By Wendell Potter
The New York Times, Dec. 18, 2024

By Brenda Gazzar
Code Wack Podcast, Dec. 16, 2024

Why are seniors between a rock and a hard place when choosing between various Medicare options? How do private Medicare plans, known as Medicare Advantage, limit patients’ options and why are they considered riskier than traditional Medicare? And what’s the ‘Medigap Trap?’

To find out, we spoke to Dr. Diljeet Singh, an integrative gynecologic oncologist and the incoming president of Physicians for a National Health Program [PNHP]. With more than 25,000 members across the United States, PNHP advocates for a universal, comprehensive, single-payer national health program.

Check out the Transcript and Show Notes for more!

https://heal-ca.org…

By Diane Archer
The New York Times, Letters, Dec. 16, 2024

Re: “UnitedHealth Group C.E.O.: The Health Care System Is Flawed. Let’s Fix It,” by Andrew Witty (Opinion guest essay, nytimes.com, Dec. 13):

A recent Gallup poll shows Americans’ satisfaction with health care access, costs and coverage at an all-time low since polling began in 2000. Not surprising. Corporate health insurers have had free rein over our health care system, and it continues to deteriorate.

Yes, as Mr. Witty says, the killing of Brian Thompson, UnitedHealthcare’s chief executive, was unconscionable. So are the needless deaths of tens of thousands of Americans, the increased morbidity of millions more and the medical debt that 41 percent of Americans face.

UnitedHealth “succeeds” by impeding health care access, denying coverage and driving up costs. Mr. Witty knows that all too well. That’s how UnitedHealth maximizes profits.

If Mr. Witty really supports a health care system that works better for everyone, he should advocate Medicare for all — guaranteed affordable coverage — instead of blocking efforts for a government-administered system.

The writer is the president of Just Care USA and the founder and former president of the Medicare Rights Center.

https://nytimes.com…

By Carol Paris, M.D.
The Tennessean, Dec. 16, 2024

In the aftermath of the recent murder of UnitedHealthcare CEO Brian Thompson, I feel both sympathy for his family’s loss and rage at the misrepresentation of the thousands of stories of needless anxiety, suffering and premature death that have flooded social media.

Whether the story posted is from a patient or a doctor, the antagonist is always the same – the health insurance industry.

In their anger, have some people overstepped the bounds of moral decency? Yes.

That’s something people do when they are chronically anxious about going into medical debt, and always vulnerable to the whims of a health insurance industry that profits from denying them care. But to make that the story is despicable.

People expressing anger at health insurers are different from Jan. 6 rioters

And that is just what the Washington Post editorial board did on December 7, “A sickness in the wake of a health insurance CEO’s slaying.”

These editors compared heart-wrenching posts on social media to the violent mob that stormed the Capitol on Jan. 6, 2021.

They categorized these posts as “very different in their degrees of moral transgression and practical impact, but similar in their embrace of extreme measures to right perceived wrongs.”

Apparently, these writers consider posting on social media one’s anger and frustration at UnitedHealthcare’s tactics of delaying and denying care in the service of record-breaking profit as “extreme measures to right perceived wrongs” but then dismiss them as of little “practical impact.”

Sadly, that’s my point. As much as I want to believe that this time our elected officials will listen to our deafening outcry and take substantive action on our behalf to, at the very least, sanction and regulate the health insurance industry, I’m not holding my breath.

Rather, I fear that this outpouring of rage at the health insurance industry will have no practical impact no matter how loudly or persistently we cry  because members of Congress are not listening to us. They listen to the threat of losing campaign contributions if they fail to do as their corporate donors demand.

Reformers and activists should unite to change the system

The Washington Post editors listen to their billionaire owner who proffers a narrative dictated by the health insurance industry “Wizards of Oz,” from behind the safety of the black curtain. Ignore all those silly Munchkins. The mighty Oz has spoken.

