February 28, 2021
James McGee, recently retired from the Transit Employeesâ Health & Welfare Fund, outlines why single payer would be a win for organized labor. âThe main reason is that it would take health care off the bargaining table. You cannot imagine what a relief that would be.â
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By Kenny Stancil
Common Dreams, February 26, 2021
Calling it a moral imperative as well as an urgent public health and economic necessity, over 400 progressive groups on Friday urged U.S. President Joe Biden to save hundreds of thousands of lives by joining more than 100 nations in supporting an emergency waiver of the World Trade Organization’s intellectual property rules, which are currently blocking the rapid production and equitable global distribution of Covid-19 tests, treatments, and vaccines.
At a press conference joined by Reps. Rosa DeLauro (D-Conn.), Earl Blumenauer (D-Ore.), and Jan Schakowsky (D-Ill.), a coalition of health, labor, human rights, faith, and other groups released a letter (pdf) signed by hundreds of prominent organizations calling on the Biden administration to reverse the Trump administration’s “dangerous and self-defeating” obstruction of an effort to bring the coronavirus disaster to a swift end by temporarily suspending Big Pharma’s exclusive rights over tests, treatments, and vaccinesâlife-saving tools developed with public subsidies.
“As a global community, we must come together and use every tool at our disposal to stop this pandemic,” Blumenauer said. “Unfortunately, we have seen intellectual property rules and corporate greed have disastrous impacts for public health during past epidemics, and we need to ensure that this doesn’t happen again.”
“Working to ensure that trade rules do not stunt the developing world’s access to vaccines, treatments, and diagnostic tests is a clear step,” he added. “It’s the right thing to do not only for our country, but for the entire world.”
After governments invested billions in COVID-19 vaccine development, the drugs will be protected by private proprietary rights.
We must make vaccines available everywhere if we are going to crush the virus anywhere. https://t.co/6w6IueAhKb #PeoplesVaccine pic.twitter.com/mfh2rWSKQf
â Global Trade Watch (@PCGTW) February 22, 2021
The WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires countries to give pharmaceutical corporations lengthy monopoly control over the knowledge and technology used to produce medicines, even though governments and taxpayers have contributed billions of dollars to quickly develop multiple coronavirus vaccines as well as diagnostic and therapeutic tools.
India and South Africa in October 2020 introduced a proposal (pdf) calling on the WTO to exempt member nations from enforcing pandemic-related patent protections. The TRIPS waiver is backed by more than 100 countries, but a small group of powerful states in the Global Northâled by the U.S., U.K., and Canadaâis actively and successfully impeding the will of a supermajority of the world.
While former President Donald Trump was at the forefront of objecting to the TRIPS waiver, Biden, despite having had the opportunity to do so at two recent WTO committee meetings, has not yet ended U.S. opposition to India and South Africa’s proposalâeven though current trends indicate that the world’s poorest countries will be forced to wait until 2024 for mass inoculation, causing needless suffering and death, and generating more than $9 trillion in economic losses.
“As an expert in intellectual property law and access to life-saving medicines, I can assure the Biden administration that intellectual property barriers are real, and they’re blocking millions of people around the world from accessing life-saving Covid-19 vaccines,” Brook Baker, senior policy analyst at Health GAP and professor of law at Northeastern University, said during the press conference. “By obstructing the TRIPS waiver proposal, President Biden is breaking his promise to share Covid-19 vaccine technologies with the world.”
During an interview with healthcare activist Ady Barkan in July 2020, Biden committed to sharing technology and access to any Covid-19 vaccine produced in the U.S., saying “it’s the only humane thing in the world to do.” As Common Dreams has reported, health justice campaigners have argued that rejoining and contributing funding to the World Health Organization-backed COVAX program, while welcome, is insufficient.
Ahead of the WTO’s upcoming General Council meetings next Monday and Tuesday, the coalition’s letter implored Biden to “deliver on that promise” by supporting the TRIPS waiver. During his testimony, Baker said the Biden administration must “send a message to Big Pharma that it’s unacceptable to write off the lives of 90% of people in low- and middle-income countries.”
Denying poor countries the Covid vaccine to allow Pharma to profit from IP is cruel & morally bankrupt. This should be a no-brainer. President Biden must grant the waiver so that millions around the world can develop the vaccine and save lives. https://t.co/VWjNEIvrT6
â Ro Khanna (@RoKhanna) February 23, 2021
Describing the fight against the pandemic as “a race against time,” Lori Wallach, director of Public Citizen’s Global Trade Watch, asked during the press conference: “What is the possible upside of the U.S. blocking this WTO waiver supported by most countries given there is manufacturing capacity around the globe to greatly increase supplies of vaccines, tests, and treatments if formulas and technologies are shared?”
Akshaya Kumar, director of crisis advocacy at Human Rights Watch, pointed out that “instead of arguing about how to ration better, we could be rationing less.”
“Sharing the recipe for vaccines by pooling intellectual property and issuing global, open, and non-exclusive licenses,” Kumar added, “could help scale up manufacturing and expand the number of vaccine doses made.”
