Category Archives: Health Care

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.

COVID-19 and America’s Social Safety Net

Friday’s HuffPost published an article by Emily Peck on the Coronavirus (COVID-19) and its impact on the country’s broken social safety net.

The article indicates that millions of working Americans do not get paid sick days. It also states that a stunning 70% of low-wage workers and one of three workers in the private sector, have no access to paid sick time.

According to Ms. Peck, the US is one of the few countries in the world without a national paid sick leave policy. In addition, she adds, millions of Americans do not have health insurance, or their policies are designed to keep them away from doctors with high co-payments and deductibles.

Both these issues, Ms. Peck writes, highlights how coronavirus, or COVID-19, could test the US’ uniquely weak social safety net.

Kristin Rowe-Finkbeiner, the executive director of MomsRising, a nonprofit advocating for paid leave is quoted in the article, “Right now we’re looking at a situation where we have a lack of policies that most other countries take for granted that protect their public health.”

This isn’t just a “coronavirus” problem, Ms. Peck says. Even though the CDC warned Americans earlier in the week, so far there have been very few case reported in the US. (Note: As of this writing,  there have been 74 reported cases in the US, and two men have died in Washington State, and one case was recently reported in Rhode Island, and one in Manhattan)

Yet, fears of an outbreak has put a spotlight on the public health system. With cuts to many agencies by Trump, many experts fear that we will be unable to deal with the crisis, especially since the Trump called it a hoax at a recent political rally.

He also appointed his evolution-denying Vice President, Mike Pence to coordinate the Administration’s response after gagging several Administration personnel from appearing on the Sunday talk shows. It was mentioned after the announcement that Pence did not believe that smoking causes cancer when he was Governor of Indiana.

For the Democrats, says Ms. Peck, coronavirus makes the case for policies like universal health care and paid sick and family leave.

Some key points to consider:

First, flu rates are higher without sick leave. What about coronavirus?

In the US, the article reports, just 10 states, 20 cities and three counties have some kind of paid sick leave. This is compared with the rest of the world, where more than 145 countries have this benefit. People who live in those places, research shows, are less likely to get sick, Ms. Peck reports.

And lack of paid sick leave is certainly a “risk factor”, according to Nicolas Ziebarth, associate professor in health economics at Cornell. Professor Ziebarth’s 2019 paper in the Journal of Public Economics, looked at Google data on flu rates, compared cities with leave policies with those without, and found that flu rates were 5% lower in places with sick leave.

An upcoming paper of Professor Ziebarth’s, based on CDC data, has found that the rates are actually 11% lower.

For those workers in low-wage jobs, if they get sick, they cannot afford to take time off of work because they are barely getting by. So, they end up going to work, and they get their co-workers sick.

Working from home isn’t an option.

Many companies are telling employees to work from home with the threat from coronavirus. However, for low-wage hourly workers, says Ms. Peck, this just isn’t an option. Many work in industries that have contact with the community — such as food servers, people who care for children, clean offices and homes.

As stated above, it is not just sick leave, The US also lacks any kind of comprehensive paid family leave policy, according to Ms. Peck, which would enable workers to take time off to care for a close family member’s health issues. This issue first came to light in 1993 when Bill Clinton signed into law, the Family and Medical Leave Act, which required covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons.

An example of just how needed is paid family leave, comes from the experience of Ericka Farrell, a mother of three in Maryland, who lost her temp job in the early 2000s because she had to take so much time off to care for her young son. She did not regret staying home, but now works with MomsRising to advocate for paid leave herself, writes Ms. Peck.

Millions are uninsured. Many more have terrible insurance.

According to Ms. Peck, even if you take time off when you are sick, you might not be able to afford to see the doctor. Slightly more than 10% of Americans. she mentions, or about 30 million people, don’t have health insurance. This is because their employers do not offer it, or it is too expensive.

Things to consider regarding the uninsured:

  • Far less likely to go to the doctor
  • Americans with insurance face obstacles to getting care due to high co-payments
  • Then there are the deductibles, which have been going up for decades
  • Most people haven’t come near clearing those deductibles at the beginning of the year

John Graves, associate professor of health policy at Vanderbilt University Medical Center was quoted as saying, “If we as a society are going to face a spreading infectious disease, the worse time of the year is the beginning of the year.”

Graves added that the US health care system is simply not designed to deal with a potential pandemic.

First, he says, the US relies on employment-based insurance. If people are thrown out of work due to an economic downturn, they lose coverage.

