PNHP

The Haven debacle shows the need to adopt Medicare for All

The Haven debacle shows the need to adopt Medicare for All

By Donald R. Frey, M.D.
Omaha World-Herald, January 26, 2021

As America tiptoes into the unknown of 2021, an event will soon occur that will be largely unnoticed.

Just three years ago, the corporate giants Amazon, Berkshire Hathaway and JP Morgan Chase announced they would join forces to create a new health care company called Haven. Revolutionary in its scope, Haven would use market forces to create disruptive innovation that would bring down the costs of employer-based insurance.

In the minds of many, this was long overdue. Each year, rising health care costs were eating into both corporate bottom lines as well as employee take-home pay. Omaha’s Warren Buffett had already thrown down the gauntlet when he’d called health care costs the “tapeworm” inside American economic competitiveness, adding that costs “were the biggest single variable where (America) keeps getting more and more out of whack with the rest of the world.”

Now, the collective strengths of Buffett, Jeff Bezos and Jamie Dimon (not to mention their combined $4 trillion in company assets) would be brought to bear on the cost crisis. The health care world braced for a shock wave of innovation.

In short order, the highly respected Harvard surgeon and author Dr. Atul Gawande was hired to spearhead the project. It was widely anticipated that Haven would use such items as value-based purchasing and massive economies of scale to radically alter health care delivery.

Instead, the whole thing landed with a flop.

To date, there’s been no evidence of meaningful innovation. Gawande left the project after less than two years, and last month came this announcement — Haven would cease operations in February.

Advocates of market-based health care are now scratching their heads. If three of America’s most successful business leaders can’t solve our country’s health care cost dilemma, who can?

In the coming months, the issue of health care will echo through the halls of Congress. With the COVID pandemic spotlighting our national deficiencies, the scope of the Affordable Care Act (the ACA, or, Obamacare to some) will again come into focus. Democrats, who crafted the original legislation, will seek to bolster it, and Republicans, who came within a whisker of demolishing it (save for the courageous vote of John McCain), will try to diminish it.

But will any of this really move us forward? Let’s look at the past 10 years. Incremental changes such as the ACA have expanded coverage to a degree, but failed to address costs. Republican proposals have sought to reduce costs, but would have resulted in further loss of coverage.

What has been virtually absent from any meaningful congressional discussion has been the concept of a single-payer, universal health insurance approach — what some call Medicare for All.

But with over 400,000 dead from COVID-19, millions either lacking insurance or with inadequate coverage, and costs that continue to spiral upward, consideration of universal coverage is long overdue.

As a physician for over 40 years, let me make this observation: Haven didn’t fail because it was too bold and innovative. It failed because it wasn’t bold enough.

Moving forward, it will take bold innovation by our Congress to address our twin dilemmas of cost and coverage. Medicare for All is our only reasonable path forward.

Or not. We can continue to just nibble incrementally around the edges of our health care crisis. But if we do, we should expect our results to be no different than those of Haven.

Dr. Donald R. Frey is professor of family medicine at Creighton University’s School of Medicine, and the author of “Pay Me Now or Pay Me Later: One Physician’s Guided Tour through an Insane Asylum called American Health Care.” This essay expresses his views alone and not those of Creighton University.

https://omaha.com…

Health Economists May Be Getting The Supply-And-Demand Framework All Wrong

Podcast: Health Economists May Be Getting The Supply-And-Demand Framework All Wrong

By Alan Weil, Adam Gaffney
Health Affairs, January 26, 2021

Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That’s certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.

As Gaffney and co-authors note in their paper, “focusing only on the impact of health care reform on government expenditures is short-sighted.” On the supply side, there’s a natural limit to doctor and nurses’ time as well as the number of hospital beds in a given facility.

Their analysis suggests that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.

On this episode of A Health Podyssey, Alan Weil and Adam Gaffney take listeners through health reform economics 101 before sharing the implications of the paper, ultimately questioning whether health reform is too focused on a demand-side framework.

