Category Archives: Health Care Costs

The Free Market Utopian Fantasy

Whenever the subject of what to do about the cost of health care arises on the social media site, LinkedIn, invariably there is someone who attempts to deflect the discussion away from the logical solution of Medicare for All/Single Payer, to what I am calling the Free Market Utopian Fantasy.

Those of you who read my post, “Health Care Is Not a Market”, will understand that when it comes to health care, the rules of the market do not apply. That is why I have called the attitude and comments made by these individuals, the Free Market Utopian Fantasy. Because the free market in health care is a fantasy. It is usually the expression of economic libertarianism coming from the right-wing propaganda machine.

Simply put, the Free Market Utopian Fantasy states that if we only had a truly free market health care system, costs would regulate themselves through competition, as in other areas of the free market.

In fact, one observer recently said the following in a thread on LI: “This would not be the case IF there were created and implemented an ORDERLY market for health care services based upon free market enterprise principles whereby ALL costs are transparent to ALL parties.”

An orderly market? Are you serious? More of the same BS from the Free Market Utopians.

Then there is the idea that consumers, read that as patients, must educate themselves as to the best choice. Choice? When you are dying of a heart attack? Choice, when you only have a short time to live due to a serious illness like Cancer or Diabetes?

Folks, we are not talking about choosing between buying steak or chicken. This is not choosing to go to Italy next summer or to the Caribbean. We are talking about life and death. And the only choice is to do what will save your life, not choose between colors on a swatch.

This Free Market Utopian Fantasy has infected so many people in the health care industry, and they are trying to prevent the American people from receiving the same quality of care at lower cost than all the other Western and other nations already do for their people.

They claim that we can’t afford to do it. I ask, can we afford not to?

They cite statistics about Medicare like some cite similar statistics about Social Security, but they are wrong then, and they are wrong about Medicare for All, because it will be expanded to cover everyone and everything, not requiring separate insurance for things like vision and dental care, mental health, and long-term care.

Here is what one person said in the same thread cited above:

“We can barely afford Medicare for the 60 million current Medicare recipients. Adding another 270 million recipients would bankrupt the nation in short order. Latest data (2017) on Medicare shows an annual cost of $700 billion, and projections show the Medicare Trust Fund will be insolvent in 2026 – and by the way, Medicare actually only covers about half of the real cost because the rest is covered by supplementary insurances that have to be bought by the patient. If you assume that Medicare expansion was at the same cost rate as current Medicare, Medicare for all would cost at least $3.15 trillion in 2017 dollars. Total 2019 federal government revenue is estimated at $6.5 trillion, and estimated Medicare for all costs for 2019 would be $3.5 trillion. It is simply not feasible.”

Boy, they really know how to BS their way to keeping us the only Western nation that does not have universal health care. What they don’t realize is, there won’t be any private insurance, because it is private insurance that drives up the cost of health care with administrative costs and waste,

Well, it is high time we call BS on all of them, and their Free Market Utopian Fantasy. Until we stop listening to these folks who are protecting their careers and profits, no American will never have to worry if they or a loved one gets sick and cannot afford the needed medical care without going bankrupt or dying without ever receiving the care they so desperately need. I said as much in my other post, “By What Right”, where I took these folks to task for preventing the enactment of MFA/Single Payer.

These Free Market Utopians are not doing anyone any favors. They are only hurting millions of Americans, born or not-yet-born who will someday need a truly comprehensive, universal health care system, and it won’t be there thanks to them and their associates.

Opinion | Universal Health Care Might Cost You Less Than You Think – The New York Times

Today’s New York Times Opinion piece on universal health care is a timely one, given the attempts by the medical-industrial complex and their allies to derail any move towards health care for all. It is even more important now that the 2020 Democratic primary campaign is gaining momentum.

