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St. Louis takes healthy step of endorsing Medicare for All

St. Louis takes healthy step of endorsing Medicare for All

‘It’s time to reform our health care system’

By Alvin A. Reid
The St. Louis American, May 24, 2022

St. Louis is now among more than 90 American cities whose governing bodies have passed Medicare for All People resolutions of support.

Alderwoman Pam Boyd introduced the proposal as Resolution 25. After clearing the Board of Aldermen Health and Services Committee, it was passed by the full board on May 13.

People in St. Louis are hurting. They can’t afford to see a doctor, and they really can’t afford to get sick,” Boyd said.

“With Medicare for All, everyone can get the healthcare we need, the prescription drugs that can keep us alive, and the peace of mind to not worry about deciding between our medicine and the roof over our heads.”

Dr. Ed Weisbart, Physicians for a National Health Program – Missouri chapter chair, said during the committee hearing that America spends double on healthcare than any other country.

“[Medicare for All] would reduce that. This comes down to plain, old morality. It makes me furious to see the moral injustice,” said Weisbart, who also serves on the national board.

Angela Brown, St. Louis Regional Health Commission CEO, said “access to health care continues to be a public health crisis.”

“We have developed ‘sick care system’ that prevents our most vulnerable populations from accessing health care until there is an extreme crisis. We recognize it’s time to transform our health care system into a system everyone can access when needed.”

Brown said the pandemic illuminated discrepancies in health care, which could be reduced if Medicare for All became mandated by Congress.

“Medicare for All is the most valid means of insuring health care coverage for all Americans and a step toward achieving zero health disparities in our region,” she said.

U.S. Rep Cori Bush is among the original cosponsors of HR 1976, a proposed bill that would create Medicare for All. It now has 121 cosponsors.

“Medicare for all is a transformational policy change that would implement a national, single-payer universal health care system that guarantees comprehensive health care coverage to every person in America and end the for-profit, privatized, broken system we have in place now,” Bush said during a House Oversight Committee hearing on March 30, 2022.

“I have personally borne witness to the stark inequities faced by uninsured and under-insured patients during my tenure as a registered nurse. For some people, it’s hard to imagine rationing expensive medication like insulin; skipping dialysis appointments; forgoing surgical procedures; or refusing medical care entirely. People are having to choose between their life or a lifetime of medical debt.”

According to Physicians for a National Health Program, Medicare for All could:

  • Expand Medicare’s benefit design to include coverage of hearing, vision, dentistry, prescription drugs, and long-term care
  • Include a full choice of physicians and hospitals and eliminating narrow “networks”
  • Eliminate copays, deductibles, and need to purchase supplemental policies
  • Eliminate individual premiums, which would be funded through an equitable tax model

The benefits of Medicare for St. Louis include improved health and health equity of residents and a lessened financial burden on the city’s budget

Many St. Louisans depend on emergency rooms as the only realistic healthcare option, at significant cost to the city and local business community, according to Weisbart.

“Medicare for All improves health equity by ensuring everyone has affordable access to needed healthcare throughout their life.”

Medicare for All is also endorsed by: Missourians for Single Payer Physicians for a National Health Program; Mound City Medical Forum; Students for a National Health Program-St. Louis University Chapter; Consumers Council of Missouri Green Party of St. Louis; Missouri Health Care for All; National Nurses United at St. Louis University Hospital; Democratic Socialists of America-St. Louis Chapter; League of Women Voters-Metro St. Louis Chapter; Missouri Jobs with Justice; and the Ethical Society of St. Louis.

https://www.stlamerican.com…

Value-Based Payment = Corporate Control of Health Care

Summary: A blog in Health Affairs promotes ACOs and other VBP despite the lack of evidence for benefits. Why? Because VBP reinforces the corporate / private equity model of health care with growing profits for shareholders. We must elect those who would instead foster a truly equitable system.

ACO REACH and Advancing Equity Through Value-Based Payment, Part 1, Part 2, Health Affairs Forefront, May 17 & 18, 2022, by William K. Bleser, et al

[E]vidence suggests that the uptake of VBP models has lagged in marginalized populations, and that in some circumstances, VBP could exacerbate disparities. … [A]ddressing equity through VBP remains a nascent field with diverse approaches in use—with limited evidence on which approaches work or help avoid undesirable outcomes.

The Center for Medicare and Medicaid Innovation (the Innovation Center) recently announced that its Global and Professional Direct Contracting pilot will be redesigned into a new model called the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH). Reflecting the Innovation Center’s strategic focus on health equity as a top priority—and on achieving the broader equity goals of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS)—ACO REACH incorporates many new health equity-focused elements affecting upfront payments, data collection, provider selection, community governance, and delivery and benefit design.

ACO REACH is a substantial pilot program. It is aimed at improving equity but also at assessing which payment reform design elements can best do so while also achieving the “Triple Aim”—better care experience, better population outcomes, and lower health care costs. ACO REACH and the other equity-focused VBP models consequently provide an unprecedented opportunity for augmenting the meager evidence we have on how to improve equity.