Deploying a metaphor to make the same point, Abby Maxman, president of Oxfam America, said that “rather than slicing the existing pie of vaccines even more finely, we need to share the recipe so that we have enough for everyone. We need a people’s vaccine. A vaccine that is free to everyone around the world, that is fairly distributed based on need and not on nationality or ability to pay.”
All of the speakers stressed the need for urgency in combating “vaccine apartheid.” As Schakowsky noted, “The new Covid-19 variants, which show more resistance to vaccines, prove that further delay in immunity around the world will lead to faster and stronger mutations.”
“Equitable access is essential,” she added. “Our globalized economy cannot recover if only parts of the world are vaccinated and have protection against the virus. We must make vaccines available everywhere if we are going to crush the virus anywhere.”
Decrying the “vast chasm of inequality” created by giving “just a handful of giant pharmaceutical corporations… monopoly control over the live-saving technologies we all need,” Maxman noted that the U.S., with only 4% of the world’s population, has purchased almost half of Pfizer’s total expected supply in 2021.
Last week, as Common Dreams reported, United Nations Secretary-General AntĂłnio Guterres lamented the fact that 10 countries had gobbled up 75% of the world’s Covid-19 vaccines while people in more than 130 countries had yet to receive a single dose. The U.N. chief warned that this “wildly uneven and unfair” allocation of vaccines threatened to prolong a pandemic that has claimed the lives of more than 2.5 million people around the world.
Medical anthropologist Paul Farmer, a co-founder of Partners in Health, made it clear that “the world does not have time to wait for the usual, slow, and unequal distribution of treatments, diagnostics, and vaccines.”
“We can take a lesson from the global AIDS movements and make sure patent laws don’t block access to life-saving therapies for the poor,” Farmer added. “It’s a similar story for vaccines, which in the case of Covid-19, we’re so lucky to have and in such short order. Moderna has waived these rights, and others should follow suit as we deploy one of the mainstays required to end this pandemic.”
Echoing Farmer’s call to learn from past epidemics, Yuanqiong Hu, policy co-coordinator of the Access Campaign at Doctors Without Borders, said that “governments must not squander this historic opportunity and avoid repeating the painful lessons of the early years of the HIV/AIDS response.”
The TRIPS waiver, Hu added, “would give countries more ways to tackle the legal barriers to maximizing production and supply of medical products needed for Covid-19 treatment and prevention. Defending monopoly protection is the antithesis to the current call for Covid-19 medicines and vaccines to be treated as global public goods.”
Drawing attention to the public nature of Covid-19 tests, treatments, and vaccines, Sister Simone Campbell, executive director of NETWORK Lobby for Catholic Social Justice, emphasized that “the U.S. government has invested over $13 billion in taxpayer funds to create vaccines, and other developed nations have invested as well.”
Instead of hoarding vaccines and causing unnecessary suffering and preventable deaths, Campbell said, “rich nations have an obligation to share with the global community. That is the only way to protect the vulnerable here and abroad.”
“The United States must stop blocking the WTO TRIPS waiver in order to share the vaccine with the developing world and to prevent the killing of our vulnerable siblings in the developing world,” Campbell added. “If we don’t get the waiver, we in the United States, I believe, will have blood on our hands, and we cannot allow that to happen. Let’s change this.”
Watch the full press conference:
By Jonathan Cohn
St. Martin’s Press, February 2021
Excerpts from the Conclusion – What Change Looks Like:
The next great debate over health care reform might not happen for many years. Or it might happen right away. It depends to some extent on what else is happening in politics – and how the Supreme Court rules on the new Obamacare case. But a debate will happen sooner or later, and when it does, two directions are possible.
One is to reverse course, to scale back the Affordable Care Act or eliminate it altogether. This remains the agenda of the Republicans and their allies. The idea is to cut back on the things conservatives instinctively oppose, so that taxes are lower, regulations are looser, and federal spending comes down. But for many, the objection to Obamacare also reflects a more basic rejection of universal coverage, which by definition means putting everybody into one system with a lot of redistribution – with contributions from healthy people financing the costs of the sick, and the wealthy paying extra to cover the poor.
Republicans want less of that redistribution or maybe none at all. And if they get their way someday, people who are healthy will save money, at least while they remain healthy, and people at higher incomes won’t have to pay so much in taxes. But the burden of medical expenses will shift onto those who have more health problems and those who have less money, which is what every reputable projection about every serious Republican plan of the last ten years has shown.
The alternative approach on health care is to continue the crusade for universal coverage that Democrats have been carrying on since the days of Roosevelt and Truman. It would mean finding some way to make sure everyone has insurance – as in 99 percent of the population, not just 92. It would mean improving benefits, so everyone can afford to go to the doctor, or fill a prescription, or be admitted to the hospital without having to pay big out-of-pocket costs. Today, that’s a problem for many Americans with “good” coverage. Ideally, it would also mean a simpler system, one in which patients and providers weren’t constantly fighting with insurance companies over billing and approvals, or shifting between plans and networks.