Alan Weil, Health Affairs Editor-in-Chief: “If we free up physicians’ time, we say, ‘Oh, there’s going to be more utilization,’ and in a fee-for-service world, more utilization is more cost, but if you change how a physician spends time from administrative tasks to clinical care, they’re more productive and that actually isn’t a new cost to the health care system. That’s a more efficient use of the money we have, and it actually, once you move out of a fee-for-service world, that isn’t a cost-creating phenomenon.”

Adam Gaffney, former president of PNHP: “We do need to actually plan so we can have supply when we need it, and not just where it’s revenue-generating.”

Reader Comment:

By Don McCanne, M.D.

This Podcast is really important because it answers President Biden’s question he asked repeatedly during the campaign, “How can we pay for Medicare for All? We can’t afford it.”

Ironically, he has chosen the most expensive method of expanding coverage. On top of what we are already spending, he is going to give more taxpayer subsidies to the private commercial insurance industry – the source of the highest prices, and, even worse, the source of profound administrative waste, both their own and the administrative burden they place on the health care delivery system.

Medicare for all would greatly reduce the administrative waste by eliminating the private insurers, saving hundreds of billions of dollars, plus prices would be set at a lower level – enough to cover costs plus fair profit margins.

But the most important reason that single payer Medicare for All would be affordable is explained in this Podcast. Listen to it if you haven’t, and then encourage President Biden and his advisers to listen to it as well.

https://www.healthaffairs.org…

The Health Affairs article, “Pricing Universal Health Care: How Much Would The Use Of Medical Care Rise?” by Adam Gaffney, David U. Himmelstein, Steffie Woolhandler, and James G. Kahn was previously covered in the Quote of the Day, “We can easily afford to include everyone in Medicare for All”:
https://pnhp.org…

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

Podcast: Health Economists May Be Getting The Supply-And-Demand Framework All Wrong

Interview with Dr. Adam Gaffney

January 26, 2021

Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That’s certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.

As Gaffney and co-authors note in their paper, “focusing only on the impact of health care reform on government expenditures is short-sighted.” On the supply side, there’s a natural limit to doctor and nurses’ time as well as the number of hospital beds in a given facility.

Their analysis suggest that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.

On this episode of A Health Podyssey, Alan Weil and Adam Gaffney take listeners through health reform economics 101 before sharing the implications of the paper, ultimately questioning whether health reform is too focused on a demand-side framework.

https://www.healthaffairs.org…

Rural hospitals are closing

RURAL HOSPITAL CLOSURES: Affected Residents Had Reduced Access to Health Care Services

United States Government Accountability Office (GAO), December 2020

What GAO Found

GAO found that when rural hospitals closed, residents living in the closed hospitals’ service areas would have to travel substantially farther to access certain health care services. Specifically, for residents living in these service areas, GAO’s analysis shows that the median distance to access some of the more common health care services increased about 20 miles from 2012 to 2018. For example, the median distance to access general inpatient services was 3.4 miles in 2012, compared to 23.9 miles in 2018—an increase of 20.5 miles. For some of the less common services that were offered by a few of the hospitals that closed, this median distance increased much more. For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services.

GAO also found that the availability of health care providers in counties with rural hospital closures generally was lower and declined more over time, compared to those without closures. Specifically, counties with closures generally had fewer health care professionals per 100,000 residents in 2012 than did counties without closures. The disparities in the availability of health care professionals in these counties grew from 2012 to 2017. For example, over this time period, the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents.

Median Distance in Miles from Service Areas with Rural Hospital Closures to the Nearest Open Hospital that Offered Certain Health Care Services, 2012 and 2018:

  • General Inpatient
    • 2012: 3.4
    • 2018: 23.9
  • Emergency Department
    • 2012: 3.3
    • 2018: 24.2
  • Alcohol or drug
    • 2012: 5.5
    • 2018: 44.6
  • Coronary Care Unit
    • 2012: 4.5
    • 2018: 36.1

https://www.gao.gov…

Comment:

By Don McCanne, M.D.

The declining numbers of rural hospitals have been of concern for many years. Of perhaps greater concern is the decline in the availability of health care providers in counties where rural hospitals closed. Look particularly at the extra distance that must be traveled if you are having a heart attack. That delay could be a matter of life or death.

