PNHP

Number of uninsured children has gone up to almost 4 million

Number of uninsured children has gone up to almost 4 million

New Report Shows Progress on Children’s Health Coverage Reversed Course

By Joan Alker
Georgetown University Health Policy Institute, November 28, 2018

For the past eight years, CCF has published a report tracking health coverage rates for children across the country. This year, for the first time since we began writing this report, the number and rate of uninsured children in the United States went up.

For many years, that rate has been declining thanks to bipartisan efforts to extend coverage through Medicaid and the Children’s Health Insurance Program (CHIP). But in 2017, approximately 276,000 more children became uninsured, leading to a total of 3.9 million uninsured children nationwide. The rate for children age 18 and under went up from 4.7 percent in 2016 to 5 percent in 2017, according to our analysis of U.S. Census Bureau’s American Community Survey data.

While this may not seem like a huge change, both of these increases are unprecedented in the past decade. Even more troubling, the number of uninsured children increased during a time of economic strength – in fact, at a time when one would expect the uninsured rate to go down, as more children were covered by employer-sponsored insurance in 2017.

However, coverage for children from public sources, Medicaid and CHIP, and in the individual market – inside and outside the Marketplace – decreased during this time period. That caused the number of uninsured children to go up – despite the strong economy.

I’ve written this report for eight years in a row now, and I found it even more notable that no state, except for the District of Columbia, saw any measurable progress in reducing the number of uninsured children in 2017. Never before have we seen such uniformity in state behavior. This finding underscores that even states with the best of intentions were not able to overcome the negative national currents that are affecting children’s health coverage.

Why do we think this is happening? We can’t know for sure, but here are some of our best guesses:

The majority of uninsured children are already eligible for Medicaid or CHIP but are not currently enrolled. The name of the game here is to make sure that families are aware that their child has a path to coverage and that these kids get enrolled and stay enrolled. For these families, 2017 was a year of constant news about the President and Congress wanting to take coverage away – first with the attempt to repeal the Affordable Care Act and make drastic cuts to Medicaid, all of which continued with a last gasp effort in September 2017.

Then on September 30, funding for CHIP expired and, in an unprecedented delay, Congress did not extend funding until early 2018 – again with families hearing that their state might have to close its CHIP program. At the same time, the Trump Administration began efforts to sabotage the ACA’s Marketplace including cuts to advertising, outreach and enrollment funding for navigators – who were playing an important role connecting families with public coverage, with the repeal efforts raising insurer uncertainty and driving up premiums.

The Trump Administration also began a series of actions hostile toward immigrant families. One quarter of children living in the United States has a parent who is an immigrant. For these “mixed status” families, there is likely a heightened fear of interacting with the government and this may be deterring them from signing their eligible children up for government sponsored health coverage.

As a result, the “welcome mat” for coverage has been pulled back and we see the results – more uninsured children.

With an improving economy and low unemployment rate, the fact that our nation is going backwards on children’s health coverage is very troubling. Without serious efforts to get back on track, the decline in coverage is likely to continue in 2018 and may in fact get worse for America’s children.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.

https://ccf.georgetown.edu…

Comment:

By Don McCanne, M.D.

Imagine if everyone were automatically enrolled in a national health program for life. No resident would be uninsured. We could do this if we enacted and implemented a Single Payer Medicare for All program. Yet, because we insist on perpetuating our unstable, unsatisfactory system of financing health care, we are leaving almost 4 million children without any insurance coverage at all. Our health policy decisions border on the criminal.

Medicare for All has become a very popular concept and was used in the recent election to secure votes for proponents of reform. Yet before the next session of Congress has even begun, we are already seeing widespread efforts to suppress talk of Medicare for All and instead to support mere tweaks to our current grossly inadequate model, though some would cut coverage back even further.

Suppose Congress were to pass an alternative proposal such as a public option Medicare for Some, will all of those 4 million children be automatically enrolled? Of course not. By merely tweaking our current dysfunctional system we will perpetuate a large unnamed category of the uninsured. Perhaps we should label this group, “No Medicare for Them.” Those supporting deficient proposals should be the ones to explain to these uninsured children and their parents why, in a democracy, we support health financing policies that leave them out. In fact, someone needs to explain it to me. Why do we?

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

Full Assessment of PERI’s Economic Analysis of Medicare for All

By Stephanie Woolhandler, M.D., M.P.H.; David Himmelstein, M.D.; and Adam Gaffney, M.D., M.P.H.
University of Massachusetts Amherst, Political Economy Research Institute (PERI), November 30, 2018

The Economic Analysis of Medicare for All by the Political Economy Research Institute (PERI) team provides a robust and well-documented projection of the economic effects of a properly structured single payer health care reform. Its estimate that such reform would provide universal and comprehensive coverage without any increase in overall health expenditures is sound, and in keeping with older estimates from authoritative sources, such as the Government Accountability Office and the Congressional Budget Office, as well as evidence on the costs of care in nations that have implemented single payer reforms. Indeed, even an estimate by the Koch brothers-funded Mercatus Institute concluded that a single payer reform would realize savings of $2 trillion over ten years.

The PERI group’s projections that the utilization of medical care would rise by about 12% after a single payer reform, labelled a “high-end” estimate,” may well overstate the utilization increase likely to occur. Experience in Canada, as well as in the U.S. with the implementation of Medicare, suggests that the finite supply of hospital beds and physician time dampens increases in the society-wide use of care. Indeed, in those past cases, the increases in utilization by previously uninsured groups were offset by small decreases in utilization among those who had been covered prior to the reforms, resulting in no overall increase in the number of hospitalizations or physician visits.

The analysis’ projections of administrative savings under single-payer also incorporate conservative assumption, and hence may underestimate potential savings. Our research, along with colleagues in Canada and several European nations, suggests that hospital administrative costs could fall from the present level of 25% to 12% of total hospital expenditures, a 13% decrease. In contrast, the PERI group estimates that Medicare for All would reduce hospital administration costs by only 8.5%.

While their estimate of the administrative savings is conservative, they may be too optimistic about how quickly such savings could be achieved. Insurance overhead would, as they project, drop precipitously in the first year of the program’s full implementation. However, savings on providers’ administrative costs are likely to take somewhat longer to be fully realized. Much of the redundant documentation required by the current payment systems that drives up administrative costs is ingrained in electronic health records systems whose software will need to be revised. This revision cannot go live prior to the full implementation of the single payer system, and it will take some time for users to adapt. Similarly, many personnel, such as office receptionists, and hospital ward clerks and administrators perform both billing-related and clinical tasks. Much of the redesign of work flows and staffing patterns, and the elimination of redundant personnel cannot occur before the single payer reform is fully in place.

In some other areas the PERI researchers’ projections also appear optimistic. Their estimate that substantial savings (1.5% of total health spending) on fraud and the overuse of medical services would be realized in the first year of the program’s operation may overstate the likely short term savings. Both fraud and overuse are certainly widespread, and a single payer reform would provide a framework for their detection and mitigation. However, the failure of multiple past efforts to root our fraud in the Medicare and Medicaid programs, and to change the medical culture that encourages overuse, mandates caution about a quick fix for these sources of waste.

One could also quibble with the PERI analysts’ assumption that the single payer program would cover virtually 100% of health expenditures. It seems unlikely that such a program would cover items like cosmetic surgery or non-prescription drugs and supplies like. Excluding such items from coverage would not affect the PERI group’s projections of overall healthcare spending, but would slightly reduce their estimate of the new taxes needed to fund the system.