The Affordable Care Act, like the Clinton plan before it, was an attempt to achieve the liberal end of universal coverage through a more conservative scheme that relied heavily on competition among private insurers. But the intellectual foundation for that calculation seems increasingly shaky, especially when it comes to controlling the cost of care.
Even many card-carrying economists schooled in the virtues of markets and hazards of government control now wonder whether it’s time for the United States, like other developed nations, to set a global budget for health care, have the government regulate prices, or maybe do both of those things.
The version getting the most attention in American politics today is the single-payer proposal that Bernie Sanders and his followers have been promoting: Medicare for All. The reality is that any system that covers everybody with low out-of-pocket costs and some kind of government control over spending is going to look a lot more like Medicare for All then what the U.S. has now. That shouldn’t scare anybody. Medicare for All is the same basic idea Harry Truman proposed in the 1040s, and it’s in the DNA of Medicare, a program Americans cherish.
The case shouldn’t be that hard to make, given how well the best systems abroad perform. But it will require a lot more work – by wonks and operatives, officials and activists.
By Don McCanne, M.D.
Jonathan Cohn’s new book has been receiving excellent reviews, and rightfully so. It is a well researched, meticulously accurate summary of the last ten years with the Affordable Care Act and the preceding health care reform history leading up to it.
If you are interested in history, it is great, but more importantly, if you are interested in how we got here in health care reform and where the various pathways before us lead, it is essential reading.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Cheryl Clark
MedPage Today, February 19, 2021
When they made their bold announcement in mid 2018, three corporate powerhouses — Berkshire Hathaway, Amazon, and JP Morgan Chase — were going to revolutionize the healthcare delivery system.
After all, they had author, innovator, and surgeon Atul Gawande, MD, at the helm.
But less than three years later, the companies acknowledged the effort known as Haven would dissolve by the end of this month.
In a nutshell, the concept was fatally flawed, (Gawande) said, in so many words.
On the good side, he said, the effort accomplished a lot. In its two and a half years of existence, Haven’s thought leaders designed a coverage model with no co-insurance, no deductibles, no cost for 60 critical drugs, and low-cost mental health services and primary care.
But the pandemic brought home a critical point. “We have an employer-based system. A job-based system is a broken system in a world where people are moving every couple of years to different roles and many, many, kinds of jobs,” he said.
“The pandemic has really brought this out in spades,” he said, as the lockdowns cost many workers their jobs, and thus the health insurance that came with them.
“The vulnerability we have of tying your healthcare to your job, that remains still a big hill to climb, and the government has to solve it. That is a public core issue that we still have not faced up to,” Gawande said.
By Don McCanne
“Tying your healthcare to your job, that remains still a big hill to climb, and the government has to solve it,” so says Atul Gawande. Apparently Warren Buffett, Jeff Bezos and Jamie Dimon agree since they are walking away from any effort to try to revolutionize our health care system.
What is the obvious solution? A single payer model of an improved Medicare for All. These icons of corporate America know that. It’s too bad they won’t say it.
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Oregon Health Forum, February 25, 2021
COVID-19 has exacerbated racial disparities in disease and mortality. Should those racial groups hit hardest by the pandemic be given higher priority in vaccination distribution? Is favorable healthcare treatment of any racial group legal in the U.S.? Please join this important discussion between Harald Schmidt, PhD, Assistant Professor of Medical Ethics & Health Policy at the University of Pennsylvania and Kalpana Krishnamurthy, National Field and Policy Director at Forward Together, Portland. Together they will discuss the compelling issues raised in Dr. Schmidtâs JAMA opinion article, âIs It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?â
Download slideshow HERE.
Kalpana Krishnamurthy is National Field and Policy Director at Forward Together, Portland. In addition to national policy work, she directs the organizationâs state-based organizing and civic engagement program. She previously directed the racial justice and gender justice programs at Western States Center. She currently serves on the Advisory Board for the Philanthropic Initiative for Racial Equity.
Harald Schmidt, Ph.D. is Assistant Professor of Medical Ethics & Health Policy; Research Associate, Center for Health Incentives and Behavioral Economics; and Senior Fellow, Leonard Davis Institute at the Perelman School of Medicine, University of Pennsylvania. His research interest is improving opportunity and reducing disadvantage for marginalized populations in healthcare.
By Edmund L. Andrews
Stanford Graduate School of Business, February 23, 2021
Itâs no secret that health care in the United States is tangled in wasteful red tape. A study in 2019 estimated that administrative complexity was the single biggest source of waste in health care â bigger even than fraud or over-pricing â and imposes an annual cost of $265 billion.
The true extent of that waste, according to a new study led by Jeffrey Pfeffer at the Stanford Graduate School of Business, is even more shocking. Pfeffer and his colleagues found that administrative âsludgeâ in health care insurance costs employers and the economy billions of dollars in squandered work time, employee stress, absenteeism and reduced productivity.
Specifically, the researchers estimate, the economy loses $21.6 billion a year simply from the time employees spend on the phone with health insurance representatives. On top of that, the study estimates that companies lose $26 billion a year from extra absence on the part of employees who have to deal with health benefits administrators, and $95 billion from the reduced productivity that arises because people who spend time on the phone with health insurers are less satisfied with their jobs. All of those dead-weight losses to the economy could be diminished if employers held benefits administrators accountable for reducing administrative hassles in the system.
