By Noam Scheiber
The New York Times, December 3, 2023

Dr. John Wust does not come off as a labor agitator. A longtime obstetrician-gynecologist from Louisiana with a penchant for bow ties, Dr. Wust spent the first 15 years of his career as a partner in a small business — that is, running his own practice with colleagues.

Long after he took a position at Allina Health, a large nonprofit health care system based in Minnesota, in 2009, he did not see himself as the kind of employee who might benefit from collective bargaining.

But that changed in the months leading up to March, when his group of more than 100 doctors at an Allina hospital near Minneapolis voted to unionize. Dr. Wust, who has spoken with colleagues about the potential benefits of a union, said doctors were at a loss on how to ease their unsustainable workload because they had less input at the hospital than ever before.

By Sam Pizzigati
Inequality.org, November 30, 2023

This past summer the Wall Street Journal took a crack at listing the world’s ten highest-paid corporate CEOs. Nine of the ten, the Journal found, last year pulled down over $100 million. The tenth on the list had to make do with a mere $99 million. And all of these chiefs turned out to share a common home base: the United States.

That U.S. connection should come as no surprise. CEOs in the United States have been pocketing far lusher paychecks than their counterparts elsewhere in the world for quite some time now, giving shills for that excess plenty of practice honing their rationales for it.

At their most basic, those rationales all boil to one word: incentives. Hefty rewards for executives, the argument goes, incentivize top-tier performance. Execs who stand to take home mega millions will move heaven and earth to deliver quality products and services that gain their corporations beaucoup customers and higher share prices.

Where ought the debunking of that notion begin? How about focusing on CEO pay in an American industry that can actually make the difference between life and death for average Americans, an industry where the pay top execs pocket far, far outpaces the compensation of their global counterparts?

Let’s, in other words, talk health care.

America’s top health care execs would rather we not. They’re doing quite nicely these days flying under the radar, their paychecks getting nowhere near the scrutiny that Wall Street’s finest and high tech’s most ebullient superstars have been enduring.

Just how lavishly well are America’s health care CEOs doing these days? In 2022, a down year for the stock market, the CEOs of over 300 publicly traded U.S. health care companies combined to make some $4 billion, analysts at STAT reported this past August. The ten highest-paid of these execs just by themselves pocketed $1.4 billion.

“No matter how you slice it,” notes John McDonough, a veteran Harvard health policy prof, “the people at the top — the CEOs of these companies — are making enormous gains every year compared to ordinary Americans.”

Health insurance company CEOs have annually rated as among the health care industry’s most royally rewarded. In 2022, America’s five top-paid health insurer chiefs all pulled down over $20 million, Insurance Business magazine reported earlier this month.

The lowest-paid of these top five, UnitedHealth Group’s Andrew Witty, had to make do with a mere $20.9 million, a reward 331 times greater than the pay that went to UnitedHealth’s most typical employees.

Top execs in the “insurtech” side of the health care industry — firms that claim to be using high tech to make health insurance more efficient — seem to have an even greater compensation upside. Alignment Healthcare’s John Kao took home $34.1 million in 2022 after a $46-million payday in 2021. Bright Health’s George Mikan two years ago took in $180 million.

The chief execs of U.S.-based health care companies clearly have all the incentive they could possibly need to deliver outstanding performances. The quality of health care in the United States — by the reasoning of the defense team for sky-high U.S. CEO pay — should be unparalleled worldwide.

Especially compared to Canada.

Our neighbor to the north has not a single mega-million health care exec. The reason? Right after World War II, in the province of Saskatchewan, Canadians started setting up a tax-funded nonprofit health care system that guarantees free universal health services. By the early 1960s, all Canada’s provinces and territories had joined in on the effort.

The top executives in Canada’s health care system today make a fraction of the compensation that goes to health care execs in the United States. In 2021, the CEO of Ontario Health “raked in” just $826,000. The top health exec in the province of Alberta that same year collected a mere $583,443.

Canadians, according to the rationale of apologists for U.S. CEO pay, ought to be paying dearly for the low pay that goes to the execs who run Canada’s health care system. People in the United States, by the apologist logic, ought to be enjoying far better health care and health than people in Canada. In fact, the reverse has become the case, as analysts have been documenting for years.

By 2010, as a Population Health Metrics research journal analysis detailed just over a dozen years ago, a healthy 19-year-old Canadian could “expect to have 52 more years of perfect health versus 49.3 more years for Americans.”

Compared to Canadians, a PBS report would observe in 2020, “Americans have for years paid far more for health care while staying sicker and dying sooner.”

