Category Archives: Health Care Benefits

Majority of Americans Would Switch From Employer-based Health Care

Common Dreams and Business Insider both reported last week on polling that counters the right-wing narrative, and what some Democratic primary candidates are defending, that says that Americans like their employer-provided health care.

The survey, they wrote, showed that 59 percent of respondents who have employer-provided insurance “said they would support switching their employer-based health insurance to a government plan under Medicare for All” as long as quality of coverage would remain the same or improve.

The poll also found that Americans on government-run healthcare plans such as Medicare and Medicaid are more satisfied with their coverage than those on employer-sponsored plans, which have soared in cost over the past two decades.

According to BI, this is how the polling was broken down:

  • 44% of people said they were on an employer-based plan. Of them, 41% love their plan, 20% don’t like their plan, and 39% would be fine if it changed as long as they kept coverage.
  • 28% were on Medicare, Medicaid or military coverage. Of them, 57% love their plan, 14% don’t like their plan, and 29% would be fine if it changed as long as they kept coverage.
  • 12% directly purchased health insurance. 39% love their plan, 22% don’t like their plan, and 39% would be fine if it changed as long as they kept coverage.
  • 7% said they did not have health insurance.
  • 9% didn’t know or had some other type of coverage.

As reported in BI, the results highlight the fact that although a majority of Americans are fairly satisfied with their employer-based health coverage — which supports other polling on the subject — mainly people just like being covered in general, bearing little loyalty to a specific insurer.

Therefore, If the system provides equal or more comprehensive benefits, then broad swaths of Americans are likely to support it.

Medicare for All is not likely to pass anytime soon, but as more people come to see the benefits of such a program, compared to the rising cost of employer-based health insurance, that majority will only grow larger.

Those who advocate for Medicare for All need to keep pounding away at educating the public, and to make sure that coverage under Medicare for All is better than employer-based health care.

Voters Tuning Out of Health Care Debates

Axios reported yesterday that American voters are tuning out of the health care debates dominating Washington, the presidential campaign, and the politically active talking about Medicare for All and other proposals, according to an article by Drew Altman.

Axios conducted six focus groups in three states, Texas, Florida and Pennsylvania. It was facilitated by the Kaiser Family Foundation’s director of Polling and Survey Research. The focus groups consisted of independent, Republican, and Democratic voters in several swing states and districts.

They were only aware of candidates’ and elected officials’ proposals on health care, but they did not see them as relevant to their struggles to pay medical bills or navigating the health care system.

Each of the six focus groups had between 8 and 10 people who are regular voters and said that health care will be an important issue for them in the 2020 election for President.

Here are the takeaways from the focus groups:

  • These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
  • When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
  • When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
  • When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
  • They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.

Most of the voters in these groups did not see any of the current proposals from either side of the aisle as solutions to their top problems: namely paying for care or navigating the insurance system and red tape.

The debates on health care have gotten too far into the weeds and are too complex and complicated for the average voter to understand, let alone follow at this early stage of the presidential campaign.

The debate will become more meaningful, the article contends, when they see stark differences between the health plan of the Democratic nominee and Trump. This way, they will be able to focus more on what those differences mean for themselves and the country.

Here is the comment posted in response by Don McCanne:

Although we should be cautious about trying to draw Great Truths from half a dozen focus groups, we should be concerned about what these groups revealed about their understanding of the basis of the problems that they experience with our health care system.

They see problems with navigating the health care system and with paying their medical bills. But when offered solutions for these problems they show little understanding of even basic health policy, and they seem to be influenced more by political memes expressing a distrust of government, complexity of public solutions, and government interference with their interactions with the health care system.

A particularly important example of this is, “When asked what they knew about Medicare for all… almost no one associated the term with a single-payer system or national health plan.”

This lack of sophistication leaves them unaware that the government Medicare program is far more deserving of our trust than the private insurers (“surprise medical bills” anyone?), that a government program that includes everyone though a publicly funded universal risk pool is far less complex than a multitude of private insurers with various complex rules for accessing and paying for care, and that a single payer system interferes less since the patient has free choices in health care whereas the private plans are more restrictive of benefits while limiting coverage to their contracted provider lists (a minute fraction of the physicians and hospitals available throughout the nation).

