PNHP

Do Super PACs Pack a Punch for Single Payer?

Do Super PACs Pack a Punch for Single Payer?

Summary: Despite majority support, single payer faces huge political obstacles. In response, Joseph Q. Jarvis, a longstanding family and public health physician, proposes a political tool: a Super PAC, a political action committee which raises money from varied donors to advocate on an issue, without coordinating with parties or candidates.

American Health Security Project, Website for Super PAC

No matter who you are, where you are from, what you believe, how old you are, or what your work status is, if you live in the United States you and your family should be guaranteed to receive medically necessary care when sick or injured, without worrying about how to pay for it. …

We pay twice as much as any other developed nation for health care, yet we have the worst health of them all. And while we pay the highest taxes for health care in the world, tens of thousands of Americans die each year from treatable illness merely because they can’t afford medical care.

FAQs:

What are the goals of the American Health Security Project?

  • The AHSP is determined to get legislation passed that is Universal and removes all financial barriers from seeking care.
  • This legislation must create a system that is non-profit, publicly-funded healthcare.
  • The system must include comprehensive coverage with essential benefits such as dental, vision, audiology, and mental health services.

Does the American Health Security Project support Medicare for All?

Absolutely. Medicare for All, a single payer system, is the goal of the AHSP.

Why a Super PAC?

For too long healthcare advocates have been at a disadvantage. For-profit insurers and pharmaceutical companies have the ability through Super PACs to pour millions into fighting against Medicare for All and State-Based universal healthcare bills. It is overdue that we level the playing field.

Tell Sec Becerra to Support Granting Federal Waivers to Streamline State Healthcare Expansion, Sponsored by American Health Security Project, The Action Network. March 19, 2022

Sign this petition to Xavier Becerra (Secretary of the Department of Health and Human Services) asking him to publicly state his support of federal funding for state-based single payer healthcare and commit to approving the waivers that would streamline state healthcare expansion. While states can fund these programs via taxes, the federal government’s assistance would ensure success, even in states with limited revenue.

While we push for Medicare for All, we also encourage states to expand coverage to their residents via legislation and ballot measures. Throughout our nation’s history, our states have served as the incubators of democratic ideas. Our neighbors in Canada established their own successful national health program by allowing the province of Saskatchewan to lead with a universal hospital care program in 1947, a decade before the plan took hold nationwide.

The American Health Security Project and our allied sponsors of this action, ask you to sign this petition to Xavier Becerra asking him commit to approving waivers in states like California, Maine, Washington, New York and the many other states with active single payer legislation!

Comment:

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

Let’s be honest: the electoral / legislative politics of the US are stacked against single payer. Too many dollars flow to politicians from those who benefit from the current profit-extracting non-system of paying for and delivering healthcare. Our fight for single payer takes many forms, including grassroots organizing, education, writing (to wit, HJM), and research. We retain popular support for single payer, but lose critical battles. Meanwhile, health insurance and providers are increasingly controlled by private for-profit entities. The short-term political prospects are daunting.

Would a meet-fire-with-fire approach help break the logjam? Joseph Q. Jarvis (physician and author of “The Purple World: Healing the Harm in American Health Care”) believes so. He has launched the “American Health Security Project” (AHSP) in order to use a within-the-system political organizing tool (a Super PAC) in support of a replace-the-system solution (single payer).

You can read about AHSP in his op-ed in The Salt Lake Tribune, Support the American Health Security Project. I didn’t excerpt this above because it elides mention of the single payer goal of AHSP. Jarvis takes inspiration from John McCain, for whom the ACA owes its survival, but not a single payer proponent. Jarvis wrote in the op-ed, “Those of us who are trying to change how Americans do health care business must recognize that health system reform is about politics. No amount of education or marching to the draw attention to the plight of American patients will change the grip of the medical industrial complex on business as usual in American health care. Health system reform … is a power grab …”

The unambiguous support of AHSP for single payer is expressed on its website and in the letter to Sec. Becerra. I welcome that clarity.

