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Winning Medicare for All Would Have Massive Implications Beyond Health Care

Winning Medicare for All Would Have Massive Implications Beyond Health Care

A Medicare for All system would benefit almost everyone in America — except health care profiteers. The only way to overcome their opposition is to build a mass movement that’s large enough and powerful enough to defeat them.

Review of Medicare for All: A Citizen’s Guide, by Abdul El-Sayed and Micah Johnson (Oxford University Press, 2021).

By Jonathan Michels
Jacobin, March 31, 2021

Rep. Pramila Jayapal (D-WA) reintroduced the Medicare for All Act into Congress in March. The bill netted a record 112 cosponsors, which amounts to more than half the House Democratic caucus. Thanks to a surprise endorsement by Rep. Frank Pallone of New Jersey, the Medicare for All Act now seems destined to pass another historic marker, with its first hearing in the powerful House Committee on Energy and Commerce sometime in the current legislative term.

Meanwhile, outside of the DC Beltway, Medicare for All enjoys widespread support among the public with 72 percent of Americans in favor of making the switch to a publicly funded national health program.

Just how long support will remain at these current levels, however, is unclear. One barrier to advocates’ ability to maintain momentum are the persistent misconceptions spread about Medicare for All by its enemies.

A poll conducted by the Kaiser Family Foundation in 2020, for example, found that nearly 50 percent of Americans mistakenly believed that they could maintain their employer-sponsored health insurance under the health reform. That should alarm Medicare for All supporters, since one of their main selling points to the public is that it will eliminate increasingly exorbitant private health insurance plans.

It’s vitally important that we know and clarify exactly what we are fighting for. Drs Abdul El-Sayed and Micah Johnson understand this. Which is why they packed useful information into their book Medicare for All: A Citizen’s Guide to help anyone who needs a better understanding of the often misunderstood “policy-in-waiting.”

The book is a useful tool for even the most seasoned organizers looking to build the mass movement necessary to take on the medical profiteers who have prevented us from achieving national health insurance for more than a century.

The biggest lesson that readers ought to walk away with is this: Medicare for All is a reform with massive implications that reach far beyond health. As El-Sayed told Current Affairs in 2019, “Why single payer is so beneficial isn’t just that it would provide everybody healthcare. That’s really important, and it should be a primary goal, but it’s not the only goal.”

Medicare for All also has the potential to serve as a massive wealth redistribution program to middle- and low-income families, a jobs creator, a promoter of unionization, a check on hospital expansion and consolidation for profit, and a way to connect other human rights struggles together. Medicare for All would put tremendous constraints on private interests that, as the history of universal social programs show, will prove difficult to dismantle.

Hospitals, El-Sayed and Johnson tell us, exemplify the human cost of getting the policy details wrong, as well as the way that Medicare for All’s potential to improve health care delivery can be used by organizers to grow the movement in their states and local communities.

Medical centers have become the dominant employers and economic drivers in former industrial centers of the United States thanks to a tremendous influx of federal money. Currently, a third of all health spending goes to hospitals. But instead of using their economic leverage to decrease the financial burden on patients and to deliver higher-quality care, for-profit and not-for-profit hospitals dominate a region, then use their market power to coerce patients and insurers into paying exorbitant prices.

Giant hospital corporations, nonprofit or for-profit, are virulently opposed to Medicare for All precisely because their ability to increase revenue through monopoly power is diametrically opposed to the interests of health care workers and patients. Tenet and the Hospital Corporation of America (HCA), two of the largest for-profit hospital operators in the world, understand their shared interest, so they funneled hundreds of thousands of dollars into an anti-single-payer front group called the Partnership for America’s Health Care Future.

HR 676, the first national health insurance legislation introduced in Congress back in 2003, called for participating for-profit hospitals to convert to not-for-profit. Unfortunately, that provision is not included in the previous House bill (HR 1384) or Sen. Bernie Sanders’s signature Medicare for All Act. This omission will hopefully be corrected during the legislative process. As long as ravenous hospital corporations continue to rule the health care “jungle,” whatever Medicare for All bill that Congress churns out will likely be unpalatable to both patients and health care workers.

Thankfully, as El-Sayed and Johnson explain, the Medicare for All Act of 2021 maintained the use of global operating budgets as called for under HR676 as the mechanism for allocating funds to the envisaged national health program. They may sound technical, but global operating budgets are used every day to pay for our police and firefighting departments, libraries, and other institutions designed to meet universal, social goals.

Much of our health care right now is fee-for-service. The more procedures that are done on a patient, the more revenue is collected by the provider. The money is then laundered through a myriad of payers and financial transactions that make up our broken health care system.

Global budgets, on the other hand, cut through the unfathomable complexity by replacing per-patient billing with lump-sum payments that would be disbursed to hospitals based on what their operating costs were the previous year. That means hospitals will no longer have to waste time fighting over each patient’s payment. It will also be easier to identify where public dollars are going, so the money is spent on services that produce healthy outcomes.

El-Sayed and Johnson also remind us that Medicare or All would give a boost to health care workers looking to unionize, since hospitals would be prohibited from using public money to bankroll union-busting campaigns. The very groups that have linked rights in the workplace with the right to health of their patients have been nurses and health care unions, most notably National Nurses United.

For all their power and influence, hospitals are extremely vulnerable, since the interests of patients and health care workers are often aligned. Connecting those common interests is the key to winning Medicare for All. Medicare for All advocates should use this fact under coronavirus to mobilize community support around health care workers at their local hospitals.

“The battle for public opinion is not just a contest of ideas,” the authors remind us. “It’s also a contest of power, with supporters and opponents deploying all the resources at their disposal to get their message in front of people and change hearts and minds.”