And once again, the moment is lost because wizards like Andrew Witty, CEO of UnitedHealth Group and Jeff Bezos, founder of Amazon and owner of the Washington Post, control the narrative to their financial advantage.

I wonder what would happen if all of us Munchkins came together and took control of the narrative?

Maybe all the people who have been harmed by the health insurance industry would join their voices with the voices of health reform activists, campaign finance reform activists, climate activists, reproductive justice activists, racial justice activists, fair wage activists, affordable housing activists, food security activists and more.

Just think of the power of all our voices, together, demanding a multitude of social justice reforms.

There are no unsolvable problems, but I find that the best solutions emerge by listening to a broad spectrum of people sharing their ideas, even on social media. Together, let’s build the society we want.

I’d like to start by building the healthcare system the American people want, a National Health Program that puts patients before profits and makes corporate health insurance industry middlemen obsolete.

https://tennessean.com…

Paris Dr. Carol Paris is a healthcare activist who currently serves as vice president of Physicians for a National Health Program.

By Michael Mechanic
Mother Jones, Dec. 16, 2024

Amid the frenzied coverage of UnitedHealthcare CEO Brian Thompson‘s assassination and the public’s troubling reaction to it were references to various polls, including one conducted in 2016 by the Kaiser Family Foundation, whose results suggested that Americans were content with their private health plans.

Similar stats had crept into the debate over Medicare for All—a proposed national health insurance program to cover all Americans, and with which private insurers would have to compete. A few weeks before Thompson was murdered, AHIP, the primary trade group for commercial health insurers, published a new survey it had commissioned. About three-quarters of respondents, a “strong majority,” the group said, were satisfied with their employer-provided plans and preferred getting their coverage this way, as opposed to through any government program.

I found these numbers hard to square with the nonchalant—even celebratory—response to Thompson’s death. Until, that is, I spoke with Ed Weisbart. A veteran medical doctor, now retired, Weisbart serves as national board secretary for Physicians for a National Health Program (PNHP), a nonpartisan organization of some 25,000 doctors founded in 1987 to advocate for a public health insurance program. (Disclosure: My late mother was a member.)

So long as you’re healthy, he told me, it is in your insurer’s best interest to keep you happy by delivering on small claims. It’s only when it looks as though you’re going to cost them lots of money that the denials start coming—and maybe by then you’re too sick to fight. This interview was edited for length and clarity.

What compelled you to join PNHP?

I was a practicing physician for decades and got fed up with seeing patients unable to afford health care—not in the broad, abstract way, but in the very real, nitty-gritty way. The Type 1 diabetic who has uncontrolled disease, and I prescribe insulin for him, and it would make a huge difference in his life expectancy, but he comes back a month later and his blood sugars are no better. And I ask him why, and he would say, “Well, because I’m taking my insulin every other day. It’s all I can afford.” I know he’s barreling toward dialysis.

A patient with end-stage emphysema came into the office without her oxygen, huffing and puffing, unable to breathe. She’s had portable oxygen at home and we know this because she had it previous visits. And I said, “Where’s your oxygen? Why are you so short of breath?” She says, “Oh, I can’t afford my oxygen anymore.”

We’re living in a country where we have people who literally can’t afford to breathe. I’ve got hundreds if not thousands of stories like that. It just drives me crazy, realizing you have to advocate for patients outside of the exam room as well, and then understanding that the reason it’s like this is because of the profiteers just leeching the blood and soul of everyday human beings so they can have the best returns on Wall Street.

What did you make of the reaction to the Brian Thompson killing?

It’s obviously a tragedy and a very wrongheaded move. I was aghast. And yet it was also not hard to understand the dynamics, when there are tens of thousands of people dying because of the profiteering—people constantly running into having some bureaucrat say they can’t get the lifesaving care they need. So, I was not surprised, but I was surprised.

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What do you consider the biggest flaws of our health system?

As a medical director at various places, I’d say the biggest problem is that the system is designed to return profits rather than to improve health. And the programs that you would want to design to improve health are contrary to the business model of the people that could put those programs in place.