The Drain on Productivity
If that just sounds like grousing, itâs not. Pfeffer teamed up with researchers at Gallup, the polling company, to assess how much time employees spend on the phone with benefit administrators and how those encounters affect their work.
âUntil now, most of the research on health care sludge has focused on the paperwork costs incurred by health care providers such as doctors and hospitals,â Pfeffer says. âOur new twist, which I canât believe no one looked at before, is how much employee time is wasted and the measurable effect of that time on employee stress, burnout, increased absence, and diminished job satisfaction.â
The team began by polling people on how much time they had spent on the phone in the prior week with health insurance administrators. All told, the annual cost of lost work amounted to $21 billion â frittered away while talking on the phone with health insurance representatives.
The Impact on Worker Morale
The next step was to look at whether those encounters made people more dissatisfied and less engaged in their work.
Sure enough, the people who had talked with a benefits administrator were significantly less satisfied with their jobs and more likely to be absent from work.
Whoâs Really to Blame?
Pfeffer says the fault lies less with insurance companies than with the companies that hire them and then fail to hold them accountable.
âCEOs are the ones who should care about this, but theyâre only interested in how to reduce direct medical costs,â he says, ânot realizing that the indirect costs of turnover, absenteeism, and diminished productivity are many times the direct costs of ill-health.
The upshot, Pfeffer continues, is that companies end up paying huge sums of money for employee health care benefits that donât provide increased employee morale because of the burdens imposed by insurers.
âCompanies say they offer health insurance to attract and retain talent, but theyâre offering a benefit which is administered so that it often doesnât feel like a benefit,â says Pfeffer. âIf employers would select better-performing health insurers and get rid of those that are administratively inefficient, they would get more value for the money they are spending.â
By Don McCanne, M.D.
So finally someone has discovered that private insurance companies not only waste a tremendous amount of health care funds on administrative excesses, but they also place a tremendous administrative burden on others – the health care delivery system, the business community and the employees insured by these firms. Professor Pfeffer says that he can’t believe that no one looked at the employee burden before, but, of course, they have.
More astonishing is the fact that Pfeffer says that the fault lies less with the insurance companies and more with the companies that purchase the private insurance plans and then fail to hold the insurers accountable. Accountable? Accountable for what?
The insurance companies are private businesses rather than public service organizations. They strive for business success by erecting barriers to spending money on health care. They spend a large amount of funds on accomplishing this – not only on their own administrative services that are designed to cut back on health care spending, but also by creating administrative burdens for the health care delivery system, and businesses and their employees.
That’s just good business. If they want efficient public service organizations whose job it is to assist patients in getting the care they need, they should advocate for a single payer Medicare for All program and then dismiss the private insurers and their inefficiency at obtaining beneficial health services.
But then isn’t it characteristic of market-oriented business schools like Stanford to place the blame on the consumers? We should be assisting the consumers of health care, not blaming them.
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By Atul Gupta, Sabrina T. Howell, Constantine Yannelis & Abhinav Gupta
National Bureau of Economic Research, February 2021
Abstract
The past two decades have seen a rapid increase in Private Equity (PE) investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goal of affordable, quality care. This paper studies the effects of PE ownership on patient welfare at nursing homes. With administrative patient-level data, we use a within-facility differences-in-differences design to address non-random targeting of facilities. We use an instrumental variables strategy to control for the selection of patients into nursing homes. Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.
From the Conclusion
This paper studies PE buyouts in healthcare, an important sector where PE activity has increased dramatically, generating policy debate. Nursing homes are a useful setting because they have particularly high levels of for-profit ownership and subsidy and have experienced extensive PE investments. In an instrumental variables design incorporating facility fixed effects, we address both targeting and patient selection challenges to identification. We find that going to a PE-owned facility increases 90-day mortality by about 10% for short-stay Medicare patients, while taxpayer spending over the 90 days increases by 11%. Furthermore, we document declines in nurse availability per patient and in measures of compliance with Medicareâs standards of care. We also find a corresponding increase in operating costs that tend to drive profits for PE funds.
By Don McCanne, M.D.
Private equity investment in health care raises some concerns since there can be a conflict between the business interests of the equity investors and the health care interests of the patients.
In this paper, private equity investment in nursing homes was associated with an increase in mortality for short-stay Medicare patients, an increase in taxpayer spending, a decrease in nurse availability, a decrease in compliance with Medicare’s standards of care, and an increase in operating costs that tend to drive profits for private equity funds. Ouch!
It appears that our health care system places a higher priority on business interests than it does on patients. Instead of advocating for a national program of social insurance, maybe we should be thinking about public ownership of the system since the interests of taxpayers and patients are one and the same. Just a thought.
