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Emergency coronavirus funds for American Indians languish in bureaucratic limbo

Emergency coronavirus funds for American Indians languish in bureaucratic limbo

Exclusive: Emergency coronavirus funds for American Indian health stalled

Tribes say they’ve been forgotten in Trump’s coronavirus response and are running dangerously low on medical supplies.

By Adam Cancryn
POLITICO, March 20, 2020

The Trump administration has held up $40 million in emergency aid Congress approved earlier this month to help American Indians combat the coronavirus — a delay that’s left tribal leaders across the nation frustrated and ill-equipped to respond to the fast-growing outbreak.

The number of confirmed coronavirus cases among American Indians has risen in recent days, from four earlier this week to easily more than a dozen. The Navajo Nation has recorded cases 14 alone, and on Thursday, a Cherokee Nation citizen became the first person in Oklahoma to die from the virus just a day after testing positive.

The funding has languished in bureaucratic limbo for weeks, despite increasingly urgent pleas from tribal organizations desperate to stockpile essential supplies and keep health clinics operational. Federally run American Indian health facilities are well short on hospital beds and ventilators, some frontline clinics received fewer than a dozen coronavirus tests, and federal officials have already signaled there will be little in the way of reinforcements — telling tribal leaders that all they can send right now are expired respirators.

That’s fueled alarm throughout American Indian country and on Capitol Hill, where advocates warn the administration has done comparatively little to protect American Indians as it plans drastic action elsewhere to protect vulnerable populations and slow the virus’ spread.

Pressed further on IHS’ readiness, one IHS official characterized the agency as a “shoestring operation.” At another point, (chief medical officer Michael Toedt) downplayed the threat by telling staffers that “IHS believes this virus will be slower to reach Indian country,” according to a person on the call.

Tribes rely heavily on IHS facilities, which provide many health care services to American Indians and Alaska Natives at no cost under the federal government’s long-held trust responsibility. Over a quarter of the tribal population in the U.S. is uninsured, more than double the national rate.

In a survey published Tuesday by the National Indian Health Board, just 16 percent of its tribal leaders, providers and partners reported receiving federal resources of any form to aid the response. Even fewer — 4 percent — had received basic protective equipment.

https://www.politico.com…

Comment:

By Don McCanne, M.D.

We took their lands and then…

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Masks, Gowns, and Medicare For All

Thoughts and prayers are nice, but healthcare workers need Medicare for All

If patients want to support healthcare workers on the frontlines of the coronavirus pandemic, they should join us in calling for a universal, single-payer healthcare system.

By Jonathan Michels
Piedmont Left Review, March 20, 2020

Any hope that we might emerge from the COVID-19 pandemic unscathed is gone. So far, the novel coronavirus has claimed the lives of 150 Americans and infected 10,442 others. Those figures are certainly higher because access to coronavirus test kits remains severely limited.

I know full well the risks of contracting the deadly disease. I work as a radiology technologist at a large teaching hospital, where patients believed to be suffering from acute respiratory disease are likely to receive a chest x-ray upon check in. That means me.

Like many healthcare workers, I might be infected right now and not even know it because of the lack of testing.

As the coronavirus continues to tear through the United States, there has been a mass outpouring of love and solidarity directed at healthcare workers like me. People have sent us prayers and beautiful songs. More substantively, people have amplified our demands for more personal protective equipment (PPE), like gowns and N95 respirators, as well as paid sick leave.

It means a lot knowing that I have the support of my community.

But it’s not enough.

If patients want to support healthcare workers on the frontlines, they should also join us in calling for a universal, single-payer healthcare system more commonly known as Medicare for All.

Under Medicare for All, coronavirus testing for all US residents would be free at the point of care and more importantly, so would treatment. Providing universal healthcare now will mitigate the damaging effects of COVID-19 and maybe even prevent future pandemics.

Our expensive, inefficient and profit-driven healthcare system has left our communities defenseless against encroaching epidemics, a reality that will come as no surprise to frontline caregivers. We see daily the life-and-death consequences of a medical system in which profits are the chief measure of success.

It was healthcare workers who first sounded the alarm about COVID-19 — weeks before President Trump declared a national health emergency. According to a survey conducted by National Nurses United (NNU), only 30 percent of nurse respondents said they had enough PPE to weather a massive surge in COVID-19 patients.

I can personally attest that at this very moment healthcare workers are treating patients who do not yet know they are positive for coronavirus. Meanwhile, others are caring for confirmed patients without all of the tools to do the job.

It is no coincidence that NNU, the nation’s largest nurses’ union, is also the most vocal proponent for Medicare for All. Nurses understand that the most efficient and affordable way to prevent and contain the spread of diseases like COVID-19 as well as improve the overall health of our communities is to ensure quality healthcare for all Americans, regardless of employment status or ability to pay.

As a healthcare worker, I bear witness to a broad spectrum of suffering; the kind that we are all likely to face at some point during our lives. But what haunts me at the end of each shift is the pain that could have been prevented if patients who are uninsured or underinsured had been able to access care sooner.

So while the scope and severity of the COVID-19 pandemic may be unfathomable, the challenges facing healthcare workers right now like safe staffing ratios and basic supplies are not markedly different from any other day of the week. Our healthcare system routinely undermines caregivers’ ability to treat our patients while maintaining our own safety.

The plan laid out by the presumptive Democratic presidential nominee Joe Biden calls for “eliminating cost barriers for prevention of and care for COVID-19,” but it would bolster and even expand the private health insurance system that is making healthcare workers feel like they are caring for patients with one hand tied behind their backs.