Overall, the PERI estimate incorporates some assumptions likely to overstate new costs associated with the implementation of a single payer program, and others likely to understate these costs. Given this caveat, we believe it prudent to anticipate that health care expenditures (as a share of GDP) in the first year of a single payer reform would remain at roughly the same level as in the year prior to the reform – still a substantial saving as compared to current, relentlessly rising trends. In the medium term we expect that health care’s share of GDP would gradually fall.

It should also be pointed out that the PERI group’s projections are based on a reform that emulates Canada’s simple payment system, such as that envisioned in the current version of the House single payer bill – H.R. 676. That approach would abandon per-patient hospital billing in favor of global budget payment, and would fund hospital capital investments through direct government grants rather than from hospitals’ operating surpluses, or debt financing that is ultimately paid back from operating surpluses. Retaining Medicare’s current payment strategy – as in the current version of the Senate single payer bill – S. 1804 – would sacrifice some of the savings on hospital administration, and leave in place significant incentives for overuse, as well as financial gaming.

In sum, the PERI team is to be congratulated for producing a highly credible economic analysis of the likely result of implementing a Canadian-style single payer reform in the U.S.

Abstract:
https://www.peri.umass.edu…

Full Analysis:
https://www.peri.umass.edu…

Reviewer Assessments:
https://www.peri.umass.edu…

Supplemental Slides by Dr. Ed Weisbart:
https://pnhp.org…

Democrats lowering sights to a Medicare buy-in?

Dem single-payer fight set to shift to battle over Medicare ‘buy-in’

By Nathaniel Weixel
The Hill, November 29, 2018

Momentum is building among House Democrats for a more moderate alternative to single-payer health-care legislation.

The legislation, which would allow people aged 50 to 65 to buy Medicare, is being championed by Rep. Brian Higgins (D-N.Y.), who supported House Minority Nancy Pelosi (D-Calif.) for Speaker in exchange for a commitment to work on his bill when Democrats take control of the House early next year.

“We agreed in principle to get this done,” Higgins told The Hill.

Under Higgins’s plan, anyone aged 50 to 64 who buys insurance through the health-care exchanges would be eligible to buy in to Medicare.

Rep. Frank Pallone Jr. (D-N.J.), the likely chairman of the Energy and Commerce Committee next year, said he thinks a Medicare buy-in should be on the agenda next year.

“We certainly would consider a Medicare buy-in,” Pallone told The Hill. “I think we’ve got to wait and see what the caucus wants to do and what the committee wants to do, but I’ll just say it’s certainly something we should consider.”

“Medicare for all” supporters are energized after sweeping Democratic victories in the midterm elections, however, and see the Medicare buy-in bill as too small a step.

“We are dead set against any buy-in or public option,” said Kenneth Zinn, political director of National Nurses United. “Our goal as RNs is to ensure a universal system of guaranteed health care for everyone and this does not accomplish that. I would urge Congress to reject it.”

Zinn said private insurance shouldn’t have any role in health coverage moving forward. A single-payer plan covers everyone, regardless of income, and eliminates copays, deductibles and premiums. It also eliminates private insurance.

Rep. Pramila Jayapal (D-Wash.), who is co-chair of the Medicare for All Caucus in the House, told The Hill said she has spoken with Higgins and expressed her concerns about his bill.

“We have to be careful not to perpetuate the system we have,” Jayapal said. “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.”

Jayapal added that lowering the eligibility age “would be an appropriate way to go where we’re taking a step forward towards a system that will ultimately cover everybody.”

Higgins said a Medicare buy-in is quicker and cheaper to implement than single-payer. It can also be a bridge to Medicare for all, he said.

“I support the exploration of Medicare for all, but you have to be well balanced and practical about this. Establishing a brand-new health insurance program is going to take time,” Higgins said.

Adam Green, co-founder of the Progressive Change Campaign Committee, said he supports giving everyone the option to buy in to Medicare, and thinks the legislation from Higgins will start a conversation. He wants a “buy-in for all” to be the “new floor” in the debate.

“It’s ironic that it took a conservative Democrat to jumpstart the momentum for Medicare buy-in but now that it’s there, there will be a huge push for Medicare option for all,” Green said.

“It’s jumpstarting the concept of a buy-in in 2019 and will lead to momentum of a buy-in for every family and small business.”

https://thehill.com…

Comment:

By Don McCanne, M.D.

Many Democrats were elected after campaigning for “Medicare for All” which most of us presumed meant single payer reform. A Medicare buy-in is not single payer but rather it is merely a version of the public option. It simply adds another option to our highly dysfunctional financing system while correcting virtually none of the defects. It is not even an incremental step towards single payer since it takes us down a different pathway. If momentum seems to be building for a Medicare buy-in as a wedge to dismiss consideration of single payer, then Congress needs to hear from us – in a big way.

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

A California lesson on eliminating the individual mandate penalty

California’s Health Coverage Gains to Erode Without Further State Action

By Miranda Dietz Laurel Lucia, Dylan H. Roby, Ken Jacobs, Petra W. Rasmussen, Xiao Chen, Dave Graham-Squire, Greg Watson, Ian Perry, Gerald F. Kominski
UC Berkeley Labor Center and UCLA Center for Health Policy Research, November 2018

California’s successful implementation of the Affordable Care Act (ACA) resulted in historic increases in health insurance coverage. Over one million Californians have subsidized insurance through Covered California, the state’s ACA marketplace. The state’s Medicaid program (Medi-Cal) now covers approximately one out of three Californians, millions more than prior to the ACA.

Despite this success, 10.4 percent of non-elderly Californians (those under age 65) lacked insurance in 2016. Without state action to protect and build upon these coverage gains, we project that the uninsurance rate could grow to 11.7 percent in 2020, or approximately 4.02 million people, and to 12.9 percent in 2023, or 4.4 million people. These rates are based on a definition of insurance that excludes restricted-scope Medi-Cal for undocumented Californians.

The federal law zeroing out the ACA individual mandate penalty beginning in 2019 will result in lower individual market and Medi-Cal enrollment, but significant uncertainty exists about how much enrollment will decline in California. Using our California Simulation of Insurance Markets (CalSIM) microsimulation model and a range of assumptions about the extent to which the penalty influences enrollment decisions, we project that between 150,000 and 450,000 more Californians will be uninsured in 2020, growing to between 490,000 and 790,000 more uninsured in 2023, compared to the projected number if the ACA penalty had been maintained. The most substantial enrollment changes will occur in the individual market, where we project enrollment will decline by 10.1 percent in 2020 and 14.4 percent in 2023.

To protect the progress made under the ACA in expanding health coverage and to reduce the remaining coverage gaps, the state could expand Medi-Cal to all low-income residents regardless of immigration status, provide state subsidies to improve affordability of individual market premiums and out-of-pocket costs, implement a state individual mandate, and continue to support and strengthen outreach and enrollment efforts, among other strategies. As federal decisions threaten to reverse health coverage gains around the country, these policies would help to ensure that California continues to build on its successes and drive toward its goal of achieving universal health coverage.

http://laborcenter.berkeley.edu…

Comment:

By Don McCanne, M.D.

California has been a leader in implementing the Affordable Care Act. As such, it would be useful to estimate the impact of the law that is eliminating the penalty for not having health insurance. This meticulous study estimates that five years from now over half a million additional Californians will be uninsured when compared to estimates were the penalty to remain in place.

