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.
Yesterday, Sen. Bernie Sanders introduced the Medicare for All Act for 2019, along with 19 co-sponsors in the Senate.
This bill mostly follows the previous bill he introduced in 2017, yet it has one notable addition. The new bill is summarized as follows:
* Eligibility: Covers everyone residing in the U.S.* Benefits: Covers medically-necessary services including primary and preventive care, mental health care, reproductive care (bans the Hyde Amendment), vision and dental care, and prescription drugs. This bill also provides home- and community-based long-term services and supports, which were not covered in the 2017 Medicare for All Act.* Patient Choice: Provides full choice of any participating doctor or hospital. Providers may not dual-practice within and outside the Medicare system.* Patient Costs: Provides first-dollar coverage without premiums, deductibles or co-pays for medical services, and prohibits balance billing. Co-pays for some brand-name prescription drugs.* Cost Controls: Prohibits duplicate coverage. Drug prices negotiated with manufacturers.* Timeline: Provides for a four-year transition. In year one, improves Medicare by adding dental, vision and hearing benefits and lowering out-of-pocket costs for Parts A & B; also lowers eligibility age to 55 and allows anyone to buy into the Medicare program. In year two, lowers eligibility to 45, and to 35 in year three.
* Funding hospitals through global budgets, with separate funding for capital projects: A “global budget” is a lump sum paid to hospitals and similar institutions to cover operating expenses, eliminating wasteful per-patient billing. Global budgets could not be used for capital projects like expansion or modernization (which would be funded separately), advertising, profit, or bonuses. Global budgeting minimizes hospitals’ incentives to avoid (or seek out) particular patients or services, inflate volumes, or up-code. Funding capital projects separately, in turn, allows us to ensure that new hospitals and facilities are built where they are needed, not simply where profits are highest. They also allow us to control long term cost growth.* Ending “value-based” payment systems and other pay-for-performance schemes: This bill continues current flawed Medicare payment methods, including alternative payment models (including Accountable Care Organizations) established under the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Studies show these payment programs fail to improve quality or reduce costs, while penalizing hospitals and doctors that care for the poorest and sickest patients.* Establishing a national long-term care program: This bill includes home- and community-based long-term services and supports, a laudable improvement from the 2017 bill. However, institutional long-term care coverage for seniors and people with disabilities will continue to be covered under state-based Medicaid plans, complete with a maintenance of effort provision. PNHP recommends that Sen. Sanders include institutional long-term care in the national Medicare program, as it is in Rep. Pramila Jayapal’s single-payer bill, H.R. 1384.* Banning investor-owned health facilities: For-profit health care facilities and agencies provide lower-quality care at higher costs than nonprofits, resulting in worse outcomes and higher costs compared to not-for-profit providers. Medicare for All should provide a path for the orderly conversion of investor-owned, for-profit health-care providers to not-for-profit status.* Fully covering all medications, without co-payment: Sen. Sanders’ bill excludes cost-sharing for health care services. However, it does require small patient co-pays (up to $200 annually) on certain non-preventive prescription drugs. Research shows that co-pays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.
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
Medicare for All
“Medicare-for-More” Public Options
The Trump Administration White Paper and Budget Proposal
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.
Some statistics about the world’s healthiest nations, according to the World Economic Forum. You will notice that the first time the US is mentioned, is when we are listed as the nation with the most expensive health care.
Imagine if we actually had a “free market”, competitive system where providers of health care services could and would charge anything they wanted because there was no one to stop them? Actually, that is what drives the cost of drugs.
And you will see in the first chart, that many of the nations listed have some form of universal, single payer health care, where everyone is covered, and costs are lower, and have better outcomes.
While no males in every region shown in the second chart has a higher life expectancy, which is understood, since females live longer than males, females in Europe have the longest life expectancy, no doubt due to the better outcomes of their single payer systems.
And finally, in the fourth chart, the US is at the bottom of the bell curve for obesity for both men and women among all the Western nations, and Japan and South Korea. There is a strong correlation between the rankings from Bloomberg in chart 1, and the rates of obesity in chart 4.
So for you skeptics and opponents of single payer, here is the article with some very nice graphics that will help you see the light:
Spain has cracked the secret to a healthy life, with a Mediterranean diet and publicly funded primary healthcare sending it to the top of the latest global rankings.