Without transformative health reform like Medicare for All that is based on meeting human needs and not the needs of markets, Americans will continue to die needlessly long after the coronavirus pandemic has ended and the last quarantine is lifted.

Despite some improvements from the Affordable Care Act, 28 million Americans are uninsured, without access to primary care that could prevent costly and life-threatening diseases. An additional 41 million people are underinsured, facing prohibitively expensive co-pays, premiums and deductibles that limit access to care.

Healthcare workers–among the most at risk for contracting COVID-19–are currently not guaranteed access to medical treatment. A 2009 study found that 11 percent of American healthcare workers are uninsured. That’s 1 in 8 caregivers who could be treating coronavirus patients right now.

Medicare for All would prevent more than 68,000 unnecessary deaths each year while saving $450 billion annually in billing costs and administrative waste, according to a study published in The Lancet.

Even if employers provide health insurance, some workers’ low wages prevent them from purchasing coverage. Not only would Medicare for All increase the health of every American, it would be a big step in lifting healthcare workers out of poverty because the money that employers spend on providing health insurance could be shifted to raise wages. That would be life-changing for the estimated 1.7 million female healthcare workers and their children living in poverty.

The staggering complexity of our healthcare system requires a tremendous number of administrative staff and resources which account for a whopping 25 percent of all US healthcare expenditures. Yes, Medicare for All will eliminate around 1.8 million administrative jobs but in turn lead to the demand for 2.3 million full-time healthcare workers to accommodate the millions of patients newly eligible to receive care. This will help ensure that caregivers have the staffing levels they need to safely and swiftly respond to public health crises like COVID-19.

Medicare for All would also give a boost to healthcare workers who want to unionize over unsafe staffing levels and a lack of basic supplies because hospitals would be barred from using public money to bankroll union-busting campaigns. The very groups that have linked rights in the workplace with the health of their patients have been nurses and healthcare unions, most notably National Nurses United.

The pandemic has likely just begun in America but it has already shifted our attention away from ourselves and towards one another as more and more people come to the realization that collective problems require collective answers.

The coronavirus pandemic has exposed the gaping holes in our social and economic safety nets while underscoring the need for a robust medical system that empowers caregivers to truly meet public health challenges, big and small.

That’s not what we have in the US right now, but it could be.

Medicare for All, despite benefiting everyone, will not be won by appeasing medical profiteers. Private health insurers, medical device manufacturers, pharmaceutical companies and banks (which have ensnared millions of Americans indebted by medical expenses) stand to lose too much if America moves to a single-payer system.

The growing enthusiasm around Medicare for All represents an existential threat to private interests. In a similar act of solidarity, they have coalesced to form the Partnership for America’s Health Care Future in order to stymie the Medicare-for-All movement and keep the money flowing for as long as they can.

Voters have been inundated with anti-Medicare-for-All attack ads bankrolled by the Partnership in an attempt to turn them away from candidates like Democratic nominee Bernie Sanders who support the popular health reform. The dark money group reportedly spent a whopping 50 percent of all political advertising in advance of the Iowa caucus.

In addition to lobbying against universal healthcare, members of the Partnership are advocating for a $100 billion aid package for American hospitals. Leading the charge are the for-profit hospital corporations represented by the American Hospital Association, which stands to win big on the suffering of Americans amidst the coronavirus pandemic.

Americans have a choice. What do we value more — corporate interests? Or each other?

Healthcare workers standing on the frontlines will not be enough to counter the well-financed interests standing in the way of transformative health reform. Thoughts and prayers are nice, but what healthcare workers actually need is for patients to join us in demanding Medicare for All.

Jonathan Michels is a freelance journalist and healthcare worker based in Durham, North Carolina.

https://piedmontleftreview.com…

COVID-19 pandemic provides strong case for Medicare for all

By James Binder, M.D.
The Cincinnati Inquirer, March 20, 2020

I am one of the 23,000 members of the Physicians for a National Health Program (PNHP) who advocate for Medicare for all. Our current health crisis provides strong evidence that we indeed do need a Medicare for all system in this country. Part of the reason the United States has responded so poorly to the crisis is the fragmented, chaotic nature of our private health care system. Of course, the inept and dishonest approach of the White House contributed tremendously to the problem early on, but even this would have been significantly mitigated if we had had a Medicare for all health care system.

 Medicare for all would build an infrastructure that would support caring for all our citizens health during a crisis. In a Medicare for all system, everybody is automatically covered and their information is all in one system. This would allow us to track patients and make timely interventions. This was crucial to Taiwan’s success in containing the COVID-19 virus. Our multiple insurers each have their own system of data collection, which is not shared. In addition, the tens of millions of people who are uninsured are not even in the system.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recently testified before Congress that our current system is not set up to be able to quickly test a number of people, testing that is critical to controlling the early spread of COVID-19. Countries with a solid health care infrastructure are better able to respond to threats like COVID -19. Germany was able to do extensive testing to slow the early spread of the virus because they have a widespread network or regional laboratories. In other words, they had an infrastructure that supported the health needs of the country, not the profits of insurers.

Taiwan was able to make a strong response to COVID-19. Taiwan is only 81 miles from the mainland of China. They were expected to have the second-highest number of cases of COVID-19. Instead, they have had 108 cases and only one death so far. After the 2003 SARs epidemic, Taiwan created a health plan to deal with potential pandemics. Taiwan has a single-payer health care system, which allows it to do real health planning and place a priority on prevention. Private insurers do not invest in prevention because prevention is not in the financial interest of insurance companies with their high patient turnover.