While El-Sayed’s unsuccessful 2018 Michigan gubernatorial campaign is never mentioned in Medicare for All, the experience clearly gave him insight into how corporate interests use their money and influence to change the conversation around health reform in their favor. Before becoming a prominent spokesperson for national health insurance, El-Sayed championed a state-based single-payer plan dubbed “MichCare” during his campaign. Like Medicare for All, MichCare also called for the expansion of health coverage to every Michigander under age sixty-five through a single, publicly funded program. Dr Micah Johnson, El-Sayed’s Medicare for All coauthor, was one of the principal architects behind MichCare.

Establishment Democrats who refused to support health care reform beyond protecting and strengthening the Affordable Care Act stood in sharp contrast to El-Sayed. The young physician endeared himself to progressives by daring to speak out against Democratic primary rival Gretchen Whitmer’s close personal and financial ties with Blue Cross Blue Shield of Michigan, including a fundraiser to boost her campaign. Not surprisingly, Whitmer dodged El-Sayed’s attempts to put single payer at the forefront of the debate and cast doubt on MichCare as an unrealistic policy proposal. Despite winning the endorsement of Sanders and Rep. Alexandria Ocasio-Cortez, El-Sayed’s antiestablishment insurgency proved no match against the powerful forces united against him.

El-Sayed’s struggle to rally public support for MichCare, like numerous other attempts to pass comprehensive health reform in the United States, proved once again that the obvious merits of single-payer policy will not be enough to win Medicare for All.

“What would it take to strengthen the consensus on M4A and build the political will for reform?” ask El-Sayed and Johnson. “There is only one foreseeable possibility: a popular national movement pushing for M4A. Quite simply, there is no other force strong enough to overcome the partisan attacks and the deep-pocketed opposition from industry.”

The difficult work of building political power in support of Medicare for All will continue to rest on supporters’ ability to effectively communicate the inordinate ways that Medicare for All directly addresses people’s material needs, with the goal of inspiring more people to join such a movement. If organizers incorporate Medicare for All: A Citizen’s Guide’s insights to guide their actions, they might yet achieve single payer in the United States in our lifetime.

https://www.jacobinmag.com…

Medicare for All would improve cancer outcomes for the near elderly

Cancer diagnoses and survival rise as 65‐year‐olds become Medicare‐eligible

By Deven C. Patel, M.D., M.S.; Hao He, Ph.D.; Mark F. Berry, M.D.; Chi‐Fu Jeffrey Yang, M.D.; Winston L. Trope, B.E.; Yoyo Wang, B.S.; Natalie S. Lui, M.D.; Douglas Z. Liou, M.D.; Leah M. Backhus, M.D., M.P.H.; Joseph B. Shrager, M.D.
American Cancer Society, Cancer, March 29, 2021

Abstract

Background: A Medicare effect has been described to account for increased health care utilization occurring at the age of 65 years. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear.

Methods: Patients aged 61 to 69 years who were diagnosed with lung, breast, colon, or prostate cancer from 2004 to 2016 were identified with the Surveillance, Epidemiology, and End Results database and were dichotomized on the basis of eligibility for Medicare (61‐64 vs 65‐69 years). With age‐over‐age (AoA) percent change calculations, trends in cancer diagnoses and staging were characterized. After matching, uninsured patients who were 61 to 64 years old (pre‐Medicare group) were compared with insured patients who were 65 to 69 years old (post‐Medicare group) with respect to cancer‐specific mortality.

Results: In all, 134,991 patients were identified with lung cancer, 175,558 were identified with breast cancer, 62,721 were identified with colon cancer, and 238,823 were identified with prostate cancer. The AoA growth in the number of cancer diagnoses was highest at the age of 65 years in comparison with all other ages within the decade for all 4 cancers (P < .01, P < .001, P < .01, and P < .001, respectively). In a comparison of diagnoses at the age of 65 years with those in the 61‐ to 64‐year‐old cohort, the greatest difference for all 4 cancers was seen in stage I. In matched analyses, the 5‐year cancer‐specific mortality was worse for lung (86.3% vs 78.5%; P < .001), breast (32.7% vs 11.0%; P < .001), colon (57.1% vs 35.6%; P < .001), and prostate cancer (16.9% vs 4.8%; P < .001) in the uninsured pre‐Medicare group than the insured post‐Medicare group.

Conclusions: The age threshold of 65 years for Medicare eligibility is associated with more cancer diagnoses (particularly stage I), and this results in lower long‐term cancer‐specific mortality for all cancers studied.

Lay Summary: Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.

https://acsjournals.onlinelibrary.wiley.com…

Comment:

By Don McCanne, M.D.

This study is certainly intuitive. “Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.” Think of the innumerable other studies that have shown that Medicare for All would improve health care outcomes.

Now think of the innumerable health policy studies that have shown that Medicare for All would ensure universality, comprehensiveness, affordability for individuals, affordability for society, removal of financial barriers to care, return of free choice of health care professionals and institutions, elimination of hundreds of billions of dollars of administrative waste, and, above all, it would ensure equitable health care for all.

What further studies do we need before we decide to enact and implement single payer Medicare for All? None? Well then, let’s get on with it.

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The UK’s Vaccine Rollout Is the Latest Reminder We Need Universal Healthcare

Britain’s vaccination rate has far outpaced the rest of the West. The triumph belongs to its National Health Service.

By Natasha Hakimi Zapata
In These Times, March 30, 2021

LONDON — Dr. John Lister watched in horror as the United Kingdom’s Covid-19 mortality rate climbed above 1 per 1,000, one of the highest death rates in the world since the start of the pandemic. So, when the 71-year-old Briton was informed he would receive the Oxford-AstraZeneca vaccine in late January, he could hardly contain himself.