Many studies have demonstrated that being uninsured results in impaired physical and financial health for far too many individuals who lose their insurance. Obviously we need to pursue different policies that instead would improve access and affordability of health care.

The primary criticism of this otherwise excellent report is that the authors’ recommendations, though reducing the negative impact of eliminating the individual mandate penalty, would still fall far short of the goals of reform. Many would still be uninsured. Many would still face financial hardship due to underinsurance. Many would be deprived of their choices of health care professionals and institutions because of the perpetuation of restricted provider networks. We would all be paying more because of the costs of administrative excesses which would only increase under the authors’ recommendations, not to mention the burden placed on us by having to comply with these excesses.

So the primary defect in this 32-page report is that they left out any discussion of a proposal that would meet the crucial goals of reform: Single Payer Medicare for All. We can only speculate that the reason is that these distinguished policy experts still limit their recommendations based on their perceptions of political feasibility. It is true that President Trump and the Republican-controlled Senate would be barriers to such comprehensive reform, but with certainty only for the next two years. That is a very short time to mobilize the public into a frenzy that offers politicians no choice but to fulfill the wishes of the majority: enact Single Payer Medicare for All.

If we can show success in grassroots organizing, these authors would no doubt concur that Single Payer Medicare for All is the way to go. These policy wonks certainly understand the different impacts of a policy that financially penalizes a person for being uninsured versus a policy that automatically insures absolutely everybody for life. In fact, you don’t even have to be a policy wonk since that’s a no-brainer.

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

Medical students provide lesson on Medicare for All for NewYork-Presbyterian CEO

The CEO of a big New York hospital explains why he wants everyone in the US to have health coverage — but doesn't support 'Medicare for All'

By Lydia Ramsey
Business Insider, November 2, 2108

Dr. Steven Corwin knows what he does is expensive.

Corwin is the CEO of NewYork-Presbyterian Hospital. Surgeries, intensive care, and other costly procedures are constantly taking place within its walls. Hospital care cost about $1.1 trillion in 2016 — that’s 32% of health spending in the US.

“We do a lot of very expensive things,” Corwin told Business Insider. “We have to figure out how to reduce our costs.”

“We have to have universal coverage,” Corwin said. “Let’s forget the mechanism of getting universal coverage, but I think everybody’s gotta be insured.”

While Corwin doesn’t support Medicare for All, it’s a concept he has on his mind, in part because of how much simpler what is known as a single-payer system would be on the administrative side of the hospital. Instead of worrying about the variability in different plans, hospitals would have only one plan to keep in mind.

But to him, there are two big questions around Medicare for All:

Logistically, what’s the tax structure the US would need to support that?

Does Medicare for All makes sense for the US as a country?

“I think we should have that debate,” Corwin said.

https://www.businessinsider.com…

A group of students at Weill Cornell and Columbia explain why their CEO is wrong to oppose ‘Medicare for All’

Business Insider, Letter to the Editor, November 26, 2018

In a recent article, NewYork-Presbyterian Hospital CEO Dr. Steven Corwin commented on rising healthcare costs. He stated that “We do a lot of very expensive things…We have to figure out how to reduce our costs.” In the same article, he stated that he opposes “Medicare for All,” but that “We have to have universal coverage,”

As medical students training at the institution Dr. Corwin leads, we agree: we do need it – and we need it urgently. Unlike Dr. Corwin, we, along with a growing number of hospital leaders, believe “Medicare for All” is the only solution for universal coverage and cost reduction.

Medicare for All is a universal, comprehensive single-payer system in which healthcare is financed by one public agency but privately delivered. It would cover all medically necessary services and eliminate co-pays, premiums, and deductibles, leading to improved financial security when individuals or families get sick. It would also give patients the freedom to choose their doctor.

HR 676, a bill introduced in the US House of Representatives with 123 Democratic co-sponsors last year, and the NY Health Act, a state bill that has passed the New York State Assembly in each of the past four years, would both establish such a system.

In his interview, Dr. Corwin first asks “what’s the tax structure the US would need to support [Medicare for All]?” Both HR 676 and the NY Health Act have well-defined funding mechanisms. Each proposes a progressively graduated payroll tax paid by employers and employees, as well as a progressive tax on non-employment income such as capital gains. HR 676 also includes an increase in personal income taxes on the top 5% of earners and a small tax on stock and bond transactions.

While many recent headlines claim that Medicare for All comes with a hefty price tag for taxpayers, it is vital to understand that this increase will be more than offset by the elimination of co-pays, premiums, and deductibles, resulting in net savings for 95% of U.S. households. Studies on the fiscal feasibility of HR 676 and the NY Health Act predict that the proposed funding mechanisms will sustain a Medicare for All system while saving billions of dollars annually.

The business community is also warming up to the idea of Medicare for All. Employer spending on healthcare continues to rise dramatically: the average employer contribution to premiums per worker has risen nearly 70% in the past decade.

Despite repeated claims of government inefficiency, Medicare currently operates at roughly 2% overhead cost, compared to 12.4% overhead for private insurers. These lower administrative costs, along with reasonable limits on drug prices, procedures, and devices will result in billions of dollars of savings for businesses and consumers that can be redirected into the private sector.

Dr. Corwin also asked “Does Medicare for All make sense for the US as a country?” We believe it does—as do 70% of Americans, including 84.5% of Democrats and 51.9% of Republicans.

Medicare is a national treasure: before age 65, when most Americans are insured by private companies, the U.S. has the worst mortality rates of any comparable countries; shortly after 65, when Americans become eligible for Medicare, the U.S. shoots to the top of the rankings. Additionally, Medicare beneficiaries have much higher satisfaction rates than those insured by private companies. Medicare for All will expand these benefits to the entire country.

Medicare for All is something all Americans can get behind, because it is for all Americans. It is bigger than any one hospital, insurer, or patient. As future physicians, our goals align with Dr. Corwin’s: we want universal healthcare coverage and we want to reduce costs. Medicare for All will do both. Is it time for Medicare for All in the U.S.? Dr. Corwin said “I think we should have that debate.” We wholeheartedly agree.

Sincerely,

William Ford, Emilie George, Alex Irace, Rachel Madley, Graham Wehmeyer, and Michael Zingman; Students at Weill Cornell Medicine and Columbia University Vagelos College of Physicians & Surgeons, Members of Students for a National Health Program (SNaHP)

https://www.businessinsider.com…

A personal message:

By Don McCanne, M.D.

The future of health care in America rests with the nation’s students in medicine and in the other health professions. When you read the letter above written by members of Students for a National Health Program (SNaHP) you can be assured that the future is in very good hands.

Those of us at Physicians for a National Health Program (PNHP) who worked with Nicholas Skala were very impressed with “his incisive mind, wide-ranging knowledge and formidable skills of argument that were devoted entirely to bringing about a better world for everyone.” He was “an extremely witty and compassionate human being, and a great source of inspiration and encouragement.” He was so gifted that I personally thought that his name someday would be widely associated with the single payer Medicare for All program that would eventually be enacted. We are still reeling from his loss due to a cardiac event. We remember his legacy through multiple programs, including the Nicholas Skala Health Activist Award, Memorial Fund, and Student Scholarship Program.

On Giving Tuesday it seems appropriate to consider the contributions of Students for a National Health Program, and I am doing so through a contribution to the Nicholas Skala Student Activist Scholarship Fund. Before you decide that you are receiving too many requests today, do just one thing. Click on the following link, look at Nick’s portrait, and then just try to say no. I couldn’t. I hope you’ll join me.

https://pnhp.salsalabs.org…

Peace.

