Category Archives: Affordability

Moderate Democrats Health Care Plans Fall Short

Listening to the Democratic debates since they began last year, I have been dumbfounded and angered that so many of the candidates running for President this year believe that some halfway measure to achieve universal coverage for health care is possible, if only voters would vote for them.

With the exception of Bernie Sanders and Elizabeth Warren, the rest of the candidates, those still running, and those who dropped out, advocate a public option or fixing the ACA. (see “Medicare for All and the Democratic Debates”) Their proposals fly in the face of study after study, article after article that firmly states that the only way to provide universal coverage at lower cost, and that will save money is Medicare for All.

They are trying to scare the American people with words like “Socialism” and suggesting that their taxes will go up, or that they will lose their employer-based or private health insurance.

As I have written in the past, there is a concerted effort on the part of the health care industry to defeat Medicare for All/Single Payer, and they have been targeting the Democrats to do so.

An article last Monday in The Hill by Diane Archer, senior adviser at Social Security Works states that twenty-two studies agree that Medicare for All saves money.

According to Ms. Archer, researchers at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine.

Every single study, they found, predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

In addition, all of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. As reported last year, even the Mercatus Center, a right-wing think tank belonging to the libertarian Koch Brothers, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage

The key takeaway from the studies is that Medicare for All is far less costly than our current system largely because it reduces administrative costs.

This is because Administrative savings from Medicare for All would be about $600 billion a year. Savings on prescription drugs would be between $200 billion and $300 billion a year, if we paid about the same price as other wealthy countries pay for their drugs. A Medicare for All system would save still more with implementation of global health care spending budgets.

None of the other Democratic candidates can make that assertion because their plans leave many uninsured and and keep in place the insurance companies and pharmaceutical companies to make huge profits from the health of the American people.

While I am no fan of Bernie Sanders as a candidate, and his recent dispute with the Nevada Culinary Union not withstanding, his goal is to cover every American with universal health care. Elizabeth Warren’s plan differs somewhat from Sanders’, but has a more reasonable time frame for implementation.

The inconvenient truth, folks is that Medicare for All will save money, will cover everyone, and will finally bring down the cost of health care so that no one has to go broke paying for it, or decide not to get medical care when needed because they can’t afford it.’

Those of you who are not physicians or in the insurance industry, or the pharmaceutical industry who pontificate on social media that Medicare for All is bad, are only delaying the inevitable. You consultants, analysts, researchers and other auxiliary industries to health care must see the truth staring you in the face. You are on the wrong side of the debate, and on the wrong side of history.

Friday Morning Catch-Up

It’s been a while, so I thought I’d play catch-up this morning with some relevant postings from Don McCanne and Joe Paduda.

First up is an article from The New York Times of December 3rd by Margot Sanger-Katz. The article, “Why the Less Disruptive Health Care Option Could Be Plenty Disruptive” explains that moderate Democratic plans for health care that does not fall in line with those proposed by Bernie Sanders and Elizabeth Warren can be as disruptive as not implementing Medicare for All.

Sanger-Katz writes: “The single-payer health plans proposed by Senators Bernie Sanders and Elizabeth Warren are often assailed as being too disruptive. A government plan for everyone, the argument goes, would mean that tens of millions of Americans would have to give up health insurance they like.

Democratic presidential candidates with more moderate brands have their own proposal: a “public option” that would preserve the current private insurance market, while giving people the opportunity to choose government insurance.

A public option would be less disruptive than a plan that instantly eliminated private insurance. But a public option that is inexpensive and attractive could shake up the private market and also wind up erasing some current insurance arrangements. Conversely, a public option that is expensive and unattractive might not do much good at all.

A public option would cover a smaller population at first, and might have to negotiate with hospitals for good deals, just as other insurance companies do. In those circumstances, several economists said, the public option might look a lot like existing insurance: pretty expensive, and covering a limited set of doctors and hospitals.”

