Category Archives: pharmaceutical industry

The Debate Continues

 

The multilateral debating society that is known as the 2019 Democratic Debates has now had four such contests, and in keeping with the previous post, Medicare for All and the Democratic Debates, I want to discuss the issue of health care.

This was the first topic of the evening, and on both nights, it was a contentious, and long debate. The first night saw Sens. Sanders and Warren debating the other eight contenders over Medicare for All versus a public option.

The second night was more of the same, however, only NYC mayor Bill de Blasio argued for full MFA, while Sen. Kamala Harris argued for her plan that would enroll some Americans right away, while taking ten years to fully implement. All the rest, including former V.P. Joe Biden argued for either repairing the ACA, or adding a public option as a Medicare buy-in.

As I will report later in this article, there is a problem with the idea of a Medicare buy-in or a public option, and its impact on the ACA.

But before I do, I would like to discuss a few areas that seem to be missing from the candidate’s talking points on health care that need to be answered, addressed, or clarified. The CNN moderators, as was pointed out at one part of the debate, was questioning the candidates with what were essentially Republican talking points about MFA.

One area that was somewhat glossed over on the first night was the issue of middle class taxes being raised to pay for MFA. MSNBC host Chris Matthews of Hardball questioned Sen. Warren several times after the debate in the spin room on this very subject, yet she danced around the question by talking more about the savings people would receive.

Sen. Sanders agreed with Joe Biden when he said that those pushing Medicare for All without a middle-class tax hike are living in a “fantasy world.” In addition, Sanders said, that he knows middle-class taxes will go up, but maintained that the American people could still end up saving money on the other side.

In a CNN interview with Jake Tapper, Sanders said the following:

“The first thing that we have to understand is, under Medicare for all, similar to what Canada has, people are not gonna pay any premiums. They’re not gonna pay any deductibles. They’re not going to pay any co-payments. So if you call a premium a tax, we’re getting rid of that. But I do believe that, in a progressive way, people will have to pay taxes. The wealthy will obviously pay the lion’s share of the taxes, but at the end of the day, the vast majority of the American people will pay substantially less for the health care they now receive because we’re going to do away with hundreds of billion dollars of administrative waste. We’re gonna do away with the incredible profiteering of the insurance companies and the drug companies. People will be paying, in some cases, more in taxes, but overall, because they’re not gonna pay premiums or deductibles, co-payments, they’ll be paying less for their health care.”

Another area missing from the debates was the issue of what to do about union contracts. Rep. Tim Ryan (OH) made that a point in both debate appearances, and the question still has not been fully addressed, even though Sen. Sanders said he was very pro-union.

Finally, three other areas mentioned in the debates, but that may not have been fully discussed or explained, was the issues of private insurance and employer-based insurance. The third issue, pre-existing conditions was only mentioned in the post-debate analysis from the political pundits. At many times, it was argued by the anti-MFA candidates that those advocating MFA wanted to take away such insurance from over 150 million Americans. But as the following two articles suggest, private insurance and employer-based plans are part of the problem.

As reported by CheatSheet, the Supreme Court decision mandating that a for-profit corporation — in this case, Hobby Lobby — can actually mandate the types of healthcare provisions its employees receive, all based on the religious beliefs of the company’s owners. Hobby Lobby’s arguments were based on a stack of flawed science and misunderstood concepts, and the fact that the Supreme Court ruled that an employer’s particular religious belief — which can be made up off the top off their heads, for all the Court cares — now takes precedent over the medical needs of their employees.

CheatSheet concluded that the case in itself is ridiculous, but it brings us to one important conclusion: The era of employer-sponsored health care needs to end.

Reed Abelson in The New York Times wrote the following article, reprinted here in its entirety:

The New York Times
July 29, 2019
How a Medicare Buy-In or Public Option Could Threaten Obamacare
By Reed Abelson

It seems a simple enough proposition: Give people the choice to buy into Medicare, the popular federal insurance program for those over 65.

Former Vice President Joseph R. Biden Jr. is one of the Democratic presidential contenders who favor this kind of buy-in, often called the public option. They view it as a more gradual, politically pragmatic alternative to the Medicare-for-all proposal championed by Senator Bernie Sanders, which would abolish private health insurance altogether.