Although this crisis highlights our need for Medicare for all, there are other important reasons for single-payer. Patients with diabetes mellitus can’t afford their insulin and some die tragically. Patients with other chronic conditions are uninsured or underinsured and delay care that would have prevented serious complications. Problems with access, quality and comprehensiveness, racial disparities in health care, unaffordable long-term care of the elderly, and poor rural health care would all improve significantly in a Medicare for all.

When people work together in solidarity and common purpose, they accomplish more through coordination than individuals can on their own. And they feel good about caring for each other. Canadians are proud of including everyone.

Dr. James Binder is co-founder of the Cincinnati Chapter-Physicians for a National Health Program (PNHP).

https://www.cincinnati.com…

Protect workers, provide health coverage

By Joyce Schlag, CCW
Pittsburgh Post-Gazette, Letters, March 19, 2020

We are all connected, a community of people experiencing vulnerability in the face of the coronavirus which threatens us, our families, neighbors and friends. We are becoming aware of how the well being of one person can affect the well being of many. This puts a focus on community.   We are all inter-connected in the web of our complicated lives. This pandemic causes interruptions for all of us.

Social distancing, reports of closures, concerns about cascading economic fallout are all part of our national conversation. Health issues such as the availability of tests, treatment, masks, ventilators are high priority. We are missing the conversation about the need for universal health coverage, how important it is, and critical in time of a pandemic.

This is the time when we must call for universal health coverage. This virus should be our wake up call, Many of our own citizens are uninsured or cannot afford medical care. When the public service industry does not provide health coverage for their employees, workers who have much contact with the public are vulnerable. Among others, there are those who work in the food industry, restaurants, bars, fast food places, grocery stores, barber shops, hair salons. They need to be protected, as well as the customers they serve.

Many uninsured workers have low incomes and live paycheck to paycheck. They don’t qualify for government programs, ironically, because they have jobs. Seven out of 10 uninsured have jobs, but no insurance. Others have jobs that offer health care coverage, but the premiums, the deductibles, co-pays and medications essentially make that coverage unaffordable. The reality of at least 29 million uninsured cannot be ignored. There is no safety net for them.

Today, it’s the coronavirus. In the future, there likely will be other infectious diseases that threaten the health of our nation. We can do better. We must have universal health coverage.

https://www.post-gazette.com…

GOP-led states diverge on easing Medicaid access during COVID-19

By Harris Meyer
Modern Healthcare, March 18, 2020

At least two Republican-led states want to temporarily ease their Medicaid waiver requirements and make it easier for residents to get and keep coverage under Medicaid and the Children’s Health Insurance Program during the coronavirus pandemic.

On Tuesday, Arizona and Iowa sent requests to the CMS so they can make temporary changes to their Medicaid programs, including eliminating premiums and pausing disenrollments.

Meanwhile, two other Republican-led states, Oklahoma and Utah, are pushing ahead with Medicaid waiver changes intended to tighten eligibility for expanded coverage to low-income adults under the Affordable Care Act, including work requirements.

The sharply different directions these states are taking illustrate the pull between pragmatic and ideological pressures in the midst of the COVID-19 outbreak, which experts say requires making testing and treatment as accessible and affordable as possible to limit the spread of the epidemic.

“Work requirements and premiums are precisely the kinds of policies that are dangerous now and divert energy for state government staff, who are under enormous stress,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “They need to focus on facilitating as many people’s access to care as they can.”

The Arizona Health Care Cost Containment System’s request would help them mitigate any disruption in care for their members during the emergency declaration, the agency said in a March 17 letter to CMS Administrator Seema Verma.

Iowa asked to temporarily waive premiums and copays and permit continuous eligibility for adults and children. That runs counter to the Trump administration’s effort to test beneficiaries for eligibility more often to ensure program integrity, which has led to hundreds of thousands of people being disenrolled.

Going in the other direction, the Oklahoma Health Care Authority on Monday published its Medicaid Section 1115 waiver application and announced the start of a 30-day public comment period. The waiver would include a work requirement, premiums and co-pays.

Utah is proceeding with its plan to require Medicaid expansion enrollees report at least 48 job searches in the first 90 days of eligibility, as well as to complete an online job readiness survey.

“At a time when the job market is collapsing, the absurdity of that requirement is even more apparent,” Alker said. “I hope good-faith leaders in Utah will drop that requirement, which is a threat to public health.”

Indiana, another Republican-led state that established premiums and other restrictive conditions on coverage through a Section 1115 waiver, did not respond to requests for comment on its plans in light of the pandemic.

A handful of states have limited Medicaid’s traditional 90-day retroactive eligibility when people seek care. Experts warn that may put a heavy financial burden on hospitals serving lots of uninsured, low-income coronavirus patients.

https://www.modernhealthcare.com…

Comment:

By Don McCanne, M.D.

You would think that the COVID-19 pandemic would provoke state administrators to look for ways of reducing barriers to health care. Expanding Medicaid coverage for low-income individuals would seem to be a logical step, but it appears that some states are making Medicaid access more difficult by adding a work requirement and adding premiums and copays at a time that the job market has collapsed.

How can they? Are their hearts made of stone?

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Dr. James Kahn on “The Real News Network”

Health systems expert and epidemiology professor Dr. James Kahn appeared on “The Real News Network” on March 19, 2020. He discussed Democratic front-runner Joe Biden’s focus on Italy’s struggles with COVID-19, and pushed back on the notion that single payer “doesn’t work.” Dr. Kahn pointed to the pandemic response in Taiwan and South Korea as examples of how national health systems could address public health emergencies.