Medicare for All and Its Rivals | Annals of Internal Medicine | American College of Physicians

Richard’s Note: A shout-out to Don McCanne for posting this today from the Annals of Internal Medicine, which is providing the full article for free. The authors, Steffie Woolhandler and David Himmelstein, both MDs, should be familiar to readers as two of the authors I covered in my review of the Waitzkin, et al. book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health. In the spirit of the AIM, I am posting the entire article below with link to the original. It is that important.

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

The leading option for health reform in the United States would leave 36.2 million persons
uninsured in 2027 while costs would balloon to nearly $6 trillion (1). That option is called the
status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life
expectancy, the widening mortality gap between the rich and the poor, and rising deductibles
and drug prices. Even insured persons fear medical bills, commercial pressures permeate
examination rooms, and physicians are burning out.
In response to these health policy failures, many Democrats now advocate single-payer,
Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of
frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans
or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump
administration seeks to turbocharge market forces through deregulation and funneling more
government funds through private insurers. Here, we highlight the probable effects of these
proposals on how many persons would be covered, the comprehensiveness of coverage, and
national health expenditures (Table).

Table. Characteristics of Major Health Reform Proposals as of March 2019

Medicare for All

Medicare-for-All proposals are descendents of the 1948 Wagner–Murray–Dingell national health
insurance bill and Edward Kennedy and Martha Griffiths’ 1971 single-payer plan (2). They would
replace the current welter of public and private plans with a single, tax-funded insurer covering
all U.S. residents. The benefit package would be comprehensive, providing first-dollar coverage
for all medically necessary care and medications. The single-payer plan would use its
purchasing power to negotiate for lower drug prices and pay hospitals lump-sum global
operating budgets (similar to how fire departments are funded). Physicians would be paid
according to a simplified fee schedule or receive salaries from hospitals or group practices.
Similar payment strategies in Canada and other nations have made universal coverage
affordable even as physicians’ incomes have risen. These countries have realized savings in
national health expenditures by dramatically reducing insurers’ overhead and providers’ billing-
related documentation and transaction costs, which currently consume nearly one third of U.S.
health care spending (3). The payment schemes in the House of Representatives’ Medicare-for-
All bill closely resemble those in Canada. The companion Senate bill incorporates some of
Medicare’s current value-based payment mechanisms, which would attenuate administrative
savings. Most analysts, including some who are critical of Medicare for All, project that such a
reform would garner hundreds of billions of dollars in administrative and drug savings (4) that
would counterbalance the costs of utilization increases from expanded and upgraded coverage.
Reductions in premiums and out-of-pocket costs would fully offset the expense of new taxes
implemented to fund the reform.

 

“Medicare-for-More” Public Options

Public-option proposals, which would allow some persons to buy in to a public insurance plan,
might be labeled “Medicare for More.” Republicans Senator Jacob Javits and Representative John
Lindsay first advanced similar proposals in the early 1960s as rivals to a proposed fully public
Medicare program for seniors. This approach resurfaced during the early 1970s as Javits’
universal coverage alternative to Kennedy’s single-payer plan and gained favor with some
Democrats during the 2009 ACA debate.
Policymakers are floating several public-option variants, most of which would offer a public plan
alongside private plans on the ACA’s insurance exchanges. Although a few of these variants
would allow persons to buy in to Medicaid, most envision a new plan that would pay Medicare
rates and use providers who participate in Medicare. Positive features of these reforms include
offering additional insurance choices and minimizing the need for new taxes because enrollees
would pay premiums to cover the new costs. However, these plans would cover only a fraction
of uninsured persons, few of whom could afford the premiums (5); do little to improve the
comprehensiveness of existing coverage; and modestly increase national health expenditures.
The Medicaid public-option variant, which many states might reject, would probably dilute
these effects.
Medicare for America, the strongest version of a public-option plan, would automatically enroll
anyone not covered by their employer (including current Medicare, Medicaid, and Children’s
Health Insurance Program enrollees) in a new Medicare Part E plan. It would upgrade
Medicare’s benefits, although copayments and deductibles (capped at $3500) would remain.
The program would subsidize premiums for those whose income is up to 600% of the poverty
level, and employers could enroll employees in the program by paying 8% of their annual
payroll. The new plan would use Medicare’s payment strategies and include private Medicare
Advantage (MA) plans (which inflate Medicare’s costs [6]) and accountable care organizations.
Medicare for America would greatly expand coverage and upgrade its comprehensiveness but
at considerable cost. As with other public-options reforms, it would retain multiple payers and
therefore sacrifice much of the administrative savings available under single-payer plans.
Physicians and hospitals would have to maintain the expensive bureaucracies needed to
attribute costs and charges to individual patients, bill insurers, and collect copayments. Savings
on insurers’ overhead would also be less than those under single-payer plans. Overhead is only
2% in traditional Medicare (and 1.6% in Canada’s single-payer program [7]) but averages 13.7%
in MA plans (8) and would continue to do so under public-option proposals. Furthermore, as in
the MA program, private insurers would inflate taxpayers’ costs by upcoding as well as cherry-
picking and enacting network restrictions that shunt unprofitable patients to the public-option
plan. This strategy would turn the latter plan into a de facto high-risk pool.