One of the advantages of a single payer improved Medicare for All program is that it includes regional planning that is based on need. If rural hospitals and their facilities are needed, then they should be available, regardless of cost.

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King’s Medicare for all bill awaits passage

By Charles Robideau
Richmond (Va.) Times-Dispatch, Letters, January 25, 2021

It seems providential that our most ennobling national holiday — Martin Luther King Jr. Day — came Jan. 18, just as our country emerged from national trauma of the sort King risked his life to combat.

And as we celebrate King, we also should remember U.S. Rep. John Conyers Jr., D-Mich., the congressman who, immediately after King’s assassination in 1968, launched the campaign to establish the national holiday on King’s birthday, a goal achieved in 1983.

Twenty years later, Conyers launched another campaign — for justice in health care — that had been a vital part of King’s agenda.

In March 1966, at a meeting of the Medical Committee for Human Rights, a group of American health care officials created in 1964 to provide medical care of disadvantaged Americans, King called for direct action “to raise the conscience of the nation” against segregated and inferior medical care received by Blacks. “Of all the forms of inequality,” he said, “injustice in health is the most shocking and inhuman.”

In 2003, Conyers introduced the “single-payer” United States Health National Health Care Act, now known as “Medicare for All.” He reintroduced the bill in every Congress until 2017, attracting as many as 124 cosponsors, but the bill was never brought to a vote.

“‘Medicare for All’ is the direction Americans overwhelmingly want us to go,” Conyers told the Detroit Free Press in April 2017. “I want my colleagues to join me in supporting single-payer, not to save money or to win elections, but because it is the moral and just thing to do.”

Conyers, the longest serving African American representative in congressional history, died in 2019 at age 90. He had resigned from Congress in 2017 after charges of sexual advances by two women, which he denied.

Conyers’ bill, long numbered HR 676, which would provide ‘Medicare for All,’ has been superseded by HR 1384 with the same purpose, which awaits reintroduction in the newly elected U.S. Congress.

https://richmond.com…

Views around health, equity, and race during the pandemic

Survey: Attitudes, Views and Values around Health, Equity and Race Amid COVID-19

Many see COVID-19 as a moment for change, with improving access to health care as the shift they most want to see.

Robert Wood Johnson Foundation, January 2021

This ongoing survey from RAND Corporation attempts to understand the views and values of those who are most at risk to the adverse impacts of COVID-19 by surveying people with lower and middle incomes with a focus on communities of color. It measures the attitudes of the same group of respondents over a year with four waves of collection.

Wave 2 Key Findings

  • Many people—even those who may have been hit hardest by the pandemic and long-standing inequities—still do not see systemic racism as a barrier to good health.
  • Respondents’ willingness to risk their own health to return to “normal” has actually gone up slightly over time.
  • More than 70 percent of respondents see the pandemic as a moment for positive change. Black and Hispanic respondents are also more likely than white respondents to endorse this statement.
  • Respondents who see an opportunity for positive change believe society should prioritize expanding access to health care and reducing income inequality.
  • Nearly two-thirds of respondents believe the government should ensure health care as a fundamental right. White respondents are less likely to endorse this statement.
  • Black respondents report lower trust in government than white and Hispanic respondents.

Wave 1 & 2 Reports can be downloaded from this link:
https://www.rwjf.org…

Comment:

By Don McCanne, M.D.

This survey of lower- and middle-income households with an oversample of Black, Hispanic and Asian Americans reveals that these sectors surprisingly do not see systemic racism as a barrier to good health, but they also are willing to risk their own health to return to “normal” during the pandemic. Nevertheless, over 70 percent believe that the pandemic is a moment for positive change.

They believe that we should prioritize expanding access to health care and reducing income inequality. Nearly two-thirds of respondents believe the government should ensure health care as a fundamental right, but white respondents are less likely to endorse this statement. Black respondents report lower trust in government than white and Hispanic respondents.

