PNHP

The Corporate Assault on Medicare

The Corporate Assault on Medicare

Interview with Kip Sullivan

Ralph Nader Radio Hour, January 15, 2022

Health Care for All Minnesota advisor and longtime PNHP member Kip Sullivan spoke with the Ralph Nader Radio Hour about the decades-long corporate takeover of Medicare, including its latest incarnation: Direct Contracting.

If this Trump-era pilot pilot program goes through, “beneficiaries in the Traditional Medicare program, who deliberately decided not to enroll with an insurance company will now be, without their knowledge and possibly against their will, assigned to a Direct Contracting Entity, which is going to operate very much like an HMO.”

For more information on Medicare Direct Contracting, visit https://pnhp.org/StopDCEs.

To access a complete transcript of Kip Sullivan’s interview, visit https://secureservercdn.net.

https://www.ralphnaderradiohour.com…

Medicare for All Explained Podcast: Episode 69

Highlights, Vol. 3

January 15, 2022

Podcast host Joe Sparks returns with additional highlights from Medicare for All Explained, in honor of Dr. Martin Luther King, Jr. He features clips showing how a single-payer system could reduce the racism that exists in U.S. health care, including:

  • Racial inequities in U.S. health care, featuring Dr. Susan Rogers;
  • COVID-19 and racial inequities, featuring Dr. Susan Rogers; and
  • Sociopolitical determinants of health, and lack of health coverage as a racial justice issue, featuring Dr. Sanjeev Sriram.

“Highlights, Vol. 1” and “Highlights, Vol. 2” can be found HERE and HERE. Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Voting Rights and Single Payer – Strikingly Similar

Summary: The Freedom to Vote Act now facing a filibuster defeat in the US Senate specifies rules to implement fair elections. It is a desperately needed cure for systematic efforts to subvert the principle of one-person-one-vote in order to profit the GOP. Similarly, single payer specifies a set of rules to implement fair (and efficient) health care, a desperately needed cure for our system’s subversion of the right to health care in order to profit the rich. Both reforms enjoy majority support; can they prevail?

Letters from an American, January 12, 2022, by Heather Cox Richardson

The Freedom to Vote Act provisions [our summary from narrative]:

Voting Process: Two weeks of early voting, including nights and weekends, minimum 10 hours a day. Voting by mail and drop box. Election Day a holiday. Uniform standards for voter IDs. Waiting time max 30 minutes. Federal crime to lie to voters to deter voting. Increased penalties for voter intimidation.

Voting Eligibility: Voter registration – uniform rules; automatic at DMV; same-day & online; protection from voter list purges. Federal voting rights for people who have been incarcerated.

Equal Representation: No partisan gerrymandering.

Election Funding: Disclosure of major donors and advertising funders. Harder for PACs to coordinate with candidates. Stronger Federal Election Commission oversight.

Vote Count: Protects local election officers from intimidation and firing for partisan purposes. Expands penalties for tampering with ballots. Regulates election audits. Voting machines must leave a paper record.

Sinema Rejects Changing Filibuster, Dealing Biden a Setback, New York Times, January 14, 2022, by Carl Hulse

President Biden’s campaign to push new voting rights protections through Congress appeared all but dead on Thursday, after it became clear that he had failed to unite his own party behind his drive to overhaul Senate rules to enact the legislation over Republican opposition.

In an embarrassing setback for Mr. Biden, Senator Kyrsten Sinema, Democrat of Arizona, stunned her colleagues just hours before the president was slated to make his case to them in person at the Capitol by taking the Senate floor to declare that she would not support undermining the filibuster to pass legislation under any circumstances.

Comment:

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

Our democracy stands at a crossroads. The GOP is altering state voting laws to make it harder for Democrats to vote, to assure GOP legislator majorities much higher than vote majorities (via gerrymandering), and to install partisan election officials who can declare victory even if the GOP loses. This week, President Biden delivered a long-overdue, impassioned defense of democracy. He is urging Senate passage of The Freedom to Vote Act, already through the House of Representatives. It can win in the Senate only if all 50 Democrats agree to carve out an exception to the filibuster rule that permits 41 Senators to stall legislation. At the moment, prospects are slim, due to opposition by Kyrsten Sinema (AZ) and likely Joe Manchin (WV). Their arguments that protecting the filibuster will restore bipartisanship are not credible.