Can we put partisan politics aside during the pandemic?

Poll: As Coronavirus Spreads, Fewer Americans See Pandemic As A Real Threat

By Bobby Allyn, Barbara Sprunt
NPR, March 17, 2020

In the face of the coronavirus worsening across the U.S. and reordering the daily life of millions of Americans, fewer people view the pandemic as a real threat, according to a new NPR/PBS NewsHour/Marist poll.

Just about 56% of Americans consider the coronavirus a “real threat,” representing a drop of 10 percentage points from last month. At the same time, a growing number of Americans think the coronavirus is being “blown out of proportion.”

The differences between political parties are stark, with a majority of Republicans saying it is overblown and the vast majority of Democrats considering it a legitimate threat.

“Since the pandemic has taken root and grown in the United States, Democrats and Republicans are now poles apart,” said Lee Miringoff, director of the Marist College Institute of Public Opinion. “The consequences of these differing perspectives are shaping how people are responding to calls for action.”

Overall, fewer than half of U.S. adults are changing behaviors such as eating from home more often or canceling plans to avoid crowds, as recommended.

The poll was conducted Friday and Saturday, beginning the same day President Trump declared a national emergency, and before Tuesday’s stricter guidelines from the administration on social distancing.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has cautioned, “The worst is yet ahead for us.”

Views on the threat level

In February, a little more than a quarter of U.S. adults believed the coronavirus was being blown out of proportion. Now, that number has risen to nearly 40% of respondents.

Pollsters found that both shifts are largely driven by changes in opinion by Republicans. For instance, 72% of Republicans saw the coronavirus as a real threat in early February, but that figure has now plummeted to 40% of Republicans now believing the deadly virus is a serious menace.

And a majority of Republicans — 54% — now say the response to the coronavirus is overblown, a significant jump from last month, when about 23% of Republicans held that view.

Fewer independents, too, see the coronavirus as a real threat. Fifty percent of them view it as such now, compared with 64% of independents last month who said the virus was legitimately threatening.

Democrats remained the most unchanged on this question. An increasing number of them — 76% — now say the danger of the coronavirus is real, up from 70% last month.

Changing your behavior? Depends on your party

Some 59% of Democrats report they have made a point to dodge large gatherings, while 60% of Republicans and 54% of independents have not.

The same party division is illustrated in something as routine as choosing to eat at home versus dining out. About 60% of Democrats say they are eating in more often because of the virus, while 63% of Republicans and 60% of independents are not. (A number of states have recently banned eating out, limiting restaurants to takeout to enforce social distancing.)

https://www.npr.org…

Fauci successfully walks tightrope with Trump

By Morgan Chalfant and Brett Samuels
The Hill, March 18, 2020

Dr. Anthony Fauci has become one of the most important public figures in Washington amid a coronavirus pandemic that is quickly changing American life.

Fauci has been at the helm of the National Institute of Allergy and Infectious Diseases for nearly four decades, but the global virus shutting down much of the U.S. economy has thrust him to the forefront of the federal government’s effort to address the crisis.

At briefing after briefing, Fauci takes a factual, no-nonsense approach — one that at times has created a dissonance with President Trump, who in the past has clashed with officials who have publicly contradicted him.

There appears to be little if any friction, however, between Trump and Fauci, who has avoided direct criticism of the president and earned plaudits from members of both parties for conveying a sense of control in a crisis.

He’s seemed to win over Trump, too.

Trump, who views media coverage as a critical barometer, declared that the 79-year-old Fauci had “become a major television star.” Fauci appeared on every major Sunday show over the weekend to discuss the administration’s response efforts.

At a press briefing on Tuesday, Trump looked to be listening intently as Fauci spoke about specific data and efforts to “flatten the curve” and stave off the worst of the pandemic. When Fauci at one point stepped away from the podium, Trump urged him to keep taking questions.

Trump has also adopted a new tone this week in discussing the coronavirus, taking heed of calls from public health experts to recommend that Americans drastically limit their contact with others to prevent the spread of the virus.

People in the health community say Fauci’s role has been important and note that the White House has not pushed back on or silenced the top health official after he has contradicted the president.

“When there are misconceptions or misperceptions … he is right then and there interjecting, which we should all be very thankful for because if it wasn’t him, we don’t know who would be that person,” said (Dr. Anand Parekh, chief medical adviser at the Bipartisan Policy Center). “As much as it matters to hear from government leaders, it’s really the scientists that need to have the voice here.”

Only 37 percent of Americans have a good or great deal of trust in what they’re hearing from Trump on the coronavirus, while 84 percent say they have such trust in what they’re hearing from public health experts, according to an NPR-Marist poll released Tuesday.

https://thehill.com…

Comment:

By Don McCanne, M.D.

Unfortunately, President Trump did not get off to a sterling start in his response to the coronavirus crisis. He first wanted to minimize it so as to not distract from his campaign for reelection, and then when it appeared to be a more serious problem, he seemed more concerned about its impact on the economy rather than the potentially disastrous consequences that it would have on the health of the people (numbers counted more than people).

What is disconcerting is that the highly polarized political environment in this nation has extended into molding the public and private responses to this pending pandemic of the Covid-19 virus. As the NPR/PBS NewsHour/Marist poll shows, Democrats were more concerned about the health consequences of Covid-19, whereas the Republicans seemed to follow the lead of President Trump, dismissing it as an overblown threat, often to the point of failing to take recommended personal safeguards to prevent infection with this potentially lethal agent.