Related to that is the fragmentation of the system. That’s a consequence of the first problem. It means comprehensive solutions can’t be put in place. It means people are thrust into gaps in between care. So it creates its own set of expenses and driving up the cost.

The third piece is our inability to negotiate prices on behalf of Americans, which other countries do. Those costs are borne all across the system in ways that are obvious, like the overhead of the insurance industry—13 percent to 18 percent depending on where you look. But then they hide more than that by transferring some of the overhead onto hospitals, hospital infrastructure, and medical practices. Milliman estimated the average physician pays $100,000 for office staff to deal with the insurance industry, and where does that money come from? It comes from jacking up prices. All the fee schedules have to be adjusted so physicians can afford to pay this overhead.

This is unique to America. In Canada, the overhead of running a practice to deal with the national health insurance they have there is more like $20,000 or $25,000 per doctor.

In any other industry, auto repair for instance, you get an estimate in advance of what it’ll cost you. Why isn’t that the case with health care?

Well, I would argue that’s not the correct solution, anyway. Because in the auto repair industry, you can shop around and make an intelligent choice, and you know whether the car is going to work right afterward. In health care, it’s the exact opposite.

You can shop for prices for [commodity services like LASIK], but that kind of thing is a tiny fraction. In health care, a very large percentage [of the total cost of care] is spent in the last six months of life by people who are desperately sick, and they are not in a position to start shopping around. And even if you had the prices, how do compare that to quality? If an insurance company with six floors full of actuaries can’t do the price-versus-quality equation so that you they can direct you to the best quality care for the price, how is the person who works at the gas station on the corner supposed to make that determination?

I’m also curious about situations in which a patient gets a crazy bill, just totally unrealistic, and they kick up a fuss and the insurer suddenly reduces the cost or even wipes it out entirely. Is the whole system premised on people giving up and not fighting claim denials?

Yes. There’s data about this for Medicare. If Medicare denies a claim, it’s usually because the claim is for something that’s legally not a covered benefit. It’s extraordinary for it to be any reason other than that, and so when Medicare denies claims—which they almost never do—and someone appeals, there’s about a 1 percent chance that appeal will get reversed.

Now, with Medicare Advantage, which is the for-profit, typically proprietary, insurance industry version of Medicare, its the exact opposite. If somebody appeals a denial, I think around 80 to 85 percent of those denials get reversed, because when Medicare Advantage does a denial it’s because it wasn’t in the company’s business interest to pay for it. But nobody appeals it because they don’t know that they can—or that it would work.

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Fascinating. So it’s actually easy—well, not easy, because it’s a total headache—but you can get these things reversed if you persist.

I wouldn’t call it easy by any means. The patient has to spend significant time collecting things and going through the process. And you need a physician who’s willing to help, and who’s going to pay the physician for that? That’s a chunk of the physician’s time that is not reimbursed. Plus, most people in a situation where they need to do that are sick. They’re not at their best to begin with. It’s really hard, really time-consuming. And there’s a long delay from when you do the appeal to when you get a favorable decision.

Tell me more about the for-profit model, and how delaying and denying claims plays into it.

The commercial insurance industry collects a premium. So that’s a prepayment. The Medicare Advantage industry is prepaid by the government. That’s money in their pocket, and every time they pay a claim, that’s money that they’re spending.

They have this term, “medical loss ratio,” which is a carryover from the fire loss ratio and property loss ratio, but they call it a loss when they pay. So, they don’t want to pay, and it manifests in a couple of ways. First, if they don’t pay the claim, that’s money they can retain. Secondly, even if they just delay the care, they have sophisticated systems managing how they invest the money they’re not paying.

I once worked in a part of the insurance world where they did exactly that. They had contracts that required them to pay their bills within a certain timeframe, and if they paid long after they were contractually obliged to, there was a penalty, and they had sophisticated systems to analyze the return on their investments in the market vs. how big the penalties are for delaying the payment for care. And they would delay until they hit the right point on the curve where it was more sensible financially to pay the claim than to keep investing it in the market.

