Category Archives: Accessiblility

Medicare for All and the Democratic Debates

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For those of you who did not watch the two nights Democratic debate, and those like me who did, one thing is clear. Medicare for All is very popular among the audiences who attended, judging by the applause garnered each time a candidate was asked about their plan for providing every American with health care.

On the first night, the moderator asked for a show of hands to the question as to who supported eliminating private insurance, only two candidates, Sen. Elizabeth Warren and New York mayor Bill de Blasio raised their hands.

The rest of the candidates on the first night supported keeping private insurance or giving people the choice of a public option, and de Blasio and former Congressman Beto O’Rourke sparring over the issue.

This is how some of the candidates responded to the issue:

“I’m with Bernie on Medicare for All,” said Elizabeth Warren

Amy Klobuchar said she preferred a “public option”, “I am just simply concerned about kicking half of America off of their health insurance in four years,”

Former Texas Rep. Beto O’Rourke allowed that the goal should be “guaranteed, high-quality, universal health care as quickly and surely as possible.” “Our plan says that if you’re uninsured, we enroll you in Medicare,” and called his plan Medicare for America.

On the second night, the same question about abolishing private insurance was asked, and again, only two raised their hands, Vermont Sen. Bernie Sanders and California Sen. Kamala Harris.

Former Vice President Joe Biden, who defended the ACA, said that Americans “need to have insurance that is covered, and that they can afford.”

Candidates Pete Buttigieg, mayor of South Bend, Ind., New York Sen. Kristen Gillibrand, and Colorado Sen. Michael Bennet all gave their views on universal coverage, noting the importance of a transition period, and suggesting that a public option would allow people to buy into Medicare.

While the rest of the candidates from both evenings’ debates were divided against their fellow candidates who supported Medicare for All, those who spoke up for it, Sanders, Warren, Harris and de Blasio, won over the audience in the hall. What remains to be seen is how their ideas are received in the primaries beginning early next year.

According to Bloomberg, (the publication, not the former New York mayor), Medicare for All enjoys broad support: 56% of Americans said they supported such a plan in a January survey by the Kaiser Family Foundation. However, when told Medicare for All would eliminate private health insurance, 37% said they favor it while 58% said they oppose the idea.

So, supporters of Medicare for All have their work cut out for them. They need to convince more Americans that sustaining the current system of private insurance, whether they get it from their employers, or they purchase it on their own, is a big part of the problem facing the US health care system.

Another point that is forgotten in the debate is the fact that what is being proposed is not a government takeover of health care, but rather a transition from a broken system to a government financed system of health care. Candidates who support this should explain the difference, and not be led into the trap set by debate moderators or interviews of calling Medicare for All, government-run health care.

It must be made clear that the providing of care will remain private, but that paying for it will not. Sanders’ stump speech line about going to any doctor sounds reminiscent of President Obama’s promise that you can keep your doctor under the ACA, but the reality was far from that.

But the takeaway from the debates indicates that the campaign will be a long and hard fought one, and that Democrats must be very clear what it is they actually want to do on health care, know how to pay for it, and sell it as the best solution to our dysfunctional health care system, or as author Marianne Williamson called it, a sickness system.

Because already, the Orangutan has pounced on one issue raised in the debate, the support by all candidates for providing medical care to undocumented immigrants. In today’s charged political climate where racism has raised its ugly head, and nationalism is on the march, such ideas can be disastrous, especially if rejected by swing voters and independents.

Time and the primaries will tell.

The Providers: A Film About Rural Health Care in America

Saturday evening, I came upon a documentary film in the Independent Lens series on PBS about the problems facing a part of rural America in providing health care to a poor, mostly elderly, and under-served population.

The film, The Providers, presented a very human face to the physician shortage, as well as the opioid epidemic in rural America, specifically by following three healthcare professionals at El Centro, a group of safety-net clinics that offer care to anyone who walks through the doors in northern New Mexico.

The providers in the film are Matt Probst, a Physician’s Assistant, Leslie Hayes, a Family Physician, and Chris Ruge, a Nurse Practitioner.

