By F. Douglas Stephenson
Common Dreams, July 25, 2021

Fifty-six years ago Congress enacted Medicare to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. Since 1965, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3% to 4%, as opposed to private, for-profit health insurance, which has administrative costs above 15%. In light of the burgeoning, severe losses of jobs/employment/health insurances caused by the ravages of the Covid-19 pandemic, it’s very Important to remember that Medicare is still providing stable coverage for everyone 65 and older. If the new and improved Medicare for All, as outlined below, were in place today, everyone’s health insurance, in spite of the Covid-19 pandemic, would continue uninterrupted because the Medicare for All insurance system is based on residence, not employment.

2021 is also a very special year in the history of single-payer health insurance and public health in the U.S. because Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) introduced the modern Medicare for All Act of 2021 (H.R. 1976) in Congress. M4A 2021 is new legislation establishing a cutting edge single-payer national health program in the United States that addresses decades of health/mental health-related injustices that have been made even more painfully apparent by the Covid-19 pandemic.

Medicare for All Means Everybody In, Nobody Out!

H.R. 1976 upgrades Medicare with a 21st century modern and improved “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. Benefits of H.R. 1976 health insurance include the following new items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

1. Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs;
2. Ambulatory patient services;
3. Primary and preventive services, including chronic disease management;
4. Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products;
5. Mental health and substance use treatment services, including inpatient care;
6. Laboratory and diagnostic services;
7. Comprehensive reproductive, maternity, and newborn care;
8. Dentistry/oral health, audiology, and vision/ophthalmology services;
9. Rehabilitative and habilitative services and devices;
10. Emergency services and transportation;
11. Early and periodic screening, diagnostic, and treatment services;
12. Necessary transportation to receive health care services for persons with disabilities, older individuals with functional limitations, or low-income individuals (as determined by the secretary);
13. Hospice care; and
14. Services provided by a licensed marriage and family therapist or a licensed mental health counselor. (In addition to psychiatrists, licensed clinical psychologists, licensed clinical social workers, psychiatric nurses.)

Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80%/20% payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100%.

All residents are guaranteed access to quality healthcare while achieving significant overall savings compared to our existing Medicare system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians and other health-/mental healthcare professionals and hospitals, reducing unnecessary treatments, and expanding preventive care.

Good healthcare is established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a healthcare crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees. Health insurance is based on residence, not employment.

With M4A, citizens are guaranteed access to healthcare while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians, and other healthcare professionals and hospitals, reducing unnecessary treatments and expanding preventative care.

Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80%/20% payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100%.

We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.

More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group, and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.

According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households—one study says 95%—would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.

M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. The USA is a country where health insurance for medical and mental healthcare is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.

When Medicare was enacted 56 years ago, following a broad grassroots campaign, many believed the dream of a full national health insurance system was right around the corner. Five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, the health insurance industry, and its champions in the White House and Congress.

It’s time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for individuals and families. American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the go slow, vested interest crowd. No more waiting! Ask your legislators to fully support Medicare For All. A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. The very best way to cope with the vast dangers of Covid-19 to everyone is to immediately implement improved Medicare for All 2021 with H.R.1976. By making health insurance available to all age groups, we can enjoy and celebrate Medicare’s 56th birthday with the assurance that this life-saving health insurance program will continue.

F. Douglas Stephenson , LCSW, is a retired psychotherapist and former instructor of social work in the University of Florida Department of Psychiatry. He is a member of Physicians for a National Health Program.

https://www.commondreams.org…

By Linda Carroll
Medscape, July 21, 2021

(Reuters Health) – People of color are less likely than white patients to receive care from surgical specialists, medical specialists and pulmonary specialists, a new U.S. study suggests.

Analysis of nationally-representative data on more than 130,000 U.S. adults found that adjusted rate ratios (ARR) of visits to 29 different types of specialist were often lower among Black, Hispanic, Asian/Pacific and Native American patients compared to white individuals, according to the report published in JAMA Internal Medicine.

“If you take a step back, we already know that people of color in the U.S. have a lower life expectancy than white individuals,” said the study’s lead author, Dr. Christopher Cai, a resident physician at Brigham and Women’s Hospital and the Harvard Medical School in Boston.

One factor may be that, despite a greater need among people of color in some areas for specialty care, doctors are granting more appointments to white individuals, Dr. Cai said. “The primary cause appears to be inequities in insurance,” he added. “The bottom line is that we need to remove barriers to accessing health care.”