Other still more recent research has placed Canadian and U.S. health outcomes in a more global context. In 2021, the Commonwealth Fund in New York compared the performance of health care systems in 11 high-income countries around the world: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the United States.

“The United States ranks last overall,” the Commonwealth Fund data analysts point out, “despite spending far more of its gross domestic product on health care.”

U.S. performance on metrics that measure everything from access to health care to health outcomes, declare the Commonwealth Fund researchers , “falls well below the average of the other countries and far below the two countries ranked directly above it.”

The United States, the Commonwealth Fund added this past January, also “has the lowest life expectancy at birth” and “the highest death rates for avoidable or treatable conditions.”

Two leading research centers, The Peterson Center on Healthcare and KFF, piled on with still more unnerving health care data this past October.

Back in 1980, the Peterson-KFF Health System Tracker illustrates, life expectancy at birth showed no major differences between the United States and comparable advanced industrialized nations. But the global life-expectancy gap “has grown substantially in the following decades,” with Americans in 2021 averaging just 76.4 years in life expectancy and its peer countries averaging 82.3.

What’s going on here? How can the United States be spending so much on health care and seeing so little in return? Where does America’s health care CEO pay fit in to all this?

We’ve had no shortage of culprits when it comes to explaining how unhealthy the United States has become. Many observers point to poor diets, for instance, or the lack of adequate exercise.

But analysts like Stephen Bezruchka, a population health professor emeritus at the University of Washington, are urging us to look deeper into how our American society has evolved since the middle of the 20th century. We have over those years, they note, become a much less equal nation. Our richest are making much more — as the CEO pay data confirm — and paying a much smaller share of their hefty incomes in taxes.

“Healthier societies have a smaller gap between the rich and the poor than we do,” notes Dr. Bezruchka. “That gap causes an enormous amount of stress in our society — road rage, air rage, stress at work, child abuse.”

Dr. Bezruchka has come to call stress “the 21st century tobacco.”

“We have learned,” he warns, “that inequality kills.”

CEO compensation in the United States has contributed mightily to that inequality. Top execs don’t just collect big paychecks. To make sure they can end up collecting those paychecks, American CEOs regularly make corporate decisions that boost corporate profits at the expense of their employees and the public at large. Their fortunes also bankroll the politicos who oppose high taxes on high incomes — and the programs to help modest-income families those high taxes could be underwriting.

Curbing excessive CEO pay clearly won’t solve all the problems that face us. But curbing that excess would certainly make for a wonderfully substantive start.

https://inequality.org…

By Cheryl Kunis, M.D., M.S.
Medpage Today, Second Opinions, November 27, 2023

In 1973, The New York Times published an editorial entitled “Medicarelessnessopens in a new tab or window,” questioning the allocation of public funding for “special interest groups” — specifically, for patients with end-stage renal disease. Just 2 months earlier, President Richard Nixon had signed the Medicare Amendments Bill, which expanded coverage for dialysis and transplantation. The editorial argued that the benefits of prioritizing funding for expensive therapies like dialysis over other societal needs were unclear. At the heart of the issue was whether legislators, given limited resources, were acting responsibly when deciding how to prioritize public funding.

Exactly half a century later, the question of “Medicarelessness” is more relevant than ever, although in an entirely different context. Medicare has expanded dramatically since its inception in 1965. Supposedly to improveopens in a new tab or window its efficiency, Congress eventually created Medicare Advantageopens in a new tab or window (MA) in 2003. This new program, which is publicly funded but privately administered, ushered in a new era of Medicare privatization.

With the advent of MA, the insurance industry has pioneered new and evolving strategies to maximize profits that have led to widespread accusationsopens in a new tab or window of profiteeringopens in a new tab or window and fraudopens in a new tab or window. In 1973, “Medicarelessness” referred to “reckless” government spending on what became life-saving treatment; today, I believe it’s more appropriate to assign this label to reckless spending used to bolster corporate profits.

In a just society, healthcare is an essential service that benefits all. The U.S. stands apart from other industrialized nations in that healthcare is not guaranteed. Medicare represents an attempt by our country to partially remedy this injustice. It not only provides care to some of the most marginalized members of society (the elderly and disabled), it also helped to desegregate the healthcare system, promoting racial equity.

Despite Medicare’s historic achievements and remarkable popularity (84%opens in a new tab or window of its beneficiaries view it favorably), government-controlled healthcare remains a controversial subject. Politicians in bothopens in a new tab or window partiesopens in a new tab or window have sought to increase the role of private insurance in Medicare, under the conception that care would be cheaper and more efficient in a market-driven system. Contrary to these claims, MA has raised costsopens in a new tab or window for taxpayers using higher patient “risk scores” that are not justified in every case.