Health policy is complicated, but the message for single payer Medicare for All need not be: enrollment for life, free choice of physicians and hospitals and other health care professionals and institutions, and automatic payment by our own public program. The focus groups already understand that the Republicans do not have a replacement plan, but what they do not understand is that only the single payer model of Medicare for All meets these goals whereas the ACA/public option Medicare for Some often leaves them exposed to the access and affordability issues they already face.

Again, single payer Medicare for All means:

  • Never have to change insurers
  • Free choice always of doctors and hospitals
  • No medical bills since care has been prepaid through our taxes.

None of these are features of either the Republican proposals or the Democratic ACA/public option proposals. It’s a simple message. Let’s do our best to see that the American voter understands it.

Benefits Industry Leaders Warned About Medicare for All

It is amazing, but not surprising that we are seeing more and more business leaders coming out to prevent Americans from getting single payer health care under an improved and expanded Medicare for All.

The following article from BenefitsPro.com is aimed at warning the benefits industry not to underestimate single payer, and advises them on how to deal with this.

Naturally, it is all about selling a product to make a profit from not covering all Americans, and only those who get their health insurance from their employers, since that is what the article discusses.

They don’t care about the millions who are uninsured, under-insured, or who can’t afford insurance, let alone the cost of prescription drugs and medically necessary treatments. What matters to them is how many benefit packages they can sell to employers.

One thing to note from the article, Nelson Griswold said the following at the NextGen Growth & Leadership Summit:

“Once a country has moved to government-controlled health care, it has never gone back. My prediction is that we’ll have single payer in five years.”

I hope he’s right, as far as his prediction is concerned. However, he is also right about one other thing, No country has or will give up their current system for the one we have here in the US. They would be crazy to do so, and we are crazy for not doing what they have been doing for many years, and they are doing ok with theirs.

Change is hard, but once change happens, people generally feel that the change was worth it, and that all the worrying and apprehension over that change was misplaced, misguided, and silly.

So it will be with Medicare for All. They said the same thing about Medicare, and they recruited a has-been actor who would later turn politician to scare the living daylights out of seniors with the phrase, “socialized medicine.” Now, many Americans like Medicare. And the term, “socialized medicine” has another meaning. It means that capitalist medicine is better than socialized medicine, but that too has been proven wrong.

Anyway, here’s the link to this warning shot across the bow of single payer from an unexpected sector of the medical-industrial complex and consulting industry.

https://www.benefitspro.com/2019/02/08/why-single-payer-may-be-closer-than-you-think-and-what-to-do-about-it/?kw=Why%20single-payer%20may%20be%20closer%20than%20you%20think%20%28and%20what%20to%20do%20about%20it%29&slreturn=20190113103133

 

Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Modern Healthcare reported yesterday that the State of Arkansas dropped almost 4,000 of its citizens from the Medicaid expansion because of failure to comply with work requirements the state enacted months ago.

The following summary and link is provided:

Nearly 4,000 Arkansans lost their Medicaid expansion coverage in October because they didn’t comply with the state’s new work requirement. Another 8,462 low-income adults lost benefits in the previous two months.

Source: Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Single Payer A Bargain

Another shout out to Don McCanne for the following.

On Friday, the Nation published an article by Steffie Woolhandler, David Himmelstein, and Adam Gaffney.

You may recall these folks from my book review, “Health Care Under the Knife,” and it’s conclusion, “Some Final Thoughts on ‘Health Care Under the Knife.'”

Rather than regurgitate it for you, I am letting you read it in its entirety. But before I do, let me bring to your attention, an issue that is flying under the radar and has serious consequences for the country, our rights, and for the future of health care and other social programs.

Those lovable brothers from the Midwest, Charles and David Koch, are funding a group called ALEC, the American Legislative Exchange Council. One of the goals of ALEC is to call an Article V (of the Constitution, for those of you not familiar with the document) that allows for the creation of a convention in the event the government gets too much power.

I recommend you read up on it because it will radically alter our system of government for the benefit of the corporations and wealthy. Say goodbye to Social Security, Medicare, Medicaid, and direct election of Senators, to name a few goals.

That brings me to a quote I must let you read from a man who has no clue what he is talking about, and is emblematic of the dysfunction of his party. That man is former Oklahoma Sen. Tom Coburn, himself a physician who said the following regarding a convention and why he and others feel it is necessary.

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.”

In case you missed that, let me repeat it:

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.” Violent, ain’t he?