In this article, we present a framework for categorizing the spectrum of approaches we identified for improving equity through VBP model design.

From the Conclusion: We hope this synthesis will assist the Innovation Center, state policy makers, and commercial payers to further their efforts to embed equity in VBP model design. However, these approaches are generally new, so more evidence is needed to understand what works best and should be replicated or adapted in future VBP models—including the experiences of ACO REACH.

National Primary Care Transformation Summit, July 26-29, 2022, Produced by Global Health Care LLC

Skim the presenter affiliations, which reveal a highly corporate vision for health care.

Medicare for All: Protecting Health, Saving Lives, Saving Money, Hearing, United States Senate Committee on the Budget, Chairman Bernie Sanders, May 12, 2022

Comment:

By Don McCanne, M.D., M.P.H.

The two-part series in Health Affairs Forefront encourages pursuit of Value Based Payment (VBP) and specifically ACO REACH, despite an acknowledged lack of evidence that it works to promote equity (or savings or quality). It is yet another example of how the health care industry pursues a long-term trajectory toward private equity – corporate takeover of health care. No, the article does not say it in those words, but it does imply it in the infrastructure of the VBP models.

One glance at the landing page of the “National Primary Care Transformation Summit” should be all of the confirmation you need as to the intent for the future direction of our health care system.

Fortunately, Sen. Bernie Sanders has kept alive the concept of a single payer Medicare for All system by holding a hearing on the topic by his Senate Budget Committee and by reintroducing Medicare for All legislation.

Our problem is inertia. We talk about the clear advantages of single payer, but we have been ineffective in electing a president and Congress that will enact it. In the meantime, control of our health care system continues to shift to those holding the financial wealth of our nation. Their interests are not in correcting the severe deficiencies in health care but rather in accumulating more wealth. It is up to us to change that by instead putting control in the hands of the people who care about health care justice.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Private Equity Gloats Over A Doctor Glut

Health care vultures helped create an oversupply of ER physicians — now they want to use the surplus to cut wages and limit care.

By Maureen Tkacik
The Lever, May 20, 2022

A private-equity-owned emergency room staffing firm co-founded by a wealthy Republican congressman has been openly hailing a coming “oversupply” of doctors, promising prospective investors that a surplus of emergency physicians — soon projected to reach nearly 10,000 — will drive doctors’ wages low enough to offset the haircut that health care reforms have imposed upon its profit margins.

The physician glut was highlighted in a recent pitch deck prepared by the cash-strapped Nashville ER staffing firm American Physician Partners (APP). The company, which operates ERs in 155 hospitals, has been trying — and failing — for months to raise $580 million to pay off creditors, including Rep. Mark Green (R-Tenn.), who holds somewhere between $5 million and $25 million of the company’s debt.

Like most of its competitors, APP has watched its profit margins and credit ratings sink since various laws banning surprise billing were enacted last year. While APP claims it never sent surprise bills to patients, it has also told its doctors in email exchanges reviewed by The Lever that various laws banning the practice had resulted in a 50 percent drop in the company’s revenues from certain large insurers.

But in its November 2021 pitch deck to investors, APP tells a different story, promising the company will more than make up for the expected $5.8 million to $11.6 million hit to its $122 million in annual gross earnings, by slashing some $19.6 million from its payroll costs. APP can do this in the midst of a once-in-a-generation health care labor shortage, according to the presentation, thanks to a coming glut of ER doctors.

This ER doctor glut was primarily caused by a recent explosion in the number of emergency medicine residency programs founded to train medical school graduates in the specialty — and was part of a deliberate scheme by vulture capitalists to flood the health care system with cheap medical labor.

“It is remarkable to me that in the midst of a global pandemic where health care workers have sacrificed so much, APP brazenly shares its plans to further exploit physicians,” said Philip Sossenheimer, a Stanford Health Care physician who helped organize a recent landmark union victory at the Palo Alto, California-based hospital system.

While this physician glut is currently a phenomenon specific to emergency medicine, Sossenheimer suspects more specialties will soon face similar problems. As he put it, “I hope all physicians see this as the harbinger of what corporate health care will bring.”

The Doctor Glut Has Arrived

This “oversupply” of emergency physicians will likely never be apparent to the average patient sitting in an ER waiting room, where skeleton staffing has been thoroughly baked into the business model.

As the APP presentation points out, 70 percent of hospital ERs are outsourced, and most contracts are awarded to the lowest bidder. Nearly all of the biggest bidders on ER contracts — Envision Healthcare, TeamHealth, SCP Partners, ApolloMD, and APP — are owned by private equity firms that have accumulated nine- or ten-figure sums of debt buying out smaller competitors. Making the interest payments required by that debt leaves no room for extravagances like higher doctor-patient ratios.