I’m not a political tactician, but don’t believe that anyone has figured out the surefire political path to single payer (more on state vs. national efforts in a few days). I hope that AHSP gains traction as one piece of the puzzle, growing the breadth and strength of the single payer movement.

http://healthjusticemonitor.org…

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Medical Debt Multi-Generational Affliction

Summary: Medical debt is common and iatrogenic*, induced by un- and under-insurance. A new survey confirms that it has serious consequences, most of all for mid-life and younger demographics: Gen X (born 1965-80), Millennials (1981-96), and Gen Z (1997-2012). Boomers and the Silent Generation also feel its effects.

* Iatrogenic: Illness caused by medical interventions.

See Update below.

One in Four Gen Z, Millennials Skip Rent or Mortgage Due to Medical Debt: Survey, HealthCare.com, March 15, 2022, by Dan Grunebaum

HealthCare.com’s 2022 Medical Debt Survey shows about one in four Gen Zers and Millennials with medical debt skipped rent or mortgage payments because of their debt.

Close to half of Millennials and Gen Xers with medical debt say the debt harmed their credit score.

Two in three Gen Zers who have health insurance but still incurred medical debt say their health insurance plan didn’t cover the service they received.

More than half of U.S. adults with incomes below $25,000 and medical debt had their bills sent to debt collectors.

Comment:

By Don McCanne, M.D.

Because of the nation’s refusal to replace our fragmented, inequitable system of health care financing with a universal, comprehensive, equitable single payer system, it is inevitable that many individuals will face problems when they are unable to pay their medical bills. This survey describes some of those problems.

Perhaps one of the more alarming is the need to skip rent or mortgage payments thereby threatening their housing. This is a major consequence when you consider that a well-designed, universal, single payer system would totally remove the threat to housing caused by medical debt.

Some of the other risks are the obvious: damaged credit score decreasing flexibility in the marketplace, being hounded by debt collectors, decreased ability to build capital reserves for purposes such as retirement. In other words, screwed up credit merely because of the misfortune of having medical problems in a nation that has still declined to adopt a truly universal, comprehensive, equitable, progressively funded, health care financing system that we all could afford.

How can we tolerate seeing people evicted from their homes merely because of having faced medical misfortune for which our current health care financing system will not guarantee coverage? We can fix that.

Update:

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

This just in: credit agencies have agreed to remove paid medical debt from credit reports, thus not using it to lower credit ratings. But that doesn’t prevent the problems described in today’s post. Indeed, unpaid medical debt, and rent and credit card bills not paid due to paying off medical debts, *will* hurt credit scores. We can’t fix this broken system with band-aids.

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.

Medicaid Coverage Turmoil as COVID Pandemic Eases

Summary: With federal protections for Medicaid coverage during the public health emergency winding down, states are aiming for an orderly “redetermination” process. Translation: orderly ousting from public insurance. About 1 in 8 individuals with Medicaid coverage will lose it, up to 1 in 3 in some states, often due to process problems. This is a double whammy – administrative burden that worsens access to care. Instead, we need lifelong, universal, equitable coverage.

Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey, Kaiser Family Foundation, March 16, 2022, by Tricia Brooks et al.

Executive Summary: Enrollment in Medicaid has grown significantly during the coronavirus pandemic. Provisions in the Families First Coronavirus Response Act (FFCRA) require states to provide continuous coverage for Medicaid enrollees until the end of the month in which the public health emergency (PHE) ends in order to receive enhanced federal funding. Continuous enrollment has helped to preserve coverage and halted Medicaid churn. However, when the PHE ends, states will begin processing redeterminations and millions of people could lose coverage if they are no longer eligible or face administrative barriers despite remaining eligible. Existing state enrollment and renewal procedures, as well as their approaches to the unwinding of the continuous enrollment requirement, will have major implications for Medicaid enrollment and broader coverage. …

In 20 states able to report, it is estimated that about 13% of Medicaid enrollees will be disenrolled when the continuous enrollment requirement ends. However, the estimates range widely across reporting states from about 8% to over 30% of total enrollees. Based on available data, most states report that an increase in income will be the primary reason for the disenrollments, but several states also expect incomplete renewals or missing documentation to be a primary reason for disenrollment. If these estimates hold true, millions of people will lose Medicaid coverage in the months following the end of the PHE; however, many children will likely be eligible for CHIP and many adults will likely be eligible for Marketplace or other coverage. Successfully transitioning these individuals into those other coverage options could reduce the number who lose coverage altogether and become uninsured.