“It was a great moment of excitement when I got the notification,” Lister tells In These Times. 

Lister, a health policy expert and associate professor at Coventry University, was one of 15 million people in the United Kingdom to receive a Covid-19 vaccine before February 15, thanks to a vaccination program that has consistently ranked among the three fastest in the world. As of mid-February, the U.K. government’s tiered plan had succeeded in vaccinating roughly 80% of its healthcare workers and more than 90% of nursing home residents and people older than 70. These groups represent 88% of the country’s Covid-19 deaths and make up roughly a fifth of its population of just over 68 million.

This development marks a turning point in a pandemic response once described as ​“a string of failures,” which has left more than 100,000 people dead. While Prime Minister Boris Johnson has met the U.K. government’s benchmarks, the real triumph belongs to the National Health Service (NHS), the universal healthcare system of more than 1,000 hospitals that spans England, Scotland, Wales and Northern Ireland.

Founded in 1948 in the wake of World War II, the NHS was the jewel of the Labour Party’s social welfare state, the first of its kind in the West. Despite decades of efforts from conservatives to privatize the NHS, its three basic principles have endured: that treatment is free at the point of service, available to everyone (including non-residents) and publicly funded. The NHS vaccination program has been arguably the West’s greatest success story: By February 15, 22% of the U.K. had received a first dose compared with 11% in the United States.

Even before it began jabbing the public, the NHS had built the infrastructure for a rapid vaccine rollout. ​“Our system is pretty unique,” says Lister, co-founder of Health Campaigns Together, a broad coalition working to protect the NHS from cuts and privatization. ​“Because everybody is covered by the NHS, we have this database [that allows us] to identify risk factors in a way that no other country is able to do.”

The private-sector parts of the U.K. response, meanwhile, have failed to achieve results. Hundreds of millions of pounds have been squandered on ​“unusable” or otherwise inadequate personal protective equipment, and the outsourced contact-tracing failed to have its intended effect. Dr. Tony O’Sullivan, co-chair of advocacy group Keep Our NHS Public, says the decision to outsource contact tracing ​“led to a failure to rely on tried and tested systems that were in place with the National Health Service [based on] the cooperation between hospitals, primary care [physicians] and local [government].”

While vaccination rates in the United States are increasing, with President Joe Biden promising ​“enough vaccine supply for every adult in America by the end of May,” the rollout looks haphazard by comparison. As of early March, the U.S. Centers for Disease Control and Prevention reported just 27% of those 75 and older had received a first dose. For those 65 – 74, it was 28%.

Dr. James Kahn, a professor of epidemiology and biostatistics at the University of California, San Francisco, attributes the trouble in the U.S. rollout to the ​“highly variable and disorderly” distribution of vaccines. A New York Times report from February 19 finds some states had been stashing up to 6 million doses, while other states struggled to obtain enough for their most vulnerable residents.

Dr. Steffie Woolhandler, who works alongside Kahn at the Physicians for a National Health Program — an organization of more than 20,000 health professionals advocating for single-payer healthcare — believes a centralized health database (like the one the NHS maintains) could have prevented these problems. Woolhandler is also quick to praise another aspect of the U.K. rollout: Primary care physicians contact their patients directly and can review their personal health records, as well as help assuage any concerns about the vaccine.

“Everyone having longstanding access to medical care means that, when an emergency comes up, you can mobilize that access and get everyone in,” Woolhandler says. ​“It’s more than just a list of names and phone numbers; it’s actually a set of relationships.”

Maryland-based pediatrician and healthcare advocate Dr. Margaret Flowers ascribes the United States’ sluggish vaccine rollout to the country’s ​“disjointed” healthcare system and decades of underfunding for public health infrastructure. Online registration portals, Flowers says, are often inaccessible to Black and Brown communities who have been disproportionately impacted by Covid-19. The closure of more than 120 rural hospitals since 2010 has made it difficult for local residents to reach vaccination sites. And several private institutions have offered wealthy donors doses ahead of the most vulnerable people.

Whereas the FBI, the Food and Drug Administration and Interpol have each issued warnings about Covid-19 treatment and vaccine fraud schemes in the United States, the NHS offer of free service at point of care has inoculated the country against this kind of profiteering. ​“If anybody is offering to sell you the vaccine,” explains Lister, ​“they’re a crook.”

Now, as every adult in the U.K. is being promised a first shot by the end of July (depending on supply), Lister says one thing is clear: ​“What [the NHS vaccine program] really does is prove the superiority of the universal health care model.”

https://inthesetimes.com…

The VA advantage in the public sector

The Importance of the ‘VA Advantage’

A new study confirms that VA patients get better health care at a lower overall cost.

By Suzanne Gordon, Russell Lemle
The American Prospect, March 25, 2021

The recent reintroduction of a Medicare for All bill in Congress, with the promise of hearings in the House Energy and Commerce Committee, offers another step on the path to providing health care for all citizens. But as the conversation continues, policymakers and single-payer advocates could take lessons from the successful system already within our borders.

More than a decade’s worth of scientific studies have established that the Veterans Health Administration (VHA) delivers care that is not only equal, but often superior, to that available in the private sector. Although studies have consistently documented that veterans with cancer, hypertension, diabetes, renal failure, and mental-health problems get better care from the VA than non-veterans with private insurance or Medicare, this data trail was missing one piece of evidence. There was no apples-to-apples study that compared the outcomes of veterans getting care from the VA with care veterans receive in the private sector.

Now, we have the crucial evidence that should settle the debate about VA privatization once and for all. This, along with many other studies, should also become part of the arsenal of Medicare for All boosters, who often rely on examples of international health care systems to argue for the public funding of our own.