As I took in Prof. Richardson’s summary of The Freedom to Vote Act, it was obvious how similar this bill is to single payer.

Both are based on laudable goals rooted in fundamental values, using simple, efficient, and equitable means.

The Freedom to Vote Act aims to make voting fair, using procedures to realize the fundamental democratic value of one-person-one-vote. The rules proposed are simple (clear and unconvoluted), efficient (through standardization), and equitable (similarly treating all voters in all states).

Single payer aims to make health care universal, using procedures to realize the fundamental human right to health care. The mechanisms are simple (one payer, standard benefits, uniform payments), efficient (slash administrative burden and profits), and equitable (everyone is similarly covered).

Both end exploitation of systems (voting and health care) for personal and group gain – especially by the rich and powerful.

Both enjoy majority popular support. Democrats in the Senate represent 50-56% of US voters, depending how to count, to the GOP’s 43%. And 70% of voters support the Freedom to Vote Act. National single payer support is 50-60% with neutral phrasing.

I’m not cheered by today’s news about Sen. Sinema’s obstruction. I’m still hoping desperately that she, Sen. Manchin, and all Senate Democrats take the actions so obviously necessary to preserve voting rights and democracy.

Regardless, the linked fights for democracy and for single payer continue.

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.

Can’t we try harder to find common ground?

Dana Harbor, California, Jan. 11, 2022

By Don McCanne, M.D.

Sandy and I went down to Dana Harbor late this afternoon for our daily walk, my preferred form of rehabilitation since my recent neurological events. As Sandy and I were getting out of our car a very nice gentleman next to us was loading his dog into his SUV as we exchanged the usual pleasantries.

He happened to look down at his cell phone and expressed exasperation at the message that Gov. Newsom wanted to extend health care to all undocumented Californians. Recognizing that we likely had political differences, in a non-challenging tone of voice I said, “You’d better be careful since I’m a supporter of health care reform.”

He said, “Oh, I am too. We definitely need to finance their health care. It’s just that the governor should not allow such loose borders. I’m a supporter of health care for everyone. Have you seen the homeless on the streets of Los Angeles? We need to be taking care of them.”

As he left, with a smile on his face, he said, “I might be for Trump, but I’m not crazy.”

As Sandy and I walked along Dana Point Harbor Island, I thought, there must be much more common ground here.

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.

Drs. Claire Cohen and Marilyn Vaché on “Thinking Green”

Longtime PNHP members Drs. Claire Cohen and Marilyn Vaché appeared on “Thinking Green,” a program of the New London Green Party on Connecticut Public Access Television, on January 11, 2022. They discussed the threat of for-profit entities in U.S. health care, from Medicare Advantage to the latest scam, Medicare Direct Contracting.

Dr. Cohen reminded us that commercial insurance companies “have their hand in the cookie jar and they’re leeching off the public’s money to make profit.”

For more information on Direct Contracting Entities, visit pnhp.org/StopDCEs.

California Single Payer: Lower Net Cost to Families

Summary: Last week saw the release of a tax plan to finance California’s single payer legislation, AB 1400. It was immediately attacked as a tax increase of $12,250 per family. Hey, wait, don’t premiums and cost-sharing disappear under single payer? Yes indeed! The typical family saves money. Health insurance guaranteed, with savings. And no more medical debt or bankruptcy.

ACA-11 Taxes to fund health care coverage and cost control, California Legislative Information, Jan. 5, 2022

This measure would impose … taxes at specified rates to fund comprehensive universal single-payer health care coverage … [under AB 1400]

(1) An annual excise tax … upon a qualified business … at a rate of 2.3 percent of the gross receipts … minus the first $2,000,000 in annual gross receipts.