The Trump Administration White Paper and Budget Proposal

Unlike these proposals, reforms under the Trump administration have moved to shrink the
government’s role in health care by relaxing ACA insurance regulations; green-lighting states’
Medicaid cuts; redirecting U.S. Department of Veterans Affairs funds to private care; and
strengthening the hand of private MA plans by easing network-adequacy standards, increasing
Medicare’s payments to these plans, and marketing to seniors on behalf of MA plans. A recent
administration white paper (9) presents the administration’s plan going forward: Spur the
growth of high-deductible coverage, eliminate coverage mandates, open the border to foreign
medical graduates, and override states’ “any-willing-provider” regulations and certificate-of-
need laws that constrain hospital expansion. The president’s recently released budget proposal
calls for cuts of $1.5 trillion in Medicaid funding and $818 billion in Medicare provider payments
over the next 10 years.
Thus far, the effects of the president’s actions—withdrawing coverage from some Medicaid
enrollees and downgrading the comprehensiveness of some private insurance—have been
modest. His plans would probably swell the ranks of uninsured persons and hollow out
coverage for many who retain coverage, shifting costs from the government and employers to
individual patients. The effect on overall national health expenditures is unclear: Cuts to
Medicaid, Medicare, and the comprehensiveness of insurance might decrease expenditures;
however, deregulating providers and insurers would probably increase them.
In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and
persistent problems with access and quality triggered a roiling debate over single-payer plans.
As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative,
1 of several proposals promising broadened coverage on terms friendlier to private insurers.
Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet
the need” (10). President Nixon’s pro market HMO strategy—a close analogue of the modern-
day accountable care strategy—ultimately won out, although his proposals for coverage
mandates, insurance exchanges, and premium subsidies for low-income persons did not reach
fruition until passage of the ACA.
Five years into the ACA era, there is consensus that the health care status quo spawned by
Nixon’s vision is unsustainable. President Trump would veer further down the market path.
Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-
for-All proponents aspire to decouple care from commerce.

How to Negotiate Down Your Hospital Bills – The Atlantic

Negotiate hospital bills? Why not negotiate drug costs, insurance premiums, co-pays, deductables, etc.?

Instead of playing this game, why not Improved Medicare for All. This way, no one will get sick paying for health care that is too damn expensive.

Read on.

Doctors’ bills play a role in 60 percent of personal-bankruptcy filings.

Source: How to Negotiate Down Your Hospital Bills – The Atlantic

By What Right?

In the annals of Western history, two courageous men stood up and challenged the establishment of their nations to act to change history or to right a grievous wrong done to an innocent man.