The latest study on VHA care was done by three academic economists from Stanford, UC Berkeley, and Carnegie Mellon University, and affiliated with the National Bureau of Economic Research. The study categorically demonstrates that veterans who get their care at the VA live longer during and after a medical emergency than those receiving non-VA care. This trend holds not just for the VA system overall, but at every single one of the 170 VA hospitals. The economists were so impressed with the VA’s results that they coined the term “the VA advantage” to describe it.

To uncover this “VA advantage,” the economists analyzed seven-day, 28-day, and one-year outcomes of 400,000 emergency ambulance rides of veterans aged 65 and older who were “dually eligible,” able to receive care at either a VA or non-VA hospital. Ambulance drivers independently picked whether to transport to a VA or non-VA. This quasi-random assignment of patients allowed a direct comparison of the effects of VA versus non-VA care on health outcomes.

The results in the VA and private sector could not have been more different. Veterans who were treated inside the VA system for an emergency had a 46 percent reduction in 28-day mortality. Wondering whether these results might fade over time, the researchers tracked the death rates every week after the initial ambulance ride. They found that the survival advantage remained stable for the entire year. This “VA advantage” was, importantly, as large for Black and Hispanic veterans as for non-minority ones—a pivotal finding that should inform the debate about the pronounced and long-standing health care inequalities that are rampant in the private-sector system.

What was even more impressive was the fact that the VA spends less than private-sector providers in producing such markedly better outcomes. The VA reduces per-patient cumulative spending at 28 days by $2,548, approximately 21 percent less than the private sector. In short, the VA is more productive and achieves better outcomes at lower costs.

The ultimate message of this study, combined with more than a decade’s worth of other scientific evidence, is crystal clear: Privatizing VHA care by outsourcing more services to the private sector is not only irresponsible policymaking, but actually may cost veterans their lives. As the economists argue, VA privatization would “lead to both higher spending and worse health outcomes.”

In fact, studies like these shouldn’t only inform political and ethical debates about veterans’ health care but also broader policy discussions about much-needed reform to our fragmented, market-driven system. You don’t have to look to Canada, or the U.K., or Sweden for an example of a government-funded health care program that works. There’s often a homegrown one just around the corner. This isn’t just a political talking point; it’s an ethical imperative. If “VA advantage” coordinated care saves lives, improves health outcomes, and saves money, the same type of care should be available to all of us.

https://prospect.org…

NBER: Is There a VA Advantage?
http://conference.nber.org…

Comment:

By Don McCanne, M.D.

Opponents of single payer Medicare for All tell us, “The government can’t do anything right; just look at the VA system.” Yes, just look at that system – better outcomes at a lower cost.

Of course, providing VA care to everyone would be more like socialized medicine through a national health service, whereas single payer Medicare for All would be a social insurance program with a private health care delivery system. Also Medicare for All would be an improved version of Medicare over what we have right now.

The point is that our government can do it better, in this case through Medicare rather than through the private insurance industry, so let’s let them do it. After all, it is our government, so it should work for us, not the private insurers.

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What about our ubiquitous non-compliant plans?

Under-Covered: How “Insurance-Like” Products Are Leaving Patients Exposed

March 25, 2021

From the Executive Summary

Our organizations represent millions of patients and consumers across the country who live with serious, acute and chronic health conditions. These individuals need access to comprehensive, affordable health coverage to meet their medical needs. In March 2017, we adopted a core set of principles to guide and measure any work to reform, change or improve our nation’s health insurance system. Our core principles are that health care must be adequate, affordable and accessible.

The enactment of the ACA has radically improved our patients’ experience with health insurance. Now, issuers are required to provide comprehensive coverage and prohibited from unfair coverage restrictions that discriminate against people with serious or chronic illnesses on the basis of their pre-existing condition.

However, over the past several years, new insurance rules have allowed issuers across markets to discriminate against people with pre-existing conditions as they did prior to the passage of the ACA. The proliferation of these non-ACA-compliant (non-compliant) plans has weakened the overall effectiveness of the ACA by exposing consumers, particularly those with pre-existing conditions, to significant financial risk, segmenting the individual market risk pool and unnecessarily inflating insurance premiums for people who rely on comprehensive coverage provided through the ACA marketplaces.

In comparison to the consumer protections that apply to ACA-compliant health insurance, non-compliant plans utterly fail to provide the same degree of certainty and security for patients and consumers.

This report endeavors to compile what is known about the most common kinds of non-compliant plans and make recommendations for Congress, the administration and state leaders.

The plans examined include:

  • Short-Term, Limited-Duration Insurance
  • Heath Care Sharing Ministries
  • Farm Bureau Plans
  • Grandfathered Plans
  • Misuse of arrangements subject only to non-ACA federal regulations (ERISA), including
  • Multiple Employer Welfare Arrangements and Association Health Plans
  • Spurious single-employer self-insured Group Health Plans (Data Marketing Partnership Scheme)
  • Minimum Essential Coverage-Only Plans
  • Excepted Benefit Plans

Recommendations for Congress:

  • Codify Short-Term, Limited-Duration Insurance (STLDI) Protections Into Law
  • Prohibit the Use of Brokers for Enrollment
  • Revise the Federal Definition of Insurance
  • Investigate Spurious Single-Employer ERISA Plans Arrangements
  • Require Employer Plans to Cover Essential Health Benefits (EHBs) and Adhere to EHB Standards
  • Require Issuers Selling Excepted Benefits to Confirm Enrollee is Covered by Comprehensive Coverage and Prohibit the Sale of Excepted Benefits that Mimic Fully Regulated Insurance