Comment:

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

One thing we did right on health insurance during the COVID pandemic is to provide continuous coverage for Medicaid participants. That is, don’t remove the poor and near-poor from public health insurance during a public health emergency.

Now that the crisis is easing, we can return to business as usual. Which means:

— Spend a huge amount of effort and money to review eligibility, so if someone is again working (often at a low paying job without health insurance), take away their Medicaid.

— In the process, many people who still do qualify for Medicaid will lose coverage for bureaucratic reasons – missed process steps, not lack of eligibility.

— Net effect: reduced access to care and resulting illness, bankruptcies, and deaths.

Why do we torture ourselves with these burdensome and inhumane systems, when we could cover everyone with high quality insurance for their full lifetimes, while saving money?

Our system is operating with cumbersome rules and indefensible values.

The solution is … yes, you guessed it … single payer. Generous, simple, affordable.

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.

Medicare for All Explained Podcast: Episode 73

Some Survey Results on Why Having Health Insurance Doesn’t Mean Squat

March 15, 2022

Podcast host Joe Sparks discusses a recent survey on medical debt in the United States, which is a totally foreign concept to people in every other industrialized country. He describes the sacrifices that Americans make to pay for medically necessary care, adding that “the important thing to remember is that all of this economic pain and suffering is unnecessary.”

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

https://medicareforallexplained.podbean.com

Pharmacy Carve-Outs: How to Make Privatized Medicaid Even Worse

Summary: California recently inserted a private pharmacy benefits plan into Medi-Cal, despite evidence from other states that it adds costs. Thousands of patients have suffered medication gaps. All this makes no sense, if the goal is efficient, equitable, effective medical care.

Opinion: New Medi-Cal Rx Is Riddled with Problems, Hurting Those Who Need it Most, California Health Report, March 10, 2022, by Hector De La Torre

Despite warnings that the health of the state’s 14 million Medi-Cal beneficiaries would be threatened, on Jan. 1, the California Department of Health Care Services (DHCS) implemented Medi-Cal Rx, the questionable fee-for-service program that stripped pharmacy benefits from health plans and handed Medi-Cal prescription drug purchasing and distribution to a private, for-profit company. Now, a month into the new program, there are reports that thousands of Medi-Cal patients have been left without their medications for days or even weeks. Physicians are concerned that someone is going to die as a result of this flawed system. Remember, these are individuals in an already underfunded Medi-Cal system, and they are the same people who were disproportionately impacted by the COVID-19 pandemic.

As a former State Assembly member, I am appalled that DHCS moved forward with Medi-Cal Rx. Last November, I offered public comment expressing concerns about the system, versions of which had already failed in 10 other states. Those states expected cost savings, like those promised with Medi-Cal Rx, but they did not materialize. And in 2019, the Menges Group released a report that showed Medi-Cal pharmacy expenditures would jump more than 19 percent if California adopted a carve-out model.

Comment:

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

This policy looks like a classic but especially heinous example of corporate profit over all other considerations — notably health of public beneficiaries, and responsibly managing public funds.

Private Medi-Cal plans have their own serious problems. But adding a private medication plan is remarkable for insane counterproductive complexity layered on top of underlying dysfunction. It boggles the mind, after evidence from other states of serious problems with this strategy.

What could be the motivation? Here are some ideas:

  1. Brainwashed faith in the magic of privatization.
  2. Financial conflicts of interest, via campaign contributions and/or promises of jobs or other major monetary benefits.
  3. Advice from analysts or advisors who are brainwashed and/or financially conflicted.
  4. All of the above.

Time to switch cognitive and moral framework, to a “public good” approach – single payer.

Additional Comment:

By Don McCanne, M.D.