Beliefs are as they are, though surveys have their limitations. Beliefs would improve if we made a greater effort to make health care access universal while reducing income inequality, but it does appear that all camps could stand to be exposed to more education on our problems and their solutions, especially in public health and public policy.

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

Building Back a Better Medicare Program

By John E. McDonough and Sherry Glied
The Milbank Quarterly, January 21, 2021

Every US administration since 1966 has had to engage in Medicare policymaking. The program covers 61 million elderly and disabled Americans, accounts for 14% of all federal spending, and, unlike the larger Social Security program, requires myriad legislative and regulatory tweaks each year to continue its operations. The Biden administration, like its predecessors throughout the program’s 55-year history, will need to perform this regular program maintenance. In addition, Congress and the administration will face two kinds of policy challenges. Some prominent Democrats, including many of Biden’s former competitors in the Democratic primary, see Medicare as a critical stepping stone to a unified system of health insurance coverage for all Americans. They will want to see changes to the program that extend its reach. On the other hand, Medicare actuaries and many conservative members of Congress see the program as an underfunded giant hurtling toward insolvency by 2024. While the administration will need to respond to the insolvency problem, it should try to leverage that response to simultaneously achieve progressive gains.

Job number one is to fix the coming Trust Fund budget hole.

While almost all Americans support Medicare’s survival and solvency, neither of the obvious options for achieving that objective – new taxes or funding cuts – is popular.

A key win-win would be action on prescription drug pricing, a policy goal that the Trump Administration pursued aggressively, but with limited success. Some drug price containment strategies can be achieved through Executive branch regulatory actions, but such regulatory savings will not fill the Trust Fund hole. One problem is that Medicare prescription drugs are funded through Parts B (inpatient) and D (outpatient) of the program, which means that savings achieved through lower prices for drugs would not directly improve Part A solvency. A more comprehensive legislative strategy will be needed. For example, imposing effective controls on prices for inpatient hospital and outpatient drugs, which can be achieved legislatively within reconciliation rules, could be combined with a shift of, say, home health services from the Part A to the Part B benefit as David Cutler and co-authors have recommended. This combination would improve the Trust Fund balance while simultaneously offsetting new costs in general revenue-funded Part B with drug cost savings.

Another health policy area in which savings, and program improvements, may be possible is Medicare Advantage (Part C). Currently, 38% of all Medicare enrollees are enrolled in Medicare Advantage private plans, and the fraction has been increasing steadily. Throughout the program’s history, there have been concerns that private plans have been overpaid. In 2010, the ACA made substantial structural changes to Medicare Advantage to reduce such overpayments. The resulting savings helped to extend the fiscal life of the Part A Trust Fund from 2016 to 2030 and also funded a portion of the ACA’s coverage expansions.

Despite the ACA’s reforms, concerns about overpayment in Medicare Advantage (MA) persist. Recent research documents that many MA plans aggressively code their enrollees’ diagnoses to generate higher risk-adjusted payments from the Centers for Medicare and Medicaid Services. Most of the benefits of these coding adjustments, which cost the federal government billions every year, accrue to plans, not beneficiaries. Because Medicare Advantage plans cover both Part A and Part B benefits, legislative changes in the payment formula for Medicare Advantage would contribute to Trust Fund solvency. These could be combined with improvements to traditional Medicare that would enhance the financial protection available to those who do not participate in Medicare Advantage, such as a cap on out-of-pocket spending.

Slim majorities in Congress will make it hard for the Biden administration to pursue plans that expand Medicare eligibility. But improving the existing program may advance progressive agendas. A curious feature of the Democratic presidential primary debate around “Medicare for All” is that the “Medicare” option promoted by candidates was not the existing Medicare program. The existing program’s flaws make it a less-than-ideal base for expansion. Fixing the Trust Fund budget hole, improving the efficiency of program payments, and, most importantly, extending financial protections that traditional Medicare offers its beneficiaries would make the existing Medicare program a more viable option and framework for future expansion.

https://www.milbank.org…

Comment:

By Don McCanne, M.D.