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

Trump administration wants to change rules to bring back kickbacks

Trump Administration Invites Health Care Industry to Help Rewrite Ban on Kickbacks

By Robert Pear
The New York Times, November 24, 2018

The Trump administration has labored zealously to cut federal regulations, but its latest move has still astonished some experts on health care: It has asked for recommendations to relax rules that prohibit kickbacks and other payments intended to influence care for people on Medicare or Medicaid.

The goal is to open pathways for doctors and hospitals to work together to improve care and save money. The challenge will be to accomplish that without also increasing the risk of fraud.

With its request for advice, the administration has touched off a lobbying frenzy. Health care providers of all types are urging officials to waive or roll back the requirements of federal fraud and abuse laws so they can join forces and coordinate care, sharing cost reductions and profits in ways that would not otherwise be allowed.

Federal health officials are reviewing the proposals for what they call a “regulatory sprint to coordinated care” even as the Justice Department and other law enforcement agencies crack down on health care fraud, continually exposing schemes to bilk government health programs.

“The administration is inviting companies in the health care industry to write a ‘get out of jail free card’ for themselves, which they can use if they are investigated or prosecuted,” said James J. Pepper, a lawyer outside Philadelphia who has represented many whistle-blowers in the industry.

Federal laws make it a crime to offer or pay any “remuneration” in return for the referral of Medicare or Medicaid patients, and they limit doctors’ ability to refer patients to medical businesses in which the doctors have a financial interest, a practice known as self-referral.

These laws “impose undue burdens on physicians and serve as obstacles to coordinated care,” said Dr. James L. Madara, the chief executive of the American Medical Association. The laws, he said, were enacted decades ago “in a fee-for-service world that paid for services on a piecemeal basis.”

Melinda R. Hatton, senior vice president and general counsel of the American Hospital Association, said the laws stifle “many innocuous or beneficial arrangements” that could provide patients with better care at lower cost.

Hospitals often say they want to reward doctors who meet certain goals for improving the health of patients, reducing the length of hospital stays and preventing readmissions. But federal courts have held that the anti-kickback statute can be violated if even one purpose of the remuneration is to induce referrals or generate business for the hospital.

The premise of the kickback and self-referral laws is that health care providers should make medical decisions based on the needs of patients, not on the financial interests of doctors or other providers.

Doctors, hospitals and drug companies are urging the Trump administration to provide broad legal protection — a “safe harbor” — for arrangements that promote coordinated, “value-based care.” In soliciting advice, the Trump administration said it wanted to hear about the possible need for “a new exception to the physician self-referral law” and “exceptions to the definition of remuneration.”

“Good providers can work within the existing rules,” said Joel M. Androphy, a Houston lawyer who has handled many health care fraud cases. “The only people I ever hear complaining are people who got caught cheating or are trying to take advantage of the system. It would be disgraceful to change the rules to appease the violators.”

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

This article demonstrates some of the undesirable consequences of blindly continuing down the pathway of value-based health care through practice arrangements such as accountable care organizations. The system should be structured to serve the health care interests of patients first but these models are serving primarily the financial interests of physicians and hospitals. They are endorsed by the AMA and the American Hospital Association which seems to explain why these organizations are on the wrong side of the the debate over Single Payer Medicare for All.

The laws, rules and regulations that are being addressed by the proposed rules that would relax enforcement exist because the health industry did engage in activities that placed the financial interests of the providers above the health care interests of patients – activities that were often unethical and immoral. It is ironic that the business models being pursued today are claimed to increase value when, in fact, they bring back old behaviors that have been considered to be illegal, and for good reason. Maybe we’ve abandoned some of the old language – fee-splitting, kickbacks, ghost surgery, etc. – but the alternative payment models are bringing back arrangements that represent similar compromises in medical ethics.

Houston lawyer Joel Androphy says, “Good providers can work within the existing rules. The only people I ever hear complaining are people who got caught cheating or are trying to take advantage of the system. It would be disgraceful to change the rules to appease the violators.”

The effort of the Trump administration to relax the rules of ethics to take care of the providers is wrong, though there certainly is need to back off on their efforts to expand the dysfunctional value-based models that they are advancing.

We need a change, but a change that better serves the interests of patients – like, for instance, a Single Payer Medicare for All program. That would work better for the providers as well, except maybe for the very few who are primarily driven by greed. Besides, if we remove the opportunities for greed, then greed disappears (except for the relatively rare, hardcore, mafioso-type Medicare crooks).

Single Payer Medicare for All – where the rules serve the interests of patients first.

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

A group of students at Weill Cornell and Columbia explain why their CEO is wrong to oppose ‘Medicare for All’

By William Ford, Emilie George, Alex Irace, Rachel Madley, Graham Wehmeyer, and Michael Zingman
Business Insider, Letters, November 26, 2018

In a recent article, NewYork-Presbyterian Hospital CEO Dr. Steven Corwin commented on rising healthcare costs. He stated that “We do a lot of very expensive things…We have to figure out how to reduce our costs.” In the same article, he stated that he opposes “Medicare for All,” but that “We have to have universal coverage,”

As medical students training at the institution Dr. Corwin leads, we agree: we do need it – and we need it urgently. Unlike Dr. Corwin, we, along with a growing number of hospital leaders, believe “Medicare for All” is the only solution for universal coverage and cost reduction.

Medicare for All is a universal, comprehensive single-payer system in which healthcare is financed by one public agency but privately delivered. It would cover all medically necessary services and eliminate co-pays, premiums, and deductibles, leading to improved financial security when individuals or families get sick. It would also give patients the freedom to choose their doctor.

HR 676, a bill introduced in the US House of Representatives with 123 Democratic co-sponsors last year, and the NY Health Act, a state bill that has passed the New York State Assembly in each of the past four years, would both establish such a system.

In his interview, Dr. Corwin first asks “what’s the tax structure the US would need to support [Medicare for All]?” Both HR 676 and the NY Health Act have well-defined funding mechanisms. Each proposes a progressively graduated payroll tax paid by employers and employees, as well as a progressive tax on non-employment income such as capital gains. HR 676 also includes an increase in personal income taxes on the top 5% of earners and a small tax on stock and bond transactions.

While many recent headlines claim that Medicare for All comes with a hefty price tag for taxpayers, it is vital to understand that this increase will be more than offset by the elimination of co-pays, premiums, and deductibles, resulting in net savings for 95% of U.S. households. Studies on the fiscal feasibility of HR 676 and the NY Health Act predict that the proposed funding mechanisms will sustain a Medicare for All system while saving billions of dollars annually.

The business community is also warming up to the idea of Medicare for All. Employer spending on healthcare continues to rise dramatically: the average employer contribution to premiums per worker has risen nearly 70% in the past decade.

Despite repeated claims of government inefficiency, Medicare currently operates at roughly 2% overhead cost, compared to 12.4% overhead for private insurers. These lower administrative costs, along with reasonable limits on drug prices, procedures, and devices will result in billions of dollars of savings for businesses and consumers that can be redirected into the private sector.

Dr. Corwin also asked “Does Medicare for All make sense for the US as a country?” We believe it does—as do 70% of Americans, including 84.5% of Democrats and 51.9% of Republicans.

Medicare is a national treasure: before age 65, when most Americans are insured by private companies, the U.S. has the worst mortality rates of any comparable countries; shortly after 65, when Americans become eligible for Medicare, the U.S. shoots to the top of the rankings. Additionally, Medicare beneficiaries have much higher satisfaction rates than those insured by private companies. Medicare for All will expand these benefits to the entire country.