Indeed, as the media will often remind us, we are by most standards a nation in the throes of an acute physician shortage. Most countries have far higher numbers of doctors per capita than the United States, partly because we force doctors to endure three or four times as many years of postgraduate education as most European countries, pay an average of $300,000 for the privilege to save lives, and partake in a cutthroat competition for a fixed number of residency positions.

Each year more than a thousand new medical school graduates, most of them deeply in debt, fail to “match” into residency programs and fall into a kind of professional limbo. This is in part because Congress, in 1997, froze the number of residency slots it would allow Medicare to subsidize — a Republican policy the conservative Wall Street Journal editorial board last year shamed congressional Democrats for failing to reverse, in light of what it characterized as a rampant “shortage” of doctors, particularly emergency physicians.

Assessing the physician labor market in February, The Atlantic argued that the barriers to achieving a medical license in America amount to “a conspiracy to limit the amount of doctors practicing in America.”

And yet, younger ER doctors will tell you a starkly different story — one in which ER specialists toil four years in med school and another three or four in residencies, only to spend another six months looking for a job, during which they find that employers are delegating an increasing number of their former duties to nurse practitioners.

A surging rate of doctor resignations in response to the pressures of the pandemic has done little to improve the remaining physicians’ lot. While nurses who are willing and able to quit their jobs and become travel nurses have had little problem quadrupling their short-term pay, doctors who become travel physicians are regularly hit with more pay cuts.

In August 2021, a statistical analysis published in the Annals of Emergency Medicine put hard numbers to the sense of disposability doctors had been experiencing: A near-doubling in the number of emergency room visits being handled by nurse practitioners and physician assistants had conspired with a boom in the number of med school students specializing in emergency medicine to produce an ER doctor glut that was growing bigger every year. The study projected the ER physician oversupply will reach 7,485 doctors by 2030.

By all accounts, the glut has already arrived. A recent thread on a popular ER physician forum dissected two emergency room job listings offering $125 an hour — one a day shift travel nurse on the west coast, and the other a midwestern emergency physician gig with unspecified teaching responsibilities involved. Other discussions have focused on how doctors are increasingly getting paid the same amount as registered nurses. More recently, a labor lawyer posted an employment contract with Apollo-controlled ER staffing firm US Acute Care Solutions, specifying an hourly base physician pay of $21 an hour.

“This should be a wake-up call to the speciality that emergency medicine is becoming a less desirable specialty due to its reputation for increasing corporatization, loss of autonomy, and exploitation,” said Mitch Li, a traveling emergency room physician who also runs Take Back Medicine, a grassroots support network for doctors grappling with private equity buyouts.

The Residency Gravy Train

There’s an obvious reason for the doctors’ unique lack of labor market leverage: The emergency medicine specialty is bringing in nearly twice as many med school grads as it did a decade ago, and almost triple the number it attracted in 1998.

That is thanks to a near doubling of residency programs designed to train doctors in emergency medicine since 2008; no other medical specialty has experienced such a boom. The residency surge became particularly overheated in the years before the pandemic, when the Accreditation Council for Graduate Medical Education accredited 77 new emergency residencies in three years alone — only 19 of which claimed any affiliation with a university medical school.

And while most of those programs would be profitable solely on the basis of the deeply discounted medical labor and physician recruitment costs associated with hosting a residency, the government subsidies associated with most residencies, most of which are subsidized by Medicare, make them bona fide gravy trains. When Philadelphia’s Hahnemann hospital auctioned off its 550 residency slots in 2019 in the aftermath of a complex private equity acquisition and looting of the facilities, the residencies fetched $55 million. And according to its pitch deck, APP calculates that the expansion of a Medicaid-subsidized residency program it manages in a chain of Michigan hospitals will add an extra $3 million to its annual earnings.

Residency programs’ financial rewards likely would have caused a physician glut much sooner, had Congress not frozen the number of Medicare-funded medical residency spots as part of its 1997 Balanced Budget Amendment. In the years that followed, hospital lobbies began complaining that the caps were causing a “doctor shortage.”

The scare tactics worked. In 2013, after local newspapers eagerly reported on the coming dearth of doctors, Florida hospitals convinced then-Gov. Rick Scott (R) to earmark an extra $80 million a year in Medicaid funds to subsidize new medical residencies.

The most prominent driver of the ER doc glut, doctors say, is the hospital giant HCA Healthcare, which has emerged as the nation’s largest single sponsor of post-med school residency programs.

This is a recent development: Until 2015, HCA’s annual report contained a boilerplate sentence about how its hospitals “do not typically engage in extensive medical research and education programs.” Last year, the company issued a press release welcoming an incoming class of two thousand medical residents and boasting of being the “largest provider of graduate medical education” in the country.