(2) (A) A payroll tax … on every employer who pays … 50 or more resident employees … at a rate of 1.25 percent of wages or other compensation … [plus] 1 percent of wages or other compensation in excess of $49,900 per employee.

(3) (A) … a State Personal Income CalCare Tax:

  • $149,509 but not over $299,508 — 0.5% of the taxable income
  • $299,509 but not over $599,012 — 1% of the taxable income
  • $599,013 but not over $1,299,499 — 1.5% of the taxable income
  • $1,299,500 but not over $2,484,120 — 1.75% of the taxable income
  • $2,484,121 and above — 2.5% of the taxable income

California Considers Doubling its Taxes, Tax Foundation, Jan. 6, 2022, by Jared Walczak

A proposed constitutional amendment (ACA 11) in California would increase taxes by $12,250 per household …

Comment:

By Jim Kahn, M.D., M.P.H. and Don McCanne, M.D.

$12,250 per household in new taxes sounds like a lot. This plan includes a 2% payroll tax, a highly progressive income tax (starting at 0.5% at $150,000), and a business excise tax.

However — bottom line — the net savings for a typical middle-class family are highly attractive.

Currently, working families pay a lot for health care:

That’s $10,000, which under single payer disappears. Huge savings.

Plus, employers contribute $16,253 for premiums for family coverage. That high cost keeps wages low, so if it went away (the proposed payroll tax is about 90% lower), annual wages would rise by $10,000 or more.

Thus, for a working family, we’re into net financial gain territory.

And … the actual tax increase for a middle-class family would be way less than the $12,250 average. That’s because the tax plan relies on a very progressive income tax, $750 at $150,000 and really kicking in above $1 million in annual income.

Overall, single payer reduces costs for the vast majority of families, while providing guaranteed health care.

And: no more medical debts or bankruptcy. That’s a huge boost to financial security.

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.

The Omicron surge makes the case for California’s single-payer healthcare proposal

By Rupa Marya, M.D.

There has never been a more urgent moment to reimagine healthcare. Two long years into the COVID-19 pandemic, more people are getting sick (thanks to Omicron) and staying sick (thanks to long COVID). A piece of legislation up for debate in the California Assembly on Tuesday, aiming to create single-payer healthcare in the state, couldn’t be more timely.

Assembly Bill 1400 would replace the state’s piecemeal approach to near-universal coverage with a system known as CalCare, making California the first state in the nation to adopt a unified government-funded approach to healthcare. The state would guarantee medical, dental, visual and long-term care for all Californians, regardless of age, employment, income level, marital status, documentation or tribal status. This could finally align our public health strategies, economic health and healthcare system.

The pandemic provides a powerful case study on the need for such an approach: More than 70% of the nation’s largest health insurers have ended their COVID treatment cost waivers, leaving even insured and vaccinated patients with potentially astronomical bills if they require treatment. And make no mistake, many people are going to need a lot of care. The Omicron variant of the coronavirus, responsible for the current surge, is infecting both the vaccinated and the unvaccinated, and we now know that even with mild illness, long COVID occurs in more than half of cases, with impacts across much of the body.

Without coverage like CalCare, this will be a recipe for the virus to go untreated or for patients to face financial ruin. Despite gains promised by the Affordable Care Act more than a decade ago, medical debt is still the leading cause of personal bankruptcy.

Rather than leaving individuals at risk like that, AB 1400 proposes to curb costs by eliminating administrative bloat and setting prices, which as the world’s fifth-largest economy, California can do. Further financing would come through new corporate and progressive taxation.

That’s the scale of systemic solution that is needed in this moment, because entire systems are suffering. As a hospital medicine physician at UC San Francisco, I am watching the pandemic crush our healthcare system and the people inside it, providers and patients alike. Since the beginning of the pandemic, more than 6 million people have had COVID in California alone, with a record half million cases added this last week thanks to Omicron. Beyond healthcare, look at the struggles for schools, travel and essential services.