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By California Nurses Association
National Nurses United, February 19, 2021
Renewing its commitment to the larger fight for health care justice, the California Nurses Association (CNA) is pleased to sponsor Assembly Bill 1400 (Kalra), the California Guaranteed Health Care for All Act (CalCare), which would guarantee comprehensive, high-quality health care to all California residents as a human right. The establishment of the CalCare program is an improved Medicare for All-type health care system.
Despite the gains made under the Affordable Care Act, nearly 3 million Californians have no health insurance, while millions more have insurance that they canât afford to use because their copays and deductibles are too high. Meanwhile, for-profit insurance companies are reporting record-breaking profits, even while the Covid-19 pandemic continues to ravage California and medical bankruptcies are at an all time high.
Sponsored by CNA and authored by Assemblymember Ash Kalra, AB 1400 will ensure that all Californians, regardless of employment, income, immigration status, race, gender, or any other considerations, can get the health care they need, free at the point of service.
âA single-payer health system represents the belief that health care is truly a human right. Our current system results in unjust outcomes and these inequities are underscored especially now, exacerbating economic downturns for working families who have lost their income and meaningful access to health care,â said Assemblymember Ash Kalra. âWe will have a long fight ahead in fixing our broken system, but this bill will set us on a real path towards a single-payer system and affirms the policy that would save lives, decrease suffering, and improve public health in California.â
https://www.nationalnursesunited.org…
California Legislative Information, February 19, 2021
From the Legislative Counsel’s Digest
This bill, the California Guaranteed Health Care for All Act, would create the California Guaranteed Health Care for All program, or CalCare, to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that CalCare cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Childrenâs Health Insurance Program, Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program. The bill would require the board to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to CalCare, which would then assume responsibility for all benefits and services previously paid for with those funds.
This bill would prohibit a participating provider from billing or entering into a private contract with an individual eligible for CalCare benefits regarding a covered benefit, but would authorize contracting for a health care item or service that is not a covered benefit if specified criteria are met. The bill would authorize health care providers to collectively negotiate fee-for-service rates of payment for health care items and services using a 3rd-party representative, as provided. The bill would require the board to annually determine an institutional providerâs global budget, to be used to cover operating expenses related to covered health care items and services for that fiscal year, and would authorize payments under the global budget.
This bill would state the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. The bill would create the CalCare Trust Fund in the State Treasury, as a continuously appropriated fund, consisting of any federal and state moneys received for the purposes of the act.
This bill would prohibit specified provisions of this act from becoming operative until the Secretary of California Health and Human Services gives written notice to the Secretary of the Senate and the Chief Clerk of the Assembly that the CalCare Trust Fund has the revenues to fund the costs of implementing the act.
Section 1.
(b) (2) It is the intent of the Legislature to work to obtain waivers and other approvals relating to Medi-Cal, the federal Childrenâs Health Insurance Program, Medicare, PPACA, and any other federal programs pertaining to the provision of health care so that any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the CalCare Trust Fund.
(3) Under those waivers and approvals, those funds would be used for health care coverage that provides health care benefits equal to or exceeded by those programs as well as other program modifications, including elimination of cost sharing and insurance premiums.
(4) Those programs would be replaced and merged into CalCare, which will operate as a true single-payer program.
Section 2. TITLE 23. The California Guaranteed Health Care for All Act
Chapter 7. Funding
Article 1. Federal Health Programs and Funding
100660. (b) (1) The board shall apply to the United States Secretary of Health and Human Services or other appropriate federal official for all waivers of requirements, and make other arrangements, under Medicare, any federally matched public health program, the Affordable Care Act, and any other federal programs or laws, as appropriate, that are necessary to enable all CalCare members to receive all benefits under CalCare through CalCare, to enable the state to implement this title, and to allow the state to receive and deposit all federal payments under those programs, including funds that may be provided in lieu of premium tax credits, cost-sharing subsidies, and small business tax credits, in the State Treasury to the credit of the CalCare Trust Fund, created pursuant to Section 100665, and to use those funds for CalCare and other provisions under this title.
Article 3. CalCare Financing
100670. (a) It is the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. In developing the revenue plan, it is the intent of the Legislature to consult with appropriate officials and stakeholders.
(b) It is the intent of the Legislature to enact legislation that would require all state revenues from CalCare to be deposited in an account within the CalCare Trust Fund to be established and known as the CalCare Trust Fund Account.
https://leginfo.legislature.ca.gov…
By Don McCanne, M.D.
So California is once again attempting to enact and implement a state-level single payer system. As before, they run into the glitch as to how they are going to pay for it.
They are intensifying their efforts to obtain “waivers” for all federal sources of health care funds so that they can be deposited into California’s single payer CalCare fund. One barrier is that California cannot dictate to the federal government – Congress and the administration – the use of those funds, rather the federal government has to set up avenues through which those funds can be transferred. Some mechanisms already exist but there is considerable more work to be done to accomplish this task.
The CalCare program will also need the health care funds that are generated within the state, whether by individuals, businesses, or local governmental agencies. They will also need to generate any funds that might be required to provide additional care for those currently uninsured or underinsured. The amount is unknown especially since it is hoped that there will be considerable savings through elimination of administrative excesses and more efficient purchasing of health care products and services. As in previous California legislative attempts, this effort is addressed by stating in the legislation that it is the “intent” of the Legislature to enact legislation that would develop a revenue plan. In the last attempt, this caused a rather dramatic pulling of the bill with the claim that it was incomplete legislation.