In our quest for single payer Medicare for All, we frequently speak of an improved Medicare for All. The current Medicare program is not satisfactory. At a minimum, we need additional coverage such as a Medigap plan to cover the deficiencies in the traditional Medicare Program, particularly the lack of an out-of-pocket cap on spending.

Actually Medigap Plan F had many features that if they were rolled into the traditional Medicare program would go a long way toward establishing the improved Medicare that we want. In fact, it was so good that Congress outlawed non-grandfathered Plan F plans when they established the Affordable Care Act, since Congress has always catered to the private insurance industry, and Plan F competed very favorably with the private Medicare Advantage plans, except the premium was too high.

Folding in the Plan F benefits would have been much more efficient, reducing the administrative costs considerably. As it is, the claims are processed twice, once by the Medicare administrator and again by the private Medigap insurance plans. These plans, of course, are designed to provide profits to the insurers, so they must charge high premiums to cover not only the medical benefits but also the extensive administrative costs and also the profits. We would be much better off with the benefits rolled into the plans and paid for through equitable taxes. Plus we would not be billed separately for deductibles, coinsurance and lack on caps on out-of-pocket spending. There are several other measures, such as covering long term care and drugs directly, that would improve Medicare that we will not go into here.

Another more immediate concern is the overpayment that we taxpayers make to the private Medicare Advantage plans. Not only are the MA plans being overpaid, funds which they keep, they also are using insurer gimmicks to improve their returns – cherry picking and lemon dropping, limited provider networks, upcoding to expand payments, using prior authorization to deny benefits, passing costs on to surprise bills – measures that reduce benefits but increase their profits. and part of that is paid by us through general tax revenues rather than just by the plan beneficiaries. We are paying them their administrative costs used to cheat patients out of their benefits and to cheat taxpayers out of their dollars. UnitedHealth just reported $15.4 billion in profits alone for 2020. We would be much better off without them.

Generally, incrementalism is a bad idea. However, without a favorable political climate, we might consider taking a transitional step of improving Medicare so that it can later serve as the basis of a comprehensive, efficient, equitable single payer, Medicare for All. As the authors state, that “would make the existing Medicare program a more viable option and framework for future expansion.” First we would try to enact an improved Medicare for All. If that doesn’t work with a president who is opposed, we could then be working on fixing our current Medicare so it would serve as a viable framework for future expansion.

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

America’s healthcare system no match for pandemic

By James Fieseher, M.D., F.A.A.F.P.
Seacoast Online, January 21, 2021

The pandemic has highlighted some serious flaws in the US Healthcare system. Mislabeled as a “free market” system, Americans have spent more money on combating the pandemic and received fewer benefits per dollar than any other nation.

Our healthcare system has slowly been taking us to the proverbial cleaners, but the pandemic has put us in the fast lane.

Primary care is secondary to for-profit health insurance

The whole point of insurance is to provide funds in the event of an emergency or life-altering occurrence. Health insurance was and still is designed to cover the cost of catastrophic health care. This is the inherent problem of basing the nation’s healthcare on a system designed to only cover catastrophes, it was never intended for routine care.

Health maintenance, such as routine visits to a primary care provider is a secondary issue to health insurance companies. Primary care appointments will cost you an extra co-pay which may or may not be a part of your deductible. As a result of these extra costs, Americans tend to see their primary care providers less frequently than citizens of other industrialized countries. If you have no insurance, many practices will not even schedule an appointment.

One of the reasons that Americans are particularly vulnerable to the ravages of coronavirus is the high number of people with health risk factors such as obesity, diabetes and hypertension. All of these risk factors are reduced with routine check-ups with primary care providers.

But costs alone are not the only reason Americans have fewer preventive visits. The lack of availability of primary care providers is also a byproduct of for-profit healthcare. Insurance companies reimburse (pay) primary care providers less than they pay specialists. More US medical school graduates become specialists in order to pay off their education costs in a timely manner. This also explains why many US primary care providers are either nurse practitioners, physician assistants or a graduate from a non-US medical school.

Pandemics require planning and prevention

The US was warned of the coronavirus pandemic as early as December 2019. While it is true that China was slow in announcing details that would have helped to slow the spread of the disease, we can’t control what happens in China, but we could have taken precautions here at home, precautions that never materialized.