Our editor Jim has appropriately reinforced the outrage demonstrated by former State Assembly Member Hector De La Torre. When we have a severely malfunctioning health care financing system in dire need of replacement, society is resorting to a patchwork approach that not only is inadequate, but is moving us backwards from where we need to be as far as privatization is concerned. Serving private corporate interests at the cost of patient care is outrageous. Dare I say that it is time to consider judicious citizen action to redirect our public representatives in the direction of health justice for all?

http://healthjusticemonitor.org…

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Cook County Health chief medical officer encourages healthcare leaders to be staunch patient advocates

Interview with Dr. Claudia Fegan

By Kelly Gooch
Becker’s Hospital Review, March 15, 2022

Each day, Claudia Fegan, MD, brings her passions about healthcare reform and social justice to her role as chief medical officer of one of the nation’s largest public safety-net systems.

Dr. Fegan, an internal medicine physician, became CMO of Chicago-based Cook County Health in 2013.

During her tenure, the Physicians for Social Responsibility recognized her for her work inspiring medical students to commit to social justice careers, and she received the Paul Cornely Award in 2017 for her activist work, according to her biography. She also has been vocal about her support for universal healthcare, even penning a book on the issue: Universal Healthcare: What the United States Can Learn from Canada.

Becker’s spoke with Dr. Fegan during Women’s History Month to discuss her role caring for underserved patients in Chicago. She also shared her thoughts on whether she thinks single-payer healthcare will be a reality across the U.S. and offered some advice for her peers.

Editor’s note: Responses were lightly edited for length and clarity.

Question: As CMO of Cook County Health, how is your role different than it would be at another health system?

Dr. Claudia Fegan: I was a medical director at the now-closed Michael Reese Hospital and Medical Center in Chicago before I came to work at Cook County. I had about 800 physicians who in theory reported to me, but they were in private practice. I represented their voice, but I was also trying to ensure the quality of healthcare that we provided.

At Cook County, I have an employee workforce, and the physicians who work here are deeply mission-driven and they are committed to the patients we serve. I view my role as an advocate for those patients. But I recognize that I’m also the voice of those physicians who are taking care of those patients. I’m responsible for the quality of care we deliver. It’s important to speak with one voice about what physicians’ needs are and how we can best meet the needs of our patients.

When I was at Michael Reese, which had a large indigent population, it was predominantly private medical staff. And that medical staff — while committed to their patients — also had to keep their practices going. They were concerned about the bottom line and how we were going to survive economically. At a safety-net hospital, you’re always concerned about how you’re going to survive economically, but you also need to consider how to reach the patients where they are.

Q: In your opinion, what is the biggest reform the healthcare industry needs?

CF: Right now, we spend a lot of time and energy trying to decide how the care is going to be paid for. The first thing you see when you walk into a clinic, an emergency room, is registration. What’s the purpose of registration? To ascertain how that visit’s going to be paid for. If we had made a commitment that everyone was going to be taken care of and we have limited funds, how would we spend those dollars? We would spend it differently. It’s the difference between having to have hundreds of clerks who could do registration and insurance verification as opposed to when I went to Toronto General Hospital, where they had only three billing clerks, and that was for the occasional American who came to Canada and got sick while they were there.

First, we have to take responsibility, say we’re going to take care of everyone. Then we figure out how we’re going to provide the best care for everyone, recognizing it’s a limited resource and how you spend your healthcare dollars will vary from region to region. How you spend your healthcare dollars in Miami, where you have a lot of people who have retired, or you have snowbirds, is different from how you would spend your dollars on the South Side of Chicago or even in the Bronx, where you’re concerned about the opioid problem, and you’re concerned about making sure babies get well-child care, get immunizations. I think the first thing we need to do is first accept responsibility for everybody and then figure out how we’re going to deliver that care.

Q: Do you think single-payer healthcare will become a reality in the U.S.? 