Although a national single payer Medicare for All would be greatly preferred, we have a president that has threatened to veto any such legislation. We can be thankful for California and a few other states that are keeping the concept alive through their state efforts.
But we can no longer hide the issue of how we are going to pay for the program. Besides obtaining what federal funds are available, we are going to have to establish equitable, progressive taxes within the state, and we are going to have to let the people know just what that means. This situation requires transparency. We can no longer hide behind a vague “legislative intent” statement. We can develop a system that works well for all of the people, as long as the super wealthy recognize their obligation to return a modest portion of their rewards to society. But we are simply going to have to let the people know what that system is. Taxes are good when they enable beneficial, equitable societal goals.
In the meantime, let’s celebrate the fact that California has not given up.
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By Robert Funke, M.D.
Kingsport (Tenn.) Times News, February 21, 2021
We know the U.S. pays too much for health care, but who actually pays for it now and who will pay in the future? Economists say the answer to both is ultimately individuals and households. That simple, accurate answer only becomes complicated when we see the different ways we simultaneously pay for health care today.
About half the current national health expenditure (NHE) flows through various payroll, state and local taxes. We send over a third of NHE through private insurance companies. We pay the remainder directly out of our pockets in deductibles, copays and non-covered expenses. The 35 million currently uninsured pay everything out of pocket â and taxes.
Many Americans send additional payment through their employers. Itâs worth recalling this peculiarly American arrangement began accidentally due to a World War II wage freeze. Employers were prohibited from offering higher wages to attract needed workers, so they paid their workersâ insurance premiums instead.
Although this amounted to a hidden tax in employeesâ paychecks each month, it became accepted practice and was particularly popular with employers who reaped tax benefits. It was considered bad policy at the time but acceptable as a temporary work-around.
Now itâs just bad policy that doesnât work well for either and will worsen as automation ends factory jobs, self-driving vehicles end truck-driving jobs, and artificial intelligence disrupts white-collar jobs. Consequently itâs short-sighted, and indeed harmful, to keep tying our health insurance to jobs.
Most politicians, including President Biden, still tout market-based plans despite 70 years of the marketâs failure to control costs or provide access to all who need health care. Iâm reminded of the saying that insanity is repeating the same action while expecting different results. Never mind that economists have shown health care markets donât behave as other competitive markets. Just last month after a three-year effort, our elite businesses JP Morgan Chase, Amazon and Berkshire Hathaway gave up and admitted defeat on Haven, their bold quest to deliver better market-based health care.
The business model for profitable health insurance is to âcherry-pickâ the healthy population with gym memberships and âlemon-dropâ those needing expensive care by keeping desired hospitals and doctors out of network and inadequately covering critical medications. The industry essentially works on a commission, keeping 20% of premiums for their own use and profit. Thus their financial incentive is for the NHE to grow, not shrink. Comparatively, remember Medicareâs overhead is only 4%.
As an individual and household, I want my health care money flowing into the one, single most efficient pool with leverage for lower yet fair prices. That would be one pool for all Americans, everybody in, nobody out â ever. Experts estimate switching to single payer will save $500 billion in wasteful administrative costs alone. Copays, deductibles and out-of-pocket expenses have not lowered health care costs, so eliminate them to save the expense of billing and collecting them.
Cover everyone, then doctors and hospitals will be fairly paid for all their work. Large employers could compensate employees with raises equivalent to what they previously paid in insurance premiums, about $15,000 annually for a family of four per the Kaiser Family Foundation. The 50% of small employers who currently provide insurance will have lower expense per employee and more incentive to create additional jobs at higher wages. Aspiring entrepreneurs can leave unfulfilling jobs and flourish without the burden of buying expensive insurance.
Private health insurance may go the way of the Oldsmobile, but just like when you trade in an old clunker for a new car, youâre buying a better, safer, more dependable ride for the future.
We pay enough today to afford Medicare for everyone. Some journalists point to Congressional Budget Office projections of higher taxes, apparently not realizing the CBO only deals with current federal government revenues. They donât consider the elimination of premium purchases and out-of-pocket spending, which are designed to offset the tax increases for individuals and households. Some will spend less overall on health care than now.
Medicare-for-All bills exist now in both houses of Congress, and detail summaries are available for review. There are provisions to protect individual job disruption through retraining and a phased-in transition. In the larger economy, lost administrative jobs will be replaced by hands-on clinical jobs to care for those previously uninsured.
Despite what we hear, itâs not socialized medicine or government-run health care. Itâs publicly financed insurance â Medicare, but without the middlemen and supplemental policies. Doctors will still be private, still paid by Medicare but not through hundreds of additional insurance plans. Public spending on the health and safety of Americans is not overreach, it is the appropriate role of government large or small.
Dr. Robert Funke is a retired Kingsport family physician and member of Physicians for a National Health Program.