Second, insurance is designed to encourage people not to see the doctor through so-called “cost-sharing.”  Co-payments and deductibles exist to discourage people from visiting the doctor or going to the hospital for every “cough and sniffle.” Graves said.

Lastly, in 2018, the Administration made it easier for people to buy insurance plans with less generous coverage, and don’t always cover expenses stemming from preexisting conditions, the article says. Experts have said that these plans they consider junk policies, have even higher out-of-pocket costs.

So what does this all mean?

It means that cuts to the social safety net guarantees that should the coronavirus get out of hand, the US is not prepared to deal with it effectively, and many more people will probably die who shouldn’t because of politics and ideology.

Hospital closings in rural areas, the firing of hundreds of health care personnel at the federal level, silencing the experts in infectious diseases, and the appointment of a man who rejects evolution and says smoking does not cause cancer to coordinate the Administration’s response, is a recipe for a catastrophe of unimanigable proportions. Calling it a hoax in front of your ardent supporters who believe everything you say, will only lead to more confusion and more deaths.

But this crisis also proves that it is high time those on social media sites like LinkedIn who are part of the health care industry, whether they are physicians, in the pharmaceutical industry, work in hospitals, are device manufacturers, or are consultants and researchers, accept the fact that single payer, universal health care (Medicare for All) is not just an economic necessity, but a public health necessity as well.

Is your big, fat five or six figure incomes more important than human health? It’s your call.

Multiple studies show Medicare for All would be cheaper than public option pushed by moderates | Salon.com

For all those skeptics and naysayers who say we can’t afford single payer, Salon.com has an article from Saturday (see below) that dispels the notion that Medicare for All is too expensive.

Yet, bear in mind, that we are spending billions on two wars, raising the military spending budget, wasting money on a stupid wall that is falling down, and a host of other useless and wasteful spending that is running up the deficit, at the same time health care companies and pharmaceutical companies are raking in huge profits and returning questionable outcomes.

But go ahead, believe the Republican lies, libertarian fantasies  and moderate Democrats wishful thinking about a public option. You only have your health to lose.

Here’s the article:

Yale and Harvard researchers found that Medicare for All reduces costs while public option makes health care more expensive.

Source: Multiple studies show Medicare for All would be cheaper than public option pushed by moderates | Salon.com

The $8,000 Rip-off That Is Healthcare

Picking up on a theme I presented in two earlier posts this year, Health Care is Not a Market  and The Free Market Utopian Fantasy, Joe Paduda today asks “what would you do with another $8,000?”

Joe’s post outlines how providers, big pharma, device companies, and healthplans make money from a system designed to do so, and not to help you and your family stay healthy and functional. [ Emphasis Joe’s]

He shows us graphically how big health sector profit margins are, how we spend more than any other country, but die younger, and how healthcare premiums and deductibles and out of pocket costs keep climbing, but wages do not.

His one key point, is the following:

Healthcare is not, and cannot ever be, a free market. A free market requires buyers have the ability to make sellers respond to buyers’ needs – yet we all know we consumers have zero ability to make pharma, hospitals, big doctor groups, device companies respond to our needs.

Lastly, Joe asks the question: “If air travel worked like health care?” [Video link]

Would you rely on the airlines with your health care? Would you rely on the health care industry to fly you to your nephew’s wedding in Orlando? Of course, not.

So, why would you continue to defend, support and protect a dysfunctional, broken, wasteful, bloated, health care system that does not work like the free market, but only makes huge profits for the insurance companies, drug companies, device manufacturers, hospitals, investors, stock and shareholders.

And yes, you hanger’s on in consulting and research organizations who constantly attack single payer health care because it, one, puts you out of a job, and two, takes away any profits you and your company makes from advising  on or researching how to squeeze more profit out of the system.

One thing is for certain. I could sure use that $8,000 right now. My health care and other issues have taken a lot more from me than $8,000, but I’d settle for that. Wouldn’t you?

American College of Physicians Endorses Single Payer

For all you naysayers in the health care industry, whether you work for insurance companies, drug companies, or are consultants or analysts, the following posts from the Annals of Internal Medicine should convince you that you are on the wrong side of the issue, and that more and more physicians are coming around to the realization that single payer is necessary to improve the American health care system. The first article is authored by a panel, and the second by Woolhandler and Himmelstein.

I have been asking these questions, and many others like them for some time: What gives you the right to deny your fellow Americans universal health care? What right do you have to prevent them from getting lower cost medical care and lower cost drugs? What gives you the right to defend the profiteering in health care that has created a dysfunctional, broken, and wasteful system? The answer to these questions is the same – GREED. and your desire to protect your jobs. Well, according to these articles, you may be coming to the end of the line in that regard.