Next, Health Affairs published an article by Tara Straw, also on December 3rd, that examines how low-income workers fare poorly under the ACA. According to Ms. Straw, “The Affordable Care Act (ACA) extended health coverage to more than 20 million people and strengthened consumer protections for millions more, but it didn’t dramatically change employer-sponsored coverage, the primary source of private health insurance. Employer coverage often works well, allowing many people to enroll in comprehensive health benefits using employer contributions that make premiums affordable. But compared to middle and upper-income employees, low-income workers are often offered less robust coverage, get less employer help with their premiums, and must pay a greater share of their income toward health care costs. Among workers with job-based coverage, those with income below 200 percent of the poverty line spend 14 percent of their income on premiums and out-of-pocket costs, on average. That’s far more than people between 200 and 400 percent of poverty, who spend 7.9 percent of their income, and people over 400 percent of poverty, who spend only 4.5 percent.

Some low-income workers are actually worse off with an offer of employer-sponsored coverage than without one because it locks them out of premium tax credit (PTC) eligibility in the ACA’s health insurance Marketplaces, a prohibition known as the “firewall.”

Under the ACA, the worker’s share of the employee-only premium must not exceed 9.86 percent of family income (in 2019), irrespective of the cost of family coverage, and the plan must cover at least 60 percent of expected medical costs. When an employer’s coverage offer meets that low federal bar, the ACA’s firewall provision makes low-income workers and their family members ineligible to receive a PTC for Marketplace coverage. However, employer coverage that meets the ACA standard may be more expensive and less comprehensive than Marketplace coverage. For example, under the ACA standard, a worker making $18,000 (about 150 percent of poverty) could pay up to nearly $1,800 toward premiums for single coverage in an employer plan. But if allowed to purchase a benchmark Marketplace plan, the worker’s expected contribution, net of the PTC, would be less than $750 (4.15 percent of income in 2019).

Again from Health Affairs, comes the following on national health spending in 2018:

Abstract

US health care spending increased 4.6 percent to reach $3.6 trillion in 2018, a faster growth rate than the rate of 4.2 percent in 2017 but the same rate as in 2016. The share of the economy devoted to health care spending declined to 17.7 percent in 2018, compared to 17.9 percent in 2017. The 0.4-percentage-point acceleration in overall growth in 2018 was driven by faster growth in both private health insurance and Medicare, which were influenced by the reinstatement of the health insurance tax. For personal health care spending (which accounted for 84 percent of national health care spending), growth in 2018 remained unchanged from 2017 at 4.1 percent. The total number of uninsured people increased by 1.0 million for the second year in a row, to reach 30.7 million in 2018.”

Additionally, CMS published the National Health Expenditure Fact Sheet (NHE).

Next, Christopher Cai and James Kahn wrote in Health Affairs that Medicare for All would improve hospital financing. According to Cai and Kahn, “Hospitals account for more than one trillion dollars of health expenditures annually, and analysts have raised concerns that a shift to single payer, or Medicare for All, might adversely affect hospital care. A common narrative has emerged in the popular press and in medical journals, suggesting that Medicare for All would decrease reimbursements and force hospitals, particularly rural hospitals, to cut back on much needed services or even close altogether. These concerns have received increased attention with Elizabeth Warren’s recently released financial proposal for Medicare for All. Understandably, these points have raised concern about the feasibility of Medicare for All. But is this narrative evidence based?

Their conclusion states that “Under single payer, patients could choose any doctor and hospital, everyone would be insured, and bureaucratic burdens would be greatly diminished. Furthermore, under global budgeting, payment levels would be monitored and adjusted over time by a panel of health care experts.

And lastly, here is a post from Joe Paduda of a Gallop poll that says Americans can’t afford healthcare, According to Joe, Gallup reported that quarter of Americans have put off treatment for serious medical conditions because they can’t afford it.

These are the reasons they can’t afford it:

  • US physicians make twice what docs in other countries do
  • Drug costs are much higher here than elsewhere
  • Hospitals are making bank
  • Administrative costs are twice what they are in other developed countries.

Physician incomes by specialty exceed $400,000. No wonder Americans can’t afford health care. The doctors are making more than they are.

So, the future of health care as we know it looks very bleak from these and other experts on the matter. It would be criminal for any rational person to not explore the Medicare for All/ single Payer option, rather than to continue to prop up a market-based system that is out of control and getting worse every year.

