since most of the 70 percent have NOT experienced a major illness or injury, only when they, their loved ones or close friends do, will they discover too late the high cost of pharmaceuticals, non-covered care, fighting with insurance companies to get the care they need, inundated with paperwork, and facing bankruptcy (75% of bankruptcies in US involve medical care).

The enrollment will be almost automatic. It will NOT cost people more and in most cases less. Instead of premiums, copays, deductibles, out-of-pocket additional costs, all will be covered, mainly through the equivalent of an increased Medicare payroll tax. In addition, one’s kids will be covered, even when in college, and whether between jobs, early retirement, etc. one and ones loved ones will ALWAYS be covered and ALWAYS be able to keep the doctors they choose. With single-payer, when facing some illness or injury, dealing with it, not fighting with insurance companies and an inundation of paperwork.

Brooks states: “The insurance companies would have to transition. Lots of people work for and serve this industry. All-inclusive public health care would destroy this industry beyond recognition, and those people would have to find other work.”

Insurance company employees include doctors and nurses who would much better serve us working in actual health care. Proposals for a single-payer health-care system all contain provisions for training and helping insurance company employees find other jobs, jobs not designed to increase health insurance profits by minimalizing expenses, that is, the care we get. As discussed below, the for-profit insurance companies actually decrease our choices, often delay care, and the quality of care we receive, so, bottom line, keeping them in business makes no sense for the vast majority of Americans, unless the vast majority prefer the current nightmare that is our fragmented, dysfunctional for-profit health care system for the benefit of a few corporations at our expense, economically and health-wise.

Brooks says: “Hospitals would have to transition. In many small cities the local health care system is the biggest employer…If you live in a place where the health system is a big employer, think what happens when that sector takes a sudden, huge pay cut.”

More than 10% of hospital costs are for the excess administration necessary to deal with the private for-profit health insurance industry. Hospitals will either continue to be paid fee-for-service or given global budgets. Again, any employees losing jobs will receive retraining. Not one doctor, one nurse, one medical staff employee will lose their jobs nor see substantial pay cuts.

Brooks claims: “Doctors would have to transition. Salary losses would differ by specialty, but imagine you came out of med school saddled with debt and learn that your payments are going to be down by, say 30 percent. Similar shocks would ripple to other health care workers.”

American doctor’s bills include approximately 10% administrative overhead just to deal with the insurance companies. American doctors devote approximately 15 hours or more to filling out excess paperwork and on the phone fighting to get a patient a referral or other care compared with doctors in Canada and other nations. Since everyone will be covered, lawsuits will not include health care cost, the major portion of doctor’s liability insurance, so their insurance costs will be much less (and because we will be covered, we will get the care we need, not delayed in hopes of winning a lawsuit). In the U.S. approximately 30% of doctor bills are denied by insurance companies, while, for instance, in Canada approximately 2%. With an average of 15 minutes per doctor visit in U.S., the additional 15 hours would allow doctors to see and bill for up to 60 more patients per week.

Neither will surgeons face substantial reductions in income. So, the vast majority of doctors will see little to no reduction in income and have the satisfaction of taking care of people, not functioning as bureaucrats. And studies have found that the excess administrative efforts doctors are forced to endure actually affects them, their stress level, some often considering leaving the profession. They devoted many years and effort into learning to help people, not the time and stress of excessive paperwork and fighting with insurance companies.

Brooks states: “The American people would have to transition. Americans are more decentralized, diverse and individualistic than people in the nations with single-payer systems. They are more suspicious of centralized government and tend to dislike higher taxes.”

Under single payer each American will be able to choose his/her doctor and hospital. Much more individualistic than allowing a for-profit insurance company with their often-limited network of doctors and hospitals to decide. And without copays and deductibles, Americans will be able to do so. Currently, under our current system, with some plans having high deductibles and copays, people delay seeking care, ending up using emergency departments, and with their condition more serious, more costly, often less successful, care. And those getting care often face restricted networks, sometimes not with the specialist they need or want.

Brooks claims: “The Sanders plan would increase federal spending by about $32.6 trillion over its first 10 years.”

Yep; it will increase federal spending, but not the total amount going into health care. As discussed above, mainly one simple tax, rather than premiums, copays, deductibles, out-of-pocket will result in the monies we pay into health care actually going to health care and NOT costing us more. Brooks ignores that given current projections using our present system, the total amount will be considerably higher. Brooks omits compared to what! Quite simply, the reduction in administrative costs alone will be substantial, together with bargaining with drug companies. Despite what they claim, there is ample data showing the costs of developing drugs is exponentially less than claimed and, in fact, much of it funded by the taxpayers.