A public option, supporters say, is the logical next step in the expansion of access begun under the Affordable Care Act, passed while Mr. Biden was in office. “We have to protect and build on Obamacare,” he said.

But depending on its design, a public option may well threaten the A.C.A. in unexpected ways.

A government plan, even a Medicare buy-in, could shrink the number of customers buying policies on the Obamacare markets, making them less appealing for leading insurers, according to many health insurers, policy analysts and even some Democrats.

In urban markets, “a public option could come in and soak up all of the demand of the A.C.A. market,” said Craig Garthwaite, a health economist at the Kellogg School of Management at Northwestern University.

And in rural markets, insurers that are now profitable because they are often the only choices may find it difficult to make money if they faced competition from the federal government.

Some insurers could decide that a smaller and uncertain market is not worth their effort.
If the public option program also matched the rates Medicare paid to hospitals and doctors, “I think it would be really hard to compete,” Mr. Garthwaite said. Even leading insurers do not have the leverage to demand lower prices from hospitals and other providers that the government has.

Whether to implement a public option or Medicare buy-in has become a defining question among Democratic presidential candidates and is likely to be a contentious topic at this week’s debates.

On Monday, Senator Kamala Harris took an alternate route, unveiling a plan that would allow private insurers to participate in a Medicare-for-all scheme, akin to their role currently offering private plans under Medicare Advantage.

The recent spate of proposals reprises some of the most difficult questions leading up to the passage of the A.C.A., in many ways a compromise over widely divergent views of the role of the government in ensuring access to care.

After a shaky start, the federal and state Obamacare marketplaces are surprisingly robust, despite repeated attempts by Republicans to weaken them. They provide insurance to 11 million customers, many of whom receive generous federal subsidies to help pay for coverage.

The A.C.A. is now a solidly profitable business for insurers, with several expanding options after earlier threats to leave. For example, Centene, a for-profit insurer, controls about a fifth of the market, offering plans in 20 states. It is expected to bring in roughly $10 billion in revenues this year by selling Obamacare policies.

In spite of stock drops because of investors’ concerns over Medicare-for-all proposals, for-profit health insurers have generally thrived since the law’s passage.

But a buy-in shift in insurance coverage could profoundly unsettle the nation’s private health sector, which makes up almost a fifth of the United States economy. Depending on who is allowed to sign up for the plan, it could also rock the employer-based system that now covers some 160 million Americans.

In a recent ad, Mr. Biden features a woman who wants to keep her current coverage. “I have my own private insurance — I don’t want to lose it,” she said.

A spokesman for Mr. Biden argued that a public option can extend the success of the Affordable Care Act.

“Joe Biden thinks it would be an egregious mistake to undo the A.C.A., and he will stand against anyone — regardless of their party — who tries to do so,” said Andrew Bates, a spokesman for Mr. Biden, in an email.

Major insurers and hospital chains, pharmaceutical companies and the American Medical Association have joined forces to try to derail efforts like Medicare-for-all and the public option. Mr. Sanders denounced these powerful interests in a recent speech.

“The debate we are currently having in this campaign and all over this country has nothing to do with health care, but it has everything to do with the greed and profits of the health care industry,” he said.

Other critics of the public option, including Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, argue Democrats’ programs will lead to a “complete government takeover.”

“These proposals are the largest threats to the American health care system,” she said in a speech earlier this month.

Some experts predict that private insurers will adapt, while others warn that the government could wind up taking on the sickest customers with high medical bills, leaving the healthier, profitable ones to private insurers.

It’s uncertain whether hospitals, on the other hand, could thrive under some versions of the public option. If the nation’s 5,300 hospitals were paid at much lower rates by a government plan — rates resembling those of Medicare — they might lose tens of billions of dollars, the industry claims. Some would close.

One variant of the public option — letting people over 50 or 55 buy into Medicare — is often depicted as less drastic than a universal, single-payer program. But this option would also be problematic, experts said.

This consumer demographic is quite valuable to insurers, hospitals and doctors.

Middle-aged and older Americans have become the bedrock of the Obamacare market. Some insurers say this demographic makes up about half of the people enrolled in their A.C.A. plans and, unlike younger people who come and go, is a reliable and profitable source of business for the insurance companies.