So basically you collect a big pile of money and invest it and then avoid paying claims so you can keep that money invested as long as possible to maximize your returns in the market?

That’s exactly right.

What are the kinds of procedures insurers are most likely to deny or delay, and the most common reasons people fall into medical debt?

I can’t give you a quantitative answer, but the more expensive a procedure is, the more likely they are to want to put in a barrier to payment. Insurers typically don’t want to put barriers to things that low-expense patients get, like a blood pressure medication that’s very inexpensive and that healthier populations use. It’s to their advantage to get you to use the insurance a little bit because the people that are the most likely to disenroll from a specific company are the people who never use it. They want you to maybe get your eyeglasses or something.

But if you’re sick and you need home oxygen, or you need a CT scan or an MRI, or something that’s both expensive and predictive that you’re probably a higher risk person—that you’re going to be a more expensive patient to take care of—they don’t want to spend that money. So if you call them and say, “I’m so mad at you. You got in the way of my CT scan. I’m thinking of going to different insurance company,” the company has a win! They don’t want you in their plan.

You mention CT scans. I know imaging is among the things medical practices tend to overprescribe because it’s a cash cow, and you get a fair bit excessive testing and overtreatment. Can certain denials then be to a patient’s benefit?

There is obviously a significant percentage of what we do in medicine that is not evidence-based and could probably be avoided. But if you compare the United States to other modern nations, our utilization of those kinds of services is roughly average. The problem with the high cost of care in the US is not overutilization. Is there overutilization? Absolutely. Is that the driver of health care costs? No, it’s not.

The driver of health care costs is two things: It’s the overhead, the managing, the cost of the complexity of administering this. Most estimates are that we spend roughly a third of the health care dollar propping up the bloated, Byzantine insurance industry. The second piece is the failure to negotiate prices effectively because we’re so fragmented. That’s where the money is.

How big a cost is the failure to negotiate prices?

I can’t tell you overall, but the average prescription drug in the United States is about twice as expensive as it is in the rest of the modern world.

How does the cost of a public insurance bureaucracy compare with the cost of a private one?

The commercial insurance industry has a roughly 15 percent overhead. Traditional Medicare, parts A and B, operates with a roughly 2 percent overhead.

Wendell Potter, a former Cigna PR guy, just wrote a Bloomberg piece on the role of Wall Street, and how executives at giants like UnitedHealthcare and Cigna go to these investor conferences where there’s no mention at all of patient care. It’s all about the returns, and that’s what’s driving a lot of the misery we’re seeing.

Oh, that’s exactly right. I mean, the root issue is greed.

But don’t public systems also have their drawbacks? The Veterans Administration has weathered scandals. And I saw a CTV News piece from last fall about how Canadians fed up with long wait times for surgeries in their public system were turning to private providers.

If you go down the street in Canada and ask people, they all have a story like that. But then they’ll say, “But there’s no way I would change to the United States system where I have to have a bake sale to have my knee replaced.” They don’t want this system.

More importantly, US life expectancies were the same as Canadian life expectancies within a few months up until the early 1970s. That’s when we passed the HMO Act, creating managed care, and Canada finally finished implementing their national health insurance plan, and then there was a fork in the road. Our costs continued to go up along the same curve. Their costs started to really flatten out, and our life expectancy did not begin to keep pace with the improvements in life expectancy in Canada. Fifty-some years later, they live three to five years longer than we do and spend half as much.

Have you seen any notable pivot points for the United States in terms of the cost of care and deterioration of quality?

They’ve been on a steady, relentless curve. There’s a whole list of things that we have tried, and none have really bent the curve. There’s one obvious solution.

You mean single-payer?