Brooks further claims: “The government would also have to transition. Medicare for all works only if politicians ruthlessly enforce those spending cuts. But in our system of government, members of Congress are terrible at fiscal discipline.”

Given that everyone will be in the same system, including our politicians and their families, and that it will be transparent, this is unlikely. However, for those afraid of government insuring health care, NOT running it, do they really trust private for-profit companies more?

Single-payer is NOT socialized medicine. Doctors will not be employed by the government and hospitals will not be owned nor run by the government, simply an expanded version of Medicare, our most successful and popular healthcare program, with no need for supplemental insurance, no deductibles, no copays, and including dental, vision, long-term care, and home health care.

Sooner or later most families will need either home health care or nursing home care—finding out too late how expensive both are and that to be eligible for various Medicaid programs having to spend down, basically reach the level of impoverishment. And poor dentition leads to poor nutrition which leads to poorer health, so covering dental care saves money.

Brooks opines: “Patient expectations would have to transition. Today, getting a doctor’s appointment is annoying but not onerous. In Canada, the median wait time between seeing a general practitioner and a specialist is 8.7 weeks.”

Wait times in Canada for life-threatening and disability threatening conditions is as short as here and international studies show Canada has longer life-expectancy, lower infant mortality, and equal to better outcomes for many chronic diseases and illnesses, despite having a higher percentage of immigrants and refugees than the U.S. And, of course, Brooks ignores the wait time for the un- and underinsured in the U.S., eventually costing our system more with worse outcomes. More importantly, Canada spends only about 2/3 of what we do for health care and over the past couple of decades they have been working to shorten wait times for non-emergency care.

Currently, in the U.S., over 30 cents on the dollar goes to the excess administration, profits, and bloated salaries of health insurance executives. And what most people don’t understand, our taxes, including from those uninsured and underinsured, fund approximately 65% of health care, as much as the next most expensive system in the world which covers everyone with high quality care. So, we fund health care and the 30 cents on the dollar goes to for-profit insurance companies benefit, which results in deductibles, copays, limited doctor networks, fighting with insurance companies, and often bankruptcy.

In other words, the 30 cents on the dollar actually impedes choice and care, certainly nothing that fits any free market model I know of. Thus, the amount we have available for health care, including the 30 cents on the dollar wasted by our for-profit health insurance industry will be more than enough to ensure ALL Americans get timely care.  A simple question is: does anyone believe that this 30 cents on the dollar, this money ensures as good or better care than putting it directly into health care?

Every technologically advanced, industrialized democracy in the world has some form of universal health care coverage which international studies have found to rank far better on a multitude of measures than the U.S. And they do it for less, allowing more monies to be used in the economy for consumer spending, investment, infrastructure, and research and development. And our current system puts American industry at a disadvantage in international competition because of the high cost of health care and the wasted administrative costs of either dealing with for-profit insurance companies or running their own “in house” insurance.

Don’t be fooled by opinion pieces such as David Brooks. And don’t be fooled by anecdotal evidence how one or a few cases in another country didn’t receive the care they should. Anecdotal evidence is used to arouse emotion and short-circuit thought; but no system is perfect and one should always ask the question: Compared to what? The answer is that for every anecdotal case in another country, we have hundreds if not thousands here.

Addendum

After finishing the above, I came across a San Diego Union-Tribune Letter-to-the-Editor, “Single-payer not the panacea it seems to be” (San Diego Union-Tribune, March 29, 2019 which states: “Eliminating the private insurance industry takes monies out of research for medical innovation . . . European health care is barely adequate, and there are few specialists to treat specialties. We have personal experience with this where in a London hospital, for two weeks, a diagnosis couldn’t be made, putting my wife’s life in serious jeopardy. With an emergency flight back to the U.S., in 10 minutes a specialist diagnosed and put her on a course to resolve the issue . . . The government cannot efficiently run any program (see U.S. Postal Service).”

First, almost all medical research in the U.S. is grant funded, carried out in medical schools and universities, in-house by our National Institutes of Health, FDA, and Centers for Disease Control. For the most part, the research conducted by for-profit health care companies is marketing research and devising plans to save money/increase profits. A few non-profits like Kaiser Permanente do conduct quality “legitimate” research. I repeat “non-profits”; but even Kaiser has much higher administrative costs than Medicare. Second, the UK has contributed a heck of a lot to medical research, also, mainly paid for by government. And, despite having comparable stats on infant mortality, life-expectancy and other measures, the UK spends less than many other universal health care systems, partly still trying to undo the extreme cuts by the right-wing anti-government Margaret Thatcher.