A single-payer system will curb the influence of profit-seeking businesses that dominate the healthcare industry today. Too often, California’s pandemic response has been shaped not only by science but by healthcare executives protecting corporate interests. For example, elective surgeries have continued during surges to keep money flowing in, even though these procedures drain important pandemic resources and bring increased risk of virus spread in a hospital.

No wonder the U.S. spends more money on healthcare per person than any other country in the world, yet has the lowest life expectancy compared with 11 other comparable nations. Healthcare expenditure is soaring because of higher administrative costs, not better or more services. Even nonprofit systems such as Kaiser have been accused of controlling costs by denying services.

Before the pandemic, corporate health systems closed hospitals to consolidate, leaving many rural Californians without vital services. Such moves have contributed to making healthcare services in California, even accounting for wage differences, among the costliest in the country. Although politicians have been slow to react, healthcare workers have voted with their feet. During the pandemic, staffing cuts to save health systems money left remaining nurses with inadequate support to care for their patients and themselves, driving many to quit. Almost 20% of healthcare workers have left their jobs, and hiring is a struggle. The workers who remain are overburdened.

In a desperate stopgap attempt to save a collapsing system, the California Department of Public Health announced on Saturday that healthcare workers who test positive for COVID but have no symptoms should keep going to work — without a quarantine period and without waiting for a negative test result. Public health officials are under pressure to keep the economy going, but we cannot have a healthy economy when workers are sacrificed and we are all being put at risk.

One can see why AB 1400 is endorsed by the California Nurses Assn.: The healthcare system needs more resources and less profit motive — exactly what CalCare aims to deliver.

Dr. Rupa Marya is an associate professor of medicine at UC San Francisco, founder of the Deep Medicine Circle and a co-author of “Inflamed: Deep Medicine and the Anatomy of Injustice.” She is a member of the Healthy California for All Commission.

https://www.latimes.com…

Understanding Insurer Profits: “4.5%” = 30%

Summary: Today we scrutinize health insurer profit margins. Magically, a modest apparent margin of 4.5% reveals itself upon closer inspection to be a ginormous 30%. Let’s call it what it is: excessive and extortionate.

Medicare Advantage Delivers Better Care and Saves Money: A Response to Gilfillan and Berwick, Health Affairs Forefront, Jan. 7, 2022, by George C. Halvorson

We can argue about whether 4.5 percent profit is a good number—but it’s clearly inaccurate to say that it is an “extraordinary number,” as Gilfillan and Berwick contend. Most businesses in most industries would see their stock prices dropping with only 4.5 percent profits.

The Medicare Advantage program: Status report, MedPAC, March 2021, p. 373

The most recent data available, from 2019, show that MA plans reported margins that averaged 4.5 percent.

Comment:

By Jim Kahn, M.D.

We read that health insurer annual profits are 4.5%. Less than many other industries, like pharmaceuticals, says Halvorson. A fair return, right?

Wrong. Real profits – net earnings divided by money invested – are 30%. Why? Because health insurers put so little money on the line.

A simple example illustrates.

$1000 spent for a health insurance policy results in:

$850 for medical care (known as the “medical loss”). This is money received as premiums and paid as reimbursements. No upfront investment required by the insurer: no cash outlays, no supplies, no manufacturing, nothing. Indeed, no real risk. Just hold the money a while, let it earn interest, and then pay it out.

$150 is the insurer portion:

  • $105 covers actual costs – product design, marketing, sales, contracts, authorizations, denials, payments, dispute resolution, etc. This is the cost of doing business, by staff and contractors. It’s the investment required.
  • The remaining $45 is profit.

So, profit = $45 / $150 = 30%.

Or, if you prefer, a yield of $45 on an actual outlay of $105, or 43% return on investment.

Is that a fair profit margin? I think not.

Single payer would, of course, have no private insurers extracting these massive profits from the health care budget using their life-threatening tactic of restricting access to care. Any wonder that they oppose single payer?

(p.s. more on the Halvorson blog in future)

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.