CF: Single-payer is a financial conduit. I think we will get to something like that. I know Congress tried so many times to repeal the Affordable Care Act, and they couldn’t. I think the American public is starting to think yeah, people should be able to get the best care available. Once you start to think that way, you begin to figure out how we can get it done. The problem was we as a country never decided to accept the responsibility for everyone. We do it for education. We do it for police and fire protection. We recognize one person can’t put out a fire in their home, that they need the help of others. We all banded together and decided we’re going to take care of each other that way. And we recognize children need to be educated, and they don’t always have choices about that, so then we as a society should put forth the resources to make sure that happens. I think if we did that with healthcare, we would do better. We spend more than anybody else in the world per person on healthcare, and yet we leave a third of the people in the country either uninsured or underfunded so they can’t afford to get the care they need. Then we pay a terrible price. I look at maternal mortality, which has quadrupled in the 40 years I’ve been in practice. If you look at our response to COVID, it’s due to our lack of accepting responsibility for all the members of our society.

Q: If you could pass along a piece of advice to other hospital executives, what would it be?

CF: I think we are most powerful when we are advocating for the people we take care of. No one wants to hear about whether we’re meeting our margins or whether we have the appropriate bottom line. But when we advocate for the patients, the public listens and the public responds. If you want to in the community, you’re working to be well-regarded and be heard, then you must advocate for the people you try to take care of.

GOP Subversion of Democracy Curtails Abortion Rights

Summary: Yesterday was the end of the Roe era of federal protection of abortion rights. This is the culmination of decades of GOP anti-democratic efforts to undo majority-supported and health-enhancing reproductive autonomy.

Texas Supreme Court Shuts Down Final Challenge to Abortion Law, New York Times, March 11, 2022, by Kate Zernike and Adam Liptak

The Texas Supreme Court on Friday effectively shut down a federal challenge to the state’s novel and controversial ban on abortion after about six weeks of pregnancy, closing off what abortion rights advocates said was their last, narrow path to blocking the new law.

The decision was the latest in a line of blows to the constitutional right to abortion that has prevailed for five decades.

The Texas law, which several states are attempting to copy, puts enforcement in the hands of civilians. It offers the prospect of $10,000 rewards for successful lawsuits against anyone — from an Uber driver to a doctor — who “aids or abets” a woman who gets an abortion once fetal cardiac activity can be detected.

It is the most restrictive abortion law in the nation, and flies in the face of the Supreme Court’s landmark 1973 decision in Roe v. Wade, which prohibits states from banning the procedure before a fetus is viable outside the womb, which is currently about 23 weeks of pregnancy. …

Abortion rights supporters and legal scholars said the Texas law would encourage other states not only to pass similar bans on abortion, but to attempt to nullify other precedents they oppose.

Comment:

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

Friday sadly marked the demise of Roe v. Wade, which since 1972 – half a century – protected abortion rights based on privacy protections in the 14th Amendment to the US Constitution. The end came in the form of a Texas Supreme Court decision rejecting the last legal path to invalidating a state law banning abortion after 6 weeks of pregnancy, even in cases of rape and incest.

This is almost certain to result in a flood of similar laws in other states and further restrictions in Texas, such as prohibiting help for women seeking abortion out of state. The result will be, aside from reversal of reproductive health autonomy for millions of women, the well-documented serious psychological and physical risks associated with taking an unwanted pregnancy to term – far in excess of harms from abortion. Plus the mortality and morbidity risks from unregulated illegal abortions offered in medically suboptimal settings, often by un- or underqualified practitioners. This is a medical and health justice nightmare.

Why does the title blame “GOP subversion of democracy” for this outcome? Because for two decades, the GOP has used profoundly anti-democratic tactics to mold the US Supreme Court into the perfect anti-Roe instrument. How? By stealing elections (mainly) and ignoring long-standing governing and legal norms. Here is a partial list:

2000: The GOP (George W. Bush) steals Florida and thus the presidential election, through a combination of blocking voting for tens of thousands of mostly minority individuals incorrectly listed as having felony convictions, a horribly confusing ballot design in Palm Beach County (a Dem error), and vote recount disruptions and delay orchestrated by Roger Stone. An already GOP US Supreme Court breaks precedent in a decision removing authority over state voting from the state (contradicting conservative legal doctrine) to end the recount while Bush is still ahead.

2004: Swift Boat dirty tricks gets Bush a second term.