Second, yep, an anecdote about a bad experience. I am currently watching for the second time a series on Animal Planet, streamed online for free, called “Monsters Inside Me.” What is fascinating is that every case presented starts with the patient getting one, two, or even more misdiagnoses. Of course, in some cases, the signs and symptoms are quite similar so the doctor didn’t do anything wrong; but in other cases, the doctor simply decided without hearing the patient out or running the extra labs, just jumped to a conclusion, which in some cases caused serious hardship. In the U.S. the number of autopsies performed on hospital deaths has declined precipitously, partly because of our for-profit health care system not wanting to pay for them and partly because families refuse to allow them. The problem is that when autopsies have been performed, up to 25% of the diagnoses were wrong. This doesn’t automatically mean if the diagnoses had been correct the patient would have survived; but certainly they didn’t get the correct treatment. Without autopsies, doctors can’t learn about their mistakes and, thus, may repeat them  (Baumgartner, 2016; Combes, 2004; Groopman, 2007; Pastores, 2007; Reichert, 1985; Wittekind, 2018). And I have personally been misdiagnosed on several occasions; but before going on meds with significant side-effects, did my own research and then got a second opinion.

I’m glad the Letter-to-the-Editor writer’s wife finally received a correct diagnosis and was successfully treated; but one anecdote doesn’t prove anything. Not every UK hospital is equally good, so had they used another hospital the result may have been quite different, just as in the U.S. we have excellent hospitals; but not all are and even two equally competent doctors may each misdiagnose a case where the other would have gotten it correct. Medicine involves a very complex set of variables. And it is obvious the writer knows nothing of the funding of research nor international comparative statistics.

As for the remark about the U.S. Post Office, an oft used trope that is both wrong and insulting to those who work for the Post Office. And Medicare, with administrative costs much lower than that of the for-profit health insurance industry is a very popular program. Yep, they sometimes makes mistakes; but compared to what?

References

Baumgartner A, Anthony D (2016 Oct). The Decline of the Autopsy in Rhode Island and Nationwide: Past Trends and Future Directions. Rhode Island Medical Journal; 99(10): 36-38.

Combes A, Mokhtari M, Couveland A et al. (2004 Feb 23). Clinical and Autopsy Diagnoses in the Intensive Care Unit: A Prospective Study. Archives of Internal Medicine; 164: 389-392.

Duffy D, Milani K (2019 Feb 20). Profit over Patients: How the Rules of Our Economy Encourage the Pharmaceutical Industry’s Extractive Behavior. Roosevelt Institute.

Groopman J (2007). How Doctors Think. Houghton Mufflin Company.

Harrison JA (2008 May). Paying More, Getting Less: How much is the sick U.S. health care system costing you? Dollars & Sense.

Harrison JA (2018 Aug 10). The Case for A Non-Profit Single-Payer Healthcare System. Physicians for a National Health Program.

Kemp E (2019 Feb 4). The Case for Medicare-for-All. Public Citizen.

Pastores SM, Dulu A, Voigt L et al. (2007). Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients. Critical Care; 11(2): R48.

Reichert CM, Kelly VL (1985 Summer). Prognosis For The Autopsy. Health Affairs; 4(2): 82-92.

Witteking C, Gradistanac T (2018). Post-Mortem Examination as a Quality Improvement Instrument. Deutsches Ärzteblatt International; 115: 653-8.

Dr. Joel A. Harrison is a retired epidemiologist who has studied and worked in several countries, including Sweden (where he earned his doctorate) and Canada (where he earned a Master’s degree). Dr. Harrison is a long-time member of Physicians for a National Health Program.

https://www.eastcountymagazine.org…

Milliman footnote on ‘disruptive’

Congress asked nine questions about single payer. Here are 27 answers.

Milliman, March 2019

At its core, a single-payer system is one in which the system’s primary financing (and oftentimes the primary enrollment) comes from a single payer, which is typically the government. Reflecting the many unique ways that the federal and state governments fund and regulate American healthcare, we have identified three different single-payer scenarios, ranging from least disruptive to most disruptive compared to the status quo. (See footnote 2)

Footnote 2: The word “disruptive” was once largely pejorative, but has recently become synonymous with game-changing innovation. For the sake of our discussion, both meanings may apply.

http://us.milliman.com…

Comment:

By Don McCanne, M.D.

This Milliman white paper is not particularly helpful in defining the ideal single payer model of reform since it asks more questions than it answers. It may be useful in reviewing potential questions about single payer to prepare answers as to why a model such as that supported by Physicians for a National Health Program is the ideal which we should be pursuing. But this isn’t why this paper was chosen for today’s message.