MA only saves moneyopens in a new tab or window for insurers who use a range of techniques to extract profits at the expense of patients, such as instituting highly limited networks and arbitrarily requiring prior authorization for many services. Each year, MA plans reject millions of authorization requests, of which about 1 in 7opens in a new tab or window would have been approved under traditional Medicare.

But the most egregious method of profiteering, in my opinion, is the practice known as “upcoding.” MA insurers receive payments that are determined in part by patient diagnoses. The more diagnosis codes submitted, the higher the payment. MA plans have taken advantage of this, inflatingopens in a new tab or window the number of diagnoses on patient charts without providing additional care. Upcoding is so widespread that the Department of Justice has investigated or sued nearly all large MA insurers for either this practice or another form of fraud.

It is morally indefensible for billions of taxpayer dollars allocated for healthcare to be siphoned off as corporate profit. Margins for MA plans are significantly higheropens in a new tab or window than other types of insurance, to the point that some companies are leavingopens in a new tab or window employer-based insurance altogether to focus on government plans. In 1973, The New York Times questioned programs designed to benefit a medically needy “special interest group”; now, we have a program designed not to heal the sick, but one that instead ends up feeding taxpayer money to a far from needy special interest group: insurers.

Not only does MA cost taxpayers billions, it doesn’t even work for many of the patients that Medicare was created to serve. Despite the low premiums and benefits that MA plans aggressively advertiseopens in a new tab or window, the reality is that costs are only manageable when beneficiaries are healthy. If they become ill, their insurer can deny payment for services or restrict accessopens in a new tab or window through limited networks, often forcing patients to pay out of pocket or forgo treatment. According to a 2021 Government Accountability Office reportopens in a new tab or window, patients in their last year of life disenrolled from MA plans to join traditional Medicare at more than twice the rate of all other MA beneficiaries, potentially driven by limitations accessing specialty care under MA and by unforeseen expenses.

Proponents of MA claim that privatization promotes innovation and efficiency, but its role in healthcare appears questionable at best. The reality is that no matter what, profit-driven corporations will likely never put the interests of the public above those of their shareholders. Privatization allows the government to shirk fiscal and moral responsibilities at the expense of those it claims to serve. It is a myopic strategy that benefits corporations, yet keeps costs largely public. In short, the privatization of Medicare is “Medicareless.”

“Medicarelessness” poses a much greater threat in 2023 than it did in 1973. We are thoughtlessly subsidizing the private insurance industry at an extravagant cost to the American taxpayer, and dismantling a vital and beloved public program. We must accept that life-sustaining services should remain in public hands to safeguard citizens from the gravest injustices. Medicare remains a potent symbol of our most sacred democratic principles: equality, dignity, and self-determination. We can no longer afford to be “Medicareless,” both ethically and financially. We must say no to privatization.

Dr. Cheryl Kunis is a nephrologist and bioethicist. She currently serves as clinical professor of medicine emerita and special lecturer at Columbia University, and adjunct clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. She also serves as the director of national issues at Physicians for a National Health Program, New York Metro Chapter.

https://www.medpagetoday.com…

By Diane Archer
Common Dreams, November 21, 2023

During this Medicare Open Enrollment period, ask yourself these seven questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP—State Health Insurance Assistance Program—for free, unbiased advice on any of your Medicare questions.

Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.

Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? Unlike traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the U.S. and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the healthcare providers listed in their network or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their healthcare. The government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two, or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.

Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care.

Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.

Q. If I join a Medicare Advantage plan, can I disenroll and switch to traditional Medicare? You can switch to traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age, and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.

Q. If I have traditional Medicare and Medicaid, what should I do? If you have both Medicare and Medicaid, traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in traditional Medicare than in a Medicare Advantage plan if you need costly healthcare services or have a complex condition.

Again, for free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

Diane Archer is president of Just Care USA, an independent digital hub covering health and financial issues facing boomers and their families and promoting policy solutions. Ms. Archer began her career in health advocacy in 1989 as founder and president of the Medicare Rights Center, a national organization dedicated to ensuring that older and disabled Americans get the health care they need.

https://www.commondreams.org…

By Rep. Pramila Jayapal (D-Wash.) and Dr. Diljeet Singh
The Hill, November 17, 2023

Physicians and policymakers are, in different ways, both responsible for the health and well-being of patients. While physicians care for patients to the best of their ability, policymakers ensure that the structures that make up the health care system are effective and equitable. Whenever and wherever there is a threat to these goals, both groups have a role to play in recognizing and combating it. That is why we are speaking out on the need to make fundamental changes to the Medicare Advantage (MA) program.