Physicians with experience in various outposts of the hospital chain’s burgeoning educational empire say that HCA is exploiting residents at the expense of their educations and future patients. Doctors familiar with HCA residencies in Florida, for example, say the programs are often run by physicians with flimsy-to-nonexistent academic credentials, and many say they are mystified as to how the programs first gained accreditation.

“These hospitals have so few nurses left that the residents are stuck doing all the IV bags, changing the sheets, while any patient with a moderately complex case is going elsewhere,” said one physician familiar with HCA residency programs, who asked to remain anonymous because they live in a state where the company has substantial market power. “Now, there’s nothing wrong with doing a few IV bags or doing what needs to be done in a crunch, but a residency is where you’re supposed to learn how to handle the big complex cases. HCA is just destroying the educational experience of a lot of these young docs.”

HCA’s entrance into the residency business opened the floodgates, paving the way for dozens of smaller health systems to launch residency programs and lobby their state Medicaid agencies to subsidize them. Unsurprisingly, many of these efforts also offer subpar training opportunities.

And one APP physician shared details of a side gig supervising a new EM residency program launched by a struggling nonprofit hospital in what they called an “apocalyptically poor” Rust Belt town.

“[It has] no business running a residency program,” said the physician, adding that the hospital hadn’t even employed a board-certified ER doctor prior to launching the program. “But they’re desperate to bring in money and they’re desperate to bring in doctors.”

Stuck On The Corporate Medicine Hamster Wheel

While APP might be expecting the growing ER doctor glut to pad its bottom line, that hasn’t stopped it from resorting to questionable tactics to slash services and pay in the meantime.

For years, contract management groups like APP have used their ability to bill affluent patients at “out of network” rates as a calling card to squeeze extra revenue out of patients and insurance companies, and their private equity overlords exploited this calling card by financing the vast majority of their small practice buyout sprees with junk debt. But since various laws began to chip away at surprise billing in late 2020, these staffing firms have been left deeply indebted, and bordering on insolvent.

APP is probably among the least overleveraged companies in the private equity ER business right now — and still the company has struggled to refinance its half-billion dollar debt load. In response, several employees say APP is taking its financial woes out on doctors and using surprise billing legislation as an excuse to enact deep cuts.

A doctor whose practice was acquired by APP in 2019 says the company has repeatedly made contradictory statements about revenue in what the doctor perceived as an attempt to force through gratuitous wage and staffing cuts. “They’re using the legislation to mask their own looting,” the doctor says, who asked to remain anonymous for fear of retaliation.

Like most doctors working full-time for private equity-backed ER contractors, APP’s physician pay is calculated using a complex formula that theoretically compensates doctors based on the revenues their ERs generate during their shifts. But even though ER volumes have now fully recovered to pre-pandemic levels, the APP doctor said their pay is still roughly 30 percent lower than it was before 2020.

Similarly, a Texas lawsuit filed against APP by nine physicians in March accuses the company of using its wage formulas as a smokescreen for arbitrarily slashing pay. The lawsuit claimed APP was funneling wages from physicians in a bid “to artificially inflate its books to appeal to investors and avoid insolvency by maintaining cash flow at the direct expense of the doctors.”

While their wages are falling, doctors say these private equity-imposed compensation schemes and staffing cuts are leading them to see more patients than they can handle.

Li of the anti-private equity group TMB said the proliferation of such private equity-imposed pay formulas is another factor pushing doctors in his specialty to consider labor unionization. “Basically, these pay structures create a really toxic workplace culture even when they don’t jeopardize patient safety, where doctors are fighting one another for [high revenue] patients,” said Li, whose popular Facebook group has attracted nearly 4,000 members, mostly physicians. “And I think doctors are sick of being pitted against one another.”

In early May, Li’s Take Medicine Back group hosted a forum with physician union organizer Joe Crane. Nursing unions, Crane pointed out, had not simply achieved higher wages and work-life balance for the profession, but safer staffing ratios in the hospitals in which they organized and even whole states like California. The message had a special resonance, said Li, for ER doctors stuck on the “corporate medicine hamster wheel of doing more work for less pay.”

As Li added, “There are probably regional exceptions to this, but the basic fact is that we wouldn’t have an ‘oversupply’ of ER doctors if ERs were staffed appropriately.”

https://www.levernews.com…

Why Seniors Like Me Are Fighting Against Medicare Direct Contracting and ACO REACH

I learned the hard way that if privatization prevails and Wall Street firms are allowed to make decisions about your health care, their profits will always come first.

By Rick Timmins
Common Dreams, May 19, 2022

When I became eligible for Medicare I had to make the choice between Traditional Medicare and Medicare Advantage (MA), the version of Medicare run by for-profit insurance companies. At first glance, it was a no-brainer: Compared to Traditional Medicare, MA offered additional coverage such as vision, hearing, and dental, with a cap on out-of-pocket expenses. I took the bait and signed up for MA, but soon discovered this was a big mistake.