In reaction to the newfound popularity of single payer Medicare for All, supporters of lesser measures, such as a Medicare public option, have claimed that the single payer model of Medicare for All would be too disruptive, implying that disruption is undesirable. But in the footnote quoted, Milliman (business advisers “with no agenda other than getting it right”) indicates that “disruptive,” though formerly a pejorative, “has recently become synonymous with game-changing innovation.”

Innovation is praised in the business world. In fact, those who insist that we must perpetuate the private health insurance industry state that innovation is one of the more important reasons to continue to support their industry. However, their innovations, such as restrictive provider networks, higher deductibles that impair access to care, ineffective and intrusive pay-for-performance schemes, upcoding to obtain unwarranted risk adjustment bonuses, and the like, are measures that suggest that “innovation” has become a pejorative when applied to the private health insurance industry.

Maybe in our messages we need to add two adjectives – “beneficial” and “detrimental” – as in, “It’s time for us to replace detrimental innovation with beneficial disruption.” That should be our message whether or not the rhetoric gains traction.

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

Dr. Paul Song on “Rising Up With Sonali”

PNHP national board member Dr. Paul Song appeared on “Rising Up With Sonali” on Free Speech TV and Pacifica radio stations on March 28, 2019. He discussed the Trump Administration’s decision to seek to invalidate the entire Affordable Care Act through the courts, as well as other detrimental policies such as Medicaid work requirements. He cautioned Democrats not to settle for defending the ACA, but to advance a popular policy that would more fully address our health care crisis: improved Medicare for all.

The fundamental flaw in the Trump Administration’s approach to health care

Economic Report of the President

The Annual Report of the Council of Economic Advisers, March 2019

As shown in the Report that follows, we are ushering in an era of renewed dedication to our citizens. It is my great honor to champion the American people and to make their success and well-being my top priority. This pro- growth, pro-opportunity agenda celebrates the irreplaceable value of America’s working families and embraces the extraordinary possibilities for American ingenuity to improve the human condition. It is an economic agenda that lays the foundation for the future of American greatness.

Donald Trump

Chapter 4 – Enabling Choice and Competition in Healthcare Markets

The dominant theory in economics for centuries in the Western world has been the efficiency of the free market system. For a free market to be efficient, free choice and competition must exist in the market to allow consumer demand to be met by suppliers.

Of course, many markets deviate in substantial ways from the conditions under which markets are perfectly efficient. Market failures occur to a greater or lesser extent throughout the economy. The important question is what to do about them.

Following the research of Kenneth Arrow (1963), many economists and policymakers have argued that unique features of healthcare make it impossible for competition and markets to work. They claim that uncertainty in the incidence of disease and in the effectiveness of treatment, information asymmetry between providers and consumers of healthcare, barriers to provider entry, and the critical importance of and inelastic demand for health services all interfere with market function and justify government intervention in—or even its takeover of—healthcare markets. Some members of Congress have proposed nationalizing payments for the healthcare sector (which makes up more than a sixth of the U.S. economy) through the recent “Medicare for All” proposal. This policy would distribute healthcare for “free” (i.e., without cost sharing) through a monopoly government health insurer that would centrally set all prices paid to suppliers such as doctors and hospitals. Private insurance would be banned for the services covered by the “Medicare for All” program.

This chapter begins by critically examining the rationales offered for the government’s intervention in healthcare. We find that though some characteristics of healthcare may present obstacles to a perfectly functioning market, these are not insurmountable problems that mandate the government’s intervention in healthcare and can be overcome by market and nonmarket institutions. Moreover, these problems also occur in markets for many other goods without calls for government takeovers and the suppression of consumer choice and competition. Government intervention in healthcare is only clearly warranted where the political process has made a determination that some level of healthcare for low-income people is a merit good—a beneficial good that would be underconsumed, justifying replacing consumer sovereignty with another norm—so that government redistribution programs to provide health- care in kind for low-income people might enhance efficiency.

We next critique the “Medicare for All” proposal. This plan would eliminate choice and competition—everyone would be forced to participate in the same insurance, with mandatory premiums set through tax policy and without the option of choosing an alternate insurance if they dislike the government’s plan. Our analysis shows that the proposal would reduce longevity and health in the U.S., decrease long-run global health by reducing medical innovation, and adversely affect the economy through the large tax burden required to fund the program.