Recommendations for Federal Agencies:

  • Revise Federal Regulations Related to STLDI
  • Revoke Proposed Rule on Health Care Sharing Ministries (HCSM)
  • Rescind the Grandfathered Plan Rule
  • Rescind the 2018 Association Health Plan (AHP) Rule
  • Codifying the “Look Through” Doctrine
  • Clarifying the Term “Issuer”
  • Investigate Spurious Single-Employer ERISA Plans Arrangements
  • Vigorously Defend the Department of Labor’s Position in the Data Marketing Partnership Lawsuit
  • Ensure Sufficient Oversight of ERISA Plans, Including AHPs and MEWAs
  • Monitor and Collect Data on Large Employer Plans
  • Require Strong Disclosures of Limited Benefits

Recommendations for States:

  • Limit or Consider Prohibiting STLDI Plans
  • Require STLDI Plans to Meet Minimum Standards
  • Increase Transparency and Data Reporting for HCSM
  • Prohibit Sales Through Brokers
  • Maintain or Reestablish Authority Over Farm Bureau Plans
  • Strengthen Licensing Requirements for AHPs
  • Ensure Sufficient Oversight of AHPs and MEWAs
  • Investigate Spurious Single-Employer ERISA Plans Arrangements

This report was compiled on behalf of the following members of the Partnership to Protect Coverage:

  • The AIDS Institute
  • The Alpha-1 Foundation
  • ALS Association
  • American Cancer Society Cancer Action Network
  • American Diabetes Association
  • American Heart Association
  • American Kidney Fund
  • American Liver Foundation
  • American Lung Association
  • Arthritis Foundation
  • Asthma and Allergy Foundation of America
  • Cancer Support Community
  • Chronic Disease Coalition
  • Cystic Fibrosis Foundation
  • Epilepsy Foundation
  • Hemophilia Federation of America
  • JDRF
  • The Leukemia & Lymphoma Society
  • Mended Hearts & Mended Little Hearts
  • Muscular Dystrophy Association
  • National Alliance on Mental Illness
  • National Hemophilia Foundation
  • National Kidney Foundation
  • National Multiple Sclerosis Society
  • National Organization for Rare Disorders
  • National Patient Advocate Foundation
  • Pulmonary Hypertension Association
  • Susan G. Komen
  • United Way Worldwide
  • WomenHeart: The National Coalition for Women with Heart Disease

Full report – 26 pages:
https://www.lls.org…

Comment:

By Don McCanne, M.D.

Those who believe that the Affordable Care Act took care of the deficiencies in health plans and that all we need to do is expand existing coverage need only remind themselves of the non-compliant plans listed in the middle of the excerpts above. The organizations sponsoring this report certainly recognize the deficiencies of the non-compliant plans.

It is interesting to look at the fairly extensive list of recommendations they have for correcting the deficiencies of non-compliance. It seems that it would be more logical to enact and implement single payer Medicare for All than to try to apply patches to a system with a fundamentally flawed financing infrastructure, especially when you consider the multitude of other patches that would be required that would still fall far short of the impossible task of correcting the major deficiencies in affordability, efficiency, universality, and especially equity. We really need Medicare for All to do that.

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Private equity piles on debt to pull cash from health firms

By Sabrina Willmer
Los Angeles Times, March 24, 2021

Healthcare companies are taking on more debt to pay dividends to their private equity owners, just a year after the start of a pandemic that plunged the industry into crisis.

Healthcare firms have already borrowed about $3.7 billion in 2021, partly to fund payments to private equity owners, more than double the amount issued all of last year, according to data from S&P Global Market Intelligence.

Dividend recapitalization is one reason wealthy investors are drawn to private equity, as they don’t have to wait years for a payout.

But critics including the Private Equity Stakeholder Project say the strategy destroys value.

“By saddling companies with debt to extract cash for themselves, private equity firms put those companies at risk for restructuring, bankruptcy, or cost cutting to make up the interest payments and pay off that debt,” said Eileen O’Grady, a coordinator at the nonprofit.

https://www.latimes.com…

Comment:

By Don McCanne, M.D.

Borrowing money to pay out dividends. That is distributing profits that never existed. And in health care, who ultimately pays those dividends? The patient, usually indirectly through private insurance premiums.

With single payer Medicare for All the private insurers would be removed from the equation, and our own government program presumably would pay based on legitimate costs and fair profits. It would not pay for funds borrowed to create artificial profits.

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

We Are All in This Together

COVID-19 and the Case for Medicare for All

Produced in collaboration with PNHP and numerous other Medicare for All coalition partners. Download the full report HERE.

By Hebah Kassem
Congressional Progressive Caucus Center, March 2021

Introduction

We’ve learned the hard way during this pandemic that America’s health care system is totally unprepared to handle a national public health crisis. Sick people have gone without testing and treatment, and health care workers have been infected because of inadequate personal protective equipment (PPE). More than a half-million people have died in the U.S. from the coronavirus pandemic. In the richest nation on earth, it doesn’t have to be this way. We can do so much better.

How was the United States health care system so dreadfully unprepared for a pandemic? It didn’t happen by accident. Powerful for-profit insurance companies have insisted for decades on maintaining our broken-down health care system because it is working exactly as they want it to—churning out exorbitant profits for health insurance and pharmaceutical companies while patients and their families pay the price.

Instead of promoting equity in health care access and outcomes, our health care system picks winners and losers. The winners profit off illness, and the losers are people who are uninsured or underinsured—unable to get affordable health care when they need it. Although the Affordable Care Act (ACA) increased the number of insured people by 20 million, nearly 87 million Americans were still uninsured or underinsured before the pandemic. This lack of insurance is all the more tragic as an analysis by Public Citizen found that “about one-third of COVID-19 deaths and 40 percent of infections were tied to a lack of insurance.”