Pray tell, what country in western Europe is Marxist? Last I heard, none. Folks, these guys not only want to take away health care, they are still fighting the Cold War and godless, Marxist Communism.  No, what they are really about is defending a system, both economic and health care-wise, that cannot be sustained.

Here is the article in full:

Last week, Charles Blahous at the Koch-funded Mercatus Center at George Mason University published a study suggesting that Bernie Sanders’s single-payer health-care plan would break the bank. But almost immediately, various observers—including Sanders himself—noted that according to Blahous’s own estimates, single payer would actually save Americans more than $2 trillion over a decade. Blahous doubled down on his argument in The Wall Street Journal, and on Tuesday, The Washington Post’s fact-checker accused Democrats of seizing “on one cherry-picked fact” in Blahous’s report to make it seem like a bargain.
The Post is wrong to call this a “cherry-picked fact”—it’s a central finding of the analysis—but it is probably right that single-payer supporters shouldn’t make too much of Blahous’s findings. After all, his analysis is riddled with errors that actually inflate the cost of single payer for taxpayers.
First, Blahous grossly underestimates the main source of savings from single payer: administrative efficiency. Health economist Austin Frakt aptly demonstrated the “bewildering complexity of health care financing in the United States” in The New York Times last month, citing evidence that billing costs primary-care doctors $100,000 apiece and consumes 25 percent of emergency-room revenues; that billing and administration accounts for one-quarter of US hospital expenditures, twice the level in single-payer nations; and that nearly one-third of all US health spending is eaten up by bureaucracy.
Overall, as two of us documented recently in the Annals of Internal Medicine, a single-payer system could cut administration by $500 billion annually, and redirect that money to care. Blahous, in contrast, credits single payer with a measly fraction of that—or $70 billion—in administrative savings.
Our profit-driven multi-payer system is the source for this outlandish administrative sprawl. Doctors and hospitals have to negotiate contracts and fight over bills with hundreds of insurance plans with differing payment rates, rules, and requirements. Simplifying the payment system would free up far more money than Blahous estimates to expand and improve coverage.
Next, Blahous lowballs the potential for savings on prescription drugs. He assumes that a single-payer system couldn’t use its negotiating clout to push down drug prices, ignoring the fact that European nations and the US Veterans Affairs system achieve roughly 50 percent discounts relative to the US private sector. (Single payer’s only drug savings, he argues, will come from shifting 15 percent of brand-name prescriptions to generics.) Hence Blahous foresees only $61 billion in drug savings in 2022, even though tough price negotiations would likely achieve threefold higher savings.
Third, Blahous underestimates how much the government is already spending on health care. For instance, he omits the $724 billion that federal agencies are expected to pay for employees’ health benefits over the 10 years covered by his analysis, which would simply be redirected to Medicare for All. He also leaves out the massive savings to state and local governments, which would save nearly $3.6 trillion on employee benefits and another $5.3 trillion on Medicaid and other health programs. Hence, much of the “new money” needed to fund Sanders’s reform is already being collected as taxes.
Yes, there will need to be some new taxes—albeit much less than Blahous estimates. But those new taxes would just replace—not add to—current spending on premiums, co-pays, and deductibles. Additionally, at least some of the new taxes would be virtually invisible. For instance, the $10 trillion that employers would otherwise pay for premiums could instead be collected as payroll taxes. Similarly, Medicare for All would relieve households of the $7.7 trillion they’d pay for premiums and $6.3 trillion in out-of-pocket costs under the current system.
It’s easy to get lost in the weeds here. But at the end of the day, even according to Blahous’s errant projections, Medicare for All would save the average American about $6,000 over a decade. Single payer, in other words, shifts how we pay for health care, but it doesn’t actually increase overall costs—even while providing first-dollar comprehensive coverage to everyone in the nation. The Post’s fact-checker is wrong: Single-payer supporters can and should trumpet this important fact.
Of course, the most important benefits of single payer are altogether invisible in economic analyses like the one performed by Blahous. No matter what injury or illness we faced, we would be forever freed from one great worry: the cost of our care. It’s hard to put a price tag on that kind of freedom. Yet, paradoxically, even the slanted analysis of a libertarian economist provides evidence that it would be fiscally responsible.

Medicaid Work Requirements Worsen Health

Back in May, I posted a link to a Health Affairs blog article, Social Determinants Of Health: A Public Health Concept In Conflict in which it was reported that the current regime was seeking to impose work requirements for people on Medicaid.