Here are the articles in full, thanks to Don McCanne:

Annals of Internal Medicine

January 21, 2020

Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians

By Robert Doherty, BA; Thomas G. Cooney, MD; Ryan D. Mire, MD; Lee S. Engel, MD; Jason M. Goldman, MD; for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians

U.S. health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and public health; spends too much on administration at the expense of patient care; fails to invest and support public health approaches to reduce preventable injuries, deaths, diseases, and suffering; and fosters barriers to care for and discrimination against vulnerable individuals.

The ACP’s Vision of a Better Health Care System for All

The ACP believes the United States can, and must, do better and offers the following 10 vision statements for a better health care system for all.

1. The American College of Physicians envisions a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford.

(Nine more vision statements listed.)

The accompanying policy papers offer specific recommendations, supporting rationales, and evidence on ways the United States can move to achieve ACP’s vision.

In “Envisioning a Better Health Care System for All: Coverage and Cost of Care” (1), ACP recommends transitioning to a system of universal coverage through either a single payer system, or a public choice to be offered along with regulated private insurance. Although each approach has advantages and disadvantages, either can achieve ACP’s vision of a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford. The evidence suggests that publicly financed and administered plans have the potential to reduce administrative spending and associated burdens on patients and clinicians compared with private insurers. Other approaches were considered by ACP, including market-based approaches, yet ACP found they would fall short of achieving our vision of affordable coverage and access to care for all. The ACP asserts that under a single payer or public option model, payments to physicians and other health professionals, hospitals, and others delivering health care services must be sufficient to ensure access and not perpetuate existing inequities, including the undervaluation of primary and cognitive care.

The ACP proposes that costs be controlled by lowering excessive prices, increasing adoption of global budgets and all-payer rate setting, prioritizing spending and resources, increasing investment in primary care, reducing administrative costs, promoting high-value care, and incorporating comparative effectiveness and cost into clinical guidelines and coverage decisions.

In “Envisioning a Better Health Care System for All: Health Care Delivery and Payment Systems” (2), ACP calls for increasing payments for primary and cognitive care services, redefining the role of performance measures to focus on value to patients, eliminating “check-the-box” reporting of measures, and aligning payment incentives with better outcomes and lower costs. The position paper calls for eliminating unnecessary or inefficient administrative requirements, and redesigning health information technology to better meet the needs of clinicians and patients. The ACP concludes there is no one-size-fits-all approach to reforming delivery and payment systems, and a variety of innovative payment and delivery models should be considered, evaluated, and expanded.

In “Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health” (3), ACP calls for ending discrimination and disparities in access and care based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. This position paper calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems.

These are just a partial summary of the recommendations in the 3 position papers; considered together, they offer a comprehensive and interconnected set of policies to guide the way to a better a health care system for all. We urge readers of this call to action to review the 3 papers for a complete understanding of ACP’s recommendations and the evidence in support of them.

The ACP rejects the view that the status quo is acceptable, or that it is too politically difficult to achieve needed change. By articulating a new vision for health care, ACP is showing a willingness to try to achieve a better U.S. health care system for all. We urge others to join us.

https://annals.org/aim/fullarticle/2759528/envisioning-better-u-s-health-care-system-all-call-action

Better Is Possible: The American College of Physicians’ Vision for the U.S. Health Care System

21 January 2020 Vol: 172, Issue 2_Supplement

The following link provides full free access to nine papers in this special Annals of Internal Medicine/American College of Physicians Supplement on a bold new prescription for the U.S. health care system:

https://annals.org/aim/issue

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Annals of Internal Medicine

January 21, 2020

The American College of Physicians’ Endorsement of Single-Payer Reform: A Sea Change for the Medical Profession

By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD

For a century, most U.S. medical organizations opposed national health insurance. The endorsement by the American College of Physicians (ACP) of single-payer reform marks a sea change from this unfortunate tradition.

Canada’s generally positive experience is among the strands of evidence underpinning the ACP’s endorsement. A single-payer reform that reduced insurance overhead to 2% (the level for Canada and traditional Medicare) could save more than $200 billion annually. In addition, our multipayer system imposes complexity and expense on providers; the Cleveland Clinic has 210 000 000 different prices. Single-source payment could streamline reimbursement—for example, by replacing per patient hospital payment with global budgets and establishing uniform billing and documentation requirements. Hospitals and doctors could save billions on billing-related costs and repurpose those savings to expand care, making universal, first-dollar coverage affordable.