Today, nearly half of Americans still rely on their employment for their health care coverage. The precariousness of tying health care to employment is painfully obvious after the period of epic job loss we’ve recently experienced. With almost 26 million workers suffering negative consequences including losing their jobs, having hours or pay cut, or dropping out of the labor force during the pandemic, millions of families are also threatened with the loss of health care just when they need it most.

As a result of systemic racism, people of color are far more likely to be uninsured, more likely to work in frontline jobs, and more likely to contract COVID-19. Currently, more than half of America’s uninsured are people of color, and people of color contract and die from COVID at higher rates than white people. Systemic discrimination in the economy means that people of color are more likely to be employed in dangerous jobs or jobs that do not offer living wages or adequate health insurance. The same systemic racism also means that families of color are more likely to live in health care deserts where high quality health care is not accessible.

Immigrants, in particular, have difficulty accessing health care in America’s for-profit system. As of 2017, an estimated 10.5 million undocumented immigrants in the U.S. accounted for about three percent of the total U.S. population. Many immigrant families in the U.S. include people with mixed immigration status—both undocumented and lawfully present immigrants—and those families’ access to health coverage is often uncertain or unreliable.

About 45 percent of undocumented immigrants currently lack health insurance because they are not eligible to enroll in coverage options. At the onset of the pandemic in February of 2020, the Trump Administration issued the Public Charge rule in an effort to identify and prevent any person who may depend on government benefits, including health coverage, from applying for visas and/or lawful permanent resident (LPR) status. This policy change made it even harder for undocumented immigrants to get health insurance coverage. On March 9,2021, the U.S. Citizenship and Immigration Services reversed this policy and announced it will no longer enforce the Public Charge Rule after the Biden Administration stated it will not defend the regulation issued by the Trump Administration. Although this change was welcome, it was too little too late, as the health of some immigrant families became irreparably damaged.

The Trump Administration’s decisions to slash necessary funding, delay testing, deny access to health care, block public safety measures like workplace safety standards, and downplay the severity of the COVID-19 crisis, have made our dysfunctional health care system even more vulnerable. From the beginning of this pandemic, public health experts,including Dr. Anthony Fauci, urged social distancing and quarantines in an effort to slow the spread of COVID-19 and keep everyone safe. For months, public health experts, lawmakers, and advocacy groups called for sufficient and adequate PPE to keep essential workers protected while they are risking their lives to keep us all safe. Additionally, experts called for a mass testing and contact tracing program to help control the spread of the virus, keep our hospitals from being overwhelmed, and rebuild and reopen our economy safely in accordance with the latest public health and science.

The U.S. failed to take these measures and, as a result, the U.S. set record-high numbers in new COVID-19 cases and hospitalizations time and time again. As the summer months ended and autumn began, the U.S. experienced a record high number of new cases—on Friday, October 30, 2020, the U.S. reported 99,321 new cases in a single day breaking a global daily record. As of early November 2020,nearly 50,000 people were hospitalized due to the fall surge. The number of COVID-19 cases and deaths continued to rise as we approached the winter months and millions of people traveled over the Thanksgiving break. On December 1, 2020, the U.S. recorded its 12 millionth COVID-19 case and as experts anticipated, we experienced a post-Christmas COVID surge after holiday gatherings took place across the country and a record 300,000 cases were reported on January 8th, 2021. Since then, three COVID-19 vaccines have been authorized for use and as of March 17, 2021 more than 113 million doses have been administered. Although people are hopeful, the virus is still very much here and continues to spread throughout the nation.

Everyone deserves access to the care and medication they need to survive. Long before the pandemic, high drug prices meant everyday Americans were forced to choose between paying for their prescriptions or paying their mortgage. Now, the problems Americans already face with the current health care system are being exacerbated by COVID-19 as millions contracted the COVID-19 virus and mass layoffs caused by the pandemic forced tens of millions of people to lose their employer-sponsored health insurance. No one should have to resort to begging on GoFundMe to afford life-saving care because they lost their job due to a global pandemic. We need guaranteed, comprehensive, high-quality medical care for every person at every hospital and doctor’s office. And that means Medicare for All.

Medicare for All would address the many holes and gaps in our current health care system and ensure everyone has guaranteed access to comprehensive health care regardless of income, ZIP code, or employment status.

full report:
https://www.progressivecaucuscenter.org…

Administration and Congress are wasting tax funds on private insurance

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.

By Noam N. Levey
Kaiser Health News, March 24, 2021

When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans.

But health care researchers consider this move a short-term fix for a long-term crisis, one that avoids confronting an uncomfortable truth: The only clear path to expanding health insurance remains yet more government subsidies for commercial health plans, which are the most costly form of coverage.

The reliance on private plans — a hard-fought compromise in the 2010 health law that was designed to win over industry — already costs taxpayers tens of billions of dollars each year, as the federal government picks up a share of the insurance premiums for about 9 million Americans.

The ACA’s price tag will now rise higher because of the recently enacted $1.9 trillion covid relief bill. The legislation will direct some $20 billion more to insurance companies by making larger premium subsidies available to consumers who buy qualified plans.

And if Democrats want to continue the aid beyond 2022, when the relief bill’s added assistance runs out, the tab is sure to balloon further.

“The expansion of coverage is the path of least resistance,” said Paul Starr, a Princeton University sociologist and leading authority on the history of U.S. health care who has termed this dynamic a “health policy trap.”

“Insurers don’t have much to lose. Hospitals don’t have much to lose. Pharmaceutical companies don’t have much to lose,” Starr observed. “But the result is you end up adding on to an incredibly expensive system.”