We’ve said many times that we support optimal health policy but that politics has kept us from implementing those policies. If there ever were a time that we should set politics aside and move on with optimal policy, it certainly should be now. Millions of lives are potentially at stake.

It is reassuring to see that President Trump seems to have had an epiphany and now wants to move forward with aggressive policies to help reduce both the adverse health and economic consequences of this pandemic. In selecting Anthony Fauci to provide unrestrained guidance and direction in our national response, and then calling for implementation of public health measures based on sound policy science, the president has shown that he is now truly concerned.

The question at this point is whether Trump’s base will follow him forward and begin to support the measures that we must take to reduce the intensity of harm caused by the Covid-19 havoc, or will they stand firm in insisting that this threat is overblown and thus they do not need to adhere to the recommended preventive measures. If they do decide to move in the right direction, following President Trump, then it would demonstrate a very important point – that is that politics can be manipulated to enable forward movement with policies designed to benefit the public good. It would also demonstrate the importance of leadership in good governance. Let’s hope.

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Coronavirus: A good argument for Medicare for All

By Alice Rothchild, M.D.
The Seattle Times, March 18, 2020

As an obstetrician-gynecologist and member of Physicians for a National Health Program, I have long supported sweeping changes in how health care in the U.S. is financed, from challenging the cost and gate-keeping roles of health-insurance companies to the price gouging by big pharma. COVID-19 has laid bare the weaknesses in our system and the urgent need for Medicare for All. We cannot nationally isolate or personally buy our way out of this outbreak.

As Washingtonians shelter at home and our economy plunges into recession, the problem with a health-insurance system based on employment becomes increasingly clear. Workers are financially incentivized to avoid screening and show up for work despite symptoms. The threat from loss of wages for small businesses and gig workers as well as those on unpaid sick leave raises the negative impact of insurance payments, copays, premiums and the ability to self-pay. GoFundMe reports that a third of its campaigns are done to pay medical bills. The Trump administration’s talk of sending $250 billion directly to millions of Americans is a desperately needed temporary fix that will explode the deficit and ignore the demands for structural changes.

To make matters worse, the Trump administration’s public-charge rule, recently upheld by the U.S. Supreme Court, allows federal officials to refuse immigrants green cards if they use social-safety-net programs. Add to that the tens of thousands of migrants and asylum seekers housed in the more than 200 immigrant prisons and jails in the U.S., not to mention our general prison population, and we have a vast pool of vulnerable, disenfranchised people who suffer from lack of access to adequate nutrition, health care and housing. Poor communities are most susceptible to infectious disease and to a lack of resources to screen and treat. Recently, 700 public-health experts called on the federal government to maintain safety programs, to fund local health centers in underresourced areas, and to be sure that testing, vaccines and treatment be available regardless of ability to pay.

Even before this crisis, millions of U.S. citizens suffered financial disasters due to medical bills, were forced to declare personal bankruptcy, or forego needed care. Some polling shows there is support for Medicare for All, even in populations that are “satisfied” with their health insurer. Often not reported is that Medicare and Medicaid recipients are even more likely to be “satisfied.” The myth that most citizens are “happy” with their private insurance belies the fact that the private health-insurance industry restricts our choices, dictating which physicians, hospitals, treatments or medications we can use. Under Medicare for All, every physician would be in-network, and physicians and their staff would not spend hours battling with insurers.

Ironically, despite the fact that we spend much more money on health care than other first world countries, we are not the healthiest. U.S. infant mortality is 5.8 per thousand live births, in Canada 4.5 and Britain 4.3. The “mortality amenable to health care,” i.e., deaths that could have been prevented by medical intervention, also reveals distressing numbers: 112 per 100,000 in the U.S., but 78 in Canada, and 85 in the U.K.

Medicare for All would restrain drug prices and dismantle wasteful administrative costs, freeing up billions of dollars for health care. This isn’t about restricting care, but rather developing a more effective and fair way to pay for it. Traditional Medicare spends about 2% on administration, less than one-sixth the cost of private health insurance companies.

The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.

Dr. Alice Rothchild is a Seattle author, filmmaker, and retired obstetrician-gynecologist. She is the author of three books, most recently “Condition Critical: Life and Death in Israel/Palestine,” and has contributed to a number of anthologies including “Reclaiming Judaism from Zionism: Stories of Personal Transformation.”

https://www.seattletimes.com…

Pandemics and Medicare for All

During Pandemic, Biden Lies About Healthcare

Institute for Public Accuracy, March 16, 2020

Biden claimed at last night’s debate: “With all due respect to Medicare for All, you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All. That would not solve the problem at all.” Sanders responded: “What the experts tell us, is that one of the reasons that we are unprepared and have been unprepared is we don’t have a system. We’ve got thousands of private insurance plans. That is not a system that is prepared to provide healthcare to all people.”

Biden claimed: “The national crisis says we’re responding. It’s all free. You don’t have to pay for a thing. That has nothing to do with whether or not you have an insurance policy. This is a crisis. We’re at war with the virus. We’re at war with the virus. It has nothing to do with copays or anything.”

DAVID HIMMELSTEIN, M.D.

Himmelstein is a distinguished professor of public health at the City University of New York at Hunter College. He said today: “Biden lied about coverage, and also distorted the Italian situation. Italians will not face medical bills, or be reticent to seek care for fear of costs. The problem in Italy is a huge number of terribly sick people who are overwhelming hospitals and doctors. That’s a problem pretty much every nation will face.”