By Karl T. Johnson, B.A.; Deepak Palakshappa, M.D.; Sanjay Basu, M.D., Ph.D.; Hilary Seligman, M.D., M.A.S.; Seth A. Berkowitz, M.D., M.P.H.
HSR, Health Services Research, February 17, 2021
From the Discussion
In this study of nationally representative data, we found support for both directions of the relationship between food insecurity and healthcare expendituresâfood insecurity is associated with greater health care expenditures, and greater health care expenditures are associated with food insecurity. However, the strength of these associations appears to be unequal. Though we found a statistically significant association between health care expenditures and subsequent food insecurity, the difference in odds was smallâabout 1% greater risk of food insecurity per $1000 difference in health care expenditures. When examining the association between food insecurity and subsequent health care expenditures, the difference in expenditures between food insecure and food secure participants was relatively largerâapproximately 25% greater expenditures for those who were food insecure. This suggests that upstream efforts that seek to address food insecurity may have greater impact than downstream efforts that seek to address health care expenditures directly.
Expenditures for prescriptions made up the largest share of the difference in health care spending between those who were food insecure and those who were food secure. Furthermore, with regard to the relationship between health care expenditures (as predictor) and food insecurity status (as outcome), we found evidence that greater health care expenditures may be an indicator of underlying poor health status. In models that adjusted for both indicator health care expenditures and indicators of poor health (eg, disability) the association between health care expenditures (as predictor) and food insecurity status (as outcome) was weakened, while the association between disability and subsequent food insecurity was strong. This suggests that high health care expenditures may be associated with food insecurity risk because they indicate poor health (which can impair the ability to work), rather than because they drain household resources directly. The finding that outâofâpocket expenditures is not associated with food insecurity risk also supports this idea.
The results of this study have several implications. First, the confluence of comorbidities, health care expenditures, and food insecurity suggests that attempting to address food insecurity without paying attention to comorbidity could limit the effectiveness of the intervention. Rather than viewing food insecurity as one standalone issue to address, it may be more effective to think of addressing food insecurity as one aspect of a more comprehensive disease management plan. Relatedly, given that the strength of the association appears larger when food insecurity is the predictor and greater health care expenditures is the outcome (compared with when these roles are reversed), disease management plans, which target the upstream determinants of food insecurity and general poor health, may be more efficacious at breaking this cycle than interventions that merely offset the cost of disease management. Thirdly, the category of prescription expenditures stands out in our analyses. One reason for this may be that if food insecurity increases the risk for the development or worsening of chronic conditions, it could lead to increasingly complicated medication regimens, with attendant costs. Finally, the lack of association between outâofâpocket expenditures and food insecurity, coupled with a strong association between medical debt and food insecurity, warrants closer attention. Current insurance benefit design often considers outâofâpocket expenditures (eg, yearly outâofâpocket maximums set at an absolute number) without considering medical debt. More nuanced design that takes into account an individual’s ability to match resources to expenditures (eg, yearly outâofâpocket maximums set as a percentage of income or assets) may better protect individuals from the consequences of outâofâpocket costs.
The presence of these relationships sets up the potential for a selfâreinforcing âvicious cycleâ whereby food insecurity worsens health and worse health increases the risk for food insecurity. Given the different directional associations, however, interventions targeted at addressing food insecurity as a part of chronic disease management may be a more promising way to break this cycle and improve health for disadvantaged individuals.
https://onlinelibrary.wiley.com…
By Robin Duddy-Tenbrunsel, Shruthi Donthi, Joanna Young, Thomas Kornfield
Avalere, February 5, 2021
Over 3 million Medicare Advantage (MA) beneficiaries are enrolled in plans providing additional supplemental benefits to individuals with chronic illnesses, compared to just over 1 million in 2020.
Starting in 2020, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2018 permits plans to also target non-primarily health-related supplemental benefits to beneficiaries with chronic illnesses (e.g., diabetes, asthma). By allowing SSBCI, policymakers gave MA plans more flexibility to address social and environmental factors that may impact beneficiary health.
In 2021, the second year that plans can offer SSBCI, 787 plans are offering at least 1 SSBCI, which is more than triple the number in 2020, when 239 plans offered these benefits. As shown in Table 1 (see at link below), among the plans offering SSBCI, the most commonly offered benefits are meals (45% of plans, enrolling 1.5 million beneficiaries), food and produce (43% of plans enrolling 1.9 million beneficiaries), and pest control (25% of plans enrolling 1.4 million beneficiaries).
By Don McCanne, M.D.
We’ve long known that food insecurity is a major problem that can have a significant impact on a patient’s health. This HSR study shows that food insecurity is associated with higher health care expenditures. That certainly should catch the attention of the private health insurers, and it has.
Avalere reports that private Medicare Advantage plans are now offering “non-primarily health-related supplemental benefits to beneficiaries with chronic illnesses.” The most commonly offered benefits are meals (45% of plans, enrolling 1.5 million beneficiaries), and food and produce (43% of plans enrolling 1.9 million beneficiaries).
We have continued to sit back and watch the private insurance industry take over significant portions of the health care delivery industry. Now are we going to continue to sit back as we watch them take over the food industry as well?