2001-2008: Bush appoints 2 Supreme Court Justices.

2016: In mid-February, conservative Justice Antonin Scalia dies. Senate Majority Leader Mitch McConnell refuses to allow a hearing for Obama’s nominee Merrick Garland, despite nearly a year before the next president takes office. This is unprecedented obstruction.

2016: Trump is elected despite getting 2.9 million fewer votes, and with Russian social media support that some analysts believe tipped mid-western states and thus the election to him.

2017-2020: Trump appoints 3 Supreme Court Justices, creating a 6-3 conservative majority.

2021: Texas passes the abortion law, constructed with a novel and frightening legal theory: The state can evade 14th Amendment constraints on states taking away individual rights by delegating the enforcement of such rights limitations to private citizens via civil litigation. This has been called a “posse” or “vigilante” law – empowering individuals not working for the government to do what the government is not allowed to do. Astoundingly, the US Supreme Court (the conservative majority) permits this approach. This sets the stage for any state to circumvent any federal limits on state action, simply by delegating enforcement to the population.

Thus we see merged a heinous states-rights governing theory, harkening to the 19th century, with conservative social values. Note: only 27% of Americans wanted Roe over-turned.

The delegation legal approach likely will be used to deny other federally guaranteed rights.

A larger and more balanced Supreme Court is appealing. It can be done.

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.

Medi-Cal Expansion Not Enough

Summary: California’s Medi-Cal expansion for undocumented immigrants is laudatory … but is just a partial fix, leaving millions uncovered. It falls profoundly short of what is needed to cover everyone with high quality insurance, while saving money and boosting the economy: single payer.

California is expanding Medi-Cal – but hundreds of thousands of immigrants will still be left behind, CalMatters, February 28, 2022, by Ana B. Ibarra

Experts say allowing people to sign up for comprehensive Medi-Cal coverage regardless of their immigration status is the single biggest step California can take to insure as many people as possible in the current system. Newsom called his latest planned expansion “universal access to coverage.”

But the expansion would still leave several hundred thousand undocumented immigrants uninsured. They are unable to qualify because they have jobs where they earn above Medi-Cal’s annual income thresholds for most adults.

That leaves many low-income immigrants with few viable options for health coverage. While most Californians who earn over the Medi-Cal limit can get subsidized coverage through Covered California, undocumented people are not allowed to buy insurance through the marketplace under the federal Affordable Care Act.

In 2023, after Medi-Cal expands to cover undocumented immigrants 50 and older, about 3.2 million people will remain uninsured in California, according to researchers at the UC Berkeley Labor Center and the UCLA Center for Health Policy Research. Of those, 1.16 million will be unauthorized immigrants.

Even if Newsom’s next step is approved — covering undocumented adults 26 to 49 years old as early as 2024 — that would still leave roughly 450,000 undocumented people under 65 with no health coverage.

Lack of access because of immigration status is just one piece of the remaining uninsured. Many other Californians forgo coverage despite being eligible, likely because of the cost. According to the UC Berkeley and UCLA study, 2 million uninsured people qualify for Medi-Cal, employer coverage or Covered California.

Comment:

By Don McCanne, M.D.

Well, so we can’t have single payer reform because it is too expensive, and we can’t afford the taxes to pay for it. But at least we can fill in much of the void in California and other states by providing Medi-Cal (Medicaid) to the undocumented… or can we? Check out the numbers.

Hundreds of thousands of the undocumented in California would still be left out and millions of other Californians would remain uncovered for other reasons, primarily for lack of affordability of insurance. And worse, our highly dysfunctional, fragmented healthcare financing system that shunts much of our healthcare dollars to entrepreneurial interests while impairing access to needed care would remain in place. Defective incremental patches can never serve as an effective substitute for a comprehensive, equitable, publicly administered, affordable, progressively funded program that is truly universal for life.

The recent Nation article by Michael Lighty shows how ridiculous our concern over single payer costs and taxes has been when we could have an ideal single payer system for less money than we are paying for our current inadequate, dysfunctional system. And the recent study from the Congressional Budget Office shows us that spending on a single payer system would not only fix our healthcare financing system and bring comprehensive health care to everyone, it would also provide improvements to the economy that would benefit all of us.