JAMES G. KAHN, M.D., M.P.H.

Dr. Kahn is emeritus professor at the Philip R. Lee Institute for Health Policy Studies, the Department of Epidemiology and Biostatistics, and the Institute for Global Health Sciences in the School of Medicine, University of California San Francisco. He said today: “Biden, abetted by moderator questions focused on immediate action, claimed that he had short-term solutions, whereas Sanders wanted a revolution. Indeed, Sanders proposes both immediate solutions and long-overdue structural reforms to properly address serious long-term problems.

“Once again, Biden falsely equated his health care solution (a public option) and Bernie’s comprehensive reform Medicare for All. Biden’s approach would cost more — much more — and leave 100 million people seriously underinsured, facing large financial barriers, and limit doctor choice. Medicare for All would shift waste in our current system into giving everyone comprehensive first-dollar coverage, with free choice of doctor.”

In an accuracy.org released Sunday and challenging CNN to finally “get it” about Medicare for All, Himmelstein and Kahn anticipated Biden’s arguments about Italy. Said Himmelstein: “Our fragmented system leaves public health separate and disconnected from medical care, and provides no mechanism to appropriately balance funding priorities. Kahn noted that without a Medicare for All system, “we’re handicapping ourselves. In other words, Medicare for All is necessary but not sufficient.”

http://accuracy.org…

Comment:

By Don McCanne, M.D.

Facts about health policy are important. The way those facts are communicated is also important since they can influence the future of our health care.

Two issues were appropriately conflated during the Biden/Sanders debate. One is that nations must be prepared at all times to address current and future public health crises, and the other is that the United States needs to reform its health care financing infrastructure to make it work well for everyone. Bernie Sanders made both those points whereas Joe Biden dismissed the need for financing system reform (“It has nothing to do with Medicare for All”) while discussing the more limited topic of management of a pandemic. This led to his outrageous statement that single payer doesn’t work (in Italy).

The urgency of addressing the Covid-19 crisis aside, the most important long-term health policy debate today is whether we are going to enact and implement a single payer model of an improved Medicare that includes everyone, or if we are going to continue to try to improve the Affordable Care Act plus add a Medicare-like public option. The facts are that the two approaches are a world apart.

Merely making modifications to our current financing infrastructure is the most expensive model of reforming health care and yet it achieves none of the goals of true universality, efficiency, equity, affordability for all individuals and families, free choice of health care professionals and institutions, and other important goals of reform. Yet single payer Medicare for All achieves those goals and more and does so at a cost less than our current national health expenditures, not to mention avoiding the extra cost of trying to stoke our current dysfunctional system.

Bernie Sanders has been consistent in his efforts to accurately describe the Medicare for All model and its clear benefits over our current fragmented financing system. Unfortunately, Joe Biden has been dismissive of the single payer model, making untrue claims about the supposed deficiencies of single payer while also making untrue claims about the benefits of building on Obamacare. Just his claim alone that Medicare for All “would cost more than the entire federal budget” is emphatically untrue (Politifact: “False” 2/13/20).

The distortions and lies about single payer are rampant, and yet much of the media has been remiss in not challenging them. The debates have shown that members of the media have often used these false rhetorical depictions of single payer in the questions they ask, perhaps innocently so, although they are guilty of failing to adequately research these false claims.

Fortunately we have policy experts such as David Himmelstein and James Kahn who are meticulous with the truth and can be an invaluable resource for setting the facts straight. But we need the politicians and the media on board as well. Until they start demanding rigid adherence to the truth, the general public is apt to remain confused and then rely on the spinmeisters for their information. These spinmeisters gladly accept the generous financial support of the health insurance industry, pharmaceutical firms and others who are served so well by our current health care financing system. Should the medical-industrial complex fail in controlling the rhetorical debate, they would find themselves in need of establishing legitimacy should we enact and implement single payer Medicare for All.

PNHP does not support any political candidates for office, but we do encourage all candidates to be thoroughly and accurately informed on health policy so that they will support health care measures that are truly in the best interests of all of us.

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Rural Virginia needs Medicare for All

By Bob Devereaux, M.D.
The Roanoke (Va.) Times, February 1, 2020

With Democratic Party presidential primaries just around the corner the issue of fixing our broken health care system is back in the national conversation. Comprehensive plans proposed by Bernie Sanders and Elizabeth Warren have come under increased scrutiny.

As a family medicine physician in Giles County I am convinced that Medicare for All is the best solution for the health care problems of rural Virginia.

I think we can all agree that there are serious problems in medical care that demand change. Almost 30 million Americans still have no health insurance despite an expansion of coverage under the Affordable Care Act. It is estimated that 30,000 die every year as a consequence of not having insurance.

Co-pays and deductibles are skyrocketing, resulting in 44 million people being under-insured. This really hurts my rural patients who are not earning six figure incomes. Recently one of my patients with a severe respiratory problem refused hospital admission because with her private insurance plan she would still have thousands of dollars of out of pocket costs. Another patient with insurance was charged $1,100 for less than a month supply of insulin, which she could not afford.

Despite spending lots of money on health care and we do spend a lot, nearly twice as much per capita as other developed countries, we are not getting much bang for our buck. A study in the Journal of the American Medical Association last year ranked the U.S. dead last among 11 developed countries in infant mortality and life expectancy.

The solution to this problem is expanding one of the most popular and successful government programs ever, Medicare to the entire U.S. population.