As reported then, and on Monday in a follow-up article, CMS approved the first waiver to implement a work requirement for Medicaid beneficiaries in Kentucky on January 12th.

The article stated that a couple of weeks ago, a district court found the approval of these work requirements to be “arbitrary and capricious”, and in direct violation of the Administrative Procedures Act of 1996.

According to the article, CMS failed to consider whether the waiver’s estimated removal of 95,000 Kentuckians was in line with the program’s goals of furnishing medical assistance, and the judge ordered the waiver to be returned to CMS.

It was the government’s argument, the article states, that new research into the social determinants of health demonstrate that income and employment are associated with improved health, and so a work requirement thereby fits within the goals of the program.

The case in Kentucky hinged on the fact that work requirements worsened financial assistance, which the judge pointed out is a main tenet of the program.

The author then writes that if CMS wants to use research within the social determinants of health, then he will analyze Medicaid work requirements through this lens. A recent post in Health Affairs focused on the perversion of social determinants of health as a concept, and the current post builds off that one, to demonstrate that this regime’s justification for Medicaid work requirements is misguided at best.

To illustrate this, he follows a theoretical low-income worker, a 50-year-old from Louisville, who could no longer work in his job as a longshoreman due to cardiovascular disease and suffered chest pain whenever he exerted himself. He is uninsured, has a wife and three adult children. And is also trying to find a job.

The author continues by examining the following issues: Unemployment and Health, Medicaid Improves Health, Medicaid Work Requirements Harm Those With Jobs, and concludes by stating that Medicaid Work Requirements Worsen Health.

The theoretical case of the 50-year-old longshoreman is not so theoretical, as each of the 16 Kentucky plaintiffs in the case demonstrated. One is a graduating student with endometriosis, another is a mother of four with congenital hip dysplasia, and another is a partly blind mortician (no jokes, please) with chronic lung disease. All would have risked losing their coverage as a result of work requirements.

And to make the case more clearly, your humble blogger, while not currently on Medicaid, but eventually will be, has end-stage renal disease, and does peritoneal dialysis every night at home, and goes to the clinic twice a month for blood work and to see the nephrologist. In addition, every two weeks on a Monday, as will happen this coming Monday, I have to be home to receive my supplies, and this Friday must call in another order. Working a full-time job, if one were available that matched my experience, would prevent me from doing so.

This is another reason why our health care system is broken and needs to be replaced by a single payer system that does not separate out older beneficiaries, as Medicare does, poorer ones as Medicaid does, and children and military personnel, as the other programs do.

One system for all Americans.

Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional – The New York Times

The following article should alarm every decent American, especially those who wants to see every American have health care that does not eat into their life savings or cause them to go into debt.

Your humble author is one of them and may also be affected if this draconian decision is upheld by the courts and the Supreme Court. Thanks Bernie Bots and Steiners…thanks for giving us Justice Gorsuch by not voting or not voting for the Democratic candidate two years ago.

For what this will mean to Americans, here is Dr. Don McCanne’s take on it:

“Amongst the more important provisions of the Affordable Care Act were the requirements for guaranteed issue and community rating. For individuals with preexisting conditions, insurers could not deny them coverage nor could they charge them higher premiums than are charged for others in the same age group. This corrected two of the most serious defects in the individual insurance market that existed before enactment of ACA and made insurance available to many who otherwise could not purchase the plans.

Now Attorney General Jeff Sessions says that he will no longer defend these provisions. If the courts uphold his position, individuals with significant health care needs may find insurance with adequate benefits to be either unaffordable or not even available to them. Then concepts such as “universal” or “affordable” become moot.

How does this compare to our traditional Medicare program? The courts have already ruled that Part A of Medicare – the hospital benefit -is mandatory and must be accepted if the individual also accepts Social Security benefits. However, this does not apply to Part B – the physician benefits – nor to Part D – the drug benefits. Thus the courts have ruled that the government can require certain mandates in health care, but it also demonstrates that our current Medicare program needs to be improved, for this and for a great many other reasons. So a single payer, improved Medicare for all should be able to pass constitutional muster.

Once we have an improved Medicare that covers everyone, instead of thinking of it as some sort of unwanted government mandate, most of us would think of it as an automatic program ensuring health care financing for all of us – one that we have earned though our individual contributions based on ability to pay – guaranteed, affordable health care forever.”