The large new government commitment underscores the disparity between the high price of private health insurance and lower-cost government plans such as Medicare and Medicaid.

The main reason commercial health plans cost more and saddle patients with higher medical bills is because they typically pay hospitals, doctors and other medical providers more than public programs such as Medicaid.

https://khn.org…

Comment:

By Don McCanne, M.D.

This article makes an important point. President Biden and his staff, along with Congress, chose the most expensive method of expanding health care – giving more taxpayer funds to the private insurers. There is a bit of sleight of hand here since it is us – the taxpayers – who are paying these higher prices for a health care financing system heavily dependent on private insurers.

Why are costs higher when we use private insurers? The author indicates that private commercial insurers pay more for health care services than government programs, and, by and large, that is correct. But that is a relatively small portion of the higher spending by private insurance, and it does not take into consideration that public programs are more effective at setting appropriate prices – costs plus fair margins – not to mention that they use more efficient financing methods such as global budgeting of hospitals.

But what has been ignored in this article is the major reason that private insurers are more expensive, and that is administrative costs. Those extra taxpayer funds going to private insurers include costs such as marketing of their plans, costs of contracting for restrictive provider networks, administering prior authorization requirements, complex systems of processing claims including denial of benefits, simple administrative costs of operating large corporate entities, and distributing generous profits to their executives and passive investors. Which of these administrative services do you want to continue to pay for through increased taxes?

So these increased costs that the taxpayers are bearing are not just for more health care, but they are a gift to the most expensive and inefficient financing system on earth. Particularly galling is the fact that the administration is presenting this as if it were a gift from the government to the patients, but that government money is provided by us – the taxpayers. Much of it is hidden from view since a large portion of these taxes we pay are disassociated from health care spending. Keep in mind that funds moved into the health care financing system are not available for other important needs such as food, housing, transportation, education, environment, infrastructure, and so on.

A single payer Medicare for All program would fill in our health care financing needs without wasting the hundreds of billions of dollars on these superfluous administrative costs of the private insurers, plus their profits. But they are now talking about making these wasteful expenditures permanent. Maybe they might even add a public option, which would be only one more player in our profoundly inefficient system.

As the title of Noam Levey’s article indicates, the big boost was in buying health insurance rather than simply health care, and it didn’t come cheap. As Paul Starr states, we ended up adding on to an incredibly expensive system. We didn’t have to do that. We can still redirect our course toward an efficient, equitable system for all. After all, it’s our money, and yet progressive taxation makes health care affordable for all since it is simply based on the ability to pay. That is certainly more efficient than playing games with taxpayer subsidies for premiums and cost sharing for expensive, self-serving private insurers.

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Drug pricing is a life and death issue

U.S. Drug Prices Should Be Lowered -- But How?

By Joyce Frieden
MedPage Today, March 23, 2021

“All over this country, the American people are asking a simple question: How many people need to die before Congress is prepared to take on the greed of the pharmaceutical industry?” Sen. Bernie Sanders (I-Vt.), chairman of the Senate Health, Education, Labor & Pensions (HELP) Subcommittee on Primary Health and Retirement Security, said during a subcommittee hearing Tuesday on the high price of prescription drugs.

As to what Congress should legislate, Sanders had three ideas, embodied in bills he had introduced: Pegging U.S. drug prices to those of other industrialized countries; allowing for reimportation of prescription drugs from other countries; and allowing Medicare to negotiate drug prices. “Every other major country on earth … negotiates drug prices, and the time is long overdue for Medicare to do that as well,” he said.

https://www.medpagetoday.com…

“Why Does the US Pay the Highest Prices in the World for Prescription Drugs?”: Testimony of Dr Nav Persaud, Canada Research Chair in Health Justice and Associate Professor, University of Toronto

United States Senate Subcommittee on Primary Health and Retirement Security, March 23, 2021

Canada regulates the price of patented medicines and pays less for the same medicines

In Canada, per capita drug spending is $879 versus over $1,229 in the United States. Per capita drug spending is about 40 % higher in the United States largely because of the regulation of patented drug prices by the Canadian Patented Medicine Prices Review Board.

Posted prices for patented medicines are approximately 3 times lower in Canada. The Patented Medicines Prices Review Board is slated, in July, to drop the United States from its list of comparator countries used to set “price ceilings”, because prices are shockingly high in the United States compared with other high‐income countries including the United Kingdom.

Change is possible with political will

Pressure and lobbying by the pharmaceutical companies (and private insurers) have undermined reforms in both Canada and the United States. Multiple government reports over decades have recommended including medicines in Canada’s public single‐payer system to improve fair access and to save billions each year.vii But this has not happened, so we continue to pay higher prices than comparable countries such as New Zealand and Australia and inequities persist. America is a superpower that has not shown its strength in standing up to pharmaceutical companies that rip off Americans, as proven by the price differences for patented medicines across our border.

Three ways America – the superpower – can lower drug prices

  1. Punish abusive pricing of patented medicines by creating a new Bureau. Create a new Bureau to set price ceilings for patented medicines, give that Bureau the resources and teeth to keep prices low, and empower that Bureau to issue compulsory licences when companies price patented medicines unreasonably. The new Bureau should be able to cut annual drug spending by at least $100 billion.
  2. Use negotiating power and open tendering processes to secure low prices on a defined set of essential medicines as per international guidance. Negotiating power can help to ensure equitable access to needed medicines including off‐ patent or generic medicines.
  3. Use existing legislation, and additional political will, to discipline the companies currently bloated by high medicine prices that illegally market products. There is a need for urgent action – Americans are getting ripped off by more than $100 billion each year and, in the wrong hands, this money is used to illegally market medicines in ways that kill Americans.