The aging-related health issues of people in this group guarantee regular doctor visits for everything from rising blood pressure to diabetes, and they account for a steady stream of lucrative joint replacements and cardiac stent procedures.

The 55-to-64 age group, for example, accounts for 13 percent of the nation’s population, but generates 20 percent of all health care spending, according to the Kaiser Family Foundation.

Health Spending
People age 55–64 are responsible for one fifth of total health spending and account for a sizable share of the private insurance market. People 65 and older are eligible for Medicare and account for one third of total spending.

By The New York Times | Sources: Kaiser Family Foundation; Dept. of Health & Human Services. Data from 2016

Several experts said that designing a buy-in program that is compatible with the existing public and private plans could be daunting.

“You’d have to do it carefully,” said Representative Donna Shalala, a Florida Democrat who served as the secretary of health and human services under President Bill Clinton.
Linda Blumberg, a health policy expert at the Urban Institute, a nonpartisan think tank, agreed.

“The idea of Medicare buy-ins was taken very seriously before there was an Affordable Care Act,” she said. “In the context of the A.C.A., it’s a lot more complicated to do that.”

Many dismiss concerns about whether insurers can compete.

“Any time a market shrinks in America, insurers don’t like it,” said Andy Slavitt, the former acting Medicare administrator under President Obama and a former insurance executive. Mr. Slavitt noted that insurers raised similar concerns about the federal law when it was introduced. “They’ll figure it out,” he said.

In Los Angeles County, five private insurers that sell insurance in the A.C.A. market already compete with L.A. Care Health Plan, which views itself as a kind of public option, said John Baackes, the plan’s chief executive.

The insurer offers the least expensive H.M.O. plan in the county by paying roughly Medicare rates. “We’ve proved that the public option can be healthy competition,” he said.

But the major insurance companies, which were instrumental in defeating the public option when Congress first considered making it a feature of the A.C.A., are already flexing their lobbying muscle and waging public campaigns.

In Connecticut, fierce lobbying by health insurers helped kill a state version of the public option this spring. Cigna resisted passage of the bill, threatening to leave the state. “The proposal design was ill-conceived and simply did not work,” the company said in a statement.

Blue Cross plans could lose 60 percent of their revenues from the individual market if people over 50 are shifted to Medicare, said Kris Haltmeyer, an executive with the Blue Cross Blue Shield Association, citing an analysis the company conducted. He said it might not make sense for plans to stay in the A.C.A. markets.

Siphoning off such a large group of customers could also lead to a 10 percent increase in premiums for the remaining pool of insured people, according to the Blue Cross analysis. More younger people with expensive medical conditions have enrolled than insurers expected, and insurers would have to increase premiums to cover their costs, Mr. Haltmeyer said.

Tricia Neuman, a senior vice president at the Kaiser Family Foundation, which studies insurance markets, said a government buy-in that attracted older Americans could indeed raise premiums for those who remained in the A.C.A. markets, especially if those consumers had high medical costs.

But some experts countered that prognosis, predicting that premiums could go down if older Americans, whose health care costs are generally expensive, moved into a Medicare-like program.

“The insurance companies are wrong about opposing the public option,” Ms. Shalala said.

Dr. David Blumenthal, the president of the Commonwealth Fund, a foundation that funds health care research, said a government plan that attracted people with expensive conditions could prove costly.

“You might, as a taxpayer, become concerned that they would be more like high-risk pools,” he said.

Jonathan Gruber, an M.I.T. economist who advised the Obama administration during the development of the A.C.A., likes Mr. Biden’s plan and argues there is a way to design a public option that does not shut out the private insurers.

“It’s all about threading the needle of making a public option that helps the failing system and not making the doctors and insurers go to the mat,” he said.

Many experts point to private Medicare Advantage plans, which now cover one-third of those eligible for Medicare, as proof that private insurers can coexist with the government.

But the real value of a public option, some say, would stem from the pressure to lower prices for medical care as insurers were forced to compete with the lower-paying government plans, like Medicare.

Washington State recently passed the country’s first public option, capping prices as part of its plan to provide a public alternative to all residents by 2021.

“It’s couched in this language in expanding coverage, but it does it by regulating prices,” said Sabrina Corlette, a health policy researcher at Georgetown University.