Critics say that this is unaffordable. Not true. What we cannot afford is to perpetuate a system where bureaucratic waste now accounts for over one-third of all health care costs.

Studies indicate that moving from private insurance to Medicare, which has much lower administrative costs and has a fee schedule that limits costs, could save more than $500 billion annually. This combined with further savings from a reformed system of prescription drug pricing, would be more than enough to pay for expanding coverage to all citizens. The savings would also result in the elimination of all co-pays and deductibles and provide for expanding coverage to include dental care, vision care, mental health and prescription drugs. These are services that my patients often cannot afford.

What about taking away the freedom of people to chose their own health insurance? In my experience, my senior patients love traditional Medicare because they can go to any doctor and hospital and with a supplemental policy all of their costs are covered with the exception of some prescription drugs. Meanwhile, my younger patients and I fight a constant battle with private insurance companies who make money by restricting patients choices and limiting care.

Lastly some say Medicare for All would be tantamount to “socialized medicine.” Nothing could be further from the truth. Doctors and hospitals would remain as private entities. My patients would love to be able to change jobs, start a new business or retire early without fear of losing insurance coverage.

In fact implementing Medicare for All would restore free choice to health care. We need a system where doctors and patients together can make medical decisions unencumbered by insurance companies whose profits are dependent on limiting and denying care.

Our 50-year experience with health care being run by the free market has failed. It’s time to take a bold step forward by passing and implementing Medicare For All legislation. This means: “everybody in, no one left out.”

https://www.roanoke.com…

RAND draws wrong conclusion on capping surprise bills

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

RAND, Press Release, March 12, 2020

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps, according to a new RAND Corporation report.

RAND researchers examined the potential impact of four proposals for out-of-network payment limits: 125% of Medicare payment rates (a strict limit), 200% of Medicare payment rates (a moderate limit), the average of payments made by private health plans in a state (a moderate limit), and 80% of average billed charges in a state (a loose limit).

The analysis found that limiting out-of-network payments to 125% of Medicare would create the biggest drop in hospital payments.

A more-moderate payment limit set at 200% of Medicare rates would reduce negotiated hospital payments by 8% or 23%, depending on the modeling assumptions, while using the average private payment prices in a state are estimated to reduce negotiated hospital prices by 16% or 30%.

“Under the strict and moderate scenarios, the cost savings created by placing limits on out-of-network hospital bills creates savings that are similar to ideas such as Medicare for All, statewide rate setting and creating global health care budgets, without the particular potential disruption that could come from implementing these plans, although the limits would admittedly create some as-yet unknown level of disruption of their own,” said Christopher Whaley, co-author of the report and a policy researcher at RAND.

https://www.rand.org…

RAND Report: The Price and Spending Impacts of Limits on Payments to Hospitals for Out-of-Network Care

By Erin L. Duffy, Christopher Whaley, Chapin White

Key Findings

Strict out-of-network payment limits on hospital care could yield savings similar to more-sweeping proposals, such as Medicare for All, rate setting, and global budgets

Although cost containment can benefit patients facing rising health costs, such changes are disruptive to hospital revenues

From the Conclusions and Policy Recommendations (Page 21 of the full report)

“Notably, single-payer health care options seek to expand coverage in addition to controlling costs. In comparison, out-of-network payment limits directly address the cost of care for privately insured patients without directly expanding coverage among uninsured and underinsured people. This distinction is important in considering the potential impacts of these health reforms for different subsets of the U.S. population and the policy objectives of proponents of these different approaches.”

https://www.rand.org…

Media reports

“Cutting out-of-network hospital payments may save as much as single-payer system”

https://www.healthcaredive.com…

“Savings from capping out-of-network payment rates could save as much as $124 billion in hospital spending, making the policy a potential alternative to Medicare-for-All.”

https://revcycleintelligence.com…

Comment:

By Don McCanne, M.D.

There has been considerable discussion over what to do about surprise medical bills – bills that arise from care given outside of the insurers’ provider networks. For single payer advocates, it’s easy. Eliminate the private insurers and their networks through enactment of single payer Medicare for All and then all essential care is automatically covered by the public plan.

In this report, RAND has provided an analysis showing that placing a cap on surprise bills can yield savings similar to single payer. This conclusion is prominent in their report and has been picked up by the media. But it ignores all of the many other tremendous advantages of a single payer system – universality, elimination of restrictive provider networks, elimination of financial barriers to care, dramatic reduction in administrative waste, and making health care affordable for everyone through progressive tax policies, to name a few.

It is not as if the authors didn’t understand this. Buried in their conclusions they note that, in addition to controlling costs, single payer directly expands coverage among uninsured and underinsured people, whereas placing limits on out-of-network payments only addresses the cost of care for privately insured patients. It is difficult to see how capping out-of-network payment rates could be considered “a potential alternative to Medicare-for-All” when it fails to correct all of the other profound deficiencies in our health care financing system.

Passing surprise billing legislation would do almost nothing to correct the injustices in our health care system, but it would allow the legislators to once again walk away pretending that they have corrected the problem, when the real problem is so much larger than what they have tackled. We desperately need single payer Medicare for All, and we need it now.

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Public Health Experts: Single-Payer Systems Coping With Coronavirus More Effectively Than For-Profit Model

"Having a healthcare system that's a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources."

By Jake Johnson
Common Dreams, March 16, 2020

As the coronavirus pandemic places extraordinary strain on national healthcare systems around the world, public health experts are making the case that countries with universal single-payer systems have thus far responded more efficiently and effectively to the outbreak than nations like the United States, whose fragmented for-profit apparatus has struggled to cope with the growing crisis.