Medicare for All is something all Americans can get behind, because it is for all Americans. It is bigger than any one hospital, insurer, or patient. As future physicians, our goals align with Dr. Corwin’s: we want universal healthcare coverage and we want to reduce costs. Medicare for All will do both. Is it time for Medicare for All in the U.S.? Dr. Corwin said “I think we should have that debate.” We wholeheartedly agree.

William Ford, Emilie George, Alex Irace, Rachel Madley, Graham Wehmeyer, and Michael Zingman are medical students at Weill Cornell Medicine and Columbia University Vagelos College of Physicians & Surgeons, and members of Students for a National Health Program (SNaHP).

https://www.businessinsider.com…

Trump’s proposal could drive drug prices even higher

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, November 24, 2018

President Donald Trump’s proposal that pharmaceutical ads must include drug prices is a fool’s errand. It reminds me that I always try to pick the restaurant when going out to dinner with a particular friend of mine. If I let her decide, we wind up at a very expensive place, often enduring food that’s not nearly as good as what we can get at the cheaper local dives that I prefer.

She’s not that unusual. People often use price as a substitute for quality, particularly when they don’t have the ability to identify quality.

If President Trump gets his way and requires drug companies to include prices in their ads, this pattern will soon become rampant in pharmaceuticals and could drive prices even higher than they are today.

Researchers once tested the power of price on placebo pain pills. They gave volunteers tiny electric shocks and had them declare a numeric pain score. The researchers then had them swallow a sugar pill that they said would reduce the pain, and then remeasured the pain level after a second electric shock. Not surprisingly, those sugar pills worked; they all said the electric shock hurt less after the fake pain pill. But those placebos were far more effective when the researchers told the volunteers that the pain pill costs $4 than if they told them it cost 4 cents.

It’s hard to imagine that this is not precisely what will happen if we start requiring manufacturers to include prices in their advertisements. People will feel cheated if their insurance company denies them affordable access to the most expensive drugs.

I’ve seen this again and again with my own patients: They ask me to prescribe a specific drug they saw advertised. I know that this particular drug is a perfectly reasonable choice to treat their problem, but it’s only one of a dozen such reasonable choices. I’m willing to prescribe that advertised drug, but when I try to tell them about a less expensive and clinically comparable choice, those with insurance often tell me that the price doesn’t matter. Sure, the drug may list at $10,000 instead of $1,000, but the difference in their insurance copays are far less extreme.

If there is a clinically important reason that they need this expensive drug, I’m relieved when the price is not a driving factor in the selection. But when an expensive drug is just one choice among many less expensive alternatives, some patients are skeptical that the outrageously priced drug doesn’t provide a vital advantage. Doctors are careful to be seen as an ally and patient advocate, rather than as a barrier to medications reserved for the high-heeled.

Drug prices are badly out of control in the United States. Americans pay twice as much as the rest of the modern world does, for the very same drugs produced by the very same manufacturers in the very same factories. It’s a crisis that renders many of my patients unable to afford to treat things like diabetes, taking their insulin every other day instead of the prescribed twice daily.

Ultimately, this naively futile attempt at budgeting increases the cost of their health care. Early treatments are often the most prudent strategy, delaying or fully avoiding more expensive end-stage failures like kidney failure, strokes and heart attacks.

The good news is, we know of several strategies that would drive down the prices of prescription drugs. Several of my colleagues at Physicians for a National Health Program laid them all out in a recent article in the British Medical Journal. We should establish a single national formulary of prescription drugs and provide all Americans with full coverage of those drugs. We should negotiate the prices for those drugs with the patent holders and compel price gougers to license their patents to generic manufacturers. We need to stop allowing patents for trivial changes to existing drugs. And we need to eliminate the current tax deductions for drug advertising.

We know how to reduce the cost of prescription drugs. Sadly, President Trump’s strategy is likely to have the exact opposite approach in this case.

Dr. Ed Weisbart is a family physician in Olivette and chair of the Missouri chapter of Physicians for a National Health Program.

https://www.stltoday.com…

What can I do to make ‘Medicare for All’ happen?

By George Bohmfalk, M.D.
The Aspen (Colo.) Times, November 23, 2018

Democratic control of the next House of Representatives opens a door for some action on single-payer Improved Medicare for All.

While we don’t expect a law to be passed in the next two years, the issue may be debated in committee and possibly on the floor, with an eye toward becoming reality after 2020.

If, after reading my recent series of articles on the status of American health care, which can be found on aspentimes.com, you agree that the best solution may be Improved Medicare for All, you may want to help move it along.

Here are a few actions you might pursue.

The route to achieving Improved Medicare for All has at least four paths:

Grassroots Education

Learn more about it by reading legitimate, fact-based articles at nonprofit websites and joining such organizations as:

Educate your friends, co-workers, relatives, chairlift sharers. Educate your group — political, civic, book club, religious, social. Invite a member of PNHP-CO to give a presentation — or make one yourself!

Educate the public — write letters to editors supporting Improved Medicare for All. Wear buttons and bumper stickers, available from the organizations above.

Corporate/Business Support

Talk to small and large business owners and leaders. Arrange for them to watch the “FixIt” documentary. Once they understand how this can help their employees, their bottom lines and the entire country, they should line up to support it.

Medical Support

Ask your doctors how they feel about Improved Medicare for All. Tell them how it would help both you and them. Surveys show that a majority of physicians already support a single-payer system. All of them should, when they understand its myriad benefits.

Political Support

Call and tell your Congressional representatives, of either party, over and over, why they should support it, ideally as proposed in the House Bill H.R. 676. Bernie Sanders’ Senate bill, S. 1804, comes pretty close, and if either bill passes, their slight differences will be ironed out in a Joint Conference Committee. Urge them to cosponsor those bills, if they don’t already. In particular, call members of the next House Ways and Means and Energy and Commerce committees, and ask them to hold hearings on it. You can contact all of your representatives through the U.S. Capitol switchboard, at 202-224-3121.

The 2020 elections will be here before you know it, and in order for Improved Medicare for All to become a reality, all of the above groups must understand its merits before then. Help spread the word and prepare the ground for this critical undertaking.

Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.

https://www.aspentimes.com…

Health care industry battle plan against ‘Medicare for All’

Lobbyist Documents Reveal Health Care Industry Battle Plan Against 'Medicare for All'

By Lee Fang and Nick Surgey
The Intercept, November 20, 2018

Now that the midterms are finally over, the battle against “Medicare for All” that has been quietly waged throughout the year is poised to take center stage.

Internal strategy documents obtained by The Intercept and Documented reveal the strategy that private health care interests plan to use to influence Democratic Party messaging and stymie the momentum toward achieving universal health care coverage.

Over the summer, leading pharmaceutical, insurance, and hospital lobbyists formed the Partnership for America’s Health Care Future, an ad hoc alliance of private health interests, to curb support for expanding Medicare.

The campaign, according to one planning document, is designed to “change the conversation around Medicare for All,” then “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”

Behind the scenes, the group attempted to sway candidates during the midterms, encouraging several of them to focus on shoring up the Affordable Care Act instead of supporting single-payer health care.

In several competitive races, the Partnership pressed candidates to use industry-crafted talking points when speaking about health care.