In contrast to proposals that diminish health and damage the economy by curtailing market forces, the next section of this chapter details the Trump Administration’s efforts to improve choice and competition in health insurance markets so as to help them better serve low- and middle-income people. The Administration has reduced the penalty associated with the Affordable Care Act’s (ACA’s) individual mandate to zero, so consumers can decide for themselves the value of purchasing health insurance. We analyze this deregulatory reform and find that it will generate $204 billion in value over 10 years. In addition, the administration has increased the choices and affordability of available health insurance plans by expanding association health plans and extending the available terms and renewability of short-term, limited-duration insurance plans. As opposed to sabotaging healthcare markets, conventional incidence analysis by the CEA implies that these three deregulations of health insurance markets together will benefit Americans by $453 billion during the next decade.

Finally, the last section discusses the Administration’s reforms to enhance choice and competition in biopharmaceutical markets by streamlining the drug application and review process in a way that effectively lowers barriers to entry while ensuring a supply of safe and effective drugs.

We conclude that the market for health insurance and healthcare should be supported through increased choice and competition, not hampered by increased government intervention. Competitive markets for healthcare services and insurance—whether privately or publicly funded—can and do work to provide high-quality care for people at all income levels.

Conclusion (Chapter 4)

The U.S. economy generally relies on free markets to maximize benefits for U.S. citizens. The hallmarks of any free market are consumer choice and competition. Although some have claimed that healthcare is an exceptional case that cannot be produced and allocated through the market, we argue that these claims are exaggerated and that the costs of market failure are often lower than the costs of government failure. Deviations from perfect market conditions are present in healthcare and many other markets, but promoting choice and competition is the appropriate way to maximize efficiency and consumer welfare.

The recent push in Congress to enact a highly restrictive “Medicare for All” proposal would have the opposite effect—it would decrease competition and choice. The CEA’s analysis finds that, if enacted, this legislation would reduce longevity and health in the United States, decrease long-run global health by reducing medical innovation, and adversely affect the U.S. economy through the tax burden involved.

The Trump Administration has instead concentrated on deregulatory reforms that will increase choice and competition in the health insurance markets and pharmaceutical drug markets. Bringing the ACA’s individual mandate penalty down to zero will allow consumers to choose how much health insurance they desire. Expanding the availability of association health plans and the duration and renewability of short-term, limited-duration health plans will increase consumers’ options and spur competition. Finally, the FDA’s initiatives to speed drug approvals have already had tangible benefits in record numbers of drug approvals and increased pharmaceutical competition. All these reforms are expected to bring down prices, encourage continuing innovation, and maximize consumer welfare.

The Annual Report of the Council of Economic Advisers (705 pages):
https://www.whitehouse.gov…

Comment:

By Don McCanne, M.D.

President Trump’s Council of Economic Advisers begins their report on health care by dismissing the seminal work of Nobel Laureate Kenneth Arrow demonstrating how markets do not work in health care – a concept that has been confirmed by many decades of non-structured natural experiments. Ignoring facts, they then move into a magical world crafted from wishes derived from their ideology of free markets, competition and choice.

There is no way that this approach can lead to sound decisions in health policy if our goal is to ensure affordable, accessible, and equitable health care for everyone.

President Trump announced this week that he intends to terminate Obamacare by supporting the lower court decision declaring the entire Affordable Care Act to be unconstitutional, while at the same time promising that “we will have a plan that’s far better than Obamacare.” He has never explained what that better plan he keeps promising us would be, but by using advisers that reject Kenneth Arrow’s fundamental premises, we can conclude that our health care financing system is not in good hands. We have to do something about that.

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

The free market is bad at providing health care

By Ken Lefkowitz
The Washington Post, Letters, March 27, 2019

Regarding the March 24 editorial “The demagoguery of Medicare”:

American health care is financed through a free market that is ineffective in controlling costs because it requires transparency so consumers can compare prices. Yet the complexity of both medical care and insurance plan design precludes the consumer from making informed choices. Primary-care physicians strongly influence choice, and insurance company provider networks limit choice even further.

Rather, single-payer universal health care is quite cost-effective. Expressed as a percent of gross domestic product, it has proved to be less costly in other countries. It will wring out the wasteful administrative costs of the free marketplace and provide negotiating leverage to stabilize medical provider and pharmacy costs.

A University of Massachusetts study demonstrated that a single-payer system, or Medicare-for-all, could cover all citizens, including today’s uninsured, eliminating deductibles and co-pays, and still save $592 billion. Reduced absenteeism and increased labor productivity in the workplace would be an additional cost advantage.

So let’s move to Medicare-for-all and ditch our ineffective free marketplace.

The writer, who designed health insurance plans for major corporations, is a member of Physicians for a National Health Program and the New Jersey Universal Healthcare Coalition.

https://www.washingtonpost.com…