A few years passed with no issues, but an old injury progressed to a need for knee replacement surgery. The MA plan required my doctor to submit a request for approval for any referral. I was caught by surprise when the MA plan denied my doctor’s referral to a well-known surgeon, because he was not on their preferred “network”—a decision not based on my health, but on the insurer’s bottom line. I limped along until the end of the year when I switched MA plans to one that covered my chosen surgeon. The fact that a for-profit insurance company could overrule my doctor’s recommendation and my own medical choices was a warning sign that there was a problem with my Medicare choice. And things only got worse.

A couple years later, a small lump on my ear that had been diagnosed previously as benign began to grow and became painful. My primary care provider was concerned about a melanoma, so he quickly submitted a request to refer me to a dermatologist that had been strongly recommended and was in the MA plan’s network. Knowing that early diagnosis and immediate treatment is key to managing melanomas, I became worried when the insurance company hadn’t responded within a couple of weeks.

I called the insurance company and was told that there was no record of this request for authorization. My doctor re-submitted the request. Over the next five months, I made multiple phone calls to the MA insurer, and my doctor again re-submitted the request.

Meanwhile, the lump grew larger and more painful, and I was getting very stressed.

Finally, a customer service representative admitted that the insurer had subcontracted the prior authorization process to another company, and somehow lost the request in the shuffle. This was not very reassuring and I was very anxious.

Nine months after the original request was submitted, I am now recovering from a surgery to remove a malignant melanoma and to search for possible metastases in local lymph nodes. Because of the size and aggressive nature of the tumor, I am being assessed for immunotherapy. If I had been on Traditional Medicare, I could have made the appointment directly with the dermatologist when the symptoms first occurred. I could have potentially avoided major surgery, immunotherapy, and the stress of uncertainty .

I am not alone in this situation. Every day millions of other seniors and adults with disabilities experience denials and delays in needed medical care because MA insurance companies put profits before patients. In a survey by the American Medical Association, a majority of doctors said that prior authorization prolongs illnesses and worsens outcomes for patients. An investigation by the Department of Health and Human Services found that MA plans were inappropriately denying care for patients that would have been approved under Traditional Medicare.

Despite undeniable evidence that Wall Street middlemen drive up costs and deny care, the Center for Medicare and Medicaid Services has begun to move Traditional Medicare beneficiaries into a program called Direct Contracting, now rebranded as “ACO REACH,” which inserts profit-driven middlemen between seniors and their health care. Even worse, seniors who chose Traditional Medicare are being automatically enrolled into this program, without their knowledge or consent.

Direct Contracting/REACH may not be the same as Medicare Advantage, but it’s also sure not the same as Traditional Medicare. At least not when you follow the money. Profits that go into the pockets of investment firms and insurance companies come from taxpayers, and threaten to shrink the Medicare Trust Fund.

We can end Medicare Direct Contracting and REACH, but we need everyone to join in. On Monday, May 23, we’re launching a powerful national movement of seniors, doctors, nurses,  and community leaders who are ready to fight back against Medicare profiteering. At our “Turning up the Heat on Medicare Direct Contracting and REACH” event, you’ll hear from seniors like me and also from Congressional leaders such as Reps. Pramila Jayapal and Katie Porter. The event is free and open to all, but you must register in advance HERE.

I learned the hard way. If Wall Street firms are allowed to make decisions about your health care, their profits will always come first. Help me make sure that Medicare puts patients over profits, and join me on May 23.

Rick Timmins is a retired veterinarian who has been in private practice in Oregon, worked in the pet food industry and taught at the School of Veterinary Medicine in Davis, CA, and at Carroll College in Helena, MT. He is active in the Puget Sound Advocates for Retirement Action, which works across generations for social justice, economic security, dignity, and a healthy planet.

https://www.commondreams.org…

Fighting Racism with Health Reform

Summary: The “Great Replacement Theory” is a deeply racist philosophy pushed by the US right wing in a bid for political power. The current system of health care financing is no less racist, though mainly as side effect rather than tactic. Single payer would contribute immensely to decreasing racism.

Comment:

By Jim Kahn, M.D., M.P.H.

On Saturday, ten people, mostly black, were murdered in Buffalo NY by a young man motivated by the “Great Replacement Theory” – a belief that whites in America are being replaced in their rightful dominant position by an inferior class of individuals. This is pure racism. It has been repeatedly and intensively promoted in the pursuit of political power (and associated financial riches) by Fox News, other right-wing traditional and social media, and many GOP politicians. It is a scourge on America, a heinous myth stoked recurringly over the decades by the powerful to translate lower and middle class struggle and uncertainty into rage and votes. It contradicts two of our country’s fundamental values, equality and fair play. It elides our history of genocide of Native Americans. It is the worst of America.