Several of the candidates who agreed to embrace the Partnership’s messaging and policy ideas came up short on Election Day. But soon after Election Day results came in, the Partnership went on the offensive, informing reporters that candidates who embraced “Medicare for All” had also lost, pointing to the defeat of progressives such as Kara Eastman in Nebraska. The group also relied on research from the business-friendly Democratic think tank Third Way to argue that victorious pro-“Medicare for All” candidates couldn’t attribute their success to having supported “Medicare for All” because few Democrats explicitly mentioned the policy in their campaign advertisements.

The growing momentum for “Medicare for All” could raise expectations for the next time Democrats are in full control of power in Washington, industry groups worry. They are already pressuring conservative-leaning caucuses in the House of Representatives, such as the Blue Dogs and New Democrats Coalition, to push back against insurgent progressives’ demands.

The campaign has worked with advertising agencies to draw up a series of messages to convince select audiences. Several of the messages, categorized as “positive,” are dedicated to educating the public on more minimal reforms that do not include expanding Medicare. Other messages, categorized as “persuasion” and “aggressive,” are designed to instill fear about what could happen if “Medicare for All” passes.

In the coming weeks, the Partnership plans to ramp up a campaign designed to derail support for “Medicare for All.” The group, working with leading Democratic political consultants, will place issue advertisements to target audiences, partner with Beltway think tanks to release studies to raise concerns with the plan, and work to shape the public discourse through targeted advocacy in key congressional districts.

In one planning document circulated over the summer, the Partnership suggested a series of messages to wean Americans away from supporting single payer. The talking points emphasize that the current system provides “world-class care,” and that any move away from the Affordable Care Act would be “ripping apart our current system.”

The strategy exploits familiar themes that have long been used by business groups against new government health care programs, calling for allies to say lines such as “bureaucrats in DC have no understanding of a person’s medical situation and will be making decisions about your health care instead of doctors.”

The Partnership plans to form a speakers bureau of former Democratic elected officials who can leverage the media to make the case that expanding Medicare is bad politics and policy. The memo names former Democratic Majority Leader Tom Daschle, now a health insurance lobbyist at the law firm Baker Donelson, as one such potential surrogate.

The memo points to early success in shaping media coverage, citing several “earned media” columns such as one published in August by former Rep. Jill Long Thompson, D-Ind., which argues that Democrats should only focus on small reforms to the Affordable Care Act, and warns against wasting political capital on pursuing a “government-controlled health insurance system.”

Adam Gaffney, president-elect of Physicians for a National Health Program, a national coalition that advocates in favor of “Medicare for All,” said he is not surprised by the messaging.

“What we’re seeing is the wages of success: With single payer on the rise, it was only a matter of time before the insurance companies, big pharma, and other big-money groups came out swinging,” said Gaffney, who also serves as an instructor at Harvard Medical School.

“The smear of ‘socialized medicine’ has been used a thousand times and has lost its bite,” he added.

Influencing the 2020 Democratic Field

“We’re all focused on 2020,” Lauren Crawford Shaver, a partner at Forbes-Tate who is helping to manage the Partnership campaign, recently told the National Association of Health Underwriters in a podcast produced by the group.

Shaver, a former top staffer for the Hillary Clinton presidential campaign, explained to the group that she is working to peel support away from the “Medicare for All” bill sponsored by Sen. Bernie Sanders, I-Vt. The Sanders bill is currently sponsored by several rumored 2020 Democratic presidential candidates, including Sens. Elizabeth Warren, D-Mass.; Kamala Harris, D-Calif.; and Kirsten Gillibrand, D-N.Y.

“The No. 1 thing we need to focus on is that there are a lot of likely candidates that currently support the Senate bill,” said Shaver. “We need to make sure we educate the public, we educate both parties, and we educate all the campaigns about both the policy and political challenges.”

Shaver encouraged health care companies concerned about the growing popularity of “Medicare for All” to mobilize opposition among clients, customers, and employees. Industry groups will likely have workers or customers residing in key districts who can be tapped to influence wavering lawmakers on Capitol Hill.

The Partnership plans to “take stories of how these proposals would directly impact your clients and the constituents of the policymakers who are voting for or against these proposals,” Shaver said.

AHIP, the insurance trade group behind the 2008 plan, is also a sponsor of the Partnership’s 2020 campaign, along with the Federation of American Hospitals, Pharmaceutical Research and Manufacturers of America, the Blue Cross Blue Shield Association, the Biotechnology Innovation Organization, and the American Medical Association.

Despite a pledge by many Democratic candidates to eschew corporate PAC donations, health care lobbyists have funneled cash to many incoming lawmakers through the New Democrats PAC, the Blue Dog PAC, and other centrist committees. Unsurprisingly, the centrist New Democrats Coalition, the caucus of business-friendly centrist Democrats, has worked to depress momentum for “Medicare for All,” reprising the role centrist Democrats played in killing the public option during the Obama administration.

Immediately following the midterm elections this month, the Washington Post published a column by Third Way warning that “Medicare for All” “failed the Hippocratic Oath” because opposition to the plan helped Republican candidates, thus causing “harm” to the long-term health interests of voters.

But advocates for “Medicare for All” are feeling optimistic.

“In terms of tactics, it sounds like they will just be updating the same lines they used in the 1990s to sideline reform efforts and in the ACA fight to keep single-payer health care off the table,” said Eagan Kemp, a health care policy advocate with Public Citizen. “The Partnership for America’s Health Care Future would be more accurately titled the ‘Partnership for Profiting Off America’s Health Care.’”

Private health care interests will certainly have much more money, media attention, and political resources with which to campaign. Advocates, however, are hoping Americans see past the public relations smokescreen and support health care as a human right.

“There is no brand loyalty to insurance companies, which are rightly seen as parasitic,” Gaffney, the PNHP leader, said.

“Once single payer is widely understood as a program that covers everyone, that doesn’t impose copays and deductibles, that has more comprehensive benefits than existing plans, and that doesn’t employ restrictive insurance ‘networks,’ support will only grow,” he added.

https://theintercept.com…

Comment:

By Don McCanne, M.D.

Man your battle stations. The messaging war has begun. It’s our message of “lifetime affordable health care for everyone” versus their message of “don’t take my private insurance away.” Let me keep my high premiums, high deductibles, restrictive provider networks, and uncertainty of coverage related to my employment or lack thereof.

It seems like the battle should be no contest. The policies behind our message should clearly prevail: health care for everyone versus perpetuation of the perversities of the private insurance industry. But the hundreds of millions of dollars the opponents of Medicare for All will spend can purchase some very slick government-can’t-do-anything-right messages, ignoring the fact that health care delivery would be predominantly in the private sector.

Winning the message war means that our message must be out there. We have work to do.

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

Lobbyist Documents Reveal Health Care Industry Battle Plan Against “Medicare for All”

By Lee Fang and Nick Surgey
The Intercept, November 20, 2018

Now that the midterms are finally over, the battle against “Medicare for All” that has been quietly waged throughout the year is poised to take center stage.

Internal strategy documents obtained by The Intercept and Documented reveal the strategy that private health care interests plan to use to influence Democratic Party messaging and stymie the momentum toward achieving universal health care coverage.

At least 48 incoming freshman lawmakers campaigned on enacting “Medicare for All” or similar efforts to expand access to Medicare. And over the last year, 123 incumbent House Democrats co-sponsored “Medicare for All” legislation — double the number who supported the same bill during the previous legislative session.

The growing popularity of “Medicare for All” in the House has made progressives optimistic that the Democratic Party will embrace ideas to expand government coverage options with minimal out-of-pocket costs for patients going into the 2020 election. But industry groups have watched the development with growing concern.