The hospital industry would most likely fight just as hard to defeat any proposal that would convert a profitable group of customers, Americans who are privately covered at present, into Medicare beneficiaries.

Private insurers often pay hospitals double or triple what Medicare pays them, according to a recent study from the nonprofit Rand Corporation.

While Ms. Shalala supports a public option as an alternative to “Medicare for All,” she is clear about how challenging it will be to preserve both Obamacare and the private insurance market. “You can’t do it off the top of your head,” she said.

So, let’s see, the Republicans want to kill the ACA, and others want to fix it. But adding a public option, or including a Medicare buy-in, might harm the ACA. On the other hand, it has been shown that both private insurance and employer-based insurance are part of the problem.

The idea that people like their private plans, whether obtained from their employer, or from private insurance companies directly, and is part of the problem is being left out of the discussion.

And debate moderators who ask those questions to candidates are only echoing Republican talking points, or worse, taking their cues from the drug manufacturers and insurance companies.

So if neither fixing ACA, adding a public option, or providing a Medicare buy-in  will solve the enormous complexity and confusion that the broken and dysfunctional health care system represents,  that only leaves one alternative: Medicare for All, while currently not likely to be enacted, nevertheless is popular with the public until the issue of taxes is mentioned.

The moderate candidates, are either defending the drug and insurance companies  because of campaign contributions, or have been part of the health care industry, such as former Congressman John Delaney, and therefore is an unlikely spokesman for progressive change. Let’s hope that he and the other bottom-tier candidates drop out soon, so that perhaps these other issues can be discussed and debated.

How the campaign will turn out, and who the Democrats will nominate is still far off in the future, but who ever is nominated, will have to eventually deal with the reality that health care must be solved, and that the march towards single payer will have already begun.

No Socialists Here

Dear Insurance company execs, pharmaceutical company execs, employee benefits consultants and executives, Wall Street investors, and all other stakeholders in the current dysfunctional, broken, complex, complicated, and bloated mess called the US health care system.

You have heard many politicians, and journalists, not to mention your own peers, or even you yourselves label the push for Medicare for All as “Socialism.”

We even have the Administrator of CMS, Seema Verma, calling it, and the public option plan,  “radical and dangerous for the country” recently when she spoke to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

Her solution, and probably yours as well, is to keep selling Medicare Advantage plans, which only makes the current system worse.

So, to help you get over your fear and loathing of Socialism, and to prove to you that the only reason why the US is the only Western, industrial nation to not provide its citizens with universal health care is because you are making money off of other people’s health, or lack thereof.

You are doing so, because you are greedy. There I said it. Now I hope you will pay attention to the following graphic:

Do you see any socialist countries? Do you see any radical and dangerous regimes that are hostile to the interests of the US? Well, maybe Slovenia. After all, they did send us Melania and her illegal family.

But back to the case at hand. I defy any of you hotshots in the health care space to prove to me that all of these Capitalist, free-market countries are flaming Reds, or even a bit Pinko.

You can’t, because it is not true. You and those who call Medicare for All, Single Payer, or even the so-called “public option” radical, just don’t want the government to interfere with your looting the pockets of the American people for your financial gain.

And that is why we are the only country with an “X”, instead of a check mark below our name.

16,000 Unnecessary Deaths Tied to Failure to Expand Medicaid

The Los Angeles Times reported Monday that a new study found that Medicaid expansion brought appreciable improvements in health to enrollees, but also that full expansion nationwide would have averted 15,600 deaths among the vulnerable Medicaid-eligible population.

This is in contrast to the view of opponents of Medicaid expansion who have said that lack of evidence that enrollment in Medicaid improves health and saves lives, and therefore they believed that expansion was a waste of money.

In the 22 mostly red states that refused expansion, the cause of the 15,600 deaths of their state’s residents was attributed to failure to expand.

“This highlights an ongoing cost to non-adoption that should be relevant to both state policymakers and their constituents,” the authors of the study said.

Fourteen states are still holding out, States such as Wyoming and South Dakota, the article states, have a warped sense of “freedom.” States such as Maine and Louisiana, who have had a change in governors from Republican to Democrat, have recently adopted expansion.

medicaid

Fourteen states still resist Medicaid expansion, at great cost to their residents (Kaiser Family Foundation)

The article takes a dim view of the entire rationale for refusing to expand Medicaid, and cites a few noted Conservative voices against the entire idea of expansion and Medicaid itself.