Correct. But I’m not stupid enough to say that sometime in the next four years or six years that’s going to magically pass. One of the things PNHP has been really good about the last three or four years is thinking about a strategy of how do we pave the road to that? What has to happen? Our strategy to get the bills passed is far more robust than just pass the bill. The single-payer community five years ago, 10 years ago, would literally say you can only cross a chasm in a single leap. You know, I’ve looked at the bottom of chasms and there’s dead people who couldn’t make the jump. You cross the chasm by building a bridge slowly.

Do you think for-profit insurers play any positive role in our system, or would you like to see them go away entirely?

I would like to see them go away entirely.

I mean, it’s probably never going to happen here.

Everything looks impossible until it’s already happened.

My skepticism comes from watching Obama try to implement single-payer and having it demonized as socialism—and “death panels” and so forth.

I don’t think people care whether it’s single payer or quadruple payer. Those words mean nothing to people. You know, Medicare for All. That’s not what they care about. People want health care. They don’t care about health insurance. They’re angry at the profiteering, the outrageous prices. They’re angry they can’t afford their care. They’re much more focused on solve this problem than they are on which exact tool or mechanism you go to.

That’s what I think, too. What I care about is that everybody in the country has unfettered access to high-quality health care that they control the decisions for. I think single-payer is the smartest way to do it. But if we went to an “all payer” or some other model that accomplished that, I’m fine. I just don’t want people dying like they are today.

https://motherjones.com…

By Joshua Chaffin and Julie Wernau
The Wall Street Journal, Dec. 12, 2024

The killing of a top health insurance executive outside a Midtown Manhattan hotel last week triggered an outpouring of public anger at an industry many Americans blame for the ills of the nation’s healthcare system.

Count doctors among the aggrieved.

They deal day in and day out with insurers including UnitedHealthcare, whose chief executive, Brian Thompson, was shot to death last week by an assassin who targeted him outside the company’s annual investor conference. Doctors say their frustration is born of intimate experience and has been building for years.

Their chief complaint is the aggravation and expense of convincing insurance companies to pay them for their patients’ treatment. Even when they are ultimately approved, MRI scans and other vital but costly procedures often require days of campaigning and paperwork, say doctors.

“It’s getting worse,” said Dr. Zulfiqar Ahmed, an internist in Augusta, Ga., who has practiced in the U.S. for 35 years. “This is not only UnitedHealthcare—this is universal in this country.”

Like other clinicians, Ahmed made clear he was appalled by Thompson’s killing and those who have justified—or even celebrated—it on social media. “My heart is saddened for this Mr. Thompson,” he said. “He’s just part of the system, part of this big enormous system.”

Still, doctors say that sympathy doesn’t change their feelings about having to haggle with doctors employed by UnitedHealthcare and other insurers to evaluate proposed procedures—and oftentimes, reject them. “They hire certain doctors, and they sit at a desk, and their whole purpose is to deny or delay,” Ahmed said, echoing a common complaint among doctors.

Health insurers say they play a valuable role financing the medical care that saves the lives of many patients. Denials keep a lid on unnecessary care and high costs, companies say, thereby keeping treatment affordable for everyone. Insurers also note that doctors, hospitals and drugmakers play a big role in soaring healthcare spending that they are trying to restrain, while ensuring patients get the medical care they need.

In a message to employees Wednesday, UnitedHealth Group CEO Andrew Witty memorialized Thompson’s “profoundly positive impact” on people’s lives.

Doctors won a rare victory over an insurer last week. In November, Elevance Health’s Anthem unit had said it wouldn’t cover anesthesiology claims for surgeries in Connecticut, New York and Missouri that went beyond a certain time limit, prompting outrage from specialists and even New York Gov. Kathy Hochul. It reversed course last Thursday, a day after Thompson was killed.

An Anthem Blue Cross Blue Shield spokesman said its policy change had been widely misinterpreted. “It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” he added.

America’s Health Insurance Plans, a national industry trade association, said state laws dictate how long an insurer has to pay a provider and ensure that they are paid in a timely manner. Delays can be caused when providers go out of network or are using manual processes to submit claims and receive payments, it said.