The first individual was Patrick Henry when he gave his “Give me liberty, or give me death” speech, and the second was Émile Zola, who wrote “J’Accuse…!,” which he wrote in defense of Alfred Dreyfus, imprisoned falsely on Devil’s Island for treason.

These, of course were not the only instances where men of good intention, rallied people to a just and rightful cause; but it was the two instances that came to mind after reading another health care expert poo-poo Medicare for All on social media.

The individual commented on an article in Healthcare Dive.com that I had discussed some days ago. The article was about how kidney care in the US was being revamped, and the individual claimed that Medicare for All would damage the care dialysis patients are currently receiving.

What this person is doing is trying to scare people with propaganda that is akin to saying Medicare for All is “Socialism.” We know that none of the countries that have such a system are Socialist. They are Capitalist. The scare tactic being used here is rationing of care. It so happens that my clinic company is a European company, and I don’t believe people in their home country are rationed dialysis care. And they have a single payer system.

In the past few days, I have seen several comments made by men and women in occupations related to, or in the health care industry. These comments generally have attacked the very idea of Medicare for All for a variety of reasons. Many of these individuals are either a part of the medical-industrial complex, or they are lawyers, employee benefits consultants, or other types of consultants to specific areas of health care. They are defending a turf.

These individuals believe they can supersede the right of all Americans to have decent, affordable health care that does not force them into bankruptcy, or to go without because they cannot afford treatment for serious illnesses or diseases, or expensive medications.

Those of you who have been reading my blog of late, know that I have been very passionate about enacting Medicare for All, either because a fellow blogger has written so eloquently about it, or for personal reasons.

So, I have decided, like M. Zola did, to declare openly: By What Right?

By what right do you have to deny millions of Americans health care? By what right do you have to even suggest that Medicare for All is too expensive, would do more harm than good, or any of the other remarks made on social media to attack the very notion of health care for all?

By what right do you have to consign others to a broken, complex, complicated, bloated, and out of control health care system, whose true aim is to line the pockets of insurance companies, pharmaceutical companies, device manufacturers, hospitals, Wall Street investors, or the shareholders of these and other companies?

I don’t mind constructive criticism of this plan or that plan put forth by any number of Congressmen or Senators, but to outright state that it won’t work, or should not work, is to deny the rest of the nation the same kind of health care that the members of Congress receive.

By what right do you have to tell the millions of uninsured and under-insured, “sorry, we don’t believe in Medicare for All, so you will just have to suffer, so that we can keep our jobs, and collect our fat paychecks.”

I have yet to hear a logical answer to why the US should be the only Western nation to not provide its citizens with universal health care. Some say it is too expensive. Do you mean, it is more expensive than spending taxpayer money on weapons of war? Or on a wall on our Southern border? Or a space force?

Do you mean that it would raise taxes, first on the wealthy and corporations, and later everyone else? Well, maybe the rich and the corporations should pay more in taxes. Polls seem to indicate that as much lately.

Another line of attack says that providers would be hurt. Do you mean that certain very wealthy physicians, surgeons and specialists, would see their incomes cut in half? Do you mean that hospitals could not buy each other up and become larger conglomerations that raises health care costs, instead of lowering them?

I thought medicine was a calling, not a get-rich quick scheme.

Oh, and what about the pharmaceutical industry that uses Americans as a cash cow while the same drugs, manufactured overseas, by the same companies, cost a fraction of what they do here, and have made men like current Federal pen occupant, Martin Shkreli, a wealthy man. Why not allow Americans to import those very same drugs from Canada, the UK, Israel, Mexico, etc. so that they can have their insulin and other life-saving medications without having to cut the dosages in half or go without altogether.

By what right do you have to defend the status quo? To make huge and obscene profits? As I wrote in Health Care Is Not a Market:

“…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.”

“…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.”

“…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.”

Instead of trying to tear down Medicare for All, why not offer your expertise and knowledge to improving the Medicare for All bills introduced to Congress, as well as other plans, especially the proposal by the Physicians for a National Health Program (PNHP)?