Over the summer, leading pharmaceutical, insurance, and hospital lobbyists formed the Partnership for America’s Health Care Future, an ad hoc alliance of private health interests, to curb support for expanding Medicare.

The campaign, according to one planning document, is designed to “change the conversation around Medicare for All,” then “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”

Behind the scenes, the group attempted to sway candidates during the midterms, encouraging several of them to focus on shoring up the Affordable Care Act instead of supporting single-payer health care.

The documents show that Partnership representatives spoke to the staffs of Democratic Sens. Bill Nelson of Florida and Joe Donnelly of Indiana, and received confirmation that both senators would maintain their “moderate position.” When the team met with Rep.-elect Lori Trahan, D-Mass., she said that although she does not speak about the issue, she agreed that “language around single payer should be tempered.” (None of the three politicians’ offices provided responses to inquiries from The Intercept.)

In several competitive races, the Partnership pressed candidates to use industry-crafted talking points when speaking about health care. In one internal planning document circulated with health care lobbyists, the Partnership touted its influence over Danny O’Connor, the Columbus, Ohio-area Democrat who ran for the 12th Congressional District, claiming that O’Connor used Partnership talking points “in national news interviews.” (O’Connor’s campaign did not respond to a request for comment.)

Several of the candidates who agreed to embrace the Partnership’s messaging and policy ideas, including Donnelly and O’Connor, came up short on Election Day. A recount ending on November 18 confirmed that Nelson received fewer votes than Republican challenger Rick Scott. But soon after Election Day results came in, the Partnership went on the offensive, informing reporters that candidates who embraced “Medicare for All” had also lost, pointing to the defeat of progressives such as Kara Eastman in Nebraska. The group also relied on research from the business-friendly Democratic think tank Third Way to argue that victorious pro-“Medicare for All” candidates couldn’t attribute their success to having supported “Medicare for All” because few Democrats explicitly mentioned the policy in their campaign advertisements.

“’Medicare for All’ didn’t win,” said Joel Kopperud, the vice president of government affairs at the Council of Insurance Agents and Brokers, one of the industry groups backing the Partnership. “I don’t think that the Bernie Sanders $32 trillion solution that’s going to eviscerate the insurance for 156 million Americans is really something that’s going to be helpful to the party in critical states,” he added in an interview with The Intercept.

Kopperud represents insurance brokers who sell employer-based health insurance coverage. He noted that his organization has a vested interest in backing the Partnership. “Medicare for All,” as some envision the policy, would eventually eliminate the need for most health insurance plans — a death knell for companies represented by the CIAB.

Private health care lobbyists are confident that they can prevent any federal expansion of Medicare in Congress, given Republican control of the Senate and the White House. In the states, CIAB and other private health groups have easily defeated measures to develop single-payer proposals, such as the ColoradoCare ballot question in 2016.

But the political calculus could be changing. Recent election gains by Democrats in state government could create new opportunities for proponents of expanded government-backed health care initiatives. Gov.-elect Gavin Newsom of California campaigned on single payer and is expected to have one of the largest Democratic supermajorities in recent memory in the legislature, though California has a notoriously complex state constitution that would likely require an amendment before any significant government plan could be created.

The growing momentum for “Medicare for All” could raise expectations for the next time Democrats are in full control of power in Washington, industry groups worry. They are already pressuring conservative-leaning caucuses in the House of Representatives, such as the Blue Dogs and New Democrats Coalition, to push back against insurgent progressives’ demands.

Reframing the Debate

For industry opponents of expanded government health insurance, there are two main challenges. One is combatting growing public support for the idea. The other is shaping elite opinion within the Beltway.

Over the last two years, several opinion surveys show rising support for expanding Medicare. In March, the Kaiser Health Tracking Poll found that 59 percent of Americans support the idea, and by August, a poll conducted by Reuters-Ipsos found an astounding 70 percent of Americans support “Medicare for All,” including a majority of self-identified Republicans.

But the Partnership is quick to zero in on research that shows support for the idea drops precipitously when respondents are told that the plan would require ending employer-based coverage, tax increases, and increased government control.

The campaign has worked with advertising agencies to draw up a series of messages to convince select audiences. Several of the messages, categorized as “positive,” are dedicated to educating the public on more minimal reforms that do not include expanding Medicare. Other messages, categorized as “persuasion” and “aggressive,” are designed to instill fear about what could happen if “Medicare for All” passes.

In the coming weeks, the Partnership plans to ramp up a campaign designed to derail support for “Medicare for All.” The group, working with leading Democratic political consultants, will place issue advertisements to target audiences, partner with Beltway think tanks to release studies to raise concerns with the plan, and work to shape the public discourse through targeted advocacy in key congressional districts.

The Partnership has tapped consulting firms with deep ties to Democratic officials. Forbes-Tate, a lobbying firm founded by former officials in President Bill Clinton’s administration and conservative Democrats in Congress, is managing part of the Partnership coalition. Blue Engine Message & Media, a firm founded by former campaign aides to President Barack Obama, has handled the Partnership’s interactions with the media.

In one planning document circulated over the summer, the Partnership suggested a series of messages to wean Americans away from supporting single payer. The talking points emphasize that the current system provides “world-class care,” and that any move away from the Affordable Care Act would be “ripping apart our current system.”

The strategy exploits familiar themes that have long been used by business groups against new government health care programs, calling for allies to say lines such as “bureaucrats in DC have no understanding of a person’s medical situation and will be making decisions about your health care instead of doctors.”

The Partnership plans to form a speakers bureau of former Democratic elected officials who can leverage the media to make the case that expanding Medicare is bad politics and policy. The memo names former Democratic Majority Leader Tom Daschle, now a health insurance lobbyist at the law firm Baker Donelson, as one such potential surrogate.

The memo points to early success in shaping media coverage, citing several “earned media” columns such as one published in August by former Rep. Jill Long Thompson, D-Ind., which argues that Democrats should only focus on small reforms to the Affordable Care Act, and warns against wasting political capital on pursuing a “government-controlled health insurance system.” Thompson, now an associate professor at Indiana University Bloomington, did not respond to a request for comment.

Adam Gaffney, president-elect of Physicians for a National Health Program, a national coalition that advocates in favor of “Medicare for All,” said he is not surprised by the messaging.

“What we’re seeing is the wages of success: With single payer on the rise, it was only a matter of time before the insurance companies, big pharma, and other big-money groups came out swinging,” said Gaffney, who also serves as an instructor at Harvard Medical School.

“The smear of ‘socialized medicine’ has been used a thousand times and has lost its bite,” he added.

Influencing the 2020 Democratic Field

“We’re all focused on 2020,” Lauren Crawford Shaver, a partner at Forbes-Tate who is helping to manage the Partnership campaign, recently told the National Association of Health Underwriters in a podcast produced by the group.

Shaver, a former top staffer for the Hillary Clinton presidential campaign, explained to the group that she is working to peel support away from the “Medicare for All” bill sponsored by Sen. Bernie Sanders, I-Vt. The Sanders bill is currently sponsored by several rumored 2020 Democratic presidential candidates, including Sens. Elizabeth Warren, D-Mass.; Kamala Harris, D-Calif.; and Kirsten Gillibrand, D-N.Y.

“The No. 1 thing we need to focus on is that there are a lot of likely candidates that currently support the Senate bill,” said Shaver. “We need to make sure we educate the public, we educate both parties, and we educate all the campaigns about both the policy and political challenges.”