Achieving universal coverage would be costlier under the “public choice” model the ACP co-endorses along with single payer. Multipayer systems incorporating for-profit insurers have not gleaned large administrative savings. For-profit insurers’ overhead is high everywhere, and the persistence of multiple payers would hinder efforts to streamline providers’ billing-related work.

Moreover, real-world experience with 2 public choice models—Medicare’s Advantage program and the Consumer Oriented and Operated Plans (CO-OPs) under the Patient Protection and Affordable Care Act (ACA)—warns that in health insurance competition, public option good guys finish last.

Although no reform achieves perfection, evidence indicates that a well-structured single-payer reform might resolve our nation’s coverage and affordability problems, preserve the choices patients value, and allow doctors to focus on what matters most: caring for our patients.

https://annals.org/aim/fullarticle/2759531/american-college-physicians-endorsement-single-payer-reform-sea-change-medical

PNHP release:

https://pnhp.org/news/doctors-prescribe-medicare-for-all-single-payer-reform-endorsed-by-americas-largest-medical-specialty-society-and-recommended-in-open-letter-from-thousands-of-physicians/

Here is Don’s Comment:

Welcome to a bright new day in health care reform.

The American College of Physicians (ACP) is the largest physicians’ organization dedicated to patient care (the AMA has traditionally functioned primarily as a physicians’ guild). “ACP recommends transitioning to a system of universal coverage through either a single payer system, or a public choice to be offered along with regulated private insurance.”

ACP has proffered a large volume of material that presents a multitude of problems with our current expensive but underperforming health care system. They present many options for reform that have been under consideration, but, as mentioned, they single out two for their vision of a better U.S. health care system for all: 1) single payer, or 2) a “public choice” with regulated private insurance.

Included in the AIM supplement is an important paper by Steffie Woolhandler and David Himmelstein. They discuss the clear advantages of a Canadian-style single payer model, but they caution us about the deficiencies of the for-profit insurers that we have in the United States, and the failures of our experimentation with public choice models – CO-OPs and Medicare Advantage. (To understand better the problems with a private plan and public choice approach, you should read not only the full Woolhandler/Himmelstein paper at the link above, but also the voluminous material on this topic at pnhp.org.)

There is much more material in this AIM supplement, especially on delivery reform and addressing social determinants of health, but it is important to not get buried under the reams of material such that you might be distracted from the overriding imperative of ACP’s vision for reform – the pressing need to enact and implement the essential infrastructure on which we can build the rest of reform – a single payer national health program.

Still think you know better than the College of Physicians? You still think that physicians will not take Medicare for All because many don’t take traditional Medicare? You think that implementing Medicare for All/Single Payer will be destructive to medical care? Think again.

These physicians are more concerned with provide everyone with health care and not to make huge profits for themselves, insurance companies, drug companies, hospitals, investors, stockholders, and other stakeholders such as you and your employers. You are standing in the way.

Two Perspectives on Health Care

Dear Readers,

Sorry for the delay in getting back to writing in this new year, I have not seen too many things to write about, and have also been busy with personal issues.

So, the following post from an unknown individual via Joe Paduda, who informs us that this person is a good friend and colleague, shows just how broken and dysfunctional our health care system really is.

This post is followed by one from Don McCanne about the Canadian system, and differentiates their system with what is being proposed in the US under a Medicare for All system advocated by Bernie Sanders, Elizabeth Warren, Dr. McCanne, and the Physicians for a National Health Plan (PNHP), among others.

Joe’s post: The Greatest Healthcare System in the World

Dr. McCanne’s post was written by Caitlin Kelly in The American Prospect on January 8th. Here is her article in full, followed by comments by Don McCanne.

The American Prospect

January 8, 2020

What Medicare for All Really Looks Like

The Canadian system, also called Medicare, guarantees coverage to every resident north of the U.S. border.

By Caitlin Kelly

Canadian health care is publicly funded and privately delivered, approximately the same vision that single-payer enthusiasts have for the American system. It even shares the same name as our largest government-run insurance provider: Medicare. But contrary to persistent American partisan mythmaking, no government officials sit in doctors’ offices or haunt hospital hallways with a checklist of all the services they’ll question and deny. They don’t dictate hands-on care. Canadians face little government interference or oversight of their health care, although, for historical reasons, their doctors retain much more power than patients.

The familiar and dreaded words “co-pay,” “deductible,” “pre-existing condition,” and “out of network” are meaningless here, in English or French, Canada’s two official languages. Patients don’t waste time chasing pre-authorizations or fighting medical bills, while physicians save thousands of administrative hours.