Merriam-Webster’s definition 3b for insanity: “something utterly foolish or unreasonable”

Now there is an instance we can save on healthcare that doesn’t even take a psychiatrist to manage. Let’s just get rid of our current dysfunctional financing system and substitute it with a single payer system. We’ll not only cure our insanity, we’ll be money ahead!

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.

Single Payer Savings in California

Summary: An excellent commentary in The Nation reviews the cost advantages of single payer in California and generally, the current health care cost explosion, and the unsavory trade-off foisted on us every day: corporate profits up, family health down.

The Plan to Save Californians $117 Billion a Year by Switching to Single-Payer, The Nation, February 25, 2022, by Michael Lighty

Why is universal health care seen as prohibitively expensive when the status quo costs far more?

In the public debate over Medicare for All, the first casualty is always the truth about costs, savings, and taxes. And the recent struggle in California over a proposed statewide single-payer health care bill, the California Guaranteed Health Care for All Act, has been no exception. Scouring the media coverage of the bill, also known as AB 1400, you would find a multitude of statistics and figures, but nowhere would you find this simple fact: Under the current system, health care in California will cost an estimated $517 billion in 2022. …

Reports from the Healthy California for All Commission, a single-payer health care task force appointed by the state government, estimate that the present system, characterized by huge inequities, coverage gaps, restrictions on access to care, and administrative complexity, will cost an estimated $323–$496 billion more in 2031 than would a single-payer system covering everybody. …

But what about taxes, the favorite scare tactic of those who profit from the current dysfunctional system? According to a study from the Healthy California for All Commission, it turns out that the current cost of health care is the biggest “tax” paid by the middle class—ranging from 25 to 40 percent of a household’s income. Single-payer financing eliminates that burden. Replacing the cost of premiums, co-payments and deductibles with modest public tax increases on businesses and high-income individuals seems like a very good deal. (Under California’s AB 1400, households making less than $600,000 per year would see no more than a 1 percent tax increase.) …

If readers are surprised to hear about the savings from single-payer, chalk it up to the influence of the health care industry, which has been repeating the lie that we cannot afford universal health care since 1993. Because the industry can literally charge whatever it wants now, single-payer represents a direct challenge to its profits and power.

Consider the industry’s ability to set the health policy agenda. Counting lobbying expenditures and campaign contributions, the health care sector spends more on influencing lawmakers than any other industry. A study published in The Journal of the American Medical Association found that between 1999 and 2018 “the pharmaceutical and health product industry spent $4.7 billion, an average of $233 million per year, on lobbying the US federal government; $414 million on contributions to presidential and congressional electoral candidates, national party committees, and outside spending groups; and $877 million on contributions to state candidates and committees.” …

The profits of the biggest health care corporations are obscene: Kaiser Permanente had a net income of $8.1 billion in 2021, a record. The same year, HCA, the largest for-profit hospital corporation, booked $7 billion in profits, while United Health, the largest commercial insurer, reported profits of $17.3 billion. … Meanwhile, patients die for lack of insulin, and Congress has so far failed to limit the price of this decades-old drug (as it has failed to limit the price of any prescription drug, which single-payer will do).

Sifting through the scare tactics, misrepresentations, and influence buying of the health care industry reveals a pattern of profiting from human suffering and protecting financial interests at the expense of our health. California, like the rest of the United States, can both save money and address our health inequities by adopting a single-payer system. Yes, we can afford to provide the health care that we need and deserve. In fact, we can’t afford not to.

Comment:

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

My comment is short and sweet – Michael does a stellar job of summarizing favorable single payer cost analyses, rapidly rising healthcare costs in the current system, sky-high industry profits and salaries, political influence through donations and lobbying, and a “pattern of profiting from human suffering and protecting financial interests at the expense of our health.”

This piece is a must-read.

Single payer is a must-do.

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.