Shaver encouraged health care companies concerned about the growing popularity of “Medicare for All” to mobilize opposition among clients, customers, and employees. Industry groups will likely have workers or customers residing in key districts who can be tapped to influence wavering lawmakers on Capitol Hill.

The Partnership plans to “take stories of how these proposals would directly impact your clients and the constituents of the policymakers who are voting for or against these proposals,” Shaver said.

The Partnership strategy echoes the health insurance industry’s campaign to shape the 2008 presidential primary. At that time, the health insurance lobby group known as America’s Health Insurance Plans, or AHIP, tapped the consulting firm APCO to develop an effort to label any government-run insurance option as an existential threat to Democratic political goals. The initiative emerged from a plan to minimize the impact of Michael Moore’s documentary “Sicko,” which was deeply critical of the American health care system.

The campaign involved planting studies with think tanks, mobilizing pundits on television, and sponsoring YouTube videos on “the horrors of government-run systems,” among other publicity tactics. The APCO-crafted blitz leaned on right-wing voices such as Fox News pundit John Stossel, conservative think tanks like the American Enterprise Institute, and centrist Democratic groups such as the Democratic Leadership Council, a now-defunct group associated with the Third Way. The 2008 campaign adopted a two-pronged strategy: position private health insurance as the only positive solution to America’s health care woes and “disqualify government-run health care as a politically viable solution.”

Now, the same lobby groups are involved in a similar effort. AHIP, the insurance trade group behind the 2008 plan, is also a sponsor of the Partnership’s 2020 campaign, along with the Federation of American Hospitals, Pharmaceutical Research and Manufacturers of America, the Blue Cross Blue Shield Association, the Biotechnology Innovation Organization, and the American Medical Association.

Not only are the same health insurance groups financing a renewed campaign against “Medicare for All,” but many of the same players who worked to undermine the public option during the ACA debate are now fighting for influence within the party. The public option was the government-run insurance plan that advocates intended to use to compete with private insurance and bring down consumer costs. In one version of the plan, the public option would pay doctors and other providers the same reimbursement rates as Medicare.

Despite a pledge by many Democratic candidates to eschew corporate PAC donations, health care lobbyists have funneled cash to many incoming lawmakers through the New Democrats PAC, the Blue Dog PAC, and other centrist committees. Unsurprisingly, the centrist New Democrats Coalition, the caucus of business-friendly centrist Democrats, has worked to depress momentum for “Medicare for All,” reprising the role centrist Democrats played in killing the public option during the Obama administration. In 2009, then-Sen. Joe Lieberman, I-Conn., a founding member of the New Democrats caucus, threatened to join the Republican filibuster against health reform unless the public option was dropped from the bill.

Immediately following the midterm elections this month, the Washington Post published a column by Third Way warning that “Medicare for All” “failed the Hippocratic Oath” because opposition to the plan helped Republican candidates, thus causing “harm” to the long-term health interests of voters.

But advocates for “Medicare for All” are feeling optimistic.

“In terms of tactics, it sounds like they will just be updating the same lines they used in the 1990s to sideline reform efforts and in the ACA fight to keep single-payer health care off the table,” said Eagan Kemp, a health care policy advocate with Public Citizen. “The Partnership for America’s Health Care Future would be more accurately titled the ‘Partnership for Profiting Off America’s Health Care.’”

Private health care interests will certainly have much more money, media attention, and political resources with which to campaign. Advocates, however, are hoping Americans see past the public relations smokescreen and support health care as a human right.

“There is no brand loyalty to insurance companies, which are rightly seen as parasitic,” Gaffney, the PNHP leader, said.

“Once single payer is widely understood as a program that covers everyone, that doesn’t impose copays and deductibles, that has more comprehensive benefits than existing plans, and that doesn’t employ restrictive insurance ‘networks,’ support will only grow,” he added.

https://theintercept.com…

A Canadian academic sociologist comments on our U.S. health care system

Single-payer health care is better than ObamaCare

By Louise Marie Roth
The Hill, November 16, 2018

I was in Canada this past June when I broke my wrist and had to go to the ER. They were fast and professional and the bill was much lower than what American ERs charge you just for walking in the door.

Under single-payer health care, you can see the savings on administrative costs with your own eyes. When you walk into physicians’ offices in Canada, they have a small administrative staff, often consisting of one person behind the counter.

They don’t need to employ extra people to fill out dozens of different forms for various insurers with multiple plans, all with different copays, deductibles and coverage. There are no copays or deductibles and everyone knows the rules for what is covered and how to bill the provincial insurance plan. They don’t need staff to spend hours fighting with insurers about which services or medications they will cover or how much they will pay.

Meanwhile, the U.S. pays more than twice as much per capita for health care ($10,348 in 2016) than Canada ($4,752), Australia ($4,708), or the UK ($4,192), but has lower life expectancy and higher infant and maternal mortality rates even compared to some less developed countries.

As someone who grew up in Canada and moved to the United States more than two decades ago, I have seen firsthand that American health care is expensive, unequal and inhumane – and that there is a better way that costs less, is more equitable and covers all pre-existing conditions. It’s time to solve this problem with single-payer health insurance, so that everyone gets care regardless of their ability to pay.

In this year’s midterm elections, health care was a top issue for American voters and nearly 60 percent favored Medicare-for-all. Now that the Democratic Party is poised to take over the House, it’s time to move forward. The most likely next speaker, Nancy Pelosi, said that all health-care options are “on the table,” and 123 Democratic representatives in the House are co-sponsors of Medicare for All legislation.

Even though the ACA was an inferior solution compared to single-payer, the result is that a growing number of Americans once again lack adequate health insurance.

Of course, Republicans, including President Trump in a recent USA TODAY oped found to have many fact errors, are fighting Medicare for All by calling it “socialism.” But when I ask my students if they would prefer a capitalist fire department, where firefighters only put out a fire if you have up-to-date private insurance or can pay the bill, they think that a taxpayer-funded socialized fire department is a much better idea. They do, however, worry that single-payer health care would not work in the U.S. because of its larger population. They usually don’t know that the U.S. already has socialized medicine in the form of Medicare and Medicaid, which covers more than 30 percent of the population. If federal and state governments can cover more than 30 percent, then why can’t they simplify the whole system and cover everyone?

Single-payer is simply the most efficient and most humane way to cover everyone, including those with pre-existing conditions, which many people have through no fault of their own.

My oldest son had a vascular malformation in his brain and needed brain surgery when he was six. Fortunately he is doing fine now but, as the federal government removes more and more of the protections under the ACA, I wonder if he will be insurable when he is no longer covered under my insurance. Why should he be unable to get insurance or have to pay exorbitant premiums when he did nothing to cause his medical history? Luckily he has an anchor mom – he can always move to Canada. Not everyone has that option.

Dr. Louise Marie Roth is an associate professor of sociology at the University of Arizona and a Public Voices Fellow with The OpEd Project. She teaches medical sociology and is writing a book about maternity care in the United States.

https://thehill.com…

Comment:

By Don McCanne, M.D.

The author is an academic sociologist from Canada who lives and teaches in the United States. Her lightly edited op-ed is reproduced here since it represents a highly credible, expert view on why the United States should enact and implement a Single Payer Medicare for All system much like Canada’s rather than perpetuate our overpriced and underperforming health care financing system based on ACA.

Would it be that we were all as intelligent and discerning as her, we would make the change now.

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