I’d say that enacting and implementing a single payer system of improved Medicare for All has become an emergency, lest the out-of-control steamroller wipes out more of us.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
February 19, 2021
One year ago this month, America lost its first life to the coronavirus. Since then, nearly 500,000 Americans have succumbed to the pandemic, and many more have lost their family, their classrooms, and their livelihoods.
No person has been more widely reviled for dooming our response than former President Donald Trump. But a new report published in the British medical journal The Lancet finds that as damaging as were Trumpâs actions and his antagonism toward science, they represented merely the extension of a long tradition of harmful policies stretching back decades, which collectively left the United States acutely vulnerable to the pandemic: and resulting in the deaths of 461,000 Americans, in 2018 alone.
This report, published by the Lancet Commission on Public Policy and Health in the Trump Era, offers an unsparing assessment of the many and overlapping failures of the US health care system, as well as of the social mores and policy choices that fueled and have perpetuated those failures over four decades.
Here to discuss their findings, and what they mean for a nation still struggling to move forward, is Dr. Steffie Woolhandler, co-chair of the Lancet Commission and distinguished professor in the CUNY School of Public Health at Hunter College. Dr. Woolhandler is a practicing primary care physician as well as a co-founder and board member of Physicians for a National Health Program, the only national physician organization dedicated to implementing a single-payer health program in the United States â now encompassing more than 20,000 members. She has authored over 150 journal articles, chapters, and books on health policy and continues to guide the national debate as a staunch champion of Medicare for All.
For more about the Lancet Commission, check out:
Follow Dr. Woolhandler on her Twitter page.
And learn more about Civic Rx at civic-rx.org.
Town Meeting is coming up, and Putney residents will have a chance to join the groundswell of support for a single-payer national health plan. Article #12 on the Town Meeting warning calls on senators Leahy and Sanders and Representative Welch to work vigorously to enact emergency legislation to ensure everyone gets the care they need during the pandemic, as well as federal legislation that provides universal, comprehensive health care coverage, with no deductibles, copays, or other out-of-pocket costs.
Even before the COVID-19 pandemic, 30 million people in the U.S. had no health insurance, and about 50 million were underinsured. The pandemic has caused millions more to lose coverage because of losing their jobs. Indeed the pandemic has given us perspective on an array of injustices in our health care delivery system â including the lack of an adequate public health infrastructure, the racial disparities in access to care, the rationing of care based on ability to pay, and hospitalsâ concentration on lucrative cardiac and orthopedic services rather than mental health and primary care.
The U.S. spends twice as much per capita on health care as other high-income countries that provide universal coverage, and yet our health outcomes are worse. Life expectancy in the U.S. is lower than that in 30 other countries. Our infant mortality is three times higher than it is in economically comparable countries.
This past November, the Vermont Medical Society, representing 2,400 Vermont physicians and physician assistants, became the second state in the nation to formally endorse universal access to high quality health care through a publicly financed, single-payer national health program. This endorsement builds on the growing movement among physicians and other health professionals towards single-payer reform, also known as Medicare-for-All.
In December, the Congressional Budget Office reported that Medicare-for-All would extend coverage to everyone, yet would save $650 billion each year, by 2030. Putney voters can add their town to the more than 50 municipalities which have passed resolutions endorsing Medicare-for-All, including Philadelphia, Detroit, Knoxville and New Orleans. In New Hampshire, voters in Hanover, Grantham, Peterborough and Holderness have passed similar resolutions.
The issue of health care reform has an enormous impact on the town of Putney and its residents. Under a single-payer health care system, all our residents would be covered for medical needs in a comprehensive way, with no out-of-pocket expenses. The health of our community would benefit tremendously under this system, and disparities would be lessened. Moreover, our town would realize tremendous savings; in 2021, the town of Putney will spend $197,000 on health care costs for its 10 employees, but under Medicare-for-All, the townâs cost would drop to about $45,000 â an annual savings of around $150,000. In addition, the 2020 health care costs for Putney Central School employees were $475,000, much of which is paid for by property taxes; under Medicare-for-All, the only expense for health care coverage would be an 8 percent employer-side tax on employeesâ salaries, amounting to about $140,000, yielding significantly lower property taxes for residents of Putney.
Getting everyone in the U.S. covered for their health care needs is vital to achieving health, economic and racial justice. The passage of Medicare in 1965 not only provided health insurance for the elderly, it also eliminated segregation in hospitals and helped decrease racial disparities. Only the top executives of the highly profitable insurance and pharmaceutical corporations benefit from the current health care system. But health is not a marketable product; just like education and fire protection, it is a âpublic good.â Our democracy and our economy are strengthened if everyone is healthy and educated. Medicare-for-All is the only way to control costs, achieve equity and fairness, and improve outcomes. Passing Resolution #12 on the Putney warning is part of the nationwide political momentum to guarantee health care for all, regardless of race, income, or employment status.
Dr. Jane Katz Field is a retired local pediatrician. She is vice president of the Vermont Chapter of the Physicians for a National Health Program.