Sure, politics and a presidential denial was a major factor in the devastating impact the virus had in the US, but the CDC and other public health agencies could have had more visibility earlier in the process to organize the preventative measures necessary to lessen the early impact of the virus.  Given how poorly equipped our healthcare system is in preventing illness and the high number of people with health risk factors, this was a crucial oversight.

You can’t fight an invading army with militias

We have some of the most advanced medical teams and technologies in the world, but without a centralized, coordinating healthcare system, much of this advantage is wasted. The for-profit, “free market” approach to healthcare is based upon the principle of competition and fragmentation. When a strong, unified and swiftly moving invasion force like the coronavirus hits our shores, we have no coordinated system to combat it.

Our fragmented system against a powerful and fast-moving pandemic is akin to fighting an army with amateur militias. This problem was compounded by the President who saw no need to take the necessary precautions recommended by the CDC and his security advisors.  “Closing the border to China” except for 40,000 people cannot be considered a serious prevention, as verified by history.

The fragmented system can be subjected to a considerable amount of mixed messaging. One of the reasons that President Trump was able to politicize the virus and the US response was the lack of a central medical voice giving us the facts. Dr. Fauci and to a lesser extent, Dr. Birx symbolized the central response to the virus, but without a system in place to direct the messaging to healthcare providers and facilities, much of that information was delayed or subverted.

There were other people with medical degrees that espoused unproven contrary messages that confused the public and led to unnecessary medical delays and death.  Without a central system in place, this type of problem can recur and in even greater numbers.

Vaccination distribution problems

The US had planned to vaccinate 20 million people by the end of December, but only 2.8 million actually received the vaccine. Unsurprisingly, our “free market” healthcare system played a major role in this discrepancy because of it was never designed to treat the country as a whole.

Without a national system in place, pharmaceutical companies were doing their best to get their product to 50 different states each with several vaccine distributors. We came up with an organizational plan about which groups should receive the vaccines and in which order, but with a myriad of competing healthcare systems, there was no way to ensure that the vaccines reached the proper providers.

At the current rate of distribution, the US is projected to reach “herd immunity” in October 2023.

The problem of tying health insurance to employment

You can’t claim that the US has a “free-market” system of healthcare if individual consumers (that’s all of us) don’t pick the product, but our employers do. We wouldn’t tolerate it if our employers determined which grocery stores we could shop in, so why do we want our employers determining our health insurance plans and the doctors associated with those plans?  Even if our employers offer a choice of plans, they, not we, get do decide which options are available.

Many people fear “socialized medicine,” where other people direct our healthcare, but that is exactly what we have now. How ironic that the social medicine fear mongers rave against “public options” where the individual members of the public pick their doctors and their health plans.

Here’s the problem: Before the pandemic, ten percent of Americans had no healthcare coverage, and an estimated 30-40% of Americans were said to have inadequate healthcare coverage with high deductibles.

During the pandemic, many thousands of small businesses have closed and millions lost their insurance with their jobs.  Now, many more people are without healthcare during the pandemic when they need it the most.

The future of American healthcare

How much we’ve learned from the pandemic depends upon where we go from here.

The private health insurance and pharmaceutical industries are each spending hundreds of millions of dollars in advertising and political funding to convince us that they should be the only option for healthcare. This effort will continue despite having the pandemic expose the inherit problems with our for-profit, fractionated, healthcare system.

Inaugural Address

By Joseph R. Biden Jr.
Inaugural Address, January 20, 2021

I understand that many of my fellow Americans view the future with fear and trepidation. I understand they worry about their jobs. I understand like my dad, they lay in bed wondering, can I keep my health care, can I pay my mortgage. Thinking about their families, about what comes next. I promise you, I get it.

https://abc7news.com…

Comment:

By Don McCanne, M.D.

Show us. Please.