But so long as many Americans claim they like their private health insurance, whether it is from their employer or they purchase it directly from an insurance carrier, the fact remains that no other solution will fix the problems other than Medicare for All.

All Americans need to realize this before it is too late.

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.

Surveys Say Health Care More Expensive for US Workers

A post on LinkedIn by Jaimy Lee, Health Care Editor at LinkedIn, reported Thursday that a pair of surveys indicated that health care is getting more expensive for many workers in the US.

Ms. Lee states that,

“Of the roughly 50% of Americans who get their health insurance from their employer, the cost of the average single premium rose 3% and the average family premium jumped 5% from 2017 to 2018, according to the Kaiser Family Foundation. That means premium rate increases are rising faster than inflation, which rose 2.5% during the same period.”

In addition, the Kaiser survey reported that:

  • The average annual premium last year for one person was $6,896 and $19,616 for a family in 2018. (Workers have to pay for, on average, between 18% and 29% of their premium.)
  • The average deductible amount for single coverage in 2018 was $1,573. That’s similar to 2017.

And that a separate survey stated that, 45% of Americans between the ages of 19 and 64 years old were underinsured — meaning they have health insurance but their out-of-pocket costs exceed at least 10% of their household income — in 2018. [Emphasis added]

And, in a blow to those who would like to keep the current employer-based system and not move towards an improved and expanded Medicare-for-All system, a growing number of the underinsured are people who get their health benefits through their employers. That’s up 20% over the last four years. (Traditionally the underinsured are adults who buy insurance on the individual market.)

Ms. Lee closes her post on employer-based health care underinsured workers with the following from Vox:

“In a great historical irony, the evident faults of employer-sponsored insurance are helping fuel a new appetite for Medicare-for-all, a single-payer system where everybody gets health coverage from the government,” writes journalist Dylan Scott. “Shifting 160 million people from the coverage they currently get through their jobs to a new government plan is a lot of disruption — and disruption, especially in health care, has historically made a lot of Americans nervous.”

They may be nervous at first, but it would be much better to be fully insured and nervous for a short time, than to be uninsured and nervous worrying about how they will afford ever increasing costs of insurance.

Medicare-for-All is the only way to provide such piece of mind.

Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

Sound the alarm bells, the health care industry is trying to prevent Americans from having the same kind of health care other Western industrialized countries give their citizens — universal health care; in this case, an improved and expanded Medicare-for-All.

Instead, they want to perpetuate the current system which by all accounts, is failing to provide quality health care at affordable costs, with better outcomes.

And the tactic they are using is fear-mongering of the worse kind, saying that if we move towards a Medicare-for-All system, the people who like their employer-based health care, or the hospitals, insurance companies, pharmaceutical companies, etc., will lose what they have, hospitals will close, and companies go bankrupt; in other words, they will lose huge profits the current broken system generates for them.

As the following article from Healthcare Dive reports, the hospital lobby is opposing this movement towards a more equitable system of health care in this country all for the purpose of protecting their bottom lines.

Don’t let them scare you. Universal health care is a right, not a privilege. We are the only Western industrial nation without such a system. People before profits. Health care for all, not for the few.

Here is the article:

As more Democratic presidential hopefuls embrace the idea, health systems and providers have picked up lobbying efforts arguing it would shutter hospitals.

Source: Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

Low Wage Workers Pay More For Health Care Than High Wage Workers « Workers Comp Insider

Tom Lynch, of LynchRyan, posted this last week, but due to a technical error, it did not reach his audience. This article should be cited by anyone who encounters libertarian know-it-all’s on the Internet who put the blame of our expensive health care system on such individuals as lawyers, as one such person I recently debated. Also, the chart from the OECD should be cited over and over again when defending the subject of improved Medicare for All single payer health care. However, Tom does not support Medicare for All, which is understandable, but not a viable position given the overwhelming support it has among many Americans.

Here is Tom’s article:

Anyone who can rub two brain cells together knows America spends more, much more, on health care than any other developed nation, as this chart from the Organization for Economic and Cooperative De…

Source: Low Wage Workers Pay More For Health Care Than High Wage Workers « Workers Comp Insider

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

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

Gauze: A Film by Suzanne Garber

Nearly a year ago, while channel surfing, I came across a short film being shown on my local South Florida Public Broadcasting System (PBS) station.