Conservatives have worked hard to depict Medicaid as ineffective, the article reports. They’ve done so, it continues,  by overinterpreting limited studies such as a 2013 study of a Medicaid expansion in Oregon.

Critics focused on the researchers’ finding of “no significant improvements in measured physical health outcomes in the first 2 years” of expansion, but they overlooked the findings that the expansion did “increase use of healthcare services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

Conservative health policy Avik Roy has crowed, the article states, that the result “calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program.”

Another right-wing critic of Medicaid expansion, and not to mention, also of Medicare for All, and now more recently, the public option for Medicare, is CMS Administrator Seema Verma, a Trump flunky.

(Credit: Getty Images )  Picture worth a thousand words was never more true. What a piece of work!

Verma has argued that the expansion hasn’t been a success despite its enrollment figures and has been a leader in undermining the program by allowing states to impose premiums, work requirements and punitive disenrollments on patients. (Her efforts have been blocked by a federal judge, for now.)

This is why advocates for Medicare for All are so passionate and determined, in the face of even the slightest opposition to improving the health and lives of millions of Americans for small changes to our nation’s health care system.

Failure to expand Medicaid, failure to enact universal health care, even if it is a public option, is challenged from the right for morally indefensible and reprehensible reasons.

The cry of “freedom” from conservatives is a smoke-screen to hid their true purpose. To dismantle all social programs and funnel that money to the wealthy and corporations, as they have already done with the Trump tax giveaway.

Now they are trying to cut three million Americans off of food stamps.

All these schemes have one purpose in mind, to kill off their most ardent supporters in Southern and Midwestern states that continue to vote for these sociopaths. To them, freedom means, freedom for a company to profit off of your misfortune, whether that misfortune is due to poor diet, poor personal habits such as smoking and drug abuse, and poor health outcomes due to poverty and economic distress.

Naturally, any attempt to improve the health and lives of the poor, black or white, or Latino, etc., is viewed as “Socialism” and is deemed bad for the country, as Ms. Verma did this week to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

No, it’s not bad for the country. It’s bad for the profits of the insurance companies, the pharmaceutical companies, the benefit managers industry, the health care consultants, and Wall Street investors.

Wanting to cut of food stamps, fail to expand even Medicaid, tightening rules for who is eligible for these programs, is not only bad for the health of average Americans, it is bad for the economic vitality of the nation in an era of global competition.

The men and women at Trump rallies are angry, but they are angry at the wrong people. The clown on the stage is the person they really should be angry at, and his entire swamp of “the best people.”

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.

Trump Regime to Repeal ACA

From the Overnight News Desk:

Both CNN and The Washington Post reported yesterday that the Justice Department will back a full repeal of the Affordable Care Act (ACA), after a federal judge in Texas ruled the law unconstitutional in December.

If this repeal takes effect, millions of Americans will lose their healthcare. Those of you employed in the medical-industrial complex, and related industries, must face the fact, that if the Republicans succeed in their long-held promise to destroy healthcare for Americans who could never afford it before, or had limited coverage, there will be no other alternative left to provide healthcare than to have an Improved Medicare for All/Single Payer system.

There are those who believe that Medicaid for All is a better option, but given that many states that expanded Medicaid elected GOP governors and legislatures, or could in the future, Medicaid in those states could also be taken away from those who receive expanded coverage.

Many of you are employed by the very same insurance companies, pharmaceutical companies, device manufacturers, and other businesses that are allied with the healthcare system, and it is these companies that are gearing up to fight passage of any Medicare for All/Single Payer health care bill.

Do you really want your fellow Americans to die because they cannot generate huge profits for your employers and for Wall Street investors and shareholders?

if the Orangutan gets his way, that is what will happen. Also, our hospital ERs will once again be clogged with patients who need immediate medical attention, and the quality of health care will deteriorate even further.

The only logical solution is Medicare for All/Single Payer, because the only option left will be Medicare for All/Single Payer.

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.

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that 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.

However, 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.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, 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.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.