Monthly Archives: February 2019

Medicare for All Legislation Introduced

Yesterday, as reported by Dr. Adam Gaffney, President of the Physicians for a National Health Program (PNHP), Rep. Pramila Jayapal (D-Wash.) and more than 100 co-sponsors in the House of Representatives, introduced the Medicare for All Act of 2019.

In keeping with earlier posts on the subject, and to further convince not only the skeptics, but the opponents of Medicare for All, here is what is in the act, according to Dr. Gaffney’s letter:

What’s in the Medicare for All Act?

Coverage

  • Covers all medically necessary care, including hospitalization and doctor visits; dental, vision, and hearing care; mental health services; reproductive care, including abortion; long-term care services and supports; ambulatory services; and prescription drugs.
  • Covers all U.S. residents. Coverage is portable and lifelong.

Choice

  • Provides free choice of doctor or hospital.

Cost

  • Eliminates all patient cost-sharing such as co-pays, premiums, and deductibles.

Budgeting and Efficiency

  • Pays institutions such as hospitals and nursing homes via lump sum global operating budgets to provide covered items and services.
  • Funds capital expenditures such as expansions and renovations with a separate budget.
  • Pays individual providers on a fee-for-service basis that does not include “value-based” payment adjustments. Providers cannot use fees for profit, marketing, or bonuses.
  • Establishes a national drug formulary that promotes the use of generics. HHS will negotiate prices for drugs, supplies, and equipment on an annual basis.
  • Allows the override of drug patents when drug firms demand extortionate prices (a key recommendation from PNHP’s 2018 Pharma Proposal).

Health Equity

  • Provides regional funding for rural and urban areas that are medically underserved.
  • Preserves the benefits provided by the Dept. of Veteran Affairs and the Indian Health Service.
  • Overrides the Hyde Amendment that bans federal funding of abortion.

Transition to Medicare for All

  • Implements Medicare for All over a two-year transition period.
  • In the first year, current Medicare enrollees can utilize expanded benefits such as dental and vision care. After year one, the plan automatically enrolls everyone ages 0-18 and 55 and older, and also offers a Medicare Transition buy-in plan through the Federal and State exchanges during this time.
  • Allocates one percent of budget for the first five years to assistance for workers displaced by the elimination of private health insurance.

There are other similar legislation already introduced, especially the one introduced by Sen. Bernie Sanders, as well as several faux Medicare for All plans that are really Medicare for Some.

Sen. Sanders’ bill calls for a four-year transition period, so the difference is not that important. What is important is that both bills will transform healthcare as we know it and finally get this nation to do what other nations already are doing.

As reported today by Dr. Don McCanne, the legislation was written with the help of a broad swath of lobbyists and special interest groups, if perhaps not the kind associated with typical health policy legislation on Capitol Hill.

Among these groups, as written in The Intercept yesterday by Ryan Grim (not making that up, folks), are the following: nurses, doctors, disability rights activists, and advocates for the elderly, as well as public interest organizations such as Public Citizen and the Center for Popular Democracy.

According to Mr. Grim (don’t laugh, that’s really his name), along with Consortium for Citizens with Disabilities, the main groups involved in drafting the legislation were National Nurses United, a major nurses union that has long been on the forefront of the fight for single payer; Physicians for a National Health Program; the Center for Popular Democracy, which organizes poor and marginalized communities; Public Citizen; and Social Security Works, which represents more than a million progressive seniors who support expanding the Medicare coverage they have to the rest of the population.

Mr. Grim called these groups “special interests” and said that the insurance and pharmaceutical industries had no part in the drafting of this legislation, to which Dr. McCanne gave an affirmative comment, because they are “when that interest is for the all of the people and their health, but we need to keep out the “usual suspects.

It is sad that some choose to call those organizations who fight for people as “special interests”, yet, have no problem when those interests are insurance companies, pharmaceutical companies, large hospital systems, Wall Street, investors, and shareholders in the medical-industrial complex.

Eventually, we will get there. Unfortunately, many of us may not live to see it, or be able to take advantage of it for only a short time before the opposition party repeals it, or we pass on.

Medicare for All – the three versions – Managed Care Matters

Hot on the heels of my post this morning, Health Care Is Not a Market, comes another post from Joe Paduda.

This time he discusses the three versions of Medicare for All that have already been introduced, or soon will be.

However, there is one item that I have with Joe’s version of MFA that I believe is not a viable option – Medicaid for All.

As we have seen in Kentucky, one governor, a Democrat, expanded Medicaid in his state, only to see his successor, a Republican, eliminate it, thereby tossing millions of Kentuckians to lose health care right after getting it,

All it takes is one gubernatorial or legislative election, and millions in that state will lose coverage.

The better option is Medicare for All, since the federal government, and not the states will finance it.