As I missed most of it, I was able to learn the name of the filmmaker from the credits, and saw that she had interviewed some of the leading names in the medical travel space.

One individual I saw listed in the credits was Keith Pollard, with whom I was connected with on LinkedIn, and had communicated over the years since I began blogging about medical travel. I reached out to Keith to ask him to put me in touch with the filmmaker, Suzanne Garber.

I later learned from Keith that before she gave Keith her permission to forward her email address to me, she wanted to know if I was legitimate. Keith vouched for me without hesitation, and I reached out to Suzanne.

Unfortunately, due to ownership of the rights to the film by PBS, it has taken nearly a year for me to get to see it. What follows is my review of her film, “Gauze Unraveling Global Healthcare”.

The film is a personal account of Suzanne’s exploration into the difference between US healthcare, with its bureaucracy and lack of transparency regarding cost to patients; plus its affordability, accessibility, and quality — the three characteristics of healthcare, according to Suzanne.

Suzanne had gone through some personal medical issues, and the film begins with her discussing statements she received that were very expensive. At one point, she describes how she was forced to sign a form at a hospital in order to get service that said she was responsible for the full amount if her insurance company refused to pay.

She asked the woman at the desk who gave her the form if she knew what it would cost her, and the woman replied that she did not know, so Suzanne said that she was signing away her right to know how much it could cost her.

Then Suzanne asked some of her friends the following question: where is the best healthcare?

Having been an executive credentialing hospitals for a company she was working for, Suzanne had vast experience visiting hospitals, and had personal experience of being admitted to a hospital in Spain as a child. She decided to go and visit some of the hospitals that cater to medical travel patients.

From 2014- 2015, she visited 24 countries, 174 hospitals, and interviewed over five dozen international healthcare experts. She wanted to know the answer to the following questions: Where to go, and where not to go?

But it was when she had a medical diagnosis of cancer that she traveled thousands of miles, flying from Philadelphia to Chicago, to Tokyo, and then to Bangkok, where she went to Bumrungrad Hospital. By that time, her position had been eliminated, she was unemployed and uninsured, so she took the chance and went.

She traveled to Singapore to get a second opinion with an orthopedist. A doctor there wanted to perform a bone density scan, and even though she brought along all of her MRIs, CAT scans, etc., the doctor had her go downstairs, wait forty-five minutes, and then go back upstairs to see the doctor after the results were entered into the computer.

In all, it cost Suzanne $29 dollars, not the amount she was quoted back in the US. And all this took one day.

As part of her journey, she visited the UK, India, and visited several hospitals in France. And what she found was that there is no one way to improve our healthcare, but it is possible. We need to ask questions, we need to contact our elected representatives, and we need to take responsibility for our healthcare.

A personal note: This film when shown on PBS last year, had a long list of names Suzanne interviewed. In addition to Keith Pollard, one other person, Rajesh Rao of IndUSHealth, was someone I met in 2014 at the ProMed conference in Miami Beach. Some other names in that list were familiar to me, but as of this screening, does not appear. One more comment, I was able to view the film online, but am not able to provide readers with a copy of it in this post.

This is a very important and timely film that should be viewed by both the health care industry and those in the workers’ compensation industry who have panned the idea of medical travel. The mere fact that Suzanne paid only $29 for a bone density scan, when she was told it would be $7,300 in the US, is not only criminal, it is insane to keep insisting that medical travel for workers’ comp is a stupid and ridiculous idea, and a non-starter, as one so-called expert has written.

When are you people in work comp going to wake up? You and your insurance carriers are being ripped off by an expensive medical-industrial complex. But you just go on doing the same things over and over again, and expect different results, or you boast that frequency is going down, yet medical costs are still too high. The choice is yours, but don’t keep making the same mistake.

I want to thank Suzanne for her patience in bearing with my periodic emails regarding my viewing the film, and for being courageous enough to put her personal struggles with health and health care front and center, and comparing it to our so-called health care system. I hope that Gauze Unraveling Global Healthcare will be seen by all those interested in better health care for all Americans, workers or not.