The first clinic shown is located in Las Vegas, New Mexico, a far cry from that other Las Vegas, many of you have gone to for conventions and gambling trips. The population of this Las Vegas is 13,201, and the per capita income is $15,481.

As the opening segment states, in 2016, 70,000 deaths in rural American could have been prevented with better access to health care.

Among some of the other points the documentary brings to mind are:

  • Hospital closures due to cuts to Medicaid
  • Failure to expand Medicaid, or repealing expansion Medicaid under the ACA

Chris Ruge, the Nurse Practitioner, is part of a program funded by insurance companies called ECHO Care™, which is an innovative program designed to improve access to primary and specialty care for patients with complex needs while also reducing the cost of care by utilizing a multidisciplinary team-based approach.  In New Mexico, the ECHO Care program expanded the capacity of primary care clinicians through:

  • The assembling, training and placement  of “Outpatient Intensivist Teams” (OIT) which dramatically improve care and reduce costs for the Medicaid beneficiaries served in this program.
  • Special teleECHO clinic designed to support the OITs as they care for patients with significant multi-morbidity, including mental health and substance abuse.

At some point, as the viewer will learn, the companies funding the program want to terminate it, but the CEO of the clinic wants to continue it, whether or not it makes a profit, as long as they break even, because she recognizes the benefits outweighs the cost and profitability.

In order to make sure that they can continue to provide health care to the community, both in Las Vegas, and in another town, they are recruiting from the local high school for students interested in careers in health care.

This was a very eye-opening film and should be watched by anyone who cares about health care and access to care for rural populations, and those who deal with patients suffering from substance abuse, either opioids or alcohol.

 

 

Trump Regime to Repeal ACA

From the Overnight News Desk:

Both CNN and The Washington Post reported yesterday that the Justice Department will back a full repeal of the Affordable Care Act (ACA), after a federal judge in Texas ruled the law unconstitutional in December.

If this repeal takes effect, millions of Americans will lose their healthcare. Those of you employed in the medical-industrial complex, and related industries, must face the fact, that if the Republicans succeed in their long-held promise to destroy healthcare for Americans who could never afford it before, or had limited coverage, there will be no other alternative left to provide healthcare than to have an Improved Medicare for All/Single Payer system.

There are those who believe that Medicaid for All is a better option, but given that many states that expanded Medicaid elected GOP governors and legislatures, or could in the future, Medicaid in those states could also be taken away from those who receive expanded coverage.

Many of you are employed by the very same insurance companies, pharmaceutical companies, device manufacturers, and other businesses that are allied with the healthcare system, and it is these companies that are gearing up to fight passage of any Medicare for All/Single Payer health care bill.

Do you really want your fellow Americans to die because they cannot generate huge profits for your employers and for Wall Street investors and shareholders?

if the Orangutan gets his way, that is what will happen. Also, our hospital ERs will once again be clogged with patients who need immediate medical attention, and the quality of health care will deteriorate even further.

The only logical solution is Medicare for All/Single Payer, because the only option left will be Medicare for All/Single Payer.

Health Insurance Costs Accelerating for Workers | HealthLeaders Media

This is a follow-up to my previous post, Health Care Costs Rising for Workers. My post then cited a Kaiser study; this article references the University of Minnesota’s State Health Access Data Assistance Center.

On Monday, I reported that there is an effort underway to discredit the move towards single payer by various groups, and even Howard Schultz, the outgoing Chairman of Starbucks said the following back in June:

“It concerns me that so many voices within the Democratic Party are going so far to the left. I say to myself, ‘How are we going to pay for these things,’ in terms of things like single payer [and] people espousing the fact that the government is going to give everyone a job. I don’t think that’s something realistic. I think we got to get away from these falsehoods and start talking about the truth and not false promises.”

So, if these two studies are accurate, and there is no way to prove they aren’t, then both Mr. Schultz and the various groups attempting to derail single payer, are only going to make things worse for workers, and for everyone else.