As Americans’ life expectancy is dropping and maternal mortality is ranked shockingly high among other wealthy nations, Canadian health outcomes fare better; Canadian women live two more years than their American counterparts, men three.

But the system is far from perfect. Outpatient care, like physical and occupational therapy or prescription medicine, is paid for out of pocket. In some places, there’s no mandate to use electronic records, so patient information can be difficult to access. And medical care of impoverished and remote First Nation and Inuit communities is openly acknowledged as abysmal.

Canada provides coverage for about 35 million, one-tenth the population of the United States. But how they’ve set up their health care system, and how it evolved over the decades, is instructive, especially given the robust debate during the presidential primary about overhauling our current system. It can inform how U.S. policymakers—and Canadians, for that matter—approach cost control, physician payment, and services for vulnerable communities. Rather than scaring Americans with well-structured narratives about the alleged horrors of Canadian Medicare, we could take the opportunity to learn from it.

A Difference in Bedrock Philosophies

A fundamental conceptual difference also divides how Canadians and Americans view their relationship to using government-financed or -run services. Classic American insistence on the bedrock values of individualism, self-reliance, and shunning government aid as a sign of moral failure differs radically from that of Canadians, who are more committed politically and economically to health care equity as a collective good.  [Emphasis mine] Consistently receiving free health care and heavily subsidized university and college tuition fees means that Canadians of all ages and income levels experience firsthand a consistent, quantifiable return on their tax dollars.

“One thing I wish Americans would understand is that ‘who’s going to pay?’ is actually a distraction,” says Dr. Danielle Martin, executive vice president and chief medical executive of Women’s College Hospital in Toronto. “It’s ‘how will you organize delivery of it?’ Payment is just the first step on a worthy and interesting journey. The conflation of single-payer and wait times is false. We have wait times because of a million other issues, like we can’t get physicians to work in rural areas.”

Could This Work in the U.S.?

“The Canadian system is good, but underfunded,” says Steffie Woolhandler. “The American system is shitty but over-funded.”

https://prospect.org/health/what-medicare-for-all-really-looks-like/

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Comment by Don McCanne

Our goal is to establish a single payer model of a dramatically improved version of our Medicare program that would ensure affordable, accessible, high quality health care for everyone in our nation. The model that is closest to that vision is the Canadian Medicare program – a series of provincial single payer programs. It is not the same system as what we propose.

It is helpful for us to understand the Canadian system since it has many beneficial features that would help us improve equity and access in our own system. Also it has some deficiencies, and it is important to understand those so that we can avoid them.

The excerpts from The American Prospect article by Caitlin Kelly give you an inkling of what the Canadian system is all about. This fairly long article should be read in its entirety for a few reasons:

*  People need to understand that we are not transporting the Canadian health financing infrastructure to the United States; rather we are building a new, better-than-Canadian Medicare for All.

*  When people reject single payer Medicare for All because of certain undesirable features of the Canadian system, it is important to understand what those features are and how we would guard against them in the United States.

*  When people say that we cannot afford Medicare for All it is important to understand and explain to them how we are already paying enough to fund a better-than-Canadian system, but we need to redirect the spending of the $600 billion in recoverable administrative waste that characterizes our dysfunctional multi-payer system.

*  The most common complaint about the Canadian system is the excessive queues for some non-urgent services. People need to understand that our Medicare for All would have enough funding to ensure adequate capacity in the system through central planning and budgeting of capital improvements, not to mention including adequate funding to improve queue management.

*  Perhaps the most important lesson from Canada: “Classic American insistence on the bedrock values of individualism, self-reliance, and shunning government aid as a sign of moral failure differs radically from that of Canadians, who are more committed politically and economically to health care equity as a collective good. Consistently receiving free health care and heavily subsidized university and college tuition fees means that Canadians of all ages and income levels experience firsthand a consistent, quantifiable return on their tax dollars.”

Notice that McCanne leaves us with the same statement that I emphasized above. That is the real reason we don;t have free medical care and free college. We gained our independence from Britain when the values of individualism, self-reliance, freedom, liberty, and the right to private property were the prevailing values.

Canada, on the other hand, became independent (sort of) during the latter half of the nineteenth century, when modern liberalism emphasized the greatest good for the greatest number. This was in opposition to the classical liberalism of the American experiment begun a century earlier.

Both articles point out just where we are deficient, and where and how we can make improvements, but only if we abandon the profit-making, overly administratively bureaucratic, wasteful, and bloated current system for a more efficient Medicare for All single payer system that guarantees health care for all Americans. Then there will never be any surprise bills or upfront charges required.

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.