Health care financing is equally racist. Not by intent, for the most part, not as a tactic to create power, but as entirely predictable collateral damage in the pursuit of profit. Our fractured system of health care is tiered, from the most luxurious health plans, with access to world class care, to underfinanced “health insurance for the poor” and legions of uninsured. People of color, especially Blacks and Hispanics, are the most likely to be poor and un-insured. They are the most likely to have shortened lives. They are the most affected by inadequate capacity for treatment of drug dependency.

What can the single payer movement do to fight the horrendous racism so visible this week? We can – must – continue the pursuit of a just and efficient health care system. Covering everyone with high quality insurance will end health care financing racism. It will also ease the day-to-day struggles facing tens of millions of middle-class and poor people of all races, diffusing the anxiety among many whites that makes them susceptible to the “replacement” goading.

We must replace our profoundly dysfunctional and discriminatory system to pay for health care with a humane and efficient alternative. Yes, the replacement we’ve been advocating for is a huge element in the fight against the evil “replacement” theory that has tragically surfaced in the news.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Seniors, doctors, and members of Congress to launch summer of action against Medicare profiteering

"Turning Up the Heat on Direct Contracting and REACH” event to attract thousands of activists

FOR IMMEDIATE RELEASE: May 18, 2022

Media Contact: Clare Fauke, Physicians for a National Health Program, clare@pnhp.org

WHAT: “Turning up the Heat on Medicare Direct Contracting and REACH” event

WHEN: Monday, May, 23 at 1:00 p.m. EDT (45 minutes)

WHO: Speakers include:

  • U.S. Rep. Katie Porter
  • U.S. Rep. Pramila Jayapal
  • Drs. Ed Weisbart and Ana Malinow, Physicians for a National Health Program
  • Rick Timmins, Puget Sound Advocates for Retirement Action
  • Dee Dorsey and Bill Bianchi, Jane Addams Senior Caucus
  • Kathryn Donahue, RN, California Alliance for Retired Americans
  • Dr. Laurel Mark, co-chair of Physicians for a National Health Program Wisconsin Chapter

HOW TO WATCH: The event will be broadcast live on ActTV. Watch live at ProtectMedicare.net/WatchNow

On Monday, May 23 at 1:00 p.m. ET, thousands of seniors, doctors, nurses, and community leaders will gather to learn about Medicare Direct Contracting and REACH, and how they can fight back against Medicare profiteering. 

“Turning up the Heat on Medicare Direct Contracting and REACH” will include a presentation on the nuts-and-bolts of Direct Contacting (to be renamed “REACH” in 2023), testimonials from Medicare beneficiaries, and a call to action from Congresswomen Katie Porter and Pramila Jayapal. 

U.S. Rep. Jayapal, who is the chair of the Congressional Progressive Caucus, encouraged seniors and health care advocates to join the event. “The Direct Contracting and REACH program is Medicare privatization hidden in layers of bureaucracy,” she said. “It allows a profit seeking third-party like a health insurer or private-equity backed firm to get paid by Medicare to manage seniors’ care, taking for themselves as profit whatever they don’t want to spend on the patient. That’s why the Congressional Progressive Caucus is calling on the Biden Administration to fully end this program.”

Retired veterinarian Rick Timmins, an active member of the Puget Sound Advocates for Retirement Action (PSARA), will share his story about a life-threatening delay in care caused by insurance middlemen in Medicare Advantage. “I learned the hard way that if Wall Street firms are allowed to make decisions about your health care, their profits will always come first,” said Timmins. “When I heard that Medicare was expanding the role of profit-seeking middlemen through Direct Contracting and REACH, I knew I had to speak up.” 

Timmins noted that PSARA recently helped pass a Seattle City Council resolution calling for an end to Direct Contracting and REACH and all Medicare profiteering, and encouraged other local groups to take action. 

What is Direct Contracting and REACH?

Direct Contracting (which will be renamed “REACH” in 2023) changes the way that Traditional Medicare pays for care. Instead of paying doctors directly, Medicare pays a third-party middleman a monthly fee to “manage” seniors’ care, allowing the middleman to keep what they don’t spend on health services (up to 40%) as overhead and profit. Virtually any type of company can be a Direct Contracting middleman, including Medicare Advantage insurance companies, private equity investors, and other Wall Street profiteers. Seniors who chose Traditional Medicare are being automatically enrolled into Direct Contracting without their knowledge or consent. Today, 99 Direct Contracting Entities have enrolled 1.8 million beneficiaries in nearly every state.

The event is co-sponsored by Physicians for a National Health Program, Social Security Works, Public Citizen, Indivisible, People’s Action, California Alliance for Retired Americans, Puget Sound Advocates for Retirement Action, and Jane Addams Senior Caucus.

Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.

Bernie’s Medicare for All vs. Price Manipulation for Profiteering

Summary: Recent news highlights the stark choice we face. Bernie Sanders’ updated Medicare for All bill was introduced in the Senate. Meanwhile, a JAMA Health Forum article reveals another way that corporations (this time, Pharma) manipulate prices to maximize profits on the financial backs of patients. The choice is clear!