Oh, and by the way, there have been studies that indicated that we could afford single payer health care, especially a report sponsored by a Koch Brothers backed think tank, Mercatus.

So, consider the following from this Health Leaders article back in October of this year.

The average premium for employer-sponsored plans rose $267, or 4.4% between 2016 and 2017, which is twice the increase recorded between 2015 and 2016.

Source: Health Insurance Costs Accelerating for Workers | HealthLeaders Media

Employer Insurance Costs Growing Burden for Middle Class

The Commonwealth Fund today released a report that stated that the cost of employer-based insurance is a growing burden on middle-class families.

In 2017, more than half (56%) of people under age 65, about 152 million people, had insurance through an employer, either their own or a family member’s. In contrast, only 9 percent had a plan purchased on the individual market, including the marketplaces.

Here are the highlights from that brief:

Highlights

* After climbing modestly between 2011 and 2016, average premiums for employer health plans rose sharply in 2017. Annual single-person premiums climbed above $7,000 in eight states; family premiums were $20,000 or higher in seven states and D.C.

* Rising overall employer premiums increased the amount that workers and their families contribute. Average annual premium contributions for single-person plans ranged from $675 in Hawaii to $1,747 in Massachusetts; family plans ranged from $3,646 in Michigan to $6,533 in Delaware.

* Average employee premium contributions across single and family plans amounted to 6.9 percent of U.S. median income in 2017, up from 5.1 percent in 2008. In 11 states, premium contributions were 8 percent of median income or more, with a high of 10.2 percent in Louisiana.

* The average annual deductible for single-person policies rose to $1,808 in 2017, ranging from a low of $863 in Hawaii to a high of about $2,300 in Maine and New Hampshire. Average deductibles across single and family plans amounted to 4.8 percent of median income in 2017, up from 2.7 percent in 2008. In three states (Florida, Mississippi, and Tennessee), average deductibles comprised more than 6 percent of median income.

* Combined, average employee premium contributions and potential out-of-pocket spending to meet deductibles across single and family policies rose to $7,240 in 2017 and was $8,000 or more in eight states. Nationally, this potential spending amounted to 11.7 percent of median income in 2017, up from 7.8 percent a decade earlier. In Louisiana and Mississippi, these combined costs rose to 15 percent or more of median income.

Worker payments for employer coverage are growing faster than median income.

The average employee premium cost across single and family plans amounted to 6.9 percent of median income in 2017, up from 5.1 percent in 2008.

Average deductibles are also outpacing growth in median income.

In many states, even though costs are rising, people are not getting insurance that protects them more because deductibles are also increasing.

Still think that the free market works for health care? Guess again.

We are the only advanced nation that refuses to give its citizens universal health care like other similar nations do. This “growth” is unsustainable and will lead to single-payer health care.

 

National Health Care Spending In 2017: Growth Slows To Post–Great Recession Rates; Share Of GDP Stabilizes | Health Affairs

Yesterday, Health Affairs reported that spending on health care was slowing to post-Great Recession rates, and that its share of GDP stabilized. However, total nominal US health care spending increased 3.9 percent to $3.5 trillion in 2017, slowing from growth of 4.8 percent in 2016.

Yet, the authors stated that, “For a health sector that now accounts for nearly one-fifth of the US economy, future increases in health care expenditures will likely lead to policy decisions focused on affordability and sustainability.”

What are those policy decisions that will focus on affordability and sustainability? Single Payer, Medicare for All so that all Americans are covered, and receive all medical care they need without having to go into bankruptcy or to set up a “GoFund Me” account, or other similar application.

Just because the spending slowed to pre-Recession rates does not mean we are in the clear and all will be right with the health care world. As happens when we graph any statistics, there will always be a point in time when what looks like good news turns bad, and when bad news turns good. One day the market is up, the next it is down. That’s why they are depicted with lines instead of bars or circles or other graphic designs.

Source: National Health Care Spending In 2017: Growth Slows To Post–Great Recession Rates; Share Of GDP Stabilizes | Health Affairs