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.
Health Affairs.com published the following research article yesterday projecting national health expenditures from 2018 to 2027.
According to the article, national health expenditures are projected to grow at an average annual rate of 5.5 percent for 2018–27 and represent 19.4 percent of gross domestic product in 2027.
In addition, spending growth during 2018–27 is expected to be driven primarily by long-observed demographic and economic factors fundamental to the health sector.
Prices for health care goods and services are projected to grow 2.5 percent per year, on average, for 2018–27—faster than the average price growth experienced over the last decade—and to account for nearly half of projected personal health care spending growth.
Average annual spending growth in Medicare (7.4 percent) is expected to exceed that in Medicaid (5.5 percent) and private health insurance (4.8 percent) over the projection period, mostly as a result of comparatively higher projected enrollment growth, according to the article abstract.
And finally, the insured share of the population is expected to remain stable at around 90 percent throughout the period, as net gains in health coverage from all sources are projected to keep pace with population growth.
Yet, Don McCanne states in his comment, that the authors anticipate that a decade from now we will still have tens of millions uninsured.
So, it is vital that we continue to push to enact Single Payer/Medicare for All, and bring down the cost of health care, and the increases in spending that the current broken for-profit system generates.
Here is the link to the abstract and article:
Research Article Health Affairs Vol.0 No.0 National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth
And here is the link to another article from Healthcare Dive.com that summarizes what Health Affairs.com’s article discusses:
Following on the heels of yesterday’s post from Joe, today’s post covers the cost of healthcare, and what Medicare for All could do to solve it.
Recently, two billionaires, Former NY Mayor Michael Bloomberg and former barista-in-chief Howard Schultz have both said that the US cannot afford Medicare for All/Single Payer health care.
But if we look at Joe’s article, and his subsequent ones later this week, can we afford not to?
Here’s Joe’s article:
This week we are unpacking Single Payer/Medicare for All to better understand the many variations of SP/MFA and now they are different, how those variations might work, and whether some version is a) politically viable and b) would solve the … Continue reading Could Medicare for All Solve the healthcare cost problem?
This week, the former CEO of everyone’s favorite coffee house and time waster, Starbucks, declared that he was considering a run for president next year as an independent.
This announcement brought immediate response from both wings of the Democratic Party, as they said it would result in the re-election of the current occupant of the White House.
Even former NYC Mayor, Michael Bloomberg, another billionaire, said that he should not run.
However, as this is a blog about medical care, and not politics, I will leave the discussion as to the efficacy of an independent run for president by another billionaire for others.
What I do want to focus on is this overpaid former barista’s belief that the US cannot afford a Medicare for All, single-payer health care system.
Incidentally, this is also Bloomberg’s view as well.
But I do not think their opposition is based solely on the belief that Medicare for All, single-payer is too expensive. Rather, I believe they are afraid that after the results of last November’s midterm elections, the Democratic Party is poised to win back the White House and possibly the Senate, and that Medicare for All, in whatever form it takes, will be enacted.
I have written about the health care industry’s efforts to derail Medicare for All in previous posts. (See the following: https://wp.me/p2QJfz-QIy, https://wp.me/p2QJfz-Jki, and https://wp.me/p2QJfz-WI5)
While I cannot accuse Schultz and Bloomberg of being in the pocket of the healthcare industry, it does look suspicious that now that the Democrats control the House, they are coming out against a health care plan that many Americans voted for when they voted for Democrats.
But billionaires should not be the ones deciding whether or not we enact Medicare for All. That should be up to the voters (patients and non-patients), their elected representatives, and most importantly, those in the medical profession who believe the time has come for Medicare for All, single-payer.
One such group are physicians themselves, as reported back in August in the magazine of the Physicians for a National Health Program (PNHP), which I was informed of this morning by a high school alumnus who posted the article on another alum’s Facebook post.
The article was originally posted in Jacobinmag.com.
Here is the link to the article by Meagan Day.
One caveat to progressives: Don’t assume that every American voter who is undecided, declared themselves as an independent, or are unhappy with their choice in the last presidential election, and his behavior and actions, will vote for your chosen candidate. That is why Schultz is contemplating running. And he can do a lot of damage to your plans for 2020.
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…