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

Stop tinkering with health care and start fixing it

By Jay D. Brock, M.D.
The Washington Post, January 15, 2021

Most Americans understand that our health insurance system — the financial basis of our entire health-care system — isn’t working well. The Jan. 5 news article “Health-care venture backed by three corporate giants to close in February,” which reported on how even the wealth and power of Jeff Bezos (who owns The Post), Warren Buffett and Jamie Dimon failed to control runaway health-care costs, showed how dysfunctional our health insurance system is.

The problem? Trying to reduce health-care costs without changing our insurance system, with its huge built-in costs — $600 billion wasted yearly (compared with a single-payer system) in administrative costs alone, according to a recent study — reveals how tinkering with the system without fundamentally changing it is an exercise in futility. Without ridding the system of these useless expenditures, and that means eliminating the current insurance health system in favor of a single-payer plan such as Medicare-for-all, no comparable savings can be realized.

Regrettably, the approach most politicians are taking is to repeat the same mistakes of the past few decades: try to fix the health insurance system by tinkering with it. Unfortunately, doing the same thing over and over again hoping next time will be different just isn’t working.

Maybe it’s finally time for true health-care reform that will eliminate the staggering waste of the current system, reduce costs and allow truly affordable, universal coverage: single-payer, publicly funded, privately delivered Medicare-for-all.

President-elect Biden’s health care approach

One Sentence in Biden Stimulus Plan Reveals His Health Care Approach

An increase in subsidies could drive millions to enroll in Obamacare marketplaces, experts say.

By Sarah Kliff
The New York Times, January 16, 2021

Tucked into President-elect Biden’s $1.9 trillion stimulus plan is a one-sentence provision that could drive billions in federal subsidies to help people afford to buy health insurance.

The proposal would do two things: make upper-middle-income Americans newly eligible for premium subsidies on Obamacare marketplaces, and increase the financial help that already goes to lower-income enrollees. Taken together, some experts expect these changes to drive more sign-ups for Healthcare.gov plans after they fell in the Trump era.

Mr. Biden’s plan tackles one of the Affordable Care Act’s biggest weaknesses: affordability. Surveys of uninsured Americans and those with Healthcare.gov plans routinely find that affordability of premiums ranks as a top complaint.

The affordability challenges are a result of how drafters wrote the health law. They limited premium subsidies to those earning less than 400 percent of the federal poverty line: $51,520 for an individual and $106,000 for a family of four in 2021.

The Biden plan would create a new cap — 8.5 percent of an individual or family’s income on premium contributions — for midlevel health plans. This policy would mostly affect higher-earning Americans who do not currently qualify for subsidies.

The Biden proposal also describes a second policy that appears to be aimed at increasing subsidies for those who already qualify.

NYT Reader Comment:

By Don McCanne, M.D.

It is our private insurance industry that is charging us exorbitant amounts to take away coverage through high deductibles and other cost sharing and through narrow provider networks, while at the same time they are placing a tremendous administrative burden on the professionals and hospitals that provide the care – an administrative burden that we also pay for.

A well designed, single payer, improved Medicare for All is what we need, not more of the administratively burdensome private insurance industry that Biden wants to pay for with even more of our taxes. By condemning Medicare for All, he is missing the opportunity to finally fix our system so it works for everyone.

https://www.nytimes.com…

Comment:

By Don McCanne, M.D.

When affordability is a problem, Biden wants to spend even more through our taxes and give it to the private insurance industry – the source of our profound administrative waste, along with the administrative burden they place on the delivery system.

The private insurance industry is selling us services we don’t want – deductibles and other cost sharing, maintenance of narrow networks, prior authorization administrative costs, while ducking out on paying for surprise bills and other denied benefits.

The tragedy is that a well designed, single payer, Medicare for All program would eliminate the costs of these excessive and unwanted administrative services, but Biden has ruled this out. What is the matter with him? Everyone could be covered at a lower cost if we would just get rid of the private insurers. That is our money they are holding onto, and for that we are giving them up to 15% when our traditional Medicare takes less than 2%? Exorbitant profits for the industry when it is us who are paying the bills.

It doesn’t make sense. We are paying more but getting less, and now Biden wants to give the insurers even more – not exactly the way private markets are intended to work.

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