250+ community and senior organizations reject CMS “rebranding” of Medicare Direct Contracting, demand cancellation of ACO REACH replacement

Groups send letter to HHS Sec. Becerra calling for an end to Medicare privatization experiment

FOR IMMEDIATE RELEASE: March 8, 2022

Media Contact: Clare Fauke, PNHP communications specialist, clare@pnhp.org

Today, more than 250 organizations representing seniors, people with disabilities, consumers, and health professionals sent a letter to Health and Human Services (HHS) Sec. Xavier Becerra and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, shunning the agencies’ rebranding of the controversial Medicare Direct Contracting program into “ACO REACH,” and calling for an end to all Medicare privatization experiments. 

The signers range from major national groups like Public Citizen, Social Security Works, and The National Retiree Legislative Network, to local and regional organizations like the Consumers Council of Missouri and the California Alliance for Retired Americans.

“Hundreds of community leaders joined forces to say: You can’t fool us, we know Medicare privatization when we see it,” said Dr. Susan Rogers, president of Physicians for a National Health Program (PNHP), an organization of 25,000 doctors that support Medicare for All and oppose Medicare privatization. “HHS gave Direct Contracting a fresh coat of paint, but we can see right through it.”

Today’s letter calls on Sec. Becerra to immediately end Medicare REACH, reject the privatization of Traditional Medicare, and focus the agency’s resources on strengthening Medicare for generations to come. “If allowed to continue,” the letter states, “REACH would completely transform Traditional Medicare by allowing third-party middlemen to manage seniors’ care, without seniors’ full understanding or consent.”  

“REACH is just privatization by another name and represents a fundamental threat to traditional Medicare and seniors’ access to care,” said Lisa Gilbert, Executive Vice President of Public Citizen. “This program would mean more profit for health care companies at the expense of seniors that choose Traditional Medicare and there is no reason for it to continue. We should be working to rein in profit in health care, not expand it.”

“REACH is simply a new name for the same backdoor scheme to privatize Medicare,” added Alex Lawson, Executive Director of Social Security Works. “Unless the Biden Administration pulls the plug now, this program will put for-profit insurers and Wall Street between seniors and their doctors. This letter shows how broad-based the opposition to REACH is. Tweaks aren’t good enough — Pres. Biden and Sec. Becerra must end this dangerous experiment immediately.”

“As one of California’s foremost Senior grassroots advocacy organizations representing over 1 million members, we are deeply concerned to learn of the intentions from CMS to ‘redesign,’ and not abolish, Direct Contracting in Medicare,” said Pauline Brooks, President of the California Alliance for Retired Americans (CARA). “The Direct Contracting model introduced by the former Administration severely undercuts consumer choice —  once a core tenement of Traditional Medicare —  and expands privatization, and dilutes patient care. CMS’ attempt to advance ‘health equity’ by forcing Traditional Medicare beneficiaries to enroll into REACH is entirely contradictory and a continuation of the disastrous privatization efforts instituted from its predecessor.”

“It is disappointing to see the Biden Administration following in the footsteps of Trump by allowing the Direct Contracting privatization scheme to stand by simply giving it another name,” said Julia Santos, Senior Healthcare Policy Manager for Indivisible. “The REACH program would allow middlemen to fill their pockets at the expense of Traditional Medicare beneficiaries. The Biden Administration can change course right now by directing Sec. Becerra to end REACH and protect Medicare from privatization.”

Dr. Rogers was especially critical of REACH’s superficial nod to equity, adding that, “REACH’s equity incentives are no-strings-attached financial giveaways to middlemen, and could encourage profiteering in underserved communities.” She noted that REACH’s required “equity plan” is a simple fill-in-the blank workbook on the CMS website. 

For example, Dr. Rogers explained that under the new “Health Equity Benchmark Adjustment,” HHS will give REACH middlemen an additional $360 per year for each underserved beneficiary, regardless of how much care that beneficiary receives. REACH will also allow middlemen to inflate beneficiaries’ risk scores based on demographic factors, another opportunity to bolster revenues without increasing care, since like Direct Contracting, REACH allows middlemen to pocket up to 40% of Medicare payments as profit and overhead, incentivizing them to restrict the care of vulnerable seniors. 

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.