“It is too soon to see definite outcomes among competing healthcare systems. But even in this early phase, public health experts say the single-payer, state-run systems are proving themselves relatively robust,” the Washington Post reported Sunday. “Unlike the United States, where a top health official told Congress the rollout of testing was ‘failing‘ and where Congress is only now moving through a bill that includes free testing, the single-payer countries have been especially nimble at making free, or low-cost, virus screening widely available for patients with coughs and fevers.”

While the Trump administration only recently took steps to massively expand COVID-19 testing—sparking concerns that the outbreak in the U.S. is far more severe than official numbers suggest—countries with forms of single-payer healthcare like South Korea and Denmark have for weeks been offering “drive-through” testing and other innovative mechanisms, allowing them to quickly test hundreds of thousands of their citizens and respond accordingly.

“Unhampered government intervention into the healthcare sector is an advantage when the virus is spreading fast across the country,” said Choi Jae-wook, a professor of preventive medicine at Korea University in Seoul.

“It is too soon to see definite outcomes among competing healthcare systems. But even in this early phase, public health experts say the single-payer, state-run systems are proving themselves relatively robust,” the Washington Post reported Sunday. “Unlike the United States, where a top health official told Congress the rollout of testing was ‘failing’ and where Congress is only now moving through a bill that includes free testing, the single-payer countries have been especially nimble at making free, or low-cost, virus screening widely available for patients with coughs and fevers.”

While the Trump administration only recently took steps to massively expand COVID-19 testing—sparking concerns that the outbreak in the U.S. is far more severe than official numbers suggest—countries with forms of single-payer healthcare like South Korea and Denmark have for weeks been offering “drive-through” testing and other innovative mechanisms, allowing them to quickly test hundreds of thousands of their citizens and respond accordingly.

“Unhampered government intervention into the healthcare sector is an advantage when the virus is spreading fast across the country,” said Choi Jae-wook, a professor of preventive medicine at Korea University in Seoul.

Jorgen Kurtzhals, the head of the University of Copenhagen medical school, told the Post that the strength of Denmark’s single-payer system is that it has “a lot of really highly educated and well-trained staff, and given some quite un-detailed instructions, they can actually develop plans for an extremely rapid response.”

“We don’t have to worry too much about whether this response or that response demands specific payments here and there,” said Kurtzhals said. “We are aware that there will be huge expenditure within the system. But we’re not too concerned about it because we have a direct line of communication from the national government to the regional government to the hospital directors.”

None of which is to say that countries with forms of single-payer healthcare or nationalized systems are flawlessly handling the COVID-19 pandemic, which has infected at least 173,000 people and killed more than 6,000 worldwide.

Britain’s National Health Service (NHS), following years of austerity imposed by Conservative governments, is facing staff and supply shortages as hospitals are being overwhelmed with patients. Canada, like the U.K., is struggling with a shortage of ventilators.

But Helen Buckingham, director of strategy and operations at the London-based Nuffield Trust think tank, told the Post that the NHS is in a relatively good position to cope with COVID-19 because it has “a very clear emergency planning structure.”

Additionally, Buckingham noted, “there is no need for people to worry about the tests or vaccine or cost of care if people become ill.”

David Fisman, an epidemiologist at the University of Toronto, said that in a “time of crisis” like the coronavirus pandemic, “having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.”

During the Democratic presidential primary debate Sunday night in Washington, D.C., former Vice President Joe Biden cited Italy’s struggles to contain COVID-19 as evidence that the Medicare for All system advocated by rival candidate Sen. Bernie Sanders (I-Vt.) would not be effective in a pandemic. Italy has been the hardest-hit country outside China with nearly 25,000 cases of the novel coronavirus.

“With all due respect for Medicare for All, you have a single-payer system in Italy,” said Biden. “It doesn’t work there.”

Critics were quick to take issue with Biden’s talking point. “[Single-payer] isn’t the reason Italy is having problems,” tweeted HuffPost healthcare reporter Jonathan Cohn. “Italy’s problem is health system capacity. Independent of health system design.”

Dr. David Himmelstein, co-founder of Physicians for a National Health Program and distinguished professor of public health at the City University of New York at Hunter College, said in a statement Sunday night that the “fragmented system” in the United States “leaves public health separate and disconnected from medical care, and provides no mechanism to appropriately balance funding priorities.”

“As a result, public health accounts for less than 3 percent of overall health expenditures, a percentage that has been falling for decades, and is about half the proportion in Canada or the U.K.,” said Himmselstein. “One result is that state and local health departments that are the front lines in dealing with epidemics have lost 50,000 position since 2008 due to budget cuts.”

On the debate stage Sunday evening, Sanders made the case for transitioning the U.S. to a single-payer program, arguing that the coronavirus “exposes the incredible weakness and dysfunctionality of our current healthcare system.”

“How in God’s name does it happen,” said Sanders, “that we end up with 87 million people who are uninsured or underinsured and there are people who are watching this program tonight who are saying, ‘I’m not feeling well. Should I go to the doctor? But I can’t afford to go to the doctor. What happens if I am sick?'”

“So the word has got to go out, and I certainly would do this as president: You don’t worry,” Sanders added. “People of America, do not worry about the cost of prescription drugs. Do not worry about the cost of the healthcare that you’re going to get, because we are a nation—a civilized democratic society. Everybody, rich and poor, middle class, will get the care they need. The drug companies will not rip us off.”

https://www.commondreams.org…