Inequity and the Interstitium: Pushing Back on Disparities in Fibrosing Lung Disease in the US and Canada

By Adam W. Gaffney, M.D., M.P.H. and Anna J. Podolanczuk, M.D.
American Journal of Respiratory and Critical Care, January 6, 2022

If two patients, one poor and one wealthy, have the same fibrosing interstitial lung disease (fILD), could differential access to quality healthcare determine which one lives, and which one dies? A study published in this issue of the Journal suggests that it may — but also that such inequity is not inevitable.

In a provocative analysis, here, Goobie and colleagues provide the first transnational comparison of outcomes among individuals with this serious progressive condition, which requires multi-disciplinary evaluation, expensive therapies and vigilant monitoring.(1- 3) They assessed the effects of patients’ socioeconomic status — which they estimated based on a neighborhood-level metric of socioeconomic deprivation — on their outcomes, including mortality, lung transplantation, and lung function. Among US patients with fILD, they identified a striking mortality gap: death rates were 51% higher for those living in the most deprived quartile of neighborhoods relative to those in the least deprived quartile (95% CI 1.17, 1.95). No such disparity was present among Canadians with fILD. While lung transplant rates for all clinical conditions combined showed no consistent socioeconomic gradient in either nation, US patients with IPF residing in the most deprived quartile of neighborhoods were 64% less likely to have a lung transplant relative to those in the least deprived neighborhoods — a disparity that was not apparent among Canadians with IPF.

Continue reading…

https://doi.org/10.1164/rccm.202111-2652ED

Deception Comeuppance: Theranos & Privatized US Health Insurance

Summary: Yesterday Elizabeth Holmes was convicted of four counts of fraudulently representing the capabilities of Theranos, her incredibly hyped lab tech company. Good; that was long overdue. What’s even more overdue is holding to account those who keep telling us to trust that private for-profit health insurance will efficiently bring us healthcare.

The Epic Rise and Fall of Elizabeth Holmes, New York Times, Jan. 3, 2022, by David Streitfeld

In Silicon Valley’s world of make-believe, the philosophy of “fake it until you make it” finally gets its comeuppance.

For a decade, Ms. Holmes fooled savvy investors, hundreds of smart employees, an all-star board and a media eager to anoint a new star.

Ms. Holmes had many rules at Theranos: “I am never a minute late. I show no excitement. ALL ABOUT BUSINESS. I am not impulsive. I know the outcome of every encounter. I do not hesitate. I constantly make decisions and change them as needed. I speak rarely. I call bullshit immediately.” …

Whenever anyone — a regulator, an investor, a reporter — wanted to know a little more about exactly how the Theranos machines functioned, the company cried “trade secrets.” The real secret, of course, was that Theranos didn’t have any trade secrets because its machines didn’t work. But her answer worked for a long time. …

“We focused on creating a customized medicine tool that could be used in the home by every patient, so that every day, a patient can get real-time analysis of their blood samples.”

Who could not applaud such an invention? Theranos was making a messy, uncertain and time-consuming medical process into something effortless and painless.” …

This is a credulous age.

Comment:

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

Why is HJM noting a fraud conviction of the lab test huckster Elizabeth Holmes? Isn’t that just a Silicon Valley phenomenon? I wish …

The Holmes story, as nicely summarized in the NY Times, evokes the far larger deception being foisted on us with the increasing privatization of health insurance. The profiteers forge ahead relentlessly, perfecting business models that reap tens to hundreds of billions of dollars (far more than Theranos).

We are told repeatedly that private insurance is the path to health care efficiency and clinical effectiveness. Yet our health system performance is by far the worst in the wealthy world – the most expensive, with tenuous access to care, low life expectancy, and a unique American treat: massive medical debt.

Insurers and their political enablers say ignore those numbers, trust the secret sauce that we have (but can’t reveal the details of due to trade secrets).

We’re told that the next iteration of financial incentives to providers will improve quality and reduce costs. Data are delayed, deficient, and discouraging. But it’s ok, it’s working. Really.

Just like Elizabeth Holmes, the leaders of the dysfunctional private insurance edifice guide us down the primrose path.

Ms. Holmes was ultimately held to account. When will private insurers get their comeuppance?

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.