The industry’s overall rate of prior authorization denials isn’t public. Medicare Advantage plans, a popular form of health insurance, denied 7.4% of 46.2 million requests submitted on behalf of enrollees in 2022, up from 5.7% in 2019, according to an analysis of federal data by KFF, a health-policy nonprofit. A recent Inspector General audit found that 13% of prior authorization denials from Medicare Advantage plans were for benefits that should otherwise have been covered under Medicare.

Even when insurers pay, doctors may still find themselves on the hook. Consider the plight of Dr. Anthony Ekong, an ophthalmologist specializing in retinal care who has built a solo practice in Bangor, Maine.

Last month, Ekong received a stack of letters from a company called Cotiviti, which is an auditor for the insurer WellCare, a unit of Centene. In an effort to provide excellent customer service, Cotiviti wrote, it had reviewed payments Ekong had received for treating elderly patients with macular degeneration and macular edema. It determined WellCare had overpaid. The bill: more than $300,000.

“We would have to shut down or file for bankruptcy,” said Ekong.

WellCare, in turn, suggested he make up the difference by billing his patients. But many are elderly and struggling to get by. Among them are Eugene Strout, 71, and his wife, Donna-Marie Strout, 72, who subsist on Social Security and Eugene’s occasional shifts driving a school bus. At one point, Ekong offered to pay the couple to clean his office every week to help fund the $600 a month they’d have to pay if they switched to another insurer. The Strouts ended up reluctantly moving their care to their local hospital, which still accepts their insurance. The Strouts worry that the hospital could also end up dropping the insurance.

“It’s egregious, invalid and a breach of trust,” Ekong said.

A representative for Centene said the company is looking into the issue further and hopes to amicably resolve it.

Andrew MacLean, chief executive of Maine Medical Association, said he receives phone calls every day from physicians struggling with health insurers demanding so-called clawbacks for bills that had already been paid.

“It almost feels like they do it because they can,” MacLean said of the insurers. “By no means do we applaud this or would we condone violence, but it’s a scary indication of just how frustrated people are about the current system and the imbalance of power—and physicians certainly feel that.”

In a recent post on X, Dr. Alan Nguyen, a spine specialist in Fort Myers, Fla., noted that when insurance-company doctors reject an MRI request, he now asks for their name and health provider identification number. “I tell them if a cancer is missed, then the patient will know who to sue,” wrote Nguyen. In an interview, he said he believes the situation had worsened significantly over the last five years. When insurers denied treatment, Nguyen observed, doctors were still left to deal with the patients and their pain.

A familiar lament among doctors is how sweeping changes over the last 20 years—some instigated by insurers, others not—have degraded their profession. Once autonomous and highly esteemed, doctors are increasingly employees of large hospital chains and find themselves trapped between insurers and their own cost-conscious management.

By Adam Gaffney, M.D., M.P.H.
MSNBC, Dec. 11, 2024

Last Wednesday, amidst a national wave of animus toward health insurers, Americans turned their ire on a policy that Anthem Blue Cross Blue Shield announced last month concerning a new policy planned for three states that would deny claims for anesthesia for surgeries that went longer than a time limit set by Anthem. In addition to the groundswell of furor on social media platforms, New York Gov. Kathy Hochul, who leads one of the states where the policy was to be launched, slammed Anthem’s policy as “outrageous.” Connecticut was one of the other states, and Sen. Chris Murphy, D-Conn., called the planned policy change “appalling.”

Describing it as a miscommunication, Anthem soon announced it was abandoning its controversial new rule. Janey Kiryluik, staff vice president for corporate communications at Anthem’s parent company, Elevance Health, told The New York Times, “We realized, based on all the feedback we’ve been receiving the last 24 hours, that our communication about the policy was unclear, which is why we’re pulling back.”