Anyway, here is Joe’s article: 

There is no consensus about what MFA is – and that makes it really easy for supporters and opponents to convince the uninformed it is great or awful. They do that by picking out whatever they think you’ll love/hate – … Continue reading Medicare for All – the three versions

Source: Medicare for All – the three versions – Managed Care Matters

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that they are deciding that they have the right to tell the rest of us that we must continue to experience this broken, complex and complicated system just so that they can make money. And that they have a right to prevent us from getting lower cost health care that provides better outcomes and does not leave millions under-insured or uninsured.

However, not all these individuals are doing this because of their jobs. Some are doing so because they are wedded to an economic and political ideology based on the free market as the answer to every social issue, including health care. They argue that if we only had a true free market, competitive health care system, the costs would come down.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, the free market companies have jacked up the prices simply because they can, and because lobbyists for the pharmaceutical industry have forced Congress to pass a law forbidding the government from negotiating prices, as other nation’s governments do.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.

What is “Medicare for All”? – Managed Care Matters

Continuing his exploration of Medicare for All/Single Payer health care, fellow blogger Joe Paduda, lays out point by point, the pros and cons of Medicare for All, as their proponents and opponents claim.

You will notice that there are more pros than cons, so the only reason why it has not been enacted as of yet is because there are too many entities whose bottom-line and profitability are conducive to keeping the status quo. Never mind that there are tremendous benefits of Medicare for All, just as long as we can squeeze every bit of profit out of the system and bleed it dry.

One point not raised by Joe on the pro side is, if Medicare for All is enacted, and employer-based health insurance eliminated, companies could then hire more people because they would not have the added expense of paying for their health insurance. In addition, dropping employer-based health insurance for Medicare for All would improve the company’s bottom-line, by saving that money and plowing it back into the company, or using it to pay higher wages or a higher return on investment.

Here is Joe’s article:

MFA/M4A uses Medicare as the health insurance mechanism for people younger than 65. Some advocates are pitching “Medicare for Some” wherein folks older than 50 or 55 would be able to “buy-in” to Medicare (which covers everyone over 65 today). … Continue reading What is “Medicare for All”?

Source: What is “Medicare for All”? – Managed Care Matters

1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Readers of this blog will recall that I wrote four earlier posts about the closing of rural hospitals, so the article from Healthcare Dive.com comes as no surprise.

Previous posts ( https://wp.me/p2QJfz-GeL, https://wp.me/p2QJfz-IZ3, https://wp.me/p2QJfz-N0u, and https://wp.me/p2QJfz-QSn) go into greater detail about the seriousness of the issue.

But once again, we have to remind the readers that until we enact Single Payer health care, more Americans will lose access to medical care at rural hospitals.

Here is the article:

More than 60% of those facilities are “highly essential” to the heath and economic well-being of their communities, according to a new report.

Source: 1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth | Health Affairs

Health Affairs.com published the following research article yesterday projecting national health expenditures from 2018 to 2027.

According to the article, national health expenditures are projected to grow at an average annual rate of 5.5 percent for 2018–27 and represent 19.4 percent of gross domestic product in 2027.

In addition, spending growth during 2018–27 is expected to be driven primarily by long-observed demographic and economic factors fundamental to the health sector.

Prices for health care goods and services are projected to grow 2.5 percent per year, on average, for 2018–27—faster than the average price growth experienced over the last decade—and to account for nearly half of projected personal health care spending growth.

Average annual spending growth in Medicare (7.4 percent) is expected to exceed that in Medicaid (5.5 percent) and private health insurance (4.8 percent) over the projection period, mostly as a result of comparatively higher projected enrollment growth, according to the article abstract.

And finally, the insured share of the population is expected to remain stable at around 90 percent throughout the period, as net gains in health coverage from all sources are projected to keep pace with population growth.

Yet, Don McCanne states in his comment, that the authors anticipate that a decade from now we will still have tens of millions uninsured.

So, it is vital that we continue to push to enact Single Payer/Medicare for All, and bring down the cost of health care, and the increases in spending that the current broken for-profit system generates.

Here is the link to the abstract and article:

Research Article Health Affairs Vol.0 No.0 National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth

Source: National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth | Health Affairs

And here is the link to another article from Healthcare Dive.com that summarizes what Health Affairs.com’s article discusses:

https://www.healthcaredive.com/news/us-healthcare-spending-growth-to-hit-55-by-2027-cms-predicts/548795/

Could Medicare for All Solve the healthcare cost problem? – Managed Care Matters

Following on the heels of yesterday’s post from Joe, today’s post covers the cost of healthcare, and what Medicare for All could do to solve it.

Recently, two billionaires, Former NY Mayor Michael Bloomberg and former barista-in-chief Howard Schultz have both said that the US cannot afford Medicare for All/Single Payer health care.

But if we look at Joe’s article, and his subsequent ones later this week, can we afford not to?

You decide.

Here’s Joe’s article:

This week we are unpacking Single Payer/Medicare for All to better understand the many variations of SP/MFA and now they are different, how those variations might work, and whether some version is a) politically viable and b) would solve the … Continue reading Could Medicare for All Solve the healthcare cost problem?

Source: Could Medicare for All Solve the healthcare cost problem? – Managed Care Matters