One statistic that suggests disparities in health insurance may play a big role is the fact that one of the few areas in which people of color get similar access to specialists is nephrology.

“The unique thing about kidney disease,” Dr. Cai said, “is that Medicare offers coverage for end-stage disease. An approach like Medicare for All would go a long way to reducing these disparities.”

To take a closer look at the use of specialty services by race and ethnicity, the researchers turned to data from 2015 to 2018 Medical Expenditure Panel Survey (MEPS), which collects demographic (including self-reported race/ethnicity) and health care utilization data from a nationally representative sample of the noninstitutionalized, civilian U.S. population. Focusing on adults 18 years or older, Dr. Cai and his colleagues tabulated office and outpatient department visits to each physician specialty by each racial/ethnic minority group compared with the white population and adjusted for age.

The researchers included 132,423 individuals in their analysis. They found that Black individuals had low visit rates compared with white individuals to most specialties (23 of 29 versus 17 of 29 specialties). Among specialties with many visits, the Black versus white disparities were especially marked in dermatology (ARR 0.27), otolaryngology (ARR 0.38), plastic surgery (ARR 0.41), general surgery (ARR 0.55), orthopedics (ARR 0.59), urology (ARR 0.62), and pulmonology (ARR 0.63).

Black individuals had higher visit rates to nephrologists (ARR 2.78) and hematologists (ARR 1.65) and similar visit rates to internists, geriatricians, and oncologists.

The visit ratios for Hispanic and Asian/Pacific Islander individuals compared with white individuals were lower than 1.0 for 26 of 29 (89.7%) and 26 of 27 specialties (96.3%), respectively, and significantly lower for 20 of 29 (69.0%) and 21 of 27 specialties (74.1%). Similar patterns were seen for American Indian and Alaska Native individuals, although the 95% confidence intervals were wide.

The disparity among Hispanic versus white individuals was marked for dermatology (ARR 0.39), otolaryngology (ARR 0.47), and pulmonology (ARR 0.55). For Asian/Pacific Islander versus white individuals, ratios were markedly low for hematology (ARR 0.18), pulmonology (ARR 0.26), and otolaryngology (ARR 0.39).

“This study gives us a very detailed view into racial and ethnic disparities in the use of specialty care, which is an incredibly important metric of health care access given the rising proportion of U.S. adults with chronic conditions and multiple comorbidities,” said Jamie Daw, an assistant professor of health policy and management at the Columbia University Mailman School of Public Health in New York City. “The findings are even more troubling given that people of color have higher rates of chronic conditions such as diabetes, stroke, and heart disease, which require specialist care. Yet, the authors find that communities of color are using these services less than white patients.”

Daw believes the big problem is inequities in health care.

“The U.S. health insurance system is likely a significant driver of these disparities. A disproportionate share of people of color are enrolled in Medicaid or uninsured,” Daw said in an email. “Because Medicaid pays lower prices than private insurance, fewer doctors take Medicaid patients, especially specialists. It would have been interesting for the authors to look at whether these disparities persisted within Medicaid or private insurance, or if the disparities were reduced after age 65, when Medicare eligibility begins,” he noted.

“Health inequities in the U.S. are fundamentally driven by an unequal and unjust allocation of power and resources in the health care system and society at large,” Daw said. “Addressing these disparities will require acknowledging that both interpersonal and structural racism drive differences like those found in this study, and developing policies that can fundamentally shift the distribution of resources and social attention to meet the needs of people of color.”

“This important research shows that non-white individuals are less likely to see specialists, particularly ones who focus on procedures. Structural factors, including structural racism, may play a role in this disparity,” said Dr. Carol Horowitz, a professor of population health and of medicine, and director of the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai in New York City.

“I think it also points out limits of focusing on health care as sole driver of health disparities,” Dr. Horowitz added. “For example, life expectancy is significantly greater in Asian populations in large part because of reduced deaths from heart disease and cancer. Yet, Asian populations were much less likely to see the oncology, cardiology, internal medicine and family doctors who primarily prevent and treat these diseases. Black populations who were just as likely to see these doctors have higher heart disease and cancer death rates. This means we must also look beyond differences in who sees doctors that do procedures, and focus on the non-health drivers of health disparities that stem from generations of structural racism, including poverty, lower quality education, pollution and stress.”

https://www.medscape.com…