The news of Anthem’s policy proposal helped provoke another round of a longstanding debate: Who is to blame for America’s health care woes? By and large the public — sick of sky-high deductibles, haggling over the phone to fight denials and of unexpected medical bills arriving by mail while still convalescing — has directed its outrage at insurers. Vox’s Eric Levitz, though, pointed a finger at doctors and argued that Anthem’s mistake was its retreat from what he called a prudent policy to reduce payments to well-paid specialists. Health care costs are primarily driven by “providers,” not insurers, Levitz argued. Thus, those providers are the reason, he said, “vital medical services are often unaffordable and inaccessible in the United States.”

But Levitz and writers such as Dylan Matthews and Matt Yglesias, who made similar points, are wrong. The details of this particular episode are beside the point. (Brookings Institution’s Loren Adler calls it a contract dispute between anesthesiologists and Anthem that might have had limited impacts on patients.) The public’s fear of getting stuck in the middle between what doctors charge and what insurers pay was justified. Our private health insurance-based system inflates costs and denies care, and in a well-designed universal system, this episode would not even be possible.

It is often noted that most health care spending ultimately goes to health care providers — to hospitals, nurses, doctors (like me), nursing homes and so forth — and not to health insurers. This is true, but it’s also all but a tautology. Obviously, most health care spending goes to health care provision, just as most education spending goes to schools and most defense spending to the military. The relevant question is how to realize savings while upgrading care for everyone, and the best answer is by eliminating the gargantuan waste that is our private insurance system.

The traditional, public Medicare program spends about 2% of its total revenue on administration. Private insurers, by contrast, take 10% (or more) of your premium for administration and profit. This fivefold difference accounts for the more than $400 billion in savings that the Congressional Budget Office projects could be saved annually from eliminating private insurance and moving to “Medicare for All.” Instead, we’re basically setting that money on fire.

But what about the “unit prices” for care in the U.S. that are much higher than other nations? Those “prices” are also inflated by our complex private insurance system. They include providers’ costs of dealing with innumerable insurance plans, each with its own complex payment systems and rules. Hospitals in the United States hire armies of billers and coders to bill and haggle with insurers and spend twice the share of their budgets on administration than Canadian hospitals do. Similarly, we spend more than $80,000 per physician in the U.S. just to cover the costs of their interactions with insurers, four times more than what’s spent in Canada. This is yet another price we pay for the profits of insurance companies — even though it appears on the “provider” side of the ledger.

No doubt there are also bad behaviors from some providers, particularly with the accelerating corporate takeover of care, including vampiric private-equity firms that strip-mine their acquisitions for profit before dumping them (whatever the consequences for patients). Private-equity-owned emergency physician staffing companies were, notably, responsible for an outbreak of devastating “surprise medical” bills. One study found that Wisconsin hospitals commonly and increasingly sue patients for unpaid medical bills, half the time garnishing their wages.

News reports from other parts of the country have described harrowing stories of patients aggressively targeted by hospital debt collection, which has included putting liens on homes and putting some patients in poverty. None of these behaviors should be countenanced. But they are, again, only possible because of a private health insurance system that leaves some uncovered, others with copays and deductibles, and others “out of network.”

In contrast, under a Medicare for All system, patients would be entirely protected from the process of care payment, eliminating the very possibility of medical debt or falling between the cracks — or of waking up from surgery with an unexpected anesthesia bill.

Still, on an even more basic level, when it comes to health care reform, there’s a fundamental difference between “providers” — our nurses, doctors, hospitals, social workers, respiratory therapists, clinics and so on — and insurance companies. We need providers, including the anesthesiologists who ensure that we survive sometimes dauntingly complex operations. But we don’t need insurers.

The public recognizes this and tends to apportion blame accordingly.

Dr. Adam Gaffney is a pulmonary and critical care physician, public health researcher, and an assistant professor at Harvard Medical School.  He is a former president of Physicians for a National Health Program and the author of “To Heal Humankind: The Right to Health in History.”

https://msnbc.com…