Bernie Sanders Reintroduces Medicare for All Bill, Saying Healthcare Is a Human Right, Democracy Now, May 13, 2022

Vermont independent Senator Bernie Sanders has revived his bill to provide Medicare for all U.S. residents. The measure has 15 Senate co-sponsors, all of them in the Democratic Caucus. Sanders unveiled his proposal Thursday at a hearing of the Senate Budget Committee, which he chairs.

Sen. Bernie Sanders: “It is not acceptable to me nor to the American people that over 70 million Americans today are either uninsured or underinsured. As we speak, right now, this moment, there are millions of people in our country who would like to go to a doctor, who have to go to the doctor, but simply cannot afford to do so. This is unacceptable. This is un-American. And this cannot be allowed to happen in the wealthiest country on Earth.”

Bernie’s tweet here, and below:

Health care is a right to all in:

If every other major country can guarantee health care as a right to all its people, why can’t we? Yes, it’s time for Medicare for All.

Trends of Prescription Drug Manufacturer Rebates in Commercial Health Insurance Plans, 2015-2019, JAMA Health Forum, May 6, 2022, by Elizabeth Plummer et al.

[T]his economic evaluation show[s] that from 2015 to 2019, the growth of prerebate prescription drug costs (used for patients’ cost sharing) outpaced the growth of postrebate drug costs for all 3 commercial plan types.

[In the figure, Drug cost PCL = annual drug spending per covered life (per beneficiary)]

Comment:

By Jim Kahn, M.D., M.P.H.

The contrast is clearly captured by the two graphics:

Bernie’s flags highlight that Medicare for All bill would finally place the US into the world of wealthy nations, which guarantee health care.

Plummer’s figure shows how drug companies and pharmacy benefit managers (PBMs) manipulate the payment system to increase their profits:

  1. Both sets of bars show the relentless rise in drug costs;
  2. The blue bars show how pre-rebate spending rises especially fast. This is the basis for patient cost-sharing.
  3. The beige bars show how post-rebate spending rises more slowly. This is the cost to insurers.
  4. The blue line shows how the rebate rises rapidly from 11% to 19%. This creates a gap between prices seen by consumers and real prices.

The result is rapidly rising cost-sharing for consumers, more slowly rising costs for insurers (though ultimately paid by consumers via premiums!), skyrocketing profits for drug companies, and booming profits for PBMs, a relatively new and superfluous intermediary.

This subterfuge represents the system’s large players colluding (in effect, if not by formal grand plan) to shift more costs onto patients while padding already huge profits.

The choice is really very clear.

http://healthjusticemonitor.org…

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St. Louis aldermen unanimously endorse national Medicare for All bill

By Mark Schlinkmann
St. Louis Post-Dispatch, May 13, 2022

The Board of Aldermen, with no debate, on Friday endorsed a Medicare for All bill pushed by U.S. Sen. Bernie Sanders, I-Vermont, and progressive Democrats in Congress.

The board on a voice vote passed a resolution backing the idea. No one opposed the resolution, sponsored by Alderman Pam Boyd, 27th Ward.

At an aldermanic committee hearing Thursday, Dr. Ed Weisbart, a local physician, said the resolution is part of a nationwide effort to get municipal governing bodies to endorse the idea. St. Louis is the 98th city to adopt such a resolution, said a spokeswoman for Public Citizen, a nonprofit advocacy group.

“It’s one more argument that … the country is asking for this,” said Weisbart, who chairs the Missouri chapter of Physicians for a National Health Program.

Also speaking in favor was Angela Brown, CEO of the St. Louis Regional Health Commission.

She said the plan would offer “a system everyone can really access when it’s needed.” She said the coronavirus pandemic had highlighted longstanding inequities in health care that a single-payer plan could address.

Boyd, the resolution sponsor, said the current system of private insurance plans is confusing.

Another supporter, Alderman Christine Ingrassia, 6th Ward, said people are “falling through the cracks” under the current system.

More than 30 million Americans lack health insurance coverage, according to estimates by the Centers for Disease Control and Prevention.

The aldermanic resolution coincides with Sanders’ introduction this week of the Medicare for All Act of 2022 in the U.S. Senate.

The bill, which has 15 co-sponsors, proposes a four-year phased expansion of the existing Medicare program.

In the first year, the eligibility age would be lowered from the current 65 to 55, and benefits to older beneficiaries would be expanded to include dental care, vision care, hearing aids, prescription drug benefits and home and community-based care. Additionally, all children under 18 would be covered, according to a summary of the measure. The eligibility age would drop to 45 in the second year, 35 in the third, and include everybody else in the fourth year.

Sanders has argued that while the program expansion would be expensive, it would be less costly than the current for-profit system.

https://www.stltoday.com…

Medicare for All Explained Podcast: Episode 77

The Healthcare Skin-in-the-Game Myth

May 15, 2022

Podcast host Joe Sparks dispels the “skin in the game” myth that assumes people will overuse health care when it is freely available, and should therefore be made to pay at least part of the costs of their care out of pocket.