MA as it exists today is a threat to patient care, to health equity, and indeed to the integrity of our public health infrastructure. A new report from Physicians for a National Health Program, an organization of doctors working to reform the health care system, shows that for-profit, corporate MA insurers are overpaid anywhere from $88 to $140 billion a year. That’s money coming out of patients’ and taxpayers’ pockets.

MA is the privately-run version of the traditional government-administered Medicare program. Instead of paying directly for care, the government instead pays insurers to “manage” patients’ needs. Enrollment in this program has grown significantly over the past two decades, with over 50 percent of eligible beneficiaries opting for an MA plan in 2023. Unfortunately, growth in the program has not led to better care for beneficiaries or a better deal for taxpayers — just the opposite, in fact. Tens of billions of taxpayer dollars are being siphoned off as profit by insurance companies that don’t even provide necessary care. That money doesn’t just cost our government, it costs seniors. For example, premiums paid for Medicare Part B, which covers most medical services outside of hospitalization, totaled $131 billion in 2022. With the amount of extra money that corporate insurers get from the government, we could totally eliminate Part B premiums and still have money left over.

Where is all this money coming from? It’s complicated, the result of a tangled web of loopholes, policies, and practices that are difficult for an individual beneficiary or physician to see. Even so, scholars and regulators have identified a few major factors that lead to overpayments. For example, insurance companies in MA tend to enroll patients that are healthier and therefore cost less than average but still get paid as if their patients were much sicker. This is called favorable selection, and by some estimates, it could cost as much as $75 billion a year in extra payments.

Because Medicare gives additional money to MA insurers for patients with more severe or more numerous diagnoses, another source of overpayments are all the irrelevant or old conditions that insurers record on patient charts. This practice is known as upcoding; these conditions aren’t being actively treated, so they don’t cost the insurance company anything, but they do lead to as much as $20 billion in extra payments. These methods only scratch the surface of all the ways in which MA insurers take advantage of the system, but the bottom line is clear: these companies are pocketing billions of dollars that belong to Medicare beneficiaries.

Of course, it isn’t just about the money; it’s also about patient care. Medicare Advantage plans tout their low premiums and extra benefits, but often these are only worth it as long as you’re healthy. If you get sick and need complex or significant care, plans start to show their true colors. Difficult authorization processes and narrow networks can make getting treated under an MA plan a nightmare. In fact, high-need patients with chronic conditions and patients in their last year of life are substantially more likely to switch out of MA and back to traditional Medicare, tired of having to justify each and every needed procedure or medication to their insurance company.

In our roles as a member of Congress and a practicing physician, we see different but equally concerning manifestations of these problems. Constituents call in with stories of being lured into an MA plan, and then denied care or prevented from seeing their doctor. Cancer patients, for whom an early diagnosis and treatment plan is imperative to survival, face weeks of delay because of onerous pre-authorization requirements. In fact, some of these patients have ended up needing emergency surgery or aggressive radiation that could’ve been avoided if insurers hadn’t gotten in the way. MA doesn’t just take billions in taxpayer dollars; it makes it harder for doctors to do their jobs, and harder for patients to get well.

With the money that we spend on corporate giveaways, we could entirely fund Medicare’s prescription drug benefit, establish an out-of-pocket maximum in traditional Medicare, or even provide dental, hearing, and vision benefits to everyone on Medicare and everyone on Medicaid. This doesn’t need to be a partisan issue. We should all agree that programs paid for by the people should benefit the people. It’s time to crack down on overpayments in MA and use those resources to improve Medicare for all patients.

Pramila Jayapal represents Washington’s 7th District. Dr. Diljeet K. Singh is a women’s health advocate and an integrative gynecologic oncologist in clinical practice since 1999. She currently serves as vice president for Physicians for a National Health Program.

https://thehill.com…

November 15, 2023

Healthcare for All Campaign Director Aija Nemer-Aanerud (of People’s Action) invites anybody who cares about the state of health care in the U.S. to join the Care Over Cost campaign.

This nationwide campaign, which is carried out by a large network of local affiliates, encourages people to share their personal struggles with care denial at the hands of U.S. health insurers.

“Your community will have your back,” they say. “Your fight with the insurance company is my fight with the insurance company.”

Additional episodes will be uploaded monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com