While some get rich, others die. Cost‐related non‐adherence to medicines – not taking pills as instructed due to the cost – is more common in Canada (8%) and the United States (17 %) than in comparable high‐income countries where it is typically below 5 %. The Centers for Disease Control and Prevention estimated that all‐cause mortality was 15 % to 22 % higher among Americans with chronic diseases such as diabetes who cannot afford their medicines compared with those who could afford them. Drug pricing is a life and death issue.

https://www.help.senate.gov…

Comment:

By Don McCanne, M.D.

We often look to Canada as a possible source of lower-priced pharmaceuticals. But Canada – a nation with one-tenth of our population – can hardly serve as the source of our medications that is ten times their own need. Besides, Canada continues to struggle with its need for a Pharmacare program to serve its own people. But that does not mean that they do not have good advice for us.

I happened to have been prescribed recently a long-term medication that is priced at over $500 per month. Although I have insurance under Part D Medicare, it was designed by conservatives to be certain that the patient bears a significant portion of the costs. So I am one of those made to “feel the pain” so that maybe I’ll decline this important and perhaps life-saving medication. (Just a small example of the difference between conservative and progressive health policies – individual responsibility versus collective social good wherein individuals frequently do not have the same negotiating leverage as would our government working for us all, while still providing the medical-industrial complex with fair margins.)

The solution is simple. The United States government needs to use its negotiating power in the purchase of drugs. As part of a single payer Medicare for All, everyone could have the drugs they need in a system that is affordable for all.

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Medicare for All is the answer

By Ken Lefkowitz
The Philadelphia Inquirer, Letters, March 24, 2021

As a former consultant and senior director for major corporations, I have designed health care plans for hundreds of thousands of employees and their dependents. George Dalembert (March 17) makes a compelling case for the expansion of the Child Tax Credit as a major factor in ensuring children’s health, stating, “Addressing Poverty is an evidence-based means of improving health.”

Yet, passing Medicare for All would be an even more direct and permanent solution for addressing the issue of children’s heath, especially in Philadelphia, one of the poorest cities in the nation as reported in The Inquirer.

Medicare for All would provide comprehensive health care for all Americans with no premiums, deductibles, or copays, certainly improving the health of all our citizens, including children. And it will yield large savings while controlling costs in the future.

Three major studies, one by the University of Massachusetts, another published in The Lancet, and another appearing in the Annals of Internal Medicine, have estimated annual savings on health care spending through implementing Medicare for All ranging between $500 billion and $600 billion.

https://www.inquirer.com/opinion/letters

Complexities and deficiencies of the temporary health system tweaks

By Margot Sanger-Katz and Sarah Kliff
The New York Times, March 22, 2021

The new stimulus bill made tens of millions of Americans eligible for new health insurance subsidies. But many will have to wait to get help: It will probably take a year for the full emergency aid to reach people, because of website complications and other logistical problems.

The health law’s complex structure makes it hard to retool insurance subsidies, let alone create a new program for the unemployed. The systems that distribute the benefits depend on government coders who update websites, and marketers who help people understand the new programs and jump through various administrative hoops to collect them.

Getting those lower prices will require work: Americans who already have Obamacare insurance will have to go back to the website where they bought their insurance; make sure they don’t want to switch plans; and certify that they want the new, expanded tax credits. Those who fail to do this will keep paying their current price. They should eventually receive the additional funds as a large refund with their 2021 taxes next spring.

People who have bought their own insurance elsewhere will need to cancel their current plan and switch to an eligible one.

Another key part of the stimulus provides free health plans with a generous set of benefits to Americans who received unemployment insurance this year. Even though the coverage will be retroactive to Jan. 1, the new benefit will take months to set up, and won’t appear on Healthcare.gov until this summer. That timeline may require people to visit Healthcare.gov as many as three times: once to sign up for a plan, then to get the new income-based subsidies, and again to get the special unemployment benefit once it’s ready.

The slow rollout of government aid is partly the result of the technological challenge of updating Healthcare.gov, which is connected to a maze of federal systems to verify people’s residency, income and insurance choices.

The slowness also reflects a policy debate within the administration about how automatic the new benefits should become.

If the Biden administration automatically increases people’s tax credits, some people could face a higher risk of a large tax bill.

Research suggests that the more complex social welfare programs are to access, the more likely it is that eligible people will fall through the cracks.

Although the stimulus bill passed with overwhelming Democratic support in Congress, a substantial share of Democratic lawmakers would prefer a simpler, more universal path to wider health coverage. This month a majority of House Democrats co-sponsored a bill to create a “Medicare for all” system, which would automatically provide government health insurance to all Americans, without the current system of subsidies and signups.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

Many are celebrating the increase in health care benefits included in the stimulus bill. Improving coverage is a good thing, but how much do we have to celebrate here? First of all, many will be left uninsured or underinsured. Structural defects such as the profound administrative excesses will be perpetuated or even increased. Much of the program is temporary and thus won’t provide long term solutions. Some will have disruptions of their current programs plus further disruptions when the programs sunset.

Many potential tweaks discussed during the presidential campaign have not been included, so some are hoping that these may be enacted in the future along with making some of the temporary changes permanent. If so, most defects in our current system will remain in place. Also, efforts to make the system universal, equitable, affordable and inefficient will cease, as Congress and the administration move on to other pressing issues.

It is sad because we already have pending legislation that would fix these problems on a permanent basis: H.R.1976 – the single payer Medicare for All bill. Why would we want to continue with the complexities and deficiencies of the current approach when we can have it all now by enacting and implementing Medicare for All?

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