“People already have skin in the game when it comes to their health,” he says, “and extra costs don’t change that. They just prevent people from getting the care they need.”

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

https://medicareforallexplained.podbean.com

Who’s in charge, them or us?

Summary: This JAMA commentary supports doubling down on “value-based care” despite a dismal record of failed demonstrations, and doing so in the context of our dysfunctional multi-payer system. Make no mistake – this is all about enriching corporations that increasingly control our health system. They’re winning, but single payer can still come from behind.

The Center for Medicare and Medicaid Innovation — Toward Value-Based Care, JAMA, May 9, 2022, by John E. McDonough and Eli Y. Adashi

Section 3021 of the ACA established the Center for Medicare and Medicaid Innovation (CMMI), replete with $10 billion in guaranteed federal appropriation for 2010 through 2019. Ensconced within the Centers for Medicare & Medicaid Services (CMS), the CMMI was to expand the scope and accelerate the pace of learning with an eye toward hastening the transition from fee-for-service payment models to value-based care.

Since its inception, the CMMI has launched more than 50 model tests involving 28 million patients and more than 528,000 health care practitioners. These efforts at transitioning to value-based care involved Medicare, Medicaid, the Children’s Health Insurance Program, and commercial payers. Of the greater than 50 models tested during CMMI’s first decade, only 6 generated significant savings for Medicare and thereby for taxpayers. Despite this limited record of success and continuing political disagreements regarding Medicaid expansion and other aspects of the ACA, the drive for value-based care remains widely endorsed by both political parties and across most segments of the health care sector.

The first strategic objective of the CMMI, to “drive accountable care,” continues and accelerates this core initiative. CMMI’s new strategy sets an ambitious goal according to which “[A]ll Medicare beneficiaries with Parts A and B will be in a care relationship with accountability for quality and total cost of care by 2030,” as will “the vast majority of Medicaid beneficiaries.”

The second strategic objective of the CMMI, to “advance health equity,” will assume a much higher profile in CMMI’s second decade than it did in its first. Specifically, the CMMI will “require participants to collect and report the demographic data of their beneficiaries.”

The third strategic objective of the CMMI, to “support care innovations,” elevates and operationalizes the incorporation of social determinants of health into the “daily DNA” of the work of the CMMI.

The fourth strategic objective of the CMMI, to “improve access by addressing affordability,” seeks to reduce by 2030 the percentage of beneficiaries who forgo necessary care because of cost.

The fifth and final strategic objective of the CMMI invites opportunities to “partner to achieve health system transformation” by aligning priorities and policies across CMS, and by engaging “payers, purchasers, providers, states, and beneficiaries to improve quality, achieve equitable outcomes, and to reduce health care costs.” Under this strategic objective, all new CMMI models are to make multipayer alignment achievable by 2030.

The value-based care transformation of the US health care system as launched by the ACA is now more than a decade old. Some components of the ACA were the subject of intense and lengthy political conflict. However, the value-based care movement enjoyed near-universal support from federal leaders and key physician, hospital, and other health system organizations despite heretofore mediocre outcomes on both cost and quality. The new CMMI review and planning initiative is a welcome opportunity to renew and reinvigorate this vital national project, especially with the heightened profile of health equity as a core goal.

Comment:

By Don McCanne, M.D.

We now have a decade of “value-based care” experimentation through the Center for Medicare and Medicaid Innovation (CMMI) involving 28 million patients and over a half million health care practitioners. Eighty-eight percent of the VBC models clearly failed and the other twelve percent “successes” were dubious or minimal. Yet the contention is that “value-based care” is widely endorsed and thus the transition should be hastened. The strategic objectives planned over the next decade appear to be intensification of the same questionable policies.

Particularly ominous is the plan to have our entire health care system locked into multi-payer alignment of all new CMMI models by 2030, obviously precluding consideration of a single payer Medicare for All model. That should give the multibillionaires and their private equity enough time to acquire our entire health care delivery system. It will be interesting to see how they implement their value-based care as we pass our health care trillions to the billionaires.

Perhaps we, the people, in an effort to revitalize our movement, should consider adopting a virtual mascot, a pony named Single Payer. We could give it a trial run against a field of ponies representing private equity, corporations, billionaires, industry-supported politicians and deaf government bureaucrats. Since they all operate in secrecy, for this test run we could give our pony the lucky pseudonym Rich Strike (sound on, full screen) … from behind, Rick Strike (Single Payer) wins!

Okay, just a pretend virtual reality, but if they are going to tell us that we want value-based care for all in the form of privatized Direct Contracting/REACH and then force it upon us, can’t we, as the people, force single payer onto the billionaires, bureaucrats, and politicians – for the benefit of all of us? I’d like to ride that virtual pony!

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.