Those of you who are not familiar with the legislative process, something that at times has been compared to the production of sausages, it isn’t pretty. There is a lot of negotiating and horse-trading that occurs before a bill is passed and signed into law. Unfortunately, given a Republican President, and his lapdog, Republican Senate, none of the introduced pieces of legislation will pass the Senate, even if the House passes it.

So, consider this, by what right do you have to step in the way of progress for all Americans to get health care? By what right do you have to put your economic interests ahead of the health needs of others? By what right do you have to be cruel and inhumane, to let people die, get sick, and suffer needlessly, just so that you can sleep at night?

I hope that once you do consider this, you won’t sleep at night, because it would mean that you are not just greedy little cogs in the medical-industrial complex, but rather, kind and compassionate human beings who are motivated more out of love, than out of what’s in it for you if things don’t change.

By what right do you have to tear down something that has not even been passed and implemented? Why don’t we enact Medicare for All, and see if all the criticisms you have will come true or not? Could it be because you know deep in your heart it will, but are afraid to say so for fear of what your colleagues would say?

And finally, by what right do you have to play God with other people’s lives? You have already predicted that Medicare for All will fail, so why even bother? You are basing your opinions on what you have been told by free market ideologues, academics, business leaders, Conservative media, and politicians.

So, who cares if the poor die, if the elderly die, if children born with crippling illnesses and diseases die, if young people stricken down in the prime of life die, etc., as long as someone can make a hefty profit off of adverse selection, and the outrageous cost of desperately needed medications that they cannot afford?

I know what you are going to say to yourselves, and to me. That I don’t know what I am talking about, that I am wrong on so many levels, that I don’t have the experience in health care that you do. Well, I really don’t care what you will say. Do you have compassion and concern for your fellow citizens, or are you minions of a heartless, soulless Capitalist system that grinds people down for profits and wealth?

Patrick Henry stirred a people to revolution against a tyrant, Émile Zola rallied a nation to free a man unjustly accused and sentenced to hard labor in the most horrible prison ever constructed by Western man.

You can do what is right. You can defend Medicare for All, and even improve on what has already been proposed, but don’t attack it. Doing so will only cause more pain and suffering to millions of Americans, and will make investors, stockholders and providers and industry leaders wealthier, and the rest of us, poorer. Both spiritually and materially.

You are better than this.

How much are you really paying for healthcare? – Managed Care Matters

A little Monday evening catch-up from posts received this morning, but was not able to read and relate to you.

The article below from Joe Paduda examines how much we are really paying for health care, and shows in graphic detail how prices have gone up in health care.

Here is Joe’s article:

Recent posts have focused on defining Medicare for All/Single Payer and the problem both are intended to solve – healthcare prices in the US are the problem. Today, we’ll figure out what you really pay for healthcare. That’s pretty darn … Continue reading How much are you really paying for healthcare?

Source: How much are you really paying for healthcare? – Managed Care Matters

Medical Mystery: Something Happened to the U.S. Health System After 1980 | The Incidental Economist

Good morning all. While perusing my LinkedIn feed, I found this article from May of last year, and thought it would be a perfect addition to the series of articles posted last week about Medicare for All/Single Payer, and why opposition to it is more harmful than the alleged or imagined fear-mongering we are seeing from many quarters.

This is especially significant in light of my post last week, Health Care Is Not a Market, and as the article below suggests, the US health care system diverged exactly at the time of the election of Ronald Reagan in 1980, and the introduction of pro-market forces, supply-side economics.

So it is no coincidence that as Austin Frakt writes, that prices went up, while health outcomes went down, and that socioeconomic status and other social factors exert larger influences on longevity.

Here is the article:

The following originally appeared on The Upshot (copyright 2018, The New York Times Company). Research for this piece was supported by the Laura and John Arnold Foundation.

Source: Medical Mystery: Something Happened to the U.S. Health System After 1980 | The Incidental Economist